Every finding on record at Intensive Home Health Care, Inc

The following reflects the findings of the California Department of Public Health during a Complaint Validation Survey conducted on April 6, 2021, through April 8, 2021. Complaint number: CA00728786 Representing the California Department of Public Health: Surveyor 32192, HFEN Surveyor 36153, HFEN Surveyor 38249, HFEN Surveyor 40387, HFEN The agency's total unduplicated census: 18 Patients Current census: 3 Patients Total home visits conducted: 3 Patients Total sample size: 3 Patients

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the agency failed to continuously provide physical therapy services to the patient (Patient 1), when the Physical Therapist (PT) did not conduct a physical therapy evaluation and establish a plan of care, as ordered by the physician, to one of three sampled patients (Patient 1). This failure resulted in Patient 1 not receiving continued physical therapy to fully attain the treatment goals, which could result in functional decline and generalized weakness. Findings: On April 6, 2021, a visit was conducted to the home health agency for a complaint validation survey. On April 6, 2021, Patient 1's record was reviewed. Patient 1 was admitted to the home health agency, with a start of care (SOC) date of October 30, 2020, with diagnoses including fracture of the right tibia and fibula (a break in the long bones in the lower leg), diabetes mellitus (high blood sugar level), and osteoporosis (brittle bones). The physician orders, dated February 25, 2021, indicated, "...Patient continues to require wound care to right leg...also continues to require Physical therapy in the home..." The home health certification and plan of care, for Patient 1's third episode, with the current certification period of February 27, 2021 to April 27, 2021, was reviewed. The orders for discipline and treatments indicated, "...Patient re-certified for SN (skilled nurse) and PT for another 60 days...PT evaluate and to establish plan of care..." On April 7, 2021, at 1 p.m., a home visit for Patient 1 was conducted with Licensed Vocational Nurse (LVN). Patient 1 was observed awake, alert, and oriented, while sitting in his wheelchair in his living room. LVN was observed while conducting wound care to Patient 1's right leg. On April 7, 2021, at 1:35 p.m., Patient 1 was interviewed. Patient 1 stated he had been receiving physical therapy treatments since the start of care in October 2020. Patient 1 further stated the PT had not been coming to his home to conduct his physical therapy treatments for more than a month. Patient 1 stated, "Physical therapy is important to me," in order to have the strength to be able to walk again. On April 8, 2021, at 10:12 a.m., LVN was interviewed. LVN stated she was the case manager for Patient 1. LVN stated Patient 1 received physical therapy treatments during the first and second home health certification episodes. LVN stated she was not aware Patient 1 had not been receiving physical therapy treatments on the third (current) certification episode. On April 8, 2021, at 10:30 a.m., The Director of Patient Care Services (DPCS) was interviewed. The DPCS stated the physician's order, dated February 25, 2021, indicated Patient 1 continued to require physical therapy in the home for the current home health certification episode. The DPCS stated there was no documented evidence the PT evaluated Patient 1 and developed a PT plan of care. On April 8, 2021, at 10:40 a.m., the Administrator (ADM) was interviewed. The ADM stated the agency had been trying to contact the PT, but did not get a response. The agency's policy and procedure titled, "Care Planning Process," dated November 2020, was reviewed. The policy indicated, "...A written plan of care will be initiated within five (5) days of start of care and updated every 60 days...The patient plan of care will be developed or revised within five (5) working days of initiation of each service or of the reassessment of the patient. All clinicians involved in the patient's care, either directly or indirectly, will contribute to the plan of care..."

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 agency failed to ensure the clinical record contained the accurate comprehensive medication profile for two of three patients reviewed (Patients 2 and 3), when the medication profiles did not accurately reflect the medications Patients 2 and 3 were taking at home. This failure had the potential to put the patients at risk for medication errors, adverse drug reactions, and/or ineffective drug therapy. Findings: 1. On April 6, 2021, the record for Patient 2 was reviewed. Patient 2 was admitted to the agency on September 2, 2020, with diagnoses including cardiac arrhythmia (irregular heart rate), nutritional deficiency (decreased appetite), anxiety (a feeling of worry or nervousness), and hypertension (high blood pressure). The certification period reviewed was March 1, 2021, through April 29, 2021. The record indicated Registered Nurse (RN) made the initial visit to Patient 2 on September 2, 2020, to conduct the start of care. The record indicated a skilled nurse visit was made on March 1, 2021, and five additional skilled nurse visits were documented on March 9, 2021, March 15, 2021, March, 22, 2021, March 29, 2021, and April 5, 2021. A home health visit for Patient 2 was made on April 7, 2021, with Licensed Vocational Nurse (LVN), beginning at 10 a.m. Patient 2 was observed to be alert, oriented, and able to make her needs known. The medication record provided by the agency, dated March 1, 2021, and the medication record in the home chart were compared to Patient 2's medications in the home. The following medications were listed on the medication record from the agency and on the medication profile in the home chart, but were not available in the home: a. Megestrol Acetate (medication used for appetite stimulation) 20 mg (milligrams) one tablet daily for 30 days; b. Buspirone hydrochloride (medication used for anxiety) 10 mg one tablet daily; c. Amiodarone (medication used for irregular heart rate) one tablet two times daily; and d. Eliquis (blood thinner) 5 mg one tablet daily. On April 7, 2021, at 10:11 a.m., LVN was interviewed. She stated she visited Patient 2 on April 5, 2021, and still needed to contact Patient 2's physician regarding the continuation of Patient 2's medications to be documented and updated on Patient 2's medication profile. On April 7, 2021, at 10:45 a.m., an interview was conducted with Patient 2 and her family member (FM) during the home visit. Patient 2 stated she had been taking the medications since February 24, 2021. Patient 2's FM stated he assisted Patient 2 to receive her medications. 2. On April 6, 2021, the record for Patient 3 was reviewed. Patient 3 was admitted to the agency on February 22, 2021, with diagnoses including chronic ischemic heart disease (weakening of the heart), bradycardia (slow heart rate), and personal history of nicotine dependence. The certification period reviewed was February 22, 2021, through April 22, 2021. The record indicated RN made an initial visit to Patient 3 on February 22, 2021, to conduct the start of care. The record indicated LVN made visits to Patient 3 on the following dates: - February 26, 2021; - March 2, 2021; - March 5, 2021; - March 9, 2021; - March 15, 2021; - March 23, 2021; - March 30, 2021; and - April 6, 2021. A home visit for Patient 3 was made on April 7, 2021, with LVN, beginning at 3:30 p.m. Patient 3 was observed to be alert, oriented, and able to make his needs known. The medication record provided by the agency, dated February 22, 2021, and the medication record in the home chart were compared to Patient 3's medications in the home. The following medication was listed on the medication record from the agency and on the medication profile in the home chart, but was not available at the patient's home: a. Nicotine 7 mg/HR (hour) 24 HR Transdermal Patch (medication used to help stop smoking). Apply one patch on the skin daily for two weeks. On April 7, 2021, at 3:48 p.m., LVN was interviewed. She stated she visited Patient 3 on April 6, 2021, but did not notify Patient 3's physician to obtain an order for the discontinuation of Patient 3's nicotine patch. The following medications was listed on the medication record from the agency and on the medication profile in the home chart, but was not listed with the correct dose: a. Fluticasone (medication used to improve breathing) 250-50 inhale one puff daily. On April 7, 2021, at 4:10 p.m., Patient 3 was interviewed and stated he followed the prescription label and has used the Fluticasone medication inhaler twice a day since it was prescribed on March 15, 2021. The agency's policy and procedure titled, "Administration and Documentation of Medications," revised November 2020, was reviewed. The policy indicated, "...Licensed nursing personnel will administer and document only those medications which have been ordered as a part of the plan of care and have been approved for safe administration and monitoring during a home visit...A comparison will be made between the physician's (or other authorized licensed independent practitioner's) orders and the current medications the patient is taking. Any discrepancies or contradictions should be reported to the physician for resolution..."

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure expired medical supplies and medications were not readily available for use. This failure had the increased potential for patients to receive expired medical supplies and medications. Findings: On April 6, 2021, at 11:37 a.m., during the initial tour of the home health agency, an inspection of the medical supplies and medications cabinet was conducted with the Administrator (ADM). The following medical supplies and medications were observed past their expiration dates: -One box of 200 each, Alcohol Prep Pads (used to clean an injection site prior to injection), McKesson MFR 58-204, 1.2" (inch- a unit of measurement) X (by) 2.6", expiration date of July 2017; -Five bottles of Normal Saline (cleansing solution), 500 ml (milliliter- a unit of measurement), McKesson MFR 47-6280, expiration date of January 21, 2021; -One bottle of Povidone-Iodine Prep Solution (cleansing solution), 16 Fl. Oz. (fluid ounce- a unit of measurement), Reorder # (number) 1415, expiration date of January 2020; -One box of 100 Telfa 3" X 4" Non-adherent Dressing (wound dressing), Covidien # 2132, expiration date of May 2020; -Four boxes of 25 packets Povidone-Iodine Swabsticks (wound cleanser), Dynarex # 1202, expiration date of March 2021; -Six each AMSINO AMSure Foley Insertion Tray (foley catheter - thin, sterile tube inserted into the bladder to drain urine), Reference # AS880, expiration date of November 30, 2020; -11 each of 16 Fr (French- a unit of measurement) 5 cc (cubic centimeter- a unit of measurement) Balloon Silicone Coated Foley Catheter, BARD 123516A, expiration date of September 2020; -Two each of Rate Flow Regulator IV (intravenous- within a vein) Set, Reference # V5922, expiration dates of April 20, 2020 (1 each) and May 16, 2020 (1 each); -Four each of Heparin Lock Flush Solution (helps to keep blood flowing smoothly and from clotting in the catheter), 500 USP (United States Pharmacopeia) units/ (per) 5 ml, expiration date of July 31, 2019; -11 each of Vacutainer SST (blood collection tube), Reference # 367988, expiration date of January 31, 2019; -One each of Health Line HLSV 205077MB 10 drops/ml IV Administration Set with Valve Injection Site (IV administration set), expiration date of February 2018; -One each of Secondary IV Set, B. Braun V1921, expiration date of April 2019; -12 pairs of Flexam Sterile Powder-Free Nitrile Exam Gloves, Catalog # N8832, expiration date of June 2019; and -36 each of Xeroform Occlusive Gauze Strip (sterile, non-adhering protective dressing consisting of absorbent, fine-mesh gauze impregnated with a petrolatum blend), 5" x 9", Reference # 8884433605, expiration date of October 31, 2020. During a concurrent interview, the ADM stated the licensed nurses are responsible for checking the medical supplies and medications that are outdated. The ADM further stated outdated supplies and medications should have been discarded upon their expiration dates. On April 6, 2021, at 12:05 p.m., Licensed Vocation Nurse (LVN) was interviewed. LVN stated she last checked the medical supplies and medications on April 2020. On April 8, 2021, at 11:08 a.m., LVN was interviewed. LVN stated a previous office staff (OS) member was responsible in monitoring and discarding expired medical supplies and medications. LVN further stated since the OS no longer worked at the agency, nobody had checked for expired items. LVN stated she just monitored for the PPE (personal protective equipment- equipment designed to help protect individuals from injury, infection, or other hazards) for Covid-19 (coronavirus- a highly infectious disease). The agency's policy and procedure titled, "Storage of Medications and Nutritional Therapies," dated November 2020, was reviewed. The policy indicated, "...All medications, chemical, and biologicals will be labeled for contents, with expiration dates clearly identified..."