Every finding on record at Cabell Huntington Hospital Home Health

An emergency preparedness survey was conducted at Cabell Huntington Hospital Home Health from 07/12/21 through 07/14/21. The agency is in compliance with the Emergency Preparedness Conditions of Participation with no deficiencies cited as a result of the survey.

A recertification survey was conducted at Cabell Huntington Hospital Home Health from 07/12/21 through 07/14/21. The agency provides skilled nursing, physical therapy, occupational therapy, speech therapy, medical social worker, and home health aide services to Cabell, Lincoln, Putnam, and Wayne counties. At the time of survey the current active census was one hundred thirty-three (133) and the unduplicated census for the past twelve (12) months was seven hundred forty-three (743). A total of seventeen (17) open and closed medical records were reviewed, and seven (7) home visits were made. One (1) Condition level deficiency was cited at G 510, with two (2) related standard level deficiencies cited at G 512 and G 514, and one (1) standard level deficiency unrelated to the Condition cited at G 682. As a result of the Condition level deficiency identified and cited during the recertification survey, this agency will not be permitted to complete home health aide training or competency evaluations for two (2) years as per regulation 42 CFR 484.80(f)(3).

Comprehensive Assessment of Patients CFR(s): 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. This CONDITION is not met as evidenced by: Based on record review, document review and staff interview it was determined the facility failed to ensure an initial assessment was conducted within forty-eight (48) hours of the referral to the agency in seven (7) out of seventeen (17) patients (patients #2, 3, 5, 6, 7, 11 and 13). This delay in care has the potential to cause great harm to any patient referred to the agency for care (See Tags G 512, G 514).

Standard: Initial assessment visit. CFR(s): 484.55(a) Standard: Initial assessment visit. This STANDARD is not met as evidenced by: Based on record review, document review and staff interview it was determined the facility failed to ensure an initial assessment was conducted within forty-eight (48) hours of the referral to the agency in seven (7) out of seventeen (17) patients (patients #2, 3, 5, 6, 7, 11 and 13). This delay in care has the potential to negatively impact all patients receiving care from the agency. Findings include: 1. A review was conducted of the medical record of patient #2. A referral was received by the agency on 05/25/21. Documentation on 06/03/21 at 9:29 a.m. states in part: "Per T.O. (Telephone order) on 06/02/21 from office nurse ... that we were unable to reach pt (patient) MD (medical doctor) is in agreement start of care be 06/04/21." The initial assessment was conducted on 06/07/21. There is no documentation of why there was a delay, a discussion with the physician about the additional delay, or the patient was in agreement with the delay. 2. A review was conducted of the medical record of patient #3. A referral was received by the agency on 07/09/21. Documentation on 07/13/21 at 1:14 p.m. states in part: "Physician ordered SOC (start of care) date is 07/12/21." The initial assessment was conducted on 07/12/21. There is no documentation of why there was a delay, or the patient was in agreement with the delay. 3. A review was conducted of the medical record of patient #5. A referral was received by the agency on 06/24/21. Documentation states in part: "Per MSW, the internal medicine team agrees SOC for 06/30/21." The initial assessment was conducted on 06/28/21. There is no documentation of why there was a delay, or the patient was in agreement with the delay. 4. A review was conducted of the medical record of patient #6. A referral was received by the agency on 06/30/21. The initial assessment was conducted on 07/05/21. There is no documentation of why there was a delay, a discussion with the physician about the delay, or the patient was in agreement with the delay. 5. A review was conducted of the medical record of patient #7. A referral was received by the agency on 06/08/21. Documentation states in part: "Patient requests SOC 6/21/21. Physician notified, order for SOC 06/21/21." The initial assessment was conducted on 06/28/21. There is no additional documentation of why there was a delay, a discussion with the physician about the delay until 06/28/21, or the patient was in agreement with the delay. 6. A review was conducted of the medical record of patient #11. A referral was received by the agency on 03/08/21. The initial assessment was conducted on 03/16/21. There is no documentation of why there was a delay, a discussion with the physician about the delay, or the patient was in agreement with the delay. 7. A review was conducted of the medical record of patient #13. A referral was received by the agency on 04/14/21. The initial assessment was conducted on 04/17/21. There is no documentation of why there was a delay, a discussion with the physician about the delay, or the patient was in agreement with the delay. 8. An interview was conducted with the Director of Home Health on 07/13/21 at 5:00 p.m. He concurred the initial assessments must be conducted within forty-eight (48) hours of the referral, but explained there were physician orders for the delay, and was unaware there needed to be documentation the patient was in agreement with the delay. 9. An interview was conducted with the Quality Assurance Nurse on 07/14/21 at 9:44 a.m. She confirmed there was no additional documentation related to the delay in the initial assessment beyond forty-eight (48) hours from the referral for patients #2, 3, 5, 6, 7, 11 and 13.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on record review, document review and staff interview it was determined the facility failed to ensure the initial assessment was conducted within forty-eight (48) hours of the referral to the agency in seven (7) out of seventeen (17) patients (patients #2, 3, 5, 6, 7, 11 and 13). This delay in care has the potential to negatively impact all patients receiving care from the agency. Findings include: 1. A review was conducted of the medical record of patient #2. A referral was received by the agency on 05/25/21. Documentation on 06/03/21 at 9:29 a.m. states in part: "Per T.O. (Telephone order) on 06/02/21 from office nurse ... that we were unable to reach pt (patient) MD (medical doctor) is in agreement start of care be 06/04/21." The initial assessment was conducted on 06/07/21. There is no documentation of why there was a delay, a discussion with the physician about the additional delay, or the patient was in agreement with the delay. 2. A review was conducted of the medical record of patient #3. A referral was received by the agency on 07/09/21. Documentation on 07/13/21 at 1:14 p.m. states in part: "Physician ordered SOC (start of care) date is 07/12/21." The initial assessment was conducted on 07/12/21. There is no documentation of why there was a delay, or the patient was in agreement with the delay. 3. A review was conducted of the medical record of patient #5. A referral was received by the agency on 06/24/21. Documentation states in part: "Per MSW, the internal medicine team agrees SOC for 06/30/21." The initial assessment was conducted on 06/28/21. There is no documentation of why there was a delay, or the patient was in agreement with the delay. 4. A review was conducted of the medical record of patient #6. A referral was received by the agency on 06/30/21. The initial assessment was conducted on 07/05/21. There is no documentation of why there was a delay, a discussion with the physician about the delay, or the patient was in agreement with the delay. 5. A review was conducted of the medical record of patient #7. A referral was received by the agency on 06/08/21. Documentation states in part: "Patient requests SOC 6/21/21. Physician notified, order for SOC 06/21/21." The initial assessment was conducted on 06/28/21. There is no additional documentation of why there was a delay, a discussion with the physician about the delay until 06/28/21, or the patient was in agreement with the delay. 6. A review was conducted of the medical record of patient #11. A referral was received by the agency on 03/08/21. The initial assessment was conducted on 03/16/21. There is no documentation of why there was a delay, a discussion with the physician about the delay, or the patient was in agreement with the delay. 7. A review was conducted of the medical record of patient #13. A referral was received by the agency on 04/14/21. The initial assessment was conducted on 04/17/21. There is no documentation of why there was a delay, a discussion with the physician about the delay, or the patient was in agreement with the delay. 8. An interview was conducted with the Director of Home Health on 07/13/21 at 5:00 p.m. He concurred the initial assessments must be conducted within forty-eight (48) hours of the referral, but explained there were physician orders for the delay, and was unaware there needed to be documentation the patient was in agreement with the delay. 9. An interview was conducted with the Quality Assurance Nurse on 07/14/21 at 9:44 a.m. She confirmed there was no additional documentation related to the delay in the initial assessment beyond forty-eight (48) hours from the referral for patients #2, 3, 5, 6, 7, 11 and 13.

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 and staff interview it was determined the agency failed to follow accepted standards of practice to prevent the transmission of infections and communicable diseases. This deficiency was identified in three (3) of seven (7) home visits completed (patients # 13, 14 and 15). This deficiency has the potential to adversely affect all patients. Findings include: 1. A home visit was conducted with patient #13 on 7/13/21 at approximately 9:05 a.m. Registered Nurse (RN) #1 laid her equipment on the patient's bed then proceeded to take the patient's vital signs. After completing the vital signs, she laid her equipment back onto the patient's bed. Then she proceeded to clean her stethoscope; she only cleaned the bell of the stethoscope then placed the stethoscope back into her supply bag. She failed to properly clean the stethoscope before placing it back into her supply bag. She then cleaned the Pulse Ox monitor and sensor but failed to clean the cord connecting the sensor to the monitor before returning the Pulse Ox to her supply bag. 2. A home visit was conducted with patient #14 on 7/13/21 at approximately 1:00 p.m. RN #2 used hand sanitizer and donned clean gloves. Patient #14 handed the nurse a soiled bandage he removed from his left lower extremity (LLE). She took the soiled bandage in her right hand and examined the drainage and threw the bandage away. She proceeded to clean the LLE and applied lotion to his LLE. She then applied bandages to the outer calf of the LLE and applied an unna boot. She failed to remove her soiled gloves and use hand sanitizer after touching the soiled bandage and before applying a clean bandage and unna boot to the LLE. After care to the LLE, she proceeded to remove her soiled gloves, used hand sanitizer and provided care to the right lower extremity (RLE). The RLE did not have any open areas. After completing care to the RLE she proceeded to clean her equipment and place it back in the supply bag. She failed to clean her stethoscope which she placed around her neck after assessing the patient's blood pressure. 3. A home visit was conducted with patient #15 on 7/13/21 at 11:10 a.m. RN #3 got all supplies for the intravenous (IV) medication. She used hand sanitizer, donned gloves and started an IV in the patient's left forearm. She removed her gloves and donned a clean pair of gloves. She failed to use hand sanitizer after doffing her gloves. After mixing three (3) vials of medication for the IV infusion, she wiped off vial #1 with an alcohol pad, then laid the alcohol pad onto the outside of the IV start kit package. She placed an adapter into the rubber top of the vial of medication. She proceeded to remove the alcohol pad that was placed on the IV starter kit package and wiped the second vial of medication with the same alcohol pad. She placed the alcohol pad back onto the IV starter kit package. She placed an adapter into the rubber top of the second vial of medication. She got the third vial of medication, retrieved the alcohol pad she placed on the IV starter kit package and wiped the third vial of medication before placing an adapter into the rubber top. She failed to wipe each vial of medication with a clean alcohol or prep pad before inserting the adapter into the rubber top to withdraw the medication. 4. An interview was conducted with the Administrator on 7/13/21 at approximately 3:00 p.m. When informed of the infection control issues identified at each home visit, he concurred staff did not follow accepted standards of practice.