Every finding on record at Compassionate Hearts Home Health 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 # 44916, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 151 Active Patients - 67 Sample Size - 7 Home Visits- 3

Plan Based on All Hazards Risk Assessment CFR(s): 484.102(a)(1)-(2) §403.748(a)(1)-(2), §416.54(a)(1)-(2), §418.113(a)(1)-(2), §441.184(a)(1)-(2), §460.84(a)(1)-(2), §482.15(a)(1)-(2), §483.73(a)(1)-(2), §483.475(a)(1)-(2), §484.102(a)(1)-(2), §485.68(a)(1)-(2), §485.625(a)(1)-(2), §485.727(a)(1)-(2), §485.920(a)(1)-(2), §486.360(a)(1)-(2), §491.12(a)(1)-(2), §494.62(a)(1)-(2) [(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 the following:] (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.* (2) Include strategies for addressing emergency events identified by the risk assessment. * [For Hospices at §418.113(a):] Emergency Plan. The Hospice must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach. (2) Include strategies for addressing emergency events identified by the risk assessment, including the management of the consequences of power failures, natural disasters, and other emergencies that would affect the hospice's ability to provide care. *[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. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents. (2) Include strategies for addressing emergency events identified by the risk assessment. *[For ICF/IIDs at §483.475(a):] Emergency Plan. The ICF/IID must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing clients. (2) Include strategies for addressing emergency events identified by the risk assessment. This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to implement and maintain their emergency preparedness plan/drill for all field and office staffs. This failure has the potential for the staffs to lack the knowledge to respond effectively during an emergency/disaster crises situation. Findings: On 12/5/22, during a review of the HHA's list of hired employees indicated a total of 63 office and field staffs, (18 skilled nurses, 18 physical therapists, 6 occupational therapists, 4 speech therapists, 4 medical social workers, 4 home health aides, 1 case manager, and 9 office staffs). During a review of the HHA's earthquake drill/ in-service on 10/20/22, at 1020 a.m., disclosed in the " Staff Sign in Sheet" six office staffs signed in and attended the earthquake drill out of 63 staffs. During an interview with the Administrator (Admin) on 12/5/22, at 1:20 p.m., stated the agency's coverage service area was within a 75-mile radius from the agency. Admin also stated they have staffs assigned to see their patient at different areas. Admin stated the drill/in service was conducted for all field staffs, however there was no documented evidence the staff attended the earthquake drill. Admin stated the importance of all staffs to attend the emergency preparedness drill to know how to respond effectively in case of emergency. A review of the HHA's undated document titled " Emergency Management Plan" indicated, The HHA must develop and maintain an emergency preparedness plan that must be reviewed and updated at least annually. The plan must do all the following: address patient population, including but not limited to, the type of services the HHA has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans. The HHA must maintain documentation of the training. Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing the services under arrangement, and volunteers, consistent with their expected roles.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 151 Active Patients - 67 Sample Size - 7 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, and current medication profile for 1 of 7 patients (Patient 4). This failure has the potential to result in placing the patient at risk for medication errors and adverse drug reactions. Findings: A review of Patient 4's "Home Health Certification and Plan of Care" indicated, a start of care (SOC) date of 11/22/21 with diagnoses that included chronic obstructive pulmonary disease (a condition involving constriction of the airways and difficulty or discomfort in breathing) ,and lupus anticoagulant syndrome (a rare autoimmune disorder that causes blood clots to form in various parts of the body. It's more common in people with lupus, so it's also called lupus anticoagulant syndrome. Depending on the location of clots, the effects can be life threatening). A review of Patient 4's Plan of Care (POC) for certification period of 11/17/22 to 1/15/23 indicated skilled nurse (SN) to continue to perform observation and assessment of all body systems, signs and symptoms of infection, medication/diet compliance and effectiveness, knowledge and compliance with proper diet, home safety and caregiving situation, assess pain level, joint function and mobility, swelling, functional status, skin integrity, assess proper oxygen use, care and maintenance. SN to continue instruct and reinforce teachings on disease process, risk factors and management, precipitating factors, medication regimen, oxygen use, care and precaution, breathing treatment, assess for home safety/fall risk. SN visit frequency once a week for nine weeks. A home visit was conducted on 12/6/22, at 12:08 p.m., with Licensed Vocational Nurse 1(LVN 1). Patient 4 was observed sitting in the couch inside her room, alert and oriented to name, place, and time, not in any respiratory distress. LVN 1 started her visit. During a review of Patient 4's medications on 12/6/22, at 12:30 p.m., indicated the following medications were not updated in the medication profile: Xanax 0.25 milligrams (mg- a unit of measurement) 1 tablet three times a day as needed for anxiety. The patient's medication was kept on an unmarked bottle. Patient 4 stated she poured the new medication in the unmarked bottle and threw the other bottle in the trash. Patient 4 also stated that her Xanax was changed to 2 mgs. Patient 4 stated she cuts the tablet in half and takes half a tab four times a day as needed for anxiety. Prednisone 10 mg 1 tablet daily for breathing. Patient 4 stated it was discontinued but still present on the POC. Tylenol 500 mg 2 tablets every 6 hours as needed for pain. Patient 4 has a bottle of Tylenol Arthritis 650 mg tablet on hand. Patient 4 stated she takes 1-2 tablets as needed for pain. Clopidogrel 75 mg 1 tablet daily as antiplatelet. Patient stated was discontinued. Vitamin B-6 50 mg 1 tablet daily. Patient stated, "not taking anymore". Triolto-Respimat inhaler 1 puff as needed every day for wheezing. Patient stated was a new medication that she started several weeks ago. During an interview with LVN 1 on 12/6/22, at 1 p.m., after the home visit, LVN 1 stated " I always ask the patient if she has new or changed medications every time, I visit her." LVN 1 stated "It's totally on my part to call and verify the correct medication orders to the physician. LVN 1 stated the importance of checking medication bottles every visit. During a joint interview with the Chief Executive officer (CEO) and the Director of Patient care Services (DPCS) on 12/7/22 at 12:15 p.m., CEO stated the skilled nurse should follow accepted standards of practice in documentation of correct medication to avoid medication errors and adverse effects. A review of the HHA's policy titled " Medication Reconciliation" revised March 2018, indicated the Agency will reconcile patient's medications at time of admission and on an ongoing basis in order to identify potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy and non-compliance with drug therapy. At time of admission, the admitting registered nurse (RN), Physical therapist (PT), will create and document a complete list of medications that the patient is taking at home, including dose, strength, route and frequency. Any concerns or discrepancies will be reconciled by an RN with the patient's physician. Agency will document. Patients and families will be reminded to discard old medication lists to update records with all medication providers and applicable retail pharmacies. A review of the HHA's policy titled " Medication Orders" revised March 2018, indicated agency staff will verify with the physician for any incomplete, illegible, or unclear medication orders prior to administering the medication and/or providing patient education about the medication. A review of the HHA's policy titled " Medication Labels" revised March 2018, indicated Agency staff will review patient's medications at the time of admission and on an ongoing basis. Each medication should be labeled with the medication name, strength, dose, frequency and expiration date.

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 provide an individualized plan of care that included continuous education and teaching for wound care for 1 out of 7 sampled patients (Patient 6). This deficient practice has the potential risk in the decline of the wound condition, infection or delayed wound healing. Findings: A review of Patient 6's “Home Health Certification and Plan of care” indicated a start of care (SOC) on 3/12/22 with a diagnosis of left heel skin graft (foot skin graft and tissue replacement can be used to treat foot ulcers in people by reconstructing the skin defect). The plan of care for certification period of 11/7/22 to 1/6/23, included skilled nurse visits twice a week for 9 weeks. The skilled nurse was to continue to perform observation and assessment observation and assessment of vital signs and all body systems with emphasis on integumentary, pressure ulcer healing progress, measurements, drainage, odor, color, character of surrounding skin, signs and symptoms of infection, knowledge and compliance with wound care regimen, blood pressure changes, medication compliance and effectiveness, home safety and caregiving situation. Patient and caregiver will demonstrate knowledge of proper wound care and implement measures to hasten wound healing in 2-3 weeks. A review of the wound care orders dated 11/16/22, indicated to stop current wound care and add Betadine wet to dry and add Kerlix wrap to wound site and secure with tape to protect wound site every other day due to use of orthopedic boot during physical therapy. During an interview with the case manager (CM) stated Patient 6’s caregiver was forgetful and did not qualify to perform wound care. CM also stated that Patient 6 was not able to reach the affected area to perform wound care by himself. During a concurrent review of Patient 6’s POC indicated for the patient and caregiver will demonstrate knowledge of proper wound care and implement measures to hasten wound healing in 2-3 weeks. There was no documented evidence the Patient 6 and caregiver were taught and demonstrated proper wound care to achieve the patient care goals to hasten wound healing in 2-3 weeks. A review of the HHA’s policy titled “Coordination of Patient Care” revised March 2019, indicated Agency staff members regularly communicate to ensure their efforts are coordinated effectively and ultimately support the objectives outlined in the plan of care. Ensure that each patient, and his or her caregivers, where applicable receives ongoing education and training provided by the agency, as appropriate, regarding the care and services identified in the plan of care. The Director of patient care Services (DPCS) provides oversight of all patient care services including the development, implementation and updates of the individualized plan of care. A review of the HHA’s policy titled “Patient Education” revised March 2018, indicated that based on the patient’s condition, physician ordered care and assessed needs, patient and family will receive education as appropriate about plan of 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, interview, and record review, the agency failed to label and monitor the expiration dates of the medications/treatment stored in the supply/storage room. This failure has the potential for the unlabeled medication/treatment will be re-used after the expiration dates. Findings: On 12/5/22, at 12:05 p.m., during a facility tour of the supplies/storage area with the office staff, it was observed packs of 4x4 gauze (absorbent dressing for wounds) and Calmoseptine cream (used to treat and prevent minor skin irritations) were stored on the shelf. These supplies did not have expiration dates labeled. During a review of the packing slip indicated the supply was delivered on 11/23/22. There was no written documentation of expiration dates on the receipt. On 12/5/22 at 12:05 p.m., the office staff confirmed there were no expiration dates on the supplies. A review of the HHA's policy titled " Medication Storage" revised March 2018, indicated that the agency will properly store medications properly and safely, only as permitted only by State Board of Pharmacy rule and other applicable laws and regulations. If the Agency stores medications onsite in office, medications will be stored properly and safely. Medications will be stored under proper conditions to ensure stability. Medications will be appropriately labeled. If the Agency stores medications, the storage area will be periodically inspected to make sure that the medications are stored properly.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on interview, and record review, the agency failed to check the patient’s blood sugar every visit and calibrated (important process to ensure the calibration strip matches the code displayed in the glucometer and on the test strips in the box) the glucometer (device to measure concentration of glucose in the blood) for 1 out of 7 sampled patients. (Patient 5). This deficient practice has the potential the blood sugar levels results will not be accurate that could impact the patient's health status and wellbeing. Findings: A review of Patient 5's clinical record indicated a start of care (SOC) of 6/8/21, with the diagnosis of type 2 diabetes (A chronic condition that affects the way the body processes blood sugar) with foot ulcer (A diabetic foot ulcer is an open sore or wound). The plan of care (POC) for certification period of 11/30/22 to 1/28/23, included skilled nurse (SN)to notify MD (medical doctor) for blood sugar less than 60 milligrams per deciliter (mg/dl- a unit of measurement) or greater than 300 mg/dl if symptomatic. SN to monitor signs and symptoms of hypo/hyperglycemia (hypo- low and hyper high blood sugar) and complications of uncontrolled blood sugar level. SN to visit once a week for 9 weeks. On 12/3/22, at 3 p.m., Ddring a phone interview with the Licensed Vocational Nurse 1 (LVN 1) stated she checked Patient 5’s blood sugar during her visit. LVN 1 also stated that she did not know what kind of glucometer the patient used. LVN 1 also stated she did not know if Patient 5's glucometer required to be calibrated. On 12/7/22, at 12:15 p.m., during a joint interview with the Chief Executive Officer (CEO) and the Director for Patient Care Services (DPCS) both stated that SN should follow the standards of practice of knowing what kind of glucometer the patient was using at home and know if it needed to be calibrated and should be documented in the nurse's notes. A review of Patient 5's "Nurse Progress Notes" dated 12/2/22, indicated no written documentation for type of glucometer and calibration on record. A review of the HHA's undated policy titled "Blood Glucose Monitoring" indicated to check accuracy and precision. Meter must meet OSHA (Occupational Safety and Health Administration) standards to prevent contamination when cleaning or using the meter. Review the package instructions included with the reagent strips. Also, review the operating manual of an automated lancet device and/or a reflectance meter/glucometer(if used). Document in the clinical record calibration or testing of the meter , as applicable.