Every finding on record at Interim Healthcare of Johnstown

Based on the findings of an onsite unannounced Medicare recertification survey completed 4/10/2023, Interim Healthcare of Johnstown was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies – Emergency Preparedness.

Based on the findings of an onsite unannounced Medicare recertification and state relicensure survey 4/10/2023, Interim Healthcare of Johnstown was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on review of medical records (MR), agency policy and procedure, home visit observation (OBS), and employee (EMP) interview, it was determined the agency failed to ensure the patient was provided and accurate and up to date medication schedule for two (2) of five (5) patient home observations that were conducted (MR2 and MR5). Findings included: Review of agency policy and procedures on 4/7/2023 at approximately 10:00 AM revealed, “Coordination of Care/Services-continued Procedure…5. The designated Clinical Manager ensures the patient/client/caregiver is provided written instructions outlining: a) Visit schedule, including the frequency of care/services to be provided: b) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by the agency; c) Any treatments to be administered by the agency, including therapy services; d) Any other pertinent instruction related to the patient’s care needs; and e) The name and contact information of the clinical manager to ensure coordination of care/service…” Visit (OBV2) on 4/5/2023 at approximately 9:02 AM patient care (MR1) revealed, EMP5 provided direct patient care. The surveyor requested EMP5 to provide a medication list from the agency folder within the home. EMP5 did not locate an agency medication list for review. Visit (OBV5) on 4/5/2023 at approximately 1:30 PM for the patient (MR5) revealed, EMP6 provided direct patient care. The surveyor requested EMP6 to provide a medication list from the agency folder within the home. A medication list was provided but was from another (agency). The surveyor confirmed with the patient and family no additional services were being provided by any other agencies at that time. EMP6 confirmed no agency medication list was available for review. An exit interview was conducted (via conference call) with the regional QAPI, regional QAPI, executive VP & COO and regional HR. Present for the exit interview was the administrator and director on 4/10/2023 at approximately 1:15 PM which confirmed the above findings.

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 review of agency policy and procedure, observations (OBV) during home visits and staff (EMP) interview, the agency failed to ensure staff followed infection control standards of practice and agency policy and procedure for two (2) of five (5) observations (OBV) providing direct care to patients (OBV1 and OBV5). Findings Included: Review of agency policy and procedures on 4/7/2023 at approximately 10:00 AM revealed, “Equipment/Supply Bag Technique…4. The following steps in bag technique should be used to maximize the efficient use of the equipment/supply bag and to assure that principles of infection control and/or standard precautions are being carried out. a) Provide explanation to the patient/client and family what you are doing and place your bag: i. in a clean area ii on a clean, dry surface, or a barrier should be placed under the bag to avoid contamination the outside of the bag iii. Where an inquisitive child or pet cannot gain access to the bag and contaminate it or harm him/herself iv. Within your sight…” Visit (OBV1) on 4/5/2023 at approximately 9:02 AM patient care (MR1) revealed, EMP5 provided direct patient care. EMP5 placed a chuck/barrier on a table with the nursing/supply bag on top of the chuck/barrier. The strap from the healthcare bag was laying under the chuck on the tabletop. Visit (OBV5) on 4/5/2023 at approximately 1:30 PM for the patient (MR5) revealed, EMP6 provided direct patient care. EMP6 placed one chuck/barriers on a couch. EMP6 placed the nursing/supply bag on the chuck/barrier located on a couch. The nursing/supply bag strap was lying off the chuck/barrier onto the couch cushion. An exit interview was conducted (via conference call) with the regional QAPI, regional QAPI, executive VP & COO and regional HR. Present for the exit interview was the administrator and director on 4/10/2023 at approximately 1:15 PM which confirmed the above findings.