Every finding on record at Guardian Home Health Care of La., Inc.

The entity is in compliance with the federal emergency preparedness requirements.

Recertification 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 record review and interview, the agency failed to reconcile medications at every skilled nurse visit to maintain an accurate record of patients’ medications. This deficient practice was identified for 1 (Patient #4) of 10 patients sampled for accurate medication Findings: Review of the agency’s Medication Policy revealed, in part, the nurse was responsible for continuous monitoring of all medications the patient may be taking to identify ineffective therapy or adverse reactions, side effects, allergies, contraindications, provide teaching when applicable, and report any problems to the physician. Review of Patient #4’s current home medications revealed the following medications not listed on the Medication Profile List: Ventolin (treatment for shortness of breath) HFA Inhaler 200 puffs and Albuterol (treatment for shortness of breath) HFA Inhaler 200 puffs 8.5grams. In an interview on 03/01/2023 at 2:10 p.m., Patient #4 stated she had been taking Ventolin and Albuterol inhalers for a few years. In an interview on 03/01/2023 at 2:17 p.m. S3Registered Nurse stated he checked Patient #4’s medications every couple of visits. In an interview on 03/02/2023 at 11:28 a.m., S2Director of Nurses confirmed the two inhaler medications should have been on Patient #4’s medication list since admit.

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 record review and interview the agency failed to maintain a coordinated agency-wide infection control program to prevent the spread of infections by tracking and trending. This deficient practice had the potential to affect any of the 136 patients receiving home health services. Findings: Review of the agency’s Infection Control in Home Health Care Policy revealed, in part, reportable infections are community acquired infections and nosocomial infections for the Performance Improvement Committee to evaluate and track. Review of the agency’s infection control binder revealed, in part, not all patient infections were being logged for 2022. Further review did not reveal any tracking or trending of patient infections. In an interview on 03/03/2023 at 9:45 a.m., S2Director of Nursing (DON) stated he noticed in October of 2022 infections were not being documented in the patients’ medical record. S2DON confirmed all infections should be documented on in the patients’ medical record and tracked to evaluate for trends.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure patients receive all visits as ordered by the physician for 3 (Patient #1, Patient #3, and Patient #4) of 10 sampled patients. This deficient practice had the potential to affect any of the 136 patients receiving home health services. Findings: Patient #1 Review of Patient #1’s Home Health Certification and Plan of Care, with a certification period of 02/10/2023 through 04/10/2023, revealed, in part, a physician’s order for Physical Therapy (PT) to evaluate Patient #1 the week of 02/12/2023. Review of Patient #1’s PT evaluation, with a date of 02/15/2023, revealed, in part, a frequency of visits to be completed once a week for one week, twice a week for two weeks, and once a week for one week. Review of Patient #1’s PT visit log revealed only one PT visit the week of 02/19/2023. In an interview on 03/02/2023 at 10:57 a.m., S2Director of Nurses (DON) confirmed all visits ordered by the physician should have been completed. Patient #3 Review of Patient #3’s Home Health Certification and Plan of Care, with a certification period of 01/04/2023 through 03/04/2023, revealed, in part, a frequency of visits by a skilled nurse to be once a week for one week and twice a week for 8 weeks. Review of Patient #3’s Skilled Nurse visit log revealed no nurse visit completed the week of 02/19/2023. In an interview on 03/02/2023 at 11:16 a.m., S2DON confirmed the nurse should have made two visits the week of 02/19/2023 to see Patient #3. Patient #4 Review of Patient #4’s Home Health Certification and Plan of Care, with a certification period of 01/08/2023 through 03/08/2023, revealed, in part, a frequency of visits by a skilled nurse to be once a week for 8 weeks. Review of Patient #4’s Skilled Nurse visit log revealed no nurse visit completed the week of 01/29/2023. In an interview on 03/02/2023 at 11:28 a.m., S2DON confirmed the reason for Patient #4 not having a skilled nurse visit the week of 01/29/2023 was due to a scheduling error, but the skilled nurse visit should have been completed.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a nurse completed a supervisory visit for a Home Health Aide every 14 days for 1 (Patient #1) of 10 total patients sampled. Findings: Review of the Registered Nurse/Staff Nurse Job Description revealed, in part, the nurse prepares the assignment plan for the home care aide and directly and indirectly supervises the aide every fourteen days. Review of Patient #1’s Home Health Certification and Plan of Care, with a certification period of 02/10/2023 through 04/10/2023, revealed, in part, a home health aide ordered frequency of once a week for one week and twice a week for 8 weeks. Review of Patient #1’s Home Health Aide Visit Log revealed visits on the following dates: 02/10/2023, 02/13/2023, 02/17/2023, 02/22/2023, 02/24/2023, and 02/27/2023. Review of Patient #1’s Skilled Nurse Visit Log revealed visits on the following dates: 02/23/2023, 02/20/2023, and 02/24/2023. Further review did not reveal nor did the agency provide any documented evidence of a completed skilled nurse supervisory visit on a home health aide during her completed skilled nurse visits. In an interview on 03/02/2023 at 10:57 a.m., S2Director of Nurse confirmed a nurse should have completed a supervisory visit on the home health aide every 14 days. S2DON further confirmed a supervisory visit should have been completed by the nurse on the home health aide on 02/24/2023.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure weekly wound care measurements and/or assessments were completed to monitor for wound status for 3 (Patient #3, Patient #4, and Patient #7) of 10 sampled patients. Findings: Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed, in part, assessment and documentation of wound status, includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes, in part: dimensions, depth, and location of and depth of any sinus tracts or undermining areas. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Review of the agency’s Daily Wound Care Policy and Procedure revealed, in part, the nurse must document significant assessment findings, performance of the skilled procedure, the patient’s response, and descriptions and measurements of wounds. Patient #3 Review of Patient #3’s Home Health Certification and Plan of Care, for certification period of 01/04/2023 to 03/04/2023, revealed, in part, a stage 2 pressure ulcer to his sacrum. Review of Patient #3’s Skilled Nurse Visit Log revealed a visit completed the week of 01/04/2023 and no documented evidence of wound measurements completed. Further review revealed two skilled nurse visits completed the week of 01/08/2023 and no documented evidence of wound measurements completed. In an interview on 03/02/2023 at 11:16 a.m., S2Director of Nurses (DON) confirmed the nurse should have measured Patient #3’s wound once a week. Patient #4 Review of Patient #4’s Home Health Certification and Plan of Care, for certification period of 01/08/2023 to 03/08/2023, revealed, in part, a surgical wound to Patient #4’s abdomen. Review of Patient #4’s Skilled Nurse Visit Log revealed a visit completed the week of 01/08/2023, the week of 01/15/2023, and the week of 01/22/2023 with no documented evidence of wound measurements completed. In an interview on 03/02/2023 at 11:28 a.m., S2DON confirmed the nurse should have completed wound measurements at every skilled nurse visit for Patient #4. Patient #7 Review of Patient #7’s Home Health Certification and Plan of Care, for certification period of 01/21/2023 to 03/021/2023, revealed, in part, pressure ulcers to Patient #7’s right medial forearm, left medial forearm, left lateral foot, and sacrum. Review of Patient #4’s Skilled Nurse Visit Log revealed 3 visits completed the week of 01/22/2023, 3 visits completed the week of 01/29/2023, 3 visits completed the week of 02/05/2023, 3 visits completed the week of 02/12/2023, and 2 visits the week of 02/19/2023 with no documented evidence of wound measurements completed. In an interview on 03/02/2023 at 11:36 a.m., S2DON confirmed wound measurements should have been completed weekly on Patient #7’s wounds.

Recertification Survey and a Covid-19 Focused Infection Control Survey. Tag # 682 was cited as a result of the Covid-19 Focused Infection Control Survey. Tag # 590, # 710, #9123 were cited as a result of the Recertification Survey and Re-licensing survey. Census 137.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to notify the physician of a change in wound status for 1 of 4 patients (Patient #4) reviewed for wounds in a total sample of 10 patients. Findings: Review of Patient #4's Home Health Certification and Plan of Care for certification period of 02/06/2021 to 04/06/2021 revealed Patient #4 was admitted with diagnoses of, in part: Type II Diabetes Mellitus with Foot Ulcer, Non-pressure Chronic Ulcer of other part of Right Foot with Fat Layer Exposed; and Chronic Osteomyelitis (bone infection). Further review revealed the skilled nurse was to assess skin breakdown every skilled nurse visit. Review of Patient #4's Skilled Nurse Visit dated 02/09/2021 revealed, in part: right heel wound with pungent odor noted. Further review revealed no documented evidence of Patient #4's physician having been notified of the odor. Review of Patient #4's Skilled Nurse Visit dated 02/25/2021 revealed, in part: right heel wound with foul odor noted. Further review revealed no documented evidence of Patient #4's physician having been notified of the odor. In an interview on 03/04/2021 at 1:23pm, S2DON (Director of Nursing) and S3ADON (Assistant Director of Nursing) stated there was no documented evidence and the nurses could not present any documented evidence of the physician having been notified of the foul and pungent odors to Patient #4's wound on 02/09/2021 and 02/25/2021.

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 and interview, the agency failed to ensure visitors were screened for signs and symptoms of COVID-19 (coronavirus 19) per CDC (Centers for Disease Control) guidelines. Findings: Review of the CDC's (Centers for Disease Control) Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic revealed the agency should screen and triage everyone entering a healthcare facility for signs and symptoms of COVID-19. Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented. Further review revealed the agency was to establish a process to ensure everyone (patients, healthcare personnel, and visitors) entering the facility was assessed for symptoms of COVID-19, or exposure to others with suspected or confirmed SARS-CoV-2 infection and that they are practicing source control. On 03/01/2021, 03/02/2021, 03/03/2021, and 03/04/2021, the surveyor entered the agency and was not screened for signs and symptoms of COVID-19, temperature was not taken, and was not asked to perform hand hygiene. Observation on 03/02/2021 at 10:00am to 1:00pm, revealed two men were observed working in the agency's office running wires in the office. In an interview on 03/04/2021 at 9:45am, S2DON (Director of Nursing) stated all staff including office staff go through an extensive screening process for COVID-19 daily. S2DON was then asked what screening procedure was in place for screening of visitors. S2DON stated the agency does not allow outside visitors other than the surveyor so they never had any issues. S2DON was then asked if any job interviews were conducted or work conducted in office by outside persons. S2DON stated the agency only had two people interview for jobs in the agency office and they did not screen the potential employees upon entering the office. S2DON further confirmed the two men working on 03/02/2021 in the office were not screened for COVID-19 prior to being allowed to enter the office or at any time while present in the agency.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to: 1. Ensure care and services were provided per the frequency ordered by the physician for 2 of 10 sampled patients (Patient #2 and Patient #3) reviewed for care and services; 2. Ensure pulse oxygenation levels were obtained per the plan of care for 1 of 10 sampled patients (Patient #5) reviewed for care and services; and 3. Ensure the patients weights were obtained at every skilled nurse visit per the plan of care for 3 of 10 sampled patients (Patient #5, Patient #6, and Patient #8) reviewed for care and services. Findings: Patient #2 Review of Patient #2's Home Health Certification and Plan of Care for a certification period of 12/23/2020 to 02/21/2021 revealed Patient #2 was admitted to the agency on 12/23/2020 with diagnoses of, in part: Heart Failure, Diabetes Mellitus type II, Stage III Chronic Kidney Disease, and Pulmonary Hypertension with Hypoxia. Review of Patient #2's Post Hospital Order dated 02/02/2021 (Resumption of Care) revealed Patient #2 was to receive skilled nursing care twice a week for three weeks. Review of Patient #2's Record revealed the only skilled nurse visit which was completed for the week of 02/14/2021 to 02/20/2021 was documented on 02/18/2021. Further review revealed no documented evidence of a second visit for the week, or documentation as to why a second visit was not made. In an interview on 03/04/2021 at 12:24pm, S2DON (Director of Nursing) and S3ADON (Assistant Director of Nursing) stated the skilled nurse frequency starting 02/02/2020 was twice a week for three weeks. S2DON stated the second visit for the week of 02/14/2021 to 02/20/2021 was not made and should have been. Patient #3 Review of Patient #3's Home Health Certification and Plan of Care for a certification period of 02/11/2021 to 04/11/2021 revealed clinician frequency (how often the clinician provides care) of, in part: social worker times one. Review of Patient #3's Record revealed no documented evidence of Patient #3 having had a social worker visit for the certification period of 02/11/2021 to 04/11/2021. Further review revealed no documented evidence of when a visit was scheduled, or reason as to why the visit not scheduled. In an interview on 03/04/2021 at 12:39pm, S2DON and S3ADON stated the social worker visit had never been plotted on the schedule and was never scheduled to be conducted; therefore, was not completed. Patient #5 Review of Patient #5's Home Health Certification and Plan of Care for certification period of 01/12/2021 to 03/12/2021 revealed Patient #5 was admitted with diagnoses of, in part: Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Chronic Kidney Disease stage III. Further review revealed the skilled nurse was to obtain a pulse ox (oxygen saturation level) prn (as needed) and to weigh the patient at every skilled nurse visit. Review of Patient #5's Skilled Nursing Visit Notes dated 01/12/2021, 01/19/2021, 01/27/2021, 02/04/2021, 02/09/2021, 02/18/2021, and 02/23/2021 revealed Patient #5 had shortness of breath with moderate exertion with no oxygen saturation number recorded. Further review of the Skilled Nursing Visit Notes listed above revealed no weight was documented. In an interview on 03/04/2021 at 1:10pm, S2DON and S3ADON stated this was discussed with the nurse previously and she was never able to present documentation that a pulse oxygenation level or weight was obtained at the above mentioned visits. Patient #6 Review of Patient #6's Home Health Certification and Plan of Care for certification period of 01/16/2021 to 03/16/2021 revealed Patient #6 was admitted to the agency with diagnoses of, in part: Atherosclerotic Heart Disease; Presence of Aortocoronary Bypass Graft, Hypertension, and Cardiac Murmur. Further review revealed Patient #6 was to be weighed at every skilled nurse visit. Review of Patient #6's Skilled Nursing Visit Notes dated 01/19/2021 and 02/18/2021 revealed no documented evidence of Patient #6's weight having been obtained. In an interview on 03/04/2021 at 1:12pm, S2DON and S3ADON stated Patient #6's weights were not obtained on 01/19/2021 or 02/18/2021 and should have been. Patient #8 Review of Patient #8's Home Health Certification and Plan of Care for certification period of 10/27/2020 to 12/25/2020 revealed Patient #8 was admitted to the agency with diagnoses of, in part: Diabetic Type II with foot ulcer, End Stage Renal Failure (kidney failure), Congestive Heart Failure, and Atrial Fibrillation. Further review revealed the skilled nurse was to obtain a weight every visit, and if unable to obtain weight, then skilled nurse was to measure abdominal girth every visit and then report to physician an increase of greater than 3cm (centimeters) since last visit. Review of Patient #8's Skilled Nursing Visit Notes dated 11/12/2020, 11/19/2020, 11/24/2020, 12/03/2020, 12/10/2020, and 12/17/2020 revealed no documented evidence of a weight or abdominal girth measurement having been documented. In an interview on 03/04/2021 at 1:30pm, S2DON and S3ADON stated the agency did not have documented evidence of the weight or abdominal girth measurements having been obtained.