Every finding on record at Jobet Corporation

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 601 S. Brand Blvd. Suite 312 San Fernando, CA 91340 Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID: 44916 Health Facilities Evaluator Nurse, Surveyor ID22303 Unduplicated Admissions - 70 Active Patients - 21 Sample Size - 7 Home Visits- 3

Information to patient CFR(s): 484.50(a)(1) Provide the patient and the patient's legal representative (if any), the following information during the initial evaluation visit, in advance of furnishing care to the patient: This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the visiting nurse failed to provide a copy of patient's rights and to explain the patient rights to one of seven patients during the initial assessment visit (Patient 3). This deficient practice resulted in the patient not being made aware of his rights to meet his immediate care and support needs. A review of Patient 3’s clinical record titled, “Home Health Certification and Plan of Care”, for the certification period 1/28/23 to 3/28/23, indicated a Start of Care date of 1/28/23, with a diagnosis that included essential hypertension (high blood pressure reading). During an observation of the home visit on 2/11/23, at 1 p.m., Patient 3 did not have a copy of the patient's rights in the agency folder. During an interview on 2/11/23, at 1:30 p.m., when Patient 3 was asked if the initial visiting nurse explained his patient's rights to determine the immediate care and support needed, Patient 1 stated, “No, the visiting nurse did not mention about it". He also stated the agency folder left with him was empty. On 2/12/23, at 12 p.m., during an interview with the DPCS (Director of Patient Care Services), she stated during the initial visit, the visiting nurse should always explain to the patient their patient rights and to provide a copy of the patient's rights in their agency folder.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the HHA failed to provide and ensure one of seven sampled patients (Patient 3) received information regarding the state toll free home health telephone hotline, its contact information, its hours of operation, and its purpose. This failure resulted in a violation of Patient 3's rights due to not having the information necessary to make a complaint regarding the agency’s care. A review of Patient 3’s clinical record titled, “Home Health Certification and Plan of Care", for certification period 1/28/23 to 3/28/23, indicated a Start of Care date of 1/28/23, with a diagnosis that included essential hypertension (high blood pressure reading). During an observation of the home visit on 2/11/23, at 1 p.m., Patient 3 did not have the information to call the California Department of Public Health (CDPH). Patient 3 was observed looking for the agency folder but there was an incorrect State hotline number written on the front page of the folder. During an interview on 2/11/23, at 1:30 p.m., Patient 3 stated, “No, I do not know how to contact the state." The visiting nurse did not mention about it". A review of the HHA’s undated policy and procedure titled, “Admission Criteria and Process”, indicated patient rights and responsibilities will be explained to the patient and family/caregiver.

Document efforts to resolve problems CFR(s): 484.50(d)(5)(iv) (iv) Document the problem(s) and efforts made to resolve the problem(s), and enter this documentation into its clinical records; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to ensure the visiting nurse documented attempted efforts for missed visits for three of seven patients (Patients 2, 4 and 5). This failure had the likelihood to cause patient harm or injury and the delay of necessary services required in the patients care. 4. A review of Patient 4's Patient Profile indicated, a start of care (SOC) date of 12/21/22, with a diagnosis that included benign prostatic hyperplasia (enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder) and essential hypertension (high blood pressure) During a review of Patient 4's Plan of Care (POC), for the re-certification period from 12/21/22 to 2/18/23, included an order for skilled nurse (SN) to visit twice a week for one week, three times a week for one week and twice a week for seven weeks. SN to screen patient for Covid-19, check blood pressure, temperature, heart rate and respirations, pain relief measures and evaluate its effectiveness, assess/monitor patient/caregiver for compliance with no added salt diet, low fat cholesterol diet, fall and safety measures, assess/monitor patient/caregiver for any concerns regarding home health visits. A review of the Patient 4’s “Visit Notes” indicated patient had 10 missed visits on 12/23/22, 12/28/22, 12/30/22, 1/13/23, 1/20/23, 1/24/23, 1/31/23, 2/3/23, 2/7/23 and 2/10/23. A review of the communication notes from the visiting nurse indicated “patient hasn’t been able to be reached to schedule this visit. There was no written documentation why the patient was unreachable and no written documentation of several efforts made to communicate with the patient. 5. A review of Patient 5's Patient Profile indicated, an SOC date of 8/11/22, with a diagnosis that included multiple myeloma (cancer of the bone marrow) and pain. During a review of Patient 4's Plan of Care (POC), for the re-certification period from 12/9/22 to 2/6/23, included an order for skilled nurse to visit twice once a week for nine weeks. SN to screen patient for Covid-19, check blood pressure, temperature, heart rate and respirations, pain relief measures and evaluate its effectiveness, assess/monitor patient/caregiver for compliance with no added salt diet, low fat cholesterol diet, fall and safety measures, assess/monitor patient/caregiver for any concerns regarding home health visits. A review of the Patient ’s “Visit Notes” indicated patient had 4 missed visits, on 12/23/22, 1/27/23, 2/2/23 and 2/3/23, . A review of the communication notes from the visiting nurse indicated “Couldn’t coordinate with patient.” There was no written documentation why the SN could not coordinate her visit with the patient and no written documentation of several efforts made to communicate with the patient 5. During an interview with the DON on 2/12/23 at 2:30 p.m., DON stated that the visiting nurse should notify the administrator, DON, and the doctor of the missed visits and should perform a wellness visit to verify what happened to the patient if after several efforts was made to reschedule a visit and document it on the patients record. A review of the HHA’s policy titled “Missed Visits” revised April 2020, indicated that is a visit is missed for any reason, the clinician should attempt to reschedule it for the same week so that the physician ordered frequency is maintained and would not be considered a missed visit. If a visit is missed and not rescheduled, the clinician will notify the physician and the clinical supervisor of the missed visit and the reason for missed visit. The clinical supervisor will track the number of missed visits to assess patterns and to assure that the plan of care contained the correct number of visits. a. A review of Patient 2's Patient Profile indicated, a start of care (SOC) date of 1/24/23, with a diagnosis that included primary hypertension (high blood pressure reading). A review of Patient 2's Plan of Care (POC), for the re-certification period from 1/24/23 to 3/24/23, included an order for skilled nurse (SN) to visit twice a week for one week, three times a week for one week and twice a week for seven weeks. SN to screen patient for Covid-19, check blood pressure, temperature, heart rate and respirations, pain relief measures and evaluate its effectiveness, assess/monitor patient/caregiver for compliance with no added salt diet, low fat cholesterol diet, fall and safety measures, assess/monitor patient/caregiver for any concerns regarding home health visits. A review of the Patient 2’s “Nursing Progress Notes ” indicated from dates 2/5/23 to 2/11/23, indicated that the visiting nurse had two missed visits. A further review of Patient 2's clinical record indicated no documented evidence of a communication note to verify the reason of the two missed visits for Patient 2. On 2/12/23, at 1 p.m., during an interview with the DPCS (director of patient care services), she stated she could not find any communication note why there were two missed visits on the week of 2/5/23 to 2/11/23 for Patient 2.

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on interview and record review, he home health agency (HHA) failed to ensure the initial comprehensive assessment was completed no later than five days after the Start of Care for one out of seven patients (Patient 1). This failure had the potential to result in patient harm or injury and in the delay of necessary services required in the patients care. A review of Patient 1's Patient Profile indicated, a Start of Care (SOC) date of 2/3/23, with a diagnosis that included osteomyelitis ( Inflammation of bone caused by infection, generally in the legs, arm, or spine). A review of Patient 1's Plan of Care (POC), for the re-certification period from 2/3/23 to 4/3/23, included an order for the Skilled Nurse (SN) to visit of once a week for 9 nine weeks and to screen Patient 1 for Covid-19, check blood pressure, temperature, heart rate and respirations, pain relief measures and evaluate its effectiveness, assess and monitor the patient and caregiver for compliance with no added salt diet, low fat cholesterol diet, fall and safety measures, and assess and monitor the patient and caregiver for any concerns regarding home health visits. On 2/12/23, at 11 a.m., a review of Patient 1's Initial Comprehensive Assessment (OASIS) dated 2/3/23, indicated the visiting nurse failed to complete the entire form. On 2/12/23, at 1 p.m., during an interview with the DPCS (Director of Patient Care Services), she stated the OASIS for Patient 1 was incomplete and the visiting nurse had no time to finish it. She also stated the OASIS needed to be completed within five days after admission to the agency.

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, current medication profile for two of seven patients (Patient 3 and Patient 4). This failure has the potential to result in placing the patient at risk for medication errors and adverse drug reactions. A review of Patient 4's Patient Profile indicated, a start of care (SOC) date of 12/21/22, with a diagnosis that included benign prostatic hyperplasia (enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder) and essential hypertension(high blood pressure) During a review of Patient 4's Plan of Care (POC), for the re-certification period from 12/21/22 to 2/18/23, included an order for skilled nurse (SN) to visit twice a week for one week, three times a week for one week and twice a week for seven weeks. SN to screen patient for Covid-19, check blood pressure, temperature, heart rate and respirations, pain relief measures and evaluate its effectiveness, assess/monitor patient/caregiver for compliance with no added salt diet, low fat cholesterol diet, fall and safety measures, assess/monitor patient/caregiver for any concerns regarding home health visits. On 2/11/23, at 9:10 a.m., a home visit was conducted at Patient 3's residence with the Director of Nursing (DON). Patient 4, answered the door, and sat on a chair in the kitchen. DON proceeded to administer care. During a review of Patient 4's medications on 2/11/22 at 9:30 a.m., when asked where his home health book, Patient 4 stated that someone just dropped the home health book this morning prior the home visit. patient 4 stated that he had not read the book yet. During a concurrent review of the home health book, noted that the medication profile list inside the book was empty. Patient 4 shared a piece of paper that he called "his list" of medications and compared it with the medication list the DON had on her phone. The following discrepancies were noted: Amlodipine 5 milligrams (mg-unit of measurement) 1 tab daily for hypertension was increased to 10 mg. Vitamin A and D ointment was not found at patients home for skin management. Preservision AREDS 2 twice daily for eye supplement was not listed. Patient stated he is currently taking. There were 2 prescription bottles that contained different medications. During an interview with the DON at the same date, DON stated the importance of visiting nurses to update the medication profile every visit. The HHA's policy and procedure titled " Medication Profile" revised April 2020 indicated upon admission to the organization, the admitting clinician will initiate a medication profile to document the current medication regimen. Patient receiving medications will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications, new , and /or discontinued medications. A review of Patient 3's Plan of Care (POC) for the certification period from 1/28/23 through 3/28/23, indicated the start of care date was 1/28/23, with diagnosis that included hypertension (high blood pressure). The POC included Skilled Nurse (SN) visit three times a week for 9 weeks to perform skilled observation and assessment of vital sign and all body systems and medication/dietary regimen. The SN was to teach/instruct medication, adverse reaction. On 2/11/23, at 1p.m., a home visit was conducted at Patient 3's residence with DPCS (director of patient care services). Patient 3 was alert and oriented, sitting on the couch. At 1:20 p.m., a review was conducted of Patient 3's current medications comparing with the medication profile provided by the agency. It was noticed, Patient 3 a bottle of Clopidogrel bisulfate 75 milligram (mg) to administer one tab daily, a bottle of Isosorbide 10 mg one tab twice daily and a bottle of Januvia 25 mg one tab daily. All these three mentioned medications were included in the medication profile. At 1:35 p.m., during an interview with Patient 3, he stated he was not taking the Clopidogrel 75 mg, Isosorbide 10 mg and Januvia 25 mg medications since 11/2022. At 2 p.m., during an interview with the DPCS, she stated the visiting nurse have missed checking the patient's medication during her visits. A review of the agency's policy of "Medication Profile", indicated the medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to provide education for two of seven sampled patients (Patient 3 and Patient 4). For Patient 3, the patient/caregiver with a potential risk for not acquiring correct blood sugar (BS) readings while using their glucometer. This deficient practice had the likelihood to put the patient at risk for safety that could affect the patient clinical status and well being. A review of Patient 4's Patient Profile indicated, a start of care (SOC) date of 12/21/22, with a diagnosis that included benign prostatic hyperplasia (enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder) and essential hypertension(high blood pressure) During a review of Patient 4's Plan of Care (POC), for the re-certification period from 12/21/22 to 2/18/23, included an order for skilled nurse (SN) to visit twice a week for one week, three times a week for one week and twice a week for seven weeks. SN to screen patient for Covid-19, check blood pressure, temperature, heart rate and respirations, pain relief measures and evaluate its effectiveness, assess/monitor patient/caregiver for compliance with no added salt diet, low fat cholesterol diet, fall and safety measures, assess/monitor patient/caregiver for any concerns regarding home health visits. On 2/11/23, at 9:10 a.m., a home visit was conducted at Patient 3's residence with the Director of Nursing (DON). Patient 4, answered the door, and sat on a chair in the kitchen. On concurrent interview with Patient 4, stated that someone just dropped the home health book this morning prior to the home visit. Patient 4 stated that he had not read the book yet. During a concurrent interview with patient 4's wife, stated that no one explained what they need to do, or who to call. Patient 4's wife also stated that Patient had fell at home twice and they drove themselves to the emergency room. Patient's wife stated "No one told them that they need to call the agency for such things." During an interview with the Director of Nursing (DON) , stated the importance of visiting nurses to teach patients of the agency's emergency phone numbers for them to call when they have concerns or emergencies to call 911 first then call the home health. DON also stated that it is the agency's responsibility to put the emergency numbers on the home health book. A review of the HHA's policy titled " Initial and Comprehensive Assessment" revised April 2020, indicated during the initial and comprehensive assessment all baseline data to be used in measuring the patient's progress towards goals and other relevant information will be documented in the patients clinical record, including at least the following the patient's and family/caregiver educational needs ,abilities , motivation, and readiness to learn. Name and address of the patient's physician, name of the hospital, other agencies and persons involved in the past and present care of the patient. A review of Patient 3's Plan of Care (POC) for the certification period from 1/28/23 through 3/28/23, indicated the start of care date was 1/28/23, with diagnosis that included hypertension (high blood pressure). The POC included Skilled Nurse (SN) visit three times a week for 9 weeks, for assessment of all body system and medication compliance. One of the SN interventions was to teach patient/caregiver in blood glucose monitoring and how to perform how to use the glucometer the proper way. On 2/11/23, at 1p.m., a home visit was conducted at Patient 3's residence with DPCS (director of patient care services). Patient 3 was alert and oriented, sitting on the couch. At 1:20 p.m., when Patient 3 was interviewed, he stated that he is a diabetic patient and used his own glucometer to check his blood sugar readings. He also stated that he was not aware that his glucometer needs to be calibrated and the visiting nurse did not mention it to him. A further review of Patient 3's clinical record indicated no documented evidence the visiting nurse provided patient teaching on glucometer usage with a return demonstration by the patient/caregiver to validate teaching. On 11/20/22, at 12 p.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse should be teaching regarding glucometer usage and patient/caregiver should do a return demonstration to the visiting nurse to show proper way and to validate the teaching. A review of the agency's policy "Patient Education" indicated the agency should educate patients about their disease process, care plan and treatments while on service.