Every finding on record at At Home Senior Care Services LLC

This was a federal recertification and state re-licensure survey of a home health agency. The survey was fully extended on 10/7/21 at 3:52 PM. The agency’s owner confirmed their decision to voluntarily terminate their Medicare agreement on 10/12/21 at 10:40 AM, and the survey was exited prior to the review of all regulations. Survey Date: October 5, 6, 7, 8, 12; 2021 Facility Number: 013611 Provider Number: 15K138 Unduplicated Admissions for Last 12 Months: 10 Active Census: 21 Based on the Condition-level deficiencies during the October 12, 2021, survey, At Home Specialized Services was subject to a partial or extended survey pursuant to section 1891(c)(2)(D) of the Social Security Act. Therefore, and pursuant to section 1891(a)(3)(D)(iii) of the Act, At Home Specialized Senior Care is precluded from operating or being the site of a home health aide training and/or competency evaluation programs for the two years beginning October 12, 2021, and continuing through October 12, 2023, for being found out of compliance with the Condition of Participation 42 CFR 484.100 Compliance with Federal, State, and local laws and regulations related to health and safety of patients. These deficiencies reflect State findings cited in accordance with 410 IAC 17.

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, record review and interview, the home health agency failed to ensure all employees followed agency infection control policies and procedures and standard precautions for 3 of 3 home visit observations (#1, 2, 4). Findings include: An agency policy numbered 4003, titled “Hand Hygiene” and dated 9/1/14, indicated but was not limited to “… Policy: … All personnel will use the hand-hygiene techniques, as set forth in the following procedure: … Decontaminate hands before having direct Patient contact … Decontaminate hands after removing gloves … Procedure: Using antimicrobial soap and water or non-antimicrobial soap and water: … Wash hands thoroughly, using rigorous scrubbing action for at least 20 seconds ….”An agency policy numbered 4001, titled “Standard Precautions” and dated 9/1/14, indicated but was not limited to “Policy: … Standard Precautions include the following: … Gloves are to be worn when touching blood, body fluids, secretions, excretions and other contaminated items. Clean, nonsterile gloves will be adequate. Gloves shall be changed between tasks and procedures on the same Patient after contact with material that may contain a high concentration of microorganisms … Patient Care Equipment … Make sure that reusable equipment has been cleaned and reprocessed appropriately, prior to use on another Patient ….”McGoldrick (1/2014). “Bag Technique: Preventing and Controlling Infections in Home Care and Hospice.” Retrieved 10/14/21 from www.nursing.ceconnection.com. “… Bag Technique: … 4. Do not reenter the bag with gloves on. Remove the gloves if worn, perform hand hygiene, and then renter the bag. 5. Clean the equipment and supplies that had direct patient or environmental contact ….”A home visit was conducted on 10/6/21 at 10:06 AM with Patient #1 (start of care 5/28/19) and Home Health Aide (HHA) #1. At the start of the visit, HHA #1 donned gloves without performing hand hygiene prior to donning. Later during the visit, HHA #1 scrubbed her hands for 5 seconds only when washing her hands. HHA #1 was also observed removing her gloves then immediately donning new gloves, without performing hand hygiene in between. A home visit was conducted on 10/8/21 at 9:30 AM with Patient #2 (start of care 4/19/21) and HHA #2. During the visit, HHA #2 removed bed linens soiled with urine and stool without wearing gloves. After the aide removed the dirty linens, she donned gloves without performing hand hygiene. HHA #2 then assisted Patient #2 with showering. The aide wiped stool off the patient’s buttocks with a washcloth, then used the same washcloth to wash the rest of the patient’s body. HHA #2 was observed with stool on a glove at the beginning of the shower but did not change gloves. After the shower was complete, HHA #2 was observed adjusting her mask with the same gloves worn throughout the shower, and then collected the patient’s towels and took them to the laundry. A home visit observation was conducted on 10/8/21 at 1:58 PM with Patient #4 (start of care 4/13/21) and Registered Nurse (RN) #1. During the visit, RN #1 was observed obtaining the patient’s vital signs (blood pressure, heart rate, temperature, and oxygen saturation), cleaning the vital sign equipment with alcohol foam, then placing the equipment immediately back into the nursing bag without allowing the alcohol to dry. During the visit, RN #1 was also observed entering the nursing bag with dirty gloves. An interview was conducted on 10/12/21 at 10:40 AM with the Administrator. During the interview, the Administrator confirmed staff should follow standard precautions and agency infection control policies. 17-12-1(m)

Compliance with Federal, State, Local Law CFR(s): 484.100 Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients. The HHA and its staff must operate and furnish services in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients. If state or local law provides licensing of HHAs, the HHA must be licensed. This CONDITION is not met as evidenced by: Based on observation, record review, and interview, the home health agency failed to operate and furnish services in compliance with all applicable federal and state laws by failing to evidence a current home health agency license filed with the state licensing authority (see G 860). The effect of this problem resulted in the agency being out of compliance with the Condition of Participation 42 CFR 484.100 Compliance with Federal, State, and local laws and regulations related to the health and safety of patients. 1. See Tag G 860 for further findings.

Licensing CFR(s): 484.100(b) (b) Standard: Licensing. The HHA, its branches, and all persons furnishing services to patients must be licensed, certified, or registered, as applicable, in accordance with the state licensing authority as meeting those requirements. This STANDARD is not met as evidenced by: Based on observation, record review, and interview, the home health agency failed to evidence a current home health agency license filed with the state licensing authority, which had the potential to affect all agency patients and employees. Findings include: An agency policy numbered 6088, dated 9/1/14 and titled “Compliance with Federal, State, and Local Laws,” indicated but was not limited to “Policy: [The home health agency] complies with all applicable federal, state, and local laws and regulations regarding all aspects of home health business practices … All required licenses, certifications, and notifications are displayed prominently within the Agency.”A tour of the agency was conducted on 10/6/21 at 8:25 AM. During the tour, a home health agency license provided by State Agency #1 was observed with the expiration date of 2/28/2020. The tour failed to evidence a current home health agency license.An interview was conducted on 10/7/21 at 9:45 AM with the Administrator and Clinical Manager. During the interview, the Administrator confirmed the agency did not have a current home health agency license filed with State Agency #1. A list of patients who received services from 3/1/2020 – 10/6/2021 was reviewed on 10/6/21. The list evidenced a total of 49 patients received services from the home health agency while the agency’s license was expired. A list of employees who were employed by the agency from 3/1/2020 – 10/7/2021 was reviewed on 10/7/21. The list evidenced a total of 32 employees (22 active and 10 inactive) were employed by the agency while its license was expired. One employee (Former Employee #1) was placed on the Home Health Aide registry by the agency on 9/9/2020. A follow up interview was conducted on 10/12/21 at 10:40 AM with the Administrator (who was also the sole owner of the agency). During the interview, the Administrator confirmed they had decided to close the agency. The Administrator was unable to provide an anticipated date of closure. 17-10-1(b)