Every finding on record at Home Health Services of Mary Lanning Memorial Healthcare

Home Health Services of Mary Lanning Memorial Healthcare is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

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 record review, policy and procedure review, and staff interview, the agency failed to update the physician to modify the plan of care for 3 of 7 clinical records reviewed (Patient 4, 5, and 7) when visits were missed and/or the patient declined ordered services. The census was 60. Findings are: A. Review of the agency policy and procedure titled, Visit Cancellations, revised 5/22, revealed the agency was to notify the physician if a patient canceled a visit and orders were to be written as appropriate. B. Review of Patient 4's clinical records revealed: 1. The Home Health Certification and Plan of Care (POC) for the certification period of 4/30/22 through 6/28/22 included orders for Skilled Nursing (SN) services 1 time a week for 1 week, then 3 times a week for 2 weeks, then 2 times a week for 2 weeks, then 1 time a week for 4 weeks. The POC also included orders for Occupational Therapy (OT) 2 times a week for 2 weeks. 2. There was no documentation of a third SN visit conducted the week of 5/1/22 through 5/7/22) (the second week of services). 3. A SN Telephone Visit Note dated 5/11/22. The note revealed the patient reported having a doctor appointment on 5/11/22 and requested only 2 SN visits for the week. 4. An OT Telephone Visit Note dated 5/10/22. The note revealed the occupational therapist received a message to cancel OT visit for 5/10/22; patient requested no OT visit until 5/12/22. 5. There was no documentation in the clinical record the physician was notified of the missed visits by OT and SN for the dates listed above. C. Review of Patient 5's clinical record revealed: 1. A Physician Order dated 4/14/22 for OT to evaluate and treat post-hospitalization for wound infection to foot with non-weight bearing and possible need for modifications to the home. 2. A Physicians Order dated 4/14/22 for Physical Therapy (PT) to evaluate and treat post-hospitalization for wound infection to foot with non-weight bearing and possible need for instructions on crutches. 3. A Physicians Order dated 5/23/22 for PT to evaluate and treat for crutch training due to non-pressure chronic ulcer to left foot with necrosis of bone (death of bone tissue due to lack of blood supply). 4. An OT Telephone Visit Note dated 4/18/22 revealing the patient declined OT and PT services. 5. A PT Telephone Visit Note dated 4/24/22 revealing the patient declined PT services. 6. There was no documentation in the clinical record the physician was notified the patient declined PT and OT services as ordered on 4/14/22 and PT services as ordered on 5/23/22. D. Review of Patient 7's clinical record revealed: 1. A Physician Order dated 3/2/22 for Speech Therapy (ST) 2 times a week for 8 weeks. 2. ST Telephone notes date 3/30/22 and 4/1/22 revealed the patient cancelled both ST visits for the week of 3/27/22 through 4/2/22. 3. There was no documentation in the clinical record the physician was notified of the 2 missed ST visits the week of 3/27/22 through 4/2/22. E. During an interview on 6/6/22 at 12:30 PM the Director of Home Care (DHC) and the Clinical Manager (CM) confirmed the physicians for Patient 4, 5, and 7 were not notified of the missed visit as listed in B, C, and D above. The DHC and the CM confirmed agency staff did not follow the agency policy to notify the physician of missed visits or need to alter the plan of care when services are declined by the patient.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to include the patients progress towards the measurable outcomes and goals identified by the home health agency and the patient on the revised/updated plan of care for 1 of 1 clinical record reviewed that had a revised/updated plan of care (Patient 1). The census was 60. Findings are: A. Review of the agency policy and procedure titled, Plan of Care (POC), revised 5/22, revealed the agency was to inform the physician of the patient's condition and response to the plan of care. This policy and procedure does not require all the items listed in this regulation to be included on the patient's plan of care. B. Review of Patient 1's clinical records revealed the Home Health Certification and Plan of Care (POC) for the certification period of 4/18/22 through 6/16/22 did not include the patient's progress towards the measurable outcomes and goals identified by the patient and the Home Health Agency on this revised/updated plan of care. C. During an interview on 6/2/22 at 08:45 AM the Director of Home Care (DHC) and the Clinical Manager (CM) confirmed Patient-1's revised/updated POC did not include the patient's progress towards the measurable outcomes and goals identified by the patient and the Home Health Agency on this revised/updated plan of care.

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 policy and procedure review, the observation of the provision of cares, and staff interview, 3 of 3 agency staff observed during the provision of care (Staff- C, E, and F) to Patient's 1, 2, and 3 respectively, failed to utilize proper cleaning of patient equipment and supplies and multiuse equipment, proper hand hygiene/glove use, and proper bag technique according to the agency policies to prevent the potential spread of infection. The total sample size was 7. The census was 60. Findings are: A. Review of the agency policy and procedure titled, Nursing Bag Technique, revised 5/22, revealed the purpose of the policy was to prevent contamination of clean areas. The policy only lists the blood pressure cuff to be cleaned with a germicidal wipe prior to returning to the supply bag. The policy does not address the care of items such as oximeter, thermometers, laptops, scissors, or any other items used in the provision of care of multiple patients, nor does it address the procedure for the care of equipment used and left in the patient home. B. Review of the agency policy and procedure titled, Handwashing, revised 2/22, revealed the staff were to wash their hands before and after patient contact, before applying gloves, after removing gloves, after toileting patient, after handling patient equipment, and anytime their hands become soiled. C. The observation of the provision of cares by agency staff revealed: 1. On 6/1/22, Staff-C failed to sanitize scissors and wound wash bottle after using the items during the provision of wound care, and prior to returning the items to Patient 1's box of supplies (which included clean wound care and dressing supplies). 2. On 6/2/22, Staff-E failed to change gloves and sanitize hands after removing Patient 2's clothing and handling the patient's catheter bag (a bag which is attached to tubing inserted into the urethra used to collect urine) and prior to washing the patient's face and hair. Staff-E also failed to change gloves and sanitize hands after washing the patient's peri-rectal area and prior to drying the patient, and again after handling the catheter bag when dressing the patient and prior to touching the patient's walker, recliner, and gait belt (a belt used to steady and assist a patient when walking or transferring) when returning with the patient to the living room. 3. On 6/2/22, Staff-F failed to sanitize the laptop, which had been placed on Patient 3's couch without a barrier, prior to returning the laptop to the staff's supply bag. D. During an interview on 6/2/22 at 8:45 AM, Director of Home Care (DHC) and the Clinical Manager (CM) confirmed Staff-C did not sanitize the scissors and wound wash bottle used during the provision of cares to Patient 1 prior to returning those items to the patient's supply box. E. During an interview on 6/2/22 at 11:45 AM, the DHC and the CM confirmed Staff-E did not perform proper hand hygiene and glove changes during the provision of cares to Patient 2, as required by the agency policy and procedure for hand hygiene. F. During an interview on 6/2/22 at 2:15 PM, the DHC and the CM confirmed Staff-F did not sanitize the laptop used during the provision of cares to Patient 3 prior to returning the laptop to the staff's supply bag.