Every finding on record at Healthview Home Health LLC

The following reflects the findings of the California Department of Public Health during a Recertification Survey at the agency's proposed new location on 3/17/23 to 3/21/23 12750 Center Court Drive Suite 670 Cerritos CA. 90703 Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor #09697, Health Facilities Evaluator Nurse Unduplicated Admissions - 925 Active Patients - 280 Sample Size - 23 Home Visits- 9

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 profiles for 7 out of 23 patients (Patients 1, 2, 3, 12,13,20 and 21). This failure had the likelihood to result in placing these seven patients at risk for medication errors and adverse drug reactions. a. A review of Patient 12's admission record indicated Patient 12 was admitted to the facility on 1/20/23, with diagnosis that included hemiplegia (paralysis of one side of the body). A review of Patient 12's plan of care (POC) from 1/20/23 to 3/20/23, included a SN (skilled nursing ) visits of once a week for one week, twice a week for three 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 3/18/23, at 1 p.m., a home visit was conducted at Patient 12's residence with RN 1 (registered nurse). Patient 12 was alert and oriented and sitting on his wheelchair at entrance of the assisted living facility. At 1:30 p.m., a review was conducted of Patient 12's current medications reconciling with the medication profile provided by the agency. It was observed Patient 12 had a bubble pack of Cetrizine 10 mg (milligrams) one tab daily, a bubble pack of Omeprazole 40 mg one cap daily, a bubble pack of Eliquis 5 grams one tab twice daily and a bubble pack of Atorvastatin 10 mg take 1/2 tab at bedtime. All these mentioned medications were not included in the agency's medication profile sheet. At 1:45 p.m., during an interview with the Medication Technician 1, she stated the patient's visiting nurse would only ask her if there were any new medications but does not check the actual bubble pack medication during their visits to the facility. On 3/20/23, at 11 a.m., during an interview with the DPCS, she stated the visiting nurse missed checking the patient's medications. b. A review of Patient 13's admission record indicated Patient 13 was admitted to the facility on 12/15/22, with diagnosis that included hemiplegia (paralysis of one side of the body). A review of Patient 13's plan of care (POC) from 12/15/22 to 2/12/23, included a PT (physical therapist) visits of once a week for one week, twice a week for four weeks, once a week for for one week, to provide therapeutic exercises, transfer and gait training, range of motion and home safety training. However, the plan of care did not include an intervention to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. On 3/18/23, at 2 p.m., a home visit was conducted at Patient 13's residence with RN 1 (registered nurse). Patient 13 was alert and oriented and sitting on his wheelchair at the dining room. At 2:10 p.m., a review was conducted of Patient 13's current medications reconciling with the medication profile provided by the agency. It was observed Patient 13 has a bubble pack of Prednisone 10 mg (milligrams) take four tabs daily for four days, 3 tabs daily for 4 days, 2 tabs daily for 4 days and one tab daily for 4 days and a bubble pack of Setraline 100 mg one tab at bedtime. All these mentioned medications were not included in the agency's medication profile sheet. At 2:15 p.m., during an interview with the Medication Technician 1, she stated the assigned physical therapist for Patient 13 does not check medications during his visits at the facility. c. A review of Patient 20's admission record indicated Patient 20 was admitted to the facility on 3/9/23, with diagnosis that included systemic lupus (inflammatory disease caused when the immune system attacks its own tissues). A review of Patient 20's plan of care (POC) from 3/9/23 to 5/7/23, included a PT (physical therapist) visits of once a week for one week, twice a week for six weeks, to provide therapeutic exercises, transfer and gait training, range of motion and home safety training. However, the plan of care did not include an intervention to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. On 3/19/23, at 11:30 a.m., a home visit was conducted at Patient 20's residence with RN 1 (registered nurse). Patient 20 was alert and oriented and sitting on her couch in the living rooom. At 11:45a.m., a review was conducted of Patient 20's current medications reconciling with the medication profile provided by the agency. It was observed Patient 20 has a bottle of Carvedilol 6.25 mg (milligrams) take one tab daily, a bottle of Omeprazole 20 mg one tab daily and Clopidogrel 75 mg one tab daily. All these mentioned medications were not included in the agency's medication profile sheet. At 12 p.m., during an interview with Caregiver 1, she stated the PT does not check the patient's medication during visits. On 3/20/23, at 11 a.m., during an interview with the DPCS, she stated the PT needs to check the patient's medication during their visit per policy protocol and contract agreement. d. A review of Patient 21's admission record indicated Patient 21 was admitted to the facility on 2/27/23, with diagnosis that included aftercare following joint replacement surgery. A review of Patient 21's plan of care (POC) from 2/27/23 to 4/27/23, included a PT (physical therapist) visits of twice a week for six weeks, to provide therapeutic exercises, transfer and gait training, range of motion and home safety training. However, the plan of care did not include an intervention to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. On 3/19/23, at 12:30 p.m., a home visit was conducted at Patient 21's residence with RN 1 (registered nurse). Patient 21 was alert and oriented and sitting on her couch in the living rooom. At 1 p.m., a review was conducted of Patient 21's current medications reconciling with the medication profile provided by the agency. It was observed Patient 21 has a bottle of Tramadol 50 mg (milligrams) take one to two tabs every six hoys as needed and Zyrtec 10 mg one cap daily. All these mentioned medications were not included in the agency's medication profile sheet. On 3/20/23, at 11 a.m., during an interview with the DPCS, she stated the PT needs to check the patient's medication during their visit per policy protocol and contract agreement. 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. 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. 1. A review of Patient 1's admission record indicated Patient 1 was admitted to the facility on 1/20/23, with diagnosis that included chronic pain syndrome and low back pain. A review of Patient 1's plan of care (POC) from 1/20/23 to 3/20/23, included a SN (skilled nursing) for evaluation, PT once a week for one week and twice a week for five weeks and once a week for one week, to perform therapeutic exercise, bed mobility, transfer training and gait training. On 3/18/23, at 3:15 p.m., a home visit was conducted at Patient 1's assisted living facility(ALF) with RN 1 (registered nurse). Patient 1 was alert and oriented and ambulates with four wheel walker as she entered the clinic. At 3:45 p.m., a review was conducted of Patient 1's current medications reconciling with the medication profile provided by the agency. The following medication discrepancies were noted. Levothyroxine 125 mcg 1 tablet every morning before breakfast. on med profile it was 137 mcg. Fluticasone propionate 1 ml nasal spray each nostril twice daily on med profile but ALF stated it was discontinued. Triamcinolone 0.1% ointment daily on affected area on med profile. ALF stated was also discontinued. Escitalopram 10 mg 1.5 tablets daily. ALF staff stated only 1 tab is ordered daily. Ammonium lactate 12% ointment twice daily on both feet on med profile . ALF stated was also discontinued. Vitamin D3 50 mcg 1 tablet daily noy listed on med profile Metamucil 4 caps three times daily for constipationnot on med profile melatonin 3 mg at bedtime not listed on medprofile ibuprofen 600 mg every 6 hours as needed for pain not on med profile. Tylenol 325 mg 3 tablets patient stated is at patients bedside she uses every day. Tylenol 1000 mg at night at patients bedside 2. A review of Patient 2's admission record indicated Patient 2 was admitted to the facility on 2/3/23, with diagnosis that included parkinson's disease (a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves) and dementia ( a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). A review of Patient 2's POC from 2/3/23 to 4/3/23, included a SN for evaluation, PT once a week for one week and twice a week for four weeks and once a week for one week, to perform therapeutic exercise, bed mobility, transfer training and gait training. On 3/18/23 a joint home visit was conducted with RN 1 at 3:45 p.m., a review of Patient 2's current medications was reconciled with the medication profile provided by the agency. The following medication discrepancies were noted. Docusate Sodium 100 mg 1 capsule daily for constipation on med profile was changed to as needed per ALF Erythromycin eye drops antibiotic 4 times a day for 10 days was already discontinued per ALF Tylenol 500 mg as needed for pain is not listed on med profile Ibuprofen 600 mg as needed for pain is not listed on med profile Meclizine 25 mg as needed for dizziness is not listed on med profile Trazodone 50 mg 1 tablet as needed for sleep is not on med profile Vitamin C 1000 mg 1 tablet as supplement is not listed on med profile Zinc Sulfate 200 mg daily for 10 days for wound supplement is not on med profile 3 . A review of Patient 3's admission record indicated Patient 3 was admitted to the facility on 3/6/23, with diagnosis that included diabetes ( a chronic (long-lasting) health condition that affects how your body turns food into energy) A review of Patient 2's POC from 2/3/23 to 4/3/23, included SN for evaluation, PT once a week for one week and twice a week for three weeks and once a week for one week, to perform therapeutic exercise, bed mobility, transfer training and gait training. On 3/18/23 a joint home visit was conducted with RN 1 at 3:45 p.m., a review of Patient 3's current medications was reconciled with the medication profile provided by the agency. The following medication discrepancies were noted. There were 2 orders of Citalopram 20 mg 1 tablet daily on med profile. per ALF Patient 3 is taking 1.5 tablets. Loperamide 2 mg one tablet one time then one tablet after each loose stool max of 4 tablets in 24 hours was discontinued per ALF Arnica Arnicare 2.5 oz to keep in patients room and apply directly to to open wound for pain. Not listed on med profile Tylenol 650 mg 2 tablets as needed for pain not on med profile Dulcolax 2 tablets as needed for constipation not on med profile Folic Acid 1 mg daily as supplement not on med profile Meclizine 12.5 mg every 8 hours as needed for dizziness not on med profile Proctozone cream as needed for hemorrhoids not on med profile Vitamin B complex daily as supplement not on med profile. Glucose gum as needed for blood sugar lower than 70 not listed on med profile During an interview with RN 1 at the same date and time, stated that he makes it a point to review the patients medications when he visits the assisted living facility. When asked how he reconciles medications at the ALF, the RN 1 stated " I ask the med techs to print out the med list and I compare it with my list. I do not compare it with the bubble packs or patients bottles." During an interview with the Director of Patient Care Services (DPCS) on 3/21/23 at 12:55 p.m., DPCS stated that the SN should always per policy perform a bottle to med list check for medication reconciliation every visit. For Physical Therapy Services they send the medication list and we enter it on the patients chart. During a phone interview with the physical therapist 1 (PT 1) on 3/21/23 at 2:15 p.m., PT 1 stated she checks her patients medications because her patient only has pain medications. especially before conducting any exercise. PT 1 also asks if there are any changes and writes it on her notes and reports to the HHA when needed. A review of the HHA's document titled " Medication Profile" revised 1/2019 stipulated patient receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. medication profiles will be updated for each change to reflect current medications, new , and/or discontinued medications. In rehabilitation therapy-only cases, the patient's therapists must submit a list of patient medications to a registered nurse for review. During subsequent home visits, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver as well as other clinicians understand the medication regimen. .

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 interview and record review, the skilled nurses (SN) failed to obtain an order for Mupirocin (medicine use to kill bacteria or prevent their growth) 2 percent ointment for wound treatment for one out of 23 patients (Patient 15). This deficient practice placed the patient's open wound at risk for slow healing. A review of Patient 15's admission record indicated Patient 15 was admitted to the facility on 3/4/23, with diagnosis that included unstageable sacral pressure ulcer ( a wound at lower back, stage not clear, full tissue loss, covered by thick layer of green, or black tissue and pus). A review of Patient 15's plan of care (POC) from 3/4/23 to 5/2/23, included a skilled nursing (SN) visits of daily for two weeks, then three times a week for 6 weeks, to observe and assess all body systems focusing on integumentary system (skin) One of the nursing intervention was to provide wound care to unstageable sacral pressure ulcer as follows: cleanse with Normal Saline ( sterile water), pat dry, apply Santyl ointment ( medicine that remove dead tissue from wounds), cover with dry dressing, secure with foam dressing. A review of Patient 15's Skilled Nursing Visit dated 3/9/23, indicated the visiting nurse applied Mupirocin 2 percent ointment on the Sacral wound during her wound treatment. On 3/20/23 at 1:30 p.m., during an interview with the director of patient care services (DPCS), she stated the visiting nurse should not have applied Mupirocin 2 percent ointment because there was no order for that.

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 physical therapy staff provided instructions or health teaching to the the patient's caregiver (PCG) to one of 23 sample patients (Patient 23). This deficient practice had the potential to compromise Patient 23's health status and well being. A review of Patient 23's record, titled "Home Health Certification and Plan of Care" (POC), for the certification period from 1/23/2023 to 3/31/2023, indicated the start of care (SOC) of 12/2/2023, with diagnoses of gastrointestinal hemorrhage (bleeding in the stomach), high blood pressure, and with dialysis (a procedure to remove waste products and excess fluid from the blood) treatment. The POC indicated skilled nursing (SN) for evaluation, physical therapy (PT) services re-evaluation on 1/30/2023, and continue physical therapy twice a week for eight weeks. A review of Patient 23's "Orders and Treatments" indicated, PT to notify physician of: temperature greater than 102 or lower than 95, pulse (a measure of the heartbeat) greater than 120 and lower than 50, respirations greater than 28 and lower than 12, systolic blood pressure (the amount of pressure experienced by the arteries while the heart is beating) greater than 160 and lower than 90, diastolic blood pressure (the resistance to the blood flow in the blood vessels) greater than 100 and lower than 50, and oxygen saturation (the amount of oxygen circulating in the blood) less than 90 percent. The "Orders and Treatments" indicated "Therapist to assess pain level and effectiveness of pain medications and current pain management therapy every visit. Therapist to instruct to take pain medication before pain becomes severe to achieve better pain control. SN to evaluate patient for signs and symptoms of depression. Therapist to instruct patient/caregiver to contact agency to report any fall with or without minor injury and to call 911 for serious injury." During a phone interview on on 3/21/2023 at 3:30 p.m., with the consent of Patient 23's daughter, daughter stated that her mom goes to dialysis twice a week and her blood pressure is uncontrolled. Daughter stated that Patient 23 only has PT services at this time. Daughter stated that she often reschedule her mom's PT depending on her blood pressure. Daughter stated that it is lucky when her mom reaches a blood pressure as low as 160's and that most of the time its on 200's. When asked if she calls the home health agency if Patient 23's blood pressure goes up, daughter stated "Should I call the agency? I did not know I was supposed to call them. I thought the PT informs them of my mom's blood pressure?" Daughter stated last time she saw the nurse came was during her mom's admission to the home health. Daughter also mentioned that she plays with the blood pressure medications on a daily basis to manage her mom's blood pressure. A review of the HHA's policy, titled " Care/Service Coordination" CA ACHC Home Health/revised 11/2020, indicated stipulated timely and ongoing communication is the responsibility of each team member of the Interdisciplinary group (IDG) and will be appropriate to the needs and abilities of the patient and relevant to the care/service provided. The policy indicated the clinician will be responsible for facilitating communications about changes in the patients status among the assigned personnel. Care coordination will include but not limited to: ensuring that each patient and their caregivers, where applicable receive ongoing education and training provided by the organization regarding the care and services identified in the plan of care. the organization shall provide training, as necessary to ensure a timely discharge.