Every finding on record at Caring Nurses Inc

A Medicare Recertification survey including a review of the Emergency Preparedness Program was conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Department of Health and Human Services. The survey conducted from 06/07/2021 to 06/09/2021 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.22.

A Medicare Recertification and Focused Infection Control Survey were conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Department of Health and Human Services. The survey conducted from 06/07/2021 to 06/09/2021 resulted in a finding of substantial compliance respective to the applicable Condition of Participation (CoP) under 42 CFR 484, Subparts A through C with the following standard-level deficiencies listed below.

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 observation, interview, and document review the home health agency (HHA) failed to ensure staff followed accepted standards of practice for hand hygiene and bag technique during three of seven patient (Patient (P)1, P2, and P6) home visit observations. This failure had the potential to increase the risk of transmission of infections and communicable diseases for all patients receiving services from the HHA. Findings include: 1. Review of the printed copy of the plan of care (POC) for P2 revealed a diagnosis of a right lower extremity cellulitis wound that cultured positive for staphylococcus aureus (a bacterial infection requiring antibiotic treatment.) On 06/07/2021 between 1:00 PM and 1:45 PM, observed Registered Nurse (RN) 2 providing wound care to the right leg of P2. Observed RN2 put on gloves and cleansed the wound using a clean gauze and normal saline (NS). RN2 then removed the gloves and put on another pair of gloves without doing hand hygiene. RN2 took a new piece of gauze and proceeded to cleanse the wound again with NS. With the same gloves on, RN2 cut a piece of calcium alginate (type of wound dressing), put the scissors in their pants pocket, placed the piece of calcium alginate on the wound, and covered with Mepilex (brand name of dressing). RN2 then removed the gloves and did not complete hand hygiene. RN2 completed hand hygiene before leaving the home. 2. Review of printed copy of the POC for P1 revealed a diagnosis of vitamin B12 deficiency, aphasia (loss of ability to understand or express speech) and hemiplegia (paralysis of one side of the body) following a cerebral infarction (stroke), and dementia. The POC indicated that during skilled nursing (SN) visits, the nurse provided the vitamin B-12 injections, the PT/INR (blood test to determine the time it takes for a blood clot to form which helps the physician determine the dose of medication to order), and medication box set-up. On 06/07/2021 between 3:00 PM and 3:50 PM observed RN1 providing SN services. RN1 put on gloves, pricked P1's finger with a lancet to get a drop of blood, and placed the sample in the PT/INR device. RN1 then removed gloves, did not complete hand hygiene, placed the PT/INR device back into the bag used to carry supplies for home visits without cleaning it. RN1 put on a new pair of gloves and drew up the vitamin B-12 in a syringe and gave the injection in P1's right arm. RN1 removed the gloves without doing hand hygiene. RN1 put on another pair of gloves to put medications in a weekly pill box. After completing the medication set-up RN1 took off the gloves and did not complete hand hygiene. RN1 completed hand hygiene prior to leaving the home. During an interview at 3:20 PM, RN1 stated the PT/INR device was owned by the agency and was used for multiple patients. RN1 did not identify why it was not cleaned after use. 3. Review of the printed copy of the POC for P6 revealed a start of care (SOC) date of 06/02/2021 following a short stay at a skilled nursing facility for strengthening after a fall at home. Past diagnoses included chronic obstructive pulmonary disease (COPD-chronic inflammatory lung disease) and dementia. During a home visit on 06/09/2021 between 9:45 AM and 10:45 AM observed Physical Therapist (PT) set a bag containing the medical supplies used during a routine home visit on the floor of the kitchen without placing any type of barrier down. Review of an undated policy titled "Hand Hygiene Policy" revealed, "When and How to Perform Hand Hygiene ... After contact with blood, body fluids, excretions, mucous membranes, non-intact skin, or wound dressings ... If hands will be moving from a contaminated body site to a clean-body site during patient care ... After glove removal" Review of an undated policy titled "Wound Care/Documentation Policy" revealed, "All dressing changes will be done by aseptic (clean) technique unless otherwise ordered, using non-sterile exam gloves. Gloves will be changed after removing old dressings, use hand disinfectant or wash hands thoroughly, and apply new gloves to do wound care." Review of an undated policy titled "Bag Technique Policy" revealed, "In the home, identify a clean and safe area for the healthcare bag. Never set the healthcare bag on the floor ... Spread an impervious barrier on the surface before setting the bag down. Bag soiled reusable items, that cannot be cleaned in the patient's home and transport them according to agency policy. Do not put these soiled items back into the healthcare bag." Review of a manufacturers "User's Manual" for the PT/INR device revealed "Clean the meter after every patient ... The exterior of the meter and test strip guide area should be cleaned and disinfected before being used between each patient." During an interview on 06/07/2021 at 2:15 PM, the Administrator stated it was the expectation that staff complete hand hygiene, using the alcohol-based hand gel provided or using soap and water, before putting on gloves and after removing gloves. The Administrator stated it was the expectation that after cleansing the wound, gloves should be removed, hand hygiene completed, new gloves put on, and then the new clean wound dressing can be applied. During an interview on 06/09/2021 at 11:45 AM, the Administrator stated it was the expectation that staff place the home health bag on a surface such as a chair or table with a barrier placed beneath it to maintain clean surface contact.