Every finding on record at Hye Nurses Home Health Inc

The following reflects the findings of the Department of Public Health during a Recertification Survey.Representing the Department of Public Health:Surveyor ID #- 43929 RN-HFEN Surveyor ID #- 22303 RN-HFEN Unduplicated Admissions -84Active Patients -16Sample Size -7 PatientsHome Visit - 3

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the emergency preparedness plan and staff training were done on an annual basis. This failure had the potential for the staffs to lack the knowledge to respond effectively during an emergency situation. During a review of the emergency preparedness plan and disaster training of the HHA on 7/10/22, at 11:30 a.m., the HHA did not have documented evidence of Emergency Preparedness training/Disaster drill for all staffs and did not have evidence of emergency plan annual review. During an interview with the Administrator (ADM) on 7/10/22, at 12 p.m., the ADM stated the Emergency preparedness/Disaster drill training had not been done with staff annually. There was no documented evidence the governing body reviewed the policy annually on Emergency Preparedness/Disaster. The HHA's undated policy and procedure titled, "Emergency Preparedness Plan" indicated “this emergency preparedness plan was designed to provide continuing care/service in the event of an emergency that would result in interruption of patient care services.”

The following reflects the findings of the Department of Public Health during a Recertification Survey.Representing the Department of Public Health:Surveyor ID #- 43929 RN-HFEN Surveyor ID #- 22303 RN-HFEN Unduplicated Admissions -84Active Patients -16Sample Size -7 PatientsHome Visit - 3

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 observation, interview and record review, the home health agency (HHA) failed to ensure the patient's current medication profile matches with the medications the patient is currently taking at home for one of seven patients (Patient 1 ). This failure had the potential to place the patients at risk for medication errors and adverse drug reactions. A review of Patient 1's clinical record indicated a start of care date 2/15/22, with primary diagnosis of hypertension (high blood pressure). A review of Patient 1's plan of care from 6/15/22 to 8/13/22, included an order for SN (skilled nurse) visits of once a week for one week, twice a week for two weeks, once a week for six weeks. The SN was to assess activities of daily living (ADLs) and home safety, knowledge on disease process and management, medication, and compliance. SN was also to instruct on signs and symptoms of adverse reaction to report to medical doctor (MD). On 7/9/22, at 1 p.m., a home visit was conducted at Patient 1's residence with RN 1 (registered nurse), Patient 1 was observed sitting on the chair in the living room. During a review of Patient 1's medications, indicated a bottle of Furosemide 20 milligrams (mg) 1/2 tab daily as needed for fluid retention. During a review of Patient 1's clinical record indicated a physician's order for the Memantine (to treat moderate to severe Alzheimer's disease) 5 milligrams (mg) one tab daily and Megedrol 40 mg one tab daily medications in which the patient was regularly taking. On 7/9/22, at 1:30 p.m., during a review of Patient 1's actual medications, There was a bottle of Memantine 10 mg one tab daily and Megedrol 20 mg tab, to take two tabs twice daily. On 7/9/22, at 1:45 p.m., during an interview with Patient 1, he stated he takes Memantine 10 mg one tab daily and Megedrol 20 mg two tabs twice daily. On 7/10/22, at 10:30 a.m., during an interview with RN Supervisor, he stated that the visiting nurse should have been checking all the patient's medications during their visits. A review of the HHA’s undated policy and procedure titled, “Administration of Medications”, indicated “Registered Nurses and Licensed Vocational Nurses will review the patient’s medication on a routine basis or as ordered within the Plan of Care”. Findings: Patient 4’s record was reviewed. The form titled “Home Health Certification and Plan of Care” (POC), certification period 6/22/22 to 8/20/22, indicated the start of care (SOC) date for Patient 4 was 6/22/22, with diagnosis of chronic obstructive pulmonary disease (a breathing condition causing difficulty breathing). During a home visit on 7/9/22, at 11:25 a.m., Licensed Vocational Nurse 1 (LVN 1) was observed providing care to Patient 4. The LVN did not review the medications Patient 4 was taking during the visit. On 7/9/22, at 11:37 a.m., Patient 4 was observed speaking with LVN 1. Patient 4 stated she was experiencing a migraine (a form of headache) and did not want to take the medication “Imitrex” (medication for migraine) because it did not make her feel good. During an interview, on 7/9/22, at 11:55 a.m., LVN 1 stated she did not check the medication because she forgot. LVN 1 stated she was supposed to check the medications Patient 4 was taking using the medication profile. LVN 1 stated it was important to check the medications to make sure all medications Patient 4 was taking were listed and was taking them correctly and to make sure the medications were working for her. During a concurrent interview and record review on 7/9/22, at 11:55 a.m., of Patient’s record titled, “Medication profile”, dated 6/28/22, indicated Imitrex (a medication used for migraine-a form of headache) was not listed. LVN 1 stated the medication profile was supposed to be updated with all the medication the patient was taking. LVN 1 acknowledged Imitrex was not listed. A review of the HHA’s policy and procedure titled, “Medication Profile “, dated November 2018” , indicated “Patients receiving medications will have a current, accurate medication profile in the clinical record.”

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 home health agency (HHA) failed to screen the visitors for signs and symptoms of COVID-19 infection (an acute serious respiratory illness). This failure had the potential to spread COVID-19 virus to other staff and patients. On 7/8/22, at 3 p.m., upon entry to the HHA , it was observed there was no screening for COVID-19 signs and symptoms, including temperature checking. During an interview on 7/10/22, at 1 p.m., the Administrator (ADM) stated the agency screens employees and visitors for COVID 19 symptoms, but the information is not documented. The ADM also stated temperatures are not checked for employees and visitors entering the HHA. During a review of the infection control policy on 7/10/22, at 1:15 p.m., the HHA did not have a policy for COVID-19 screening procedures for staff and visitors. A review of the HHA’s undated policy and procedure titled, “Infection Control Procedures”, indicated “It is the policy of California Nurses Home Health Services to protect the clients and the health care workers from potential spread of infection.” Findings: During an interview on 7/10/22, at 10:20 a.m., the administrator (ADM) stated Employee 1 (E1) was not vaccinated against COVID 19 and did not have a declination form in the employee file to state the reason for the declination. The ADM stated the declination form was supposed to be filled out and placed in the employee form. During an interview on 7/10/22, at 11:50 a.m., the ADM stated she was not vaccinated because she was scared. The ADM stated she did not have a religious or medical exemption for not being vaccinated. During an interview on 7/10/22, at 11:50 a.m., the RN designee stated the HHA did not have a policy in place for vaccination requirement and for employees who are not vaccinated. A review of the State of California All facilities Letter “AFL 21-34.3”, dated 2/22/22, indicated “Facilities and providers must document HCP COVID-19 vaccination or exemption status by the following dates to be in compliance with the public health orders: Healthcare facilities: September 30, 2021,Home health agencies and hospice providers: November 30, 2021”

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to ensure Registered Nurse (RN) supervisory onsite visit to certified home health aides (CHHA) was conducted every 14 days for one of seven sampled patients (Patient 2 ). This deficient practice had the potential to result in care and services not being provided to the patients. Findings: A review of Patient 2's record indicated a start of care (SOC) dated 2/15/22, with diagnosis which included hypertensive heart disease. A review of Patient 2's "Home Health Certification and Plan of Care" (POC), for the certification period from 6/15/22 to 8/13/22, included CHHA (certified home health aide) to visit twice a week for 8 weeks and Registered Nurse (RN) supervisory visits every 14 days per month. A review of Patient 2's clinical record indicated there were no documented evidence the RN Supervisor conducted a CHHA supervisory visit from 6/15/22 to 7/8/22. On 7/10/22, at 1:30 p.m., during an interview with the ADM (administrator), stated the RN Supervisor failed to conduct CHHA supervisory visits every 14 days. A review of the undated agency's policy and procedure titled, "Home Health Aide Personal Care Services Supervision" indicated if the patient receive skilled nursing care, the registered nurse/vocational nurse shall perform the supervisory visit every 2 weeks.