Every finding on record at Los Angeles Home Health Care Agency, Inc.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 2741 S Robertson Blvd 2nd Floor, Los Angeles, CA 90034. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 37 Active Patients - 9 Sample Size - 7 Home Visits- 3

EP Training and Testing CFR(s): 484.102(d) §403.748(d), §416.54(d), §418.113(d), §441.184(d), §460.84(d), §482.15(d), §483.73(d), §483.475(d), §484.102(d), §485.68(d), §485.625(d), §485.727(d), §485.920(d), §486.360(d), §491.12(d), §494.62(d). *[For RNCHIs at §403.748, ASCs at §416.54, Hospice at §418.113, PRTFs at §441.184, PACE at §460.84, Hospitals at §482.15, HHAs at §484.102, CORFs at §485.68, CAHs at §486.625, "Organizations" under 485.727, CMHCs at §485.920, OPOs at §486.360, and RHC/FHQs at §491.12:] (d) Training and testing. The [facility] must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least every 2 years. *[For LTC facilities at §483.73(d):] (d) Training and testing. The LTC facility must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually. *[For ICF/IIDs at §483.475(d):] Training and testing. The ICF/IID must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least every 2 years. The ICF/IID must meet the requirements for evacuation drills and training at §483.470(i). *[For ESRD Facilities at §494.62(d):] Training, testing, and orientation. The dialysis facility must develop and maintain an emergency preparedness training, testing and patient orientation program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training, testing and orientation program must be evaluated and updated at every 2 years. This STANDARD is not met as evidenced by: Based on record review, and interview, the home health agency (HHA) failed to ensure the emergency preparedness (EP) training and testing program for all agency staffs are conducted in an annual basis as required and as indicated in their policy and procedure. This failure had the potential to result in the staffs' lack of knowledge and readiness to respond effectively when an emergency/disaster situation could occur. Findings: On 11/11/22, at 1:54 p.m., during an interview with the Director of Patient care services (DPCS), and Administrator (Admin), both stated they have not conducted emergency drills for field and office staffs. DPCS and Admin stated field staffs carry basic supplies in their cars for emergency services. Both DPCS and Admin stated, "We have the policy, and it is important to implement the policy for emergency preparedness". DPCS further stated they have not participated in the county's "Great Shakeout" earthquake drills conducted annually. Review of employee files did not indicate any documented evidence the emergency operations orientation and in-services were conducted in an annual basis. A review of the home health agency's undated policy no 7-001.1 titled, "Emergency Management Plan", indicated organization leadership will provide for orientation and education of all personnel regarding participation in the emergency management plan. Education will be provided during orientation and annually thereafter.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 2741 S Robertson Blvd 2nd Floor, Los Angeles, CA 90034. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 37 Active Patients - 9 Sample Size - 7 Home Visits- 3

Strengths, goals, and care preferences CFR(s): 484.55(c)(2) The patient's strengths, goals, and care preferences, including information that may be used to demonstrate the patient's progress toward achievement of the goals identified by the patient and the measurable outcomes identified by the HHA; This ELEMENT is not met as evidenced by: Based on interview, and record review, the Home Health Agency (HHA) failed to develop patient specific goals for one of seven sampled patients (Patient 5). This deficient practice had the potential to cause Patient 5 to receive inadequate nursing care that is needed to reach highest health potential. Findings: A review of Patient 5’s face sheet indicated a start of care (SOC) date of 10/26/22, with a diagnoses of aortic stenosis (narrowing of the valve in the large blood vessel branching off the heart, which reduces blood flow to the body), Hypothyroidism (condition in which the thyroid gland does not produce enough thyroid hormone which can disrupt such things as heart rate, body temperature and metabolism), and Hypertension (high blood pressure). A review of Patients 5’s plan of care (POC), for certification period 10/26/22-12/24/22, indicated skilled nursing (SN) was to visit once a week for three weeks. Further review of Patient 5’s care plan did not indicate any patient specific goals. A review of Patient 5’s initial OASIS (Outcome and Assessment Information Set) SOC (start of care) assessment, dated 10/26/22, indicated no patient care goals developed for Patient 5 under the Goals and Interventions section. During an interview on 11/11/22, at 1:50 pm, the Director of Patient Care Services (DPCS) stated that goals should be added at SOC, then updated as needed every 30 days. The purpose of the goals is to know if the patient is making progress with the nursing care being provided. A review of the HHA’s police titled “Initial and Comprehensive Assessment”, dated 10/2012, indicated a comprehensive assessment will be completed within five days of the start of care. During the initial and comprehensive patient assessments, all baseline data will be used in determining patient goals. A review of the HHA’s policy titled “Ongoing Assessments”, dated 10/2012, indicated the clinicians will reassess the patient for progress toward goals and patient needs and problems. Based on each reassessment, the plan of care-including problems, needs, goals and outcomes—will be reviewed and revised by the clinician.

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: 3. A review of Patient 5’s face sheet indicated a start of care (SOC) date of 10/26/22, with a diagnoses of aortic stenosis (narrowing of the valve in the large blood vessel branching off the heart, which reduces blood flow to the body), Hypothyroidism (condition in which the thyroid gland does not produce enough thyroid hormone which can disrupt such things as heart rate, body temperature and metabolism), and Hypertension (high blood pressure). A review of Patients 5’s plan if care (POC), for certification period 10/26/22-12/24/22, indicated skilled nursing (SN) was to visit once a week for three weeks. SN was to teach the patient regarding current medication regimen (dosage, frequency, effects, purpose, and side effects). During a home visit on 11/10/22, at 11:45 am, with licensed vocational nurse 1 (LVN 1), Patient 5’s medications were reviewed. The following medications supplements were not listed on his medication profile… 1. Magnesium 400 milligram (mg: unit of measurement) daily 2. Vitamin C 1000 mg daily 3. Vitamin D 50,000iu Take 1 cap by mouth every 7 days for 12 weeks. During an interview on 11/11/22, at 1:35pm, with LVN 1and DPCS, LVN 1 stated she as unaware stated that Patient 5 was taking supplements. LVN 1 stated during her visits she asks patients again if there are any changes to medications, and she shows them the medication list to confirm. DPCS stated that it is important to know all medications that a patient is taking including vitamins, for safety because not all medications can be taken together. A review of the HHA’s policy titled “Medication Management” (undated), indicated that a comprehensive client assessment is performed at the start of care and at other time intervals and includes review of all medications the client is taking (prescribed, samples, over the counter, herbal remedies, and PRN medications) and records the medication in the clinical record. Based on observation, interview, and record review, the home health agency (HHA) failed to maintain an accurate, and current medication profiles for 3 of 7 sampled patients (Patients 1, 2 and 5). This failure has the potential to result in placing the patient at risk for medication errors and adverse drug reactions. Findings: 1. A review of Patient 1's Patient Profile Information indicated, a start of care (SOC) date of 5/19/22, with a certification period of 9/16/22 to 11/14/22. Patient 1's diagnosis included type 2 diabetes (is a chronic condition where the body does not produce insulin which regulates the blood sugar) and unspecified dementia ( is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). A review of Patient 1's Plan of Care dated 9/14/22, indicated Skilled Nursing (SN) to assess/evaluate/observe patient's body system including vital signs with focus on cardio-pulmonary status, signs and symptoms of CHF(congestive heart failure) , signs and symptoms of hypertension, severity of pedal edema, muscular status, integumentary status, genitourinary status , gastrointestinal status, nutrition/effectiveness /compliance with medication regimen, signs and symptoms of infection, home safety measures, response to teaching and coping skills. SN to notify physician of random blood sugar levels less than 70 or greater than 350. A home visit was conducted on 11/10/22 at 12:40 p.m., with Director of Patient Care Services (DPCS). Patient 1 was observed sitting in the dining area, alert and oriented to name, place, and time, with periods of forgetfulness, walks around the home using a cane for assistance, not in any respiratory distress. Patient caregiver present. During a review of Patient 1's medications currently taking reconciling with the medication profile on 11/10/22, at 1:00 p.m., indicated the following medication discrepancies: Mirtazapine 7.5 mg (milligrams- a unit of measure) 1 tablet daily for depression not listed in plan of care Tradjenta 5 mg 1 tablet daily for diabetes not listed on plan of care Metformin 500 mg 2 tablets once daily for diabetes was changed to 1000 mg 1 tablet twice daily. Namzaric Oral 21-10 mg 1 tablet daily for dementia was listed on the plan of care but was not taken by patient During an interview with the DPCS, stated that "those medications were not listed the last time I came here. The nurse should always review the patient's medication every visit to prevent medication errors". 2. A review of Patient 2's Patient Profile Information indicated, an SOC date of 9/15/22, with a certification period of 9/15/22 to 11/13/22. Patient 2's diagnosis included cerebral infarction (defined as brain or retinal cell death due to prolonged ischemia- loss of blood oxygen- resulting in sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination). A review of Patient 2's Plan of Care dated 9/15/22 indicated Skilled Nursing (SN) to assess/evaluate/observe patient's body system including vital signs with focus on cardio-pulmonary status, signs and symptoms of CHF(congestive heart failure), signs and symptoms of hypertension, severity of pedal edema, muscular status, integumentary status, genitourinary status , gastrointestinal status, nutrition/effectiveness/ compliance with medication regimen, signs and symptoms of infection, home safety measures, response to teaching and coping skills. A home visit was conducted on 11/10/22 at 2:00 p.m., with Administrator (Admin). Patient 2 was observed lying on her bedroom, alert and oriented to name, place and time, walks around the home using a cane for assistance, not in any respiratory distress. Patient caregiver present. Admin proceeded with her visit. During a review of Patient 2's medications currently taking reconciling with the medication profile on 11/10/22, at 2:30 p.m., indicated the following medication discrepancies: Caltrate 600 mg plus Vit. D3 1 tablet daily as supplement was not in the patients home. Patient 2's daughter stated she changed it to Multivitamin plus Omega 3, 1 gummy daily. Multivitamin 1 tablet daily as supplement was not found. Vitamin C 250 mg 1 gummy daily as supplement was not listed in the medication profile. Ocuvite Adult 50 plus multivitamin daily was not found in the patients home. Patient's daughter stated she changed it into gummies. During an interview with the Admin, stated that she only asks the patient's daughter every visit if there are changes in medications.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to implement their infection control program by failing to: - Screen visitors, field and office staffs and patients for signs and symptoms of COVID-19 (an acute serious respiratory illness) - Maintain and monitor expiry dates of their medical supplies in the office. - Observe and implement proper bag technique (Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care to prevent the transmission of pathogenic microorganisms) and perform proper handwashing during the home visit. These deficient practices had the potential to spread infection to the already compromised patients of the home health agency. Findings: During the recertification survey of the home health agency on 11/9/22, at 10:30 a.m., and 11/11/22 at 10:30 a.m., observed there was no COVID-19 screening for visitors, office, and field staffs upon entrance of the home health agency (HHA). During an agency tour at 11/9/22 at 11:00 a.m., with the Administrator (Admin), during an inspection of the storage/supply cabinet noted the following: 1. Barrier cream cloth expired on 5/12/2017 2. Repara Xeroform gauze expired on 1/2016 3. Single dose saline vials expired on 3/2018 4. Irrigation tray was noted open. There was no date it was opened and no expiry date 5. Supply log had no written entries noted. On concurrent interview with the Admin, stated she was not able to check her medical supplies cabinet because of COVID and had not ordered any new ones because they don't have any patients with wound care. Admin stated it will cause more infection if patients use expired supplies and treatment will not be effective. On 11/10/22 at 12:40 p.m., a home visit was conducted at Patient 1's residence with Director of Patient Care Services (DPCS). Patient 1 was observed alert with periods of forgetfulness, ambulated with the use of a cane. DPCS proceeded with his visit. DPCS had his equipment placed in two plastic bags. DPCS did not clean or sanitize his equipment before and after patient care. It was further observed after using his medical equipment, DPCS placed his dirty equipment back to the clean plastic bag. When asked where he keeps his dirty and clean equipment, DPCS stated he keeps his clean equipment in the inner plastic bag and the dirty equipment on the outer plastic bag. DPCS was further observed not wearing gloves and face mask. DPCS also did not wash his hand after the home visit. On 11/10/22, at 1 p.m., during an interview with the DPCS, stated " I should've used alcohol, usually I do, but I did not do it." DPCS also stated the importance of proper bag technique and handwashing will prevent infection. On 11/11/22, at 1:54 p.m., during a concurrent interview with the DPCS and Administrator (Admin), stated that field staff call ahead of time if they have symptoms. DPCS and Admin stated that they don't log the call for COVID-19 Screening and have no written documentation for tracking. Admin and DPCS stated they should have followed and implemented their policy for proper bag technique and hand washing during home visits to prevent spread of infection. A review of the HHA's policy no. 9-009.1 titled "Hand Hygiene" revised October 2012 indicated to prevent cross-contamination and home health-acquired infections, personnel providing care in the home setting will regularly wash their hands, per the most recently published CDC(Center for Disease Control and Prevention) regulations and guidelines for hand hygiene in health care settings. When hands are not visibly soiled, they should be decontaminated using an alcohol-based hand rub. An Alternative to use of an alcohol-based hand rub is to wash hands with an antimicrobial soap and water. Hand decontamination using an alcohol-based hand rub should be performed before having direct contact with patients, after contact with a patient's intact skin (when taking a pulse, blood pressure or lifting a patient). A review of the HHA's undated policy titled " Infection Control Surveillance " indicated that the agency will establish a continuous data monitoring and collecting system to detect infections or identify changes in infection trends. The agency will implement a process of identifying all infections in the client and/or employee population and evaluate effectiveness of current control measures or identify an action plan to improve incidence of infection. A review of the HHA's undated document titled " OSHA Infection Control/Exposure Control Plan" indicated client infection control procedures shall include but not limited to: use of appropriate protective equipment including gloves, gowns, masks when indicated. A review of the HHA's policy no 9-014-1 titled "Bag technique" revised October 2012, indicated personnel must regularly check the expiration date of any disposable supplies kept in the nursing bag. Expired supplies should be returned for disposal.