Every finding on record at Best & Dependable Home Health Care

An unannounced Home Health Agency recertification survey was conducted on May 10-12, 2021 by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Home Health Medicare/Medicaid recertification survey was conducted at the above noted agency on May 10-12, 2021 by a Medical Facilities Inspector from the Virginia Department of Health, Office of Licensure and Certification. Due to the COVID-19 Public Health Emergency declared by the Governor, the survey was conducted both onsite and offsite. Deficiencies were identified and cited in this report. The agency was found to be out of compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on staff interview and document review, it was determined the agency failed to ensure that patients were informed about and consented to the frequency of proposed visits in advance of care being provided in seven (7) of seven (7) clinical records reviewed in the survey sample (clinical record #'s 1-7). The findings were: The clinical records were reviewed both onsite and electronically offsite in read only mode on May 10-11, 2021. The clinical records for all seven (7) patients in the survey sample contained an untitled form signed by the patient that contains a section that reads in part, "Consent for treatment" with a line for the patient's name and reads,"hereby request and authorize". Under that section is a preprinted list of each of the disciplines with a box before the discipline title and a line after it. The agency staff check the box to indicate which disciplines would be providing care but failed to write the visit frequency on the line provided. There was no evidence in the clinical record of the patient being advised of the visit frequency prior to receiving care. An interview was conducted with the administrator on 5/12/2021 at 9:30 AM. The administrator remembered the form being revised to include that section after a prior survey but was not aware staff were not filling it in.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on staff interview and review of clinical records it was determined the agency staff failed to follow physicians orders and failed to notify the physician of missed visits for two (2) of seven (7) clinical records in the survey samples (clinical record #2 and 5). The findings were: The clinical records were reviewed both onsite and electronically offsite in read only mode on May 10-11, 2021. The clinical record for patient #2 revealed a plan of care/physician orders for skilled nursing to see the patient one (1) time a week for one (1) week, two (2) times per week for four (4) weeks and one (1) time a week for four (4) weeks. The skilled nurse failed to make any visits the second week of service from 11/23/2020 through 11/29/2020. Physical therapy was ordered two (2) times a week for eight (8) weeks effective 11/23/2020. The physical therapist only made one (1) visit the week of 11/23/2020. The clinical record failed to contain missed visit notes and there was no evidence the patient's physician was notified of the visits not being provided in accordance with the patient's plan of care. An interview with the administrator on 5/12/2021 at 9:30 AM revealed the clinician remembered the family did not want visits during that time due to the holidays however; no note was placed in the patient's record. The clinical record for patient #5 revealed a plan of care/physician orders for occupational therapy three (3) times per week for four (4) weeks then two (2) times per week for four (4) weeks. On 4/13/2021, the visit frequency was increased back to three (3) times per week for three (3) weeks. The occupational therapist only made two (2) visits the week of 3/15/2021 and 4/12/2021. The clinical record failed to contain missed visit notes and there was no evidence the patient's physician was notified of the visits not being provided in accordance with the patient's plan of care. An interview with the administrator on 5/12/2021 at 9:30 AM revealed the therapist forgot to write a note.

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 of clinicians during home visits, policy and procedure review, and staff interview, it was determined the agency failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases for one (1) of three (3) patients observed during home visits (patient #6). The findings were: A home visit was conducted by this inspector to patient #6's residence on 5/11/2021 at 2 PM accompanied by the administrator to observe employee #4 perform wound care. Staff #4 had a clean field set up with all needed supplies. Just prior to beginning care, the nurse bumped the table and knocked the hand sanitizer onto the floor. Staff #4 used a clean pad to pick the bottle up and set it aside outside the work area. Staff #4 began by removing the soiled dressing and discarding it. Staff #4 removed the soiled gloves and without performing hand hygiene, put on clean gloves. The nurse then picked up the spray wound cleanser, reached into a pack of gauze and removed several 4x4 gauze. The nurse proceeded to spray wound cleanser on the gauze and clean the wound while still holding the spray bottle, at one point even reaching back into the package of gauze to obtain more. The bottle became contaminated with the soiled gloves and was placed back on the clean work field. The nurse then using the same contaminated gloves, picked up the tube of calmoseptine ointment, reached into the contaminated gauze package and got gauze then proceeded to squirt the calmoseptine onto the gauze and spread it out onto the wound. This step was repeated a second time to fully cover the wound. The nurse opened a package of clean foam dressing with the dirty gloves and placed it over the wound before securing it with tape. The nurse then removed the soiled gloves and walked over to the hand sanitizer that had fallen off the table earlier and performed hand hygiene. Staff #4 was asked what would be done with the supplies now and the nurse said it would be returned to the dresser with the other supplies. An interview with the administrator immediately following the visit was conducted. The administrator stated yes, (staff #4) went from dirty to clean without hand washing. Fundamentals of Nursing Mosby, Potter and Perry, 7th Edition St. Louis Missouri, page 654 states in part: Asepsis is the absence of pathogenic (disease producing) microorganisms. Aseptic techniques refers to practices/procedures that assist in reducing the risk for infection. Medical asepsis, or clean technique, includes procedures used to reduce the number of organisms present and prevent the transfer of organisms. Hand hygiene, using clean glove to prevent the transfer of organisms from one client to another or to prevent direct contact with client blood or body fluids and cleaning the environment routinely are examples of medical asepsis. Principles of medical asepsis are commonly followed in the home. After an object becomes unsterile or unclean it is considered contaminated. For example, a used dressing is considered a contaminated item. During the home visit, the nurse broke aseptic technique when moving from a dirty to a clean field without changing gloves and performing hand hygiene.