Every finding on record at 1st Priority Healthcare Inc

This visit was for a Federal and State Complaint investigation of a Home Health agency conducted by the Indiana Department of Health. Survey dates: 04-15-2024, 04-16-2024, 04-17-2024, 04-18-2024, and 04-19-2024 Complaint: IN00105687. Related and unrelated Federal and State deficiencies were cited. 12-month unduplicated skilled census: 10 1st Priority Healthcare, Inc. was found to be out of compliance with 42 CFR 484.75 (c)(1) Nursing Services and 484.50 Patient Rights as related to this complaint. This deficiency report reflects State Findings cited in accordance with 410 IAC 17. Refer to State form for additional State findings.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure Home Health Aides (HHA) followed appropriate infection control practices per agency policy while providing patient care in 1 of 3 home visits conducted. (Employee: HHA 4) Findings include: 1. An agency’s policy dated November 2022, titled, ‘STANDARD PRECAUTIONS Policy No. 70007’ revealed, “ … C. Gloves are to be changed: 1. Between tasks and procedures on the same patient … “ An agency’s policy dated November 2022, titled, ‘HAND HYGIENE Policy No. 7-009’ revealed, “ … When hands are not visibly soiled, they should be washed using an alcohol-based hand rub for routinely decontaminating hands. An alternative to use of an alcohol-based hand rub is to wash hands with an antimicrobial soap and water … 3. Hand decontamination … E. when moving from a contaminated body site to a clean body site … G. After removing gloves … Hand washing with Soap and Water … 3. Rinse with warm water and dry the hands with a disposable towel 4. Use a dry disposable towel to turn off the faucet … “ 2. On 04/17/2024 at 8:00 AM, during a home visit at Patient #7's residence, observed HHA 4, provide personal care. HHA 4 entered Patient #7’s home, went to the kitchen, washed hands appropriately, turned the water off with bare hands but did not have paper towels to dry their hands, so they patted their hands on their pant legs, and donned a pair of gloves. HHA 4 escorted Patient #7 to their bathroom, assisted Patient #7 with undressing, with Patient #7 stepped into the shower. HHA 4 assisted Patient #7 with washing their backside, after Patient #7 shower was completed, HHA 4 handed Patient #7 their towel, and assisted Patient #7 with drying off and dressing. HHA 4 went to the kitchen, doffed their gloves, washed their hands appropriately, turned the water off with their bare hands, and patted their pant legs with their wet hands. 3. On 04/17/2024 at 8:35 AM, during an interview, HHA 4 indicated they should have used paper towels to turn the water off and dry hands. On 04/17/2024 at 3:05 PM, the Alternate Administrator indicated HHA 4 should have used paper towels to turn the water off and dry their hands, and should have performed hand hygiene and changed their gloves after assisting with shower. 410 IAC 17-12-1(m)

HHA maintains documentation of training CFR(s): 484.80(b)(4) The HHA must maintain documentation that demonstrates that the requirements of this standard have been met. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure documentation for home health aide training was complete and accurate, in 3 of 5 home health aide personnel records reviewed. (Home Health Aide (HHA) 1, 4, and the Administrator (who is also a HHA)) Findings include: 1. Review of an agency document titled 'TRAINING/INSERVICE EDUCATION Policy No. 1-028.1' stated, "... POLICY ... Paraprofessional personnel will receive education as follows: 1. Aides (CNAs/HHAs) must receive at least twelve (12) hours of in-service training per calendar year ... PROCEDURE ... 3. A record will be maintained for each session, including: ... C. Speaker, and his or her qualifications ... 4. An in-service log will be kept to track the number of in-service hours the aides (CNAs/HHAs) and all staff have obtained on a cumulative basis ..." 2. Review of the personnel file for Home Health Aide (HHA) 1 with a date of hire of 03-15-2022 evidenced in-service trainings, 'Personal and In-home Safety Techniques Test', 'Corporate Compliance and Standards of Conduct', 'HIPAA and Confidentiality', 'Complaints and Grievances Test', 'Communication Barriers Test', 'Agency Emergency Test Plan', 'QAPI Test', 'Nutrition', 'Personal Care and Reporting Changes' were all undated. 'Patient Rights and Responsibilities' was undated, graded, and failed to evidence who had administered or graded the test. 'Ethics Test' dated 03-24-2023, was graded at 70% and marked, "FAIL ... reviewed 4-17-2023 [illegible] 100%" and failed to evidence who had administered or graded the test. 'Standard Precautions and Infection Control Test' was graded and failed to evidence who had administered or graded the test. The documentation failed to evidence any in-service trainings for 2024. 3. Review of the personnel file for Home Health Aide (HHA) 4 with a date of hire of 05-02-2018 evidenced an in-service training 'Patient Rights and Responsibilities' which was undated, graded, but failed to evidence who had administered or graded the test. 'Ethics Test' failed to evidence who answered the test questions, was undated, graded, and failed to evidence who had administered and graded the test. 'Standard Precautions and Infection Control Test' failed to evidence who had answered the test questions, was undated, was graded and failed to evidence who had administered and graded the test. The documentation failed to evidence any in-service trainings for 2024. 4. Review of the personnel file for the Administrator who is also a Home Health Aide (HHA) with a date of hire of 09-10-2017 evidenced an in-service training, 'Corporate Compliance and Standards of Conduct' which was undated. 'HIPAA and Confidentiality' was undated, ungraded, and failed to evidence who had administered the test. 'Personal and In-home Safety Techniques Test' was undated. 'Complaints and Grievances Test', 'Communication Barriers Test', 'Agency Emergency Plan Test', 'QAPI Test', 'Nutrition', and 'Personal Care and Reporting Changes' failed to evidence a date the tests were taken, and failed to demonstrate a Registered Nurse had administered the tests. The documentation failed to evidence any in-service trainings for 2024. 5. On 04-19-2024 at 12:35 PM, in an interview with the Administrator, when queried as to why so many of the aide in-service training documents were incomplete, for example, failed to contain names of the test takers, were undated, some had not been graded, some that had been graded were not signed off by a nurse, the Administrator offered nothing further. 410 IAC 17-14-1(I)(2)

Duties of a HH aide CFR(s): 484.80(g)(3) The duties of a home health aide include: (i) The provision of hands-on personal care; (ii) The performance of simple procedures as an extension of therapy or nursing services; (iii) Assistance in ambulation or exercises; and (iv) Assistance in administering medications ordinarily self-administered. This ELEMENT is not met as evidenced by: Based on interviews and record review, the agency failed to ensure home health aide (HHA) followed the patient's aide plan of care (POC) in 1 of 3 home visits. (Employee: HHA 1) Findings include: 1. An agency’s policy dated November 2022, titled ‘HOME HEALTH AIDE PLAN OF CARE Policy No. 2-003’ revealed, “ … 2. The home health aide plan of care will be individualized to the specific patient … F. Activities permitted … “ 2. A review of the clinical record for Patient #2 revealed a document titled ‘AIDE PLAN OF CARE’ revealed the HHA frequency/duration was 3 hours daily which identified the following daily tasks: hair care, skin care, mouth care, foot care, dressing, other – assist and reposition as needed, light laundry, make bed, light housekeeping, meal preparation, encourage fluids, shower, check for pressure points, toileting, assist with wheelchair and transfers as needed, medications reminder, encourage conversation, and take out trash. Weekly tasks were: shampoo (more often if requested), nail care (clean/file), bed linen change (more often if requested), and vacuum (more often if requested). 3. During an interview on 04/17/2024 at 9:25 AM, HHA 1 indicated they shower, cook, go shopping and to the bank, and try to clean everyday when they’re at Patient #2’s home. When queried how do they know what tasks they are to do, HHA 1 indicated it’s on the care plan which they access on their own device. 4. During an interview on 04/18/2024 at 8:40 AM, Patient #2 indicated HHA 1 cooks, clean, showers them, and go to the grocery store. 5. During an interview on 04/17/2024 at 3:10, the alternative administrator indicated HHAs are not to run errands for patients. The administrator indicated they would have to research this. 410 IAC 17-14-1(h)(1-14)

Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure Home Health Aides (HHA) maintained a current certification in their employee record for 1 of 1 HHA without a current certificate. ( Employee: HHA 1) Findings Include: 1. Review of an agency document revised November 2018, titled 'LICENSURE/CERTIFICATION/REGISTRATION Policy No. 1-007.1' stated, "PURPOSE To ensure that all personnel have current licensure/certification. POLICY All organization personnel will be properly licensed, certified, and/or trained to meet specific job requirements. PROCEDURE 1. Personnel must maintain and show proof of licensure, certification, and/or registration as appropriate. 2. Personnel must comply with requirements to maintain such licensure, certification, and/or registration in accordance with applicable state law and regulation. Human Resource staff will track dates of licensure certifications/registrations expiration dates and notify personnel of upcoming expiration date. Personnel will show proof of updated license, certification and/or registration and a copy will be kept in personnel record. 3. A current copy or other proof of licensure, certification, and/or registration will be kept in the personnel file ... 5. Any employees who fail to maintain a required license, certification or registration will be subject to suspension or termination." Review of an agency document revised November 2018, titled 'CATEGORIES/QUALIFICATIONS OF PERSONNEL Policy No. 1-005.1' stated, "POLICY ... The organization will employ or contract only those individuals who have valid credentials as stipulated by Federal and State requirements ... Home Health Aide ... B. Have a cleared registration status of "registered" on the Home Care Aide Registry ..." 2. Review of the personnel file for Home Health Aide (HHA) 1 failed to evidence a current 'Home Health Aide' Certificate. On 04-18-2024, search results on the Indiana State Professional Licensing Agency (PLA) website evidenced HHA 1's Home Health Aide certificate had expired 03-15-2023, indicating "Status: Expired". 3. Review of the clinical record for Patient #3 evidenced Home Health Aide (HHA) visits were completed by HHA 1 who had submitted visit notes from 03-15-2024 to 04-12-2024. 4. On 04-18-2024 at 11:10 AM, in a telephone interview, Home Health Aide (HHA) 1 indicated sees Patient #3 regularly, "7 days a week". When queried as to the most recent visit completed, indicated that they had just seen the patient that morning and added, "I better make sure I clocked out!" When queried if they ever missed a visit with Patient #3, indicated, "can't remember if I ever missed a visit". When queried about their Home Health Aide certification, indicated it was, "getting reinstated now". When queried as to the date the certification had expired, would only answer "recently". HHA 1 then indicated a scheduler had informed them their home health aide certification had expired. When queried as to what that meant, HHA 1 indicated, "Can't go to work". When queried as to what the agency's policy would be when an HHA's certification expires, HHA 1 indicated, "I believe you can't work" and then reconfirmed was with Patient #3 this morning and "got [Patient #3] up". On 04-18-2024 at 3:22 PM in a telephone interview, the Alternate Clinical Supervisor (who is also the case manager for Patient #3), indicated was not aware that HHA 1's certification had expired. When queried further as to what should or should not happen with an HHA whose certification had expired, indicated "shouldn't be giving any care". On 04-19-2024 at 12:20 PM, when queried as to who was responsible for ensuring an HHA with an expired certification was not able to continue to make patient visits, the Administrator indicated the schedulers had been, but would make sure going forward this was tasked to a particular individual, indicated would create a new process where an aide would be pulled off of a case immediately and made 'inactive' in their system. 410 IAC 17-12-1(d)(3)

Administrator CFR(s): 484.115(a) Standard: Administrator, home health agency. (1) For individuals that began employment with the HHA prior to January 13, 2018, a person who: (i) Is a licensed physician; (ii) Is a registered nurse; or (iii) Has training and experience in health service administration and at least 1 year of supervisory administrative experience in home health care or a related health care program. (2) For individuals that begin employment with an HHA on or after January 13, 2018, a person who: (i) Is a licensed physician, a registered nurse, or holds an undergraduate degree; and (ii) Has experience in health service administration, with at least 1 year of supervisory or administrative experience in home health care or a related health care program. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure the Administrator was qualified to serve in the role. Findings include: 1. Review of an agency document titled 'Appointment of Executive Director/Administrator Policy No. 8-006' stated, "... The Governing Body will appoint the Executive Director/Administrator ... The Executive Director/Administrator will: ... 3. Have at least two (2) years health related experience, education, knowledge, and ability to fulfill his/her responsibilities. A master's degree is preferred ..." 2. Review of the personnel file for the Administrator evidenced a document titled 'Job Title/Description' which stated, "Executive Director/Administrator ... Position Qualifications: 1. Is a licensed physician, registered nurse, or holds an undergraduate degree. A bachelor's degree in business administration, master's degree in healthcare or related field is preferred ..." The document was signed by the Administrator on 03-10-2018. Further review of the personnel file for the Administrator failed to evidence required qualifications for the role were met. 3. In an interview on 04-17-2024 at 3:21 PM, the Administrator indicated was not a physician, was not a registered nurse, and did not hold an undergraduate degree or degree of any kind, acknowledged a qualified individual was required for the role, and further indicated had recently sought legal counsel regarding the matter and was awaiting referrals/recommendations for a qualified individual.

An Emergency Preparedness Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 484.102 Survey Dates: 08-28-2023,08-29-2023,08-30-2023, and 08-31-2023. Active Census: 33 At this Emergency Preparedness survey, 1st Priority Healthcare INC was found in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 484.102 QR completed by A3 on 9-06-2023.

This visit was for a Federal Recertification and State Re-licensure of a Home Health Provider, conducted by the Indiana Department of Health. Survey dates: 08-28-2023, 08-29-2023, 08-30-2023 and 8-31-2023. 12-month Unduplicated Skilled Census: 2 This deficiency report also reflects State Findings cited in accordance with 410 IAC 17. Refer to State Form for Additional State Findings. QR completed by A3 on 9-06-2023.

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on record review, and interview, the agency failed to ensure the comprehensive assessments were complete and accurately reflected the patients’ status for 2 of 5 active clinical records. (Patients #1 and #5) Findings include: 3. In an interview on 08-31-2023 at 5:14 PM, when queried as to what was expected of the case managing nurse during a patient’s assessment, the Alternate Administrator indicated a full assessment was expected to be performed in order to assess, address, and respond to any deficits found with a patient. IAC 17-14-1(a)(1)A 1. A review of the clinical record for Patient #1 with a start of care (SOC) 01-23-2023 and a Resumption of Care( ROC) of 03-29-2023, following a hospitalization for acute hypoxic respiratory failure (severe and sudden onset of lack of oxygen), evidenced the ROC assessment was completed by Registered Nurse(RN) #1 on 03-29-2023. The assessment evidenced a section titled immunizations that was left blank, a patient learning preference that was left blank, a respiratory section that indicated “normal” but the section for assessment of lung sounds was left blank, and a section for home health aide (HHA) goals was left blank. 2. A review of the clinical record for Patient # 5 with a SOC 03-07-2023 and a certification period of 07-5-2023 to 09-02-2023 and a diagnosis of hemiplegia (paralysis on one side of the body) evidenced a recertification assessment completed by RN #1 on 07-03-2023. The assessment evidenced sections for drug allergies, immunizations, patient learning preferences, lung sounds, bowel frequency, and Neuro/Emotional/Behavior (neurological) were left blank.

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 record review, observation and interview the agency failed to complete a medication reconciliation to include duplicative medications and or medications discontinued in 2 of 5 records reviewed. (Patients # 1 and # 3). Findings include: 3. A review of the clinical record for Patient #3 with a start of care (SOC) of 12-28-2021 evidenced a Plan of Care for the certification period of 06-21-2023 to 08-19-2023, signed on 06-20-2023 by Registered Nurse (RN) #1, and indicated, “Reason for Medicaid services: The SN [Skilled Nurse] performs assessments for the start of care and recertifications along with medication review and reminders…” Patient’s medications included, but were not limited to, “Tylenol 8 hour Arthritis Pain Oral Tablet Extended Release (pain reliever/fever reducer) 650 MG - 2 – Tabs - TWICE DAILY – PO [by mouth] – on going” and, “Acetaminophen Extra Strength (pain reliever/fever reducer) 500 MG – 2 – Caps – THREE TIMES DAILY – PO [by mouth] – on going”. The current record indicated the patient received five thousand, six hundred (5,600) milligrams of Acetaminophen per day. On 08-29-2023 at 10:00 AM during an interview, Patient #3 indicated they do not take the medications as written in the plan of care. Indicated they only took one (1) Tablet of the Tylenol Arthritis formula when experiencing pain, and if pain were excessive would take one (1) Extra Strength Tylenol along with it, but this was rare. Indicated further was aware they should not take excessive amounts of Tylenol or Tylenol containing products as they had been warned by their physician not to do so. Patient #3 could not recall if the agency nurse had provided this same education. On 08-30-2023 at 11:40 AM during an interview, RN 1 indicated medication reconciliation occurs at start of care and is updated at recertification, the electronic medical record automatically checks for interactions when medications are entered into the record, but does not check for duplicative drug therapies. Indicated medications are also reconciled at resumptions of care, states the office will usually obtain discharge paperwork from rehabs or facilities before he/she makes a resumption visit and then he/she checks medications against such records during resumption of services. When queried as to Patients #3 medication list, indicated the maximum amount of Tylenol that should be taken would be three thousand (3,000) milligrams per day and that Patient #3's record needed to be updated and the physician contacted, to reflect how the medication is actually ordered and taken. On 08-30-2023 at 3:39 PM when queried about duplicative drugs evidenced on Patient #3's medication record, the Alternate Administrator indicated that during the QA/QR (Quality Assurance/Quality Review) process, "we should be looking". IAC 410 17-14-1(a)(1)(B) 1. A policy titled “1st Priority Healthcare REASSESSMENT/RECERTIFICATION policy No. 1-018, received from the Alternate Administrator on 08-31-2023 at 3:40 PM, indicated but was not limited to “1. Each clinician will follow the policies and procedures for ongoing assessments for each home visit. 3. The update of the comprehensive assessment must, at a minimum, include: …B. Drug regimen review of all medications for drug interactions, potential adverse effects and drug reactions, duplicative drug therapy, ineffective drug therapy, significant side effects, significant drug interactions.” 2. A review of the clinical record for Patient #1 with a start of care (SOC) of 01-23-2023 and a resumption of care (ROC) of 03-29-2023 indicated the Patient’s medications included Acetaminophen (pain and or fever treatment), Eliquis (blood thinner), Lisinopril (blood pressure treatment), Metoprolol Tartrate (blood pressure and or heart failure treatment), and Rosuvastatin Calcium (high cholesterol treatment). During a home observation for Patient #1 on 08-29-2023 at 8 AM a review of medications in the Patient’s home included a punch card pill container with Guaifenesin 400 Milligrams to be taken as needed for congestion as well as Acetaminophen, Eliquis, Lisinopril, Metoprolol Tartrate, and Rosuvastatin Calcium. During an interview on 08-29-2023 at 8:05 AM Patient #1 indicated receiving that medication ( referring to the Guaifenesin) while hospitalized in 2022 for Pneumonia (respiratory infection) and indicated he did not know what it was for, does not take it, and the medication needs to be thrown away. During an interview on 08-30-2023 at 11:30 AM with Patient #1’s case manager, Registered Nurse (RN) #1, they indicated Patient #1 has not taken the medication (referring to Guaifenesin) and they do not take it as far as RN #1 knows.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure physicians were contacted and collaborated with prior to recertification in 4 of 5 active clinical records reviewed. (Patients #1, #3, #4, and #5) Findings include: 6. A review of the clinical record for Patient #3 with a start of care (SOC) date of 12-28-2021 evidenced a Plan of Care a certification period of 06-21-2023 to 08-19-2023 signed on 06-20-2023 by Registered Nurse (RN) #1 failed to evidence the physician was contacted to verify the plan of care. The plan of care indicated the agency may certify the patient every 56-60 days without calling the physician. 7. A review of the clinical record for Patient #4 with a SOC date of 03-07-2023 evidenced a Plan of Care a certification period of 06-17-2023 to 08-15-2023, signed on 06-14-2023 by Registered Nurse (RN) #1 failed to evidence the physician was contacted to verify the plan of care. The plan of care indicated the agency may certify the patient every 56-60 days without calling the physician. IAC 410 17-13-1(a)(2) 1. A policy received on 08-31-2023 at 3:40 PM from the Alternate Administrator titled “REASSESSMENTS/RECERTIFICATION Policy no.1-018” contained but was not limited to “The comprehensive assessment must be updated every 60 days beginning with the start of care…The physician (or other authorized licensed independent practitioner) will be contacted to verify the continued need for care and his/her agreement with the continued plan of care.” 2. A review of the clinical record for Patient #1 with a start of care (SOC) 01-23-2023,evidenced a Plan of Care for the recertification period of 07-22-2023 signed on 07-19-2023 by Registered Nurse(RN) #1 failed to evidence the physician was contacted to verify the plan of care. The plan of care indicated the agency may certify the patient every 56-60 days without calling the physician. 3. A review of the clinical record for Patient #2 with a SOC 06-23-2021, evidenced a Plan of Care for the recertification period of 08-12-2023 to 10-10-2023, failed to evidence the physician was contacted to verify the plan of care. The plan of care indicated the agency may certify the patient every 56-60 days without calling the physician. 4. A review of the clinical record for Patient # 5 with a SOC 03-07-2023, evidenced a Plan of Care recertification period of 07-5-2023 to 09-02-2023, failed to evidence the physician was contacted to verify the plan of care. The plan of care indicated the agency may certify the patient every 56-60 days without calling the physician. 5. During an interview with the Alternate Administrator on 08-29-2023 at 3:23 PM, she reported they do not always contact the physician for a voice order to recertify patients but when they do the nurse should document that communication.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on record review, observation and interview the agency failed to ensure staff members took appropriate infection prevention measures while providing hands on care to patients in 1 of 3 home visit observations. (Home Health Aide [HHA] 2). Findings include: 1. Review of the Centers for Disease Control on 09-01-2023, "WHEN TO PERFORM HAND HYGIENE," (https://www.cdc.gov/handhygiene/providers/), stated, "Multiple opportunities for hand hygiene may occur during a single care episode. Following are the clinical indications for hand hygiene: Use an Alcohol-Based Hand Sanitizer or wash with soap and water immediately before touching a patient … after touching a patient or the patient's immediate environment … or contaminated surfaces, or immediately after glove removal … 'WHEN AND HOW TO WEAR GLOVES" stated, "Wear gloves, according to Standard Precautions, when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes … potentially contaminated skin or contaminated equipment … Change gloves and perform hand hygiene during patient care, if … moving from work on a soiled body site to a clean body site on the same patient or if another clinical indication for hand hygiene occurs..” “TECHNIQUES FOR WASHING HANDS WITH SOAP AND WATER” stated, “… When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse your hands with water and use disposable towels to dry. Use towel to turn off the faucet.” 2. On 08-29-2023 at 10:00 AM, during a home visit, Home Health Aide (HHA) 2 was observed providing care for Patient #3. HHA 2 proceeded to wash hands at the patient’s kitchen sink, using soap and water lathered up hands and rubbed to together, scraped under fingernails, then proceed to rinse hands. The HHA then shut off faucet handles with bare hands and and dried hands with paper towel. Gloves were donned before assisting patient with a shower, the HHA used gloved hands to reposition the patient’s walker outside the bathroom, handled the patient’s clothing, placed a clean towel on the floor for the patient to use when exiting the shower, touched the shower curtain, handled the patient’s washcloth, then assisted the patient with drying off and redressing. For the duration of the showering activity, one (1) pair of gloves was utilized, which were doffed only after the patient left the bathroom. In an interview on 08-29-2023 at 10:45 AM after the home visit for Patient #3, HHA 2 was asked to talk through the proper sequence of hand hygiene when using soap and water at the sink, and recalled he/she had failed to use paper towel to shut off the faucet handles. When queried as to when gloves ought to be worn or changed HHA 2 indicated, gloves should be worn “anytime giving a shower” and should be changed after each task, “when I do something else”. In an interview on 08-30-2023 at 3:39 PM when informed of the infection control breach during the home visit with HHA 2, the Alternate Administrator indicated staff should be changing gloves after they touch their face, touch other things, and indicated staff should have a lot of gloves in their pockets and stated, “we drill it”. 410 IAC 17-12-1(m)

Aides are members of interdisciplinary team CFR(s): 484.80(g)(4) Home health aides must be members of the interdisciplinary team, must report changes in the patient's condition to a registered nurse or other appropriate skilled professional, and must complete appropriate records in compliance with the HHA's policies and procedures. This ELEMENT is not met as evidenced by: Based on record review, observation, and interview the agency failed to ensure the home heath aide reported a patient's change in condition to the registered nurse, in 1 of 7 clinical records reviewed. (Home Health Aide [HHA] 2) Findings include: 1. Review of an agency document, revised October 2009, titled, 'HOME HEALTH VI - Job Description' stated, "Job Title/Position: Certified Home Health Aide... Reports to: Clinical Director/Supervisor... JOB DESCRIPTION SUMMARY The home health aide is a paraprofessional member of the home care team who works under the supervision of a registered nurse ... and performs various personal care services as necessary to meet the patient's needs. The home health aide is responsible for observing patients, reporting these observations and documenting observations and care performed..." evidenced HHA 2's signature and failed to evidence the date the document was signed. Review of an agency document, revised on 07-14-2022, titled, 'ONBOARDING POLICIES ACKNOWLEDGEMENT FORM' stated, "Certified Home Health Aide Job Description...Reports to: Clinical Supervisor... Responsibilities of the home health aide include, but are not limited to, the following: …11. Reporting on patient's condition and significant changes to the assigned nurse..." evidenced HHA 2's signature and was dated 06-08-2022. 2. On 08-29-2023 at 10:07 AM, during a home observation, Patient #3 was seen rubbing an area above their right browbone indicated "still" having a bump above the right eye. When Patient #3 was queried further, indicated had, "bumped into the cabinet" approximately one month prior and had developed a larger bump to the area as a result. When queried if the patient had made the nurse aware of the incident, Patient #3 indicated they had not made the nurse aware. When HHA 2 was queried as to whether he/she had reported the incident to the nurse, Patient #3 interrupted and stated, "I told [HHA 3] not to tell anybody" and further indicated had not seen a physician either because the patient's Medicaid was not active at the time, but would make an appointment to see their physician. When HHA 2 was queried as to whether he/she had ever made the nurse aware of Patient #3's incident/injury, the aide indicated they had not done so. 3. On 08-30-2023 at 11:40 AM, Registered Nurse (RN) 1, indicated was unaware of Patient #3 having any incidents or injuries and had received no reports from HHA 2 regarding Patient #3 having "bumped into a cabinet" and having a small bump still present above the right eye. On 08-30-2023 at 3:39 PM, the Alternate Administrator indicated the expectation was for their aides to report changes in patient's condition to the nurse, indicated the agency had set up a retraining for tomorrow, and indicated the aides are specifically instructed to call the office and ask to speak with the RN.