Every finding on record at A&C Healthcare, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 44802, Health Facilities Evaluator Nurse Surveyor # 45887, Health Facilities Evaluator Nurse Unduplicated Admissions-14 Active Patients - 1 Sample Size - 7 Patients Home Visits – 1

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure all staff members were provided emergency and disaster preparedness training annually. This failure had the potential for staffs to lack the necessary skills needed to provide patient safety during a disaster and emergency situation. Findings: During a concurrent interview, and record review on 8/19/2022, at 10:00 am with the DPCS designee (DPCS), the Emergency Preparedness binder was reviewed. There was no documented evidence that all staffs had emergency preparedness training/disaster drill for all staff members. The DPCS designee stated that not all staffs were able to be trained and that it was important so staff could be aware of what to do during a disaster. A review of the agency's policy on Emergency Disaster Preparedness Plan dated November 2013, indicated to in-service the staff on the Emergency management plan during orientation and annually thereafter.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 44802, Health Facilities Evaluator Nurse Surveyor # 45887, Health Facilities Evaluator Nurse Unduplicated Admissions - 14 Active Patients - 1 Sample Size - 7 Patients Home Visits – 1

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the skilled nurse (SN) failed to assess all body systems which included the wounds for one of seven patients (Patient 4). This deficient practice placed the patient's wounds at risk for infection that could delay the healing process. Findings: A review of Patient 4's profile indicated a Start of Care (SOC) on 8/11/2021, with diagnoses including hypertension (high blood pressure), and stage 1 pressure ulcer (a superficial reddening of the skin (or red, blue or purple hues in darkly pigmented skin) that when pressed does not turn white) to the sacral region. A review of Patient 4's Plan of Care (POC) for certification period 2/7/2022 to 4/7/2022 indicated the Skilled Nurse (SN) visit was to visit once a week for nine weeks to perform skilled observation and assessment of vital signs, medication reconciliation, and to asses the patient's pressure ulcer to sacral area, stage 1, for signs and symptoms of further skin breakdown and to report to MD when noted. A review of Patient 4’s SN notes, dated 2/8/2022, indicated the visiting nurse did not perform a skin assessment to the sacral region during the SN visit. There was no documented evidence that a wound assessment was done. During an interview on 8/19/2022 at 10:40 am, the Director of Patient Care Services designee (DPCSD) stated the SN should have assessed the wound and documented the assessment in the notes. A review of the HHA agency's policy, Wound Care Policy (undated) indicated the nurse/therapist will provide wound care per physician orders and continue to implement and evaluate the plan o care based on the effectiveness of treatment regimen, response to treatment, effectiveness of interdisciplinary services, need for assessment by Wound Care Specialist, patient/caregiver participation and identification of obstacles/risk factors interfering with wound healing. The policy indicated at each visit the patient's skin will be assessed and at each dressing change the wound will be assessed and documentation will include a description of the wound bed, drainage, signs and symptoms of infection, healing and peri wound skin condition.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on observations, interviews, and record reviews, the HHA (Home Health Agency) failed to ensure there is an ongoing communication with physician involved in patient's care for one of seven sampled patients (Patient 1). This deficient practice places the patient at a potential risk for harm that could affect his/her overall health status Findings: A review of Patient 1's Patient Profile Information indicated, a start of care (SOC) date of 08/11/22, with a certification period of 8/11/22 to 10/09/22. Patient 1's diagnoses included occlusion and stenosis of unspecified carotid artery (is a condition in which one or both carotid arteries become narrowed or blocked), and type 2 diabetes (is a chronic condition where the body does not produce insulin which regulates the blood sugar). A home visit was conducted on 8/18/22 at 9:25 a.m., with Licensed Vocational Nurse 1 (LVN 1). Patient 1 was observed lying on his bed in his private room, alert and oriented to name, place, and time, not in any respiratory distress. LVN 1 performed hand hygiene and started his visit. During an observation of skilled visit on 8/18/22 at 10:00 a.m., Patient 1’s Medication Administration Record and current medications with expiration dates reviewed with LVN 1. LVN 1 stated he reviews Patient 1’s medication at least once a week. A review of Patient 1’s clinical records dated 8/12/22 indicated Registered Nurse (RN) did not call Patient 1’s doctor for clarification of the medication Repatha (an injectable medication for adults with cardiovascular disease to reduce the risks of heart attack or stroke and is administered subcutaneously into areas of the abdomen, thigh, or upper arm that are not tender, bruised, red, or indurated) ordered on 8/9/22 and the medication Praluent (same drug class with Repatha but contain different ingredient and is an injectable medication for adults with cardiovascular disease to reduce the risks of heart attack or stroke and is administered subcutaneously into areas of the abdomen, thigh, or upper arm that are not tender, bruised, red, or indurated) which also ordered on 8/11/2022. A review of Patient 1’s plan of care dated 8/18/22 indicated Skilled Nurse (SN) to prepare and administer Praluent 150mg in 1 ml prefilled syringe subcutaneously every 2 weeks with no indication and duration. On 8/19/22 at 12:25 p.m., during an interview with the Director of Patient Care Services designee (DPCS) stated “we do the updates on the plan of care and SN should verify medication orders, SN should communicate with the doctor or office regarding clarification of orders, stated Repatha is not available from Patient 1’s pharmacy but Praluent is, stated we do not have a standing policy regarding discontined (dc) order or communication with the physician”. On concurrent review of Patient 1’s medical record, indicated no written communication from the physician when the previous order (Repatha injection) was discontinued and or changed. A review of the HHA’s policy titled “Identification of Medication for Administration” dated April 2015 indicated orders for the administration of patient medications must be given by a physician (or other authorized licensed independent practitioner) and will include patient name, patient identifier, name of the medication, dosage, dilution, route, frequency of administration and rate of infusion if applicable, the nurse will review the written physician's order prior to medication administration, nurse will not administer medication and will clarify order with physician if medication order is incomplete, illegible or unclear, it will be the nurse's responsibility to be knowledgeable about the medication to be administered, including generic vs brand name clarifications, indications, normal dosage range, dilution, route of delivery, rate of delivery, precautions, side effects, expected therapeutic effect, proper antidote, and incompabilities as applicable.

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, interview, and record review, the home health agency (HHA) failed to implement Coronavirus Disease 19 (COVID-19, a respiratory viral infection that affects primarily the lungs and results in cough and difficulty breathing) screening procedures and policy. This failure had the potential to spread infection to staffs, patients and visitors. Findings: During an observation on 8/17/2022, at 9:50 am, the HHA did not perform screening procedures for COVID-19 signs and symptoms or temperature check for the staffs and visitors prior to entering the agency. During an interview on 8/19/2022 at 12:25 pm, the Director of Patient Care Services designee (DPCSD) stated the agency did not have a policy for COVID-19 screening. The DPCSD stated the staff should have performed COVID-19 screening on staffs and visitors and stated it was important to check for COVID-19 symptoms and temperature to prevent the spread of infection. There was no policy governing COVID-19 screening provided by the HHA. A review of the Centers for Disease Control Guidelines, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, dated 2/2/2022, indicated recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic which included establishing a process to identify anyone entering the facility, regardless of their vaccination status, who as any of the following three criteria so that they can be properly managed: 1) a positive viral test for SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2, the virus that causes a respiratory disease COVID-19) , 2) symptoms of COVID-19 or 3) close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for healthcare personnel). The guidance indicated it applied to all United States settings where healthcare is delivered, including home health.