Every finding on record at Home Health Professionals Inc

On 08/07/2023 at 1:05 PM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 8/14/2023 at 2:52 PM, an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. On 8/10/2023 at 1:50 PM, the Agency Administrator was informed there was an Immediate Jeopardy to patient health and safety in that: The Agency failed to provide HHA staff infection control education. The Agency failed to provide Job-specific, infection prevention education and training to all health care personnel for all of their respective tasks. The Agency failed to implement processes to ensure that all health care personnel understand and are competent to adhere to infection prevention requirements as they perform their roles and responsibilities. The Agency failed to provide training before individuals are allowed to perform their duties and periodic refresher training as designated by HHA policy. The Agency failed to provided to staff education at periodic intervals consistent with accepted standards of practice. Such education must be provided at orientation, annually, and as needed to meet the staff’s learning needs to provide adequate care; identify infection signs and symptoms; identify routes of infection transmission; appropriately disinfect/sanitize/transport equipment and devices used for patient care; and use proper medical waste disposal techniques. Such education must include instructions on how to implement current infection prevention/treatment practices in the home setting. The condition not met was 484.70.The HHA must provide infection control education to staff, patients, and caregiver(s). The immediate Jeopardy was abated with the following plan on 8/14/23 at 2:00 PM: CENTRAL VENOUS ACCESS DEVICE (VAD), DRESSING CHANGE PROCEDURE:IMMEDIATLEY THE DEFICIENT NURSE WILL BE REMOVED FROM DOING ANY FURTHER VAD DRESSING CHANGES. A POLICY REVIEW AND EDUCATION OF VAD DRESSING CHANGES WILL BE CONDUCTED BY THE NURSING SUPERVISOR ON TUESDAY 08/15/2023 WITH ALL NURSING STAFF. FOLLOWED BY AN EDUCATIONAL INSERVICE 08/15/2023 TITLED "CENTRAL LINE MANAGEMENT" UPDATED BY THE NIH MAY 26, 2023. A HANDS ON DEMOSTRATION OF VAD DRESSING CHANGE WILL BE DONE BY EACH NURSE UNDER THE SUPERVISION OF THE AGENCY'S SUPERVISORY NURSE/DON. THE NURSES WILL BE CHECKED OFF IN THE HOME BY THE SUPERVISORY NURSE AS EACH CAN BE ROTATED THRU THE PATIENTS (2) WITHIN A 6 WEEK PERIOD. TO MONITOR COMPLIANCE EACH NURSE WILL BE REASSESSED EVERY 3 MONTHS FOR ONE YEAR THEN ANNUALLY FOR 2 YEARS. NEW HIRE NURSES WILL ADHERE TO THE SAME PLAN OF CORRECTION UPON HIRE. IT IS THE RESPONSIBLITY OF THE ADMINSITRATOR AND NURSING SUPERVISORY/DIRECTOR OF NURSING TO MONTIOR THE ONGOING PROCESS THROUGH QAPI FOR A PERIOD OF 3 YEARS. Condition 484.70 The HHA must provide infection control education to staff, patients, and caregiver(s) was reduced to a 90 day termination.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: . Based on Clinical Record reviews, Agency Policy and Procedure review, observation during home visits and staff interviews, it was determined the Agency failed to provide the patient with complete and accurate written patient medication schedule / instructions in 3 (#1-#3) of 7 (#1 - #7) Clinical Records reviewed. This deficient practice if continued, had the potential to affect all patients on census in that patients and families who are not knowledgeable of the name, dosage, frequency, purpose, and specific instructions related to ordered medications could result in medication errors, noncompliance with drug therapy, and unreported side effects which could result in adverse events and hospitalizations. 1) Observation during a home visit on 08/09/2023 at 2:10 PM for patient #1 revealed: a) Surveyor was not able to locate patients medication list in home folder. b) Patient #1 was asked if The Agency had provided a written medication list for her folder. Patient #1 stated, "No." 2) Observation during a home visit on 08/09/2023 at 11:49 PM for patient #2 revealed: a) Surveyor was not able to locate a medication list in the patients home folder. b) Patient #2 was asked if The Agency had provided a written medication list for her folder. Patient #2 stated "No." 3) Observation during home visit on 08/09/2023 at 12:16 for Patient #3 revealed: a) Surveyor was unable to locate medication list in home folder. b) Caregivers were asked if they had taken the medication list from the folder. Caregiver stated "No".

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 during home visits, staff interviews, and review of Center for Disease Control (CDC) guidelines, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 1 (#2) of 3 (#1- #3) home visits conducted. This failed practice had the potential to place the Patient at risk for wound related infections and hospitalization. Findings: . Hand Hygiene Hand Hygiene should be performed at a minimum: • Before contact with a patient; • Before performing an aseptic task (e.g., insertion of IV, preparing an injection, performing wound care); • After contact with the patient or objects in the immediate vicinity of the patient; • After contact with blood, body fluids or contaminated surfaces; • Moving from a contaminated body site to a clean body site during patient care; and • After removal of personal protective equipment (PPE). The term “hand hygiene” includes both handwashing with either plain or antiseptic containing soap and water, and use of alcohol-based products (gels, rinses, foams) that do not require the use of water. In the absence of visible soiling of hands, approved alcohol based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience. The HHA must ensure that supplies necessary for adherence to hand hygiene are provided. 2) During a home visit on 08/09/2023 at 11:49 AM, surveyor was present to observe wound care. a) SN (Skilled Nurse) donned gloves and removed the old dressing. SN doffed gloves and used hand sanitizer. SN donned clean gloves and proceeded to clean wound. SN did not change gloves at this point as is standard practice. SN placed dressing over wound and secured with tape.

Infection control education CFR(s): 484.70(c) Standard: Education. The HHA must provide infection control education to staff, patients, and caregiver(s). This STANDARD is not met as evidenced by: The Agency is responsible for providing each staff member infection control training and education at regular and ongoing intervals. This training occurs before staff members are allowed to perform their duties as well as periodic refresher training as designated by HHA policy to assure patients are not placed at risk for complications of their respective health challenges. Infection may facilitate prolonged and extended episodes of home health services, increased physician visits, use of antibiotics, poor outcomes, rehospitalization, and possible death. This standard was not met in 2 (#1-#2) patients home visits during surveyor observation. This deficient practice, if left uncorrected, increases the risk for all patients on census requiring dressing changes of any type. Findings as follows: 1)Patient #1: A) During a home visit on 08/09/2023 at 2:10 PM, surveyor observed SN (Skilled Nurse) provide care for a patients PICC line (Peripherally Inserted Central Catheter that is threaded through a larger vein (usually close to the bend of arm) and extends internally from the arm to the heart and is used to provide antibiotic infusions.) SN cleaned hands with hand sanitizer, donned clean gloves & put a mask on. Patient remained unmasked and observed the care being provided. It is standard practice for the patient to be positioned so the breathing of the patient is away from the PICC site to prevent contamination from respiratory air flow with exhalation. SN then began to loosen the edges of the dressing without removing the dressing. SN then took clean gloves off and donned sterile gloves. SN proceeded to remove the old dressing and the STAT Loc (an adhesive holder made specifically for use with PICC lines) securing the PICC. SN then returned to the sterile filed and touched several items w contaminated gloves. SN then began to clean PICC insertion area w chlorhexidine for 10-15 seconds. SN then used a piece of gauze to blot at the wet chlorhexidine. Surveyor stopped the dressing change at this time. There were no other kits in the home. The area was covered w a clean (contaminated from the sterile field) drape & after prompting, the nurse secured the PICC with a supplied piece of adhesive tape from the PICC dressing kit. There was a gap of almost 2 hours while waiting for another dressing change kit to be obtained. When dressing kit arrived, SN gave a mask to patient to wear. SN donned mask, cleansed hands w sanitizer & donned sterile gloves and proceeded to place STAT Loc, bio patch (a sterile and small foam like circular pad impregnated with antimicrobial substance that is placed directly over the PICC insertion site to decrease infection of PICC) and new tegaderm transparent dressing over PICC site without recleaning the area. Next, SN cleaned tip of needleless access and flushed w saline. SN then proceeded to draw blood from the PICC for ordered labs and flushed PICC again w both saline flush & heparin flush. After lab specimens were drawn, SN placed a cap cover over the access. The needleless access was NOT changed secondary to the specimen draw as is standard of care. 2) Patient #2: During observation of a SN wound care visit on 08/09/2023 at 11:49 AM, surveyor witnessed SN clean hands with sanitizer and don clean gloves. SN then removed the old dressing. SN removed gloves, used sanitizer to clean hands and donned clean gloves again. SN proceeded to clean wound area. SN then placed new dressing to wound and secured with tape. SN did not change gloves between cleaning the wound and placing new dressing.