Every finding on record at L. A. Family Home Health Inc

The following reflects the findings of the California Department of Public Health during a Recertification survey at this location: 1301 W. 2nd street, Suite 206, Los Angeles, CA 90026 Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 45 Active Patients - 1 Sample Size - 7 Home Visits: 1

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview, and record review, the home health agency (HHA) failed to ensure the emergency preparedness training for all staffs was conducted at least annually. This failure had the potential to result in the HHA staffs' lack of knowledge to readily and effectively respond during an emergency crises situation. Findings: On 11/13/22, at 1 p.m., during an interview with director of patient care services (DPCS), stated she did not conduct emergency preparedness training for all staffs. During a record review indicated no documented evidence of an emergency preparedness training was conducted to all HHA staffs. The HHA's undated policy and procedure titled, "Emergency Preparedness Plan" indicated the plan uses the term "all hazard" to address all types of incidents. The incidents which may require action by home care and emergency service personnel to prevent or minimize loss of life or damage to property and environment.

The following reflects the findings of the California Department of Public Health during a Recertification survey at this location: 1301 W. 2nd street, Suite 206, Los Angeles, CA 90026. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 45 Active Patients - 1 Sample Size - 7 Home Visits: 1

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on interview and record review, the physical therapist (PT) failed to provide an initial rehabilitation assessment within 48 hours for one out of seven sample patients (Patient 6). This deficient practice has the potential in the delay to identify the patient's rehabilitative needs and develop the PT plan of care to start treatment to achieve the patient care goals. Findings: A review of Patient 6's clinical record indicated the start of care date of 10/1/21, with a diagnosis of hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs and facial muscles). A review of Patient 6's plan of care (POC) from 10/1/21 to 11/29/21, included an order for a PT evaluation and treatment. A review of Patient 6's PT Evaluation Note dated 10/7/21, indicated the PT provided the initial visit 6 days after the PT order date. A further review of Patient 6's clinical record indicated no communication note to indicate the reason in the delay of the PT assessment. On 11/13/22, at 1:30 p.m., during an interview with the director of patient care services (DPCS), she stated that she could not find the documented reason why PT assessment was conducted 6 days late. A review of the policy " Admission Process" indicated that each client referred to the agency shall be evaluated by a registered nurse/therapist and the initial assessment will be completed within 48 hours of referral or on the physician ordered start of care date.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the agency failed to administer Aspirin (blood thinner) 81 mg every other day as ordered by the physician for one of seven patients (Patient 1). This deficient practice had the potential to result in medication error that could affect the patient's health status and well being. Findings: A review of the document titled "Patient Information" indicated Patient 1's start of care date was on 5/2/22 with the primary diagnosis of deficiency of specific B group of vitamins (otherwise known as Vit. B12 deficiency may lead to a reduction in healthy red blood cells causing generalized body weakness). A review of Patient 1's "Home Health Certification and Plan of Care" for the certification period of 10/29/22 to 12/27/22 indicated skilled nursing (SN) to continue teaching and interventions every visit with emphasis to assess medication compliance. SN was to instruct patient/caregiver on medication actions, uses, frequency, dose, side effects, interactions of all new and changed medications, importance of medication compliance as prescribed by MD (Medical Doctor). SN may set up medications weekly as needed. SN visits once a week for nine weeks. A home visit was conducted on 11/12/22, at 11 a.m., at Patient 1's residence with the Registered Nurse (RN). Patient 1 was oserved alert and oriented to name and place, with periods of forgetfulness, ambulated using a cane and a walker. Patient 1's daughter was the primary caregiver. RN proceeded with her home visit. During a review of Patient 1's medications with the RN, disclosed: Aspirin 81 mg (milligram- a unit of measure) 1 tablet every other day was ordered in the POC. Patient 1's medication bottle indicated Aspirin 81 mg take 1 tablet daily. RN stated the physician's ordered Aspirin 81 mg 1 tablet every Mondays-Wednesdays-Fridays. This specific instruction was not listed in the POC. During an interview with the RN on 11/12/22, at 11:30 a.m., RN stated the importance of following medication orders for treatment to be effective. A review of the HHA's undated policy titled " Medication Orders and Administration" reference number 8015, indicated to promote the integrity of medication management when patients are receiving care, treatment and/or services from the HHA. To ensure accurate, safe and effective administration of prescribed medications by the qualified HHA staff. To adhere to applicable laws, regulations and standards of practice. Documentation of medication administration should include date, time, name of medication, dose, route of administration.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on interview, and record review, the skilled nurse (SN) failed to notify the physician regarding the patient's significant change of condition for one of seven patients (Patient 7). Patient 7's SN identified the patient had bilateral +2 pitting edema (excess fluid builds up in body causing swelling, when pressure is applied to swollen area, a pit or indentation will remain) on both knees. There was no documented evidence the SN promptly notified the physician. This deficient practice has the potential in the delay of treatment that could lead to complications and severe discomfort of the patient. Findings: A review of Patient 7's clinical record indicated a start of care (SOC) date of 9/15/21, with diagnosis that included of hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). A review of Patient 7's plan of care (POC) from 9/15/21 to 11/13/21, included an order for the skilled nurse (SN) to visit once a week for 9 weeks, to perform total body assessment focusing on cardiovascular status. One of the SN interventions was to assess/instruct patient and caregiver on control of risk factors including fluid retention/edema and home management of cardiovascular status related to medication and dietary restriction. A review of Patient 7's Skilled Nursing Visit Notes dated 11/2/21, indicated the patient had a newly existing bilateral knee +2 pitting edema. However, there was no documented evidence the physician was notified regarding Patient 7's existing bilateral knee edema. On 11/13/22, at 11 a.m., during an interview with the DPCS (director of patient care services), stated the skilled nurse should have notified the physician about Patient 7's new existing edema on both knees because that was considered as a change of condition. A review of Agency's policy "Change of Condition (undated)," indicated the clinician is responsible for any specific treatment would notify the attending physician of significant changes in the patient's condition.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review the agency failed to coordinate care and services for one of seven patients (Patient 1). This has the potential for the patient's continued needs for in-home services will not be met. Findings: A review of the document titled "Patient Information" indicated Patient 1's start of care date was on 5/2/22. The primary diagnosis included deficiency of specific B group of vitamins (otherwise known as Vit. B12 deficiency may lead to a reduction in healthy red blood cells causing generalized body weakness). A review of the document titled "Home Health Certification and Plan of Care" for the certification period of 10/29/22 to 12/27/22 indicated skilled nursing (SN) to continue teaching and interventions every visit with emphasis to assess psychological status. Patient 1 has inability to leave home. Leaving home requires a considerable and taxing effort for the patient. Family provided assistance for activities of daily living, medical appointments, delivery of medications and management of finances. A home visit was conducted on 11/12/22, at 11 a.m., at Patient 1's residence with the Registered Nurse (RN). Patient 1 was alert and oriented to name and place with periods of forgetfulness, ambulated using a cane and a walker. Patient 1's wife helped with the care. The daughter was the primary caregiver. RN proceeded with her home visit. During an interview with Patient 1 at 11/12/22, at 12 p.m., Patient 1 expressed concern of his need for in home supportive services. Patient 1 expressed his wife was getting weak, had medical issues of her own, and no longer able to take care of him and did not know where he can access this service. On concurrent interview with RN assigned, stated the HHA had medical social worker to help give information regarding the services and will call the agency to send a social worker to visit the patient. A review of the HHA's undated policy titled "Coordination of Patient Services" reference # 10025 indicated to ensure effective and appropriate coordination and continuity of care, treatment and/or services to promote positive patient outcomes, care, treatment and/or services shall be provided by LA Family HHA in an interdisciplinary, collaborative manner as appropriate to the needs of the patient and the HHA's scope of service. All HHA staff, including providers under contractual agreement, providing care, treatment and other services to HHA patients shall maintain liaison with other healthcare team members to ensure effective coordination of efforts and to support the goals and objectives outlined in the plan of care.

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 home health agency (HHA) failed to follow the accepted professional standards of practice to prevent the spread of infection by failing to: Tracking and document for signs and symptoms of COVID-19 (an acute serious respiratory illness) to visitors, all agency staffs, and patients. Maintain and monitor expiry dates of their medical supplies in the office. These failures had the potential to spread infection to patients, staffs, and visitors. Findings: During the recertification survey on 11/11/22 and 11/13/22, it was observed there was no COVID-19 screening for visitors, office and field staff upon entrance of the home health agency (HHA). During an observation of the home visit conducted on 11/12/22, at 11 a.m., with the registered nurse (RN), it was observed the RN used a hand sanitizer that expired 5/22. On concurrent interview on the same date and time, RN stated the use of expired supplies will not be effective in killing germs and preventing the spread of infection. During an agency tour at 11/13/22, at 11 a.m., with the Administrator (Admin), during an inspection of the storage/supply cabinet, was observed the hand sanitizers were expired since July 2022. The wound care supplies like bandages and tapes did not have any dates when it was opened and did not indicate any expiry dates. The supplies log was requested; however, the Admin was able to provide any written documentation of the supply log. Admin further stated that she buys supplies from a nearby CVS store over the counter if they needed supply for the office and field staff or order from their contracted medical supplier. A review of the HHA's undated policy titled" Infection Prevention and Control Program" reference # 5001 and # 5002, indicated LA Family HHA's ensures that this organization develops , implements, and maintains an active, organization-wide program for the prevention, control and investigation of infections and communicable diseases in order to reduce the risks of endemic and epidemic infections in patients, visitors and healthcare workers, and to optimize use of resources. Periodic checks of clinician's automobile trunks to ensure adherence to standard precautions and limiting the transmission of infections associated with the use of medical equipment, devices and supplies examples include cleaning, disinfection and sterilization of equipment per manufacturer's guidelines, sterile supplies and single-use devices.