Every finding on record at Advantage Home Health Services, LLC

Based on the findings of an onsite unannounced Medicare recertification and State relicense survey completed 11/7/2024, Advantage Home Health Services Llc 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.

Based on the findings of an onsite unannounced Medicare recertification and state relicense survey completed 11/7/2024, Advantage Home Health Services Llc was found not to be in compliance with the following requirement of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of agency policy and procedure, observations (OBV) during home visits and staff (EMP) interview, the agency failed to ensure staff followed infection control standards of practice and agency policy and procedure for two (2) of seven (7) observations providing direct care to patients (OBV4 and OBV7). Findings Included: Review of the agency policy and procedures was conducted on 11/6/2024 at approximately 3:53 PM which revealed, “Bag Technique Policy, POLICY The Agency staff will demonstrate and maintain proper bag technique when completing home visits…PROCEDURE 1. Bag is professional in appearance and contains equipment necessary for home visit. 2. Bag placed on barrier on clean/dry/flat surface (or hung from a doorknob or back of a chair) 3. Hand hygiene performed before all patient care and before entering bag to remove supplies…4. Clean section to be kept closed at all times when not actively removing/putting things in bag…5. All supplies/equipment removed from bag will be placed on a “clean” barrier 6. All supplies/equipment after use (before being sanitized) will be placed on a separate “dirty” barrier 7. All supplies/equipment to be sanitized with alcohol wipes, Clorox wipes, or Sani-cloth disinfectant wipes prior to placing back in bag 8. Electronic device to record visit is placed on barrier throughout patient care 9. Clinician will dispose of all waste at end of visit prior to leaving home” Review of the manufacture’s direction for use on 11/7/2024 at approximately 3:45 PM revealed, “Sani-Cloth GERMICIDAL DISPOSABLE WIPE BACTERICIDAL, TUBERCULOCIDAL, VIRUCIDAL* IN 2 MINUTES SUITABLE FOR USE ON EQUIPMENT REQUIRING ALCOHOL-BADSED PRODUCTS…Contact time: Use wipe to thoroughly wet surface. Allow surface to remain visible wet for two (2) minutes. Let air dry…” Review of the manufacture’s direction for use on 11/7/2024 at approximately 3:45 PM revealed, “Clorox Disinfecting Wipes…Direction for Use…To disinfect and deodorize hard, nonporous surfaces: For visibly soiled surfaces, clean first. Wipe surface; use enough wipes for treated surface to remain visible wet for 4 minutes…” Observations (OBV4), during a visit to residence MR2 on 11/6/2024 at 11:37 AM revealed, EMP5 provided direct patient care. The following equipment was observed being used during treatment: stethoscope, pulse oximeter, thermometer and blood pressure cuff. After patient use EMP5 wiped off each piece of equipment with Sain-Cloth and placed the reusable items immediately into the healthcare/equipment bag with no dry time. Observations (OBV7) during a visit to residence MR4 on 11/6/2024 at 3:02 PM revealed: EMP6 provided direct patient care. EMP6 placed chucks/barriers on the patient’s table. Removed an equipment caring bag from the healthcare/equipment bag. EMP6 placed the equipment caring bag on top of a chuck/barrier with both ends of the equipment caring bag being off the chuck/barrier onto the table. After patient use EMP6 wiped off each piece of equipment with Clorox Disinfecting Wipes and placed the reusable items immediately into the equipment caring bag with no dry time. Then placed the equipment caring bag into the healthcare/equipment bag without cleaning. An exit interview with the vice president of clinical compliance, vice president of quality & utilization, regional clinical manager and (via conference call) CEO on 11/6/2024 at approximately 3:52 PM confirmed the above findings.

Based on the findings of an onsite unannounced Medicare recertification and State relicensure survey conducted 11/1/2021 through 11/4/2021, Advantage Home Health Services Llc 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.

Based on the findings of an onsite unannounced Medicare recertification and State relicensure survey conducted 11/1/2021 through 11/4/2021, Advantage Home Health Services Llc was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of agency policy and procedure, observations (OBV) during home visits and staff (EMP) interview, the agency failed to ensure staff followed infection control standards of practice and agency policy and procedure for two (2) of six (6) observations providing direct care to patients (OBV3 and OBV7). Based on review of agency policy and procedure, observations (OBV) during home visits and staff (EMP) interview, the agency failed to ensure staff followed infection control standards of practice and agency policy and procedure for two (2) of six (6) observations providing direct care to patients (OBV3 and OBV7). Findings Included: Review of the agency policy and procedures was conducted on 11/4/2021 at approximately 12:25 PM which revealed, “Bag Technique Review…Decontaminating/Cleaning Bags…ALWAYS place your bag on a barrier if setting on a surface in a patient’s home…Steps for proper bag technique…In the home, identify a clean and safe area for the healthcare bag. Never set the healthcare bag on the floor. Always choose a place to set the bag that gives you enough workspace, is close to the patient, and is away from children and pets. Spread a barrier on the surface before setting the bag down. A separate barrier should be used for your tablet-do NOT set your tablet on your bag…Remove the clean supplies that are needed for the visit (BP cuff, stethoscope, wound care supplies, etc.) and place on the barrier…” Observations (OBV3), during a visit to MR13 residence on 11/3/2021 at 10:10 AM revealed, EMP4 provided direct patient care. Upon entering the residence, the bag, clean reusable items and laptop was placed on the same chuck/barrier on a stool adjacent to where the patient was sitting. The following equipment was observed being used during treatment: pulse oximeter, thermometer, goniometer and blood pressure cuff. After patient use EMP4 placed the reusable items back to the same location on the chuck/barrier prior to cleaning the equipment. Observations (OBV7) during a visit to MR17 residence on 11/3/2021 at 2:45 PM revealed: EMP6 provided direct patient care. EMP6 placed two chuck/barriers on the patient’s table. Removed items from the healthcare bag and placed the clean reusable items on the same chuck/barrier as the healthcare bag. The following equipment was observed being used during treatment: pulse oximeter, thermometer and blood pressure cuff. After patient use EMP7 placed the reusable items back to the same chuck/barrier with the equipment leaning against the healthcare bag prior to cleaning the equipment. The strap to the bag was also off the chuck and laying on the patient’s table. An exit interview with the vice president of clinical compliance on 11/4/2021 at approximately 2:00 PM confirmed the above findings.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on a review of department documentation, agency policy, observations tour (OBV) and staff (EMP) interview the agency failed to ensure that everyone entering the agency office and agency consumers were being screened and triaged for COVID-19 for two (2) of two (2) observations (OBV1 and OBV2). Based on a review of department documentation, agency policy, observations tour (OBV) and staff (EMP) interview the agency failed to ensure that everyone entering the agency office and agency consumers were being screened and triaged for COVID-19 for two (2) of two (2) observations (OBV1 and OBV2). Findings Included: Based on review of the Pennsylvania Department of Health documents on 11/8/2021 at approximately 3:00 PM reveal the following, PENNSYLVANIA DEPARTMENT OF HEALTH 2021 – PAHAN – 597 – 09-21-UPD… 9/21/2021…UPDATE: Interim Infection Prevention and Control Recommendations for Healthcare Settings during the COVID-19 Pandemic…This update replaces PA-HAN-563, PA-HAN-554, PA-HAN-544 and PA-HAN-521… 1. RECOMMENDED ROUTINE INFECTION PREVENTION AND CONTROL (IPC) PRACTICES DURING THE COVID-19 PANDEMIC DOH recommends using the following additional infection prevention and control practices during the COVID-19 pandemic, along with standard practices recommended as a part of routine healthcare delivery to all patients. These practices are intended to apply to all patients, not just those with suspected or confirmed SARS-CoV-2 infection (See Section 2 for additional practices that should be used when caring for patients with suspected or confirmed SARS-CoV-2 infection). A. Establish a Process to Identify and Manage Individuals with Suspected or Confirmed SARS-CoV-2 Infection • Ensure everyone is aware of recommended IPC practices in the facility. o Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) with instructions about current IPC recommendations (e.g., when to use source control and perform hand hygiene). Dating these alerts can help ensure people know that they reflect current recommendations. • Establish a process to identify anyone entering the facility, regardless of their vaccination status, who has any of the following so that they can be properly managed: 1) A positive viral test for SARS-CoV-2; 2) Symptoms of COVID-19, or 3) Who meets criteria for quarantine or exclusion from work…” Observation #1 was conducted on 11/1/2021at approximately 11:50 AM. No signage pertaining to COVID-19 Screening upon entrance to the agency’s office building was observed on the door or outside the office. No screening process noted upon entry to the office building. On 11/1/2021. Covid-19 screening was not conducted by the agency staff for the state surveyor. Observation #2 was conducted on 11/2/2021at approximately 9:30 AM. No signage pertaining to COVID-19 Screening upon entrance to the agency’s office building was observed on the door or outside the office. No screening process noted upon entry to the office building. On 11/2/2021. Covid-19 screening was not conducted by the agency staff for the state surveyor. An exit interview with the vice president of clinical compliance on 11/4/2021 at approximately 2:00 PM confirmed the above findings.