QA Investigation Results

Pennsylvania Department of Health
ADVANTAGE HOME HEALTH AND HOSPICE
Health Inspection Results
ADVANTAGE HOME HEALTH AND HOSPICE
Health Inspection Results For:


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Initial Comments:Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022 through November 10, 2022, Advantage Home Health and Hospice, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation" Home Health Agencies-Emergency Preparedness.


Plan of Correction:




Initial Comments:Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022, through November 10, 2022, Advantage Home Health and Hospice, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B &; C, Conditions of Participation: Home Health Agencies.


Plan of Correction:




484.60(b) STANDARD
Conformance with physician orders

Name - Component - 00
Standard: Conformance with physician or allowed practitioner orders.

Observations: Based on reviews of agency policy, clinical records (CRs), and interview with the vice president of compliance (EMP#1) and employee registered nurse # 2, it was determined agency failed to follow physician orders for one (1) of thirteen (13) clinical records reviewed. (CR# 8) Findings included: Review of agency policy 'Physician Orders-Verbal Orders' on November 10, 2022 at approximately 9:45 a.m. states, "POLICY: Drugs and treatments are administered by the Agency staff only as ordered by physician... " Review of CRs conducted on November 7, 2022 between approximately 12:30 p.m. to 3:00 p.m., November 8, 2022 between approximately 9:00 a.m. to 12:00 p.m. and November 10, 2022 between approximately 9:00 a.m. to 12:00 p.m. revealed the following: CR # 8, Start of Care (SOC), 6/3/2022; Plan of Treatment (POT) certification period reviewed 10/1/2022-11/29/2022 with diagnosis: acute myelomonocytic leukemia (rare type of acute myeloid leukemia (AML) in which there is an increased production of immature neutrophil white blood cells and immature monocyte white blood cells in the bone marrow) not having achieved remission and encounter for adjustment and management of VAD (ventricular assist device- a mechanical pump used to support heart function and blood flow in people with weak or failing hearts). POT for Skilled Nursing (SN) Orders: 1 wk 9 wk (one visit per week for 9 weeks). Medications listed included: "Normal Saline Flush (NSF) 0.9% injectable solution: Inject 5-10 milliliter(s) intravenously (IV) before and after medications; Flush IV with 5-10 mL NSF before and after medications and PRN (as needed) for IV patency" 'Skilled Nursing Visit Note' from 10/6/2022, section, 'Care Plan Documentation' contained documentation of "Flush Details: Flush Solution: Heparin 10 units/ml." No physician order for Heparin to be used as a flush solution. Interview with employee registered nurse # 2 that documented on the 'Skilled Nursing Visit Note' from 10/6/2022 was conducted on November 10, 2022 at approximately 9:30 a.m. Surveyor questioned the employee registered nurse # 2 to explain her documentation and she replied, "I didn't flush it with Heparin. I have several patients that get flushes, it was an error in documentation." Interview with EMP # 1 on November 10, 2022 at approximately 12:30 p.m. confirmed above findings.

Plan of Correction:

Effective week of November 21, 2022,all field staff will be re educated on the Policy and Procedure for Physicians Orders-Verbal Orders to include Drugs and treatments are administered by the Agency Staff only as ordered by physician. Handouts of the Policy and Procedure will be given to all field staff.
All field staff will sign off on required reeducation by December 5, 2022
All Medication Profiles for all Starts of Care/POT or any additional medication orders received during home health services will be reviewed at 100% weekly until 100% x 4 consecutive weeks either by Clinical Director or qualified clinician if director is not available
QAPI director or designated clinician will continue to audit quarterly as part of agency QAPI program


Initial Comments:Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022 through November 10, 2022, Advantage Home Health and Hospice, was found not to be in compliance with the requirements of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart G, Chapter 601, Home Health Care Agencies.


Plan of Correction:




601.31(d) REQUIREMENT
CONFORMANCE WITH PHYSICIAN'S ORDERS

Name - Component - 00
601.31(d) Conformance With
Physician's Orders. All prescription
and nonprescription (over-the-counter)
drugs, devices, medications and
treatments, shall be administered by
agency staff in accordance with the
written orders of the physician.
Prescription drugs and devices shall
be prescribed by a licensed physician.
Only licensed pharmacists shall
dispense drugs and devices. Licensed
physicians may dispense drugs and
devices to the patients who are in
their care. The licensed nurse or
other individual, who is authorized by
appropriate statutes and the State
Boards in the Bureau of Professional
and Occupational Affairs, shall
immediately record and sign oral
orders and within 7 days obtain the
physician's counter-signature. Agency
staff shall check all medicines a
patient may be taking to identify
possible ineffective drug therapy or
adverse reactions, significant side
effects, drug allergies, and
contraindicated medication, and shall
promptly report any problems to the
physician.

Observations: Based on reviews of agency policy, clinical records (CRs), and interview with the vice president of compliance (EMP#1) and employee registered nurse # 2, it was determined agency failed to follow physician orders for one (1) of thirteen (13) clinical records reviewed. (CR# 8) Findings included: Interview with employee registered nurse # 2 that documented on the 'Skilled Nursing Visit Note' from 10/6/2022 was conducted on November 10, 2022 at approximately 9:30 a.m. Surveyor questioned the employee registered nurse # 2 to explain her documentation and she replied, "I didn't flush it with Heparin. I have several patients that get flushes, it was an error in documentation." Review of agency policy 'Physician Orders-Verbal Orders' on November 10, 2022 at approximately 9:45 a.m. states, "POLICY: Drugs and treatments are administered by the Agency staff only as ordered by physician... " Review of CRs conducted on November 7, 2022 between approximately 12:30 p.m. to 3:00 p.m., November 8, 2022 between approximately 9:00 a.m. to 12:00 p.m. and November 10, 2022 between approximately 9:00 a.m. to 12:00 p.m. revealed the following: CR # 8, Start of Care (SOC), 6/3/2022; Plan of Treatment (POT) certification period reviewed 10/1/2022-11/29/2022 with diagnosis: acute myelomonocytic leukemia (rare type of acute myeloid leukemia (AML) in which there is an increased production of immature neutrophil white blood cells and immature monocyte white blood cells in the bone marrow) not having achieved remission and encounter for adjustment and management of VAD (ventricular assist device- a mechanical pump used to support heart function and blood flow in people with weak or failing hearts). POT for Skilled Nursing (SN) Orders: 1 wk 9 wk (one visit per week for 9 weeks). Medications listed included: "Normal Saline Flush (NSF) 0.9% injectable solution: Inject 5-10 milliliter(s) intravenously (IV) before and after medications; Flush IV with 5-10 mL NSF before and after medications and PRN (as needed) for IV patency" 'Skilled Nursing Visit Note' from 10/6/2022, section, 'Care Plan Documentation' contained documentation of "Flush Details: Flush Solution: Heparin 10 units/ml." No physician order for Heparin to be used as a flush solution. Interview with EMP # 1 on November 10, 2022 at approximately 12:30 p.m. confirmed above findings.

Plan of Correction:

Effective week of November 21, 2022,all field staff will be re educated on the Policy and Procedure for Physicians Orders-Verbal Orders to include Drugs and treatments are administered by the Agency Staff only as ordered by physician. Handouts of the Policy and Procedure will be given to all field staff.
All field staff will sign off on required reeducation by December 5, 2022
All Medication Profiles for all Starts of Care/POT or any additional medication orders received during home health services will be reviewed at 100% weekly until 100% x 4 consecutive weeks either by Clinical Director or qualified clinician if director is not available
QAPI director or designated clinician will continue to audit quarterly as part of agency QAPI program


Initial Comments:Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022 through November 10, 2022, Advantage Home Health and Hospice, was found to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 51, Subpart A.


Plan of Correction:




Initial Comments:Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022 through November 10, 2022, Advantage Home Health and Hospice, was found to be in compliance with the requirements of 35P.S.§ 448.809 (b).


Plan of Correction: