Every finding on record at Kaiser Foundation Hospital Home Health - San Francisco

The following reflects the findings of the California Department of Public Health during a Home Health Agency Recertification survey conducted from 8/29/2024 to 9/6/2024. The agency had a total of 1819 unduplicated patient admissions from 8/29/2023 to 8/29/2024. The sample size was 12 patients. The total number of patient record reviews with home visits was = 10. The total number of patient record reviews without home visits including two closed records = 2. The total number of records reviewed = 12.

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 obtain, much needed, basic podiatry care for Patient 5, one of 10 sampled patients, when the patients’ toenails, on both feet, were long, jagged, crooked, and yellow and needed cutting. This failure has caused patient discomfort and pain. Patient 5 had a start of care on 3/31/2024 and recertification on 7/29/2024 with diagnoses including hypertensive heart disease with heart failure, chronic ulcers to right and left lower limbs, wound complications, leg infection, and history of falling. Communicates without difficulty. Utilizes walker, cane, or wheelchair, for mobility. During an observation and interview of sponge bath on 9/3/2024 at 3:07 PM, Patient 5’s toenails were very long, jagged, crooked, and yellow. Patients’ fingernails were also very long and needed trimming. Patient 5 stated no one has cut her toenails or her fingernails for months. She stated her toenails hurt on both feet. She stated she has tried to cut her own fingernails but could not do it. Review of Home Health Aide (HHA) services order, two visits per week for 9 weeks, ordered by physician, included personal care, foot care, safety/infection control, fall prevention… Order states, Foot care, “assist patient with foot care.” HHA has viewed feet and toenails twice a week for more than six weeks during bed bath and did not inform nurse or physician. Review of Skilled Nurse services orders, three visits per week for 8 weeks, ordered by physician, included falls injury risk, wound care… Wound care included viewing feet and toenails three times a week for more than 6 weeks. Skilled Nurse did not inform physician. Review of Skilled Nurse notes dated 9/6/2024 indicated, “Skilled Nurse reminded patient's [family member] to set up podiatry appointment…Informed [family member] that Skilled Nurse can provide a list with podiatry resources that do home visits coming from the Medical Social Worker but this needs to be paid out of pocket…Visit Notes: Assisted patient with medical application, [family member] to submit proof of income, citizenship, and Medicare premium. Patient has hospital bill of $13,000 plus, called hospital and learned that the bill is for copayment for hospitalization… [Family member] to mail with proof of income. Patient refuses to hire help at this time due to low income…” During an interview on 9/5/2024, at 3:45 PM, Director of Nurses (DON) stated patient is unwilling to pay for podiatry services. DON was informed patients’ feet cannot be left untreated for months.

Participate in the HHA's QAPI program; CFR(s): 484.75(b)(8) Participation in the HHA's QAPI program; and This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to include a physician in the annual group QAPI (Quality Assurance & Performance Improvement) meetings when review of list of attendees did not include a physician. During an interview on 9/5/2024, at 4:24 PM, the Administrator stated physician signed off on manual, signed 1/23/2024, for the policies and procedures of the meeting but was not present at the 1/9/2024 annual Governance meeting. When questioned about the annual 2023 meeting the Administrator stated physician did not attend the meetings. Review of agency policy on Governing Body, revised 11/30/2022, indicated, “Purpose: To describe the role and responsibilities of the Governing Body of a home health agency … Procedure: 7. The Governing Body will authorize adequate resources and support to establish and maintain a home health agency-wide quality assessment and performance improvement (QAPI) program. Information related to the QAPI program will be provided to the Governing Body on a periodic, but systematic basis. 8. The Governing Body must ensure that the QAPI program: A. Addresses priorities for improved quality of care and patient safety. B. Reflects the complexity of the home health agency and services. C. Involves all home health services, including those under contract or arrangement. D. Focuses on indictors related to improved outcomes. Note: The Governing Body will approve the frequency and detail of quality indicator data collection. The home health agency must assure that its QAPI program utilizes quality indicator data, including measures derived from OASIS (such as hospital admission and readmissions) where applicable and other relevant data, in the design of the QAPI program …”