Every finding on record at Charter Health Holdings, Inc.

Charter Home Health of Omaha, LLC is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

An unannounced recertification survey and complaint investigation were completed on 1/31/23. An allegation of the the complaint was substantiated and a deficiency was cited at G572 related to the allegation. The agency census was 187.

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 record review, policy and procedure review, and staff interview, the agency failed to ensure Home Health Aide services ordered by the physician were provided at the frequency ordered and failed to notify the physician when the agency missed visits for 4 of 17 patient records reviewed (Patients 1, 2, 3, and 12). The census was 187. Findings are: A. Review of the agency policy and procedure titled, Implementing Care and Treatment, effective 1/1/23, revealed it is the policy of the agency to provide the level of care and treatment needed, and will be provided within the frequency parameters established on the plan of care. It also revealed the agency was to notify the responsible physician when the provision of care and treatment cannot be implemented as established on the plan of care. B. Review of Patient 1's clinical record revealed: 1. A Physician Orders form dated 1/2/23, included orders for Home Health Aide (HHA) services 2 times per week for 6 weeks starting 1/1/23. 2. There was one HHA visit completed the week of 1/1/23 and the week of 1/15/23 (1 visit missed each week). 3. There was no documentation in the clinical record explaining the reason for the missed visits. 4. There was no documentation in the clinical record to indicate the physician was notified of the missed visits. C. Review of Patient 2's clinical record revealed: 1. The Plan of Care for the certification period of 12/8/22 through 2/5/23, included orders for HHA services 1 times per week for 1 weeks starting 12/8/22, then 1 time per week for 8 weeks starting 12/11/22. 2. There was no documentation of a HHA visit completed the week of 12/8/22 (1 visit missed). 3. There was no documentation in the clinical record explaining the reason for the missed visits. 4. There was no documentation in the clinical record to indicate the physician was notified of the missed visits. D. Review of Patient 3's clinical record revealed: 1. A Physician Orders form dated 12/7/22, included orders for HHA services 1 time per week for 1 week then 2 times per week for 4 weeks starting 1/1/23. 2. There was no documentation of a HHA visit completed the week of 12/11/22 and the week of 12/18/22 (2 visits missed each week). 3. There was no documentation in the clinical record explaining the reason for the missed visits. 4. There was no documentation in the clinical record to indicate the physician was notified of the missed visits. E. Review of Patient 12's clinical record revealed: 1. The Plan of Care for the certification period of 11/28/22 through 1/26/23, included orders for HHA services 1 times per week for 9 weeks. 2. There was no documentation of a HHA visit completed the week of 11/28/22 and the week of 1/15/23 (1 visit missed each week). 3. There was no documentation in the clinical record explaining the reason for the missed visits. 4. There was no documentation in the clinical record to indicate the physician was notified of the missed visits. F. During an interview on 1/30/23 at 3:30 PM, the Director of Patient Care Services and the Patient Care Services Manager both confirmed the agency failed to provide HHA services as ordered and failed to notify the responsible physician of the missed visits for Patients 1, 2, 3, and 12.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure the patient's medication profile (a real-time document used by the agency that lists patient medications including new and updated orders received between certification periods) included all medication orders as received by the agency for 3 of 17 patient records reviewed (Patients 9, 10, and 13). The census was 187. Findings are: A. Review of the agency policy and procedure titled Physician Orders, effective 1/1/23, revealed: 1. When the nurse or therapist receives an order they are to immediately record the date, specific order, sign the order form and send it to the responsible practitioner for signature. 2. If the client or caregiver initiates an order change that has been communicated to them by a licensed practitioner, the nurse or therapist was to document the day they were informed of the change, and indicate on the order the actual day the order change was made. B. Review of Patient 9's clinical record revealed: 1. The Plan of Care for the certification period of 11/3/22 through 1/1/23 revealed the Assisted Living Facility (ALF) where the patient resides manages/administers the patient's medications. 2. A copy of an ALF Physician Communication form signed and dated by the practitioner on 1/6/23, included an order for Ativan (an antianxiety medication, generically known as lorazepam) 0.5 milligrams (mg) to be taken three times per day (TID) and an additional Ativan 0.5 mg twice a day (BID) as needed (PRN). 3. The patients Medication Profile contained the order for Ativan (lorazepam) 0.5 mg TID, but did not include the PRN dose. C. Review of Patient 10's clinical record revealed: 1. A copy of an ALF Physician Notes and Orders form signed and dated by the practitioner on 1/3/23, included an order for Buspar (an antianxiety medication, generically known as buspirone) 5 mg to be taken BID 2. The patient's Medication Profile did not include the order for Buspar (buspirone). D. Review of Patient 13's clinical record revealed: 1. A hospital Discharge Summary dated 10/9/22, included an order for torsemide (a medication used to treat edema-excess fluid retained in the body) 100 mg tablet, take a half tablet (50 mg) by mouth every day. 2. The patient's Medication Profile lists torsemide 100 mg, take one tablet by mouth daily (dated 10/11/22). This does not match the discharge order. There was no documentation of an order to increase the torsemide to 100 mg daily. 3. The patient's Medication Profile listed an additional, as needed, dose torsemide; if client gains 1-2 pounds per day, take 150 mg that day. There was no documentation is the clinical record to add or clarify the additional, as needed, torsemide dosage. E. During an interview on 1/30/23 at 3:30 PM, the Director of Patient Care Services (Administrator) and the Patient Care Services Manager confirmed the Medication Profile for Patients 9, 10, and 13 did not include accurate, updated, and/or new medications as ordered.

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 record review, policy and procedure review, observation of the provision of cares, and staff interview, the agency failed to ensure 3 of 7 staff (Staff C, D, and F), observed during the provisions of care to Patients 1, 3, and 7, performed appropriate hand hygiene, glove use, cleaning of equipment, and/or use of clean bag technique according to the agency's policies and procedures. Findings are: A. Review of the agency policy and procedure titled Hand Hygiene Policy, effective date 01/01/22, revealed: 1. Staff were to perform hand hygiene before patient contact, prior to entering the nursing bag, before applying gloves, between completing a dirty task and starting a clean task, after removing a dirty dressing and before applying a clean dressing, after contact with bodily fluids, after handling equipment, after touching patient surroundings. 2. Staff were not to use gloves as a replacement for hand hygiene. 3. The agency policies do not address the practice of layering of multiple pairs of gloves during the provision of cares. B. Review of the agency policy and procedure titled Bag Technique, effective 01/01/22, revealed the inside of the supply bag and its contents are considered clean and staff are to clean all items removed from the nurse bag before returning items to the bag. C. The observation of the provision of cares to agency patients revealed: 1. Staff- C was observed to assist with bathing, grooming, and dressing Patient 1 on 1/24/23 between 08:30 AM- 9:20 AM. During the observation Staff- C failed to remove gloves, sanitize hands, and apply a new pair of gloves: a. After providing perineal care (cleaning of the front and back private areas) and prior to washing the patient's hair. b. After applying a moisture barrier cream to the patients perineal area and prior to assisting the patient to dress. 2. Staff- D was observed assist with bathing, grooming, and dressing Patient- 3 on 1/24/23 between 1:00 PM - 1:30 PM. During the observation Staff- D failed to: a. Perform hand hygiene after removing a glove that was used to touch a draining wound and prior to using a cell phone to notify the patient's case manager of the draining wound. b. Sanitize the cell phone after using the cell phone to notify the patient's case manager of the draining wound and prior to putting the cell phone in the staff members pocket. c. Sanitize the electronic tablet (used to document the visit) after the patient held the tablet to electronically sign the visit slip and prior to returning the electronic tablet to the nurse supply bag. 3. Staff- F was observed during the provision of a skilled assessment and wound care to Patient- 7 on 1/26/23 between 12:00 PM - 1:00 PM. During the observation Staff F: a. Applied 2 pairs of gloves to apply the ordered wound dressing to the patients right lower leg, removed one pair of gloves, and proceeded to complete the physical assessment of the patient failing to remove both pairs of gloves, sanitize hands, and apply a new pair of gloves between steps. b. Applied 2 pairs of gloves prior to cleansing the old ointment from the patient's bottom, removed one pair of gloves, proceeded to apply fresh layer of ointment to the patients bottom, failing to remove both pairs of gloves, sanitize hands, and apply a new pair of gloves between steps. D. During an interview on 1/26/23 at 2:00 PM, the Director of Patient Care Services (Administrator) and the Patient Care Services Manager, confirmed agency staff C, D, and F failed to follow the agency policy and procedures for hand hygiene, glove use, and equipment care and confirmed that the use of layering of gloves does not replace the need to sanitize hands between tasks.