Every finding on record at Carolina's Medical Center at Home, LLC

An unannounced, onsite recertification survey was conducted on 9/22/25-9/24/25. No deficiencies to the Emergency Preparedness Plan was identified.

An unannounced, onsite recertification survey was conducted 9/22/25-9/24/25. A standard level deficiency was identified related to infection control.

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 agency policy, direct observation, and staff interviews, the RN failed to follow appropriate infection control policies during observed wound care for 1 of 2 patients receiving a joint nursing visit [# 7]. The policy, Wound dressing application, home care [2/24/25], was provided by RN # 3 on 9/23/25 at approximately 2:25 pm. The policy stated, “...Arrange the equipment and supplies according to the order of use to avoid cross-contamination while performing wound care...apply topical wound treatments to the wound bed using a cotton-tipped applicator...” Patient # 7 had a Start of Care date of 9/16/25 with admitting diagnosis of venous insufficiency [chronic], non-pressure chronic ulcer other part right lower leg, and non-pressure chronic ulcer of other part of left lower leg. Review of the Plan of Care for the certification period 9/16/25-11/14/25 included orders for SN [skilled nursing] 2 times a week for 5 weeks and “...Cleanse wound with wound cleanser, apply plurogel to wound bed, cover with xeroform gauze then absorbent dressing...location of wound: bilateral LE [lower extremities] ...” On 9/23/25 at approximately 11:30 am a joint visit was conducted with RN # 1 to observe wound care. During the visit, RN # 1 completed hand hygiene, donned clean gloves and removed the soiled dressing. The RN then completed appropriate hand hygiene and donned clean gloves. The RN then used a cotton tipped applicator to apply plurogel to the open areas on the left lower leg, using the same cotton tipped applicator the RN placed the dirty applicator back into the container of plurogel and applied plurogel to the open areas on the right lower leg. RN # 1 then completed the dressing change. During an interview with the agency director and RN # 2 on 9/24/25 at approximately 10 am, it was confirmed RN # 1 should have used a clean cotton tipped applicator to apply plurogel to the right lower leg and should not have re-entered the container of plurogel with the cotton tipped applicator.

An onsite recertification survey was conducted 10/3/22-10/5/22. No deficiencies to the Emergency Preparedness Program were identified. ABH

An onsite recertification survey was conducted 10/3/22- 10/5/22. Deficiencies to the Medicare Conditions of Participation were identified. ABH

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 policy and procedure review, and direct observation the agency staff failed to use proper wound care technique for 1 of 7 virtual home visits (#2), failed to use proper hand hygiene for 1 of 7 virtual home visits (#2) and failed to use proper venipuncture draping technique for 1 of 7 virtual home visits (#2). Findings included: Review of a policy “Wound dressing application, home care”, revised 02/18/22 was received from the agency director on 10/04/22 at 10:42 a.m. The policy stated,” …organize the equipment and supplies on a clean surface…avoid cross-contamination while performing wound care…” Review of policy “Hand Hygiene Policy and Compliance Program”, revised 02/2022 was received from the agency director on 10/04/22 at 10:42 a.m. The policy stated,” …alcohol-based hand rub hand hygiene indications are before and after direct patient contact…before and after each procedure...”. Review of policy “Venipuncture, home care”, revised 08/19/2022 was received from the agency director on 10/04/22 at 10:42 a.m. The policy stated,” …organize the equipment and supplies on a clean surface…place a fluid-impermeable pad between the environment and equipment…” 1a. Patient #2 was admitted on 09/13/22 with diagnoses of pyogenic arthritis (joint infection), dilated cardiomyopathy (heart chambers are thin and stretched), osteomyelitis (bone infection), type 2 diabetes with foot ulcer, and encounter for adjustment and management of a vascular access device. The plan of care for 09/13/22 to 11/11/22 had orders for skilled nursing 2 times a week for 6 weeks. A virtual home visit was conducted on 10/3/22 at 1:30 p.m. with the registered nurse. Employee #4 was observed dropping a piece of wound care packing at 1:34 p.m. onto the ottoman and placing it back into the wound of the foot. 1b. Patient #2 was admitted on 09/13/22 with diagnoses of pyogenic arthritis (joint infection), dilated cardiomyopathy (heart chambers are thin and stretched), osteomyelitis (bone infection), type 2 diabetes with foot ulcer, and encounter for adjustment and management of a vascular access device. The plan of care for 09/13/22 to 11/11/22 had orders for skilled nursing 2 times a week for 6 weeks. A virtual home visit was conducted on 10/03/22 at 1:30 p.m. with the registered nurse. Employee #4 was observed not cleansing her hands after cleaning up PICC (peripherally inserted central catheter) supplies at 1:39 p.m., and not cleansing hands after taking off her gloves at 1:45 p.m. 1c. Patient #2 was admitted on 09/13/22 with diagnoses of pyogenic arthritis (joint infection), dilated cardiomyopathy (heart chambers are thin and stretched), osteomyelitis (bone infection), type 2 diabetes with foot ulcer, and encounter for adjustment and management of a vascular access device. The plan of care for 09/13/22 to 11/11/22 had orders for skilled nursing 2 times a week for 6 weeks. A virtual home visit was conducted on 10/3/22 at 1:30 p.m. with the registered nurse. Employee #4 was observed not using a barrier under the venipuncture supplies while obtaining ordered labs at 2:06 p.m.

Supervision of home health aides CFR(s): 484.80(h) Standard: Supervision of home health aides. This STANDARD is not met as evidenced by: Based on policy review, clinical record review, and staff interview the agency failed to provide home health aide supervision for 1 of 4 home health aide records reviewed (#14). Findings included: Review of policy “Home Health Aide Supervision”, approved 03/25/2020 was received from the agency director on 10/05/22 at 10:13 a.m. The policy stated,” …home health aides are closely supervised to ensure their competence in providing care… at least every 14 days…” Patient #14 was admitted on 06/05/21 and included diagnoses of encounter for surgical aftercare following surgery on the digestive system, calculus of ureter (stones), and pressure ulcer of right buttock (wound). The plan of care for 06/05/21 to 08/03/21 had orders for skilled nursing 2 times a week for 1 week, 1 time a week for 6 weeks, and home health aide 1 time a week for 1 week, and 2 times a week for 3 weeks. Review of the skilled nurse visits for 06/13/21, 06/16/21, 06/26/21, 07/01/21, 07/07/21, 07/13/21, 07/22/21, and 07/29/21 revealed a home health aide supervision visit was not done the week of 06/21/21. Interview with Employee #3 on 10/05/22 at 11:14 a.m. revealed, “no, we didn’t have a supervisory visit that week”.