Every finding on record at Kah Development 4, LLC

On 06/01/26 at 13:45 PM, an entrance conference was conducted with Facility Representatives. The facility was informed the purpose of the visit was to conduct a Medicare recertification survey. On 06/04/26 at 10:30 AM, an exit conference was conducted with Facility Representatives. The findings of the survey were discussed. The Facility Representatives were given an opportunity to present additional information for the findings discussed. No additional information was presented.

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 during home visits, clinical record review, staff interview, and review of the Agency's standard precautions and wound dressing application policy, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 1 (# 1) of 4) home visits conducted. This failed practice had the potential to place the patient at risk for a wound infection and hospitalization. The deficient practice identified, if continued, potentially placed all patients with wounds and wound care at risk of adverse outcomes and hospitalization. The findings are: 1. The Agency's "Standard Precautions, home care," showed "The Centers for Disease Control and Prevention (CDC) developed standard precautions to protect against the transmission of infection. Standard precautions are a group of infection prevention practices based on the idea that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may be infectious. CDC officials recommend that health care workers assume that all patients, regardless of their diagnosis, are potentially colonized with an organism that the patient may transmit to others. Standard precautions include hand hygiene, appropriate use of personal protective equipment, and proper handling of potentially contaminated items including patient equipment, items in the environment, sharps and specimens. Implementation: Gather and prepare the necessary equipment and supplies Perform hygiene before and after patient care; when moving from a contaminated body site to a clean body site; after contact with body fluids, excretions, mucous membranes, nonintact skin, or wound dressings (even if you wore gloves); and after contact with inanimate objects in the patient environment. " 2.The Agency's "Wound Dressing Application" showed the process to include: "after dressing removed and wound cleansed to remove soiled gloves, perform hand hygiene and put on new gloves. " 3. Review of Clinical record # 7 showed a patient with diagnoses of cellulitis of right lower limb, acquired absence of right leg below knee, and sepsis. The Plan of care dated 05/31/26 through 07/29/26 included orders dated 5/21/26 of "Skilled nurse to perform/teach wound care to stump, Cleanse with wound cleanser apply, pat dry with 4x4 gauze, apply aquacell ag advantage, cover with 4x4 gauze, wrap with Coban multi-layer wrap twice a week. 4.A home visit was conducted on 06/02/26 at 10:25 AM for patient # 7 with wound care orders dated 5/21/26. The SN began the procedure without having adequate supplies assembled which resulted in failure to practice appropriate infection control measures. The SN re-entered the clean dressing supplies container that was placed on the bed with the patient and entered her nursing bag hanging from her shoulder to retrieve hand sanitizer. After cleaning hands and applying disposable gloves, the SN (Agency Personnel #2) removed the soiled dressing on the Patient's right lower extremity, cleansed the wound and then without removing disposable gloves and without sanitizing hands, the SN entered the clean supply container to retrieve clean supplies for dressing the wound on the right below knee amputation. 5. On 6/03/26 at 8:24 AM, during an interview with surveyor, Agency Personnel #1 confirmed the SN did not adhere to infection control techniques following standards of practice during the home visit. "

On 7/10/2023 at 12:10 PM,an entrance conference was conducted with agency representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification Survey for compliance with the Conditions of Participation for Home Health. On 7/13/2023 at 11:15 AM, an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on Home visits and agency staff interview, it was determined that the Agency failed to provide the required information in writing of planned schedules for visits of all disciplines for 2 (#5 and #7 ) of 5 (#5 - #9) home visits completed. This failed practice had the potential to affect all patients on census in that a lack of communication and information prohibits the patient and or caregiver from making informed decisions about care and potentially prohibits coordination of care. A home visit with Patient #5 on 07/12/2023 at 12:45 PM revealed the following: A.) During a review of Patient #5 home folder provided by the agency, there was no evidence Patient #5 was provided with a current visit schedule. 2. A home visit with Patient #7 on 07/12/2023 at 11:48 AM revealed the following: A.) During a review of Patient #7 home folder provided by the agency, there was no evidence Patient #7 was provided with a current visit schedule. 3. Agency Staff accompanying surveyor was given an opportunity to verify the planned visits were not in the home folders. For each instance, agency staff were unable to locate the required schedules, verifying the Agency failed to provide Patients #5 and #7 with a written schedule of planned visits.

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 Home Visits it was determined the Agency failed to provide the Patients/Caregivers with a complete and current medication list and instructions in 2 (#5 and #7) of 5 (#5-#9) home visits completed. This failed practice prohibits the Patients/Caregivers and Care Providers from making informed decisions about their current medications regimen. Home visit for Patient #5 on 07/12/2023 at 12:45 PM revealed the following: A. Review of Agency provided home folder for Patient #5 showed there was no evidence a medication list had been provided to the Patient/Caregiver. 2. Home visit for Patient #7 on 07/12/2023 at 11:48 AM revealed the following: A. Review of Agency provided home folder for Patient #7 showed there was no evidence a medication list had been provided to the Patient/Caregiver.

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 during home visits, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 3 (#6, #7, #9) of 5 (#5- #9) home visits conducted. This deficient practice had the potential to place these patients with wound care at risk for adverse outcomes, wound infection and/or hospitalization. During a home visit 07/12/2023 at 3:15 PM to observe care for client #6 surveyor observed the following: A. SN donned gloves and cleaned wound with moistened gauze. SN then discarded the soiled gauze in a cardboard box on the floor. According to the EPA (Environmental Protection Agency), it is recommended that all soiled bandages, gauze and gloves used to provide wound care, be placed in a plastic bag securely closed prior to placing in the garbage to prevent illness and infection. B. Surveyor observed SN wrapping the wound area to leg with kerlex (rolled gauze) and cut it without cleaning scissors prior to use. According to National Institute of Health, all equipment (including scissors) used in patient care should be cleaned well to kill bacteria, fungus and virus' to prevent infection. 2. During a home visit 07/12/2023 at 11:48 AM for care of client #7, surveyor observed the following: A. SN did not change gloves between cleaning the wound bed and application of the new dressing materials. According to WHO (World Health Organization) infection control guidelines, gloves should be changed between tasks, and when working from contaminated to clean. B. SN used scissors without cleaning. According to National Institute of Health, all equipment (including scissors) used in patient care should be cleaned well to kill bacteria, fungus and virus' to prevent infection. 3. During a home visit 07/12/2023 at 10:22 AM for care of client #11, surveyor observed the following: A. SN used scissors without cleaning. According to National Institute of Health, all equipment (including scissors) used in patient care should be cleaned well to kill bacteria, fungus and viruses to prevent infection.