Every finding on record at Grande Ronde Hospital Home Care Services

An unannounced Federal recertification survey was completed at this agency on 8/10/2022. The agency was surveyed for compliance with 42 CFR Conditions of Participation for Home Health Agencies, Part 484. An entrance conference was held with the Clinical Care Manager and the Chief Nursing Officer on 8/8/2022 at 1:48 PM. The purpose of the survey and the survey needs were explained. An opportunity was provided for questions, answers and comments. Definitions and abbreviations: CFR - Code of Federal Regulations CHF - Congestive Heart Failure ER - Emergency room mg - milligram

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on interview and medical record review, it was determined the agency failed to ensure the individualized plan of care included complete medication orders and patient-specific measurable outcomes and goals for 2 of 5 active patient records reviewed (Patients #2 and 3). Findings: 1. Patient #2: Review of the "Home Health Certification and Plan of Care," for certification period from 6/17/2022 to 8/15/2022, revealed the medication order "brimonidine (ALPHAGAN) 0.2% solution Apply 1 drop to eye 2 times daily." The order failed to specify which eye. Patient #3: Review of the "Home Health Certification and Plan of Care," for certification period from 6/24/2022 to 8/22/2022, revealed the medication order "loratadine (CLARITIN) 10 mg Take 1 tablet by mouth as needed for Allergies." The order failed to specify the frequency the medication could be taken. Further review revealed the order "cephalexin (KEFLEX) 500 mg capsule Take 1 capsule by mouth 3 times daily." The antibiotic order failed to include a reason the medication was ordered, and a stop date or instruction that the medication should be taken indefinitely. During an interview with Employee #1 on 8/10/2022 beginning at 9:45 AM, the above findings were presented. Employee #1 acknowledged the findings. 2. Patient #2: Review of the "Home Health Certification and Plan of Care," for the certification period from 6/17/2022 to 8/15/2022, revealed the care plan goals "Patient will have good understanding of management of CHF; Patient will have no unnecessary ER visits or hospitalizations during time on home health" and "Patient and caregiver will have good understanding of management of edema long term." The care plan goals lacked measurable, patient-specific information such as how "good understanding of management of CHF; good understanding of management of edema long term;" and "unnecessary ER visits" would be measured and who would make that determination. Patient #3: Review of the "Home Health Certification and Plan of Care," for the certification period from 6/17/2022 to 8/15/2022, revealed the care plan goals "Patient and caregiver will understand proper management of Diabetes; Patient will have good understanding of management of cardiac conditions by end of time on home health" and "Patient will have no unnecessary ER visits or hospitalizations during time on home health." The care plan goals lacked measurable, patient-specific information such as how patient and/or caregiver understanding of "proper management of Diabetes" and "management of cardiac conditions" would be measured and who would make that determination. The care plan also contained the same goal as Patient #2 "Patient will have no unnecessary ER visits or hospitalizations during time on home health" and lacked information on how "unnecessary ER visits" would be measured and who would make that determination. During an interview with Employee #1 on 8/10/2022 beginning at 9:45 AM, the above findings were presented. Employee #1 acknowledged the findings and stated the need for "more detail in those goals. That makes sense to me."

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 home visit observation and interview, it was determined the agency failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. Observation of a home visit for Patient #4 revealed Employee #7 provided direct patient care, including but not limited to, performing wound care to the left lower extremity. Throughout the performance of wound care, Employee #7 failed to perform hand hygiene after removing gloves. Employee #1 was also present to observe the visit and acknowledged the findings immediately after the visit. During an interview with Employee #3 on 8/9/2022 beginning at approximately 11:00 AM, the findings were discussed. Employee #3 acknowledged the findings and stated "That's a big no-no."