Every finding on record at Dynamic Home Care

The following reflects the findings of the California Department of Public Health during a Recertification survey. Representing the Department of Public Health: Surveyor: 43929 Surveyor: 19096 Surveyor: 09697 Unduplicated admissions: 871 Sample Size: 17 Home visits: 7

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 two of 17 patients (Patient 1 and Patient 14). This deficient practice had a potential for medication error and serious side effect if the medication was not received on time. b. A review of patient 14’s clinical record indicated a start of care date (SOC) date of 12/22/22, with diagnoses urinary tract infection (condition in which bacteria invade and grow in the urinary tract (the kidneys, ureters, bladder, and urethra), Indwelling catheter (is a flexible plastic tube that's inserted into the urethra, providing continuous drainage from the bladder into a collection bag), and anemia (a condition of lack enough healthy red blood cells to carry adequate oxygen to body's tissues) A review of Patient 1’s plan of care (POC) for the certification period of 2/20/23 through 4/20/23, included an order for skilled nurse (SN) visit once a week for one weeks, then once a month and physical therapist to visit twice a week for therapeutic exercises . The plan of care (POC) further indicated for the skilled nurse to ensure patient will demonstrate knowledge of and compliance with medication management: dose, route and schedule/actions, interactions and contraindication/administration and compliance with medications. On 4/12/23, at 11 a.m., during a joint home visit with Registered Nurse 2 (RN 2) conducted at patient 14’s residence. A review of Patient 14’s current medications, the patient's medication profile a bottle of apple cider vinegar 480 mg , and Prilosec 20 milligrams (mg, unit of measurement) was not documented in the medication profile. During an interview with Patient 14 and the patient's caregiver stated, the patient was taking one tablet every day. During an interview with the Administrator and director of patientcare services designee in the HHA conference room on 4/13/23, they stated the medications should be checked per visit. a. A review of Patient 1’s clinical record indicated a start of care date (SOC) date of 4/1/23, with diagnoses as aftercare following joint replacement surgery (a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic or ceramic) and presence of right artificial hip joint. A review of Patient 1’s plan of care (POC) for the certification period of 4/1/23 through 5/30/23, included an order for skilled nurse (SN) visit once a week for 6 weeks. The plan of care (POC) further indicated for the skilled nurse to ensure patient will demonstrate knowledge of and compliance with medication management: dose, route and schedule/actions, interactions and contraindication/administration and compliance with medications. On 4/12/23, at 11 a.m., during a joint home visit with RN 1, was conducted at Patient 1’s residence. A review of Patient 1’s current medications, a bottle of “Extra Strength Non-Aspirin 500 mg – Acetaminophen 500 mg was not documented in the patient's medication profile. During an interview with Patient 1 stated, she was taking one tablet every four hours for pain. During an interview on 4/12/23 at 11 a.m., RN1 stated, the medications or changes of the medications should be updated every visit and per policy and procedure.

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 ensure patient care supplies were not expired. The deficient practice had the potential for patients receiving expired home health supplies and placed the patient at risk for potential infection and ineffective care and treatments. During a concurrent observation and interview on 4/12/2023 at 2:05pm with Director of Patient Care Services (DPCS), in the office supply room, a box of Optifoam Nun-Adhesive Foam Wound dressing containing 10 dressings with an expiration date 4/1/2023 and a box of BD Vacutainer Safety -Lok blood collection set 21g with 50 pieces with an expiration date 12/31/2022 was observed. DPCS stated, “once a month our inventory is checked and if any supply is expired, it should be destroyed. If its sharps, it would go into the sharp container. These two items should have been brought to be disposed. This was missed.” During a review of the Policy and Procedure titled “Disposal of Expired Patient Care Supplies” dated (January 28, 2017), the policy indicated, “Disposal of expired patient care supplies shall be performed to prevent harm to patient from occurring. 1). Medical Records/Supply personnel will go through the supply once a month. 3). Medical Records/Supply personnel will remove all expired materials from supply cabinets.”