Every finding on record at Home Care Network, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 44802, Health Facilities Evaluator Nurse Surveyor # 45887, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 73 Active Patients - 22 Sample Size - 7 Patients Home Visits – 3

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 44802, Health Facilities Evaluator Nurse Surveyor # 45887, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 73 Active Patients - 22 Sample Size - 7 Patients Home Visits – 3

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on observation, interview and record review the Home Health Agency (HHA) failed to ensure orders in the plan of care (POC) were followed for one of two sampled patients (Patient 5). Patient 5 did not have access to a glucometer (device used to check blood sugar levels) to check and monitor his blood sugar (BS) levels daily. This deficient practice had the potential for Patient 5 to develop signs and symptoms of hypoglycemia ( low blood sugar levels) or hyperglycemia (high bloos sugar levels) that could result in hospitalization or death. Findings: A review of Patient 5's POC for certification period of 7/29/22-9/26/22, indicated a start of care date (SOC) of 7/29/22. Patient 5's primary diagnosis was type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar). The POC included an order to have the nurse check the patient's blood sugar via glucometer as needed and instruct patient to notify doctor if BS is above 180 milligram/deciliter (mg/dl-unit of measurement) or below 70 mgdl. Patient 5's goal included for the BS level is within 70 mg/dl to 110 mg/dl by 8/28/22. During a concurrent observation and interview during a home visit conducted on 8/24/22, at 1pm, Registered Nurse 1 (RN 1) checked Patient 5's blood sugar with a glucometer RN 1 brought with him. RN 1 stated that Patient 5 does not have his own glucometere yet because it has not yet been delivered. RN 1 stated that Patient 5 is only getting his BS checked once a week when he does his home visits, but he should be checking levels daily. A review of Patient 5's sklled nursing (SN) Visit Note, dated 8/3/22, indicated that RN 1 instructed Patient 5 to check BS every day. A review of Patient 5's BS readings taken during the home visits showed the following... 7/29/22---134mg/dl 7/31/22---245mg/dl 8/3/22--151mg/dl 8/7/22--137mg/dl 8/10/22---127mg/dl 8/17/22---141mg/dl 8/24/22---152 mg/dl A review of Patient 5's medication list, dated 7/29/22-9/26/22, indicated an order dated 7/29/22 for Januvia (medication used to treat Diabetes type 2 and lower blood sugar levels) 50 mg tablet. Take 1 tablet by mouth daily. A review of the medication guide for Januvia, dated 7/2022, indicated that individuals taking this medication should check their blood sugar as their doctor tells them to. During an interview on 8/25/22, at 12:42pm, Director of Nursing (DON) stated that the doctor ordered a glucometer for Patient 5 at the SOC on 7/29/22, but it was never delivered through his insurance company, because there were issues with coverage. DON stated that they will follow up with another pharmacy to see if they can get Patient 5 a glucometer. DON stated that Patient 5 should be taking his blodd sugar reading every day, but is currently only getting it read once a week with RN 1. DON stated that is it important for Patient 5 to check his BS daily to know if he is hypoglycemic (low BS level) or hyperglycemic (high BS level), and he can be educated on symptoms and what he should do if he is experienving symptoms. A review of Patient 5's Medical Orders, dated 8/1/22, indicated order for a glucometer kit, glucometer test strips, and lancets (special needle used to obtain blood for testing BS). A review of the HHA's policy titled, Equipment Management: Safe and Appropriate Use of Medical Equipment ans supplies, (undated), indicated that it is the responsibility of the clinician, as appropriate, to instruct patients regarding the safe and appropriate use of home medical equipment. Needs will be identified with ongoing assessment and follow-up as approptiate. A review of the HHA's policy titled, Care Plans, (undated), indicated that each patient will have a care plan that addresses their identified needs and the HHA's plan to respond to those needs. Care plan should also be developed with the patient and interventions shall correspond to the problem indetified, services needed, and the patient goals.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to develop and implement a care plan for a patient with insomnia (difficulty sleeping). This failure had the potential to result in negative effect on the patient’s well-being and quality of life. Findings: A review of Patient 1’s Plan of Care (POC) indicated a Start of Care (SOC) on 1/31/2022 with a principal diagnosis of a pressure ulcer of the right heel, unstageable (full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed). The POC indicated a certification period of 7/30/2022 through 9/27/2022 and included an order for a Skilled Nurse (SN) to visit twice a week for the first week then once a week for seven weeks to perform skilled observation and assessment of vital signs and physiological status. On 8/23/2022, at 1.p.m., a home visit was conducted with the Registered Nurse (RN) at Patient 1’s residence. Patient 1 was alert and was lying in bed in her room. RN checked Patient 1’s vital signs and performed wound care to Patient 1’s right heel. During an interview at 1:15 pm, the Family Member (FM) stated Patient 1 had not been sleeping well for the last two to three days and will stay up all night talking. FM stated Patient 1 has had problems sleeping for years and takes Ambien for it. FM stated they had started with 10 mg Ambien, decreased to 5 mg Ambien and now 2.5 mg Ambien. FM stated the dose was decreased because the patient was sleeping in to late. FM stated Patient 1 may have gotten used to the medication. A review of Patient 1's Medication Profile file indicated Ambien (a sedative used to treat insomnia), 2.5 milligram (mg) tablet, take one tablet by mouth every bedtime as needed for sleep problem. Further review of Patient 1's clinical record indicated no care plan was developed identifying the Patient 1’s problems sleeping. During an interview on 8/25/2022 at 12:15 pm, the Administrator (ADM) stated Patient 1 was initially started with 10 mg Ambien at the SOC and that because the family reported that she was sleeping in late, the dose was decreased from 10 mg to 5 mg and now to 2.5 mg. The ADM stated there was no care plan for the patient having problems sleeping and that it should have been developed from the start of care. A review of of the Facility’s policy, Care Plans (undated), indicated each patient will have a care plan on file that addresses their identified needs and the HHA’s plan to respond to those needs. The policy indicated that following the initial assessment, a Care Plan shall be developed with the patient and/or caregiver and interventions shall correspond to the problems identified, services needed and the patient goals for the episode of care.

Contact information for the patient CFR(s): 484.110(a)(4) Contact information for the patient, the patient's representative (if any), and the patient's primary caregiver(s); This ELEMENT is not met as evidenced by: Based on interview and record review, the HHA (Home Health Agency) failed to include emergency contact information on Intake form/face sheet for one of seven sampled patients (Patient 7). This failure has a clinical impact on patient’s clinical records for inaccurate and incomplete information. Findings: A review of Patient 7's Patient Profile Information indicated, a start of care (SOC) date of 06/16/22, with a certification period of 8/15/22 to 10/13/22. Patient 1's diagnosis that included dysuria (Painful urination, discomfort or burning with urination, usually felt in the tube that carries urine out of your bladder or the area surrounding your genitals) on initial certification and type 2 diabetes (is a chronic condition where the body does not produce insulin which regulates the blood sugar) on second verification. A review of Patient 7’s clinical record dated 8/24/22 indicated no emergency contact on Face sheet/Intake information. On 8/24/22 at 11:30 a.m., during an interview with the Director of Patient Care Services (DPCS) stated “SN (Skilled Nurse) should ensure that intake form and face sheet include the patient’s emergency contact information”. A review of the HHA’s policy titled “Patient Admission Process” undated, indicated that Intake Form shall include at minimum: Patient’s name, current address, date of birth/age, sex, referral source, date of discharge from a facility as applicable, name/address/telephone number of nearest relative or responsible person to contact in the event of emergency, name/address/telephone number of attending physician, diagnosis (primary/secondary), whether the patient is under the care of the physician, licensed by the state of the patient’s residence, if plan of care is required, known allergies and names of other individual/organizations who might be involved in care.