Every finding on record at Homechoice of Alabama, Inc.

Based on the recertification survey conducted on 1/12/23 Springhill Home Health and Hospice was found to be in substantial compliance with the Conditions of Participation for Emergency Preparedness.

A recertification survey was conducted on 1/12/23 with standard level deficiencies cited.

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 observations, Medical Record (MR) review, agency policy and procedure, and interviews it was determined the agency staff failed to review the medications and update the medication list for each patient. This deficient practice affected three of seven Home visit (HV) records reviewed including HV # 6, HV # 2 and, HV # 4 and had the potential to affect all patients admitted to this agency. Findings include: Agency policy: Medication Administration and Management Policy number: none listed Revised: 8/5/22 Policy: The Agency will reconcile patient's medications at time of admission and on an ongoing basis... Procedure: ...2. For accuracy and to reconcile medications across the continuum of care, a drug history will be taken during the start of care assessment and a comparison made between the physician orders and the current medications the patient is taking.... 3. HV # 4 was admitted to agency on 4/18/22 with diagnoses including Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-dominant Side and Aphasia Following Cerebral Infarction. Review of the Skilled Nurse Visit Note Report dated 12/20/22 revealed Magnesium Citrate 1 bottle was ordered by the physician. Review of the CMR, printed on 1/10/23, revealed no documentation of the Magnesium Citrate. An interview was conducted on 1/11/23 at 3:23 PM with EI # 1, who confirmed the staff failed to update the CMR. 2. HV # 2 was admitted on 12/6/22 with diagnoses including Sepsis Due to Enterococcus, Other Specified Sepsis, and Type 2 Diabetes Mellitus with Foot Ulcer. Review of the Home Health Certification and Plan of Care (HHC and POC) dated 12/6/22 revealed orders for Skilled Nurse (SN) one time a week x nine weeks, Physical Therapy (PT) one time a week x one week, two times a week x one week, then one time a week x four weeks, and Home Health Aide (HHA) one time a week x three weeks then two times a week x three weeks. A HV was conducted on 1/10/23 at 12:00 PM to observe care provided by EI # 4, HHA. The surveyor reviewed the current medications with HV # 2 and his/her spouse and compared the medications to the CMR printed on 1/10/23. Metformin 1,000 milligrams (mg) take two times a day was in the home and not on the CMR. HV # 2 stated he/she had been taking the Metformin since 2014. In an interview conducted on 1/11/23 at 3:20 PM, EI # 1, Branch Director, confirmed the staff failed to review the medications and update the CMR. Metformin was a current medication but was not listed on the CMR. 1. HV # 6 was admitted to the agency on 9/14/2022 with diagnoses including Hypertensive Chronic Kidney Disease with Stage 1-4 Unspecified Chronic Kidney Disease and Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease, and recertified for care from 11/13/22-1/11/23. A HV was conducted on 1/11/23 at 9:15 AM to observe care provided by Employee Identifier (EI) # 8, Speech Therapist. The surveyor reviewed the current medications with EI # 8, HV # 6 and spouse. The medications observed in the home were compared to the Client Medication Report (CMR) printed on 1/11/23. The following discrepancies were observed: a) Allopurinol 100 milligrams (mg), 0.5 tablet daily, was listed on the CMR. Allopurinol 100 mg, one tablet daily, was in the home. The date filled on the bottle was 12/2/22 and confirmed by the caregiver. b) Colcrys 0.6 mg tablet, one tablet twice daily, was listed on the CMR and was not in the home. The caregiver confirmed medication had been discontinued several months ago. c) Pantoprazole 40 mg tablet, delayed release, one tablet daily, was listed on the CMR and was not in the home. The caregiver confirmed medication had been discontinued in November or December. d) Pregabalin 150 mg capsule, one tablet three times daily, was listed on the CMR and was ordered twice daily on the bottle in the home. The last fill date was 11/4/22. The caregiver confirmed the medication is taken twice daily. e) Equate Men's Health One Daily Multivitamin, one tablet daily, was not listed on the CMR and was present in the home. The caregiver was unsure of how long the patient had been taking the over the counter medication, and stated that it had "been awhile." f) Azelastine 0.1%, 2 sprays each nostril twice daily, was present in the home and was not listed on the CMR. The fill date noted on the box was 8/9/22 and confirmed by caregiver. An interview was conducted on 1/12/23 at 10:40 AM with EI # 2, Clinical Manager, who confirmed agency staff failed to review medications and update the CMR.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on review of Medical Records (MR) and staff interviews it was determined the agency staff failed to ensure the physician was notified of patient noncompliance with glucometer testing. This deficient practice did affect MR # 10, one of seven patients diagnosed with Diabetes, and had the potential to affect all patients served by the agency. Findings Include: 1. MR # 10 was admitted to the agency on 11/9/22 with diagnoses including Malignant Neoplasm of Thyroid Gland, Secondary Malignant Neoplasm of Bone, and Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 11/6/22 to 1/7/23 revealed physician orders to instruction/reinforce Diabetic Blood Glucose testing and report a Fasting Blood Sugar) of below 70 and above 300. Review of the Skilled Nurse (SN) notes dated 11/9/22, 11/11/22 and 11/17/22 revealed the SN was unable to assess the patient's blood sugars due to the patient not monitoring blood sugars. There was no documentation the SN notified the physician of the patient's noncompliance with monitoring blood sugars. An interview was conducted on 1/11/23 at 4:02 PM with Employee Identifier (EI) # 1, Branch Director who confirmed there was no documentation the physician was notified of the patient's noncompliance with monitoring blood sugars.

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 observations, agency policies and procedures, Sani-Cloth General Guidelines for Use and interviews it was determined the agency failed to ensure the staff followed the agency policy for hand hygiene and bag technique. This deficient practice affected three of seven Home Visit (HV) patients including HV # 2, HV # 7, HV # 4, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Infection Prevention and Control Policy number: none listed Revised: 7/6/22 ...Procedure: 1. Standard precautions will be used to prevent transmission of infectious agents... 2, ...Hand Hygiene should be performed, at a minumum a. Before contact with a patient b. Before performing an aseptic task (...performing wound care) c. After contact with the patient or objects in the immediate vicinity of the patient d. After contact with blood, body fluids, or contaminated surfaces e. Moving from a contaminated body site to a clean body site during patient care... f. After removing personal protective equipment (PPE) Agency Policy and Procedure: Bag Technique Procedure Policy number: none listed Revised: 2/24/22 Procedure: The principles in bag technique are developed and used to maximize the efficient use of the bag and to prevent cross-contamination. Heatlhcare personnel will follow this procedure for maintaining a contaminate free bag. 1. Contents of the nursing (agency) bag: ...Assessment equipment ... 2. ...In the patient's home, place the bag on a clean and dry surface. A barrier (such as newspaper, paper towel, small trash bag...) is to be placed under the bag. Bags should never be placed on the floor... ...5. When the visit is completed, reusable equipment will be cleaned using...disinfectant wipe...and placed on a clean surface... Sani-Cloth manufactures General Guidelines for Use Update Date: 2021 ...3b. Unfold a clean wipe and thoroughly wet surface 4. Allow treated surface to remain wet for two (2) minutes. Let air dry. 3. HV # 4 was admitted to agency on 4/18/22 with diagnoses including Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-dominant Side and Aphasia Following Cerebral Infarction. An HV was conducted on 1/10/23 at 3:24 PM with EI # 6, Occupational Therapist, to observe care provided. EI # 6 cleaned the thermometer, stethoscope, pulse oximetry and blood pressure cuff with a sani-cloth and immediately placed the equipment in the clean section of the agency bag. EI # 6 failed to allow the equipment to air dry for two minutes per sani-cloth manufactures general guidelines. An interview was conducted on 1/11/23 at 3:23 PM with EI # 1, who confirmed the agency staff failed to follow the policy and procedure for bag technique. 1. HV # 2 was admitted on 12/6/22 with diagnoses including Sepsis due to Enterococcus, Other Specified Sepsis, and Type 2 Diabetes Mellitus with Foot Ulcer. A HV was conducted on 1/10/23 at 12:00 PM to observe care provided by Employee Identifier (EI) # 4, Home Health Aide (HHA). EI # 4 donnned gloves, bathed the anterior body, wiped the genitals with disposable wipes then applied lotion to the upper body, arms and legs. EI # 4 failed to remove gloves and perform hand hygiene after cleaning the genitals , before applying lotion to the clean area. EI # 4 performed hand hygiene, donned new gloves, rolled HV # 2 to the side, and bathed the back and legs. EI # 4 then bathed the patient's buttocks and rectal area, applied a new adult diaper, and applied lotion to the back. EI # 4 failed to remove gloves and perform hand hygiene after bathing the buttocks/rectal area, before applying lotion to clean area. After the bath was complete, EI # 4 removed the barrier from under the HHA bag, placed the bag on the floor, then disposed of the barrier. EI # 4 failed to follow agency policy and placed the bag on the floor. EI # 4 then removed the gloves. EI # 4 failed to perform hand hygiene after removing gloves. In an interview conducted on 1/11/23 at 3:20 PM, EI # 1, Branch Director, confirmed the staff failed to follow agency policy for hand hygiene and bag technique. 2. HV # 7 was admitted on 12/30/22 with diagnoses including Diverticuli of Intestines, Infectious Gastroenterites and Colitis, and Encounter for Adjustment and Management of Vascular Access Device. Review of the Home Health Certification and Plan of Care (HHC and POC) dated 12/30/22 revealed orders for Skilled Nurse (SN) two times a week x one week then one time a week x eight weeks and for SN to perform IV (Intravenous) site care weekly and as needed. A HV was conducted on 1/11/23 at 7:55 AM to observe PICC (Peripherally Inserted Central Catheter) line care performed by EI # 9, Registered Nurse (RN). EI # 9 donned gloves and removed the tape from around the PICC line site. EI # 9 then removed the gloves and donned new gloves and removed the soiled dressing. EI # 9 failed to perform hand hygiene after removing gloves. In an interview conducted on 1/11/23 at 3:40 PM, EI # 1 confirmed the staff followed the agency policy for hand hygiene.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on review of Medical Records (MR), agency procedure and staff interviews it was determined the agency failed to ensure education was provided to the patient and/or caregiver with a return demonstration to determine competency for: 1. Tracheostomy Care 2. Newly diagnosed Urinary Tract Infection (UTI). This deficient practice did affect MR # 10, one of one records reviewed with a Tracheostomy and MR # 5, one of two records reviewed with a UTI, and had the potential to affect all patients served by the agency. Findings Include: Agency Procedure: Tracheostomy Tube Care, Home Care Revised: 11/28/22 ...Patient Teaching ...If the patient or a family member will perform routine care independently, demonstrate the proper technique and have the patient or family member perform a return demonstration to identify learning gaps, correct misconceptions, and determine competency... 1. MR # 10 was admitted to the facility on 11/9/22 with diagnoses including Malignant Neoplasm of Thyroid Gland, Secondary Malignant Neoplasm of Bone, and Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 11/6/22 to 1/7/23 revealed physician orders to instruct/reinforce Tracheostomy (trach) care, including stoma care, suctioning, trach care and dressing change. Review of the Skilled Nurse (SN) visit dated 11/9/22 revealed the "...patient, caregiver self manage tracheostomy..." There was no documentation the patient and/or caregiver provided a return demonstration of the trach care determine competency. An interview was conducted on 1/11/23 at 4:02 PM with Employee Identifier (EI) # 1, Branch Director who confirmed there was no documentation the patient and/or caregiver provided a return demonstration of the trach care to determine competency per the agency procedure. 2. MR # 5 was admitted to the agency on 12/7/22 with diagnoses including Chronic Obstructive Pulmonary Disease, Unspecified and Acute Respiratory Failure, Unspecified with Hypoxia or Hypercapnia. Review of the Home Health Certification and Plan of Care dated 12/7/22 to 2/4/23 revealed a physician order for SN to instruct/reinforce UTI management. Review of the Physical Therapy Assistant note dated 12/12/22 revealed MR # 5 was prescribed an antibiotic for a new diagnosis of UTI and the SN was notified. Review of the MR revealed no documentation the SN provided education to the patient and/or caregiver on the new diagnosis of UTI. An interview was conducted on 1/12/23 at 10:48 AM with EI # 1, who confirmed there was no documentation the SN provided education to the patient and/or caregiver on the new diagnosis of UTI.

Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This ELEMENT is not met as evidenced by: Based on review of Medical Record (MR), agency policies and procedure and staff interview the agency staff failed to coordinate patient care with the physician for Medical Social Worker (MSW) services. This did affect MR # 5, one of two records reviewed with MSW services, and had the potential to affect all patient's who require MSW services. Agency Policy: Coordination of Care Revised Date: 10/19/22 Policy: All personnel involved in the patient's care are responsible for coordinating care effectively to support the objectives outlined in the patient's plan of care. The agency will coordinate care by: Ensuring communication with all physicians...involved in the plan of care... Procedure: ...2. The clinical manager or other staff designated by the agency is responsible for...ensuring the orders are approved by the responsible physician/allowed practitioner. 3. The agency will integrate services provided by various disciplines by: ...assuring that staff who provide care are communicating any patient concerns...with others involved in the patient's care... Agency Policy: Comprehensive Assessment of Patients Revised Date: 12/2/22 Policy: ...The agency will reassess each patient on an ongoing basis to evaluate current problems and needs as well as to adjust the care provided as needed with necessary physician/allowed practitioner orders obtained...All collaboration efforts...will be documented in the MR.... 1. MR # 5 was admitted to the agency on 12/7/22 with diagnoses including Chronic Obstructive Pulmonary Disease, Unspecified and Acute Respiratory Failure, Unspecified with Hypoxia or Hypercapnia. Review of the Skilled Nurse (SN) visit dated 12/16/22 revealed the patient's adult child yelled at the patient multiple times during the visit and it was determined a MSW visit was needed. There was no documentation the SN coordinated with the physician to obtain an order for the MSW to evaluate the patient. Review of the Occupational Therapy (OT) visit dated 12/29/22, 13 days later, revealed the OT contacted the physician to obtain an MSW evaluation for the patient complaint of verbal abuse by the adult child. Review of the SN coordination note dated 12/29/22, the physician's office requested an MSW evaluation from the agency. Review of the Physician orders dated 12/30/22 revealed a MSW was ordered to evaluated the week of 1/1/23. Review of the MSW note dated 1/5/23, 20 days after it was determined a MSW evaluation was needed by the SN, revealed a MSW evaluation was completed. An interview was conducted on 1/12/23 at 10:48 AM with Employee Identifier # 1, Branch Director, who confirmed there was no documentation coordination with the physician for MSW evaluation order until 12/29/22 and the MSW evaluation was not completed until1/3/23.