Every finding on record at Hale County Hospital Board

Based on the recertification survey conducted on 5/18/22, Hale County Hospital Home Health was found to be in substantial compliance with the standards for Emergency Preparedness.

A recertification survey was conducted at Hale County Hospital Home Health from 5/17/22 to 5/18/22, standard level deficiencies were written which will require an acceptable Plan of Correction.

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 review of Medical Records (MR), agency policy and procedure, Home visit (HV) observations, and interviews, it was determined the agency failed to ensure the staff maintained an accurate medication profile. This deficient practice affected 2 of 3 HVs including HV # 3, and HV # 2 and had the potential to negatively affect all patients admitted to this agency. Findings include: Agency Policy: Medication, Patient Information, and Reconciliation Policy #: 8001 Reviewed: 1/24/22 Policy: Hale County Hospital (Home Health Agency) shall implement a patient medication information/reconciliation process to obtain and document a complete list of a patient's current medications... The patient's medications shall be reviewed and assessed during each skilled visit. Any changes to the medications or changes in the patient's response to the medications shall be conveyed to the ordering physician... The Medication Profile shall be reviewed and updated as necessary according the (Home Health Agency) Policy... Procedure: The patient's medications shall be reviewed and assessed during each skilled visit... The Medication Profile shall be reviewed and updated as necessary according to HHA (Home Health Agency) policy... 2. HV # 2 was admitted to the agency on 1/2/2020 with a recertification date of 4/21/22 to 6/19/22 and admitting diagnoses of Encounter For Attention to Other Artificial Opening of Urinary Tract and Other Neuromuscular Dysfunction of Bladder. A HV was conducted on 5/17/22 at 12:15 PM with EI # 4, Home Health Aide. During the HV the patient's medications were reviewed using the Patient Medication Order List provided to the surveyor by the agency and the patient's medication bottles. The following medication was found in the home and not on the medication list: Stool Softener 1 tablet daily by mouth which was an over the counter medication. The sitter was asked how long the patient had been on this medication and the sitter replied "she has been taking it for maybe a year". The surveyor was unable to obtain a date the medication was started. An interview was conducted on 5/18/22 at 1:00 PM with EI # 1 who confirmed the the staff failed to maintain an accurate medication profile. 1. HV # 3 was admitted to the agency on 4/5/22 with diagnoses including Primary Generalized Osteoarthritis, Essential (Primary) Hypertension, and Chronic Kidney Disease. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 4/5/22 revealed orders for Skilled Nurse (SN) 2 times a week for 2 weeks, 1 time a week for 2 weeks, then once every 2 weeks for 5 weeks. Review of the Skilled Nursing Visit Note (SNVN) dated 4/11/22 revealed the Registerd Nurse (RN) documented "instructed on new med (medication), Potassium, to take 10 meq (milliequivalents) one tablet daily..." Review of the Patient Medication List dated 5/17/22 revealed no documentation of the new medication Potassium. A HV visit was conducted on 5/17/22 at 9:40 AM to observe care provide by Employee Identifier (EI) # 5, Physical Therapist. A Patient Medication List was provided to the surveyor on 5/17/22 and compared with the medications in the home. Potassium Chloride 10 meq take on daily, prescription dated 4/8/22 was in the home but not listed on the Patient Medication List. HV # 3's caregiver stated his/her doctor had prescribed the Potassium during a previous doctor visit and he/she has been taking the Potassium since the prescription was filled on 4/8/22. In an interview conducted on 5/18/22 at 1:15 PM, EI # 1, Director, confirmed the staff failed to update the Patient Medication List with the new medication per agency policy.

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 review of medical records (MR), agency policies and procedures and interviews with the staff it was determined the agency failed to ensure the staff followed the agency policy for hand hygiene, cleaning of equipment, cleaning of the blood pressure cuff after use and bag technique for barrier placement. This affected 1 of 3 Home Visits (HV) and did affect HV # 2 and had the potential to negatively affect all patients served by the agency. Findings include: Agency Policy: Hand Hygiene - CDC Guidelines Policy Number: 5011 Revised Date: January 2022 Purpose: To provide guidelines for effective hand hygiene, in order to prevent the transmission of bacteria, germs and infections. Policy: Gloves shall be worn when contact with ...body fluids...is anticipated. Change gloves and discard after each patient contact... Change gloves when moving from a contaminated body site to a clean body site... All staff shall use the hand-hygiene techniques, as set forth in the following procedure... Before each patient encounter Before applying...gloves After coming in contact with patient's intact skin, i.e., taking a patient's blood pressure, pulse... After working on a contaminated body site and then moving to a clean body site on the same patient... After contact with medical equipment/supplies in patient areas Always after removing gloves or facemask Procedure: Using an alcohol-based hand rub: Apply the manufacture's recommended amount of alcohol-based hand rub to palm of one hand. Rub hands together, covering all areas of the hands and fingers, until hands are dry, per manufacture's recommendations. Agency Policy: Nursing Bag Technique Policy Number: 5016 Reviewed Date: January 2022 Policy: ...The nursing bag shall be stocked appropriate to the job descriptions the the staff with items that shall include but not limited to: Hand hygiene equipment: skin cleanser and paper towels Stethoscopes and sphygmomanometers ...non sterile gloves Alcohol pads... Procedure: ...The bag shall be placed up on a chair or table with protective barrier (paper towels, under pads) underneath. Prior to administering care...the bag shall be opened and hands shall be cleansed according to HHA (Home Health Agency) policy and procedure. After hand cleansing, all the clean supplies and equipment needed for the visit shall be removed from the bag. When visit is completed: Reusable equipment shall be cleaned using alcohol, sani wipes and/or soap and water as appropriate... Blood pressure cuff: Cleanse according to the manufacture's guidelines at a frequency recommended by the cuff manufacturer... Hands shall be cleansed prior to returning clean equipment and supplies to the bag... 1. HV # 2 was admitted to the agency on 1/2/2020 with a recertification date of 4/21/22 to 6/19/22 and admitting diagnoses of Encounter For Attention to Other Artificial Opening of Urinary Tract and Other Neuromuscular Dysfunction of Bladder. A HV was conducted on 5/17/22 at 12:15 PM with Employee Identifier (EI) # 4, Home Health Aide, to observe care provided to the patient during a bed bath. After entering the home EI # 4 placed a barrier on a chair and placed the aide bag on the barrier. EI # 4 sanitized hands, obtained equipment from the bag and placed on barrier. EI # 4 obtained the tablet, cleaned the tablet with bare hands and laid the tablet on top of multiple papers on the dining room table without a barrier. EI # 4 then took HV # 2's vital signs and failed to sanitize hands after cleaning the tablet, and failed to don gloves. When EI # 4 completed vital signs, picked up the tablet and documented findings and walked to patients bed and laid the tablet on the bed without barrier. Once documentation on the tablet was complete EI # 4 placed the tablet back on the table without a barrier. EI # 4 sanitized hands donned gloves and picked up the Foley bag which was lying on the floor. EI # 4 removed gloves and donned clean gloves and failed to sanitize hands prior to donning the clean gloves. After the use of wipes to clean patient's buttocks EI # 4 removed gloves and used hand sanitizer and failed to rub hands until dry according to the agency policy and waved hands in the air to dry. Once the bath was completed and the patient was dressed EI # 4 washed hands and began to clean the equipment. EI # 4 had rolled the blood pressure cuff up after use and when cleaning the cuff EI # 4 failed to unroll the cuff to clean. EI # 4 cleaned the tubing, bulb and the blood pressure gage only and placed the cuff in the bag. An interview was conducted on 5/18/22 at 1:00 PM with EI # 1, Director, who confirmed the tablet should not have been laid on the table or the patient bed without a barrier, and gloves are not to be placed in the scrub pocket. EI # 1 also confirmed hands are to be rubbed together when using hand sanitizer until dry.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on review of agency policies and procedures, medical records (MR) and interview with agency staff, it was determined the agency failed to ensure patient education and teaching was provided as ordered by the physician. This deficient practice affected 2 of 7 MR reviewed including Home visit (HV) # 1 and MR # 3 and had the potential to negatively affect all patients admitted to this agency. Findings include: Policy: Patient/Family Education Policy Number: 10201 Effective Date: Jan 2022 Purpose: To improve patient outcomes by educating the patient and family… as appropriate, by promoting recovery, life-style modifications, and healthy behavior… Policy: All patients admitted for care, treatment and /or services shall be provided with appropriate education and training specific to needs identified during the initial and ongoing assessments… Procedure: … The Skilled Nurse (SN) shall provide instructions to patient/family before and during care, treatment, and services… These instructions may include, but shall not be limited to: … Nutritional interventions, dietary requirements… Policy: Care Planning Policy Number: 10022 Revised: 11/21 Policy: All clinical services shall be implemented only in accordance with Plan of Care (POC) established by a physician’s written orders. An individualized POC shall be developed for each patient and is documented by the Registered Nurse (RN) … Procedure: The POC shall include… Interventions to address the identified patient needs, including teaching… Nutritional requirements… Patient-specific interventions and education 1. HV # 1 was admitted to the agency on 12/15/2021 and recertified for continued care on 4/14/22 with diagnoses including, Secondary Malignant Neoplasm of Liver and Intrahepatic Bile Duct, Dehydration, Muscle Weakness (generalized) Candidal Stomatitis, Nausea, Anorexia, Colostomy Status and Depression, Unspecified. Review of the Home Health Certification (HHC) and POC dated 4/14/22 to 6/12/22 revealed a physician order for the SN teach and encourage healthy diet, adequate fluid intake… status every visit. Review of the SN visit notes dated 4/12/22, 4/18/22, 4/21/22, 5/2/22, 5/5/22, 5/9/22 and 5/16/2/22 revealed no documentation the SN provided teaching or encouraged the patient on healthy diet and/or adequate fluid intake as ordered in the POC. An interview was conducted on 5/18/22 at 1:12 PM with Employee Identifier (EI) # 1 RN, Agency Director who confirmed the SN failed to document teaching and encouragement to the patient per physician orders. 2. MR # 3 was admitted to the agency on 4/5/22 with diagnoses including Metabolic Encephalopathy, Altered Mental Status-Unspecified, Muscle Weakness (generalized), Alcohol Abuse-Uncomplicated, Unspecified Atrial Flutter, Low Back Pain-Unspecified, Scoliosis-Unspecified, Mixed Hyperlipidemia and Repeated Falls. Review of the HHC and POC dated 4/5/22 to 6/3/22 revealed the SN was to provide teaching and encourage no added salt diet, adequate fluid intake … every visit. Review of the SN visit notes dated 4/5/22, 4/8/22, 4/11/22, 4/14/22, 5/3/22, 5/11/22 and 5/13/22 revealed no documentation of teaching or encouragement to the patient every visit as ordered by the physician. An interview conducted on 5/18/22 at 12:53 PM with EI # 2 RN, Clinical Case Manager confirmed the SN failed to provide teaching for no added salt diet and fluid intake as ordered.

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 review of medical records (MR), agency policy and procedure and interviews with the staff it was determined the agency failed to ensure the Registered Nurse (RN) updated the Aide Plan of Care with changes in the patient's condition and the frequency of visits. This affected 1 of 2 MR's reviewed with aide service and did affect Home Visit (HV) # 2 and had the potential to negatively affect all patients served by the agency with HHA services. Findings include: Agency Policy: Updating Aide Plan of Care Policy Number: 4042 Effective Date: 12/2017 Policy: Hale County Hospital HHA (Home Health Agency) shall update the Aide Plan of Care at any time there is a change in patient condition that requires a change in services provided by the Aide. Procedure: The HHA's Home Health Aides/CNA's (certified nursing assistants) shall report to RN (Registered Nurse) if at any time the current plan of care no longer appropriately meets the needs of the patient due to change in condition, ambulation or transferring status etc. The RN shall update the Aide Plan of Care according to the patient's needs and capabilities at any time the current plan of care is not sufficient or appropriate to the patient's needs... 1. HV # 2 was admitted to the agency on 1/2/2020 with a recertification date of 4/21/22 to 6/19/22 and admitting diagnoses of Encounter For Attention to Other Artificial Opening of Urinary Tract and Other Neuromuscular Dysfunction of Bladder. A HV was conducted on 5/17/22 at 12:15 PM with Employee Identifier (EI) # 4, Home Health Aide, to observe care provided to the patient during a bed bath. Patient was found to be lying in bed unable to speak or move due to paralysis. Review of the Home Health Certification and Plan of Care dated 4/21/22 and a recertification dates of 4/21/22 to 6/19/22 revealed the frequency of visits for the Home Health Aide was one week one (one time a week for one week), two times a week for eight weeks for assistance with ADL's (activities of daily living) and personal care... Review of the Home Health Aide Plan of care dated 1/2/2020 revealed the following frequency and tasks assigned to the Home Health Aide by the RN: Activity Assistance: Ambulation: To chair Transfer: To chair Frequency/Special Instructions: 3 times weekly. Review of the Home Health Aide notes dated 4/22/22, 4/26/22, 4/29/22, 5/2/22, 5/4/22, 5/10/22 and 5/13/22 revealed the aide checked repositioned in bed. The patient is bed bound and unable to ambulate to chair or transfer to chair as directed by the aide plan of care. The Aide failed to notify the RN in the change in patient's condition. Review of the Frequency/Special Instruction section of the aide plan of care revealed the frequency of visit as 3 times weekly and not updated at the time of recertification to two times a week for eight week and the assist to chair or transfer to chair was not updated to reposition in bed. An interview was conducted on 5/18/22 at 1:00 PM with Employee Identifier (EI) # 1, Director, who confirmed the patient is bed bound and unable to ambulate and the frequency of visits are to be performed 2 times a week and not 3 times a week per the aide plan of care. EI # 1 stated the aide plan of care should have been updated at the time of recertification.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on review of Medical Records (MR), agency policy and procedure, and interviews, it was determined the agency failed to ensure the Home Health Aide (HHA) followed the Aide Care Plan. This deficient practice affected 1 of 2 MR reviewed with HHA services including Home Visit (HV) # 3, and had the potential to affect all patients receiving HHA services. Findings include: Agency Policy: Home Health Aide Assignments and Duties Policy #: 4042 Date Reviewed: 01/2022 ...Policy: 1.Hale County Hospital (Home Health Agency) shall assign Home Health Aides/CNAs (Certified Nursing Assistants) to specific patients under the supervision of a Registered Nurse (RN). 2. Home Health Aides/CNAs must follow written Patient Care Instructions as prepared by the RN. 3. Home Health Aides/CNAs must report changes in the patient's condition to a RN. 4. Home Health Aides/CNAs must complete appropriate records in compliance with the (Home Health Agency) policies and procedures. Procedure: The (Home Health Agency) Home Health Aides/CNAs shall provide services that are: 1. Ordered by the physician 2. Included in the plan of care... 2. HV # 2 was admitted to the agency on 1/2/2020 with a recertification date of 4/21/22 to 6/19/22 and admitting diagnoses of Encounter For Attention to Other Artificial Opening of Urinary Tract and Other Neuromuscular Dysfunction of Bladder. Review of the most current Home Health Aide Plan of Care dated 1/2/2020 revealed the following tasks to be provided and the frequency of each task was not listed on the Aide Plan of Care: Personal Care: comb hair, shampoo, lotion/cream to hands/feet, Fingernails: Clean, Toenails: Clean. Oral Care: Teeth, Mouth Incontinence Care: Bladder: Incontinent, Catheter care, Pericare, Empty drainage bag. Activity Assistance: Dress: Bed clothes, Ambulation: To chair, Transfer: To chair. Review of the Home Health Aide notes dated 4/22/22, 4/26/22, 4/29/22, 5/2/22, 5/4/22, 5/10/22 and 5/13/22 revealed the aide completed skin care, oral care, nail care and repositioned in bed. Further review revealed no documentation as to what skin care (lotion, Cream or powder) , nail care (Clean) and oral care (teeth and mouth) was performed and no task was assigned by the Registered Nurse for repositioning the patient in bed. An interview was conducted on 5/18/22 at 1:00 PM with Employee Identifier (EI) # 1, Facility Director, who confirmed the aide notes do not go into detail of each task like the aide care plan does and just checking the box is all the aide can do. EI # 1 also confirmed repositioning of the patient was not on the aide plan of care. 1. HV # 3 was admitted to the agency on 4/5/22 with diagnoses including Primary Generalized Osteoarthritis, Essential (Primary) Hypertension, and Chronic Kidney Disease. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 4/5/22 revealed orders for HHA 1 x a week for 1 week, 2 times a week for 4 weeks, then 1 time a week for 4 weeks. Review of the Aide Care Plan dated 4/5/22 revealed instructions under Personal Care for the HHA to comb hair, shampoo, shave, and apply lotion to hands/feet on each HHA visit. Review of the Aide Visit Notes dated 4/8/22, 4/13/22, and 4/15/22 revealed no documentation the tasks for comb hair, shampoo, shave, or apply lotion were completed. Review of the Aide Care Plan dated 4/19/22 revealed instructions under Personal Care for the HHA to comb hair, shampoo, shave, and apply lotion to hands/feet on each HHA visit. Review of the Aide Visit Notes dated 4/20/22, 4/22/22, 4/27/22, 4/29/22, 5/2/22, 5/4/22, and 5/11/22 revealed no documentation the tasks for comb hair, shampoo, shave, or apply lotion were completed. In an interview conducted on 5/18/22 at 1:15 PM, Employee Identifier (EI) # 1, Director, confirmed all of the tasks should have been completed on each visit and there was no documentation the staff completed the tasks.