Every finding on record at Care Plan, Inc

A Medicare recertification and COVID-19 infection control survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 1/4/2021 through 1/6/2021 at: American Angels Home Care 6 Parklane blvd. Ste 135 Dearborn, MI 48126 This was a partial extended survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness, were not reviewed.

A Medicare recertification and COVID-19 infection control survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 1/4/2021 through 1/6/2021 at: American Angels Home Care 6 Parklane blvd. Ste 135 Dearborn, MI 48126 This agency has no extension sites. For this survey 3 home visits with record reviews, 2 active records without a home visit and 2 discharged records were reviewed. At the conclusion of the survey, the agency was found to be out of compliance with standard level deficiencies for the conditions of participation for home health agencies at: 42 CFR Part 484, Home Health, and 42 CFR Part 484.70, Infection Control.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined that the registered nurse failed to document a complete wound dressing order from the physician in 1 of 7 records reviewed (MR#7), resulting in the potential that patient's wound could become infected. Findings include: **Agency policy "Care Plan Management and Evaluation" (no date) stated, "Skilled planning and management activities are determined from an overall assessment..." MR#7: This patient was admitted to homecare on 11/20/20 after being hospitalized with diagnoses of brain cancer surgery, melanoma of right foot with surgery, and hypertension. The plan of care, dated 11/20/20, specified, "Skilled nurse frequency of 1 time a week for 3 weeks, 3 prn (as needed)...to cleanse wound bed with 0.9% NS (normal saline), apply betadine, cover with 4x4 gauze, wrap with kerlix, and secure with tape." The physician order failed to specify the frequency of dressing changes to right foot that the caregiver/patient would complete the days the skilled nurse was not scheduled to visit. During an interview on 1/6/20 at 1000 hours, DON-A (director of nursing) stated, "The nurse failed to receive an order that specified the wound dressing was to be completed daily."

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: Based on record review and interview, the agency failed to maintain a coordinated agency-wide program for the surveillance, identification, and prevention of COVID-19; and failed to develop a method of screening visitors and all 19 staff employed by this agency and those (13 staff) who were granted clinical privileges, resulting in the potential development, and spread of a contagious viral infection between agency staff and the agency's 46 current patients. Findings include: ***Agency policy: The agency did not have a policy for screening of visitors. On 1/4/21 at 9:00 a.m., upon arrival to the agency, it was noted there were no signs instructing visitors on the protocol for entrance into the agency's suite. There was no screening process, temperature checks or questionnaires about potential exposure to Covid-19. There was no immediate availability of hand sanitizer, masks, or other personal protective equipment (PPE). The agency's Administrator (Adm #1) was queried regarding the process or tool used for screening visitors upon entrance into the agency and reported, "We do not have a process for screening other than requiring a mask. We have a sign up to wear a mask." When asked if there was a process in place for the screening of field and office staff for potential Covid-19 infections, Adm #1 reported, "There is no screening of office staff, it is an honor system. The field staff just tell me if they have a fever or symptoms." When asked if there was documentation of recorded staff temperatures, Adm #1 stated, "No." When asked if the field staff were screened for exposure to anyone with Covid-19 or recent travel, Adm #1 reported, "No." There was no evidence that visitors had been screened upon entrance into the agency. Further, there was no documented evidence that office or field staff had been thoroughly screened for Covid-19 prior to providing care and services. Additionally, a request was made to review the agency's infection control surveillance logs for all patients and staff. There was no Infection Control surveillance documented. During the review, Adm #1 stated, "We have COVID-19 positive patients, and our employees know the policies for caring for these patients, but we have not been tracking the information." There were no Infection Control meeting minutes or surveillance logs available for review. The above findings were discussed with and acknowledged by the Administrator (Adm #1) on 1/6/21 at 10:30 a.m.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, it was determined the Registered Nurse (RN) failed to prepare clearly written patient care instructions and include safety precautions on the aide's care plan, in 4 of 4 records in which Home Health Aide (HHa) services were provided (MR#s 1, 4, 5 and 6) resulting in the potential for the provision of unsafe care and unmet care needs. Findings included: ***Agency policy: III.89, Home Health Aide Care Plan, undated. "Documentation requirements that demonstrate the involvement of a case manager to manage and evaluate the aide care plan (if applicable) include but are not limited to: oe Functional Limitations oe Aide Frequency oe Personal Care with frequency oe Household with frequency oe DME oe Supplies oe Activities Permitted......."(sic). M.R. #1: The Plan of Care (POC) dated 8/6/20, documented the following diagnoses, "Congestive heart failure (CHF), diabetes mellitus (DM) and essential hypertension." During review of the 485/POC dated 8/6/20 on 1/6/21, there were documented fall, bleeding, oxygen, cardiac and use of assistive devices precautions. During review of the HHa POC dated 8/6/20 on 1/6/21, there were no documented safety precautions. During an interview on 1/6/21 at 1:00 PM, after a review of the aide's care plan, the administrator and director of nursing (DON) stated, "I agree, the safety precautions should be there and we will include them as a comment on the aide care plan." MR#4: This plan of care (POC) dated 11/24/20, included the patient diagnoses of Covid-19 acute respiratory disease, hypertensive chronic kidney disease, and myocardial infarction. The POC specified the following safety measures, "Keep pathway clear...Anticoagulant precautions...Covid-19 precautions. Cardiac precautions..." During review of the home health aide care plan dated 11/24/20 there was no evidence of safety precautions documented. MR#5: This POC dated 12/25/20, included the patient diagnoses of Covid-19 acute respiratory disease, diabetes mellitus type 2, and hypertension. The POC specified the following safety measures, "Keep pathway clear...Anticoagulant precautions...Covid-19 precautions. Cardiac precautions. Diabetic precautions..." During review of the home health aide care plan dated 12/25/20 there was no evidence of safety precautions documented. MR#6: This POC dated 10/29/20, included diagnoses of diabetes mellitus type 2, hypertension, and dementia. The POC specified the following safety measures, "Keep pathway clear...Slow position change, Support during transfer and ambulation...Fall precautions..." During review of the home health aide care plan dated 10/29/20 there was no evidence of safety precautions documented. During an interview on 1/6/21 at 1:00 PM, after a review of the aide's care plan, the administrator and director of nursing (DON-A) stated, "I agree, the safety precautions should be there and we will include them as a comment on the aide care plan."