Every finding on record at Home Care of Denver LLC

A recertification survey was completed on 2/3/22. One deficiency was cited.

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 agency failed to ensure nursing staff complied with professional standards and principles pertaining to appropriate infection control for 1 of 1 patients whose wound care was observed during a home visit (Patient #1). Findings Include: AGENCY POLICY According to agency policy "Hand Hygiene" dated 2/1/17 (in pertinent parts) "All agency staff providing patient/client care will observe proper hand hygiene techniques. If hands are not visibly soiled, staff may use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations Decontaminate hands after contact with a patient's/client's intact skin, even when gloves are worn. Decontaminate hands after removing gloves." 1. The clinical record for Patient #1 was reviewed on 2/1/22. The plan of care for the certification period dated 12/25/21 to 2/22/22 revealed a start of care date of 7/2/21; diagnoses included pressure ulcer of other site stage 2, fibromyalgia, major depressive disorder, arteriosclerotic heart disease, type 2 diabetes mellitus with diabetic chronic kidney disease diabetic neuropathy and peripheral angiopathy without gangrene. Plan of care orders included skilled nursing (SN) three times a week for eight weeks then one time for one week, to provide skilled assessment, diabetic teaching and management, medication set up and wound care to stage 2 pressure ulcer on the left upper thigh. Wound care orders on the plan of care, dated 12/25/21, were to cleanse with wound cleanser, apply medihoney gel, and cover with a bordered foam using clean/aseptic technique. Change the dressing three times per week. a) Observations showed the registered nurse (RN) #4 failed to utilize appropriate infection control procedures during the provision of wound care for Patient #1. A home visit was conducted on 2/1/22 at approximately 12:38 p.m. to Patient #1. The surveyor observed RN #4 providing wound care to Patient #1's left upper thigh wound. A barrier with wound cleanser, 4x4 gauze, a disposable tape measure, a plastic bag, medihoney gel and an open border foam dressing were placed on a barrier, on the bathroom counter. RN #4 was observed to be wearing gloves and was cleansing the wound, with a wound cleanser she had applied to a 4x4 gauze. There was no old dressing to be removed, per the client, it fell off in the shower that morning. After cleansing the wound, she measured the wound and threw the paper tape measure in the plastic bag, she then took off her gloves and threw them in the plastic bag. RN #4 then reached in her left pants pocket and pulled out 2 new gloves which she donned, she then applied the medihoney and foam border to the wound. RN #4 did not wash her hands or use an alcohol based sanitizer prior to donning new gloves. During an interview on 2/1/22 at approximately 1:18 p.m., RN #4 stated she had been providing wound care to Patient #1 for about two months, and that she sanitized her hands after she removed her gloves. She stated she always washed or sanitized after wound care. However, when asked specifically about sanitizing hands between glove changes RN #4 had no response. The director of clinical services (DCS) who was present during the home visit did not speak about the lack of hand hygiene by RN #4 between cleansing Patient #1's wound and applying the new dressing. During an interview on 2/1/22 at 1:45 p.m., the administrator stated the DCS had informed her of the poor hand hygiene between doffing and donning gloves during Patient #1's wound care performed by RN #4. The Administrator had nothing more to say about RN #4's poor hand hygiene.