Every finding on record at Kaiser Foundation Hospital Home Health - Martinez

The following represents the findings of the California Department of Public Health during a recertification survey conducted on 3/27/23 through 3/29/23. Representing the Department: HFENs: 38534, 32717, 44946 and HFES 40638.

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 interview and records review, the agency failed to ensure one of 17 sample selected patients (Patient 14) received the services based on the frequency of the plan of care when, Patient 14 had a missed visit by the nurse on 3/18/23 and the nurse did not re-arrange the visit for the same week. This deficient practice resulted in Patient 14 did not have nurses’ visits for the week of 3/12/23 and possibility of health complications and incision site infection for Patient 14. Findings: A review of Patient 14's " Home Health Certification and Plan of Care" dated 2/26/23 indicated Patient 14 was admitted to the agency on 2/26/23 with multiple diagnoses, including artificial openings of urinary tract status, and the presence of a urogenital implant (replacement of bladder by artificial or mechanical device or prosthesis). Further review indicated the nurse was supposed to visit Patient 14 two times a week for two weeks and one visit a week for two weeks from the start of care date. A review of Patient 14's list of visits showed the nurse had one missed visit on 3/18/23. A review of Patient 14's "Conversation" dated March 27, 2023 indicated "PT (Patient 14) was not seen on 3/18/23 because there was a mistake in the visit frequency with the computer." During a record review and interview on 3/28/23 at 9:35 a.m., with the Quality Assurance Utilization Coordinator (QAUC)1, QAUC1 reviewed the Home Health Certification and Plan of Care, Conversation, the list of the visits, and confirmed the nurse did not visit Patient 14 the week of 3/12/23 (agency's week starts on Sunday) and did not write any missed visit note. Furthermore, QAUC 1 stated nurses should try to contact the patient to rearrange the visit for the same week if they miss visits. A review of the agency's policy and procedure, "Care Planning Process" last reviewed 10/29/20, indicated "...5. B. …the reason for the missed visit and notification of the physician/authorizing provider must be documented in the medical record..."

Standard: Initial assessment visit. CFR(s): 484.55(a) Standard: Initial assessment visit. This STANDARD is not met as evidenced by: Based on interview and records review, the agency failed to ensure three of 17 sampled, selected patients (Patient 14, 6 and 10) received the services in 48 hours after the referral. Patient 14, 10 and 6 were referred to the agency by the physician and the agency opened cases for the care later than 48 hours. This deficient practice had the potential to result in health complications for Patients 6, 14 and 10. During a review of Patient 6’s Home Health Certification and Plan of Care (POC), dated 2/2/23, the POC indicated Patient 6 was admitted to the agency on 2/2/23 with multiple diagnoses to include Amyotrophic Lateral Sclerosis (a nervous system disease that weakens muscles and impacts physical function). During a review of Patient 6’s Referral Information, dated 1/28/23, the document indicated the agency received the referral for Patient 6 on 1/28/23. During an interview with Quality Assurance Utilization Coordinator (QAUC) 1, QAUC 1 stated the case needs to be opened within 48 hours of receiving the referral. QAUC 1 confirmed there was a delay in the start of care. Based on interview and records review the agency failed to ensure three of 17 sample selected patients (Patient 14, 6 and 10) received the services in 48 hours after the referral when, Patient 14, 10 and 6 referred to the agency by the physician and agency opened cases for the care later than 48 hours. This deficient practice could be resulted in Patient 14 and 10 health complications. Findings: A review of Patient 14's " Home Health Certification and Plan of Care" dated 2/26/23 indicated Patient 14 admitted to the agency on 2/26/23 with multiple diagnosis including Artificial openings of urinary tract status presence of urogenital implant (replacement of bladder by artificial or mechanical device or prosthesis). A review of Patient 14's "Referral information" dated 2/17/23 indicated referral received from the physician on 2/17/23. During a record review and interview on 3/28/23 at 9:15 a.m., with Quality Assurance Utilization Coordinator (QAUC)1, QAUC1 reviewed the Home Health Certification and Plan of Care and referral information, and confirmed that Patient 14 was referred by the physician on 2/17/23 and was visited by the agency on 2/26/23 for the for the visit, furthermore, stated the agency should open the referral cases in 48 hours after receiving the referral and they did not for Patient 14. During a record review and interview on 3/29/23 at 10:30 a.m., with Site Director (SD), SD confirmed the agency opened Patient 14's case later than 48 hours and stated, the agency's intake department had issues with opening the cases on time and they were aware of that and started to plan for resolving issue. A review of Patient 10's "Home Health Certification and Plan of Care" dated 3/2/23 indicated Patient 10 admitted to the agency on 3/2/23 with multiple diagnosis including congestive heart failure (when heart can't pump blood well enough to give the body a normal supply). A review of Patient 10's "Message note" dated 2/25/23 indicated Patient 10 referral date was 2/24/23. During a record review and interview on 3/29/23 at 2:10 p.m., with QAUC 2, reviewed Patient 10's plan of care, referral message and confirmed there was a delay on opening the case and starting the care. Furthermore stated the agency supposed to open patient's cases in 48 hours after receiving referral. A review of the agency's policy and procedure "Initial and Comprehensive Assessment" revised 6/29/22, indicated "... The initial assessment visit will be performed either with 48 hours of the referral, within 48 hours of the patient's return home, or on the start of care date ordered by the physician/authorizing provider...".

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 the agency failed to ensure one of 17 sampled patients (Patient 6) received services within five days after the initial assessment. This deficient practice could have resulted in a deterioration in condition for Patient 6. During a review of Patient 6’s Home Health Certification and Plan of Care (POC), dated 2/2/23, the POC indicated Patient 6 was admitted to the agency on 2/2/23 with multiple diagnoses to include Amyotrophic Lateral Sclerosis (a nervous system disease that weakens muscles and impacts physical function). During a review of the messages sent to the physician, dated 2/3/23 at 11:56 a.m., the message indicated the agency would not be able to start Occupational Therapy (promotes health, well-being and participation of things you want and need to do in daily life) or Speech Therapy within the usual five day period. During a review of the Episode Information, the document indicated the start date for Occupational Therapy was 2/5/23 and Speech Therapy was 2/15/23. During an interview with the Quality Assurance Utilization Coordinator (QAUC) 1, QAUC 1 stated the case needs to be opened within 48 hours of receiving the referral and all other disciplines need to be opened within five days. QAUC 1 confirmed there was a delay in care for Occupational and Speech Therapy for Patient 6. During a review of the policy titled, "Initial and Comprehensive Assessment", dated 6/29/22, the policy indicated subsequent discipline assessments when ordered on the referral will be conducted no later than five days after the start of care date.

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, interview and record review, the agency nurse failed to practice standard infection control for one of 17 sampled selected patients (Patient 16) during the home visit for Patient 16. This deficient practice had the potential to result in cross-contamination and transfer of infection to other people who were in contact with Patient 16. Findings: A review of Patient 16's "Episode Information" dated 3/26/23, indicated Patient 16 was admitted to the agency with diagnosis of a blister (a bubble on the skin filled with serum and caused by burning, or other damage). A review of Patient 16's "Skin Assessment" dated 3/26/23, indicated Patient 16 had a wound on the left great toe. During an observation and interview on 3/28/23 at 1:30 p.m., with Licensed Vocational Nurse (LVN) 1, at Patient 16's house, LVN 1 changed the old dressing on patient's left toe and dropped the old dressing on the floor (floor was covered by a rug), LVN 1 changed gloves multiple times in between the dressing change and did not do hand hygiene a few times between removing old gloves and wearing new gloves. Furthermore LVN 1 put the bag of new dressing (gauze, roll gauze) on Patient 16's coffee table with no barrier protection. LVN 1 confirmed he did not do hand hygiene every time between changing gloves, when he dropped the old dressing on the floor and put the bag of new dressings on Patient 16's coffee table with no barrier. LVN 1 stated he made a mistake and was nervous. During an interview on 3/29/23 at 1:38 p.m., with the Quality Assurance Utilization Coordinator (QAUC) 1, QAUC 1 stated nurses are supposed to put their stuff on the barrier, should use hand sanitizer between changing gloves and not drop any old dressing on the floor. During a review of the agency's policy and procedure, "Bag technique" last reviewed 1/18/23, indicated "...Home visit bags must be placed on a disposable barrier..." The agency's policy and procedure for handwashing did not included changing gloves and using hand sanitizer between glove changes.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the agency failed to measure the wound for one of 17 sampled patients (Patient 1). This deficient practice resulted in a lack of documentation and monitoring the progression of Patient 1’s wound. During a review of the Home Health Certification and Plan of Care (POC) for Patient 1, dated 1/28/23, the POC indicated Patient 1 started care on 1/28/23. Patient 1 had a primary diagnosis of essential hypertension (high blood pressure with no identifiable cause) with additional diagnoses to include polyneuropathy (multiple peripheral nerve damage) with an open wound left lower leg and peripheral vascular disease (circulatory condition in which narrowed blood vessels reduce blood flow to the limbs). During a review of the medical record, “Wound Assessment” dated 3/27/23, the record indicated the wound on Patient 1’s left lower leg measured 4 cm (centimeters) in length, 2.5 cm in width, and 0.1 cm in depth on 1/28/23. Further review of the document indicated there were no other measurements taken of the wound after 1/28/23. During an observation and concurrent interview with Registered Nurse (RN) 1, on 3/27/23 at 1:25 p.m., RN 1 did not measure the wound while changing the dressing. RN 1 stated she has not been measuring the wound due to multiple small skin tears that are hard to measure. RN 1 further stated she was advised by her manager to take pictures when she notices a change in the wound. During an interview with the Quality Assurance Utilization Coordinator (QAUC) 1 on 3/28/23 at 9:10 a.m., QAUC 1 stated the wound is large enough to be measured and the policy is to measure all wounds weekly. Review of the policy, “Documenting Wounds” dated January 2023, indicated wounds are to be measured at the start of care, resumption, recertification, with a new wound, change in wound status, and with weekly assessments.