Every finding on record at Care Providers, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 3325 Wilshire Blvd. suite 950, Los Angeles CA 90010 Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 54 Active Patients - 11 Sample Size - 7 Home Visits- 3

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on record review, the home health agency (HHA) failed to ensure the emergency preparedness plan/drill for field staff were completed in an annual basis. This failure had the potential to result in the staff lacking of knowledge to respond effectively when an emergency/disaster situation occur. Findings: On 4/17/22 at 12:30 p.m., during a review of the HHA's policy titled "Emergency Management Plan" indicated the HHA will test the emergency management plan at least annually, either in response to an actual emergency or in a planned exercise. Planned exercises are realistic scenarios and related to the priority emergencies defined by leadership, and DO NOT include tabletop drills nor are they required to be performed in patients' homes. All actual responses and exercises will be documented and critiqued through a multidisciplinary process that includes administrative, clinical and support staff. Documentation will be used to identify deficiencies and opportunities for improvement based on all monitoring activities and observations during the exercise.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 3325 Wilshire Blvd. suite 950, Los Angeles CA 90010 Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 54 Active Patients - 11 Sample Size - 7 Home Visits- 3

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to maintain an accurate, current medication profile for one of seven sampled patients (Patient 5). This failure had the potential to result in placing the patient at risk for medication errors and adverse drug reactions. Findings: A review of Patient 5's Patient Profile indicated, a start of care (SOC) date of 3/31/22, with diagnoses of surgical wound on left knee and chronic obstructive pulmonary disease (COPD- obstruction in the airflow in the lungs) During a review of Patient 5's Plan of Care (POC), for the re-certification period from 3/31/22 to 5/29/22, included an order for skilled nurse (SN) to visit twice a week for nine weeks and as needed for wound care. On 4/16/22, at 2:00 p.m., a home visit was conducted at Patient 5's residence with registered nurse (RN 1) and Administrator (Admin). Patient 5 was observed sitting on a chair in the living room. RN 1 proceeded to administer care. During a review of Patient 5's medications on 4/16/22 at 2:30 p.m., the patient stated she was dyslexic and reads her medications differently. During this same time and date, it was observed that all medications inside Patient 5's medication box were expired. A concurrent review of Patient 5's medication profile as follows: Vitamin C 500mg 1 tab twice daily when resident stated that she takes it once a day onlyAcetaminophen/codeine 5/325mg 1 tab every 6 hours as needed for pain and wound care. Patient 5 stated she needed refill as the bottle was not in a box.Zinc sulfate 220mg not in box, and Patient 5 stated she had not taken it awhile now.Trazodone 50mg ½ tablet was on medication list and was discontinued last 3/28/22 as per RN. Still in the current medication profile and plan of care.Colace 100mg, the patient does not take it per RN since 3/28/22.Famotidine 20mg daily on medication list but was discontinued last 3/28/22Montelukast 10mg daily had a bottle expired since 2015, Patient 5 stated she was still taking that medication.Ventolin 90mcg inhaler cannot be found and was not in box.Vitamin C duplicate order 500mg tab daily but patient had one a day gummies in her kitchen.Doxycycline 100mg twice daily, not in box and was discontinued on 3/26/22 which was still on medication profile.Voriconazole 200mg twice daily listed on medication profile but not present in box.Tramadol 50mg 1 tab taken when Norco is not present per Patient 5 and the bottle is expired since 2015.Symbicort 160/4.5mcg inhaler was expired since 2020 present in box and Patient 5 stated not using it.Loratadine 10mg daily, Patient 5 was still taking and the bottle is expired since 2016. Medication is not in medication profile.One a day gummies daily, the patient is taking but not on medication profile.On concurrent interview on 4/16/22 at 12:00 p.m., RN 1 stated that she checked the patients meds every visit. RN 1 stated that she should be checking the medications to ensure the medication profile is up to date. The HHA's policy and procedure titled "Medication Management C-705" indicated medications in the home are reviewed with the client/family to determine current medications and client understanding of the medications actions and side effects. Specific instructions for how and when to take the medications will be reviewed and documented. Medications in the home that are not on the current plan of care will be checked to assure they have not expired, and to review if medications are being prescribed by multiple physicians. Clients will be instructed to notify the agency if they begin taking any of these medications again or if there are new prescriptions. All expired, damaged, or contaminated medications will be removed from the home.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to follow the written plan of care established by the physician that included right hip replacement surgical site wound assessments for one of 7 sampled patients (Patient 1). This deficient practice had the potential in the delay of healthcare response, treatment, and intervention that could result to complications to an already compromised patient's health status. Findings: A review of Patient 1's clinical record indicated a start of care (SOC) of 2/26/22, with diagnosis which included diabetes mellitus ( a group of disease that result in too much sugar in the blood). The Plan of Care (POC) for the certification period 2/26/224/26/22, included an order for Skilled Nurse (SN) frequency of once a week for one week, twice a week for one week, once a week for six weeks for to continue doing skin assessment and observation on left hip replacement surgical site. One of the physician's orders was to monitor incision and suture site for increase drainage and signs and symptoms of infection. A review of Patient 1’s Nursing Progress Notes from dates 2/26/22 to 4/8/22, did not indicate a documented evidence that the left hip replacement surgical incision site was assessed during the skilled nursing visits. During an interview with the Director of Patient Care Services (DPCS) on 4/17/22, at 12 p.m., she stated she could not provide the documented evidence that the patient's left hip replacement surgical incision site was assessed for the size (length, width, and depth) during the SN visits. A review of the agency’s undated policy titled “Wound Assessment and Documentation” indicated to assess the wound location and its size; measure the length, width, and depth.

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 interview and record review, the SN (skilled nurse) failed to notify the physician promptly of the patient's change of condition for two out of seven sampled patients (Patients 1 and 2). Patient 1 and 2 had newly existing pitting edema on their lower extremities but SN failed to inform the physician of their present condition. This deficient practice had the potential to place the patients at risk for serious complications that could affect the patient's overall health status and quality of care. Findings: a. A review of Patient 1's clinical record indicated a start of care (SOC) of 2/26/22, with diagnosis which included diabetes mellitus ( a group of disease that result in too much sugar in the blood). The Plan of Care (POC) for the certification period 2/26/224/26/22, included an order for Skilled Nurse (SN) frequency of once a week for one week, twice a week for one week, once a week for six weeks for SN to continue doing comprehensive skilled nursing assessments and evaluation of cardiovascular (heart) status. One of the SN interventions included in the plan of care was to report to physician if having signs and symptoms of cardio-respiratory distress. A review of Patient 1's Nursing Progress Notes dated 2/28/22, 3/1 and 3/8/22, indicated that Patient 1 had a right leg +2 pitting edema. There was no documented evidence to indicate the visiting nurse notified the physician of patient's new existing +2 pitting edema on right leg. On 4/17/22, at 11 a.m., during an interview with the director of nursing services (DPCS), she stated the visiting nurse should have notified the physician regarding the patient's edema to evaluate what medication to take to prevent edema formation. b. A review of Patient 2's clinical record indicated a start of care (SOC) of 3/21/22, with diagnosis which included osteoarthritis ( a type of arthritis that occurs when flexible tissue at the ends of the bone wears down). The Plan of Care (POC) for the certification period 3/21/22 to 5/19/22, included an order for Skilled Nurse (SN) frequency of twice a week for two weeks, once a week for seven weeks, for SN to continue doing comprehensive skilled nursing assessment and evaluation of cardiovascular (heart) status. One of the SN interventions included in the plan of care was to report to physician if having signs and symptoms of cardio-respiratory distress. A review of Patient 2's Nursing Progress Notes dated 3/29/22 and 4/8/22, indicated that Patient 2 had a right foot and knee +2 pitting edema. There was no documented evidence to indicate the visiting nurse notified the physician of patient's new existing +2 pitting edema on right foot and knee. On 4/17/22, at 11 a.m., during an interview with the director of nursing services (DPCS), she stated the visiting nurse should have notified the physician regarding the patient's edema on right foot and knee to evaluate what medication to take to prevent edema formation. A review of Agency's policy "Reporting To Physician (undated)", indicated the patient's physician will be contacted on the same day when there is changes in the patient's condition.

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 Home Health Agency (HHA) failed to ensure the staffs are fit tested for the use of N95 (a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles) masks to prevent COVID-19 (an acute respiratory illness) transmission. This failure had the potential for an increased risk of cross contamination and spread of infection. Findings: During an interview with the Director of Patient Care Services (DPCS), on 4/17/22 at 12 p.m. , she could not provide evidence that all of the HHA staff were fit tested for N95 masks. The DPCS stated she would have to follow up with the fit testing for N95 masks to all staff to prevent the spread of COVID-19 infection. The HHA's undated policy and procedure titled, "COVID-19 Plan," indicated the goal of the organization is to prevent the transmission of COVID-19 in the workplace. The policy stated the agency will provide and ensure facemasks or higher level of respiratory protection will be worn by employees..