Every finding on record at Comprehensive Health Care, 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 # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - 193Active Patients -50Sample Size - 8 Patients Home Visits- 3

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (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 all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [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. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to implement the emergency preparedness plan/drill by not training the field staff in an annual basis. This failure resulted in the staff not being trained on the emergency preparedness which had the potential for the staff to have lack of knowledge and not able to respond effectively during a emergency/disaster situation. Findings: During a review of the emergency preparedness plan of the HHA on 1/25/22 at 1:30 p.m., the HHA did not have evidence that the field staff were trained on Emergency Preparedness/Disaster Drill. During an interview with the Administrator and Director of Patient Care Services on 1/25/22 at 1:35 p.m., they stated they could not provide evidence of the field staff receiving emergency preparedness training/disaster drill training. The HHA's undated policy and procedure titled "Emergency Preparedness Plan" indicated all staff shall receive emergency preparedness training appropriate for their position on a yearly basis.

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 # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - 193Active Patients -50Sample Size - 8 Patients 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, current medication profile for two of eight sampled patients (Patient s 1 and 3) . This failure had the potential to place the patients at risk for medication errors and adverse drug reactions. A review of Patient 3's Patient Profile indicated, a start of care (SOC) date of 10/5/18, with a diagnosis that included benign prostatic hyperplasia (enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder). During a review of Patient 3's Plan of Care (POC), for the re-certification period from 1/17/22 to 3/17/22, included an order for skilled nurse (SN) to visit once a week for nine weeks and as needed for leakage on suprapubic area. Patient 3's physician's order dated 11/17/21 indicated to administer baby aspirin 81 milligrams (mg- unit of measurement) 1 tablet orally daily. On 1/22/22, at 1:00 p.m., a home visit was conducted at Patient 3's residence with licensed vocational nurse (LVN 2) . Patient 3 was observed sitting on a chair in the living room. LVN 2 proceeded to move the patient into his bedroom to administer care. During a review of Patient 3's medications on 1/22/22 at 1:30 p.m. the patient's family member stated they did not have the medication aspirin because the patient has not taken since June 2021. During this same time and date, LVN 2 stated that she should be checking the medications to ensure the medication profile is up to date. The HHA's policy and procedure dated 8/2/09 and titled "Medication profile/ reconciliation" indicated patients receiving medications will have a current, accurate medication profile in the clinical record. A review of Patient 1's Patient Profile indicated, a start of care (SOC) date of 05/29/2021, with a diagnosis that included retention of urine (inability to completely or partially empty the bladder) and epilepsy (a neurological disorder in whish brain activity becomes abnormal causing tremors or seizures and sometimes loss of awareness). During a review of Patient 1s Plan of Care (POC), for the re-certification period from 11/25/2021 to 01/23/2022, included an order for skilled nurse (SN) to visit twice a week for eight weeks. On 1/21/2022 at 11:00 a.m., during a concurrent home visit and medication review indicated that Enulose 10gm/15 ml was not listed on patient 1's medication profile. Caregiver stated medication was ordered last September 2021. On 1/21/2022 at 11:30 a.m., during a concurrent interview and record review with the Director of Nursing confirmed that the medication profile was not updated timely.

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, interview and record review, the home health agency (HHA) failed to maintain an accurate, individualized plan of care for one of eight sampled Patients (Patient 1). This deficient practice had the potential to negatively affect the patient's physical , mental, psychosocial wellbeing. Findings: A review of Patient 1's Patient Profile indicated, a start of care (SOC) date of 05/29/2021, with diagnoses that included retention of urine (inability to completely or partially empty the bladder) and epilepsy (a neurological disorder in whish brain activity becomes abnormal causing tremors or seizures and sometimes loss of awareness). During a review of Patient 1s Plan of Care (POC), for the re-certification period from 11/25/2021 to 01/23/2022, included an order for skilled nurse (SN) to visit twice a week for eight weeks. SN to notify MD (Medical Doctor) any problems or discomfort urinating, changes in urine output, color, amount, and odor, signs and symptoms of urinary tract infection related to use of in and out straight catheter, presence of foul-smelling cloudy urine output, fever, chills, flank pain, dysuria and dribbling, pain level, development of skin breakdown or infection or any changes in patient's condition. On record review of Patient 1’s 30-day Summary report dated 12/24/2021, LVN 1 wrote “SN performed skilled assessment and observation of all bodily systems with no documented evidence of bowel and bladder, catheter problems, activities of daily living (ADL) such as toileting, hygiene and equipment use. Checked pain and unstable/abnormal vital signs with no written documentation of vital signs on notes. During a record review of Patient 1’s Nursing Progress Notes on 1/14/2022 homebound status assessment indicated patient is bed/chair bound, requires assistance with ADLs and no problems with motor/musculoskeletal status. On 1/21/2022 at 11:00 a.m., during a home visit, Patient 1 was observed to ambulate using a walker. Caregiver at board and care stated that Patient 1 requires assistance with ADLs such as toileting, hygiene, and meal preparation. Caregiver stated Patient 1 had a full diaper this morning and goes to the bathroom frequently with assistance during the day. A review of the Home Health Agency policy, titled, "Care planning" effective date 08/02/2009 indicated to plan and provide individualized plan of care and or services appropriate to the goals and needs of the patients serviced by Comprehensive Health care, Inc Agency. An individualized plan of care is developed by agency licensed staff for each patient based upon assessment that reflects the patient's identified problems and needs, consistent with physician and licensed independent practitioners’ orders or prescriptions in accordance with applicable laws and regulations. Interventions, including teaching and training guidelines, are appropriate to the scope of practice of the individual developing and or updating the plan of care and consistent with relevant clinical practice guidelines. The plan of care interventions to address the identified patient needs. Measurable patient outcomes, the plan of care is reviewed, updated and or modified at east every 2 weeks and more often as necessary.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to implement infection control practices during suprapubic catheter care for one of eight sampled patients (Patient 3) by failing to clean the catheter before performing the irrigation. This failure had the potential to cause infection. Findings: A review of Patient 3's Patient Profile indicated, a start of care (SOC) date of 10/5/18, with a diagnosis that included benign prostatic hyperplasia (enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder). During a review of Patient 3's Plan of Care (POC), for the re-certification period from 1/17/22 to 3/17/22, included an order for skilled nurse (SN) to visit once a week for nine weeks and as needed for leakage on suprapubic area. The POC indicated the SN will perform suprapubic catheter (tube that is used to drain urine from the bladder) care every visit. The POC indicated to irrigate catheter with 60 milliliter (ml-unit of measurement) of normal saline. On 1/22/22, at 1:00 p.m., a home visit was conducted at Patient 3's residence with licensed vocational nurse (LVN 2) . Patient 3 was observed sitting on a chair in the living room. LVN 2 proceeded to move the patient into his bedroom to administer care. LVN 2 removed the drainage bag from the suprapubic catheter and flushed 40 ml of normal saline filled in a syringe into the catheter without cleaning the catheter. During an interview with LVN 2 on 1//22/22 at 1:30 p.m., she stated that she forgot to clean the suprapubic catheter with an alcohol pad before irrigating the catheter. She stated she should clean the catheter to prevent infection. During an interview with the Director of Patient Care Services (DPCS) on 1/25/22 at 1:05 p.m., he stated that the nurse should have cleaned the catheter with alcohol or betadine before irrigating the catheter.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) staff failed to provide care as ordered by the physician as indicated in the written plan of care (POC) for one of eight sampled patients (Patient 3). The agency staff failed to irrigate the patient's suprapubic catheter with the correct amount (60 milliliter) of normal saline (NS) indicated in the POC. This failure had the potential to clog the patient's catheter. Findings: A review of Patient 3's Patient Profile indicated, a start of care (SOC) date of 10/5/18, with a diagnosis that included benign prostatic hyperplasia (enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder). During a review of Patient 3's Plan of Care (POC), for the re-certification period from 1/17/22 to 3/17/22, included an order for skilled nurse (SN) to visit once a week for nine weeks and as needed for leakage on suprapubic area. The POC indicated the SN will perform suprapubic catheter (tube that is used to drain urine from the bladder) care every visit. The POC indicated to irrigate catheter with 60 milliliter (ml-unit of measurement) of normal saline. On 1/22/22, at 1:00 p.m., a home visit was conducted at Patient 3's residence with licensed vocational nurse (LVN 2) . Patient 3 was observed sitting on a chair in the living room. LVN 2 proceeded to move the patient into his bedroom to administer care. LVN 2 removed the drainage bag from the suprapubic catheter and irrigated the catheter with 40 ml of NS. During an interview with LVN 2 on 1//22/22 at 1:30 p.m. , she stated that she failed to follow the correct amount of NS as indicated in the POC . During an interview with the Director of Patient Care Services (DPCS) on 1/25/22 at 1:05 p.m., he stated the nurse should have followed the POC and irrigate the catheter with the indicated amount of 60 ml of NS. The HHA's policy and procedure titled "Care planning" indicated to plan and provide and individualized care/ and or services appropriate to the goals and needs of patients serviced.

The following reflects the findings of the California Department of Public Health during a complaint investigation. Complaint number: 61582 Representing the California Department of Public Health: Surveyor # 44916, Health Facility Evaluator Nurse The inspection was limited to the specific complaints and facility-reported incidents investigated and does not represent the findings of a full inspection of the facility. One deficiency was issued for Complaint number 61582

Transfer and discharge CFR(s): 484.50(d) Standard: Transfer and discharge. The patient and representative (if any), have a right to be informed of the HHA's policies for transfer and discharge. The HHA may only transfer or discharge the patient from the HHA if: This STANDARD is not met as evidenced by: Based on interview and record review, the facility failed to inform one of one patient, (Patient 9) or its family representative, prior to discharge of plans and reasons for discharge according to the home health agency’s policy and procedure. This failure had denied the patient one of its rights to be informed and had the potential to affect their highest practicable well-being when an unsafe discharge was provided. During a review of Patient 1’s plan of care, it indicated the start of care date was 11/02/2022 with diagnosis that included parkinson’s disease (a brain disorder that presents shaking, stiffness and difficulty with walking, balance and coordination) and dependence on wheelchair. During a review of the Physician’s orders dated 12/21/2021, indicated that the home health agency received a call from Patient 1’s family member (FM) to hold physical therapy (PT, the treatment of disease, injury, or deformity by physical methods), and the physician’s order indicated to discontinue physical therapy as per FM’s request. During an interview on 1/24/2022 at 11:00 a.m., when asked how they would discharge a patient from their services, the Director of Nursing (DON) and the Administrator (Admin) stated they will call the doctor for an order for discharge and complete the discharge OASIS (Outcome and Assessment Information Set, a patient-specific, standardized assessment used in Medicare home health care to plan care, determine reimbursement, and measure quality). Admin also stated that they will call the family or caregiver if the patient is being discharged and tells them that the patients’ goals are met. During an interview on 1/24/2022 at 11:00 a.m., the DON and Admin stated that Patient 1’s FM called and requested to be discharged to another agency and to discontinue PT. DON stated they called the doctor and received the order to discontinue PT services and told contracted PT services of the order. During a review of the clinical record for Patient 1, the documentations did not indicate that the home health agency called the FM to notify regarding Patient 1’s discharge. During a phone interview on 1/24/2022 at 3:30 p.m., FM stated that he requested to be transferred to another home health agency and that the current home health agency did not give him any legal paperwork for the discharge. During a phone interview on 1/28/2022 at 3:38 p.m., the owner of the contracted PT services stated that Patient 1’s FM got upset for having another evaluation and wanted to just continue with physical therapy services and refused to make another appointment for evaluation. A review of the home health agency’s policy and procedure titled “Discharge planning, Transfer and Continuing Care Needs” dated 01/12/2018, indicated that the decision to discharge or transfer a patient from service is made in collaboration with the primary physician, patient/family, and agency staff… Criteria for discharge or transfer may include but not limited to patient requests that services be discontinued, and the physician sanctions the request. It also indicated the staff member should prepare the patient for discharge by instructing the patient/caregiver to perform necessary care and should work toward making alternate plans for continuing care when further healthcare is needed. The agency will work with the physician and patient/caregiver in arranging continuing care of the patient. Agency staff provides patients/caregivers with written and verbal information and assistance, if possible, for resources to meet identified continuing care needs and with information on how to care for themselves. The patient/caregiver, when possible, actively participates in planning for his or her discharge, referral of transfer. Patients are informed prior to discharge of plans for discharge and the reason for discharge.