Every finding on record at Arkansas Homecare of Forrest City, LLC

On 12/05/2022 at 11:40 AM, an entrance conference was conducted with Agency Staff. The Agency was informed the purpose of the visit was to conduct a Recertification Survey for compliance with the Conditions of Participation for Home Health. On 12/08/2022 at 10:00 AM, an exit conference was conducted with Agency Staff. Preliminary findings were discussed. On 12/19/2022 at 10:45 AM additional information was requested and received.

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 Clinical Record Review and Staff interviews, it was determined the Skilled Nurse (SN) failed to include all medications during the review and reconciliation of patient's medication in 3 (#8, #11, #15) of 18 (#1-#18) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm to all patients on census by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug interactions, significant side effects or significant drug interactions. Findings as follows: Clinical Record #8: A. Document titled "Client Medication Report" with Certification period of 10/25/2022 through 12/23/2022 revealed a medication of "Medical Oxygen 2 liters via nasal cannula PRN (use as needed)" B. The Oxygen was blue highlighted in the EMR (electronic medical record) indicating the medication was not checked for interactions against all other medications. 2. Clinical Record #11 Revealed: A. Document titled "Client Medication Report" with Certification Period of 10/21/2022 through 12/19/2022 with oral supplements of Uritrax, Activnutrients, Ossopan and Vitamin D3. B. Above named supplements were listed and highlighted in blue indicating theses items were not checked against all other medications for interactions. 3. Clinical Record #15 revealed the following: A. Document titled "Home Health Certification and Plan of Care" with dates of 09/30/2022 through 11/28/2022 shows a pertinent diagnosis of "Malignant Neoplasm of Endometrium" (growing cancer of the uterine lining) and "Malignant Neoplasm Uterine Adnexa, Unspecified" (growing cancer of the parts around the uterus). A document titled "Visit Note Report" dated 10/04/2022 revealed documentation by SN (skilled nurse), " Has appt (appointment) for chemo (chemotherapy) on 10/13/2022. 2. A document titled "Visit Note Report" dated 10/11/2022 shows documentation by SN "Has chemo treatment scheduled for 10/13/2022." 3. The record revealed no chemotherapeutic medications. On 12/08/2022 Agency staff were given the opportunity to provide additional information. None was provided.

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 direct observation during Patient home visits, the Skilled Nurse (SN) failed to demonstrate appropriate infection control standards of practice and follow Agency policy while performing Patient care in 3 (#2, #3, #6) of 18 Clinical Records reviewed. Findings as follows: CDC (Centers for Disease Control) standards of hand hygiene which reads, "Multiple opportunities for hand hygiene may occur during a single care episode. The following are the clinical indications for hand hygiene: -Immediately before touching a patient -Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices. -Before moving from work on a soiled body site to a clean body site on the same patient -After touching a patient or the patient's immediate environment -After contact with blood, body fluids or contaminated surfaces. -Immediately after glove removal" During home visit observations of wound care performed by the SN on 12/06/2022 at 11:00 AM for patient #2, the surveyor observed the SN opening clean supplies to be used for the wound care procedure. After opening the clean supplies, the SN was observed by the surveyor obtaining additional supplies from the clean side of the nurse's bag without sanitizing hands or donning clean gloves. The SN was observed by the Surveyor handling the soiled dressings trash bag and continuing to provide wound care without removing soiled gloves and re-sanitizing hands. 3. During home visit observations on 12/06/2022 at 10:30 AM for patient #3, the surveyor observed the SN was observed removing soiled gloves and donning clean gloves without re-sanitizing hands. The Surveyor observed the SN picking up a cleansing bottle after sanitizing hands and did not re-sanitize hands prior to donning clean gloves. 4. During home visit observations on 12/06/2022 at 1:00 PM for patient #6, the Surveyor observed the SN touching the electronic tablet used for documentation and did not sanitize hands before donning clean gloves to provide wound care.