Every finding on record at Constant Care Home Health Services LLC

EXTENDED RECERTIFICATION SURVEY SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 62663 No deficiencies were cited related to the allegation contained in substantial allegation 62663 completed on 05/17/22; however, the facility was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiency are cited. Constant Care Home Heath Services, 369045, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C Home Health Agency. An onsite entrance conference was conducted with the Administrator the morning of 05/09/22, and a phone exit conference was completed with the Administrator the morning of 05/17/22. Constant Care Home Health Services is precluded from providing its own home health aide training and competency testing or competency evaluation program for a period of two years from the date of the receipt of the deficiency report (2567) for this survey.

Infection prevention and control CFR(s): 484.70 Condition of Participation: Infection prevention and control. The HHA must maintain and document an infection control program which has as its goal the prevention and control of infections and communicable diseases. This CONDITION is not met as evidenced by: Based on review of QSO memo 22-09-ALL Attachment G, review of facility COVID-19 vaccination records, observation, staff interview, and review of the facility policy, the facility failed to ensure 100% of staff were either vaccinated or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC) within 90 days from the effective date of the healthcare worker vaccine mandate and the agency failed to follow it's contingency plan in their policy for unvaccinated staff to prevent the spread of COVID-19. The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' infection control needs would be met (G687).

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on review of QSO memo 22-09-ALL Attachment G, review of facility COVID-19 vaccination log, staff interview, observation, and review of the agency policy, the agency failed to ensure 100% of staff were either vaccinated or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC) within 90 days from the effective date of the healthcare worker vaccine mandate, and the agency failed to follow their policy by allowing unvaccinated staff without an approved exemption to continue working with patients. The agency’s percentage of vaccinated staff for COVID-19 was 91.8%. This affected nine patients (Patient #4, #5, #6, #7, #8, #9, #10, #11, and #12) who continued to receive care from eight staff members (Staff D, E, F, G, H, I J, and K) the facility identified as unvaccinated for COVID-19 without a qualifying medical or religious exemption and one staff (Staff C) discovered at the time of the survey to be unvaccinated for COVID-19 without a qualifying medical or religious exemption. The agency census was 252. Findings include: Review of QSO memo 22-09-ALL Attachment G, dated 01/14/22, revealed within 90 days of issuance of this memorandum all , 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC). The memo also states the home health agency (HHA) must develop and implement policies and procedures which includes the contingency plan for staff who have not completed the primary vaccination series for COVID-19. Contingency plans should include actions that the agency would take when staff have indicated that they will not get vaccinated and do not quality for an exemption. Facilities should prioritize contingency plans for those staff that have obtained no doses of any vaccine over staff that have received a single dose of a multi-dose vaccine. For example, contingency plans could include a deadline for staff to have obtained their first dose of a multiple-dose vaccine. The plans should also indicate the actions the HHA will take if the deadline is not met. Review of the staff vaccination log revealed the agency reported a total of 98 staff. The agency log indicated 89 staff were fully vaccinated and one staff had a medical exemption. The agency's vaccination rate was 91.8%. The agency identified there were no COVID-19 vaccinations or exemptions on file for the following employees who provided direct patient care: Staff D, E, F, G, H, I J, and K. The agency identified Patient #5, #6, #7, #8, #9, #10, #11, and #12 as receiving care from the eight unvaccinated staff members. Observation on 05/12/22 starting at 11:10 AM during a home visit of Patient #4 revealed Staff C was the caregiver. Staff C was identified to be unvaccinated for COVID-19. Staff C, was wearing an N-95 mask, gloves, and all standard precautions were observed as being followed during the visit. Interview with Staff C at the time of the home visit observation confirmed he/she was unvaccinated for COVID-19. Staff C stated the reason for being unvaccinated was for religious purposes. Staff C was unable to confirm a religious exemption was submitted to the agency. Review of the agency policy titled "COVID-19 Vaccination Contingency Plan Policy," approved 01/10/22, revealed employees that are eligible for the COVID-19 vaccine and have not been granted a medical or spiritual/religious exemption or a temporary exemption will be notified of the option to resign. Eligible employees that refuse the COVID-19 vaccine will no longer be eligible for employment. Interview with Staff A on 05/12/22 at 1:35 PM confirmed the facility did not have 100% of the staff vaccinated for COVID-19. Staff A verified Staff C was not vaccinated for COVID-19 and did not have a religious exemption approved by the agency. Staff A also confirmed the agency failed to follow the agency policy regarding unvaccinated employees by allowing Staff C, D, E, F, G, H, I J, and K to continue to work with patients. This was an incidental finding discovered during the complaint investigation.