Every finding on record at Miji Care of Palm Springs Inc

The following reflects the findings of the California Department of Public Health during a recertification survey conducted on 2/17/22. The unduplicated census in the last 12 months was 58. The census at the time of the survey was 54. The survey sample size was 7 with 5 record reviews and 2 home visits with record reviews. Representing the California Department of Public Health: 38174, Health Facilities Evaluator Nurse; and 35386, Health Facilities Evaluator Nurse.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to ensure patients were informed of the state home health hot line telephone number(s) and purpose to receive complaints or questions about the HHA when the patient service handbook contained the wrong home health complaint hot line telephone number(s) and a family member was not advised of the home health complaint hot line telephone number(s) and it's purpose for filing complaints for one of two sampled home visit patients (7). This failure had the potential to compromise patient’s rights. Review of Patient 7’s clinical record indicated he was admitted to the HHA on 7/24/21 with a diagnosis of muscular dystrophy (a group of genetic disease that causes progressive weakness and loss of muscle mass), tracheostomy (surgical opening through the neck to allow access to the breathing tube), dependent on ventilator (machine that blows air with extra oxygen into your airways and lungs), supplemental oxygen, and gastrostomy (surgical opening into the stomach for the introduction of food). During a home visit, concurrent record review, and interview with Patient 7’s family member (FM) on 2/16/22 at 1:30 p.m., a review of the patient service handbook indicated the wrong home health complaint hot line telephone number. The FM stated they were unaware there was a state home health hot line telephone number(s) and it's purpose for filing complaints. Review of the HHA’s patient service handbook indicated the wrong toll free and direct-dial state home health complaint hot line telephone number(s). Outgoing telephone calls to the number(s) listed in the HHA's patient service handbook were placed on 2/14/22 at 3:15 p.m., and were answered by the California Department of Public Health, Licensing and Certification Program, Fresno District Office. During an interview with the administrator (ADM)/director of patient care services (DPCS) on 2/17/22 at 11:15 a.m., she acknowledged it should be the San Jose District Office information and she stated she would change it. During a concurrent observation and interview with the Regional Director (RD) on 2/17/22 at 1:35 p.m., outgoing calls were placed to the toll free, direct-dial home health complaint hot line telephone number(s) listed in the patient service handbook and should have been answered by the Department of Public, Health Fresno District Office. The RD acknowledged the call was answered by the Fresno District Office and stated they would change it. Review of the agency’s 2009 policy “Patient Bill of Rights” indicated it was the right of the patient to receive in writing, prior to the start of care, the telephone numbers for the State Home Health Hotline and the purpose of the hotlines to receive complaints or questions about the organization.

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 home health agency (HHA) failed to provide an accurate comprehensive medication profile for one of 2 sampled patients (6). This failure had the potential to cause patient harm from receiving incorrect medications. Review of Patient 6's plan of care (POC) certification period from 1/19/2022 to 3/19/2022, indicated oxygen (colorless and odorless gas that helps a patient to breath) inhalation 2liters/minute (L/min, a type of measurement) continuous use effective 7/23/2021. During a home visit observation and concurrent interview on 2/15/22 at 1:00 p.m., Patient 6’s medications were observed with a family member (FM). Patient 6 did not have oxygen equipment. The FM stated Patient 6 did not need oxygen for a "long time now". The FM also stated Patient 6 was taking glycopyrrolate oral solution (used to reduce excessive drooling) as directed in the bottle, three times a day, and had been taking the medicine for a long time. The glycopyrrolate oral solution was not included in Patient 6's POC. During an interview and concurrent record review with the director of patient care services (DPCS) on 2/15/22 at 2:25 p.m., the DPCS acknowledged the POC did not reflect a current and accurate medication summary for Patient 6's oxygen and glycopyrrolate oral solution. The DPCS stated during every home visit, nurses should perform a thorough check on patients' medications. Review of the agency's undated policy, "Medication Profile", indicated, "Patients receiving medications will have a current, accurate medication profile in the clinical 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 observation, interview and record review, the home health agency (HHA) failed to ensure one of 7 sampled patients (6) had an accurate individualized plan of care. This failure had the potential to compromise patient care. Review of Patient 6’s plan of care (POC) indicated a start of care on 7/23/2021 and a diagnosis including muscular dystrophy (a group of diseases that cause progressive weakness and loss of muscle mass), and dependence on supplemental oxygen (colorless and odorless gas that helps a patient to breath). Review of Patient 6's certification period from 1/19/2022 to 3/19/2022 indicated oxygen inhalation 2liters/minute (L/min, a type of measurement) continuously, safety measured, and interventions for oxygen precautions. Review of Patient 6's certified home health aide (CHHA) POC, dated 1/14/2022, indicated use oxygen as needed (prn) respiratory distress, prn oxygen use if oxygen sat (saturation, measures the amount of oxygen-carrying hemoglobin in the blood) was less than 92%. During a home visit observation and concurrent interview with Patient 6's family member (FM) on 2/15/22 at 1:00 p.m., Patient 6 did not have oxygen equipment. The FM stated Patient 6 did not need an oxygen for a "long time now". During an interview with the director of patient care services (DPCS) on 2/16/2022 at 9:42 a.m. the DPCS stated the licensed nurse made a mistake to include oxygen on Patient 6's POC during the recertification period. Review of the agency's policy, "Care Planning Process", revised on 4/2021, indicated "Based on the assessment and conclusions, the plan of care will include, but will not be limited to reasonable, measurable, and individualized goals and outcomes identified by the organization and the patient". Review of the agency's policy, "Initial and Comprehensive Assessment", revised on 4/2021, indicated during the initial and comprehensive patient assessment, all baseline data to be used in measuring the patient's progress goals, other relevant information will be documented in the patient's clinical record, including at least the following information, if applicable; equipment presently in the home, and potentially needed by patient.