Every finding on record at Medical Services of Northwest Florida Inc

An unannounced recertification survey was completed on December 19-21, 2023 at Medical Services of Northwest Florida. The agency was not in compliance with Code of Federal Regulations (CFR) 42, Part 484, Subparts A-F, Conditions of Participation for Home Health Agencies at the time of the survey. During the recertification survey, Emergency Preparedness was also reviewed and the agency was in compliance with CFR 42, Part 484.22, Condition of Participation for Home Health Agencies.

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 observations, review of the agency's policy and procedure and staff interview, agency nursing staff failed to follow standard precautions to prevent transmission of infections for 1 of 2 patients observed during home visits. (Patient #2) The Findings Are: Observations made on 12/20/2023 starting at 1:30 PM during a skilled nursing home visit with patient #2 revealed the Licensed Practical Nurse (LPN) in the process of removing the patient's Chest Percussion Therapy (CPT) vest. The LPN was noted to be wearing disposable latex gloves at the time of the surveyor's arrival. The LPN then repositioned the patient with assistance from the patient's step-father. Upon repositioning, the LPN noted leakage from the Foley catheter which had resulted in the pad under the patient becoming wet with urine. She removed the damp pad from underneath the patient, readjusted the Foley catheter tubing and repositioned the patient. During this process, she also handled tubing from the attached wound vacuum and the humidifier attached to the patient's tracheostomy. All of this was done with the same gloves which had been observed on the LPN's hands since the surveyor's arrival onsite. The LPN was then observed to remove a package of gauze 2 x 2's from the patient's bedside supplies, open the package and remove the gauze 2 x 2. She then removed the plastic tracheostomy collar which was covering the open tracheostomy and use the gauze to clean accumulated secretions from the collar. She then repositioned the collar over the tracheostomy opening. Again, she wore the same gloves observed on her hands since the arrival of the surveyor. The LPN then drew water into a syringe and used it to check placement of the gastrostomy tube (G-Tube) and to flush the tube. She then reconnected the tubing from the hanging bag of tube feeding supplement to the G-tube site and restarted the pump to deliver the supplement (tube feeding had been stopped during treatment with the CPT vest). All of the care observed was performed with the LPN wearing the same pair of disposable gloves noted to be on her hands at the time of the surveyor's arrival. There was no removal/replacement of gloves, and no hand hygiene observed at any time during the visit or throughout any of the procedures performed by the LPN. Review of the infection control policy and procedure provided by the agency's Director of Nursing (DON) revealed a general policy/procedure for standard precautions which described when employees should use personal protective equipment (PPE) such as gloves, masks, protective eyewear, face shields, gowns and aprons. The policy/procedure did not include general handwashing protocols and did not detail when to change disposable gloves, when to perform hand hygiene (with either alcohol based sanitizers or soap and water) or other basic precautions to prevent cross-contamination during routine patient care. During an interview with the DON on 12/21/2023 at approximately 10:30 AM, he was asked if the agency has any other infection control policies/procedures which would guide employees regarding standard hand hygiene, hand washing, and use of disposable gloves. The policy previously provided was reviewed with him at this time and he confirmed none of the agency policies provide guidance on the issue of hand hygiene or use of disposable gloves. Concerns noted during the home visit to patient #2 were discussed with the DON at this time and he concurred that hand hygiene and changing of disposable gloves should have occurred at various points during the care provided by the LPN. He attributed the lapse in appropriate infection control practice to "nerves" on the part of the LPN, but stated he would be sure she receives a "refresher" on proper methods to prevent cross-contamination during provision of patient care.

During the standard recertification survey conducted on 03/08/2021 through 03/10/2021 at Medical Services of Northwest Florida, Inc., a home health agency, Emergency Preparedness was reviewed. Medical Services of Northwest Florida, Inc. is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.22, Conditions of Participation for Home Health Agencies.

An unannounced standard recertification survey was conducted on 03/08/2021 through 03/10/2021 at Medical Services of Northwest Florida, Inc, a home health agency located in Navarre, Florida. The agency has no branches. The agency was not in compliance with Code of Federal Regulations (CFR) 42, Part 484.22, Conditions of Participation for Home Health Agencies.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on interview and record review the home health agency failed to document and provide wound care as ordered in the plan of care for skilled nursing care for 1 of 9 sampled patients, (#5). The findings include: A review of sampled patient #5's Home Health Certification and Plan of Care, for certification period from 1/10/21 to 3/11/21 was completed. The Home Health Certification and Plan of care revealed patient #5 had 4 pressure ulcers with a wound care order of mepilex dressing change every other day. A review of sampled patient #5's Home Health Certification and Plan of Care, for certification period from 3/12/21 to 5/11/21 was completed. The Home Health Certification and Plan of care revealed patient #5 had 1 pressure ulcer to the coccyx, with notable improvement, with wound care orders of medi-honey. A review of patient #5 medical record failed to reveal any documentation of wound assessment, wound measurements or dressing changes for the documented wounds. A review of the medical record failed to reveal a wound care order for medi-honey dressing change. A case conference note dated 1/5/2021, found in the medical record revealed patient #5 had 4 pressure ulcers that are being treated with mepilex dressings changed every other day. A case conference note dated 3/8/2021 found in the medical record revealed patient #5 had 1 pressure ulcer to the coccyx, that was healing well with the treatment per orders. An interview was conducted with the Director of Nurses, (DON), on 3/10/21 at approximately 10:45 AM. The DON confirmed the 4 pressure ulcers were healed, but patient #5 developed a new pressure ulcer approximately 2 weeks ago. The DON confirmed there was no documentation of wound assessment, wound measurements or dressing changes in the medical record. The DON confirmed the order for medi-honey wound dressing was obtained via verbal order, but the order was not documented in patient #5 medical record. An interview was conducted with the DON on 3/10/21 at approximately 3:45 PM. The DON confirmed she assessed patient #5 wound and took wound measurements, and confirmed the wound is healing. The DON confirmed the assessment documentation was not in patient #5 medical record.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure the Home Health Certification and Plan of Care included the duration of scheduled visits for 7 of 9 sampled patients (#1, #2, #3, #5, #6, #8, #9). The findings include: A review of sampled patient #1 Home Health Certification and Plan of Care for certification period 1/1/21 to 3/2/21 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. A review of sampled patient #5 Home Health Certification and Plan of Care for certification period 1/10/21 to 3/11/21 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. A review of sampled patient #6 Home Health Certification and Plan of Care for certification period 1/2/21 to 3/3/21 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. A review of sampled patient #8 Home Health Certification and Plan of Care for certification period 1/1/21 through 3/2/21 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. A review of sampled patient #2 Home Health Certification and Plan of Care for certification period 02/06/2021 to 04/05/2021 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. A review of sampled patient #3 Home Health Certification and Plan of Care for certification period 1/19/21 through 3/19/21 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. A review of sampled patient #9 Home Health Certification and Plan of Care for certification period 10/26/20 to 12/25/2020 was completed. The Home Health Certification and Plan of Care included the frequency of visits to be made but failed to reveal the duration of visits to be made. An interview was conducted with the Director of Nurses on 3/10/2021 at approximately 11:59 AM. The DON confirmed there was not a duration for services listed on the Home Health Certification and Plan of Care for sampled patients # 1, #2, #3, #5, #6, #8 and #9.