Every finding on record at Interim Healthcare Gulf Coast Inc

A recertification survey was completed on 5/07/2021 at Interim Health Gulf Coast. The facility was no in compliance with the Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on interviews and record reviews the agency failed to ensure patient plans of care included the Medicare requirement for description of the patient's risk for emergency department visits and hospital re-admissions and interventions to address the risk factors for 17 (#1, #2, #3, #4, #5, #6, #7, #8, #9,#10, #11, #12, #13, #14, #15, #16, #17) patient's out of 17 records sampled. Findings included: A review of the plan of care for patient's #1, #2, #3, #4, #5, #6, #7, #8, #9,#10, #11, #12, #13, #14, #15, #16, #17, revealed there was no documentation or plan to address the patient's risk for re-admission to the hospital and interventions to prevent the risk of re-admission to the hospital. An interview was conducted on 5/07/2021 at 1:48 p.m., the Alternate Administrator confirmed the findings. "We will need to contact our computer vendor to see how we can fix this." An interview was conducted on 5/07/2021 at 2:40 p.m., the Agency Administrator said, "This is the first time I have heard of this." An interview was conducted on 5/07/2021 at 3:00 p.m., the Director of Nurses also confirmed the findings and said, "I will make sure that is addressed on each patient plan of care going forward." A review of QSO-18-25-HHA (Home Health Agency) dated August 31, 2018, "The Centers for Medicare & Medicaid Services (CMS) is releasing the final (Advanced Copy) of the HHA Interpretive Guidelines associated with the new Conditions of Participation (CoPs) for HHAs that became effective on January 13, 2018. The individualized plan of care must include the following: (i) All pertinent diagnoses. (ii) The patient's mental, psychosocial, and cognitive status. (iii) The types of services, supplies, and equipment required. (iv) The frequency and duration of visits to be made. (v) Prognosis. (vi) Rehabilitation potential. (vii) Functional limitations. (viii) Activities permitted. (ix) Nutritional requirements. (x) All medications and treatments. (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate a timely discharge. (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient. (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include."

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, interviews, record and policy reviews, the agency failed to ensure 1) staff followed agency infection control policies for hand hygiene during wound care for 1 (#3) patient out of 1 sampled for wound care and 2) staff followed agency policy for bag technique and cleaning shared patient equipment during home visits for 2 (#1, #3) patients out of 6 home visits conducted. Findings included: 1. A home visit observation was conducted on 5/07/2021 at 8:47 p.m., with Staff A, Licensed Practical Nurse (LPN) to observe wound care for Patient #3. Upon entering the resident home observed clutter, debris, animal droppings and old food and dirty plates, cups throughout the patient's apartment. There was a narrow path from the front door to the back of the apartment where the patient was in his room sitting on the side of his bed. Staff A, LPN placed a non-permeable barrier on the floor and then placed her equipment/supply bag on it. Staff A sanitized her hands and then reached in her equipment/supply bag and pulled out her stethoscope, blood pressure cuff and pulse oximeter. Staff A then donned a pair of gloves and obtained the patient's temperature, 97.8, pulse 88, oxygen saturation 94% and BP 138/72. Staff A then removed her gloves and placed her stethoscope, BP cuff and pulse oximeter back into her equipment/supply bag without washing her hands or cleaning the equipment used. Staff A, LPN then reached into her equipment/supply bag for a non-permeable barrier, placed in on the floor, reached into her equipment/supply bag, took out wound care supplies and placed them on the barrier on the floor. She then went back into her equipment/supply bag for wound wash. Staff A, LPN put on gloves and removed the sock from the patient's right foot and then left foot, then with gauze, Staff A cleaned the patient's lower left leg with saline and cleaned the patient's right lower leg with the same gauze and gloves on. Staff A removed her gloves and opened the stretch compression wrap, then used scissors from her equipment/supply bag to cut the stretch compression wrap and then donned gloves without sanitizing her hands. Then removed her gloves and went into her equipment/supply bag and pulled out more gauze and then donned another pair of gloves. An interview was conducted on 5/07/2021 at approximately 10:00 a.m., with Staff A, LPN who confirmed she had not cleaned her equipment before putting it back in the equipment/supply bag. Staff A also confirmed she had not washed or sanitized her hands between gloves changes or before reaching into the equipment/supply bag. She said "You're right. Thank you for letting me know." An interview was conducted on 5/07/2021 at 11:45 a.m., with the Director of Nursing and the Alternate Administrator who confirmed that each wound should be treated separately and "Per our policy hands are to be sanitized before and after donning gloves and before entering their equipment/supply bag." 2. A home visit was conducted on 5/06/2021 at 11:05 a.m., with Staff B, Physical Therapist for Patient #1. Staff B placed a barrier on the sofa and set his medical bag down on the barrier. Staff B then washed his hands and returned to Patient #1. Patient #1 said she had her 3rd total knee replacement on her left knee. Patient #1's Left Knee was wrapped in an ACE (pressure stretch) bandage. Staff B, took out a blood pressure cuff and stethoscope from his medical bag, cleaned them, and then placed onto the patient for blood pressure (BP) and pulse. Staff B listened to the patient's pulse at the antecubital fossa and stated the patient's heart sounded good. THe patient's Pulse was 72 and BP was 140/72. Staff B returned the stethoscope and BP cuff to his bag without cleaning the equipment. In an interview with the Staff B, Physical Therapist at 11:38 a.m. on 5/6/2021, he stated that he uses his hand gel to clean his instruments instead of wipes and he stated he cleans his steering wheel with hand gel as well. An interview was conducted on 5/07/2021 at approximately 12:30 p.m., the Alternate Administrator said, "No, that is not how we clean patient shared equipment." An interview was conducted on 5/07/2021 at 3:28 p.m., the Director of Nurses confirmed that patient equipment should be cleaned after each use and returned to the clean area of their equipment/supply bag. A review of the agency policy from their Exposure Control Plan with a date of 6/24/2011 on page 22 documented under, "Equipment/Supply Bag Technique. Employees clean equipment carried in their equipment/supply bag with a disinfectant (e.g., alcohol), or according to the manufacturer's recommendations, after each use and before returning to the equipment/supply bag to prevent the spread of bloodborne pathogens or OPIM (Other potentially infectious materials). c. After handwashing, enter the bag and take out all equipment/supplies needed and place on a clean surface...e. Hands must always be cleansed after removing gloves or if they have inadvertently been contaminated..."