Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 757287 (X3) Date Survey Completed 11/03/2025
Name of Provider or Supplier Summa Home Health Care, Inc. Street Address, City, State 2500 E Foothill Blvd Unit 417, Pasadena, CA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
G0536 A review of all current medications
CFR(s): 484.55(c)(5)

A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.


This ELEMENT is not met as evidenced by:
Based on observation, interview and record review, the home health agency (HHA) failed to maintain an accurate current medication profile for one of 7 sampled patients (Patient 2). 

 

This deficient practice has the potential to place the patient at risk for medication errors and adverse drug reactions.

 


During a review of Patient 2's Face Sheet (front page of the chart that contains a summary of basic information about the patient), the Face Sheet indicated a start of care date (SOC) date of 8/26/2025, with a diagnosis of diabetes mellitus type II (high blood sugar levels due to the body’s inability to use insulin effectively). 

 

During a review of Patient 2’s Home Health Certification and Plan of Care (POC) for the re-certification period from 8/25/2025 to 10/24/2025, the POC included an order for the skilled nurse (SN) to visit the patient once a week for 9 weeks. The SN was to conduct skilled assessment and observation, management of patient’s overall health status, assess vital signs (measure the basic functions of your body that includes body temperature, blood pressure, pulse and respiratory [breathing] rate), and instruct patient and/or patient caregiver regarding medication compliance and dietary regimen.

 

During a joint home visit, on 10/31/2025, at 1 p.m., at Patient 2’s residence with the director of patient care services (DPCS), Patient 2 was observed awake, alert, oriented x 3 (to person, place, and time), and ambulatory with stable gait without using any assisted device.

 

 During a review of Patient 2’s current medication, on 10/31/2025, at 1:30 p.m., with the DPCS, it was noted there was bottle of Edarbi (used to treat high blood pressure) 80 milligram (mg, a unit of measurement) 1 tablet orally daily with a refill date of 7/16/2025 and a bottle of Felodipine (used to treat high blood pressure) 5 mg one tab daily with a refill date of 7/16/2025. Patient 2’s current medication list provided by the HHA indicated both the Edarbi and Felodipine medications were not included in the list. During a concurrent interview with Patient 2, she stated she was taking the Edarbi and Felodipine medications daily for several months.  

 

During an interview, on 10/31/2025, at 2 p.m., with the DPCS, the DPCS stated nursing staff need to review the patient’s current medication every nurse visit and update the medication profile in the patient’s clinical record.

 

During a review of the agency’s policy and procedure (P&P) titled, Medication Profile, dated April 2020, the P&P indicated patient receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications, new, and/or discontinued medications.