Every finding on record at Healing Hands Home Health Care

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 2525 Colorado Blvd., Ste. D., Los Angeles CA 90041 Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID: 44916 Health Facilities Evaluator Nurse, Surveyor ID: 22303 Unduplicated Admissions - 109 Active Patients - 40 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 training for staff was done on an annual basis. This failure had the potential to result in the staff having a lack of knowledge to respond effectively during an emergency situation. During a review of the emergency preparedness plan of the HHA on 3/26/23, at 12:30 p.m., the HHA did not have documented evidence of an Emergency Preparedness training/disaster drill for all staffs and did not have evidence of an emergency plan annual review. During an interview with director of patient care services (DPCS) on 3/26/23, at 1 p.m., she stated she had not received Emergency Preparedness/Disaster training plan from the HHA. There was no documented evidence the governing body reviewed the policy annually for Emergency Preparedness/Disaster The HHA's undated policy and procedure titled "Emergency/Disaster Plan" indicated the purpose was to outline a planned, coordinated strategy to promote the safety and continuation of care and/or services to agency patients in the event of a disaster.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 2525 Colorado Blvd., Ste. D., Los Angeles CA 90041 Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor # 44916 Health Facilities Evaluator Nurse, Surveyor # 22303 Unduplicated Admissions - 109 Active Patients - 40 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 profile for four out of seven patients (Patients 1, 2, 4 and 5). This failure had the likelihood to result in placing these four patients at risk for medication errors and adverse drug reactions. 1. A review of Patient 1's Patient Profile Information indicated, a start of care (SOC) date of 1/31/23, with a certification period of 1/31/23 to 3/31/23. Patient 1's diagnosis included type 2 diabetes (is a chronic condition where the body does not produce insulin which regulates the blood sugar) with eye complications. A home visit was conducted on 3/25/23 at 10:15 a.m., with Director of Patient Care Services (DPCS). Patient 1 was observed sitting in the living room area, alert and oriented to name, place, and time, not in any respiratory distress. Daughter/caregiver was present. During a review of Patient 1's medications currently taking reconciling with the medication profile on 3/25/23, at 10:30 a.m., indicated the following medications were not updated in the medication profile: Kerendia 20 milligrams for diabetes(mg- unit of measurement) daily was not listed. Glipizide 10 mg twice daily for diabetes on bottle but on med profile its daily. Colace 100 mg for constipation bottle was missing. Daughter stated that patient is not taking anymore. Diclofenac 1% gel for pain as needed was not on med profile. Yupelpri 175 micrograms(mcg- unit of measurement) per 3 milliliters(ml- unit of liquid measurement) daily was not on med profile but at patients home. Fluocinonide 0.05% cream as needed for fungal infection on face not on med profile Clotrimazole 1% cream as needed for fungal infection not in med profile. Tramadol 50 mg as needed for pain, daughter stated patient is not taking anymore. Flovent 220 mcg 2 puffs orally twice a day on med profile but was discontinued and changed to another inhalation. 2. A review of Patient 2's Patient Profile Information indicated, a start of care (SOC) date of 12/9/22, with a certification period of 2/7/23 to 4/7/23. Patient 2's diagnosis included kaposi's sarcoma (is a cancer that develops from the cells that line lymph or blood vessels and lymphedema. During a review of Patient 2's medications currently taking reconciling with the medication profile on 3/26/23, indicated the medication profile does not include the use of tylenol. During a review of the visit notes for the following dates 3/22/23,3/15/23, 3/8/23, 3/3/23, 3/1/23, 2/24/23, 2/22/23, the licensed nurse were documenting current pain management and effectiveness: rest, tylenol. During an interview with the Administrator (Admin)designee on 3/26/23 at 1:30 p.m., Admin designee confirmed on Patient 2's electronic medical record there was no order for tylenol to be administered. Admin designee stated the importance of the staff to call and update the office of the changes in medications to update the med profile. A review of the HHA's policy titled "Medication Profile" revised 5/1/15, indicated that to define the use of medication profile in evaluating a patient's current medication regimen. Upon admission to the agency, the admitting clinician will initiate a medication profile to document the current medication regimen. During subsequent home visits, the medication profile will be used as a care planning and teaching guide to assure the patients/representatives as well as other clinicians understand the medication regimen. A review of Patient 4's admission record indicated Patient 4 was admitted to the facility on 2/9/23, with diagnosis that included hypertensive heart disease. A review of Patient 4's plan of care (POC) from 2/9/23 to 4/9/23, included a SN (skilled nursing ) visits of once a week for one week, twice a week for one week, once a week for 7 weeks, to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. The SN was to teach and instruct about medications and adverse reactions. On 3/25/23, at 1:30 p.m., a home visit was conducted at Patient 4's residence with RN 1 (registered nurse). Patient 4 was alert and oriented and sitting on a chair at dining area. At 1:45 p.m., a review was conducted of Patient 4's current medications reconciling with the medication profile provided by the agency. It was observed Patient 4 had a bottle of Atenelol 50 mg 1/2 tab daily. At 2 p.m., during an interview with Patient 4, she stated she takes Atenelol 50 mg 1/2 tab in a.m. and 1/2 tab at p.m.. On 3/26/23, at 11 a.m., during an interview with the DPCS, she stated the visiting nurse missed checking the patient's medications. A review of the HHA's document titled " Clinical policy and Procedures Manual: Medication Profile", indicated Patient's receiving medications will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the SN (skilled nurses) failed to administer Clonidine medication as ordered for one out of 7 patients (Patient 4). This deficient practice placed the patient at risk for hypertension crisis. . A review of Patient 4's admission record indicated Patient 4 was admitted to the facility on 2/9/23, with diagnosis that included hypertensive heart disease. A review of Patient 4's plan of care (POC) from 2/9/23 to 4/9/23, included a SN (skilled nursing ) visits of once a week for one week, twice a week for one week, once a week for seven weeks, to observe/assess all body systems focusing on cardio-vascular system (heart). One of the nursing intervention was to administer Clonidine transdermal 0.1 mg (milligrams)/24 hr. one patch apply to chest area every week. On 3/25/23 at 1:30 p.m., a home visit was conducted at Patient 4's residence with RN 1. Patient 4 was observed sitting on a chair at the living room with a Clonidine 0.1 mg patch dated 3/20/23 on her left arm. A further review of Patient 4's LVN Skilled Nursing Visits dated 2/9, 2/14,2/21,2/28/23 and 3/7/23, indicated there was no documented evidence the visiting nurse administered Clonidine 0.1 mg patch to Patient 4 as ordered. On 3/26/23 at At 11:20 a.m., during an interview with DPCS (director of patient care services), she stated she could not find any documentation that the visiting nurse administered the Clonidine medication as ordered.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to provide an individualized plan of care that included specific interventions for blood sugar management for one out of seven sampled patients (Patient 1). This deficient practice had the potential likelihood for Patient 1 and his caregiver to poorly respond when Patient 1 had episodes of low( less than 60) and high (more than 300) blood sugar reading. A review of Patient 5's record was reviewed. The forms titled, "Home Health Certification and Plan of Care" (POC), certification period from 1/31/23 to 3/31/23, indicated the start of care (SOC) date of 1/31/23, with a diagnoses type 2 diabetic mellitus (high blood sugar) with diabetic ophthalmic (eyes) complication. The POC indicated the Skilled nurse (SN) was to visit twice a week for one week and once a week for eight weeks. It further indicated the SN was to perform a skilled assessment and evaluation of all body systems, vital signs, and blood sugar measurements every visit and record. The SN was to assess for signs and symptoms of hypo/hyperglycemia, response to prescribed insulin/injectables; signs and symptoms of glaucoma (a chronic, progressive eye disease caused by damage to the optic nerve, which leads to visual field loss). Additionally, the SN was to instruct/validate the patient and caregiver’s ability to check blood sugar levels, prepare and administer prescribed insulin timely/safely, proper record keeping; on disease processes, signs and symptoms, complications, interventions; prescribed diet and meds. The SN was to notify the MD of blood sugar levels less than 70 and more than 300, unrelieved pain, difficulty breathing and other significant findings. The listed goals and outcomes indicated the blood sugar levels will be controlled within the range of 80-120 without signs and symptoms of hypo/hyperglycemia and the patient will be able to administer insulin timely and safely observing site rotation/universal precautions throughout the episode. Discharge patient to self and care of family with MD supervision and follow up once goals are met, and no skilled care is needed. A home visit was conducted on 3/25/23, with the Director of Patient Care Services (DPCS), and Patient 1's caregiver. During a review of Patient 1's medications in the home indicated Patient 1 takes Tresiba subcutaneous 100 unit per milliliter 10 units at bedtime and Novolog Flexpen 100 units per ml - unit of measure) subcutaneous 30 units twice a day. On concurrent observation of Patient 1's insulin boxes indicated there was no dates when the insulin pens were opened. During the interview with Patient 1's caregiver/daughter stated that Patient 1 had a history of having episodes of low blood sugar readings twice that is why the doctor ordered home health. When asked if they were provided specific interventions when blood sugar becomes low, daughter denied being instructed by the home health. The daughter stated they were given instructions by the doctor to give the patient orange juice for episodes of low blood sugar. During an interview with the DPCS on the same date and time, DPCS stated the agency's plan of care is very generalized. DPCS stated the HHA wrote " interventions" but did not specify what kind of interventions written on the plan of care. DPCS stated the plan of care should specify the diabetic intervention when patient has episodes of low or high blood sugar and the importance of calling the HHA to notify the physician for such episodes to update the plan of care. A review of the HHA's policy titled " Situations Requiring Physician Contact" indicated that there should always be contact with the physician if any of these are present: Blood sugar level more than 300 and or less than 70 with signs and symptoms of hypo/hyperglycemia. Change in patients' expected response to treatment and/or medication. A review of the HHA's policy titled " Emergency Procedures: Hypoglycemia" dated 1/10/03 indicated the purpose is to identify and care for the patient with hypoglycemia in the home setting. To promote self-care in the home. Treat hypoglycemia based on the severity of the patients symptoms and blood glucose ranges in the following manner: a. Manage mild hypoglycemia by having the patient drink 10 to 20 grams (gm-unit of measurement) of carbohydrate (main source of energy in the body) like milk, juice, cola or syrup after 15 mins and re-check the blood sugar. b. Manage moderate to severe hypoglycemia by having the patient ingest 20 to 30 gms. of rapid acting carbohydrates like sugar, candy, sweetened fruit juice, honey, cake icing, jelly or jam and recheck blood glucose in 15 to 20 minutes. c. Manage severe hypoglycemia in the unconscious or uncooperative patient by administering 1 mg of glucagon injected into the muscle. A second dose may be given if the patient does not regain consciousness 10 minutes after the first dose. and recheck blood sugar.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency ( HHA) failed to ensure the nursing staff provided instructions or health teaching to the the patient's caregiver (PCG) for one of seven sampled patients (Patient 1). Patient 1 who was a diabetic and on a insulin regimen was not taught to monitor the expiration dates on two insulin Flexpens (a small prefilled insulin pen), and teach specific interventions for having low and high blood sugar. This deficient practice had the potential to result in placing the patient at risk of manifesting low and high blood sugar levels that could affect the patient clinical status and well being. A review of Patient 5's record was reviewed. The forms titled, "Home Health Certification and Plan of Care" (POC), with a certification period from 1/31/23 to 3/31/23, indicated a start of care (SOC) of 1/31/23, with diagnoses that included type 2 diabetic mellitus (high blood sugar) with diabetic ophthalmic (eyes) complication. The POC indicated the Skilled nurse (SN) was to visit Patient 5 twice a week for one week and once a week for eight weeks. The SN to perform skilled assessment and evaluation of all body systems, vital signs and blood sugar every visit and record. SN to assess for signs and symptoms of hypo/hyperglycemia, response to prescribed insulin/injectables; signs and symptoms of glaucoma(a chronic, progressive eye disease caused by damage to the optic nerve, which leads to visual field loss). SN to instruct/validate patient and caregiver ability to check blood sugar, prepare and administer prescribed insulin timely/safely, proper record keeping; on disease processes, signs and symptoms, complications, interventions; prescribed diet and meds. SN to notify MD of blood sugar less than 70 and more than 300, unrelieved pain, difficulty breathing and other significant findings. Goals and outcomes indicated blood sugar levels will be controlled within the range of 80-120 without signs and symptoms of hypo/hyperglycemia and patient will be able to administer insulin timely and safely observing site rotation/universal precautions throughout the episode. Discharge patient to self and care of family with MD supervision and follow up once goals are met and no skilled care is needed. A home visit was conducted on 3/25/23, with the Director of Patient Care Services (DPCS), and Patient 1's caregiver. During a review of Patient 1's medications in the home indicated Patient 1 takes Tresiba subcutaneous 100 unit per milliliter 10 units at bedtime and Novolog Flexpen 100 units per ml - unit of measure) subcutaneous 30 units twice a day. On concurrent observation of Patient 1's insulin boxes indicated there was no dates to indicate when the insulin pens were opened. During the interview with Patient 1's caregiver/daughter denied the HHA taught them to maintain when the insulin pens were opened. The daughter stated she did not know the viability of insulin and the importance of monitoring its effectiveness. During an interview with the DPCS on the same date and time, DPCS stated the agency's plan of care is very generalized. DPCS stated the HHA wrote "Interventions" but did not specify what kind of interventions on the plan of care. DPCS stated the plan of care should specify the diabetic interventions to take when Patient 1 has episodes of low or high blood sugar and the importance of calling the HHA to notify the physician for such episodes to update the plan of care. A review of the HHA's Policy and Procedure titled, "Patient and Family Education" effective 2/1/03 stipulated, the agency will provide the patient and family/caregiver with the information or education as needed for the patient to reach and maintain the optimum level of care and to improve outcomes of care. Staff also educate the patient/caregiver regarding supplies and medications necessary to the patient's 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 update, maintain and implement a current COVID-19 (an acute serious respiratory illness) mitigation plan This failure had the potential to spread COVID-19 infection to staff and patients. A request was made to review the HHA's COVID-19 Mitigation Plan. During an interview on 3/26/23 at 1:30 p.m., with the Administrator Designee (Admin Designee), the Admin Designee, stated the their COVID-19 mitigation plan was last reviewed on 12/28/20. Admin designee stated that they have not updated their COVID-19 mitigation plan. Admin Designee also stated the outcome would expose their staff and patients to COVID-19 if it was not updated with the current guidelines. A review of the document titled " COVID-19 Vaccination Guideline" reviewed on 12/28/20, indicated Healing Hands Home Healthcare Inc. (HHHI) will establish guidelines to follow in recognizing COVID-19 vaccination is an essential tool to reduce the presence and severity of COVID-19 cases in the workplace and patient community; and to safeguard the health of our employees from the hazard of COVID-19. This policy will continue to be updated pertinent to compliance with OSHA'S (to ensure safe and healthful working conditions for workers). HHHI will try to provide a safe working environment for the employees and patients, and to curtail the spread of the virus thru vaccination(s).