Every finding on record at Health Com Management, LLC

A recertification survey entrance was conducted on 5/16/2022 at 10:35 a.m. with the Alternate Administrator. Census: L&C: 6 PAS: 8 An exit conference was conducted on 5/20/2022 at 10:30 a.m. with the Administrator and Alternate Administrator. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies.

A recertification survey entrance was conducted on 5/16/2022 at 10:35 a.m. with the Alternate Administrator. Census: L&C: 6 PAS: 8 An exit conference was conducted on 5/20/2022 at 10:30 a.m. with the Administrator and Alternate Administrator. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies.

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 agency failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections for two of three patients (Patient #1 and #2) who were observed for treatment in that: 1. The Supervising Nurse (also the Alternate Administrator) failed to remove the soiled gloves (used to treat Client #2's feet) before touching other items (stethoscope, admission folder, and shears) 2. The Supervising Nurse failed to remove the soiled gloves (used to treat Client #1's lower back wound) before touching other items (pen). This failure could affect all clients in the agency and could result in the spread of infections. The findings included: 1. Observation during Client #2's home visit on 5/18/2022 at 10:36 a.m.., revealed The Supervising Nurse provided treatment to Client #2’s feet. Further observation revealed the Supervising Nurse removed the dressing from Client #2’s right second toe and proceeded to clean the Client’s right and left toes with gauze and wound cleanser. With the same gloves used clean Client #2’s toes, the Supervising Nurse touched her pen, Client #2’s admission folder, and touched other items in her work bag to remove a pair of shears. Afterwards, the Supervising Nurse removed her stethoscope from her bag to assess Client #2’s breath sounds. Following this procedure, the Supervising Nurse applied dressing to Client #2’s toes. 2. Observation during Client #1's home visit on 5/19/2022 at 9:19 a.m. revealed the Supervising Nurse provided treatment to Client 1’s wound to his lower back. Further observation revealed the Supervising Nurse donned clean gloves, sprayed the wound with wound cleanser and wiped it with gauze. The Supervising Nurse then sprayed another gauze with wound cleanser and applied it to Client #1’s wound bed and applied a dressing. With the same gloves used to provide treatment to Client #1’s wound, the Supervising Nurse touched her pen to chart. During an interview on 5/19/2022 at 10:05 a.m., the Supervising Nurse stated she was nervous because she was being watched. Further interview revealed she was supposed to use one pair of gloves for wound care, and then remove it. During an interview on 5/20/2022 at 10:20 a.m., the Administrator was presented with the findings of not removing gloves during treatment. Further interview revealed a potential outcome of not removing gloves would be infection to the wound. Record Review of the agency's policy and procedure titled "Nursing Procedures Manual” read in part, “(name of agency) has adopted the following manual: Manual of Home Health Nursing Procedures, 2nd edition…Copyright 2000 Mosby Corporation, as the official procedure manual for clinical procedures.” Record review of the agency’s Administrative Policy Manual titled “Infection Control Program,” read in part, “…G…Policies and procedures address prevention and control activities, as well as strategies to minimize, reduce or eliminate the prioritized risk including but are not limited to 1. Standard precautions.” Record review of this Nursing Procedure Manual revealed “ Chapter one: Infection Control Procedures, applying principles of Standard Precautions: General Guidelines…Procedure: Gloves: Wear gloves if the possibility of contact transmission may occur, change gloves between each patient procedure or when going from dirty to clean.”

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 provide services as indicated in the plan of care for one of seven clients (#1) whose treatments were observed, in that 1. The Supervising Nurse failed to follow Client #1's POC during treatment of Client #1's wound. This failure all clients in the agency and could result in improper treatment and delayed wound healing. The findings included: Review of Client #1's plan of care (dated 4/28/2022) for certification period 4/26/2022 through 6/24/2022 revealed Client #1 had diagnoses of Non-Pressure Chronic Ulcer of back, Osteoarthritis, and Malignant Melanoma of the Nose. Further review of Client #1's plan of care revealed the following order and treatment that read in part, “Using aseptic technique, skilled nursing to perform wound care to lower back…as follows, cleanse with wound cleanser using gauze, pat dry, with gauze, apply gauze moistened with normal saline to wound bed, cover with gauze...” Observation during Client #1's home visit on 5/19/2022 at 9:19 a.m. revealed the Supervising Nurse provided treatment to Client 1’s wound to his lower back. Further observation revealed the Supervising Nurse donned clean gloves, sprayed the wound with wound cleanser and wiped it with gauze. The Supervising Nurse then soaked another gauze with wound cleanser (instead of normal saline), applied it to Client #1’s wound bed, and applied a dressing. During an interview on 5/19/2022 at 2:39 p.m., the Supervising Nurse stated wound cleanser was used for Client #1’s wound bed because the bottle of Normal Saline wasn’t available. During an interview on 5/19/2022 at 10:05 a.m., the Supervising Nurse stated a potential outcome of not following the plan of care is the wound wouldn’t heal properly. During an interview on 5/20/2022 at 10:20 a.m., the Administrator was presented with the information on Client #1’s plan of care not being followed. Further interview revealed a potential outcome if the plan of care wasn’t followed was the wound wouldn’t heal as it should. Review of the agency's Administrative Policy Manual titled “ Plan of Care (7/1/2021),” read in part, “ Q. The patient will receive all services outlined in the plan of care.” No additional information was provided at the time of exit on 5/20/2022. Additional information was provided and reviewed within two business days after the exit.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to include treatments and services and response to those interventions each client record on the day of service for three of 7 clients (Clients #1, #2, and #3) whose clinical records were reviewed, in that: 1. The record for Client #1 did not include treatment, interventions, and response for skilled nursing visits made on 3/25/2022, 4/1/2022, 4/6/2022, 4/11/2022, 4/14/2022, 4/18/2022, 4/20/2022, and 4/25/2022. 2. The record for Client #2 did not include treatment, interventions, and response for skilled nursing visits made on 4/13/2022, 4/19/2022, 4/20/2022, and 4/23/2022. 3. The record for Client #3 did not include treatment, interventions, and response for skilled nursing visits made on 3/25/2022, 4/1/2022, 4/4/2022, 4/6/2022, 4/11/2022, 4/12/2022, 4/14/2022, and 4/15/2022. This failure could affect all clients in the agency and could result in lack of evidence that necessary care and services were provided for the clients. The findings included: A. Review of Client #1's plan of care (dated 4/28/2022) for certification period 02/25/2022 through 04/25/2022 revealed Client #1 had diagnoses of Non-Pressure Chronic Ulcer of back, Osteoarthritis, and Malignant Melanoma of the Nose. Further record review of Client #1’s POC revealed skilled nursing interventions and treatment included assessing the integumentary status, perform complete physical assessment, each visit with emphasis on wound healing, other co-morbidities including hypertension, and provide skilled assessment of pain level each visit. Review of Client #1's skilled nursing visits conducted on 3/25/2022, 4/1/2022, 4/6/2022, 4/11/2022, 4/14/2022, 4/18/2022, 4/20/2022, and 4/25/2022 revealed no documentation of interventions or treatment for the integumentary, physical assessment, or pain assessment in the nurse’s notes. B. Review of Client #2’s POC (dated 5/4/2022) for certification period 3/25/2022 to 5/23/222 revealed diagnoses of Tinea Unguium, Chronic Combined Systolic and Diastolic heart failure, and Diabetes Type II. Further review of Client #2’s POC revealed nursing interventions and treatment included assessing the integumentary status, perform complete physical assessment, each visit with emphasis on Tinea Unguium, other co-morbidities including hypertension, provide skill assessments, manage and mitigate pain. Review of Client #2's skilled nursing visits conducted on 4/13/2022, 4/19/2022, 4/20/2022, and 4/23/2022 revealed no documentation of interventions or treatment for the integumentary, physical assessment, or pain assessment in the nurse’s notes. C. Record review of Client #3’s POC (5/1/2022) for certification period 3/27/2022 to 5/25/2022 revealed diagnoses of Venous Insufficiency (chronic) Peripheral, Peripheral Vascular Disease, Chronic Systolic Congestive Heart Failure, and Diabetes Type II. Further review of Client #3’s POC revealed orders for discipline interventions and treatment included skilled nursing to perform complete physical assessment each visit with emphasis on Venous Insufficiency, assess integumentary status, and provide skilled assessments, manage and mitigate pain. Review of Client #3's skilled nursing visits conducted on 3/25/2022, 4/1/2022, 4/4/2022, 4/6/2022, 4/11/2022, 4/12/2022, 4/14/2022, and 4/15/2022 revealed no documentation of interventions or treatment for the integumentary, physical assessment, or pain assessment in the nurse’s notes. During an interview on 5/17/2022 at 11:49 a.m., the Supervising Nurse stated the visits were made but she documented the information on a note pad. Further interview with the Supervising Nurse revealed the information wasn’t documented in the nurse’s notes was due to lack of time management. During an interview with the Administrator on 5/20/2022 at 10:20 a.m., she indicated the lack of timely charting was due to staffing, if there were more staff, the agency would benefit overall. Further interview with the Administrator revealed a potential outcome for not charting timely was the agency couldn’t catch trends. Record review of the agency’s policy and procedure titled “Medical Record Content (7/1/2021)”, read in part, “ Purpose: to ensure a medical record is created for every patient who receives treatment, care or services and is maintained for the primary purpose of providing patient care.”