Every finding on record at Magnolia Home Health Care Services, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 3314 W Burbank Blvd., Burbank CA 91505 Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 19096, Health Facilities Evaluator Nurse Unduplicated Admissions - 41 Active Patients - 19 Sample Size - 7 Home Visits- 3

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 3314 W Burbank Blvd., Burbank CA 91505 Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 19096, Health Facilities Evaluator Nurse Unduplicated Admissions - 41 Active Patients - 19 Sample Size - 7 Home Visits- 3

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: Based on observation, interview and record review, the hospice staff failed to review all medications the patients were taking and update the medication profiles with the currently used medications for one of 7 sample selected patients (Patients 2). This deficient practice had the potential to place the patient at risk for medication errors and adverse drug reactions. a. A review of Patient 2's clinical record indicated a start of care date (SOC) 0f 7/2/22 for the certification period of 7/2/22-9/22/22, with diagnosis that included cerebral Ischemia (a common mechanism of acute brain injury that results from impaired blood flow to the brain), vertigo of central origin (a sudden internal or external spinning sensation, often triggered by moving your head too quickly and radiculopathy. Patient 2 was admitted to the hospice agency on 2/6/2022, with a primary diagnosis of Alzheimer's disease (affects memory, thinking and behavior). A review of the "Initial orders and Plan of Care," dated 2/6/2022, indicated the Skilled Nurse (SN) visit frequency for Patient 2 was once a week and two visits as needed for symptom management, nursing assessment of patient/caregiver needs, evaluation of patient/caregiver response to effectiveness of intervention and to monitor and education on medication. On 9/1/2022, at 10:45 a.m., during a joint home visit with License Vocational Nurse 1 (LVN 1), Patient 2 was observed sitting at the dining room table in the living room with Family member 1. During Patient 2's medication review comparing the medication profile with Family Member (FM) 1, FM 1 indicated the following discrepancies were verified: Patient 2 's medication profile indicated Patient 2 was to take Meclizine 12.5 mg, one capsule daily for Vertigo. During review of the medication, Family Member 1 stated patient 2 had not been taking Meclizine for a while. However, he needed to reorder it due to her dizziness. Patient 2 had Polyethylene Glycol 3350 powder osmotic laxative 30 ounces daily, which was not listed on the medication profile. Patient 2's medication profile indicated patient 2 was taking cranberry concentrate one capsule daily. During a review of the medication in Patient 2's home with Family member 1, he stated Patient 2 no longer takes the cranberry concentrate. During an interview with the Administrator on 9/2/22, at 1:10 p.m., she stated the medication profile should be updated every visit.

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 interview and record review, the home health agency (HHA) failed to follow professional standards of practice for infection control by failing to implement their policies and procedure for COVID-19 (an acute serious respiratory illness) by not maintaining and monitoring expired dates on their medical supplies in the office. This failure had the potential to spread infection and cause serious harm, injury or death when expired medical supplies are sent for patient use. a). During the recertification survey of the home health agency on 8/31/22, at 12:10 p.m., there was no COVID-19 screening for visitors, office, and field staff upon entrance to the home health agency (HHA). Also, Healthcare personnel (HCP) were not wearing facial coverings inside the office. During an agency tour at 8/31/22 at 3:00 p.m., with the Administrator (Admin) and the Director of Patient Care Services Designee (DPCS Designee), during an observation of their storage/supply cabinet, the following was observed: 1). An unsealed gallon of hand sanitizer with no expiration date or manufacturer's date and no date when the sanitizer was opened 2). Clobetasol 0.05% cream with an expiration date of June 2013 3). CareFusion 0.9% sterile Sodium Chloride irrigation 110 ml (milliliter- a unit of measurement) vial with an expiration date of 04-2016 4). McKesson Sterile water 100 ml, Lot number 1805045 with an expiration date of 5/28/20. 5). Dynarex Sterile Packing Strip, Lot number 330030, with an expiration date of 7/2016. On concurrent interview with the Administrator (ADM), the Administrator stated she was not able to check the medical supplies cabinet because of Covid and had not ordered any new ones because they did not have any patients with wound care. The Administrator stated it would cause more infection if patients used expired supplies and treatment would not be effective. b. On 9/1/22 at 2:40 p.m., during a home visit at Patient 3's residence with LVN 1. LVN 1 was observed to be pregnant and wearing a KN95 mask. During an interview with Patient 3's daughter, the daughter stated Patient 3 and the whole family had contracted COVID-19 last January 2022. On concurrent interview with LVN 1, LVN 1 stated she called prior to the visit and asked if Patient 3 or any caregivers had symptoms of COVID-19. On 9/2/22 at 11:00 a.m., there was no COVID-19 screening observed taking place for visitors, office, and field staff upon entrance to the HHA. On 9/2/22 at 11:30 a.m., during an interview with the DPCS Designee, the DPCS stated that field staff call ahead of time if they have symptoms. The DPCS designee stated they do not log the call for COVID-19 Screening. The DPCS Designee further stated that if a field staff have symptoms, then they log it. The DPCS Designee could not provide written documentation of any COVID-19 Screening log or COVID-19 staff screening. On 9/2/22 at 11:45 a.m., during a concurrent interview with the Administrator, the Admin stated the HHA provide the field staff with a KN95 (Chinese Standards for respirators) and other personal protective equipment (PPE-personal protective equipment are used to protect the wearer from particles or from liquid contaminating the face). The Admin further stated HHA's field staff were not fit tested for N95 masks (U.S. standard for respirator masks). A review of the HHA's document titled " Addendum Policy No. 2-005-7 Protocols for Coordination of Care/Assessment/ and Investigation of Home Health Agencies with actual or suspected Covid-19 cases" dated 3/28/20 indicated Magnolia Home health care services inc. addendum to patient care due to Covid-19 according to CMS regulations and guidance support home health agencies are taking appropriate action to address potential and confirmed Covid cases and mitigate transmission including screening, treatment and transfer to higher level of care(when appropriate). This guidance applies to most Medicare and Medicaid providers. Magnolia Home health care Inc should monitor the CDC (Centers for Disease Control and Prevention) website for information and resources and contact our local health department when needed. Also, Magnolia HH should be monitoring the health status of patients, visitors, and staff in the home care setting for signs and symptoms of Covid-19. Per CDC, prompt detection, triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel and visitors.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on observations, interviews, and record reviews, the HHA failed to provide necessary skilled services according to federal, state, and local law for two out of five sampled residents. (Patient 1 and Patient 3). This deficient practice had the potential to cause patient harm or injury and the delay of necessary services required in the patients plan of care. A review of Patient 3's Patient Profile Information indicated, a start of care (SOC) date of 7/15/22, with a certification period of 8/15/22 to 10/13/22. Patient 3 is an 88-year-old female with diagnosis that included type 2 diabetes (a chronic condition where the body does not produce insulin which regulates the blood sugar) and neuropathy (weakness, numbness, and pain from nerve damage, usually in the hands and feet). Patient 3’s orders included Skilled nursing (SN) visits twice a week for two weeks and once a week for seven weeks. A home visit was conducted on 9/1/22 at 2:40 p.m. with Licensed Vocational Nurse 1(LVN 1). Patient 1 was alert and oriented to name, place and time, ambulatory with a cane, not in any respiratory distress and spoke mostly Armenian language. LVN 1 started her visit in the bedroom. During an observation of the skilled visit on 9/1/22, LVN 1 did not calibrate Patient 1’s glucometer machine. LVN 1 stated “Patient 3 checks her own blood sugar with her own machine. When asked if it was regularly calibrated, LVN stated “No, I never do. I don't know if the machine needs calibration" On concurrent interview with Patient 3's daughter, the daughter stated she has another glucometer that was delivered by the pharmacy but "My mom prefers to use the older one." Patient 3's daughter stated she did not know if it required calibration. During an interview on 9/2/22 at 11:00 a.m., with the Director of Patient Care Services Designee (DPCS Designee) stated that the HHA educates the patients to do their own glucometer calibration but could not provide written documentation for patient education. A review of the HHA's policy no. 6-039.1 titled " Risk Management: Infection and safety" indicated all nurses utilizing home glucose monitoring (HGM) devices will have evidence of specific training on the HGM device, orientation to the organization's process of monitoring and current competence. All nurses will receive training in the HGM device issued to them. Training will include instruction and return demonstration of the following procedures according to the manufacturer's directions. All of the procedures listed below are to be conducted in accordance with standard precautions: Calibration performance and recording. Control solution checks and recording.

Documentation of inservice training CFR(s): 484.80(d)(2) The HHA must maintain documentation that demonstrates the requirements of this standard have been met. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to document and implement their policy for In-service training. This failure had the potential to result in poorly trained staff who produce low quality work and a lower level of performance which can lead to errors and quality of care issues. On 9/2/22 at 11:30 a.m., during a concurrent interview with the Director of Patient Care Services designee (DPCS designee) and the Administrator (Admin), the Admin stated "If the DPCS is here, I do not do the In-services. If there are questions from staff, then we just discuss what we should do." When asked to provide written documentation regarding In-services, the DPCS designee and Admin could not provide any documentation. A review of the undated Policy no. 4-008.1 titled "Responsibilities/Supervision of Clinical Services" indicated the Clinical director will be responsible for the clinical direction of the organization and will take reasonable steps to assure that policies and procedures, which guide and support the provision of services, are developed, and implemented. The Clinical Director will be qualified and possess appropriate clinical training and experience as verified by education, training, and previous work experience. A review of the HA's document titled "Job description for Director of Patient Care services" indicated a DPCS supervises and teaches in order to improve practice within the agency. Consults with supervisors and staff, individually or in a group, regarding client and families, special programs, or services program. Promotes staff development by utilizing capabilities of nursing and paramedical personnel in the development of orientation and staff education programs. Provides for continuing evaluation of the program by evaluating performance of the individuals in the program in relation to established standards and the individual's professional development. Evaluating own job performance and utilization of resources in planning for professional growth.