Every finding on record at Boone Memorial Homecare, LLC

An emergency preparedness survey was conducted Boone Memorial HomeCare on May 28, 2024 through May 30, 2024 as part of a recertification survey conducted during the same survey period. The agency was in compliance with the Emergency Preparedness Condition of Participation for Home Health Agencies.

A recertification survey was conducted at Boone Memorial HomeCare on May 28, 2024 through May 30, 2024. It was determined the agency was not in compliance with the requirements of 43 CFR, Part 484- The Medicare Conditions of Participation for Home Health Agencies, with deficiencies cited at G0682.

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, document review, and staff interview, the facility failed to ensure that tablet sanitation, hand hygiene, and handling equipment were according to the agency’s policies/procedures. This failure has the potential to negatively impact all Patients receiving treatments from the agency. (Refer to 484.70(a)) Findings are as follow: iPad Sanitation A policy titled “Cleaning of Re-Useable Equipment” revised on 06/01/22 was reviewed. The policy stated, in part, “... Procedure ... 6 … a. The hand-held computer device (i.e. tablet or smartphone) should be wiped down with a low-level disinfectant at the beginning and end of each visit …” An observation was conducted on 05/28/24 at 4:27 p.m. Employee (emp) #1 did not sanitize the tablet upon entering the patient’s home. An observation was conducted on 05/29/24 at 10:14 a.m. Emp #2 did not sanitize the tablet upon entering the patient’s home. An interview was conducted with emp #4 on 05/28/24 at 4:52 p.m. Regarding the tablet being disinfected, emp #4 responded, “I was told from PI (Performance Improvement) that the tablet was considered clean when it comes out of the bag like the equipment is. So, it doesn’t need to be disinfected. PI just told me this last week Wednesday.” When pointed out the “Cleaning of Re-Useable Equipment” revised on 06/01/22 and asked if there was an updated policy, emp #4 answered, “No, I just printed this policy out this morning. So, I don’t think there is an updated policy.” Hand Hygiene A policy titled “Hand Hygiene” revised on 05/01/19 was reviewed. The policy stated, in part, “... Policy: … Hand Hygiene will be performed using soap and water or an alcohol-based hand sanitizer. Procedure: … 7. Review of Hand Washing Technique: … b. Wet hands up to 2-3 [two to three] inches above the wrists …” An observation was conducted on 05/28/24 at 4:27 p.m. Emp #1 sanitized hands using hand sanitizer. However, hands were not sanitized two to three (2 - 3) inches above the wrists. An observation was conducted on 05/29/2024 at 11:53 a.m. Emp #3 sanitized hands using hand sanitizer. However, hands were not sanitized two to three (2 - 3) inches above the wrists. An interview was conducted with emp #4 regarding hand sanitizing. When discussed the hand hygiene policy, emp #4 stated, “When washing hands with soap and water, yes, you would wash your hands two to three (2 - 3) inches above the wrists. I never thought of washing hands above the wrists. But it makes sense. It’s the same as washing your hands just using hand sanitizer.” Handling equipment An observation was conducted on 05/28/2024 at 4:27 p.m. Emp #1 did not sanitize the tablet upon entering the patient’s home and prior to laying the tablet on the clean barrier. Emp #1 continued to lay the stethoscope, blood pressure cuff, pulse oximeter, and the thermometer. During this process, the stethoscope and blood pressure cuff touched the tablet. An observation was conducted on 05/29/24 at 10:14 a.m. Emp #2 placed the pulse oximeter on the clean barrier after it was used to examine the patient and did not replace the barrier. An observation was conducted on 05/29/24 at 11:53 a.m. Emp #3 pulled out the blood pressure cuff, stethoscope, tape measure, and stethoscope from the supply bag and laid it on the clean barrier. However, the blood pressure cuff touched the surface outside of the barrier and the exterior of the supply bag. Emp #3 did not disinfect the equipment prior to examining the patient. An interview was conducted with emp #4 on 05/29/24 at 1:53 p.m. regarding the equipment handling process. Emp #4 explained the equipment disinfecting and barrier as, “You set clean barrier and dirty barrier. When the equipment comes out of the bag, you place it on the clean barrier. Once the equipment is used, it goes on the dirty barrier. Then, you disinfect the equipment and place it on the clean barrier to let it dry and then put it in the bag. If the equipment was used and placed on the clean barrier, a new barrier should be put in place since the barrier is considered contaminated because the equipment was used.” Emp #4 stated that the exterior of the bag was considered contaminated, and the equipment should be sanitized.

An emergency preparedness survey was conducted at Boone Memorial Homecare from 10/18/21 to 10/20/21. The agency is in compliance with the Emergency Preparedness Medicare Conditions of Participation.

A recertification survey was conducted at Boone Memorial Homecare from 10/18/21 to 10/20/21. The agency provides skilled nursing, physical therapy, and social worker services for Boone, Lincoln, and Logan counties. A total of four (4) home visits were made and ten (10) medical records were reviewed. One (1) standard level deficiency was cited at G 682.

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, document review, and staff interview it was determined the agency failed to follow standard infection practices in one (1) of four (4) home visits observed (patient #5). This failure has the potential to negatively impact the already immune compromised patients receiving the services of this agency. Findings include: 1. A home visit was made to patient #5’s home with physical therapist (PT) #1 on 10/19/21 at 11:25 a.m. The PT placed gloves on and cleaned the electronic device, then preceded to take patient #5’s vital signs without performing hand hygiene or changing gloves. After taking the patient’s temperature, the PT cleaned the thermometer with the same gloves and did not perform hand hygiene again or change gloves again before returning to the patient to begin the patient’s physical assessment. 2. A review of the agency policy entitled “Hand Hygiene,” revised 5/1/19, states in part: “Staff performs hand hygiene by washing hands with soap and water or using alcohol-based hand sanitizer: a. before direct contact with patients.” 3. An interview was conducted with the Executive Director on 10/19/21 at 12:20 p.m. During the interview, it was stated, “Expectation is hand hygiene is done after cleaning the iPad and patient equipment.”