Every finding on record at Advent Home Health Care Services, 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 # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - 11 Active Patients - 5 Sample Size - 7 Patients Home Visits – 3

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 that all staffs are trained in emergency preparedness and conduct the emergency drill annually. This failure had the potential to affect the staff's immediate response to emergency procedures to be carried out during emergency crisis. During a review of the agency's emergency preparedness policy on 2/1/22 at 12 p.m., indicated no documented evidence of Emergency Preparedness training/disaster drill for all staffs. During an interview with Director of Patient Care Services (DPCS) on 2/11/22 at 12:50 p.m., confirmed she did not have evidence of Emergency Preparedness/Disaster training for all HHA staffs. The HHA's undated policy and procedure titled "Emergency Preparedness Plan" indicated the purpose was to ensure the safety and well being of clients and employees in the event of an emergency that results in the interruption of client care or services.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - 11 Active Patients - 5 Sample Size - 7 Patients Home Visits – 3

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 observation, interview and record review, the home health agency (HHA) failed to maintain an accurate and current medication profile for one of seven patients (Patient 1). This failure has the potential to result in putting the patient at risk for medication errors and adverse drug reactions. A review of Patient 1's "Patient Information" record indicated, a start of care (SOC) date of 2/16/21, with a diagnosis that included osteoarthritis (degenerative joint disease) and chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs). During a review of Patient 1's Plan of Care (POC), for certification period from 12/11/21 to 2/8/21, included an order for skilled nurse (SN) to visit once a week for eight weeks. The POC indicated for the nurse to teach, instruct, and validate medications. Patient 1's physician's order dated 2/5/22, included the following medication orders, benzonatate (used to treat cough) 100 milligram (mg-unit of measurement) three times a day; Prednisone (prevents the release of substances in the body that cause inflammation) 20 mg daily; and Promethazine/Codeine (used to treat cough, runny or stuffy nose caused by flu, allergies, or the common cold) 1 teaspoon every six hours as needed for cough. On 2/10/22, at 11 a.m., a home visit was conducted at Patient 1's residence with licensed vocational nurse (LVN 1). During a review of Patient 1's medications included a bottle of Prednisone 20 mg. A review of the medication profile identified Prednisone 10 mg instead of Prednisone 20 mg. Further review of the medication profile did not indicate benzonatate and Promethazine/Codeine in the profile at the time of the visit. During an interview with LVN 1 on 2/10/22, at 11:30 a.m., he stated the nurse should reconcile the medications every visit. LVN 1 confirmed the nurse should check the medication profile and the medications to ensure they are correct every visit. The HHA's undated policy and procedure titled " Administration and documentation of medications" , indicated the staff will assess and provide instructions of the medications to the patient/client. The policy indicated any discrepancies or contradictions should be reported to the physician for resolution.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on interview, and record review, the licensed staff failed to administer drugs and treatments as ordered by the physician for one of seven patients (Patient 5). This deficient practice has the potential for the patient's existing ailment will not be treated accordingly that could lead to further pain and discomfort. A review of Patient 5's "Patient Information" record indicated, a start of care (SOC) date of 1/16/22, with a diagnosis that included UTI (infection on any part of the urinary system). During a review of Patient 5's Plan of Care (POC), for certification period from 1/16/22 to 3/15/22, included an order for skilled nurse (SN) to visit of daily for seven days, twice a week for two weeks, once a week for six weeks. The POC indicated for the nurse to teach, instruct, and validate medications. The physician's order dated 1/16/22, in the plan of care included to administer Rocephin (treat many kinds of bacterial infections) one gram intramuscular daily for seven days. A review of Patient 5's Skilled Nursing Visit notes dated 1/22/22, indicated no documented evidence that LVN 1 administered the Rocephin medication to Patient 5 during this visit. On 2/11/22, at 11:30 a.m., during an interview with the DPCS (director of nursing services), she stated that LVN 1 should have documented that she administered the Rocephin medication to Patient 5 or else, it was not given.

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 agency staff failed to implement COVID-19 (an acute respiratory illness) infection policy and procedure. This failure had the potential to spread infection. On 2/9/22, at 1 p.m., it was observed there was no screening for COVID-19 signs/symptoms, and no temperature checks conducted to all staffs and visitors upon entry to the facility. During a review of the infection control policy on 2/11/22 at 12:50 p.m., revealed the agency did not have a policy and procedure for COVID-19 infection and did not have evidence all staffs were fit tested for N95 masks/respirator. During a concurrent interview with the Director of Patient Care Services (DPCS), she stated there was no COVID-19 infection policy and procedure and it will be created. DPCS also stated COVID-19 infection screening will be conducted for all staffs and visitors upon entry to the agency. The DPCS further confirmed all staffs were not fit tested for N 95 masks/respirator. The HHA's undated policy and procedure titled "Infection Control Plan", indicated the agency will address surveillance, prevention, identification, and control of infections.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview , and record review , the agency staff failed to follow the plan of care (POC) for one of seven sampled patients (Patient 4). The visiting nurse failed to provide patient teaching regarding insulin management . This failure had the potential to affect the patient's progress in reaching their goals. A review of Patient 4's "Patient Information" record indicated, a start of care (SOC) date of 8/13/21, with a diagnosis that included diabetes mellitus (group of diseases that result in too much sugar in the blood). During a review of Patient 4's Plan of Care (POC), for certification period from 12/11/21 to 2/8/22, included an order for skilled nurse (SN) to visit of twice a week for one week, once a week for 8 weeks. The POC indicated for the skilled nurse to teach, instruct, and validate medications. The physician's order in the plan of care included for the SN to administer Lantus (long acting insulin for diabetes) 100 units per ml (milliliter) 50 units subcutaneously daily. During a home visit at Patient 4's residence with the DPCS on 2/10/22, at 12 p.m., Patient 4 was observed sitting on the couch in the living room. During a review of Patient 4's medications, it was observed an open vial of Lantus 100 units per ml 50 units that was not dated when it was opened. On 2/10/22, at 12:30 p.m., during an interview with Patient 4, stated he self administered the Lantus insulin daily as ordered. Patient 4 also stated that the visiting nurse did not give instructions to put the date whenever a new Lantus insulin vial was opened to use. Patient 4 further he was not aware insulin will expire in 28 days from the day it was opened. A further review of Patient 4's Skilled Nursing Visit notes from 12/11/21 to 2/8/21, indicated no documented evidence the visiting nurse instructed the patient/caregiver regarding insulin management. On 2/11/22, at 11:30 a.m., during an interview with the DPCS, she stated the insulin vial should be dated once it was opened. She also stated that the patient should have been provided patient teaching on insulin management as per plan of care.