Every finding on record at Community Home Nursing and Therapy Services, Inc

Based upon the findings of an unannounced onsite home health agency Medicare recertification survey conducted between 9/8/2021-9/9/2021 and 9/13/2021, Community Home Nursing and Therapy Services, Inc. was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based upon the findings of an unannounced onsite home health agency Medicare recertification survey conducted between 9/8/2021-9/9/2021 and 9/13/2021, Community Home Nursing and Therapy Services, Inc. was found to be not in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 may choose to include. This ELEMENT is not met as evidenced by: Based upon review of agency policy, medical records (MR) including nurses notes, and interview with owner (EMP # 1), agency failed to show plan of treatment contained all required elements including (i) mental status (ii) types of services and equipment required, (iii) frequency of visits, (iv) prognosis, (v) rehabilitation potential (vi) functional limitations, (vii)activiti permitted, (viii) nutritional requirements, (ix) medications and treatments,..." for three (3) of seven (7) files reviewed. (MR # 1; MR # 5; MR # 7). Findings included: Review of agency policy on 9/9/2021 at approximately 2:00 PM titled " Patient Care Policies" stated " The plan, based on patient's immediate and long-term needs, which shall include, but is not limited to the following: ... functional limitations/activities permitted.. nutritional requirements.... medications and treatments..." Review of MR on 9/8/2021 between approximately 11:00 AM-12:00 PM and 1:30 PM-3:00 PM and on 9/9/2021 between approximately 8:30 AM-11:00 AM revealed: MR # 1, Start of Care (SOC) 9/4/2021; physician orders 9/4/2021-11/2/2021; Diagnosis: Pleural Effusion {build up of fluid between layers of tissue outside the lungs}, type 2 diabetes mellitus {excessive sugar in the blood}, essential hypertension {elevated blood pressure}. Orders: "Skilled Nursing (SN) 1-3x/week x 60 days...Teach pt/g {patient/caregiver}s/s {signs/symptoms}of infection: fever" Skilled nursing visit notes: on admission, 9/4/2021, vital signs taken and documented- Temperature {98.0}, pulse {98}, respiratory rate {22}, blood pressure {101/67}, under wound treatment " change dressing to bilateral pleural drains weekly" 9/6/2021- Temperature {97.3}, Pulse {101}, respiratory rate {22}, blood pressure {117/59}, pulse ox {98 %} pain medication listed " extra strength Tylenol pm used nightly at bedtime. Narrative section: " patient demonstrated proper technique of draining bilateral pleural drains... Bilateral pleural drain dressing changed by myself with sterile technique." No physician orders for parameters to contact physician for " fever", pulse oximeter, or orders for drain site care or how often dressing is to be changed. Orders have oxygen listed in body of physician orders but not listed in medications which oxygen is considered. PM Tylenol is listed on nurses notes but not listed anywhere on physician orders. MR # 5, SOC 2/21/2020; physician orders 2/21/2020-4/20/2020; Diagnosis: unspecified combined systolic and diastolic heart failure {right/left ventricles of heart don't contract normally}, weakness, difficulty walking, history of falling. Orders: "Skilled Nursing (SN) 1-3x/week x 60 days..." no physician orders completed for DME and supplies, nutritional requirements, functional limitations. No rehabilitation potential documented on orders. No orders for vital signs. MR # 7, SOC 1/9/2020; physician orders 1/9/2020-3/8/2020; Diagnosis: cellulitis right lower limb { bacterial infection of the skin}; sepsis {infection in blood stream}; gangrene{ death of body tissue due to lack of blood flow}. Orders: " Skilled nursing {SN} 1-3x week x 60 days..." " Interventions to address underlying risk factors for ER/Hospitalization MRSA in the right knee, and staff in the right knee, iv abt tx { intravenous antibiotics treatment}, iv infusion {intravenous medication administration via infusion}, pain acute, wound vac to right knee, allergies, pcn {penicillin}, surgically cleanse right knee, picc {peripherally inserted central catheter}{ tube inserted in a vein passed through larger vein near heart} line single lumen in the right arm." " Integumentary status: teach pt/cg {patient/caregiver} infection control/universal precautions, SN to assess/instruct pt/cg in s/s {signs/symptoms} of infection: fever..." Skilled nursing visit notes: 1/9/2020, vital signs taken { temperature {98.0 F}, pulse {72 and 74}, respirations {16} and blood pressure {80/110}" No documentation of wound vac frequency or settings or dressing change." 1/20/2020: vital signs " temperature {98.0 F}, pulse {78 and 70}, respiratory rate {16}, blood pressure {122/76 and 120/70}". " under musculoskeletal ordered: wound vac as ordered" no documentation of set order, wound vac frequency, or settings, or dressing change." " wound vac set forth by hospital wound clinic" An interview conducted with agency Administrator (EMP # 1) on 9/13/2021 at approximately 2:00 PM confirmed above findings.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on a review of Department of Health (DOH) guidance, review of updated Center Disease Control ( CDC) Guidelines for Tuberculin ( TB) screening for 2019, agency policy, observations, personnel files (PF), and an interview with the agency Administrator (EMP # 1), the agency failed to ensure that everyone entering the health care facility is screened and triaged for COVID-19 for one (1) of one (1) observations (Observation #1); agency failed to complete Tuberculin (TB) screening requirements for four (4) of four (4) PF reviewed. (PF # 1-4). Findings Include: Pennsylvania Department of Health 'Health Alert Network' dated August 7, 2020 'Subject' 'Update: Interim Infection Prevention and Control Recommendations for Patients with known or Patients Under Investigation for 2019 Novel Coronavirus (COVID-19) in a Healthcare Setting' section (I) Recommended Routine Infection Prevention and Control (IPC) Practices During the COVID-19 Pandemic' (B) 'Screen and Triage Everyone Entering a Healthcare Facility for signs and symptoms of COVID-19':....symptom screening remains an important strategy to identify those who could have COVID-19 .......". "Screen everyone (patients, healthcare personnel, visitors) entering the facility for symptoms consistent with COVID-19 .....". "Actively take their temperature and document absence of symptoms consistent with COVID-19". Review of updated CDC TB guidelines for 2019 on 9/8/2021 at approximately 2:30 PM-3:00 PM with updated guidelines to include individual risk assessment and symptom evaluation at baseline (preplacement) and annual TB education of all healthcare personnel. Agency COVID-19 policy/procedures requested on 9/9/2021 2021 at approximately 11:00 a.m. and none were provided. Observation #1: On 9/8/2021 at approximately 9:20 a.m. the state surveyor arrived at the main office entry. No temperature screening nor symptom screening conducted. No COVID-19 screening log observed. Review of PF on 9/8/2021 between approximately 10:45 AM-11:30 AM and 9/9/2021 between approximately 10:00AM-11:00AM revealed: PF # 1, Date of Hire (DOH) 6/18/2021; no risk assessment tool documented. Tool from CDC is titled " Health Care Personnel (HCP) baseline Individual TB Risk Assessment: which asks (1) Temporary or Permanent residence of >or equal 1 month in a country with a high TB rate (2) or current or planned immunosuppression (3) or close contact with someone who has had infectious TB disease since the last TB test" PF # 2, DOH 7/27/2020; no risk assessment tool documented. Tool from CDC is titled " Health Care Personnel (HCP) baseline Individual TB Risk Assessment: which asks (1) Temporary or Permanent residence of >or equal 1 month in a country with a high TB rate (2) or current or planned immunosuppression (3) or close contact with someone who has had infectious TB disease since the last TB test" PF # 3, DOH 2/1/2021; no risk assessment tool documented. Tool from CDC is titled " Health Care Personnel (HCP) baseline Individual TB Risk Assessment: which asks (1) Temporary or Permanent residence of >or equal 1 month in a country with a high TB rate (2) or current or planned immunosuppression (3) or close contact with someone who has had infectious TB disease since the last TB test" PF # 4, DOH 6/5/2019; no risk assessment tool documented. Tool from CDC is titled " Health Care Personnel (HCP) baseline Individual TB Risk Assessment: which asks (1) Temporary or Permanent residence of >or equal 1 month in a country with a high TB rate (2) or current or planned immunosuppression (3) or close contact with someone who has had infectious TB disease since the last TB test" Interview #1: On 9/8/2021 at approximately 10:00 a.m. an interview was conducted with EMP # 1. The administrator was asked what the agency screening protocols are for people who enter the agency office. The administrator stated "The agency used to screen all visitors entering the building but we are all vaccinated". There were two (2) agency staff in the office and shortly thereafter one (1) other employee arrived. No documentation of COVID-19 screening upon entry. An interview conducted with agency Administrator on 9/9/2021 at approximately 2:00 PM confirmed above findings.