Every finding on record at Fmm Home Care Corporation

The following reflects the findings of the California Department of Public Health during a Re-Certification Survey conducted from June 26 to June 29, 2023. Representing the California Department of Public Health: Surveyor, 29623, HFEN. and Surveyor 41459, HFEN. The agency's current active census: 137 Patients. The agency's unduplicated admissions during the past 12 months: 540 Patients. Sample size: 14 Patients. Record review with home visits: 5 Patients. Record review without home visits: 5 Patients. Closed records: 4 Patients.

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 failed to ensure the medications listed in the patient's Plan Of Care (POC) and current medication profile were updated, accurate, and complete for four of five patients reviewed (Patients 1, 2, 3, and 9) when: 1. For Patient 1, - The medication Prozac (medication to treat depression) 40 milligram (mg- a unit of measurement) had been discontinued since May 16, 2023, and was still listed on Patient 1's current medication profile; and - Six medications Patient 1 was currently taking at home were not listed in patient's current POC and medication profile. 2. For Patient 2, - The topical medication A and D ointment used as a skin barrier for patient's left buttock area of healed ulcer, was not included in the patient's POC and current medication profile; - Six dietary supplements Patient 2 was currently taking were not listed in her current POC and medication profile; and - One medication, Cal Mag Zinc + D3 (supplement) was not available but was listed in the patient's current POC and medication profile. 3. For Patient 3, - One medication, Temazepam (used for insomnia - trouble falling asleep) 7.5 mg one capsule every night as needed was not available; - One medication, Benazepril HCl (used for high blood pressure) 40 mg one tablet oral daily was not available; and - Two medications, Clopidogrel (blood thinner) 75 mg one tablet oral daily and Cilostazol (used to reduce leg pain that worsen when walking) 100 mg one tablet twice a day were not listed in the patient's current POC and medication profile. 4. For Patient 9, - Three over-the-counter the medications Patient 9 was currently taking were not listed on Patient 9's current POC and medication profile; and - One medication, Midodrine HCL (used for sudden drop of blood pressure) 5 mg one tablet twice a day as needed was not available for review. These failures had the potential for Patient's 1, 2, 3, 9, and their primary care givers (PCG) not to be able to identify the significant drug interactions, ineffective drug therapy and non-compliance with prescribed medications. Findings: 1. On June 26, 2023, Patient 1's record was reviewed. Patient 1 was admitted to the agency with a start of care (SOC) date of March 23, 2023, with diagnoses which included right hip arthroplasty (hip replacement) and irrigation and debridement (removal of dead tissue from a wound) of the right hip wound. The POC for the certification period from 05/22/2023 to 07/20/2023, indicated Skilled Nurse (SN) to perform treatment to the right hip...Assess compliance with medication regimen. Teach actions, side effects of medications and medication management. On June 27, 2023, at 9:30 a.m., a home visit was conducted for Patient 1 with the Registered Nurse (RN). Patient 1 was observed lying in a hospital bed, awake, alert and able to verbalize her needs. Patient 1 was aware of the home visit and able to sign the consent for the home visit. Patient 1 stated her primary care givers (PCG) were family members living in her home. She stated she and her PCG managed her daily medications. Patient 1 was observed with wound on her anterior (front) area of her right thigh. The RN performed the wound treatment and dressing changes as ordered by the physician. On June 27, 2023, at 9:52 a.m., a concurrent interview and medication review was conducted with Patient 1, family member (FM) and the RN. During medication review, the following were observed: One medication Prozac 40 mg 2 capsules oral daily with the start date of 03/23/2023, listed in Patient 1's current POC and medication profile was not available. Patient 1 stated the medication had been discontinued last month, and the physician had changed it to another medication. Patient 1 could not remember the name of the medication. The FM stated the medication Prozac was discontinued May 16, 2023. The RN stated she was not aware the medication was discontinued by the physician; and Six medications observed were not listed in Patient 1's current POC and medication profile. - Escitalopram Oxalate 20 mg one tablet oral daily, started May 16, 2023. - Magnesium 250 mg one tablet oral daily. - Tart Cherry 30 mg - 250mg...2 gummies oral every night. - Valerian Root 500 mg, 2 capsules oral (1,000mg) every night. - Citracal- Vitamin D, 1, 200mg Calcium-1000 unit one tablet oral daily. - Transdermal compound ointment 1:1 cream with CBD (Cannabidiol - used to treat chronic pain). Apply to affected area twice a day as needed. Patient 1 stated she started all the dietary supplements two weeks ago, and the compound ointment two months ago. The RN stated she was not aware of the supplements and the topical cream that Patient 1 had started. She stated she should have asked Patient 1 during home visits new prescribed medications and over-the-counter medications. 2. On June 26, 2023, Patient 2's record was reviewed. Patient 2 was admitted to the agency with the Start of Care (SOC) date of September 17, 2022, with diagnoses which included pressure ulcer left buttock and congestive heart failure (CHF - a condition when the heart cannot pump adequately). and edema (swelling) of both lower extremities (legs). The POC for the certification period from 05/15/2023 to 07/13/2023, indicated "SN to perform treatment to bilateral lower extremities with treatment regimen...Assess compliance with medication regimen. Teach actions, side effects of medications and medication regimen..." On June 27, 2023, at 11 a.m., a home visit was conducted For Patient 2, with the Licensed Vocational Nurse (LVN) 1. Patient 2 opened the door and was observed ambulating independently using her rolling walker. Patient 1 was alert, oriented, and able to verbalize her needs. Patient 1 was aware of the visit and signed the consent for home visit. Patient 1 stated she lives alone and independent of her activities. She stated she managed her own medications daily. On June 27, 2023, at 11:53 a.m., a concurrent interview and medication review was conducted with Patient 1 and LVN 1. During medication review the following were observed: The A and D ointment used for Patient 1's left buttock during treatment was not listed in Patient 1's current medication profile. The POC indicated "Patient to continue to apply A & D ointment to left buttock after showers and twice a day...; One medication Cal Mag Zinc + D one tablet oral on Monday, Wednesday and Friday listed in Patient 1's current medication profile was unavailable for use; and Six dietary supplements Patient 1 were currently taking were not listed in the current medication profile. - Airborne 1,000 mg. One tablet (50 mg) effervescent oral daily. - L-Lysine 1,000 mg one tablet oral daily as needed for cold symptoms. - Calcium 500 mg one tablet oral daily. - Prevagen 50 mg one tablet oral daily. - Ocuvite eye health 50 mg three tablets oral daily. - Cal Mag Plus 333 mg Calcium, one tablet oral daily. Patient 1 stated she gave a list of her dietary supplement to the agency. She stated she had not taken the supplement Cal Mag Zinc + D3 333 mg Calcium for a long time. LVN 1 stated she was not aware of the other dietary supplements that Patient 1 were currently taking and acknowledged over-the-counter medications or dietary supplements should be listed in patient's current medication profile. 3. On June 26, 2023, Patient 3's record was reviewed. Patient 3 was admitted to the agency with the Start Of Care (SOC) date of August 8, 2022, with diagnoses which included anemia (a condition in which the blood lack healthy red blood cells). The POC for the certification period from June 4, 2023 to August 2, 2023, indicated Skilled Nurse (SN) to assess compliance with medication regimen and medication management. On June 27, 2023, at 2 p.m., a home visit was conducted for Patient 3, with the Physical Therapist (PT). The PT stated Patient 3 was living with her daughter as the primary care giver (PCG). Patient 3 was observed sitting on the sofa, alert and able to verbalize her needs in Spanish. The PCG was present during the visit. The PCG was listed as the primary contact. The PCG signed the home visit consent. The PCG stated she managed Patient 3's daily medications. On June 27, 2023, at 2:36 p.m., a concurrent interview and medication review was conducted with the PT and Patient 3' PCG. During the medication review the following were observed; One medication Temazepam 7.5 mg one capsule oral every night as needed for insomnia was not available for use. The PCG stated she run out of the medication, and needed refill from the doctor. she stated she will follow up with the physician's office. One medication Benazepril HCL 40 mg one tablet oral daily was not available for use. The PCG stated the medication Benazepril HCL was replaced by Linosipril 20 mg. one tablet oral daily, on March 2023. The medication Benazepril was still listed in Patient 3's current medication profile. The PT stated he was not aware of the changes in Patient 3's current medications. Two medications Clopidogrel and Cilostazol were not listed on Patient 3's current medication profile. The PCG stated Patient 3 had been taking the Clopidogrel for three months and the Cilostazol since November 14, 2022. The PT stated he had not seen Patient 3 for a while and the Skilled Nurse (SN) should have performed the medication review on every home visit. 4. On June 27, 2023, at 11:30 a.m. a record review of Patient 9's face sheet (a document that gives a summary of patient's information), indicated a start of care date of February 16, 2023, with a certification period from June 16, 2023, through August 14, 2023. Patient 9 had a diagnoses that included Post laminectomy syndrome (chronic back or neck pain following surgery and localized edema (swelling due to an excessive accumulation of fluid). On June 27, 2023, at 11:30 a.m., an observation was made with Licensed Vocational Nurse (LVN) 2. LVN 2 reviewed Patient 9's medication bottles with the medication profile. On June 27, 2023, at 11:52 a.m. an observation was made of the medication profile and medication bottles of Patient 9 indicating: a. Diclorenac Sodium (used to treat pain and reduce inflammation) 1% gel (gram) apply 2-4 grams topically to area affected by pain three times daily as needed for pain. The home health agency did not have a record of this medication in the medication profile. b. Triamcinolone Acetonide (used to treat skin conditions) 0.1% ointment (gram) apply topically to scalp (avoid eye contact) three times daily as needed for itchiness. The home health agency did not have a record of this medication in the medication profile. c. Prevagen (supplement for healthy brain function) 50mg, 1 capsule, daily. The home health agency did not have a record of this medication in the medication profile. The home health agency did not have a record of this medication in the medication profile. d. Midodrine HCL 5mg, 1 tablet two times daily as needed for hypotension (the pressure of blood circulating around the body is lower than normal). This medication was not available for review. On June 27, 2023, at 12:10 p.m., an interview was conducted with LVN 2. LVN 2 stated, the Registered Nurse (RN) usually reviews the medication profile, "I know I do more visits; I need to start reviewing the medications more often." On June 28, 2023, at 12:45 p.m. the Administrator/DPCS stated, the medications should be reviewed at every nursing visit. A record review of the policy and procedure titled, " Medications", dated August 2017, indicated:"...the skilled nurse/case manager (including PT on PT only cases) consolidates all pertinent orders for medications into the medication profile at the time of any medication change and at the time of recertification and leaves an updated copy in the patient home folder, Skilled Nurse/Case Manager assess all medications which a patient is taking for possible ineffective drug therapy, adverse reactions, significant side effects, drug allergies and contraindicated medications, any over the counter (OTC) medications listed are added to the patient medication profile and are approved for use by the physician, any problems are promptly reported to the Medical Doctor (MD)..."

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure physician's verbal orders were signed and dated timely, within 30 days of order date, for six of 14 patients reviewed (Patients 3, 7, 8, 10, 11, and 14). This failure resulted in verbal orders not authenticated and dated by the physicians in accordance with the agency's policy and procedure. This failure also had the potential to result in incorrect verbally ordered medications and treatment for patients which could cause unnecessary care and services. Findings: 1. On June 27, 2023, Patient 3's record was reviewed. Patient 3 was admitted to the agency with the Start Of Care (SOC) date of August 8, 2022, with the diagnoses which included anemia (a condition when the blood does not enough heathy red blood cells). Patient 3's Plan Of Care (POC) for the certification period from April 5, 2023 to June 3, 2023, indicated a supplemental physical therapy order to extend home physical therapy treatment two times a week for one week (2W1), effective 03/30/23, due to missed visit during treatment episode. The order date for the physical therapy treatment was April 30, 2023, at 12 p.m. The verbal order was not signed and dated until June 2, 2023. The verbal order was signed and dated after 32 days from the order date by the physician. 2. On June 28, 2023, Patient 7's record was reviewed. Patient 7 was admitted to the agency with the SOC of April 3, 2023, with diagnoses which included subdural hematoma (a condition when there is a pool of blood between the brain and its outermost covering usually caused by head injury). The POC for the certification period from April 3, 2023 to June 1, 2023, indicated the following: The initial orders for the POC was signed and dated by the Registered Nurse (RN) on April 3, 2023. The POC was not dated and signed by the physician until June 27, 2023. The verbal order was signed and dated after 84 days from the order date; The missed visit report and notification of physician dated April 10, 2023, was not signed and dated until June 27, 2023. The missed visit verbal order report was signed and dated after 77 days from the order date to cancel Patient 7's visit due to refusal of service; and The missed visit report and notification of physician dated May 2, 2023, had no physician's signature to authenticate the order. On June 29, 2023, at 1:16 p.m., a concurrent interview and record review was conducted with the Administrator/Director of Patient Care Services. She acknowledged the verbal orders for Patients 3 and 7 were signed and dated by the physician after 30 days of the order dates and one missed visit note for Patient 7, dated May 2, 2023, was missing physician's signature. The Administrator /DPCS stated verbal orders should be signed and dated by the physicians within 30 days of the order dates. 3. On June 28, 2023, Patient 8's record was reviewed. Patient 8 was admitted to the agency with a start of care date of December 19, 2022, with diagnoses including: Obstructive and reflux uropathy (disorder of urinary tract that occurs due to obstructive urinary flow) and nephrostomy catheter (rubber tube that is placed through the skin into the kidney to drain the urine). Patient 8 had a certification period of April 18, 2023, through June 16, 2023. a. A record review on June 28, 2023, of Patient 8's POC, indicated a recertification period (a period of time that a patient can be active before the next renewal is due) of April 18, 2023, through June 16, 2023. The physician did not sign the POC until June 22, 2023, 36 days from the start of the recertification period. b. A record review on June 28, 2023, of a verbal order for Patient 8 indicated, a physician signature 66 days from the order date of April 18, 2023. c. A record review on June 28, 2023, of a verbal order for Patient 8 indicated, a physician signature 67 days from the order date of April 27, 2023. 4. On June 28, 2023, Patient 10's record was reviewed. Patient 10 was admitted to the agency with a start of care date of June 30, 2022, with a diagnosis of Type 2 diabetes mellitus (high level of sugar in the blood). Patient 10 had a certification period of February 25, 2023, through April 25, 2023. A record review on June 28, 2023, of a verbal order for Patient 10 indicated, a physician signature of 122 days from the order date of 2/25/2023. 5. On June 28, 2023, Patient 11's record was reviewed. Patient 11 was admitted to the agency with a start of care date of October 21, 2022, with a diagnosis of Non pressure chronic ulcer of right foot (injury to the skin and underlying tissue). Patient 11 had a certification period of February 18, 2023, to April 18, 2023. A record review on June 28. 2023 of a verbal order for Patient 11 indicated, a physician signature of 61 days from the order date of February 18, 2023. 6. On June 28, 2023, Patient 14's record was reviewed, Patient 14 was admitted to the agency with a start of care date of September 6, 2022, with diagnoses of Encephalopathy (a decrease in blood flow or oxygen to the brain) and Dementia (a term used to describe a group of symptoms affecting memory thinking, and social abilities). Patient 14 had a certification period of March 5, 2023 through May 3, 2023. a. A record review on June 28, 2023, of a verbal order for Patient 14 indicated, no physician signature noted for the certification date March 5, 2023 through May 3, 2023. b. A record review on June 28, 2023, of a verbal order for Patient 14 indicated, no physician signature noted for verbal order dated May 4, 2023. c. A record review on June 28, 2023, of a verbal order for Patient 14 indicated, no physician signature noted for verbal order dated May 22, 2023. On June 29, 2023, at 1:16 p.m., a concurrent interview and record review was conducted with the Administrator/Director of Patient Care Services. She acknowledged the verbal orders for Patient's 8,10, 11, and 14 were signed and dated by the physician after 30 days, and one POC along with two verbal orders, were missing the physician's signature. The Administrator /DPCS stated verbal orders should be signed and dated by the physicians within 30 days of the order dates. A record review of the policy and procedure titled, "Physician Telephone Orders", dated June 29, 2023, indicated:"...All MD orders are to be signed and dated on the chart within 30 days of the order date..."

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 follow infection control precautions for one of five patients (Patient 8) when the Licensed Vocational Nurse did not place a clean barrier (a device used to limit potentially infectious contact between health care providers and patients) before putting down her nursing supply bag on Patient 8's coffee table. This failure had the potential for patients to suffer inferior care practices risking transmission of infectious agents through cross contamination. Findings: On June 26, 2023, a record review of Patient 8's face sheet, indicated a start of care date of December 19, 2022, with a certification period of April 18, 2023, through June 16, 2023. Patient 8 had diagnoses which included obstructive and reflux uropathy (disorder of urinary tract that occurs due to obstruction urinary flow), and nephrostomy catheter (rubber tube that is placed through the skin into the kidney to drain the urine). On June 27, 2023, at 10:00 a.m., during a home visit with LVN 3 and Patient 8, LVN 3 was observed placing her nursing bag on Patient 8's coffee table without a barrier to separate the nursing supply bag from the coffee table, risking cross contamination of infectious agents. On June 27, 2023, at 10:52 a.m., an interview was conducted with LVN 3. LVN 3 confirmed that she should not have placed her nursing bag on Patient 8's coffee table without a barrier. On June 28, 2023, at 12:36 p.m., an interview was conducted with the Administrator/Director of Patient Care Services. She stated their policy is to use a barrier between any nursing supplies and contact to patients' furniture or floor. A record review of the policy and procedure titled, "Clinical Bag Technique," dated August 1, 2022, indicated "...All contents of the bag are considered clean, and anything taken from the bag is placed on paper towels or newspapers. Place unopened bag on newspapers or paper towels on a clean flat surface. Show direction and consideration in area chosen if furniture is available but avoiding the floor..."

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency failed to ensure that the Home Health Aide's (HHA) visit note followed the HHA Care Plan prepared by the Registered Nurse (RN), for one of 14 patients (Patient 14). This failure had the potential to result in harm to Patient 14 due to lack of care from the home health aide and the plan of care not being individualized to Patient 14 needs. Findings: A record review conducted on June 29, 2023, indicated Patient 14 had a start of care date of September 6, 2022, with a certification period of May 4, 2023, through July 22, 2023. Patient 14 had a diagnosis of encephalopathy (a decrease in blood flow or oxygen to the brain) and dementia ( a term used to describe a group of symptoms affecting memory, thinking, and social abilities). The "Home Care CHHA (Certified Home Health Aide) Care Plan" prepared by the RN, indicated the nursing staff caring for Patient 14 was given the assignment to perform certain tasks on every visit, weekly, and on an as needed basis. The Home Care CHHA Visit Notes dated March 6, 2023, through June 22, 2023, were reviewed and did not indicate what tasks were being performed every visit, weekly, or on an as needed basis. An interview on June 29, 2023, at 3:00 p.m., was conducted with the Administrator/Director of Patient Care Services. She agreed the Home Care CHHA Care Plan for Patient 14 should coincide with the Home Care CHHA Visit Note. A record review of the policy and procedure titled, "Home Health Aide Assignment," dated June 28, 2019, indicated "...when a patient needs a personal care, service is admitted or recertified, the RN fills out the Home Health Aide Activity (Care Plan) form according to the service or care that the patient needs, a duplicate copy is placed in the Home Health file chart for reference by the HHA in the home, the HHA records care given in the HHA Visit Note form and submits notes to the office according to policy..."