Every finding on record at Baton Rouge Home Care,LLC

This entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure the patient received skilled nursing services for the frequency specified in the plan of care for 2 (Patient #6 and Patient #10) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for care and services per the plan of care. Findings: Patient #6 Review of Patient #6’s Home Health Certification and Plan of Care for certification period of 11/15/2023 to 01/13/2024 revealed, in part, Patient #6 was to receive skilled nursing services once a week for nine weeks. Review of Patient #6’s record revealed no documented evidence and the agency presented no documented evidence that the skilled nurse provided services the week of 12/03/2023 through 12/09/2023. In an interview on 12/20/2023 at 1:18 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no documented evidence, nor any explanation for the reason as to why the skilled nurse did not provide services the week of 12/03/2023 through 12/09/2023 to Patient #6. Patient #10 Review of Patient #10’s Home Health Certification and Plan of Care for certification period of 11/21/2023 to 01/19/2024 revealed, in part, Patient #10 was to receive skilled nursing services once a week for nine weeks. Review of Patient #10’s record revealed no documented evidence and the agency presented no documented evidence that the skilled nurse provided services the week of 12/03/2023 through 12/09/2023. In an interview on 12/20/2023 at 1:05 p.m., S1Administrator/DON stated the agency had no documented evidence, nor any explanation for the reason as to why the skilled nurse did not provide services the week of 12/03/2023 through 12/09/2023 to patient #10.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to notify the patient’s physician: 1. For a patient who experienced a fall with pain (Patient #5); and 2. For a patient who had weight gain in excess of the parameters set by the physician (Patient #17). This deficient practice was identified for 2 (Patient #5 and Patient #17) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) reviewed for physician notification of change of condition. Findings: Patient #5 Review of Patient #5’s Client Coordination Note Report dated 11/09/2023 revealed, in part, upon skilled nurse’s arrival Patient #5 was on the floor on the side of the sofa. Review revealed Patient #5 had slid off the sofa and had a pain level of 8 (on a scale of 0 being no pain and 10 being the worse pain). Further review revealed no documented evidence and the agency presented no documented evidence Patient #5’s physician had been notified of the fall. In an interview on 12/20/2023 at 1:17 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no documented evidence that Patient #5’s physician had been notified of Patient #5’s fall. Patient #17 Review of Patient #17’s Home Health Certification and Plan of Care for certification period of 09/15/2023 to 11/13/2023 revealed a diagnosis of, in part, heart failure. Further review revealed the skilled nurse was to obtain a weight every visit and notify the physician of a weight gain or loss of 3-5 pounds within one day. Review revealed the skilled nurse was to instruct on the importance to obtain weights and to keep a weight log. Review of Patient #17’s record and Vital Signs report revealed the following weights, in part, 09/15/2023 a weight of 317 pounds; 09/18/2023 a weight of 320 pounds; 09/22/2023 a weight of 320 pounds; 09/25/2023 a weight of 317 pounds; and 10/04/2023 a weight of 321 pounds. There was no documented evidence and the agency presented no documented evidence that Patient #17 had obtained daily weights nor had documentation of daily weights. There was no documented evidence and the agency presented no documented evidence Patient #17’s physician had been notified of Patient #17’s three pound weight gain from 09/15/2023 to 09/18/2023 nor the four pound weight gain from 09/25/2023 to 10/04/2023. In an interview on 12/20/2023 at 1:27 p.m., S1Administrator/DON stated the agency had no documented evidence the nurse was ensuring Patient #17 was taking daily weights, nor did the agency have any documented evidence of the physician had been notified of the weight gains as mentioned above.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to coordinate care with a patient’s physician to ensure a urine specimen was collected for culture and sensitivity for 1 (Patient #14) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for coordination of care. Findings: Review of Patient #14’s Physician Order dated 01/17/2023 revealed the skilled nurse was to obtain a urine specimen for urinalysis and culture and sensitivity. Review of Patient #14’s record revealed the urine specimen was collected on 01/17/2023 with only the urinalysis requested. Review of Patient #14’s record revealed on 01/20/2023 Patient #14 was discharged from the agency. Review of faxed lab note dated 01/25/2023 revealed the urine culture testing was not performed due to the age of the urine specimen. Review of Patient #14’s record revealed no documented evidence and the agency presented no documented evidence of communicating with Patient #14’s physician to ensure Patient #14 received a urine culture and sensitivity and/or if further testing was needed. In an interview on 12/20/2023 at 1:22 p.m., S1Administrator/Director of Nursing stated the agency had no documented evidence of the coordination with Patient #14’s physician to ensure Patient #14’s physician was aware the urine culture was unable to be completed.

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 failed to ensure the skilled nurse removed her gloves and performed hand hygiene after cleaning the patient’s foot and prior to cleaning an open wound for 1 (Patient #18) of 1 (Patient #18) sampled patients observed for wound care. Findings: Review of Patient #18’s Home Health Certification and Plan of Care for certification period of 12/15/2023 to 02/12/2024 revealed, in part, the skilled nurse was to perform wound care to Patient #18’s right heel. Further review of Patient #18’s Home Health Certification and Plan of Care revealed the skilled nurse was to cleanse Patient #18’s right heel wound with normal saline, apply honey treatment using clean technique, and apply a wet to dry dressing. Observation on 12/20/2023 at 8:15 a.m. revealed after S2Licensed Practical Nurse (LPN) cleaned Patient #18’s periwound tissue (intact skin on the border of the wound) to his right heel wound, disposed of the gauze, and did not change her gloves and/or perform hand hygiene. Further observation revealed S2LPN then cleaned Patient #18’s entire right foot including between the toes, disposed of the gauze, did not remove her gloves and/or perform hand hygiene, and then proceeded to clean Patient #18’s right heel wound. In an interview on 12/20/2023 at 8:37 a.m., S2LPN stated she had not removed her gloves and performed hand hygiene after cleaning Patient #18’s foot and toes prior to cleaning Patient #18’s right heel wound, and should have. In an interview on 12/20/2023 at 11:20 a.m., S1Administrator/Director of Nursing stated S2LPN should have changed her gloves and performed hand hygiene between cleaning Patient #18’s foot and toes and then clean Patient #18’s right heel wound.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure a registered nurse measured pressure ulcers weekly for 2 (Patient #9 and Patient #16) of 3 (Patient #9, Patient #15, and Patient #16) sampled patients with pressure ulcers reviewed. Findings: Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed assessment and documentation of wound status, which includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes dimensions and depth; and presence, location and depth of any sinus tracts or undermining areas. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses Wound Care Management revealed, in part: the registered nurse may delegate to a Licensed Practical Nurse (LPN) wound care if the Registered Nurse (RN) had deemed the wound stable; and provides appropriate supervision. Patient #9 Review of Patient #9’s Home Health Certification and Plan of Care for certification period of 11/15/2023 to 01/13/2024 revealed Patient #9 was to receive skilled nursing services for assessment and care of his stage four pressure ulcer (open wound in which the bone and/or tendon is exposed) to the right buttock. Review of Patient #9’s record revealed no documented evidence and the agency presented no documented evidence the registered nurse had measured Patient #9’s right buttock stage four pressure ulcer the week of 12/03/2023 through 12/09/2023. In an interview on 12/20/2023 at 1:15 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no documented evidence the registered nurse had measured Patient #9’s right buttock stage four wound the week of 12/03/2023 through 12/09/2023. Patient #16 Review of Patient #16’s Home Health Certification and Plan of Care for certification period of 01/13/2023 to 03/13/2023 revealed Patient #16 was to receive skilled nursing services for assessment and care of his stage two pressure ulcer (open wound caused by pressure) to the left below the knee amputation site. Review of Patient #16’s record revealed no documented evidence and the agency presented no documented evidence the registered nurse had measured Patient #16’s left below the knee amputation site pressure ulcer for the weeks of, in part: 01/15/2023 through 01/21/2023; 01/22/2023 through 01/28/2023; and 01/29/2023 through 02/04/2023. In an interview on 12/20/2023 at 1:25 p.m., S1Administrator/DON stated the agency had no documented evidence the registered nurse had measured Patient #16’s left below the knee amputation site pressure ulcer for the above mentioned dates.

Recertification Survey, Re-licensing Survey, and a Covid-19 Focused Infection Control Survey. Tag #682 was cited as a result of the Rercertification Survey and Covid-19 Focused Infection Control Survey. Tag # 984 was cited as a result of the Recertification Survey. Tag #9123 was cited as a result of the Re-licensing Survey.

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 agency failed to: 1. Ensure visitors were screened for signs and symptoms of Covid-19 (coronavirus 19) per CDC (Centers for Disease Control) guidelines; and 2. Ensure the skilled nurse changed her gloves and performed hand hygiene between each wound to prevent the spread infection between wounds for 1 of 2 sampled patients (Patient #4) observed for wound care in a total sample of 13 patients. Findings: Review of the CDC's (Centers for Disease Control) Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (Covid-19) Pandemic revealed the agency should screen and triage everyone entering a healthcare facility for signs and symptoms of Covid-19. Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have Covid-19 so appropriate precautions can be implemented. Further review revealed the agency was to establish a process to ensure everyone (patients, healthcare personnel, and visitors) entering the facility was assessed for symptoms of Covid-19, or exposure to others with suspected or confirmed SARS-CoV-2 infection and that they are practicing source control. Observation on 03/15/2021, 03/16/2021, 03/17/2021, and 03/18/2021 revealed the surveyor was allowed to enter the building without being screened for signs and symptoms of Covid-19 and without having the surveyor's temperature taken. Observation on 03/17/2021 at 1:00pm revealed an employee for a shredder company arrived to pick up orders. Further observation revealed the employee was allowed in building, but he was not screened for signs and symptoms of Covid-19, and/or had his temperature taken. Review of the agency's Visitor Covid-19 Visitor Pre-Screening Questions revealed, in part: the agency was committed to the safety, well-being, and protection of our patients, our employees, and our visitors. For that reason and out of an abundance of caution- our Covid-19 task force has decided that all employees, volunteers, students, contractors, and visitors will be pre-screened for Covid-19 according to CDC guidelines. Pre-screening is comprised of three questions that determine if a person should be placed into a person under investigation status, indicating the possibility that they have been exposed to Covid-19. In an interview on 03/18/2021 at 10:52am, S1Executive Director stated the agency had a form to complete for screening of visitors, but normally they do not allow visitors inside the building. The surveyor then asked if the shredding company staff was screened prior to entry. S1Executvie Director stated no, the shredding company employee was not screened. The surveyor explained she was not screened prior to entry into the building for all four days of the survey. S1Executive Director stated the surveyor should have been screened daily for signs and symptoms of Covid-19. The surveyor then asked to review any screenings on visitors, and S1Executive Director stated the agency did not have any visitor screenings completed. Patient #4 Review of Patient #4's Home Health Certification and Plan of Care for certification period of 02/27/2021 to 04/27/2021 revealed Patient #4 was to receive skilled nursing services for Type II Diabetes Mellitus Type II with Foot Ulcer (foot wound), Non-Pressure Ulcer (wound) of the Left Heel and Mid-foot, Non-Pressure Ulcer of the Right and Left Calf, Non-Pressure Ulcer of the Right and Left Lower Legs, and Cellulitis (infection) of the Right and Left Lower Limb. Further review of Patient #4's physician orders for wound care to bilateral extremities revealed, in part: to cleanse the wounds with wound cleanser, apply calcium alginate with silver (dressing with silver), apply collagen (dressing), exudry (absorbent dressing), skin barrier cream, skin prep, and profore lite compression (dressing that applies pressure) to bilateral lower extremity. Review of Patient #4's Client Medication Report revealed Patient #4 was currently taking Amoxicillin/Potassium Clavulanate (antibiotic) 875mg/125mg (milligrams) one tablet every 12 hours for wound infection and Doxycycline Monohydrate (antibiotic) 100mg one capsule twice a day for wound infection. Observation on 03/17/2021 at 9:02am, of wound care provided to Patient #4 revealed, in part: S2LPN (Licensed Practical Nurse) cleansed Patient #4 left leg intact skin with gauze and a wound cleanser, then without removing gloves or performing hand hygiene cleansed the open wounds to the patients left anterior leg, then without removing gloves or performing hand hygiene cleaned the patients left bottom of foot diabetic foot ulcer. S2LPN proceeded with the same gloved hands then cleaned Patient #4's right leg intact skin with gauze and a wound cleanser, then without removing gloves or performing hand hygiene cleansed the open wounds to the patient's right leg. S2LPN then removed her gloves, used hand sanitizer, applied new gloves, then proceed to place the calcium alginate dressing into the wounds with her gloved hands without changing her gloves or using hand hygiene between wounds. In an interview on 03/17/2021 at 10:42am, S2LPN stated she should be changing her gloves and performing hand hygiene between wounds. S2LPN further stated she should have changed her gloves between applying the dressing into the wounds with each individual wound. In an interview on 03/17/2021 at 10:45am, S1Executive Director stated S2LPN should have changed her gloves and performed hand hygiene between each wound being cleansed and dressings applied.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to: 1. Ensure the physical therapist and occupational therapist obtained vital signs for a patient with multiple falls for 1 of 4 sampled patients (Patient #8) reviewed for therapy services in a total sample of 13; and 2. Ensure a registered nurse measured and assessed pressure ulcers weekly for 1 of 5 sampled patients (Patient #11) reviewed for wound care in total sample of 13. Findings: Review of the American Physical Therapy Association's for Vital Signs and Other Patient Screenings revealed taking vital signs and obtaining simple clinical measures provide valuable information about your patients that in many cases are important to evaluating and managing care appropriately. Patient #8 Review of Patient #8's Home Health Certification and Plan of Care for certification period of 01/04/2021 to 03/04/2021 revealed Patient #8 was admitted on 01/04/2021 with diagnoses of Multiple Sclerosis and a Fracture of the Neck of the Right Humerus (right arm bone fracture). Further review revealed Patient #8 was to receive physical therapy once a week for nine weeks, and occupational therapy once a week for one week, then twice a week for seven weeks, then once a week for one week. Review of Patient #8's Occupational Therapy Visit Note Report dated 02/19/2021 revealed the patient reported multiple falls over the last couple of days, decreased range of motion of the right upper extremity noted, increased soreness and decline in transfers to multiple services with pivot. Review of Patient #8's Physical Therapy Notes, Occupational Therapy Notes, and Vital Signs Report for certification period of 01/04/2021 to 03/04/2021 revealed the only vitals (blood pressure and heart rate) obtained were upon admit on 01/04/2021. In an interview on 03/18/2021 at 3:57pm, S1Executive Director stated she had spoken with the therapist involved in Patient #4's care, and the occupational therapist communicated therapy did not take vitals. S1Executive Director stated because Patient #4 only had therapy in the home, and because the patient had multiple falls, a blood pressure should have been obtained to check for orthostatic hypotension (low blood pressure caused by position changes) as part of the assessment post fall. Patient #11 Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses Wound Care Management revealed, in part: the registered nurse may delegate to a LPN (Licensed Practical Nurse) wound care if the RN (Registered Nurse) had deemed the wound stable; and provides appropriate supervision. Review of Patient #11's Home Health Certification and Plan of Care for certification period of 08/19/2021 to 10/17/2020 revealed Patient #11 had diagnoses of, in part: Left and Right Heel Pressure Ulcer stage III (wound caused by pressure where the fat tissue layer is exposed). Further review revealed the skilled nurse was to provide wound care twice a week for eight weeks. Review of Patient #11's Skilled Nursing Visit Note Reports for the certification period of 08/19/2021 to 10/17/2020 revealed the following weeks: 08/23/2021 to 08/29/2021 the patient received services from the LPN with no documented evidence a registered nurse assessing the wound or the patient having attended wound care clinic for assessment; and 09/27/2021 to 10/03/2021 the patient received services from the LPN with no documented evidence a registered nurse assessing the wound or the patient having attended wound care clinic for assessment. In an interview on 03/18/2021 at 4:14pm, S1Executive Director stated a registered nurse should have assessed Patient #11's wounds weekly, especially on the weeks of 08/23/2021 to 08/29/2021 and 09/27/2021 to 10/03/2021 because the patient did not attend wound care clinic those weeks for assessment.