Every finding on record at A Touch of Grace Healthcare, Inc

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 105059 The following deficiencies are based upon substantial allegation 105059 completed on 04/11/24. A touch of Grace Healthcare is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies.

A qualified HH aide successfully completed: CFR(s): 484.80(a)(1)(i-iv) A qualified home health aide is a person who has successfully completed: (i) A training and competency evaluation program as specified in paragraphs (b) and (c) respectively of this section; or (ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or (iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of §483.151 through §483.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or (iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure home health aides received required training prior to performing patient care. This had the potential to fect all patients receiving services from the agency. This affected one (Staff F) of five home health aide personnel files reviewed. The census was 14. Findings include: Review of the personnel file for Staff F, a home health aide (HHA), revealed a hire date of 09/28/21. Staff F was currently employed as an HHA. There was no documented evidence of HHA training, a competency exam or HHA skills checklist being completed . Review of the employee application did not reveal any home health aide experience. During an interview on 04/11/24 at 1:03 PM, the Administrator confirmed that there was no documented evidence of HHA training, a competency exam or HHA skills checklist for Staff F prior to working with a patient. Review of the agency policy titled “Competency Evaluation of Home Care Staff” with no effective date, revealed competency evaluations are to assure the personnel providing services to home care patients are trained, competent and able to respond to needs of the patient in a safe and effective manner. The home health aide (HHA) must demonstrate evidence of successful completion of a training program totaling at least 75 hours or successful completion of a competency evaluation program. Skills tests including written tests and direct observation of skill will be completed. Skills competency is evaluated by observing the aide with a patient or “pseudo” patient. The HHA demonstrates competency in a minimum of 11 of the 12 areas required in federal guidelines. A HHA will not be permitted to provide HHA services until evidence of adequate training and/or competency has been determined.

Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This STANDARD is not met as evidenced by: Based on record review, staff interview and policy review, the facility failed to ensure the required home health aide (HHA) skills were observed on a patient or “pseudo” patient. This affected four (Staff E, F, H and I) of five personnel files reviewed. The census was 14. Findings include: 1. Review of the personnel file for Staff E, did not reveal documented evidence that the skills required were demonstrated and observed on a live patient or pseudo patient. Staff E was working as a home health aide (HHA) 2. Review of the personnel file for Staff F, HHA, did not reveal documented evidence that the skills required were demonstrated and observed by a RN on a live patient or pseudo patient. Staff F was working as a HHA. 3. Review of the personnel file for Staff H, HHA, did not reveal documented evidence that the skills required were demonstrated and observed on a live patient or pseudo patient. Staff H was working as a HHA. 4. Review of the personnel file for Staff I, HHA, did not reveal documented evidence that the skills required were demonstrated and observed on a live patient or pseudo patient. Staff I was working as a HHA. During an interview on 04/11/24 at 10:25 AM, the Administrator confirmed there was no documented evidence that the skills required were done on a patient or “pseudo” patient or by a RN. Review of the agency form titled “Competency Evaluation Tool Home Health Aide” revealed the competency evaluation for the home health aide (HHA) must be performed by a registered nurse (RN). Evaluation and observation of competency must be completed prior to the first assignment. Review of the agency policy titled “Competency Evaluation of Home Care Staff” with no effective date, revealed competency evaluations are to assure the personnel providing services to home care patients are trained, competent and able to respond to needs of the patient in a safe and effective manner. Skills tests including written tests and direct observation of skill will be completed. Skills competency is evaluated by observing the aide with a patient or “pseudo” patient.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on record review, interview and policy review, the facility failed to ensure all staff had a current cardiopulmonary resuscitation (CPR) certificate before working with patients. This affected four (Staff B, C, E and F) of eight staff reviewed. The census was 14. Findings include: Review of personnel files for Staff C, E and F revealed they did not have evidence of current CPR training. Review of the personnel file for Staff B revealed the CPR certificate expired August 2023. During an interview on 04/11/24, the Administrator stated CPR was required for all home health aides. It was also confirmed the four staff listed above did not have current CPR training. Review of the agency Home Health Aide Orientation Checklist revealed CPR verification or scheduled for training is required. Review of the agency Employee Handbook, on page 15, revealed under Employment Information that CPR certification was required. Review of the agency policy titled “CPR Training” with no effective date, revealed Licensed nursing personnel will be initially certified (or within 90 days of hire) in Basic Life Support according to American Heart Association standards.