Every finding on record at Cosmopolitan Healthcare Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 21860 Burbank Blvd, Suite 180 Woodland Hills, CA. Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 110 Active Patients - 20 Sample Size - 7 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 ensure the emergency preparedness plan/drill for field and office staffs were completed in an annual basis. This failure had the potential for the staff to lack the knowledge to respond effectively during a emergency/disaster situation. Findings: During a review of the emergency preparedness plan of the HHA on 7/17/22 at 11:45 a.m., the HHA did not provide written evidence of Emergency Preparedness training/disaster drill for all field staffs. During a joint interview with the Director of Patient Care Services (DPCS) designee and the Chief Operations Officer (COO) on 7/17/22 at 11:45 a.m., DPCS designee stated they do not have written evidence of the field staff receiving Emergency Preparedness training/disaster drill training. A review of the HHA's policy no 7-001.4 titled "Emergency Management Plan" indicated Cosmopolitan healthcare, Inc. will test the emergency management plan at least annually, either in response to an actual emergency or in a planned exercise. Planned exercises are realistic scenarios and related to the priority emergencies defined by leadership, and DO NOT include tabletop drills nor are they required to be performed in patient's homes. All actual responses and exercises will be documented and critiqued through a multidisciplinary process that includes administrative, clinical and support staff. Documentation will be used to identify deficiencies and opportunities for improvement based on all monitoring activities and observations during the exercise.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 21860 Burbank Blvd, Suite 180 Woodland Hills, CA. Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 110 Active Patients - 20 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 agency staff failed to review all medications the patient is currently using for three of seven patients (Patients 1, 2 and 4 ). This failure has the potential to result in putting the patients at risk for medication errors and adverse drug reactions. a. A review of Patient 1's Patient Profile indicated that Patient 1 is a 59 year old male, alert and oriented with periods of confusion and irritability, Unable to leave home unassisted, used a walker for ambulation. Patient 1's start of care (SOC) date of 2/14/20, with a diagnosis that included diabetes mellitus (A condition results from insufficient production of insulin, causing high blood sugar and breast cancer. During a review of Patient 1's Plan of Care (POC), for the re-certification period from 7/5/22 to 9/2/22, included an order for skilled nurse (SN) to visit once a week for nine weeks to monitor vital signs( blood pressure, blood sugar , respirations, heart rate), teach patient disease process, preventative measures, signs and symptoms of complications and disease management. SN to do medication review /reconciliation every week and ensure compliance to prescribed medication and medication regimen. On 7/16/22, at 10:00 a.m., a home visit was conducted at Patient 1's residence with registered nurse (RN2) . Patient 1 was observed sitting on a chair in the receiving area. RN2 proceeded to administer care. During a review of Patient 1's medications on 7/16/22 at 10:30 a.m., the following medications were not listed on the plan of care(POC): 1. Ferrous sulfate 325 milligrams(mg- a unit of measure for solid medications) 1 tablet every 12 hours as supplement. 2. Seroquel 100 mg 1 tablet in the morning for irritability. 3. Atenolol 50 mg at bedtime for high blood pressure During this same time and date, the following medications were discontinued but still listed in the plan of care: 1. Letrozole 2.5 mg 1 tablet for breast cancer 2. Clonazepam 0.5mg 1 tablet daily for irritability 3. Metformin 1000 mg twice daily for high blood sugar On 7/16/22 at 10:00 a.m., during observation and concurrent interview with RN2 stated that he reviews and reconciles medication every week during every visit. RN 2 was not observed to review the medication box, did not call physician to clarify and review missing medications on the medication profile and POC during the home visit. b. A review of Patient 2's Patient Profile indicated that Patient 2 is a 62 year old male, alert and oriented with periods of forgetfulness, impaired decision making and anxiety, Unable to leave home unassisted. Patient 2's start of care (SOC) date of 4/20/22, with a diagnosis that included unilateral primary osteoarthritis (Primary osteoarthritis refers to degenerative changes to cartilage and joint of unknown cause giving pain to affected leg) and bipolar disorder (A serious mental illness characterized by extreme mood swings. They can include extreme excitement episodes or extreme depressive feelings). During a review of Patient 1's Plan of Care (POC), for the re-certification period from 6/19/22 to 8/17/22, included an order for skilled nurse (SN) to visit once a week for nine weeks to monitor vital signs( blood pressure, blood sugar , respirations, heart rate), teach patient disease process, preventative measures, signs and symptoms of complications and disease management. SN to do medication review /reconciliation every week and ensure compliance to prescribed medication and medication regimen. On 7/16/22, at 11:00 a.m., a home visit was conducted at Patient 2's residence with registered nurse (RN2) . Patient 2 was observed sitting on a chair in the receiving area. RN2 proceeded to administer care. During a review of Patient 2's medications on 7/16/22 at 10:30 a.m., the following medications were not listed on the plan of care(POC): 1. Ferrous sulfate 325 milligrams(mg- a unit of measure for solid medications) 1 tablet every 12 hours as supplement. 2. Seroquel 100 mg 1 tablet in the morning for irritability. 3. Atenolol 50 mg at bedtime for high blood pressure During this same time and date, the following medications were not listed in the plan of care: 1. Sodium chloride (Salt) 1 gram (gm-a unit of measure for solid medications) 1 tablet daily as supplement 2. B Complex mg 1 tablet daily for supplement 3. Phenytoin Sodium 100 mg 2 capsules in the morning for seizures 4. Phenytoin Sodium 100mg 3 capsules at bedtime for seizures 5. Levothyroxine 75 micrograms (mcg- unit for measure for solid medications) 1 tablet daily for low thyroid 6. Clonazepam 1 milligram (mg) twice daily for mood disorder 7. Vitamin C 500 mg 1 tablet daily 8. Memantine 28 mg taken at bedtime not in the morning. On 7/16/22 at 11:00 a.m., during observation and concurrent interview with DPCS designee stated that he reviews and reconciles medication every week during every visit. DPCS designee was not observed to review the medication box, did not call physician to clarify and review missing medications on the medication profile and POC during the home visit. A review of the HHA's policy no. 3-014.1 titled " Medication Monitoring" indicated the ongoing patient medication monitoring will use a collaborative approach among the clinicians, physicians, pharmacists, patients, family and caregivers. The results of medication monitoring will be used to improve the patients medication regime. the ongoing monitoring will occur in accordance with the established goals of therapy and be used to evaluate the continued use of a medication in the current regimen. Evaluate patient adherence to the prescribed medication regimen. The information obtained through patient medication monitoring will be documented in the patient's clinical record and if applicable, in the pharmacy record. A review of Patient 4's Patient Information indicated, a start of care (SOC) date of 6/11/22, with diagnosis that included non-pressure chronic ulcer of left lower leg. During a review of Patient 4's Plan of Care (POC), for the certification period from 6/11/22 to 8/9/22, included an order for skilled nurse (SN) to visit every two to three days for 30 day then re-assess. The SN was to instruct the patient on medication management. A physician's order dated 6/11/22, included to administer Furosemide 40 milligrams (mg-unit of measurement) one tab by mouth daily. On 7/16/22, at 2 p.m., a home visit was conducted at Patient 4's residence with registered nurse (RN 1). During a review of Patient 4's medications indicated a bottle label for Furosemide 40 mg one tab daily. On 7/16/22, at 2:30 p.m., during an interview with Patient 4, he stated he was taking the Furosemide 40 mg medication only as needed. On 7/16/22, at 2:40 p.m., during an interview with RN 1, he stated he checked the patient's furosemide medication bottle but he did not ask the patient if he was taking the Furosemide medication on a daily basis. The HHA's undated policy and procedure titled "Medication Regimen Review/Medication Profile" indicated to ensure ongoing patient monitoring essential to providing appropriate care and to identify potential complications from medication therapy being provided.

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 observation, interview and record review, the agency staff failed to ensure care followed the written plan of care for one of seven sampled patients (Patient 4) with an open wound at left lower leg. This deficient practice has the potential risk in the decline of the wound condition or delayed wound healing. Findings: A review of Patient 4's Patient Information indicated, a start of care (SOC) date of 6/11/22, with diagnosis that included non-pressure chronic ulcer of left lower leg. During a review of Patient 4's Plan of Care (POC), for the certification period from 6/11/22 to 8/9/22, included an order for skilled nurse (SN) to visit every two to three days for 30 days then re-assess. SN was to perform a comprehensive skilled assessment on integumentary status (skin). The SN was to perform wound care every visit to left lower leg. The wound care consisted of cleansing the wound with wound cleanser, pat to dry, and apply Silvasorb gel, then cover with 4x4 Mepilex Border dressing. On 7/16/22, at 2 p.m., a home visit was conducted at Patient 4's residence with registered nurse (LVN 1). Patient 4 was observed with an open wound at the left lower leg with no drainage. A review of Patient 4's Skilled Nursing Visit Notes dated 7/5, 7/11 and 7/13/22, indicated no documented evidence the skilled nurse (SN) assessed the wound condition during the visits. During an interview with the Director of Patient Care Services Designee on 7/17/226/12/22, at 11 a.m., stated the visiting nurse should documented on their notes that they were assessing the patient's wound condition every visit. A review agency's policy and procedure "Wound Assessment (undated)," indicated during initial and follow-up nursing visits, any non-intact skin areas shall be assessed and document, to complete measurement of the wound (length, width, depth) shall be documented at least weekly.

Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA's services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This STANDARD is not met as evidenced by: Based an interview, and record review, the home health agency failed to ensure an ongoing quarterly Quality Assessment and Performance Improvement( QAPI) projects. This deficient practice has the potential for the care and services will not be evaluated and improvement of past performance of services provided will not be identified/assessed that could impact the patients quality of care. Findings: During a review of the HHA’s QAPI plan, and interview with the Director of Patient care designee (DPCS) designee on 7/17/22, at 11:35 a.m., DPCS designee showed no written evidence of a quarterly QAPI review was conducted. DPCS designee further confirmed and stated that they should perform QAPI meeting every quarter. A review of the policy no. 4-004.1 titled “Governing Body” indicated that the Governing body will authorize adequate resources and support to establish and maintain an organization-wide performance improvement program. Information related to the performance improvement program will be provided by the Governing Body.

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 Based on observation, interview, and record review, the hospice agency failed to follow the accepted standards of practice including the use of standard precautions to prevent spread of COVID-19 infection (Coronavirus 19 disease, a highly, contagious respiratory illness caused by virus that spread from person to person) for one of seven patients (Patient 4). This deficient practice placed the patients, staff, and/or visitors at risk for COVID-19 infection and further spread of infection that could lead to severe respiratory illness, hospitalization and/or death. During observation on 7/15/22 at 3:25 p.m., upon entrance to the HHA, staff were not wearing masks and there was no procedures to screen for Covid-19 symptoms including no temperature check. During observation on 7/17/22 at 10:40 a.m., upon entrance to the HHA, there was no procedures to screen for Covid-19 symptoms including no temperature check. On 7/15/22 at 3:45 p.m., during a concurrent interview with the Chief financial officer (CFO) stated that she just came back from being sick from Covid-19. CFO stated that everyone in the office became positive with Covid-19 despite being fully vaccinated. A review of the HHA’s policy titled “Infection Control Measures for Covid-19”Indicated monitoring shall be performed daily, prior to beginning work duties until the CDS and government officials indicated the infection had subsided and no longer poses a threat to the general public. All staff must complete pre-screening requirements for each scheduled workday (i.e. manually or electronic). All staff working in the office or performing patient visits will be screened or self monitored for symptoms and risks for exposure. Screening will be performed daily or self monitored for symptoms and risk for exposure. Screening will be performed daily or before shifts prior to beginning work duties. Screening can be documented in a log or electronic (e.g. PHR) All non-employees are screened prior to entry to the workplace and those with suspected or confirmed Covid-19 are not allowed to enter the workplace. A review of Patient 4's Patient Information indicated, a start of care (SOC) date of 6/11/22, with diagnosis that included non-pressure chronic ulcer of left lower leg. During a review of Patient 4's Plan of Care (POC), for the certification period from 6/11/22 to 8/9/22, included an order for skilled nurse (SN) to visit every two to three days for 30 days , then to re-assess. The SN was to perform wound care every visit to left lower leg. The wound care consisted of cleaning the wound with wound cleanser, pat to dry, and apply Silvasorb gel , then cover with 4x4 Mepilex Border dressing. On 7/16/22, at 2 p.m., a home visit was conducted at Patient 4's residence with registered nurse (LVN 1). At 2:30 p.m., during wound care observation, RN 1 was observed washing his hands with soap and water, donned a new pair of gloves and wiped the open wound at left lower leg with wound cleanser and repeated the procedure two more times. RN 1 applied Silvasorb gel on the wound and cover with Mepilex Border dressing without removing his old gloves and washing his hands. During an interview with RN 1 on 7/16/22, at 2:30 p.m., he stated that he forgot to removed his dirty gloves and washed his hands after cleaning the wound because he was nervous. A review of the agency's policy titled "Hand Hygiene and Compliance Program (undated)", indicated that staff should perform hand hygiene (wash hands) before and after direct patient care, when hands are soiled and after any contact with contaminated materials.

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) failed to follow the written plan of care (POC) for one of seven patients (Patient 4). This failure had the potential to affect the patient's progress in reaching their goals. Findings: A review of Patient 4's Patient Information indicated, a start of care (SOC) date of 6/11/22, with diagnosis that included non-pressure chronic ulcer of left lower leg. During a review of Patient 4's Plan of Care (POC), for the certification period from 6/11/22 to 8/9/22, included an order for skilled nurse (SN) to visit every two to three days for 30 days , then to re-assess. The POC indicated for the SN to calibrate and clean the glucometer (machine used to check blood sugar) and ensure proper storage. On 7/16/22, at 2 p.m., a home visit was conducted at the patient's residence with RN 1. Patient 4 has a glucometer sitting on top his medicine table. At 2:35 p.m., during an interview with RN 1 when asked if he attempted to find out if the patient's glucometer needed to be calibrated, RN1 stated he did not check it and he forgot to do it. During record review of Patient 4's clinical record on 6/12/22, at 11:50 a.m., there was no documentation of type of glucometer machine and if it was calibrated. During an interview with the Director of Patient care Services designee on 6/17/22 at 12 p.m., he stated the plan of care should include glucometer type and the calibration should be documented monthly. The HHA's undated policy and procedure tilted "Plan of Care" indicated the POC should include type of services and equipment required; medications; treatments, and procedures. Show Original Findings