Every finding on record at Immaculate Heart of Mary Home Health, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 14329 WOODRUFF AVE SUITE A BELLFLOWER, CA 90706 Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID: 44916 Health Facilities Evaluator Nurse, Surveyor ID: 22303, Unduplicated Admissions - 65 Active Patients - 15 Sample Size - 7 Home Visits- 3

Accuracy of encoded OASIS data CFR(s): 484.45(b) Standard: The encoded OASIS data must accurately reflect the patient's status at the time of assessment. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the agency failed to maintain an accurate patient information in the encoded Outcome and Assessment Information Set (OASIS) data for two of seven patients (Patients 1 and 4). The deficient practice has the potential to result in the delay of continued care, services, and treatment. A review of Patient 4's Patient Profile Information, indicated a SOC date of 2/16/23. Patient 2's diagnosis included non-chronic pressure ulcer (an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal) of the right and left foot and morbid obesity (a complex chronic condition in which a person has a body mass index (BMI- is a person's weight in kilograms (or pounds) divided by the square of height in meters (or feet) of 40 or higher). A review of the " Home Health certification and Plan of Care" for certification period of 2/16/23 to 4/16/23 indicated Skilled nursing (SN) visit frequency and duration of once a week for one week and three times a week for eight weeks. SN to perform wounds care on right and left plantar feet area- cleanse with normal saline, pat dry and apply mupirocin ointment then cover with dry sterile dressing wrap with conforming gauze and secure with tape then apply ace bandage three times a week for three weeks. SN to assess all body systems with emphasis on integumentary-wound, cardiovascular, pulmonary, endocrine, GI/GU, musculo-skeletal, neuro/mental/cognitive, peripheral vascular, nutrition/hydration status, all medications for potential problems, knowledge and compliance to status, psycho-social, adjustment, caregiver availability/ability and home safety. SN to notify MD for any significant change in the patients condition. SN to teach pt/pcg on disease process related to congestive heart failure, on proper wound care, measures to promote wound healing, medication regimen including its action and side effects, diet regimen, pain control measures, signs and symptoms to report to MS/SN universal precautions, infection control measures, emergency measures, 911 protocol and home safety. A phone call attempt to interview Patient 4 at his home on 4/15/23 at 9:47 a.m., on the phone number listed on the "Patient Profile", a woman answered and stated " you've got the wrong number miss, this was his home but he is not living here anymore he is in a facility. I don't have time to speak to you because I am making breakfast" and she hung hung up the phone. During a phone interview with the Director of Patient Care Services (DPCS) stated that the patient lives in an assisted living facility and gave a phone number. When the phone number was called a voice prompt answered " Brookdale Assisted Living Care Offices are closed at this time and is open Monday to Friday 8am to 5pm." Rechecked the address on Patient 4's Patient Profile and looked it up via online directory for Brookdale Assisted Living Facilities and called the correct phone number. Verified with the med tech of this facility that this was Patient 4's correct address and phone number for the HHA to reach at. During an interview with the DPCS on 4/16/23 at 4:00 p.m., DPCS verified there was no name of the assisted living on the face sheet and Home Health certification and Plan of care. DPCS further stated that the correct name of the assisted living facility, its address and phone number should be encoded accurately on the OASIS so that the field staff would be able to contact the facility promptly for any changes in the patients care. A review of the HHA's policy titled " Continuum of Care and Services : Coordination of Services with other Providers" dated 2007 indicated the clinician will be responsible for coordinating services provided to the patient by the organization, including services provided directly and thru contract. The clinician will act as a liaison with other organizations/individuals also providing care to the patient to assure effective coordination or related services. All internal referrals to other disciplines will be documented within the clinical record. During a review of Patient 1's Patient Profile indicated, a start of care (SOC) date of 1/24/23, with diagnosis that included non-pressure chronic ulcer at right and left lower leg. During a review of Patient 1's Plan of Care (POC), for the re-certification period from 3/25/23 to 5/23/213, included an order for skilled nurse (SN) to visit of twice a week for 8 weeks, once a week for one week, for SN (skilled nurse) to assess all body system with emphasis on integumentary wound. One of the skilled nursing intervention was to perform wound care on right and left lower leg wounds as follows: cleanse with Normal Saline, pat dry, apply Zinc Oxide, then apply Medigrip twice a week for three weeks. A review of Patient 1's Comprehensive Recertification (OASIS assessment) form dated 3/23/23, indicated under wound assessment indicated the patient's right leg wound was assessed as healed. However, it was also indicated that there was a wound size measurement of 0.1 cm (centimeter) in length by 0.1 cm in width by 0.1 cm in depth for the right leg wound. On 4/16/23, at 1 p.m., during an interview with the DPCS (director of nursing services), he stated the patient's right leg wound was healed but he made an error of documenting the size measurement of the wound in the OASIS assessment on 3/23/23.

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 maintain an accurate, and current medication profile for 3 of 7 patients (Patients 2, 4 and 5). This failure had the potential to result in placing the patient at risk for medication errors and adverse drug reactions. 2. A review of Patient 4's Patient Profile Information, indicated a SOC date of 2/16/23. Patient 2's diagnosis included non-chronic pressure ulcer (an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal) of the right and left foot and morbid obesity (a complex chronic condition in which a person has a body mass index (BMI- is a person's weight in kilograms (or pounds) divided by the square of height in meters (or feet) of 40 or higher). A review of the " Home Health certification and Plan of Care" for certification period of 2/16/23 to 4/16/23 indicated Skilled nursing (SN) visit frequency and duration of once a week for one week and three times a week for eight weeks. SN to perform wounds care on right and left plantar feet area- cleanse with normal saline, pat dry and apply mupirocin ointment then cover with dry sterile dressing wrap with conforming gauze and secure with tape then apply ace bandage three times a week for three weeks. SN to assess all body systems with emphasis on integumentary-wound, cardiovascular, pulmonary, endocrine, GI/GU, musculo-skeletal, neuro/mental/cognitive, peripheral vascular, nutrition/hydration status, all medications for potential problems, knowledge and compliance to status, psycho-social, adjustment, caregiver availability/ability and home safety. SN to notify MD for any significant change in the patients condition. SN to teach pt/pcg on disease process related to congestive heart failure, on proper wound care, measures to promote wound healing, medication regimen including its action and side effects, diet regimen, pain control measures, signs and symptoms to report to MS/SN universal precautions, infection control measures, emergency measures, 911 protocol and home safety. A phone interview was conducted on 4/15/22, at 1:00 p.m., with assisted living facility med tech. During a medication review with the med tech, the following medication discrepancies were noted: Ascorbic Acid 500 mg 1 tablet daily for wound supplement was increased to twice daily. Med tech stated patient has been taking this medication for "some time now" and it has been the order for the medication. Furosemide 20 mg 1 tablet daily as diuretic (is any substance that promotes diuresis, the increased production of urine) was increased to twice daily. Mupirocin 0.02 mg/mg apply to wound. Med tech stated she doesn't have that order on her medlist. Voltaren 0.01 mg/mg apply to both knees twice daily for pain. Does not have the order on her medlist. Biofreeze 0/04mg.mg apply to both knees alternately with voltaren as needed for knee pain was also not on her med list Milk of Magnesia 30 ml every 6 hours as needed for constipation was not listed on the patients medication profile but is on the medlist of the ALF. On concurrent interview at the same date and time, med tech stated that the mupirocin, biofreeze and the voltaren is not present in the medroom. When asked if the medications may be located in the patient's room, Medtech stated " Per ALF policy, patients are not allowed to have medications in their room unless they have doctor's orders". Medtech also stated that the ALF does not perform any wound care on their patients and there are no current wound treatment orders on their record. During an interview on 4/16/23 at 12:40 p.m., with the Director of Patient Care Services Designee (DPCSD) stated that all medications and treatments should be communicated and reviewed with the assisted living facility staff every visit. DPCSD further stated it is important to communicate with the ALF staff and follow their policies on where to keep the patients medications and to provide them with information of wound treatment orders and medication updates. 3. A review of Patient 5's Patient Profile Information, indicated a SOC date of 7/17/20. Patient 5's diagnosis included venous insufficiency (improper functioning of the vein valves in the leg, causing swelling and skin changes) and non-chronic pressure ulcer of the right lower leg. A review of the " Home Health certification and Plan of Care" for certification period of 3/4/23 to 5/22/23 indicated Skilled nursing (SN) visit frequency and duration of once a a day for fourteen days, three times a week for three weeks, twice a week for two weeks, and once a week for two weeks. SN to perform wounds care on right and left lower leg- cleanse with no rinse pads or soap and water using wash cloth, wrap both legs with moist gauze or towel for 5- 10 minutes then remove non-viable skin/scab before dressing change, apply Purachol AG(a native collagen wound dressing with antibacterial silver and a unique three-dimensional Microscaffold that promotes natural healing is indicated for the management of partial- and full-thickness wounds, pressure ulcers, venous ulcers, ulcers caused by mixed vascular etiologies, diabetic ulcers, first- and second-degree burns, donor sites and other bleeding surface wounds, abrasions, trauma) or any collagen with AG to all wounds moisten with saline solution, cover with dry sterile dressing, wrap with conforme gauze and secure with tape three times a week for three weeks. SN to assess all body systems with emphasis on integumentary-wound, cardiovascular, pulmonary, endocrine, GI/GU, musculo-skeletal, neuro/mental/cognitive, peripheral vascular, nutrition/hydration status, all medications for potential problems, knowledge and compliance to status, psycho-social, adjustment, caregiver availability/ability and home safety. SN to notify MD for any significant change in the patients condition. SN to teach pt/pcg on signs and symptoms of wound care, measures to promote wound healing, medication regimen including its action and side effects, diet regimen, pain control measures, signs and symptoms to report to MS/SN universal precautions, oxygen precautions, infection control measures, emergency measures, 911 protocol and home safety. There was no written documentation on plan of care to monitor for signs and symptoms for bleeding for this high risk medication. During a concurrent review and interview on 4/16/23 at 12:31 p.m., with the DPCSD of Patient 5’s medications, DPCSD stated that Patient 5 does not want her medications to be touched and wants it to be just where she wants it to be. She confirmed that patient 5 is taking the following: 1. Gabapentin 100 mg 1 tablet daily for mood stabilizer. 2. Xarelto 20 mg 1 tablet once daily for blood thinner 3. Clonazepam 0.5 mg ½ tablet by mouth at bedtime. Do not take on Wednesdays and Saturdays 4. Clonazepam 0.5 mg to start on Monday 3/20/23, ½ tab on MWF then the next week will be ½ tab on Monday and Friday then the next week (3rd week) ½ tab once only then stop. DPCSD verified there was no stop date on the medication profile. DPCSD could not verify when the stop date is or if the patient is still taking the clonazepam to this date. A review of the HHA's policy titled " Care, Treatment and Service: Medication Profile" dated 1999, indicated the agency requires that a medication profile must be maintained for each patient. This profile must be updated after each home visit. It will be part of the patients permanent record. a. A review of Patient 2's admission record indicated Patient 2 was admitted to the facility on 9/20/22, with a diagnosis that included unspecified open wound at right lower leg. A review of Patient 2's plan of care (POC) from 3/19/23 to 5/17/23, included SN (skilled nursing) visits of daily for three weeks, three times a week for three weeks, twice a week for two weeks, once a week for one week, to perform a skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. The SN was to teach and instruct about medications and adverse reactions. On 4/15/23, at 1 p.m., a home visit was conducted at Patient 2's residence with RN 1 (registered nurse). Patient 2 was alert and oriented and sitting on her couch at family room. At 1:20 p.m., a review was conducted of Patient 2's current medications reconciling with the medication profile provided by the agency. It was observed Patient 2 had a bottle of Metformin 1000 mg 1 tab twice daily. At 1:30 p.m., during an interview with Patient 2, she stated she takes Metformin 1000 mg one tab once a day for a year now. On 4/16/23, at 12 p.m., during an interview with the DPCS, he stated the visiting nurse missed checking the patient's medications.

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 interview and record review, the Home Health Agency (HHA) failed to provide an individualized plan of care three (3) of seven (7) sampled patients (Patient 3, 4 and 5) This deficient practice had the potential likelihood to result in a delay in providing care and services available to meet the needs of the patients. 2. A review of Patient 4's Patient Profile Information, indicated a SOC date of 2/16/23. Patient 2's diagnosis included non-chronic pressure ulcer (an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal) of the right and left foot and morbid obesity (a complex chronic condition in which a person has a body mass index (BMI- is a person's weight in kilograms (or pounds) divided by the square of height in meters (or feet) of 40 or higher). A review of the " Home Health certification and Plan of Care" for certification period of 2/16/23 to 4/16/23 indicated Skilled nursing (SN) visit frequency and duration of once a week for one week and three times a week for eight weeks. SN to perform wounds care on right and left plantar feet area- cleanse with normal saline, pat dry and apply mupirocin ointment then cover with dry sterile dressing wrap with conforming gauze and secure with tape then apply ace bandage three times a week for three weeks. SN to assess all body systems with emphasis on integumentary-wound, cardiovascular, pulmonary, endocrine, GI/GU, musculo-skeletal, neuro/mental/cognitive, peripheral vascular, nutrition/hydration status, all medications for potential problems, knowledge and compliance to status, psycho-social, adjustment, caregiver availability/ability and home safety. SN to notify MD for any significant change in the patients condition. SN to teach pt/pcg on disease process related to congestive heart failure, on proper wound care, measures to promote wound healing, medication regimen including its action and side effects, diet regimen, pain control measures, signs and symptoms to report to MS/SN universal precautions, infection control measures, emergency measures, 911 protocol and home safety. 3. A review of Patient 5's Patient Profile Information, indicated a SOC date of 7/17/20. Patient 5's diagnosis included venous insufficiency (improper functioning of the vein valves in the leg, causing swelling and skin changes) and non-chronic pressure ulcer of the right lower leg. A review of the " Home Health certification and Plan of Care" for certification period of 3/4/23 to 5/22/23 indicated Skilled nursing (SN) visit frequency and duration of once a day for fourteen days, three times a week for three weeks, twice a week for two weeks, and once a week for two weeks. The POC further indicated the SN is to perform wound care on the right and left lower leg- cleanse with no rinse pads or soap and water using a washcloth, wrap both legs with moist gauze or towel for 5- 10 minutes then remove non-viable skin/scab before dressing change, apply Puracol AG(a native collagen wound dressing with antibacterial silver and a unique three-dimensional Microscaffold that promotes natural healing is indicated for the management of partial- and full-thickness wounds, pressure ulcers, venous ulcers, ulcers caused by mixed vascular etiologies, diabetic ulcers, first- and second-degree burns, donor sites and other bleeding surface wounds, abrasions, trauma) or any collagen with AG to all wounds moisten with saline solution, cover with dry sterile dressing, wrap with conforme gauze and secure with tape, three times a week for three weeks. SN to assess all body systems with emphasis on integumentary-wound, cardiovascular, pulmonary, endocrine, GI/GU, musculoskeletal, neuro/mental/cognitive, peripheral vascular, nutrition/hydration status, all medications for potential problems, knowledge and compliance to status, psycho-social, adjustment, caregiver availability/ability and home safety. SN to notify MD for any significant change in the patient's condition. SN to teach patient and caregiver on signs and symptoms of wound care, measures to promote wound healing, medication regimen including its action and side effects, diet regimen, pain control measures, signs and symptoms to report to MS/SN, universal precautions, oxygen precautions, infection control measures, emergency measures, 911 protocol and home safety. There was no written documentation on the plan of care to monitor for signs and symptoms of bleeding for this high risk medication. During a concurrent review and interview on 4/16/23 at 12:31 p.m., with the DPCSD of Patient 5’s medications, DPCSD stated Patient 5 does not want her medications to be touched and wants it to be just where she wants it to be. She confirmed patient 5 is taking the following medications: 1. Gabapentin 100 mg 1 tablet daily for mood stabilizer. 2. Xarelto 20 mg 1 tablet once daily for blood thinner 3. Clonazepam 0.5 mg ½ tablet by mouth at bedtime. Do not take on Wednesdays and Saturdays 4. Clonazepam 0.5 mg to start on Monday 3/20/23, ½ tab on MWF then the next week will be ½ tab on Monday and Friday then the next week (3rd week) ½ tab once only then stop. The DPCSD verified there was no stop date on the medication profile. The DPCSD could not verify the stop date or if the patient is still taking the clonazepam to this date. The DPCSD further stated continued patient education due to noncompliance should also be included in the plan of care. A review of the HHA’s policy titled “Plan of Care” dated 1999, indicated the plan of care developed in consultation with the agency covers all pertinent diagnosis, involving mental status, types of services and equipment required, frequency of visit, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, any safety measures to protect against injury, instruction for timely discharge or referral, and any appropriate items.

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 observation, interview and record review, the skilled nurse (SN) failed to notify the physician regarding a patient with a low diastolic blood pressure (BP) reading for one out of seven (7) sample patients (Patient 3). This deficient practice placed the patient at risk for hypotension. A review of Patient 3's admission record indicated the patient was admitted to the Home Health Agency on 3/24/23, with a diagnoses that included malignant neoplasm of the right breast. A review of Patient 3's plan of care (POC) from 3/24/23 to 5/22/23, included an order for the skilled nurse (SN) to visit twice a week for one week, three times a week for four weeks, twice a week for two weeks, and once a week for one week, for assessment of all body systems and medication compliance. One of the skilled nursing intervention was to monitor patient's BP during the visit and to notify the physician if the SBP (systolic blood pressure) is > (greater) than 150 or 90 and <60 mmhg. On 4/15/23, at 12 p.m., a home visit was conducted at the patient's residence with RN 1. The patient was observed sitting on her couch with edema in both legs. A review of Patient 3's Skilled Nurse Clinical Notes dated 4/5/23, indicated the patient's BP reading was 101/55. However, there was no documented evidence the physician was notified. On 4/16/23, at 11:30 a.m., during an interview with the DPCS (Director of Patient Care Services), he stated the visiting nurse should have notified the physician regarding the patient's low diastolic reading. A review of the Agency's undated policy titled "Change of Condition" indicated the clinician is responsible for any specific treatment and would notify the attending physician of significant changes in the patient's condition.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to coordinate care and services with the Assisted Living Facility for one of seven (7) sampled patients (Patient 4). This deficient practice had the potential to result in a delay in medications, wound care treatments and the plan of care to meet Patient 4's needs. A review of Patient 4's Patient Profile Information, indicated a SOC date of 2/16/23. Patient 2's diagnosis included a non-chronic pressure ulcer (an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal) of the right and left foot and morbid obesity (a complex chronic condition in which a person has a body mass index (BMI- is a person's weight in kilograms (or pounds) divided by the square of height in meters (or feet) of 40 or higher). A review of the "Home Health Certification and Plan of Care" for the certification period of 2/16/23 to 4/16/23 indicated a Skilled nursing (SN) visit frequency and duration of once a week for one week and three times a week for eight weeks. The SN to perform wound care on the right and left plantar feet area by cleansing with normal saline, pat dry and apply mupirocin ointment (antibiotic) then cover with dry sterile dressing, wrap with conforming gauze and secure with tape then apply ace bandage three times a week for three weeks. The SN to assess all body systems with an emphasis on the integumentary-wound, cardiovascular, pulmonary, endocrine, GI/GU, musculoskeletal, neuro/mental/cognitive, peripheral vascular, nutrition/hydration status, all medications for potential problems, knowledge and compliance to status, psycho-social, adjustment, caregiver availability/ability and home safety. The SN to notify the MD for any significant change in the patient's condition. SN to teach the Patient and Caregiver on the disease process related to congestive heart failure, proper wound care, measures to promote wound healing, medication regimen including its action and side effects, diet regimen, pain control measures, signs and symptoms to report to MS/SN, universal precautions, infection control measures, emergency measures, 911 protocol and home safety. During a phone interview with the assisted living facility medtech on 4/15/23 at 1:00 p.m., the medtech stated all visiting agencies must keep their agency book in the wellness center per their policy. The Med tech further confirmed Patient 4 did not have any wound care treatment orders listed on their order summary in their electronic medical record. The Medtech also confirmed that she does not know any current wound care treatment orders for Patient 4. When asked if the HHA leaves any documentation for them after their visit, the medtech stated, they did not receive a copy of the new wound care treatment orders. During an interview on 4/16/23 at 12:40 p.m., with the Director of Patient Care Services Designee (DPCSD), DPCSD stated all medications and treatments should be communicated and reviewed with the assisted living facility(ALF) staff every visit. DPCSD further stated it is important to communicate with the ALF staff and follow their policies regarding where to keep the patients medications and to provide them with information of wound treatment orders and medication updates. A review of the HHA's policy titled " Continuum of Care and Services : Coordination of Services with other Providers" dated 2007 indicated the clinician will be responsible for coordinating services provided to the patient by the organization, including services provided directly and thru contract. The clinician will act as a liaison with other organizations/individuals also providing care to the patient to assure effective coordination or related services.

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, interview, and record review, the skilled nurse (SN) failed to wash and sanitize her hands after removing his gloves that touched a soiled dressing, and prior to providing wound care for one of of seven sampled patients (Patient 2). This deficient practice had the potential to placed the patient at a potential risk for delay in wound healing and wound infection. A review of Patient 2's admission record indicated Patient 2 was admitted to the facility on 9/20/22, with a diagnosis that included unspecified open wound on the right lower leg. A review of Patient 2's plan of care (POC) from 3/19/23 to 5/17/23, included a SN (skilled nursing) visit of daily for three weeks, three times a week for three weeks, twice a week for two weeks and once a week for one week, to perform a skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. The SN was to perform wound care on the right and the left lower abdominal quadrant wounds and right lower leg as follows: Cleanse with Normal Saline. Pat dry. Apply Gentamicin 0.1 percent ointment. Cover with Adaptic gauze and secure with Hypafix tape daily for three weeks. On 4/15/23, at 1 p.m., during a joint home visit with RN 1 (Registered nurse), Patient 2 was observed sitting on her couch with a dressing on her right foot. During a wound care observation on 4/15/23, at 1:45 p.m., RN 1 washed her hands and put on a new pair of gloves, then removed the soiled dressing on Patient 2's left lower abdominal quadrant. RN 1 cleaned the open wound on the left lower abdominal quadrant with a 4 x 4 gauze wet with normal saline and repeated the procedure again. She then removed her soiled gloves and donned a new pair of gloves without washing her hands. On 4/15/23, at 2 p.m., during an interview with RN 1, she stated she was so nervous she forgot to wash her hands after removing the soiled dressing and her soiled gloves. On 4/16/23, at 1 p.m., during an interview with the Director of Patient Care Services (DPCS), he stated, "RN 1 should have washed or sanitized her hands after removing the gloves that touched the soiled dressing." A review of the agency's policy titled "Hand Washing" indicated all home healthcare personnel will wash their hands before and after contact with each patient and anytime their hands become soiled.