Every finding on record at Caring Hands Home Health Agency, Inc.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA), failed to ensure, that all staff members had annual training for emergency and disaster preparedness drills. This deficient practice had the potential for the staff lack of knowledge to respond effectively during an emergency/disaster situation. During a concurrent telephone interview and record review on 12/30/2022 at 10:00 a.m., of the agency's Emergency Preparedness binder, the Administrator (ADM)/Director of Patient Care Services (DPCS) stated, there was no documentation that all staff had emergency preparedness training/disaster drill for all staff members for the date of 12/28/2021. The ADM/DPCS also stated that not all staff were able to be trained and unsure to why the other staff failed to attend the drill. ADM/DPCS stated that she provided the materials discussed in the emergency preparedness to the staff but there was no documented evidence it was given. ADM/ DPCS stated that it was important for all staff to be present so they could be aware of what to do during a disaster. A review of the agency's policy titled, Emergency and Disaster Preparedness Plan, dated 8/15/2002, indicated that it shall be the policy of the agency to have an Emergency Preparedness Plan designed to provide continuing care / service in the event of an emergency resulting in the interruption of patient services and to ensure that all staff are knowledgeable of specific steps to follow in the event of the various forms of an emergency situation.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the Department of Public Health: Surveyor ID #45783, Health Facilities Evaluator Nurse Surveyor ID #45887, Health Facilities Evaluator Nurse Unduplicated admissions: 38 Census: 20 Sample size: 7 Home Visits: 3

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the plan of care (POC) and medication profile were reviewed, revised and updated for one of 7 sampled patients, for Patient 4, insulin Humalog (type of insulin medication to treat people with type 1 or type 2 diabetes for the control of high blood sugar) was discontinued dated 12/1/2022, but indicated current on the patient's plan of care (POC) and medication list. This deficient practice had the potential of medication errors that could negatively affect patient 4's overall health status. A review of Patient 4's clinical record indicated a start of care date (SOC) of 8/12/2021, with a primary diagnosis which included unilateral primary osteoarthritis (is a degenerative joint disease that can affect the many tissues of the joint areas) and secondary diagnosis which included type 2 Diabetes Mellitus (DM, a chronic disease, characterized by high levels of sugar in the blood). A review of Patient 4's clinical record indicated a POC for Patient 4 with a certification period from 12/05/22 to 2/02/23, indicated an order for patient/patient’s caregiver to administer insulin Humalog (type of insulin medication to treat people with type 1 or type 2 diabetes for the control of high blood sugar) subcutaneous (the injection is given in the fatty tissue, under the skin) 8 units insulin as needed/every day if blood sugar is greater than 200 with skilled nurse to assist on request only. A review of Patient 4’s clinical records indicated, a physician’s order to discontinue Humalog insulin dated 12/1/22. During a home visit to Patient 4 's residence, a medication reconciliation was conducted with LVN 2 (Licensed Vocational Nurse 2). POC and medication list indicated that Humalog insulin was one of active medications. Patient 4 stated that she was no longer using the Humalog insulin since it was discontinued by the doctor and the medication was discarded already. On 12/30/2022 at 1:00 p.m., during an interview with the Administrator/Director of Patient Care Services (ADM/DPCS), stated, Patient 4's care plan should be updated with the current medication list and discontinued medications should not be included to the updated care plan. A review of the home health agency's policy titled, Plan of Care, dated 8/15/2002, indicated that it shall be the policy of this agency to implement an individualized plan of care established by the patient's physician for each patient and to establish a process and procedure for the development, review and revision of the physician's plan of care for each patient. It also indicated that the plan of care will include an indication if medications/treatments/procedure is new or changed.

Written instructions to patient include: CFR(s): 484.60(e) Standard: Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to ensure a copy of the patient's current plan of care (POC - information identified based upon the patient identified needs and development of appropriate interventions) was provided to the patient and patient's caregiver for two of 7 sampled patients (Patients 4 and 5). This failure had the potential in a lack of coordination of the plan of care of the patient and other clinicians involved in the patient care and treatment. A review of Patient 4's clinical record indicated a start of care date (SOC) of 8/12/2021, with a primary diagnosis which included unilateral primary osteoarthritis (a degenerative joint disease that can affect the many tissues of the joint areas). A home visit to Patient 4's residence conducted on 12/29/2022, at 11:00 a.m., with a Licensed Vocational Nurse 2 (LVN 2). During an observation and a review of Patient 4's home health agency folder located inside the patient's room showed there was no copy of a Home Health Certification and Plan of Care. On 12/29/2022, at 11 :10 a.m., during an interview with LVN 2 stated, there was no current copy of the POC available in the home of Patient 4. LVN 2 stated that it was her first time to conduct a home visit to Patient 4 and was unsure why there was no copy of Patient's 4 POC provided for the patient/caregiver, in the home health agency folder. A review of Patient 5's clinical record indicated a start of care date (SOC) of 10/24/2019, with a primary diagnoses which included unilateral primary osteoarthritis (a degenerative joint disease that can affect the many tissues of the joint areas) and anemia (a condition in which there is a lack of enough healthy red blood cells to carry adequate oxygen to the body's tissues). During an observation and home visit to Patient 5 was conducted on 12/29/2022, at 10:00 a.m., with a licensed Vocational Nurse (LVN 1). A review of Patient 5's home health agency folder located inside the patient's room showed there was no copy of a Home Health Certification and Plan of Care. On 12/29/2022, at 10:15 a.m., during an interview with LVN 1, confirmed there was no current copy of the POC available in the home of Patient 5. LVN 1 stated that it was her first time to conduct a visit with Patient 5 and stated that agency did not provide POC copy to patients in the home health agency folder. A review of the agency's clinical record showed a POC for Patient 4 with a certification period from 12/05/22 to 2/02/23 and a POC for Patient 5 with a certification period from 12/07/22 to 2/04/23, indicated it was approved and signed by the attending physician on 12/5/22 and 12/7/22 respectively. On 12/30/2022, at 12:30 p.m., during an interview with the Administrator/Director of Patient Care Services (ADM/DPCS), the ADM/DPCS stated the agency does not provide patient or patient caregiver copies of the POC unless requested by the patient and/or family. A review of the agency's policy and procedure titled "Care Planning Process," dated August 2002, indicated a multidisciplinary, individualized and goal directed patient care plan will be initiated based on a patient assessment, within 48 hours of admission and the care coordinator/case manager in coordination with the patient’s physician and other interdisciplinary team members, develops the patient’s care plan based upon the patient’s identified needs and reviews it with the patient and/or the patient’s caregiver(s). The agency was unable to provide a policy and procedure that addresses the patient and family/caregiver will participate in decisions regarding the plan of care whenever possible and to provide the patient and caregiver with a copy of the written instructions.

Other pertinent instructions CFR(s): 484.60(e)(4) Any other pertinent instruction related to the patient's care and treatments that the HHA will provide, specific to the patient's care needs. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to ensure durable medical equipment was available, as ordered in the plan of care, was provided to one of 7 sampled patients (Patient 5). This deficient practice had the potential of patient not meeting safety measures and outcomes. A review of Patient 5's clinical record indicated a start of care date (SOC) of 10/24/2019, with a primary diagnoses which included unilateral primary osteoarthritis (a degenerative joint disease that can affect the many tissues of the joint areas) and anemia (is a condition in which there is a lack of enough healthy red blood cells to carry adequate oxygen to the body's tissues). A review of the agency's clinical record showed a POC for Patient 5 with a certification period from 12/07/22 to 2/04/23, indicated a durable medical equipment and supplies (DME) of grab bars, walker and blood pressure machine to provide for Patient 5. On 12/29/2022, at 10:00 a.m., during a home visit to Patient 5’s residence with a Licensed Vocational Nurse (LVN 2), there were no grab bars installed in the bathroom and/or hallways of Patient 5’s residence. On 12/29/2022, at 10:15 a.m., during an interview with Patient 5, she stated that the home health agency did not provide blood pressure machine and grab bars for her. On 12/30/2022, at 12:45 p.m., during an interview with the Administrator/Director of Patient Care Services (ADM/DPCS), stated that DME supplies ordered by doctor in the plan of cares should be provided to patients and was unsure as to why Patient 5 did not receive her DME supplies. The Agency was unable to provide a policy and procedure that addresses durable medical equipment supplies, installation and distribution to the patients.