Every finding on record at Calipso Home Health Care, Inc

The following reflects the findings of the California Department of Public Health during the investigation of an abbreviated survey. Complaint Intake Number: CA62171 Representing the Department of Public Health: Surveyor ID #: 43979, Health Facilities Evaluator Nurse Surveyor ID #: 44916, Health Facilities Evaluator Nurse The inspection was limited to the specific complaint investigation and does not represent the findings of a full inspection of the facility. Four deficiencies were issued for Complaint Intake Number: CA62171

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 observation, interview, and record review, the facility failed to inform the physician when 1 out of 3 sampled patient (Patient 1) tested positive for COVID 19 (respiratory disease caused by the SARS-CoV-2 virus). This failure had the potential to result in patient not receiving the proper care related to COVID 19 and placed others at risk for contracting COVID 19. Findings: A review of Patient 1’s “Patient Profile” indicated Patient 1 is a 72-year-old female with a start of care of 12/21/2021 and a primary diagnosis of bilateral primary osteoarthritis of knee. A review of Patient 1’s “OASIS-D1 Start of Care” dated 9/28/2021 indicated Patient 1 is oriented x3 to person, place and time and able to ambulate with the supervision or assistance of another person at all times. Patient 1 lives alone and has potential risk for infection due to absence of capable caregiver, medications, and poor mobility. Under Plan of Care: Safety Measures it indicates COVID 19 precautions. A review of Patient 1’s “Home Health Certification and Plan of Care” with certification period of 12/21/2021 to 2/18/2022 indicated Patient 1 is oriented x3, up as tolerated, human assistance required, cane and under safety COVID 19 precautions. Under orders for discipline and treatment it indicated Skilled Nursing (SN) to perform COVID 19 screening before visiting the patient and to observe COVID 19 precaution. A review of Patient 1’s “Physician Order” dated 12/21/2021 indicated SN to report significant findings to Medical Doctor (MD). During an interview on 2/23/2021 at 2 p.m. with Case Manager (CM), CM stated that Patient 1 called the afterhours facility phone number on 2/14/2022 and stated that she was not feeling well and will be testing for COVID 19. CM stated that she received a called from Patient 1 the next day, 2/15/2022, and was told by Patient 1 that she tested positive for COVID 19 and was requesting to cancel her physical therapy (PT) visit. During a concurrent interview and record review on 2/23/2022 at 2:30 p.m. with Administrator Designee (ADMD), Patient 1’s electronic medical record was reviewed. ADMD stated that Patient 1 has not had any nursing or physical therapy visits since she reported not feeling well on 2/14/2022. ADMD stated that Patient 1’s recertification period ended on 2/18/2022 and they discharged her from home health and will readmit her once she is cleared. ADMD stated that she believes the doctor was made aware of Patient 1’s discharge by the Case Manager (CM) and that there is no documented order for discharge from the doctor. During a concurrent interview and record review on 2/23/2021 at 2:45 p.m. with Case Manager (CM) of Patient 1’s electronic medical record was reviewed. CM stated that she was unable to find any documentation that stated the doctor was made aware Patient 1 was positive for COVID 19 or that she was discharged after her recertification period of 2/18/2022. A review of facility’s policy and procedure titled, “Physician Participation in Plan of Care” dated April 2017 indicated “A physician will direct the care of every home health patient admitted for services… The attending physician will participate in the care planning process be reviewing and revising the plan of care. The care will be provided in compliance with his/her therapeutic and diagnostic orders and accepted standards and practices… A review of facility’s policy and procedure titled, “Entries into the Clinical Record” dated April 2017 indicated “Documentation in the clinical record will be timely, detailed, accurate, and reflect the care or services provided. A clinical record will be initiated and maintained for each patient receiving care or services, according to organization policies found in this manual, and will include at a minimum: C. Physician orders and evidence of physician oversight activities.

Discharge plans communication CFR(s): 484.60(c)(3)(ii) (ii) Any revisions related to plans for the patient's discharge must be communicated to the patient, representative, caregiver, all physicians or allowed practitioner's issuing orders for the HHA plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any). This ELEMENT is not met as evidenced by: Based on interview and record review, the facility failed to communicate with the physician that plans for discharge or obtain discharge orders for 1 out of 3 sampled patient (Patient 1). This failure resulted in the patient was discharged from facility without a physician order. Findings: A review of Patient 1’s “Patient Profile” indicated Patient 1 is a 72-year-old female with a start of care of 12/21/2021 and a primary diagnosis of Bilateral primary osteoarthritis of knee. A review of Patient 1’s “OASIS-D1 Start of Care” dated 9/28/2021 indicated Patient 1 is oriented x3 to person, place and time and able to ambulate with the supervision or assistance of another person at all times. Patient 1 lives alone and has potential risk for infection due to absence of capable caregiver, medications, and poor mobility. Under Plan of Care: Safety Measures it indicates COVID 19 precautions. A review of Patient 1’s “Home Health Certification and Plan of Care” with certification period of 12/21/2021 to 2/18/2022 indicated Patient 1 is oriented x3, up as tolerated, human assistance required, cane and under safety COVID 19 precautions. A review of Patient 1’s “Physician Order” dated 12/21/2021 indicated SN to report significant findings to Medical Doctor (MD). During an interview on 2/23/2021 at 2 p.m. with Case Manager (CM), CM stated that Patient 1 called the afterhours facility phone number on 2/14/2022 and stated that she was not feeling well and will be testing for COVID 19. CM stated that she received a called from Patient 1 the next day, 2/15/2022, and was told by Patient 1 that she tested positive for COVID 19 and was requesting to cancel her physical therapy (PT) visit. During a concurrent interview and record review on 2/23/2022 at 2:30 p.m. with Administrator Designee (ADMD), Patient 1’s electronic medical record was reviewed. ADMD stated that Patient 1’s recertification period ended on 2/18/2022 and they discharged her from home health and will readmit her once she is cleared. ADMD stated that she believes the doctor was made aware of Patient 1’s discharge by the Case Manager (CM) and that there is no documented order for discharge from the doctor. During a concurrent interview and record review on 2/23/2021 at 2:45 p.m. with Case Manager (CM) of Patient 1’s electronic medical record was reviewed. CM stated that she was unable to find any documentation that stated the doctor was made aware Patient 1 was positive for COVID 19 or that she was discharged after her recertification period of 2/18/2022. A review of facility’s policy and procedure titled, “Physician Participation in Plan of Care” dated April 2017 indicated “A physician will direct the care of every home health patient admitted for services… The attending physician will participate in the care planning process be reviewing and revising the plan of care. Physician orders will be individualized, based on patient’s needs, and include A. patient diagnosis… Orders are reviewed for appropriateness and accuracy before care, treatment, and services are provided. A review of facility’s policy and procedure titled, “Verification of Physician Orders” dated April 2017 indicated “Orders will be obtained from a licensed physician for care and services to be provided to home health patients. A qualified individual will review each order or prescription before care is provided. A copy of the order will be kept in the patient’s clinical record. A review of facility’s policy and procedure titled, “Entries into the Clinical Record” dated April 2017 indicated “Documentation in the clinical record will be timely, detailed, accurate, and reflect the care or services provided. A clinical record will be initiated and maintained for each patient receiving care or services, according to organization policies found in this manual, and will include at a minimum: C. Physician orders and evidence of physician oversight activities.

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 interview and record review, the facility failed to perform COVID 19 virus (respiratory disease caused by the SARS-CoV-2 virus) screening for 2 out of 3 sampled patients (Patient 2 & Patient 3) before providing care in their homes. This failure placed the patients and others at risk for contracting the COVID 19 virus. Findings: a. A review of Patient 2’s “Patient Profile” indicated Patient 2 is an 81-year-old female with a start of care of 6/18/2021 and a primary diagnosis of Parkinson’s disease (progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement). A review of Patient 2’s “OASIS-D1 Start of Care” dated 6/18/2021 indicated Patient 2 is oriented x3 to person, place and time and is bedfast, unable to ambulate or be up in a chair. Patient 2 lives with daughter and is at risk for infection due to confounding factors of medications, poor mobility, and underlying disease process (COPD- a chronic inflammatory lung disease, Diabetes- elevated levels of glucose in the blood, ETC.). Under Plan of Care: Safety Measures, it indicates COVID 19 precautions. A review of Patient 2’s “Home Health Certification and Plan of Care” with certification period of 10/16/2021 to 12/14/2022 indicated Patient 2 is oriented x3, bed rest, human assistance required, and under safety, COVID 19 precautions. Skilled Nursing to perform COVID19 screening before visiting the patient. During a concurrent interview and record review on 2/23/2022 at 1:30 p.m. with Administrator Designee Patient 2’s electronic medical record was reviewed. ADMD was unable to demonstrate documentation that Patient 2 had the COVID 19 screening. There were two days where Patient 2 was screened for COVID 19, 4/28/2021 and 12/21/2021. b. A review of Patient 3’s “Patient Profile” indicated Patient 3 is a 93-year-old female with a start of care of 10/6/2021 and a primary diagnosis of spinal stenosis (a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine). A review of Patient 3’s “OASIS-D1 Start of Care” dated 6/18/2021 indicated Patient 3 is oriented x3 to person, place and time and is able to transfer with minimal human assistance or with use of an assistive device. Patient 3 lives alone but has daughter nearby available and is at risk for infection due to confounding factors of medications and poor mobility. Under Plan of Care: Safety Measures, it indicates COVID 19 precautions. A review of Patient 3’s “Home Health Certification and Plan of Care” with certification period of 10/6/2021 to 12/4/2022 indicated Patient 3 is oriented x3, up as tolerated, human assistance required, and under safety, COVID 19 precautions. Skilled Nursing to perform COVID19 screening before visiting the patient. During an interview on 2/23/2022 at 11:15 a.m. with Administrator Designee (ADMD), ADMD stated that nurses call patients before their visit to prescreen them for COVID 19 and then it is logged into the patient’s electronic medical record. During a concurrent interview and record review on 2/23/2022 at 1:10 p.m. with Administrator Designee Patient 3’s electronic medical record was reviewed. ADMD was unable to demonstrate documentation that Patient 3 had the COVID 19 screening. There was one day where Patient 3 was screened for COVID 19, 10/6/2021. ADMD stated that the nurses sometimes use paper screening form which is submitted with their route sheet on a weekly basis. ADMD stated, “She probably has them with her”. A review of facility’s policy and procedure titled, “Entries into the Clinical Record” dated April 2017 indicated “Documentation in the clinical record will be timely, detailed, accurate, and reflect the care or services provided. A review of facility’s policy and procedure titled, “Infection Prevention and Control, COVID-19 Pandemic Plan” dated 1/3/2022 indicated that the home health facility uses precautions to prevent and protect patients and employees from exposure to COVID 19. All current and new patients are screened based on the most up to date recommendations… Medical record documentation will contain evidence of patient screening for suspected COVID 19 upon referral and/or admission visit.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: The facility failed to implement interventions to prevent and control the spread of COVID-19 (Coronavirus 19 disease, a severe respiratory illness caused by virus and spread from person to person) in accordance with the facility's policies and procedures. Ensure HHA staff and its contracted staff (PT-physical therapists) wore N95 (a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles) mask correctly while conducting their visit to residents homes during therapy. This failure resulted in placing all residents and the staff at risk for COVID-19(Coronavirus disease, a severe respiratory illness caused by virus and spread from person to person) infection that could lead to severe respiratory illness, hospitalization and/or death. A review of Patient 1’s “Patient Profile” indicated Patient 1 is a 72-year-old female with a start of care of 12/21/2021 and a primary diagnosis of Bilateral primary osteoarthritis of knee. A review of Patient 1’s “OASIS-D1 Start of Care” dated 9/28/2021 indicated Patient 1 is oriented x3 to person, place and time and able to ambulate with the supervision or assistance of another person at all times. Patient 1 lives alone and has potential risk for infection due to absence of capable caregiver, medications, and poor mobility. Under Plan of Care: Safety Measures it indicates COVID 19 precautions. A review of Patient 1’s “Home Health Certification and Plan of Care” with certification period of 12/21/2021 to 2/18/2022 indicated Patient 1 is oriented x3, up as tolerated, human assistance required, cane and under safety COVID 19 precautions. During an interview on 2/23/2021 at 2 p.m. with Case Manager (CM), CM stated that Patient 1 called the afterhours facility phone number on 2/14/2022 and stated that she was not feeling well and will be testing for COVID 19. CM stated that she received a called from Patient 1 the next day, 2/15/2022, and was told by Patient 1 that she tested positive for COVID 19 and was requesting to cancel her physical therapy (PT) visit. A review of Patient 1's "Physical Therapy Discharge Summary" dated 2/18/2022 at 5:18 p.m., indicated reason for discharge patient tested for Covid . During a concurrent interview and record review on 2/23/2022 at 2:30 p.m. with Administrator Designee (ADMD), Patient 1’s electronic medical record was reviewed. ADMD stated that Patient 1’s recertification period ended on 2/18/2022 and they discharged her from home health and will readmit her once she is cleared. ADMD stated that she believes the doctor was made aware of Patient 1’s discharge by the Case Manager (CM) and that there is no documented order for discharge from the doctor. During a concurrent interview and record review on 2/23/2021 at 2:45 p.m. with Case Manager (CM) of Patient 1’s electronic medical record was reviewed. CM stated that she was unable to find any documentation that stated the doctor was made aware Patient 1 was positive for COVID 19 or that she was discharged after her recertification period of 2/18/2022. On 2/23/2022 at 6:49 p.m., received an email from MBJ Therapy LLC, replying to email asking N95 fit testing for their staff. MBJ Therapy indicated on email stating they do not do N95 fit testing for their staff. The therapists wear either a surgical mask or KN95. MBJ therapy further stated they do covid pre screen prior to each visit and id patient answers "yes" to having any symptoms or exposure, they do not see the patient. On 3/25/2022 at 12:44 p.m., received a reply from MBJ therapy stating "All of our therapists are vaccinated. We do require Covid testing unless there has been known exposure or the home health visit is at an assisted living that requires them. A review of the HHA policy titled " Infection Prevention and Control" Policy No. 9-001 updated 1/3/2022, COVID-19 Pandemic Plan. To prevent transmission of Covid-19 in cases of pandemic outbreak. The goal of the organization is to ensure that staff, patients and family members/caregivers are provided education regarding infection control procedures and how to avoid the transmission of covid-19. CALIPSO HOMEHEALTH CARE INC. employees use transmission-based precautions that are epidemiologically important when caring for patients documented or suspected of being infected or colonized with organisms that are transmitted via the droplet route. The HHA also uses precautions to prevent and protect patients and employees from exposure to COVID-19. CALIPSO HOME HEALTH CARE INC will have procedures for managing home visits, patients, families and staff members in an effort to reduce exposure to Covid-19 and prevent transmission and illness. 1. All current and new patients are screened based on the most up to date recommendations from CDC, CMS, local and state officials. 9. Staff should follow the organization's standard precautions including: D.4. Staff should follow droplet precautions for patients with suspected or confirmed COVID-19 for 14 days or longer. Droplet precautions include: Wear mask (preferably N95) prior to entering . Surgical masks are acceptable to wear unless the patient requires suctioning or any aerosolized or nebulized treatments, at which point the home care provider should be in an N95 mask.