Every finding on record at Genus Home Care, Inc

The following reflects the findings of the California Department of Public Health during an Emergency Preparedness survey conducted July 10, 2023 through July 13, 2023. Representing the Department: Surveyor - 43918 Surveyor- 45388 All Conditions of Participation were met.

The following reflects the findings of the California Department of Public Health during a recertification survey conducted July 10, 2023 through July 13, 2023. Representing the Department: Surveyor - 43918 Surveyor - 45388 Census: 41 Unduplicated Admissions: 2 Home Visits with Record Review: 3 Record reviews without home visits: 4 Sample size: 7 All Conditions of Participation were met. Two deficiencies were issued during this survey.

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 a medication reconciliation (the process of comparing a patient’s medication orders to all the medications that the patient has been taking) was conducted and implemented in accordance with the agency’s policy and procedure (P&P) on an ongoing basis for one of seven sampled patients (Patient 3) when Patient 3 had three medications that did not match the “Patient Medication Profile” (PMP- a current list of all medications prescribed for a specific patient) and one medication route that was incorrect. These failures had the potential to cause ineffective drug therapy, significant side effects, and noncompliance with drug therapy for Patient 3. Findings: A review of Patient 3’s “Patient Profile” (contains demographic and medical information and plan of care (a document that provides direction of the type of nursing care a patient needs), indicated start of care (SOC) of September 27, 2005, with a certification period (the period the patient is eligible to receive care) of May 30, 2023, to July 28, 2023. Further review indicated Patient 3 had a primary diagnosis of shaken infant syndrome (severe form of physical child abuse causing a head injury, resulting from violently shaking an infant by the shoulders, arms, or legs). During a home visit on July 11, 2023, at 1:10 PM, with Licensed Vocational Nurse (LVN 2), Patient 3 was sitting on the living room sofa, with the television on. During a concurrent observation, interview, and record review, on July 11, 2023, at 1:15 PM, with Patient 3’s father and LVN 2, LVN 2 inspected Patient 3’s medication bottles, which were available in the home, in a kitchen cabinet. LVN 2 compared them with Patient 3’s most current PMP and found one unopened medication bottle and one opened medication bottle, containing a liquid labeled Topiramate (a medication used to treat seizures [sudden, uncontrolled behavior, movements, feelings, and levels of consciousness]) 25 mg (milligrams- unit of measurement)/ ml (milliliters- unit of measurement) take 3 mls by mouth every morning and 4 mls every evening at bedtime (total of 175 mgs/day). Patient 3’s current PMP indicated an order for Topiramate 6 mg/ ml- 11 ml G-Tube (GT- gastrostomy tube [tube inserted through the wall of the abdomen directly into the stomach to give medication, liquid, and food]) 2 x (times) daily (total of 132 mgs/ day- which was a dose difference of 43 mgs less a day compared to what Patient 3 was taking). LVN 2 acknowledged the current Topiramate medication Patient 3 was taking did not match the current physician order and the current PMP. Patient 3’s father stated the medication dose had been changed for a few months now and he told the agency about it. During a subsequent observation, interview, and record review, on July 11, 2023, at 1:17 PM, with Patient 3’s father and LVN 2, LVN 2 found nine unopened boxes and one opened medication bottle, containing liquid labeled Epidiolex (medication used to treat seizures) 100 mg/ml- 6 ml GT twice a day (1200 mgs/ day) and compared the medication with Patient’s 3’s most current PMP. Patient 3’s current PMP order indicated an order for Epidiolex 100 mg/ml- 5 ml GT twice a day (1000mgs/ day- which was a dose difference of 200 mgs less a day compared to what Patient 3 was taking). LVN 2 stated she knew the medication changed and acknowledged this medication Patient 3 was taking did not match the current physician order and the current PMP. Patient 3’s Father stated the medication had been changed for a few months and he told the agency about it. During a subsequent observation, interview, and record review, on July 11, 2023, at 1:20 PM, with LVN 2 and Patient 3’s father, there was no Keppra (medication used to treat seizures) in the cabinet. Patient 3’s current PMP indicated Patient 3 was on Keppra 100 mg/ml- 22 mls GT twice daily. Patient 3’s Father and LVN 2 stated Patient 3 was not on Keppra for a few months now because the order was stopped. LVN 2 acknowledged the Keppra should not have been on Patient 3’s current PMP. During a subsequent observation, interview, and record review, on July 11, 2023, at 1:22 PM, with Patient 3’s father and LVN 2, LVN 2 found two unopened medication bottles and one opened medication bottle, containing liquid labeled Briviact (medication used to treat seizures) 10 mg/ml- 15 ml Oral 2 x daily. Patient 3’s current PMP and physician order indicated an order for Briviact 10mg/ml- 15 ml Oral 2 x daily. Patient 3’s father stated Patient 3 does not take any medications by mouth and the Briviact was supposed to be via GT. LVN 2 acknowledged the route was incorrect on the PMP and the physician orders because Patient 3 takes all the medications via GT. LVN 2 stated, “I should have caught that and had that changed.” During an interview, on July 11, 2023, at 1:40 PM, with LVN 2, LVN 2 acknowledged the medications Patient 3 was taking did not match the current physician orders and the current PMP and it should have. LVN 2 stated she was not sure why she did not follow the agency’s policy when she knew there was a change in the medication for Patient 3. LVN 2 stated it was important for the medications to be accurate on the PMP, to match what the patient is currently taking, and to be the correct route because it could potentially harm the patient. During a phone interview, on July 11, 2023, at 2:58 PM, with the Registered Nurse (RN 2), the RN 2 stated it was the responsibility of the RNs and the LVNs to make sure the current PMP, the routes of the medications, and the current physician orders are accurate and match what the patient is taking and is checked every time there is a visit done with the patient. The RN 2 stated, “I did not look at each individual medication and I just went with what the father said. I guess I should look at each medication myself.” During a concurrent interview and record review, on July 12, 2023, at 3:57 PM, with the Administrator (Admin), the Admin reviewed the agency’s policy and procedure (P&P) titled, “ADMINISTRATION OF MEDICATIONS POLICY,” dated December 2007, which indicated, “…1. During the initial admission/ evaluation visit, the Registered Nurse or Therapist will ask the patient to identify all the medications the patient is taking, both prescribed and over the counter medications. The Registered Nurse/ Therapist will verify the medications in the home with the medication orders given by the patient’s physician. 2. All staff nurses are to review each medication a patient may be taking, prescribed or over-the-counter, to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindicated medications. Any suspected or identified problems are to be reported to the patient’s physician… When a licensed professional from the Agency monitors the use of medications as part of the care, the medication profile is used to evaluate the use of the drugs in the patient’s current regimen. The medication profile will include at the least: a. current medication therapy, including prescribing prescription and nonprescription drugs, and home remedies with the dose, frequency, and route; and b. ongoing medication updates, including the initiation of, changes in, or discontinuation of medications. 4. When there is a discrepancy in the medications found in the home, and in the information provided to the Agency, a nurse will contact the physician as soon as possible to verify the correct medication regimen. The nurse/ therapist will instruct the patient and family in the appropriate medication regimen. The nurse/ therapist will document all telephone conversations and instructions given to the patient and/or family in the patient’s clinical record…”. The Admin stated the agency’s P&P was not followed.

Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure reference checks, pre- employment criminal background checks, and an annual performance evaluation were completed and documented in the employee files when: 1. Six of six employees (Licensed Vocational Nurse 1 [LVN 1], LVN 2, LVN 3, the Director of Patient Care Services [DPCS], the Registered Nurse [RN 1], and Certified Home Health Aide [CHHA]) reviewed for reference checks were not found in the employee files or available in the agency. 2. Five of six employees (LVN 1, LVN 2, LVN 3, the DPCS, and the RN 1) reviewed for pre-employment criminal background check were not found in the employee files or available in the agency. 3. One of six employees (LVN 1) reviewed for Annual Performance Evaluation was not completed. These failures had the potential for the agency to employ unqualified staff by not having reference checks prior to employment, completing an annual evaluation, or getting a background check and employing staff who could have a criminal record to be entrusted in the care of 41 patients and placing them at risk for injury or abuse. Findings: 1. During a concurrent interview and record review, on July 12, 2023, at 2:30 PM, with the Staffer/ Covering HR (S/CHR), the employee files were reviewed for documentation of reference checks for LVN 1, LVN 2, LVN 3, the DPCS, the RN 1, and CHHA. The S/CHR acknowledged there were no reference checks found in the employee files and or in the agency. The S/CHR stated each employee needs to have a reference check done because that would make sure the agency is hiring good employees. During an interview, on July 12, 2023, at 3:35 PM, with the Administrator (the Admin), the Admin stated all the reference checks were normally in a binder but they just found out that went missing and acknowledged the reference checks should have been available in the files. During a concurrent interview and record review, on July 12, 2023, at 4:10 PM, with the Admin, the Admin stated the agency did not have any specific policy on reference checks prior to hire. 2. During a concurrent interview and record review, on July 12, 2023, at 2:40 PM, with the S/CHR, the pre-employment criminal background checks for LVN 1, LVN 2, LVN 3, the DPCS, the RN 1, and CHHA were reviewed. The S/CHR acknowledged there were no background checks found in the employee files for five of six employees (LVN 1, LVN 2, LVN 3, the DPCS, and the RN 1) reviewed. The S/CHR stated each employee needs to have a pre-employment criminal background check done because that would make sure the agency is hiring good employees. During an interview, on July 12, 2023, at 3:35 PM, with the Admin, the Admin stated all the pre-employment criminal background checks were normally in a binder but they just found out that some of them were missing and stated the it should have been available in the files. During a concurrent interview and record review, on July 12, 2023, at 4:11 PM, with the Admin, the Admin stated the agency did not have any specific policy on pre-employment criminal background checks prior to hire. 3. During a concurrent interview and record review, on July 12, 2023, at 2:43 PM, with the S/CHR, the Annual Performance Evaluations for LVN 1, LVN 2, LVN 3, the DPCS, the RN 1, and CHHA were reviewed. The S/CHR stated each employee needs to have an annual performance evaluation done and in the employee’s file and acknowledged that one out of six employee’s annual performance evaluations (LVN 1) were incomplete, and therefore not considered done. During a concurrent phone interview and record review, on July 13, 2023, at 10:32 AM, with the DPCS, the DPCS stated she was the main person who did the annual performance evaluation and reviewed LVN 1’s performance evaluation form, titled, “DIRECT SKILLS COMPETENCY REVIEW,” dated July 19, 2022. The DPCS acknowledged the performance evaluation form was not done because it was not complete and was missing her signature. The DPCS stated it was important to do the annual evaluation because that will make sure the staff is providing safe and competent care. During a concurrent phone interview and record review, on July 13, 2023, at 10:38 AM, with the DPCS, the agency’s policy and procedure (P&P) was reviewed. The P&P titled, “Supervision of Staff Policy,” dated December 2007, indicated, “…7. An employee’s supervisor will perform shared visits with staff or observe return demonstrations when the following conditions exist: A. at least annually as part of the employee evaluation process;… 8. Data related to staff competence is collected on an ongoing basis, aggregated, and analyzed for patterns and trends. Areas in need of improvement may be identified related to staff competence and learning needs of the staff. A report about the levels of competence and competence maintenance activities is given at least annually to the Board of Directors. The report may be incorporated into the Agency’s annual evaluation process…”. The DPCS stated the policy was not followed