Every finding on record at Careage Home Health, LLC

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 Part 484 conducted this health and safety survey. Examination number: 2024-57 Dates Onsite: 04/01-05, 08/24 This survey was conducted by: Surveyor #5 DOH staff found the facility in substantial compliance with all Conditions of Participation except those standard-level deficiencies listed below. During the course of the survey, The surveyor investigated issues related to state complaint #2024-3143. The investigation determined the complaint was referred to this agency in error. . . . . . .

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 interview and record review, the agency failed to conduct an initial assessment within 48 hours of the completed referral for 4 of 17 patients (#504, #505, #509, and #511). Failure to conduct the assessment within 48 hours could result in a delay of necessary medical treatment. Findings Included: 1. The surveyor reviewed patient records for four patients. The records showed: a. Patient #504 had a completed referral date of 02/14/24. The patient had a start of care date of 02/20/24. There was no documentation evident to determine the reason for the 4-day delay in the start of care. b. Patient #505 had a completed referral date of 03/15/24. The patient had a start of care date of 03/18/24. There was no documentation evident to determine the reason for the 1-day delay in the start of care. c. Patient #509 had a completed referral date of 12/29/23. The patient had a start of care date of 01/02/24. There was no documentation evident to determine the reason for the 2-day delay in the start of care. d. Patient #511 had a completed referral date of 03/22/24. The patient had a start of care date of 03/26/24. There was no documentation evident to determine the reason for the 4-day delay in the start of care. 2. On 04/03/24 at 1:50 PM and 04/05/24 at 2:50 PM, the Surveyor interviewed the agency's Clinical Services Director (Staff #502) about the delay in the start of care for the above patients. Staff #502 confirmed the accuracy of the completed referral dates and stated that there was no justification documented to indicate the reason for the delayed start of care.

MEDICARE FOCUSED INFECTION CONTROL SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 CFR Part 484 for Home Health conducted a Medicare COVID-19 Focused Infection Control Survey for acute care. Onsite dates: 06/29/21 to 07/02/21, 07/06/21 to 07/07/21 This survey was conducted by: Surveyor #1 DOH found the agency in substantial compliance with the infection control standards as they relate to the response to the COVID-19 pandemic.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: . Based on document review and interview, the agency failed to ensure the patient's right to be free from abuse and exploitation through their failure to include the state hot-line number for reporting abuse, as described in Washington Administrative Code (WAC) 246-335- 535. Failure to provide patients and their families a means to report suspected abuse consistent with state law, puts patients at risk of harm from caregiver abuse, neglect or exploitation. Reference: WAC 246-335-535, Bill of Rights. A home health agency at the time of admission must provide each patient, designated family member, or legal representative with a written bill of rights affirming each patient's right to: (19) Be informed of the DSHS END HARM hotline number to report suspected abuse of children or vulnerable adults. Findings included: 1. Document review of the agency's Bill of Rights showed no information on the DSHS end harm Hotline phone number. 2. On 06/30/21 at 9:00 AM, the surveyor interviewed the Interim Executive Director (Staff #101) and the Vice President (Staff #102) about the missing element in the agency's Bill of Rights document. Staff #101 and Staff #102 acknowledged the missing element in the patient's Bill of Rights, and stated that they were taking steps to update the agency's BoR with the correct reporting hotlline. .

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 record review and interview, the agency failed to identify and document any potential adverse effects and drug reactions for 9 of 17 sampled record review (Patients #103, #104, #109, #111, #112, #113, #115, #116, and #117). In addition, the agency failed to report these potential adverse effects to the patients' physicians. Failure to identify potential medication adverse effects and drug reactions and failure to report them to the patient's physician puts patients at risk for injury or death. Findings included: 1. Document review of the agency's policy titled, "Initial Assessment/Comprehensive Assessment," showed that staff reviews all patient's medications and that the agency nurse must consider and document each medication to identify potential adverse effects and reports any concerns to the physician. Records reviewed (Patients #103, #104, #109, #111, #112, #113, #115, #116, and #117) showed no documentation of potential adverse effects identified during the initial comprehensive assessment of the patient, and also showed no notification to physician of these potential adverse effects. 2. On 07/06/21 at 4:30 PM, the surveyor interviewed the Interim Executive Director (Staff #101), the Vice President (Staff #102), and the Staff Development Nurse (Staff #103) about the missing information. Staff #101, Staff #102, and Staff #103 acknowledge the findings. Staff #102 indicated the agency's Electronic Medical Record allows staff to identify for potential severe interactions during the medication reconciliation review. However, the clinicians have the clinical judgment not to notify the physician of these potential severe interactions. .

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 update their Tuberculosis (TB) screening process to be consistent with state regulations, for 12 of 12 personnel files reviewed (Staff #101, #102, #103, #104, #105, #106, #107, #108, #109, #110, #111, and #112). Failure to screen staff for TB upon hire and annually, places staff and patients at risk from TB exposure. Reference: WAC 246-335-525, Personnel, contractor, and volunteer policies. The applicant or licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (15) Infection control practices, communicable disease testing, and vaccinations. Policies and procedures must include, at minimum: (c) Tuberculosis (TB) infection control program. Key elements include, but are not limited to: (i) Conducting a TB risk assessment for all new employees upon hire. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine the agency's responsibility to conduct TB testing of new employees. If TB testing is required, follow the department's tuberculosis risk assessment form testing recommendations; (ii) Conducting an annual assessment of new TB risk factors for all employees. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine agency's responsibility to conduct TB testing of employees. Retesting should only be done for persons who previously tested negative and have new risk factors since the last assessment; and Findings included: 1. Document review of the agency undated policy titled, "Regulatory Requirements," showed the agency's requirements of newly hired staff for TB skin testing only, but no risk assessment. In addition, the annual risk assessment used for ongoing surveilannce does not comply with the department requirement. Record review of personnel records for (Staff #101, #102, #103, #104, #105, #106, #107, #108, #109, #110, #111, and #112 showed no department-approved TB risk assessment form on file. 2. On 07/06/21 at 4:00 PM, the surveyor interviewed the Interim Executive Director (Staff #101), the Vice President (Staff #102), and the Staff Development Nurse (Staff #103) about the agency's policy and process for TB prevention. Staff #101, Staff #102, and Staff #103 acknowledged the findings and were not aware of the department-approved TB risk assessment form.