Every finding on record at Golden Age Home Healthcare, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 9029 Reseda Blvd, Suite 101, Northridge, CA 91324 Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID: 19096 Health Facilities Evaluator Nurse, Surveyor ID: 44916 Unduplicated Admissions - 52 Active Patients - 30 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), §485.542(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 and drill for field and office staff was completed on an annual basis. This failure had the potential to result in staff lacking the knowledge to respond effectively during an emergency or disaster. During a review of the emergency preparedness plan of the HHA on 3/5/23 at 1:30 p.m., the HHA did not provide evidence for Emergency Preparedness training and disaster drill for all office and field staff. During an interview with the Director of Nursing on 3/5/23 at 11:35 a.m., the DON stated the agency had not provided the emergency preparedness drill and was not able to update their emergency preparedness plan for 2019. The HHA's undated policy and procedure titled "Emergency Preparedness Plan" indicated all staff shall receive emergency preparedness training appropriate for their position on a yearly basis.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 9029 Reseda Blvd, Suite 101, Northridge, CA 91324 Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID: 19096 Health Facilities Evaluator Nurse, Surveyor ID: 44916 Unduplicated Admissions - 52 Active Patients - 30 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 home health agency (HHA) failed to maintain an accurate, and current medication profiles for one of seven sampled patients (Patients 3). This failure has the potential to result in placing the patient at risk for medication errors and adverse drug reactions. A review of Patient 3's face sheet indicated an admission date of 6/14/22 with a diagnosis of acute lymphangitis (an inflammation of the lymphatic channels. Acute lymphangitis is commonly caused by a bacterial infection, but lymphangitis can also be caused by parasitic infection (filariasis), mycobacterial infection, and malignancy (neoplastic lymphangitis) of the lower limbs. A review of the HHA’s document titled “Home Health Certification” for the certification period of 2/9/23 to 4/9/23 indicated the skilled nurse (SN) was to do the following: 1. Assess integumentary status. 2. Identify signs and symptoms of newly impaired skin integrity. 3. Report significant changes to physician. 4. SN to perform wound care to both lower extremities and feet related to cellulitis, non-pressure ulcers. 5. Cleanse wound with normal saline and apply mupirocin 0.1% (antibiotic skin ointment), cover with Unna boot bandage (a gauze wrap that is soaked with a zinc oxide paste. The zinc oxide paste helps ease skin irritation and keep the area moist. Typically placed on the leg from the base of the toes to just below the knee, the paste is then covered with a dry gauze wrap followed by an ace bandage), wrap, and compress legs, feet and ankles with self-adhesive bandage using aseptic technique. 6. SN to instruct about infection control precautions such as hand hygiene, waste disposal and signs and symptoms of infections. 7. SN to visit once a week for eight weeks. A home visit was conducted at Patient 3's residence with Registered Nurse (RN) on 3/4/23 at 10:00 a.m. Patient 3 was alert and oriented to name, place and time, and was sitting inside his office room. During the medication review with the Registered Nurse, the following medication discrepancies were noted: Patient 3 used triamcinolone 0.1% ointment once a week for wound dressing on his leg. There was an order for mupirocin 0.1% ointment. There was no mupirocin ointment seen. The following supplements were not listed on the HHA's medication profile, but Patient 3 was currently taking the following: 1. Vitamin D3 50 micrograms (mcg- a unit of measure) daily, 2. Selenium 250 milligrams (mg- unit of measure) 3. Quercetin 240 mg daily 4. Vitamin B1 500 mg daily 5. Lysine 1500 mg daily 6. Glutein 40 mg daily A review of the HHA's undated policy titled " Medication Profile" indicated patients receiving medications administered by the HHA Agency will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and/or discontinued medications.

Review and revision of the plan of care CFR(s): 484.60(c) Standard: Review and revision of the plan of care. This STANDARD is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to create and review an individualized plan of care for three of seven sampled patients. (Patient 3, 4 and 5). This deficient practice led to the agency's failure to ensure the plan of care was followed and revised to reach patient goals. 1. A review of Patient 3’s face sheet indicated an admission date of 6/14/22 with the diagnosis of acute lymphangitis (an inflammation of the lymphatic channels. Acute lymphangitis is commonly caused by a bacterial infection, but lymphangitis can also be caused by parasitic infection (filariasis), mycobacterial infection, and malignancy (neoplastic lymphangitis) of the lower limbs. A review of the HHA’s document titled “Home Health Certification and Plan of Care” for the certification period of 2/9/23 to 4/9/23 Orders for Discipline and treatment indicated skilled nurse developed patient plan of care with patient/caregiver involvement to be countersigned by physician. SN to perform complete physical assessment with emphasis on integumentary status. SN to assess other co-morbidities and other conditions that present themselves during this episode of care. SN to recognize and intervene to minimize complications; notify physician immediately of any potential problems that impede completion of patient recovery and desired goals. SN to visit once a week for 8 weeks. There was no written documentation for Patient 3's non-compliance with the plan of care. A home visit was conducted at Patient 3's residence with Registered Nurse (RN) on 3/4/23 at 10:00 a.m. Patient 3 is alert and oriented to name, place and time, sitting inside his office room. On concurrent interview with Patient 3 stated " I have 40 bottles of medicines there and I don't want you touching them. I can print them out for you." During an interview with the RN conducting the visit stated the patient has his own way of managing his care and his medications. All the time he doesn't want us touching his medication bottles. RN stated he compares medications with the patient himself thru his list. 2. A review of Patient 4's face sheet indicated an admission date of 6/15/22 with the diagnosis of stenosis of the coronary artery stent ( a gradual re-narrowing of the stented segment that occurs mostly between 3 to 12 months after stent placement). Patient smokes 4-5 cigarettes a day and takes Eliquis and Plavix as thrombolytics ( “clot-busting” drugs that break up and dissolve blood clots that get in the way of your blood flow). A review of the HHA’s document titled “Home Health Certification and Plan of Care” for the certification period of 1/20/23 to 3/20/23 Orders for Discipline and treatment indicated skilled nurse developed patient plan of care with patient/caregiver involvement to be countersigned by physician. SN to perform complete physical assessment with emphasis on integumentary status. SN to assess other co-morbidities and other conditions that present themselves during this episode of care. SN to recognize and intervene to minimize complications; notify physician immediately of any potential problems that impede completion of patient recovery and desired goals. SN to instruct patient on disease process including who to contact if signs and symptoms persists or worsen as well as dietary measures , medication management, injury prevention and access to community resources/ support groups where indicated. SN to instruct patient/caregiver regarding self-management of effects of cerebral vascular accident. SN to visit once a week for 8 weeks. There was no written documented care plan for bleeding, smoking and noncompliance with the plan of care on record. 3. A review of Patient 5’s face sheet indicated an admission date of 6/20/14 with the diagnosis of congestive heart failure (occurs when the heart muscle doesn't pump blood as well as it should.) and pacemaker (a small device that's placed (implanted) in the chest to help control the heartbeat). A review of the HHA’s document titled “Home Health Certification and Plan of Care” for the certification period of 1/4/23 to 3/4/23 Orders for Discipline and treatment indicated Patient 5 is at risk for emergency department visits and/or hospital readmissions. Skilled nurse developed patient plan of care with patient/caregiver involvement to be countersigned by physician. SN to assess other co-morbidities and other conditions that present themselves during this episode of care. SN to recognize and intervene to minimize complications; notify physician immediately of any potential problems that impede completion of patient recovery and desired goals. SN to instruct patient on /caregiver regarding hypertension, heart failure status and self management program. SN to visit once a week for 8 weeks. There is no written documentation for pacemaker management and care plan. During an interview with the Director of Nursing on 3/5/23 at 11:30 a.m., DON stated that the agency was not able to revise the plan of care for Patient 4 regarding bleeding precautions and smoking. DON also stated that the agency was not able to create a plan of care for Patient 5 for pacemaker management. A review of the HHA's unrevised policy titled " Coordination of Service" indicated that the agency staff coordinate patient care from admission to discharge to ensure that the patient receives necessary care necessary for meeting specified outcomes. The ongoing evaluation and assessment of the patients condition and home care needs include the patients progress , and as appropriate, his/her family's progress toward therapeutic and education goals. Evaluation of patient/caregiver progress should take into consideration the following issues: c. objective observation of the patient's response to treatment. All staff are responsible for developing and modifying the plan of care relative to the appropriate discipline.

Program scope CFR(s): 484.65(a)(1),(2) Standard: Program scope. (1) The program must at least be capable of showing measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care. (2) The HHA must measure, analyze, and track quality indicators, including adverse patient events, and other aspects of performance that enable the HHA to assess processes of care, HHA services, and operations. This STANDARD is not met as evidenced by: Based on interview, and record review, the Home Health Agency failed to provide documented evidence of a Quality Assessment and Performance Improvement (QAPI) program based upon identified or negative patient care outcomes, measurable indicators to evaluate changes in policy, procedure, and intervention. This failure has the potential to result in the HHA not being able to assess and evaluate negative patient care outcomes, and infection control program surveillance, including the HHA's operations. During a record review of the Quality Assessment and Performance Improvement (QAPI) program on 3/5/23, at 11:30 a.m., the QAPI records indicated the QAPI program was implemented in 2018. On concurrent interview with the director of Nursing/Administrator (DON/ADMIN) on the same date and time, the DON/ADMIN stated she does not have an ongoing QAPI that evaluates patient outcomes, with measurable indicators to evaluate changes in policy, procedure and intervention. Further review indicated there was no documented evidence or data collected to assess and evaluate to improve quality of care. The policy indicated the program will objectively and systematically monitor and evaluate the effectiveness and safety of services and quality of care provided for patients and families.

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 on interview and record review, the Home Health Agency (HHA) failed to ensure performance improvement projects (PIP) were conducted every year. This failure had the potential to affect the quality of care provided to the patients. A request was made on 4/11/22, at 1:30 p.m., to the Director of Nursing (DON) for the performance improvement projects (PIP) derived from the data collected from the QAPI program. The DON stated she is aware of the requirement, but they do not have any performance improvement projects and could not provide any evidence of past projects. The HHA'S policy and procedure titled "Professional Advisory Committee" approved 11/18/2002 indicated the professional Advisory Committee (PAC) will perform an annual review of the agency's home care program. The purpose of the evaluation is to determine the effectiveness, efficiency, appropriateness and adequacy of the home care program.

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 Home Health Agency (HHA) failed to maintain and observe standards of practice for observing proper bag technique and hand washing during home visits. This failure had the potential to lead to the spread of infection. 3. A review of Patient 3’s face sheet indicated an admission date of 6/14/22 with a diagnosis of acute lymphangitis (an inflammation of the lymphatic channels. Acute lymphangitis is commonly caused by a bacterial infection, but lymphangitis can also be caused by parasitic infection (filariasis), mycobacterial infection, and malignancy (neoplastic lymphangitis) of the lower limbs. A review of the HHA’s document titled “Home Health Certification” for the certification period of 2/9/23 to 4/9/23 indicated Patient 3 had infections and was a high risk for further complications. A review of HA’s document titled “Interdisciplinary Plan of Care Revision/Physicians Orders” dated 5/16/22 indicated the SN was to visit Patient 3 once a week for eight weeks. The skilled nursing (SN) was to assess Patient 3's integumentary status, identify signs and symptoms of new impaired skin integrity, report significant changes to the physician. The POC further indicated the SN was to perform wound care to both lower extremities and feet related to cellulitis, non-pressure ulcers and Cleanse the wound with normal saline and apply mupirocin 0.1% (antibiotic skin ointment), and cover with an Unna boot bandage (a gauze wrap that is soaked with a zinc oxide paste. The zinc oxide paste helps ease skin irritation and keep the area moist. Typically placed on the leg from the base of the toes to just below the knee. The paste is then covered with a dry gauze wrap followed by an ace bandage) wrap and compress legs, feet and ankles with self adhesive bandage using aseptic technique. The SN was to instruct Patient 3 on infection control precautions such as hand hygiene, waste disposal and signs and symptoms of infections. A home visit was conducted at Patient 3's residence with Registered Nurse (RN) on 3/4/23 at 10:00 a.m. Patient 3 is alert and oriented to name, place and time, sitting inside his office room. Observed RN donned his gloves to measure Patient 3's right and left leg girth. RN used the same gloves to get his medical equipment from his bag and used the same gloves and returned his equipment back inside his bag. RN did not sanitize his equipment after using it to his patient. During an interview with RN on 3/5/23 after the home visit, RN stated he does not have a clean and soiled bag inside his backpack. He stated he considers the inside of his bag clean. During an interview with the Director of Nursing (DON) on 3/5/23 at 11:30 a.m., the DON stated the skilled nurse should observe proper bag technique to prevent the spread of infection. A review of the HHA's undated policy titled "Home Care Bag" indicated after entering the patient's home, the bag shall be placed on a clean, dry surface with a barrier between the bag and the surface. Staff are to wash their hands prior to removing any equipment or supplies from the bag. Do not return soiled equipment to the bag. items such as a stethoscope shall be cleaned per policy and procedure prior to returning them to the bag. When all clean items have been returned to the proper section of the home care bag, the staff member shall wash his/her hands. 1. A review of Patient 1's clinical record indicated Patient 1 was admitted to the Home Health Agency (HHA) with a start of care (SOC) date of 12/18/21, for the certification period 12/13/22-2/10/23, with a diagnosis that included Alzheimer’s disease( a progressive disease that destroys memory and other mental functions) with late onset, paroxysmal atrial fibrillation,(an irregular, often rapid heart rate that commonly causes poor blood flow). mild cognitive impairment (a stage between the expected decline in memory and thinking that happens with age and the more serious decline of dementia), and cardiac arrhythmia (improper beating of the heart, whether irregular, too fast, or too slow). The physician ordered the skilled nurse (SN) to visit Patient 1 once a week for eight weeks, to assess all necessary interventions to address the underlying risk factors for a history of falls, cardiac arrhythmia, atrial fibrillation, abnormalities of gait and mobility and dementia without behavioral disturbances. On 3/4/23, at 11:30 am, during a joint home visit with the administrator at the assisted living facility (memory ward) section. The administrator was observed reaching into her bag for items. She failed to wipe and clean the items, which she had used during a prior visit with another patient, before taking the Patient 1's vital signs. While gloved, the administrator, reached into her pocket to access her cell phone to time Patient 1’s pulse, with the same gloves on her hand, she placed her items back into her bag without cleaning them for the next home visit. 2. A review of Patient 2's clinical record indicated Patient 2 was admitted to the Home Health Agency (HHA) with the start of care (SOC) date of 2/20/16, for the certification period 1/14/23-3/14/23, with a diagnosis of occlusion and stenosis of the bilateral carotid arteries (a build up of fatty deposits along the inner layer of the arteries causing plaque which thickens and narrows the arteries decreasing blood flow or completely blocks blood flow to the brain), chronic diastolic (congestive) right heart failure ( a condition in which the main heart’s pumping chamber becomes stiff and unable to fill properly) and pulmonary hypertension due to left heart disease with late onset, paroxysmal atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow), mild cognitive impairment (a stage between the expected decline in memory and thinking that happens with age and the more serious decline of dementia), and cardiac arrhythmia (improper beating of the heart, whether irregular, too fast, or too slow). The physician ordered the skilled nurse (SN) to visit once a week for nine weeks, to develop a patient plan of care with patient/caregiver involvement and to perform complete physical assessment each visit with emphasis on cardiovascular. On 3/4/23, at 10 am, during a joint home visit with the administrator at the assisted living facility (memory ward) section. The administrator was observed not washing her hands prior to providing care, donning her gloves to take patient 2’s vital signs. While gloved, she reached into her pocket to access her cell phone to time Patient 2’s pulse, and with the same gloves on her hand, she placed the items back into her bag without cleaning them. During an interview with the administrator at the Home Health Agency on 3/5/23, at 12:40 pm., she stated she should have cleaned the equipment, and washed her hands before during and after providing care.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to maintain, implement and update their COVID-19 (an acute serious respiratory illness) policy and procedure. This failure had the potential to result in the spread of infection. During an interview on 3/5/23 at 11:30 a.m., with the Director of Nursing (DON), the DON stated the HHA updated its COVID-19 Policy on 1/22/22. During a concurrent record review of the HHA COVID-19 policy indicated their reference for the COVID-19 policy was from 2020. A review of the HHA's Covid-19 policy stated to mitigate the transmission and spread of COVID-19 the Home health Agency will reference and follow CDC(Center for Disease Control and Prevention) as guidance for mitigation strategies.

Infection control education CFR(s): 484.70(c) Standard: Education. The HHA must provide infection control education to staff, patients, and caregiver(s). This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to provide infection control education and training for office and field staff in accordance to its policy and procedure. This failure had the potential to spread infection and communicable disease to staff and patients. During a concurrent interview and record review on 3/5/23 at 11:30 a.m., with the Director of Nursing (DON) about their infection control education and training for field and office staff, the DON could not provide written documentation for any education lesson plans or In-service training for office and field staff. The DON further stated she only calls staff and provide reminders for infection control. The DON stated she has staff sign the sign in sheets when they come in to get their checks. A review of the HHA's in-service sign in sheet dated 3/17/23 with topic " Covid-19 prevention in patient home" showed only two out of nine skilled and office staff signed the sign-in sheet but there was no lesson plan attached to it. A review of the HHA's document titled "Staff Education and Competency Testing" indicated additional education will be provided on an as needed basis either agency wide or office/team specific.

Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency's overall management and operation, the provision of all home health services, fiscal operations, review of the agency's budget and its operational plans, and its quality assessment and performance improvement program. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the governing body failed to assume full legal authority and responsibility for the overall management and operation of the HHA. This deficient practice has the potential to result in substandard quality of care that could affect the health and safety of the patients. During the recertification survey on 3/3/23 to 3/5/23, the Director of Nursing (DON) was unable to provide evidence that a governing body exists to address the functioning home health operations and QAPI program. During an interview with the DON on 3/5/23 at 11:30 a.m., the DON stated she is the only one who supervises the overall responsibilities and services of the home health agency. A review of the HHA's "Governing Body Minutes" indicated only two meetings were conducted for the year 2022, which included the appointment of a DON designee on 6/7/22 and survey preparation and implementation of a new electronic medical record software last 5/9/22. There were no other documented meetings. During a review of the Performance Improvement program and the QAPI on 8/12/22, indicated the QAPI and PIP lesson plans were empty. The home health agency personnel and the Governing body members could not present documented evidence and were not conducting their meetings for the past year.