Every finding on record at Capital Care Resources, LLC

An onsite and unannounced complaint investigation was conducted 3/25/24-3/26/24. The allegations related to skilled nursing and infection control were substantiated with standard level deficiencies.

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 agency policy, direct observation and staff interviews the RN failed to follow proper bag technique/hand hygiene for 1 of 1 patient who received a home visit [#4]. The findings included: The policy, Bag Technique, Home Care [5/20/22] was provided by the agency director on 3/27/24 at approximately 1 pm. The policy stated, “…Never remove items from the bag wearing gloves. If gloves are needed, remove gloves, perform hand hygiene, and remove supplies…” The policy, Hand Hygiene, Home Care [8/19/22] was provide by the agency director on 3/27/24 at approximately 1 pm. The policy stated, “…Using an alcohol-based hand rub is appropriate for decontaminating the hands…after contact with a patient…” Patient # 4 had a Start of Care date of 3/9/23 with an admitting diagnosis of type 2 diabetes mellitus with foot ulcer. Review of the Plan of Care [POC] for the certification period 3/3/24-5/1/24 included orders for Sn [skilled nursing] 1time a week for 1 week. 2 times a week for 7 weeks, 1 time a week for 1 week and “Skilled nurse to perform /teach wound care to left foot ulcer by removing soiled dressing, cleanse with anasept and gauze, pat dry, cover with silver alginate and mepilex with border…” On 3/26/24 at approximately 12:30 pm, a joint visit was conducted with RN # 1. During the visit, RN # 1 completed a dressing change to the left foot. The RN was noted to complete hand hygiene at the beginning of the visit, the RN then applied gloves and proceeded with obtaining the patient’s vital signs. The RN then proceeded to enter the clean section of the nursing bag to obtain a clean pair of gloves. The RN failed to remove the gloves which had come in contact with the patient, and she failed to complete hand hygiene prior to entering the clean section of the nursing bag. At the conclusion of the visit, the RN removed her gloves and failed to complete hand hygiene prior to exiting the patient’s home. During an interview with the branch director on 3/26/24 at approximately 2 pm, the director stated, “We just did our annual skills, and she knew correct bag technique and hand hygiene. She must have been nervous.”

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on agency policy, clinical record review, and interviews with staff the Registered Nurse failed to measure the length of the midline catheter [a long, thin, flexible tube that is inserted into a large vein in the upper arm. It is used to administer medication into the bloodstream] at the time the midline catheter was removed for 1 of 1 patient with a midline catheter [#1]. The findings included: The agency procedure for discontinuing midline catheters [no date] was provided by the agency director on 3/26/24 at 11:30 am. The procedure included, “…Remove midline catheters when clinically indicated, based on findings from the site assessment and/or clinical signs and symptoms of systemic complications and not solely on dwell time…Document the procedure in the patient’s health record…Length of catheter and integrity of catheter tip at time of removal…” Patient # 1 had a Start of Care [SOC] date of 2/2824 with admitting diagnoses of chronic sinusitis and encounter for adjustment and management of VAD [vascular access device-a thin, flexible tube that provides access to blood vessels without the need for repeated needle sticks]. Review of the Plan of Care for the certification period 2/28/24-4/27/24 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 1 week, 1 time a week for 7 weeks and “Skilled nurse to obtain IV access via midline using both sterile and aseptic technique…RN to perform IV site care using sterile technique…” A supplemental order was written on 3/4/24 for SN to pull [remove] the midline due to no longer patent. Review of the clinical record revealed RN # 1 completed the SOC visit on 2/28/24 and documented Patient # 1 had a VAD noted to left upper extremity. Measurements were documented as 12 cm length - exposed catheter from skin exit site to end of catheter hub and 26 cm - arm circumference above the catheter insertion site. RN # 1 documented the line was patent with “good blood return and flushed easily”. RN # 1 conducted a routine visit on 3/4/24 and documented the following information, “During the dressing change [to midline], RN noted that the drg [dressing] that was applied at _____ [name of outside agency] following the midline placement was no [sic] securely [sic]. The drg was removed…following the sterile drg change…patient reported that she felt the midline move within her arm. Patient flushed the midline and reported that she could feel the flush during the prior to flush …RN preformed a saline flush and no infiltration, no swelling, no redness to site. At the end of RN visit patient voiced no concerns…” During an interview with patient # 1 on 3/25/24 at approximately 3 pm, the patient stated, “After ______ [name of RN # 1] left and I completed the antibiotic flush, the pain was really intense. The site began to ooze blood, so I called the doctor’s office and told them I was coming in to be checked. I was advised not to come in, that the home health nurse would be back out to pull the line and I should come back in to get another line placed the following day. _____ [name of RN # 1] got back here about 6:15 pm and removed the line. She did not measure the catheter after she removed it. She applied a dressing and left.” During an interview with RN # 1 on 3/26/24 at approximately 10 am, the RN confirmed she did not measure the length of the midline catheter after she pulled the line. During an interview with the branch director on 3/26/24 at approximately 2 pm, the director confirmed the catheter should have been measured and the measurement documented in the patient’s chart.