Every finding on record at Cody Regional Health Home Health

A recertification survey was conducted by Healthcare Licensing and Surveys from 11/14/22 through 11/16/22.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on observation, medical record review, staff interview and policy review the facility failed to maintain an individualized plan of care for 1 of 9 patient (#1) care plans reviewed. The findings were: Review of the medical assessment record dated 11/07/22 for patient #9 showed the patient was admitted for home health care on 11/07/22 with diagnoses which included fracture of the pubis, pain, urinary tract infection, essential hypertension, spinal stenosis, and coronary artery disease. The physician orders dated 11/01/22 included tramadol, lidocaine patch, and oxygen at 8-15 liters per minute continuous flow. The following concerns were identified: a. Observation on 11/15/22 at 1:45 PM showed the patient was seated in a recliner with oxygen provided by a concentrator set at 8 liters per minute. As nurse #6 started to assist the patient to transfer to a four wheel walker, the patient indicated the inability to walk without high-flow oxygen via mask from a portable oxygen cylinder being added to the at-rest oxygen provided from the concentrator. b. Interview with nurse #6 on 11/15/22 at 2:09 PM revealed s/he was unaware of the additional oxygen requirement. c. Review of the care plan for patient #9 showed that an oxygen use plan had not been included. d. Interview with the clinical coordinator on 11/15/22 at 4:44 PM revealed that oxygen therapy should have been included in the care plan and that it would be added. e. Review of an undated policy titled "Home Health Coordination of Services" showed "Communication shall be maintained between those providing services regarding changes in the patient's needs, services or care to be provided, or goals that impact the overall care...The individualized plan of care shall be available to all appropriate staff, and physicians involved in the patient's care."

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, staff interview and policy review the facility failed to provide infection prevention procedures to maintain patients a safe clean environment for 1 of 3 patients (#1) observed for patient care. The findings were: Review of the medical assessment record dated 11/11/22 for patient #1 showed the patient was admitted for home health care on 11/11/22 with diagnoses which included enterocolitis, acute thrombosis of internal jugular, essential hypertension, atrial fibrillation, and neoplasms of the breast, bone, lung, colon, and liver, and chronic obstructive pulmonary disease. Physician orders included multiple pain medications and oxygen administered at 2 liters per minute supplied by concentrator. The following concerns were identified: a. Observation on 11/16/22 at 10 AM showed nurse #3 provided care for resident #1 which included review of patient condition and needs, education reinforcement and review of vital signs including blood pressure, oxygen saturation, temperature by temporal scanning, pulse and respirations with evaluation of lung and abdominal sounds using a stethoscope. Following the patient assessment at 10:20 AM the equipment used was returned to their individual containers and then to the nursing bag without decontamination. b. Interview with the agency administrator on 11/16/22 at 11:05 AM revealed it was the agency expectation that all equipment be appropriately decontaminated prior to return to the nursing bag. c. Review of the undated policy titled "Homecare Field Bag Technique and Supplies" showed "When the visit is completed, reusable equipment will be cleaned using germicidal disposal wipes, following the manufacturer's instructions, hands will be washed and equipment and supplies will be returned to the bag."