Every finding on record at Mission Home Health Services, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 36459, Health Facilities Evaluator Nurse Surveyor # 19096, Health Facilities Evaluator Nurse Surveyor # 44911, Health Facilities Evaluator Nurse Unduplicated Admissions - 440 Active Patients - 35 Sample Size - 10 Patients Home Visits – 4

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 observation, interview, and record review, the home health agency (HHA) failed to follow the written plan of care (POC) for four of four patients ordered for oxygen saturation (O2 sat- noninvasive test that measures how efficiently blood carries oxygen to the extremities furthest from the heart, including arms and legs) monitoring in a sample of ten patients (Patients 1, 2, 3, and 4). The deficient practice has the potential for the oxygen level changes will not be identified that could result in the delay to inform the physician promptly for further treatment and intervention. Findings: a. A review of Patient 1's clinical record indicated a start of care date (SOC) of 10/25/2022, with a diagnosis of encounter for change or removal of nonsurgical, wound dressing. A review of Patient 1's Plan of Care (POC) for the certification period of 10/25/2022 to 12/23/2022, indicated a skilled nurse (SN) was scheduled to visit the patient once a day for 30 days and as needed one or two visits for wound or intravenous (IV - administered into a vein) issues. The POC indicated the SN was to assess medication effects/compliance, vital signs, and pain. The SN was to notify the physician of oxygen saturation levels (O2 Sat - measures the amount of oxygen being carried by red blood cells) less than 88 percent. A review of Patient 1’s Skilled Nursing Visit Notes for the certification period of 10/25/2022 to 12/23/2022, indicated no documented evidence the O2 Sat was monitored on 11/11/2022, 11/15/2022, 11/16/2022, 11/18/202211/19/2022, 11/20/2022, and 11/21/2022. b. A review of Patient 2's clinical record indicated a start of care date (SOC) of 04/01/2022, with a diagnosis of other atherosclerosis (thickening or hardening of the arteries) of native arteries of extremities, left leg. A review of Patient 2's Plan of Care (POC) for the certification period of 09/28/2022 to 11/26/2022, indicated a skilled nurse (SN) was scheduled to visit the patient once a day for six weeks and as needed one or two visits for wound care. The POC indicated SN was to assess medication effects/compliance, vital signs, and pain. The SN was to notify the physician of oxygen saturation less than 88 percent. A review of Patient 2’s Skilled Nursing Visit Notes for the certification period of 09/28/2022 to 11/26/2022, indicated no documented evidence the O2 Sat was monitored on 10/04/2022, 10/11/2022, 10/18/2022, 10/25/2022, and 11/01/2022. c. A review of Patient 3's clinical record indicated a start of care date (SOC) of 08/27/2022, with a diagnosis of encounter for adjustment and management of ventricular assist device (VAD — device that helps pump blood from the lower chambers of your heart to the rest of your body). A review of Patient 3's Plan of Care (POC) for the certification period of 08/27/2022 to 10/25/2022, indicated a skilled nurse (SN) was scheduled to visit the patient once a day seven days. The SN is was to assess medication effects/compliance, vital signs, and pain. The POC indicated the SN was to notify the physician of oxygen saturation less than 88 percent. A review of Patient 3’s Skilled Nursing Visit Notes for the certification period of 08/27/2022 to 10/25/2022, indicated no documented evidence the O2 Sat was monitored on 08/28/2022, 08/29/2022, 08/30/2022, 08/31/2022, and 09/01/2022. During a concurrent interview and record review with the Director of Patient Care Services (DPCS) on 11/23/2022, at 12:30 p.m., stated if O2 Sat parameters are ordered in the POC, the nurse should check and document the patients' O2 Sat levels. The DPCS further stated the O2 Sat results for Patients 1, 2, and 3 should have been checked and documented as indicated in the POC. d. A review of Patient 4’s profile indicated a Start of Care (SOC) date of 11/18/2022, with the primary diagnoses of encounter for adjustment and management of venous access device (VAD) and dehydration (harmful reduction in the amount of water in the body). A review of Patient 4’s POC for certification period 11/18/2022 to 1/16/2023, indicated SN to visit once a day for five days, and as needed one or two visits related to intravenous (IV, administered into a vein) issues. The POC indicated the SN was to perform skilled assessment for all body systems with emphasis on respiratory system (the organs that are involved in breathing). The POC indicated the SN was to assess vital signs (VS, clinical measurements that indicate the state of a patient’s essential body functions including pulse rate, temperature, respiration rate, and blood pressure). The POC indicated the SN was to notify the doctor of O2 sat levels less than 88% (normal O2 sat is usually 95% or higher). On 11/22/2022, at 10:03 AM, a home visit was conducted with Registered Nurse 1 (RN1) at Patient 4’s home. During the home visit it was observed Patient 4 was lying in bed. Patient 4’s patient/family caregiver (PCG) was present during the home visit. During an interview on 11/22/2022, at 10:23 AM, with RN 1, stated she checked Patient 4’s O2 sat every visit and document the results on the SN visit notes. RN 1 stated she will report any O2 sat readings below 88% to the doctor. RN 1 stated if the O2 sat is not documented, it could mean it was not done. During an interview on 11/23/2022, at 10:48 AM, with the Director of Patient Care Services (DPCS), stated the O2 sat for Patient 4 should have been checked and documented every SN visits. DPCS stated if the O2 sat was not documented, it was not done. During a concurrent interview, and record review on 11/23/2022, at 12:26 PM, with DPCS of Patient 4’s SN Visit Notes dated 11/19/2022, 11/20/2022, and 11/21/2022 for certification period from 11/18/2022 to 1/16/2023, DPCS verified the SN Visit Notes did not have O2 sat levels documented. Further review of the SN Visit Notes indicated Patient 4 had shortness of breath when walking more than 20 feet and climbing stairs. The DPCS verified Patient 4’s POC indicated to notify the doctor if the Patient 4’s O2 sat was below 88%. The DPCS stated the importance of checking and documenting O2 sat levels every SN visit to know the immediate current condition of the patient and to identify any changes that need to be communicated to the doctor. A review of the HHA’s policy and procedure (P&P) titled “Parameters”, revised on 3/2016, the P&P indicated the HHA has established standard parameters for reporting changes in the patient’s condition to the physician (doctor) if the physician does not establish parameters. The P&P indicated during each assessment, the SN is required to document all measured vital signs, including blood pressure (BP), pulse, respiration, temperature, blood sugar, pain, oxygen saturation, and weight.

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, and interview, the Physical Therapist 2 (PT 2) failed follow the accepted standards of practice to prevent the transmission of infection to one of 10 patients (Patient 8). This deficient practice has the potential risk to increase the transmission of infection to the already compromised patient's health status. Findings: On 11/22/22, Patient 8's electronic record was reviewed. Review of Patient 8's plan of care (POC) for the certification period of 11/11/2022 to 01/9/2023, indicated the start of care (SOC) date of 11/11/2022, with diagnoses which included Monoplegia of lower limb following cerebral infarction affecting right dominant side ( a type of paralysis that impacts one limb after a stroke the which disrupts blood flow to the brain, and Type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar (glucose). The POC included a physician's order for physical therapy to evaluate and development plan of care for treatment. During a joint home visit with PT 2 in Patient 8’s residence, PT 2 was observed placing his treatment backpack directly to the protective barrier on the table in the living room. PT 2 washed her hands, put gloves on, then wiped his stethoscope, temperature monitor, Oxygen saturation device with alcohol. Using the same gloves, PT 2 took Patient 8's vital signs, performing therapeutic exercises, scrolling through her cell phone for the patient to sign route sheet. PT 2 was still wearing the same gloves. During an interview with the Administrator and DPCS on 11/23/22, at 2:20 p.m., both stated PT 2 should have changed her gloves, sanitized her hands and re-gloved throughout the visit. Review of the hospices agency's policy and procedure titled "Bag Technique" revised November 2021, stipulates, " Paper towels/newspapers used as protective barrier for bag placement in the patient's home will be discarded. When the visit is complete reusable equipment will be cleaned using alcohol and/or soap and water as appropriate, hands will be washed, and equipment and supplies will be returned. Hands will be decontaminated prior to returning clean equipment to bag."