Every finding on record at Anchor Home Health Services

During the Health Recertification survey conducted on 04/30/2024 through 05/02/2024 at Anchor Home Health Services, LLC, a Home Health Agency, Emergency Preparedness was reviewed. Anchor Home Health Services, LLC is in compliance with Emergency Preparedness per 42 Code of Federal Regulations (CFR), Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was conducted on 04/30/2024 through 05/02/2024 at Anchor Home Health Services, LLC, Home Health Agency provider, located at 3725 S.E. Ocean Blvd., Suite 205, Stuart, FL 34996. The provider was not in compliance with 42 Code Of Federal Regulations (CFR) Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, interview and observation, the Home Health Agency (HHA) failed to ensure that there were physician's orders for wound care for 1 of 2 sampled patients observed to have wound care provided (Patient #4). The findings included: Review of the record reveals Patient #4 was admitted to the HHA's services on 09/11/23. Review of the current Plan of Care, for the certification period of 03/09/24 through 05/07/24 documents the Skilled Nurse was to provide "external nephrostomy (urinary drainage tubes inserted into the kidneys) tube" care. Further review reveals this Plan of Care lacked any specific physician's orders for the wound care treatment. On 05/01/24 beginning at 12:40 PM, during an interview and home visit to Patient #4, the patient confirmed they had two new nephrostomy tubes inserted the previous day by their physician. Observation, on 05/01/24 beginning at 12:40 PM, reveals Staff A, Registered Nurse (RN), applied Vashe Wound Solution, a wound cleanser, onto gauze dressings, and soaked the insertion sites of each tube for two minutes; Staff A then placed a new gauze onto the inner side of a clear adherent dressing, and applied this to each nephrostomy site. During an interview after the home visit on 05/01/24 at approximately 1:15 PM, Staff A, explained that the private caregiver had been taught how to do the daily nephrostomy flush, but the HHA's Skilled Nurses provided once weekly dressing changes, assessment of the nephrostomy sites, and flushed the tubes. Continued review of the patient's electronic medical record lacked any specific physician's orders for care to the nephrostomy sites. During a side-by-side review of the record and interview on 05/02/24 in the afternoon, the Director of Nursing (DON) agreed with the lack of physician's wound care orders for Patient #4.

Treatments and therapy services CFR(s): 484.60(e)(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to ensure 2 of 12 sampled active patients were provided written instructions outlining any treatments, including therapy, to be provided by the HHA (Patient #1 and Patient #5). The findings included: 1) Observation, on 04/30/24 beginning at 3:30 PM, during a home visit to Patient #1, reveals Staff B, Physical Therapy Assistant (PTA), provided Physical Therapy. Review of the HHA's folder belonging to Patient #1 lacked any written instructions for the patient, related to the Physical Therapy treatments being provided by the HHA. 2) Observation, on 05/01/24 beginning at 2:45 PM, during a home visit to Patient #5, Staff C, Registered Nurse (RN), provided an injection. Review of the HHA's folder belonging to Patient #5 lacked any written instructions related to the treatments being provided by the HHA. During an interview on 05/01/24 at approximately 3:30 PM, Staff C, confirmed she completed the Start of Care assessments for patients at the HHA, along with routine home visits to continue the care; when asked what written information was provided to the HHA's patients, Staff C, explained the patient receives the HHA's booklet of general information along with a copy of their medication list; when asked if the patients received any written information as to what treatments and or therapy was being provided by the HHA, Staff C stated they did not; when asked if the patients received a copy of their Plan of Care, Staff C stated they did not. During an interview on 05/02/24 at 10:45 AM, Director of Nursing (DON) was asked if patients received any written instructions outlining the treatments and or therapy to be provided, and the DON stated that they did not.

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 the Home Health Agency (HHA)'s Policy, observation and interview, the HHA's staff failed to follow infection control standards for 2 of 7 sampled patients; "Bag Technique" was not utilized during the home visit observation for Patient #1 and Infection prevention standards were not followed during wound care for Patient #4 (Patient #1 and #4). The findings included: 1) Review of the HHA's Policy titled, "Nurse, Home Health Aide and other Staff Bags" not dated, documents, "Nursing Bag Technique … 2. Upon entering the home, place the bag on a clean surface; paper towels, newspaper or plastic bag may be used to create a clean area if indicated. … Remove all items which will be needed for the visit. Place items on one of the paper towels." Review of the guideline, "Home Care Infection Prevention and Control Program; Patient Care Practices; Wound care" documents, "Procedure: B. Use aseptic technique to perform wound care." Aseptic is defined as the absence of microorganisms, or commonly known as clean technique." Observation, on 04/30/24 beginning at 3:30 PM, during a home visit to Patient #1 reveals Staff B, Physical Therapy Assistant (PTA), entered the patient's home, and placed their "backpack," used to carry equipment needed at all home visits, directly onto the patient's entry table in the foyer; Staff B did not place any type of "barrier" under the "backpack;" after hand hygiene, Staff B, obtained a zipped bag with a Blood Pressure cuff and an Oxygen Saturation monitor from their backpack, and laid them directly on the patient's entry table, with no type of "barrier;" after using the equipment, Staff B continued to utilize the patient's entry table for their used equipment, cleaned their Blood Pressure cuff and Oxygen Monitor, but did not clean their zipped bag that housed their Blood Pressure cuff; then Staff B placed the zipped bag back into their backpack. 2) Observation and interview, on 05/01/24 beginning at 12:40 PM, during a home visit, Patient #4 confirmed they had had two new nephrostomy tubes (urinary drainage tubes inserted into the kidneys), placed by the physician the previous day; observation after hand hygiene, Staff A, Registered Nurse (RN), gathered and set up their supplies to complete wound care for both nephrostomy tubes; Staff A provided care to both sites simultaneously, removing the dressings of each, soaking each with a wound cleanser, and cleaning each wound, without glove changes or hand hygiene between the two tubes; after cleaning the two wounds, Staff A failed to change gloves and do hand hygiene, before obtaining the new clean dressing to place over the patient's new wounds. On 05/01/24 at approximately 1:15 PM, during an interview after the home visit observation, upon discussion of the wound care, Staff A, agreed she should have completed the care for one tube followed by complete care of the other, or changed gloves between wounds, in order to prevent possible infections should one of the wounds get infected; Staff A agreed she should change gloves after cleaning a wound.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to ensure all interventions and services for 2 of 7 sampled patients observed during home visits, were documented in the clinical record; as evidenced by Skilled Nursing staff who failed to document the specific nephrostomy tube (urinary drainage tubes inserted into the kidneys) care provided to Patient #4, failed to document the coordination of care related to the voiced concerns of the family of Patient #4, and failed to document the specific dose, route, and site of injection for Patient #5 (Patient #4 and Patient #5). The findings included: 1) Review of the record reveals Patient #4 was admitted to the HHA's services on 09/11/23. Review of the current Plan of Care, for the certification period of 03/09/24 through 05/07/24 documents the Skilled Nurse was to provide "external nephrostomy (urinary drainage tubes inserted into the kidneys) tube" care. Further review reveals this Plan of Care lacked any specific physician's orders for the wound care treatment. On 05/01/24 beginning at 12:40 PM, during an interview and home visit to Patient #4, the patient confirmed they had two new nephrostomy tubes inserted the previous day by their physician. Observation, on 05/01/24 beginning at 12:40 PM, reveals Staff A, Registered Nurse (RN), applied Vashe Wound Solution, a wound cleanser, onto gauze dressings, and soaked the insertion sites of each tube for two minutes; Staff A then placed a new gauze onto the inner side of a clear adherent dressing, and applied this to each nephrostomy site. Review of the "Skilled Nurse Visit Notes," for this certification period, lacked documentation as to what care was provided to the nephrostomy tubes at each visit. During a side-by-side record review and interview, after the home visit observation on 05/01/24 at approximately 1:15 PM, Staff A, who had been one of the primary nurses for Patient #4, agreed with the lack of documentation. Review of the "Skilled Nurse Visit Notes" with Staff A reveals "dressing change as ordered" and Staff A agreed there were no specific dressing change orders. Review of the "Inter-Office Communication Report," from the electronic medical record for Patient #4 reveals an entry dated 03/118/24 at 9:52 AM that documented, "... (Relative) called and stated, "port (entry) on neph (nephrostomy) tube not closing properly. SN (Skilled Nurse) to assess." Review reveals the patient's record lacked any documented Skilled Nurse follow-up or assessment. During a side-by-side record review and interview on 05/01/24 at approximately 1:15 PM, when asked about the entry related to the ... (Relative)'s voiced concerns, Staff A, explained the (HHA's) office staff informed her of the ... (Relative's) concern, and she spoke with the ... (Relative) via telephone at the time of the voiced concern; Staff A stated they discussed a home visit to assess the nephrostomy tubes, but the ... (Relative) decided to take ... (Patient #4) to the hospital, as they were near-by and were familiar with the staff there; when asked if Staff A documented the resolution to the voiced concerns in the patient's record, Staff A was unable to locate any documentation. 2) Review of the record reveals Patient #5 was admitted to the HHA's services on 06/24/21. Review of the current Plan of Care for the certification period of 04/09/24 through 06/07/24 reveals Skilled Nursing services for interventions to include the administration of weekly Ozempic (a medication for diabetes) injections. Observation, during a home visit to Patient #5, on 05/01/24 beginning at 2:45 PM reveals Staff C, RN, provided 0.5 milligrams of Ozempic via injection to the patient's right arm. Review of the "Skilled Nursing Visit Notes," for the current certification reveals they all documented the intervention to "administer Ozempic weekly" and the provision of "injection given per physician's orders." During a side-by-side review of the record and interview on 05/01/24 at 3:15 PM, Staff C agreed with the incomplete documentation for the injections, with the failure to include the dose, route and location of the injection given to Patient #5.

An unannounced Complaint, #2023003006, and Focused Infection Control survey, was conducted on 06/14/2023 at Anchor Home Health Services, LLC., Home Health Agency. provider. The provider is not in compliance with 42 CFR (Code Of Federal Regulations) Part 484, Subpart A-C, Conditions of Participation for Home Health Agencies.

Investigate complaints made by patient CFR(s): 484.50(e)(1)(i) (i) Investigate complaints made by a patient, the patient's representative (if any), and the patient's caregivers and family, including, but not limited to, the following topics: This ELEMENT is not met as evidenced by: Based on the Home Health Agency (HHA)'s Policy and Procedure review, interview and record review, the HHA failed to investigate a voiced grievance made by the family of 1 of 1 sampled patients with a known grievance (Patient #1). The findings included: Review of the HHA's Policy and Procedure titled, “Non-Discrimination & Grievance Policy” (undated) documented, “Procedure: … 4. Grievances may be filed by anyone believing she/he has been subjected to discrimination, without fear of retribution or retaliation. Grievances must be submitted to the Section 504 Coordinator within 30 days of the date the person filing the grievance becomes aware of the alleged discriminatory action. The complaint may be filed in writing, or verbally, containing the name and address of the grievant. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought by the grievant. 5. A thorough investigation will be conducted, affording all interested parties and opportunity to submit evidence relevant to the complaint. 6. The Section 504 Coordinator will issue a written decision on the grievance no later than 30 days after the filing.” During an interview on 06/14/23 at 11:36 AM, the Intake Nurse recalled Patient #1; when asked if she spoke with the patient or family, she stated she doesn’t believe that she did, but that the DON (Director of Nursing) and or Administrator had taken some (telephone) calls and when asked if she recalled any concerns with Patient #1, the Intake Nurse recalled a question as to who caught COVID (Coronavirus disease) from whom, as both the patient and nurse became ill, but there were also out of town guests in the home. During an interview on 06/14/23 at 12:50 PM, the DON was asked to provide any grievances or complaints from 2023; the DON stated she didn’t believe they had any, but she would confirm with the Administrator; the DON returned at 12:55 PM and stated they had no grievances or concerns logged for 2023; the DON went on to say that the Administrator did speak with the family of Patient #1, and she had some notes. During an interview 06/14/23 at approximately 2:00 PM, the HHA’s receptionist confirmed she answers the telephone and directs the calls to the appropriate person; when asked if she recalled any calls from the family of Patient #1, the receptionist stated she did, as they were mad and blaming the HHA for giving them COVID; the receptionist explained that even after Patient #1 was discharged from the HHA, they kept calling back, and were upset; when asked if they were yelling, the receptionist stated they were not yelling, but they were upset and mad; she was unsure who in the home was calling, but she transferred the calls either to the Intake Nurse or the DON. During an interview on 06/14/23 at 3:03 PM, when asked about telephone calls from the family of Patient #1, the DON stated the first was from a daughter, who wasn’t initially on their list to share information, but the DON recalled the daughter would not let her get a word into the conversation; the DON stated that later conversations were between the family and the Administrator, and she was just listening; the DON stated the family was upset because they had to pay extra to their private caregivers because Patient #1 got COVID; the DON stated the family was upset because everyone had traveled into town, and they couldn’t visit with Patient #1 because of his COVID status and the DON stated the family was blaming the HHA for giving Patient #1 COVID. During an interview on 06/14/23 at approximately 3:45 PM, the Administrator confirmed the family of Patient #1 called in several times; the Administrator stated, the family initially called and alleged Staff A went to the home and wasn’t feeling well; the Administrator stated the family said Staff A, LPN was reckless for not wearing a mask; the Administrator stated the issue was the private duty agency was charging premium for the caregivers because of the COVID positive status of Patient #1, and the family expected payment; the Administrator stated Staff A told her she was wearing a mask, but Patient #1 could not hear her, so she put the mask under her chin; the Administrator stated, “The daughter was screaming at me because she (Staff A, LPN (Licensed Practical Nurse) was reckless without a mask;" the Administrator continued that the daughter called back on the 20th and was upset because now one of the private caregivers had become infected with the COVID virus; during this interview, the Administrator was holding a plain piece of white paper with some handwritten notes (Photographic Evidence Obtained; when asked if the paper was her only documentation of the telephone conversation and complaint, the Administrator stated it was. Review of this document only included some words and phrases from the conversation of 02/20/23; the Administrator was asked to locate and provide their Grievance policy; the Administrator returned with the policy, and upon review agreed she had not followed it.

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 the Home Health Agency (HHA)'s Policy and Procedure review, interview and record review, the HHA failed to ensure an updated infection surveillance program affecting 1 of 1 sampled patients who became infected with the COVID (Coronavirus disease) -19 virus (Patient #1) , and for 1 of 1 sampled current staff who became infected with the COVID-19 virus (Staff A, Licensed Practical Nurse/LPN); failed to report these two communicable diseases to the Florida Department of Health; and failed to ensure review and reporting to the HHA’s quality assessment and performance improvement (QAPI) program on a quarterly basis for the most recent two quarters (4th quarter of 2022 and 1st quarter of 2023). The findings included: Review of the HHA's Policy “Infection Control Surveillance System: Prioritized Risks Defined” (undated) documented, “Procedures: 1. Agency will perform targeted infection control surveillance as follows: … Patient infections to be reported while patient is on service: (This policy documented multiple types of infections but lacked the inclusion of communicable diseases.) … Employee infections to be reported if an employee develops or has a known exposure to: … and any reportable communicable disease as defined by the local health department. Reporting of patient infections will occur through documentation in the patient record or on a written log. Written reporting of employee infections will occur through documentation on the infection control log. Data on the log should include all the following elements: Patient infection; Patient name or ID number; Date of Onset; Infection Type; Ordered Treatment: Antibiotic, X-ray, Other; Status: Seen by MD, Admitted to Hospital, Client Expired, Other; Employee Infection; Employee name or ID number; Date of Onset; Infection Type; Ordered Treatment: Antibiotic, X-ray, Other; Status: Seen by MD, Admitted to Hospital, Other. At least quarterly, the Clinical Manager and infection control and QAPI committees will review and assess the infection control logs.” Review of the HHA's Policy “Exposure to Coronavirus (2019-NCOV): Disease Response and Management (undated) documented the need to report to the local or state health department. During the Entrance Conference on 06/14/23 at 9:05 AM, the Administrator was asked to locate and provide evidence and documentation related to the most recent COVID-19 positive patients and or staff, and any type of recent infection control logs or tracking. Review of the provided information lacked any documented infections for 2023. On 06/14/23 at approximately 10:15 AM, the Director of Nursing (DON) was asked for the 2023 infection logs. During an interview on 06/14/23 at 3:03 PM, the DON explained she took over as DON in September of 2022, and the previous Administrator, who was a nurse, was handling the Infection Control program; the DON stated she was now responsible for the Infection Control program as of December 2022, when the previous Administrator left the HHA. Upon receipt of the Infection Control logs for the HHAs patients, the DON explained they had not had a quarterly review of the infections since the third quarter of 2022; the DON stated the previous Administrator had not taken the fourth quarter to QAP (Quality Assurance and Performance Improvement)I, and that she herself had not done any kind of review or surveillance; when asked if Patient #1 became COVID-19 positive during the HHAs service, the DON confirmed he became positive after his admission; when asked if he had been added to the Infection Log, the DON reviewed the 2023 log provided to the surveyor, and agreed he had not been added, but should have been. During a side-by-side review of the list of COVID-19 positive staff, the DON agreed recent staff listed, including Staff A, Licensed Practical Nurse (LPN), only documented the staff name, date of positive test, and the return-to-work date and the DON agreed that was not following the HHA’s Infection Control Surveillance policy. During this continued interview on 06/14/23 beginning at 3:03 PM, the DON was asked if she had reported the COVID-19 positive patient or staff to the Department of Health; the DON stated she had not reported any positive COVID-19 cases, and further stated she hadn’t seen any evidence that the previous Administrator had done so, as she had been reviewing her new responsibilities and looking through information provided to her upon hire as DON.