Every finding on record at Central Home Health Care, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - Active Patients - Sample Size - 7 Patients 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 interview and record review, the home health agency (HHA) failed to ensure the emergency preparedness plan and training for all staffs were done in an annual basis. This failure had the potential for the staffs to lack the knowledge to respond effectively during an emergency situation. During a review of the Emergency Preparedness plan of the HHA on 6/5/22, at 12 p.m., the HHA did not have documented evidence of Emergency Preparedness training/disaster drill for all staffs and did not have evidence of emergency plan annual review. During an interview with the Director of Patient Care Services (DPCS) on 6/5/22, at 12:10 p.m., DPCS was not able to provide evidence of all staffs attendance for Emergency Preparedness/Disaster training from the HHA. DPCS also was not able to provide evidence of emergency preparedness plan review with corresponding signatures. The HHA's undated policy and procedure titled "Emergency Preparedness Plan" indicated the agency will report and respond to patient care needs in accordance with the local office of emergency services.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - 9 Active Patients - 3 Sample Size - 7 Patients 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 patients (Patient 5). This failure has the potential to result in putting the patient at risk for medication errors and adverse drug reactions. A review of Patient 5's Patient Information indicated, a start of care (SOC) date of 6/3/22, with diagnoses that included Type 2 Diabetes Mellitus (an impairment in the way the body regulates and uses sugar (glucose) as a fuel), and left foot wound. During a review of Patient 5's Plan of Care (POC), for the certification period from 4/13/22 to 6/11/22, included an order for skilled nurse (SN) to visit for once a week for nine weeks. On 6/4/22, at 12 p.m., a home visit was conducted at Patient 5's residence with the Director of Patient Care Services (DPCS). Patient 5 was observed sitting on a chair in the living room. During a review of Patient 5's medications indicated the following prescribed medications in the bottles were not included in the medication profile as follows: Ferosul (iron supplement) 325 milligram (mg- unit of measurement) every day Calcium (supplement) 500 + D one tablet every day Vitamin D3 (supplement) 1000 international unit (IU- unit of measurement) every day Hydrocortisone (used to treat low cortisol levels) 25 mg every day Aspirin (used to treat pain, fever, headache, inflammation and reduce the risk of heart attack) 81 mg every day. On 6/34/22, at 12:30 p.m., during an interview with the DPCS, she confirmed the discrepancies and stated the medication profile should be up to date. The HHA's undated policy and procedure titled " Medication Profile indicated the profile will be updated as needed to reflect current medications the client is taking.

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 home health agency (HHA) failed to follow the written plan of care for one of seven patients (Patient 1 ). For Patient 1, the visiting nurse failed to assess the type of glucometer the patient used and if it needed to be calibrated . This failure has the potential for the patient blood glucose results will get an inaccurate blood sugar readings. A review of Patient 1's "Patient information" indicated, a start of care (SOC) date of 12/11/20, with diagnosis that included diabetes mellitus ( a group of disease that result in too much sugar in the blood). A review of Patient 1's Plan of Care (POC), for the certification period from 4/5/22 to 6/3/22, included an order for skilled nurse (SN) to visit once a week for 9 weeks, for skilled assessment and evaluation of all body system with emphasis on endocrine (pancreas) system. A review of Patient 1's Comprehensive Nursing Assessment (recertification OASIS) dated 4/5/22, indicated no of type of glucometer the patient uses and if it needs to be calibrated. During an interview with the Director of Patient Care Services (DPCS) on 6/5/22, at 12 p.m., she stated she was the assigned nurse for this patient. DPCS also stated that she did not do an assessment of the glucometer the patient uses and documentation of calibration. A review of the undated policy and procedure "Quality Control Testing/Glucometer" indicated to monitor the precision and accuracy of the glucometer and test strip used in daily blood glucose testing. Quality control tests are to be performed once a week with the check strip, to check the proper operation of the monitor.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on interview, and record review, the agency's skilled nurse failed to administer Vitamin B 12 (to treat anemia-blood condition that makes people tired and weak) 2000 mcg as ordered by the physician for one out of 7 patients (Patient 1). This deficient practice is a potential risk for the patient's anemic condition will not be meet/treated that could affect the patient's health status and well being. A review of Patient 1's Patient information indicated, a start of care (SOC) date of 12/11/20, with diagnoses that included diabetes mellitus ( disease that result in too much sugar in the blood). During a review of Patient 1's Plan of Care (POC), for the certification period from 4/5/22 to 6/3/22, included an order for skilled nurse (SN) to visit once a week for 9 weeks, for skilled assessment and evaluation of all body system with emphasis on endocrine (pancreas) system. one of the physician's order included in the plan of care was to administer Vitamin B12 (1000 mcg (micrograms)/ml (milliliters)/vial), 2000 mcg (2 vials) intramuscularly (IM) once weekly. A review of Patient 1's Skilled Nursing Visit Note dated, 4/5/22 and 4/19/22, indicated no documented evidence the visiting nurse administered Vitamin B12 2000 mcg IM weekly as ordered in the POC. On 6/5/22 at 11 a.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse probably forgot to document in the nursing note.

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 record review, the home health agency (HHA) failed to implement their policy and procedure to prevent and control infections by failing to: a. Screen the visitors for signs and symptoms of COVID-19 infection (an acute serious respiratory illness). This deficient practice had the potential to spread COVID 19 infection to patients, staffs, and visitors. b. Provide sharps disposal container for one of seven patients (Patient 5). This deficient practice has the potential risk for the patient/caregiver to be exposed to bloodborne pathogens (infectious microorganism in human blood) as a result of improper contact with the contaminated sharps. A review of Patient 5's Patient Information indicated, a start of care (SOC) date of 6/3/22, with diagnoses that included Type 2 Diabetes Mellitus (an impairment in the way the body regulates and uses sugar (glucose) as a fuel) with left foot wound. During a review of Patient 5's Plan of Care (POC), for the certification period from 4/13/22 to 6/11/22, included an order for skilled nurse (SN) to visit for once a week for nine weeks. The SN was to provide a sharps container for the patient. On 6/4/22, at 12 p.m., a home visit was conducted at Patient 5's residence with the Director of Patient Care Services (DPCS) Patient 5 was observed sitting on a chair in the living room. On 6/4/22 at 12:15 p.m., the DPCS was observed using the glucometer to check Patient 5's blood sugar. The DPCS did not have a sharps container to dispose of the needle. The DPCS stated the patient should have a sharps container in their home. The HHA's undated policy and procedure titled " Infection Control" indicated the plan defines the structures and activities for surveillance prevention and control of infections among clients and all others who come into contact with clients and established responsibility for oversite of these activities. a. During an observation on 6/3/22 at 3:30 p.m., upon entrance to the HHA, there was no screening for COVID-19 signs and symptoms, and no temperature checks were performed to the visitors entering the facility. An interview was conducted with the Director of Patient Care Services (DPCS) on 6/3/22, at 4 p.m., she stated that agency screen employees and document screening on the computer, but she did not know she had to also screen visitors.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview , and record review , the home health agency (HHA) failed to follow the plan of care (POC) for two of seven patients (Patient 5 and 6). This failure had the potential to affect the patient's progress in reaching their goals. a. A review of Patient 5's Patient Information indicated, a start of care (SOC) date of 6/3/22, with diagnoses that included Type 2 Diabetes Mellitus (an impairment in the way the body regulates and uses sugar (glucose) as a fuel), and left foot wound. During a review of Patient 5's Plan of Care (POC), for the certification period from 4/13/22 to 6/11/22, included an order for skilled nurse (SN) to visit once a week for nine weeks. On 6/4/22, at 12 p.m., a home visit was conducted at Patient 5's residence with the Director of Patient Care Services (DPCS). Patient 5 was observed sitting on a chair in the living room. Patient 5 stated, he has pain to the left foot wound during wound care treatment. Patient 5's pain was described at level 8/10 (very severe pain). Patient 5 stated that he did not have any pain medication ordered. During an interview with the DPCS on 6/4/22 at 12:30 p.m., she stated she will call the doctor for a pain medication order. The HHA'S undated policy titled "Pain Assessment" indicated continuous assessment of pain must be performed during each follow-up visit. b. A review of Patient 6's "Patient Information" indicated, a SOC date of 1/13/22, with diagnoses that included chronic obstructive pulmonary disease (COPD- disease that causes airflow blockage and breathing-related problems). During a review of Patient 6's POC, for the certification period from 5/13/22 to 7/11/22, included an order for SN to visit for once a week for eight weeks. The SN was to perform pulse oximetry (monitoring oxygen saturation) reading and report to physician for oxygen saturation of less than 90%. During record review on 6/4/22, at 12 p.m., the nurse's notes dated 5/13/22, 5/17/22 and 5/24/22, did not include pulse oximetry reading documented during the SN visits. During an interview with the DPCS on 6/4/22 at 12:30 p.m., she confirmed the nurse should follow the POC and document the pulse oximetry reading every visit. The HHA'S undated policy and procedure titled " Plan of Care", indicated the POC serves as a measurable guideline to care given by all professional disciplines involved in client care.