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 757375 (X3) Date Survey Completed 07/07/2025
Name of Provider or Supplier Intense Home Health Inc Street Address, City, State 3786 La Crescenta Ave. Suite 104, Glendale, 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 review and document all the medications the patient was currently using for two of seven sample patients (Patient 5, and Patient 7).

 

This deficient practice placed the patients at risk of drug-to-drug interaction and harm by not knowing which medications the patients were taking.


1. During a record review of Patient 5’s medical record form titled “Home Health Certification and Plan of Care” dated from 5/7/2025 to 7/5/2025, indicated a start of care date of 3/8/2025 with a primary diagnosis of other intervertebral disc degeneration. The Home Health Certification and Plan of Care form also indicated Skilled Nurse (SN) were to visit 1wk1 (once a week for one week), 2wk1, and 1wk7. SN to continue to perform every visit: 3. Assess/monitor for medications effectiveness, possible adverse effects, and medication duplications.



During a record review of Patient 5’s medical record form titled “Drug Regimen Review” dated 5/3/2025, indicated Meloxicam and Aspirin were being taken once a day.  



During a concurrent interview and record review on 7/3/2025 at 9 a.m., with Patient 5’s medical record form titled “Drug Regimen Review” dated 5/3/2025, Patient 5 stated she has not taken Meloxicam for about 10 days. Patient 5 stated she takes Aspirin EC (enteric coated – does not dissolve in the stomach). Patient 5 stated she (Patient 5) used medication patch for pain to the right lower back.  



During a concurrent interview and record review on 7/3/2025 at 9 a.m., with License Vocational Nurse 2 (LVN2) of Patient 5’s medication labels indicated, Patient 5’s Aspirin medication label did not indicate the Aspirin was EC. The Aspirin label did not indicate the route, dose, or frequency.  LVN2 stated she did not realize Patient 5’s Aspirin medication bottle label did not indicate the route, dose, or frequency. LVN2 stated the medication labels should have all the components for patient safety reasons. LVN2 was not observed asking Patient 5 for any information regarding Patient 5’s pain patch medication. LVN2 stated it was important to list all Patient 5’s medications to prevent medication errors and for safety. LVN2 stated she did not know if Patient 5 had any expired medications. LVN2 stated if Patient 5 takes expired medication the medication will not be effective.  



 

2.  During a record review of Patient 7’s medical record form titled “Home Health Certification and Plan of Care” dated from 4/15/2025 to 6/13/2025, indicated a start of care date of 4/15/2025 with a primary diagnosis of cervicalgia (neck discomfort). The Home Health Certification and Plan of Care form also indicated Skilled Nurse (SN) was to visit 2W2 (twice a week for two weeks), and 1W7. SN to continue skilled observation and assessment on all body systems with emphasis on medication compliance and effectiveness.  



During a record review of Patient 7’s medical record form titled “Drug Regimen Review” dated 4/15/2025, indicated Patient 7 was taking six different medications. The Drug Regimen Review also indicated there was no diagnosis or classifications listed for each medication.  



During a concurrent interview and record review on 7/7/2025 at 2 p.m., with the Director of Patient Care Services (DPCS) of Patient 7’s medical record form titled “Drug Regimen Review” dated 4/15/2025, the DPCS stated Patient 7’s medication list was not complete because it was missing the medication classifications. The DPCS stated each medication should list their classifications for the patient to know what the medications are for. The DPCS provided an example, as follows. The DPCS stated that Metoprolol (high blood pressure medication) and Meclizine (dizziness medication), both start with an M. If a patient does not know what either medication is for, they can mistakenly take the blood pressure medication thinking it was for dizziness, the patient can have low blood pressure, which may cause hospitalization. 



 



During a record review of the HHA’s undated document titled “Medication Reconciliation” the Medication Reconciliation form indicated “Medication reconciliation should be completed at every skilled visit and any changes should be documented both in the home medication profile and in the MD order.” 



During a record review of the HHA’s undated document titled “Medication Reconciliation”, the Medication Reconciliation form indicated “The admitting nurse will initiate a medication profile to document the current mediation regimen, including name dose, strength, route, frequency, date and time of administration and a diagnosis, condition, or indication for use for each medication ordered.”