Every finding on record at Best Home Health & Hospice LLC

A complaint survey was conducted by Healthcare Licensing and Surveys from 3/22/21 to 3/24/21. Reviewed in the course of the survey were complaint intakes WY00003078 and WY00003200. In addition, a COVID-19 focused infection control survey was conducted by Healthcare Licensing and Surveys on 3/22/21 to 3/24/21. It was determined, based upon the findings of the survey team, that no deficiencies were identified pertaining to the infection control survey.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and review of investigation documentation, the facility failed to ensure the individualized plan of care included safety measures to protect against injury for 1 of 5 sample patients (#4). The findings were: Review of the aide care plan for the period of 12/25/20 to 2/22/21 showed patient #4 had diagnoses including quadriplegia and received home health aide services 5 times per day every other day, and 2 times per day on the remaining days. Further review showed the aides were to assist with bathing every other day (on bowel program days). Review of a facility investigation report dated 3/7/21 showed on 2/7/21 CNA #1 was assisting patient #4 with bathing. The shower head was placed on the patient's lap and at one point the water temperature rose to level that burned the patient (second-degree burns). It was documented the patient had no feeling in [his/her] lower body, and therefore was not able to feel the increase in water temperature. The report further read "If the water temperature was 115-125 degrees Fahrenheit, it is possible a second-degree burn could have developed within 30 seconds." Further, the report documented that since the incident, CNAs were trained to not put the shower head in the patient's lap and to periodically check the water temperature. The following concerns were identified: a. Review of the aide care plan for the period of 2/23/21 to 3/8/21 showed the care plan was not updated to include instructions to not place the shower head on the patient's lap, or to periodically check the water temperature. b. During an interview on 3/24/21 at 9:31 AM the director of nursing (DON) confirmed the aide care plan dated 2/23/21 was not updated to include instructions on not placing the shower head in the patient's lap. She stated immediately after the incident the aide care plan was updated, but that the information must not have carried over to the new aide care plan.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and review of training and investigation documentation, the facility failed to ensure home health aides provided services that were consistent with home health aide training for 1 of 5 sample patients (#4). The findings were: Review of the aide care plan for the period of 12/25/20 to 2/22/21 showed patient #4 had diagnoses including quadriplegia, and received home health aide services 5 times per day every other day, and 2 times per day on the remaining days. Further review showed the aides were to assist with bathing every other day (on bowel program days). The following concerns were identified: a. Review of a 2/7/21 home health aide visit note and a 2/7/21 incident report, both written by certified nurse aide (CNA) #1, showed the patient "experienced what appeared to be burns to [his/her] thighs and genitals as a result of hot water" during the shower. The CNA wrote "...patient usually lays the shower head in [his/her] lap while [his/her] hair is being washed but is unable to feel the temperature of the water due to [his/her] diagnosis. Patient and HHA are unable to determine when the water temperature increased." Further review showed the CNA notified the registered nurse (RN) who advised the patient needed to seek emergency care. b. Review of the emergency room report dated 2/7/21 showed the patient had quadriplegia and had no sensation from approximately nipple line and down. The report stated "...CNA was helping [him/her] shower, and inadvertently put a hose with very hot water to the patient's groin." The clinical impression was documented as "multiple second degree thermal burns." c. Review of a facility investigation report dated 3/7/21 showed on 2/7/21 CNA #1 was assisting patient #4 with bathing. The shower head was placed on the patient's lap and at some point the water temperature rose to level that burned the patient. It was documented the patient had no feeling in [his/her] lower body, and therefore was not able to feel the increase in water temperature. The report further read "If the water temperature was 115-125 degrees Fahrenheit, it is possible a second-degree burn could have developed within 30 seconds." d. During an interview on 3/23/21 at 2:53 PM CNA #1 stated she assisted the patient with his/her shower on 2/7/21. She stated the patient laid the shower head in his/her lap at one point, which the patient normally did during showers. She confirmed the patient had quadriplegia and was unable to feel the temperature of the water below his/her chest. The CNA stated she bent over to get a washcloth which had dropped and then she picked up the shower head to rinse the patient. She stated when the water touched the resident's upper body s/he shouted the water was too hot. She thinks that maybe she bumped the water temperature control with her shoulder when she leaned down to pick up the washcloth. After the shower she noticed what appeared to be burns on the patient and so she called the RN who stated the patient should go to the emergency room. When asked what training she had as a home health aide on safety with showering she stated "general safety...constantly checking the temperature of the water." e. Review of training documentation for CNA #1 prior to the incident on 2/7/21 showed the resident received "Personal Care" training and passed a written test on 6/12/20. Review of the "Personal Care" education showed "When assisting a patient with a tub bath or shower, be alert to slippery floors, overly hot water, drafts or dizziness...Fill tub or get shower water to a comfortable 98 to 102 degrees."

An Emergency Preparedness survey was conducted by Healthcare Licensing and Surveys on 3/1/21 through 3/3/21. Unless otherwise indicated, the general use of the terms "facility" or "facilities" refers to all providers and suppliers affected by this regulation. This is a generic moniker used in lieu of the specific provider or supplier noted in the regulations. Based upon the findings of the survey, it was determined that no deficiencies were identified pertaining to the Emergency Preparedness Rule.

A recertification survey, which included a COVID 19 focused infection control survey, was conducted by Healthcare Licensing and Surveys from 3/1/21 to 3/3/21.

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 medical record review, observation, staff interview, and policy and procedure review, the agency failed to implement measures to prevent the transmission of infections in 1 of 4 observations of client care (client #1). The findings were: 1. Medical record review showed client #1 had diagnoses which included chronic obstructive pulmonary disease, prostate cancer, and hypertension. Review of the Plan of Care showed the cliient required skilled nursing services once a week. The following concerns were identified: A. Observation on 3/2/21 at 9:30 AM showed the LPN (licensed practical nurse) #4 wiped a thermometer and a pulse oximeter machine with a disinfecting wipe and placed them directly on the client's table. Continued observation showed the nurse donned gloves, poured medications from the medication bottle into her hand, and touched the medications to place into the client's pill organizer. B. Interview with the director of nursing on 3/3/21 at 11:05 AM revealed her expectation was for staff to have a bag barrier on surfaces to place clean equipment. She further stated the expectation for administering medications was to pour the medication from the bottle into the bottle cap and then dispense into the daily pill organizer. She further stated staff are not to touch the pills. C. Review of the agency's "Bag Technique policy", undated, showed, "...10. Remove any items needed for patient care, including any personal protective equipment. Place clean equipment on bag barrier...". Review of the agency's "Medication Set-Up Utilizing Clean Technique: Steps to follow for all medications, regardless of route or type" policy, undated, showed, "...7...Don gloves. Pour amount needed onto pill bottle lid. Pour medication into appropriate place in pill strip or med-minder. Pour any unused medication back into bottle. At no time, should your hands touch the medications...".