Every finding on record at City of Cookeville

An Emergency Preparedness Survey was conducted on 4/11/2022-4/13/2022 at Cookeville Regional Home Health. No deficiencies were cited under 42 CFR 484.102.

A Recertification survey was conducted on 4/11/2022-4/13/2022 at Cookeville Regional Home Health. Deficiencies were cited under 42 CFR Part 484, Requirements for Home Health Agencies.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on medical record review and interview, the agency failed to conform with physician orders for 3 patients (#5,#7, and #12) of 17 patients reviewed. The findings include: Medical record review revealed Patient #5 was admitted to the agency on 11/16/2021 with diagnoses including Pressure Ulcer to Left Heel (Unstageable), Dementia, Atrial Fibrillation, and Hypertensive Heart Disease. Review of the plan of care dated 3/16/2022 to 5/14/2022 revealed a physician's order for the skilled nurse to assess wound status and perform wound care to right lateral foot 2 times a week as needed. Review of Patient #5's skilled nurse's note revealed the skilled nurse failed to obtain a weekly wound measurement on 3/30/2022. Review of the wound flowsheet showed the skilled nurse failed to obtain a weekly wound measurement for the week of 3/30/2022. During a interview with the Clinical Manager on 4/13/2022 at 8:48 AM, revealed the skilled nurses are to measure wounds once weekly. Continued interview confirmed the skilled nurse had not measured the wound on 3/30/2022. Interview with the Administrator on 4/13/2022 at 9:25 AM, confirmed the agency failed to obtain the patient's wound measurement on 3/30/2022 and did not conform to the physician's orders. Medical record review revealed Patient #7 was admitted to the agency on 1/25/2022 with diagnoses including Type 2 Diabetes Mellitus, Chronic Kidney Disease, and Urinary Catheter. Review of the plan of care dated 3/26/2022 to 5/24/2022 revealed a physician's order for the skilled nurse to "...Assess pain including pain level..." Review of skilled nurse's notes dated 4/4/2022 revealed the skilled nurse did not assess Patient #7's pain level as ordered by the physician. During an interview on 4/13/2022 at 8:56 AM, the Clinical Manager confirmed the skilled nurse had not assessed Patient #7's pain on the 4/4/2022 visit. Medical record review revealed Patient #12 was admitted to the agency on 3/18/2022 with diagnoses including Type 2 Diabetes Mellitus, Hypertensive Heart Disease, and Chronic Kidney Disease. Review of the plan of care dated 3/18/2022 to 5/16/2022 revealed a physician's order for the skilled nurse to "...Assess pain including pain level..." Review of skilled nurse's notes dated 3/25/2022, 3/28/2022, and 4/6/2022 revealed the skilled nurse had not assess Patient #12's pain level as ordered by the physician. During an interview on 4/13/2022 at 8:36 AM, Quality Nurse #1 confirmed the skilled nurse had not assessed Patient #12's pain level as ordered by the physician.

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 review, medical record review, observation, and interview, the agency failed to maintain infection control practices during wound care for 2 patients (#1 and #4) of 7 residents reviewed with home visits. The findings include: Review of the agency policy titled, "Infection Control for Home Health," revised 10/2019, showed "...Standard precautions must be used and are based on the principle that all blood, body fluids, secretions and excretions may contain transmissible infectious agents...There are...standard precautions which apply during any episode of patient care...Hand Hygiene should be performed at a minimum...Before performing an aseptic [practices used to prevent contamination] task for example...performing wound care...After contact with the patient...After contact with...body fluids or contaminated surfaces...Moving from a contaminated body site to a clean body site during patient care..." Medical record review showed Patient #1 was admitted to the agency on 6/25/2021 with diagnoses including Non-Pressure Chronic Ulcer, Peripheral Vascular Disease, and Type 2 Diabetes. Review of Patient #1's plan of care dated 2/20/2022-4/20/2022, showed "...Perform wound care/dressing change...3 times a week..." Observation of Patient #1's wound care, in the patient's home, on 4/11/2022 at 1:23 PM, showed Registered Nurse (RN) #1 put on gloves and removed a soiled dressing from Patient #1's left lower leg. The RN touched the computer and then obtained a clean dressing from a box of supplies in the patient's home. Continued observation showed RN #1 had not changed the gloves or performed or hand hygiene. Medical record review showed Patient #4 was admitted to the agency on 11/16/2021 with diagnoses including Pressure Ulcer of Sacral Region, Pressure Ulcer of Other Site, Pressure Ulcer of Left Heel, and Unspecified Dementia without Behavioral Disturbance. Review of Patient #4's plan of care dated 3/16/2022-5/14/2022, showed "...Perform wound care /dressing change to right...foot 2x/wk [2 times per week]...Wound care to Coccyx [tailbone]...twice weekly...Wound care to left heel..." Observation of Patient #4's wound care, in the patient's home, on 4/12/2022 at 9:44 AM, showed Licensed Practical Nurse (LPN) #1 put on gloves, cleaned the wound on the coccyx, and applied a clean dressing without changing the gloves or performing hand hygiene. The LPN applied clean gloves and then removed the soiled dressing from the left heel, cleaned the wound to the left heel, and applied a clean dressing without changing the gloves or performing hand hygiene. During an interview on 4/13/2022 at 8:30 AM, Quality Nurse #1 confirmed gloves should be changed prior to touching equipment or supplies after removing a soiled dressing. She confirmed gloves should be changed prior to applying a clean dressing after removing a soiled dressing and cleaning a wound.