Every finding on record at Mlh Healthcare, Inc

The following reflects the findings of the Department of Public Health during a Recertification Survey. Representing the Department of Public Health Surveyor ID #- 22303 RN-HFEN Surveyor ID #- 35893 RN-HFEN Unduplicated Admissions -103 Active Patients -57 Sample Size - 7 Home Visit - 3

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the emergency preparedness plan and training for staff were done on an annual basis. This failure had the potential for the staffs to have a lack of knowledge to respond effectively during an emergency situation. Findings: During a review of the emergency preparedness plan and disaster training of the HHA on 1/30/22 at 12:00 p.m., the HHA did not have evidence of Emergency Preparedness training/Disaster drill for all staff, and did not have evidence of emergency plan annual review. During an interview with the Director of Patient Care Services (DPCS) on 1/30/22 at 12:15 p.m., the DPCS stated that the emergency plan has not been reviewed annually. She also stated there has not been an Emergency Preparedness/Disaster training for staff annually. There was no documented evidence the governing body reviewed the policy annually on Emergency Preparedness/Disaster. The last date of the policy review was on 12/5/17. The HHA's undated policy and procedure titled, "Emergency Management Plan" indicated the purpose was to develop processes for establishing the means and methods to continue care, treatment, and services during and after the potential emergencies.

The following reflects the findings of the Department of Public Health during a Recertification Survey at the new location at 2555 East Colorado Boulevard Suite 203, Pasadena, California 91107. Representing the Department of Public Health Surveyor ID #- 22303 RN-HFEN Surveyor ID #- 35893 RN-HFEN Unduplicated Admissions -103 Active Patients -57 Sample Size - 7 Home Visit - 3

Eligibility for Medicare home health benefit CFR(s): 484.55(b)(2) Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to assess the patient's continuing need for skilled nursing services for one of seven sampled patients. (Patient 4). This deficient practice resulted the provision of an unnecessary continuous home health services to the patient who did not need skilled nursing services. Findings: A review of Patient 4's clinical record indicated a start of care (SOC) date of 5/17/21, with diagnosis that included hypertension(high blood pressure) A review of Patient 4's plan of care (POC) from 11/13/21 to 1/11/22, included an order for the skilled nurse (SN) to visit once a week for 9 weeks, for assessment of all body system and medication compliance. The plan of care indicated to notify the physician if systolic blood pressure (top number) was greater than 160 millimeter mercury (mmHg) or less than 90 mmHg, diastolic(bottom number) is greater than 90 mmHg, or less than 55 mmHg. Pulse rate is greater than 100 beats per minute or less than 60 beats per minute. Respiration rates are greater than 20 breath per minute or less than 12 breath per minute. Temperature is greater than 100 Fahrenheit (F) or less than 95.6 F. Blood Sugar below 70 mg/dl or above 400 mg/dl. The goals included the blood pressure range will be within the physician established parameter, bowel status will be within normal range, pain will be maintained at an acceptable level and blood sugar to be maintained within ranges of 100 to 140 mm/dl. Discharge Planning indicated to discharge when medical condition is stable and the patient no longer in need of skilled care. A review of Patient 4's Skilled Nursing Clinical Notes from 11/13/21 to 1/11/22, indicated the patient's vital signs were within a normal range, BS were from 100 to 140 mg/dl., bowel movements were regulated and no complaints of constipation. There were no admissions to the hospital, no episodes of high blood pressure or any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continued skilled nursing service. During an interview with the Director of Patient Care Services (DPCS) on 1/30/22, at 1:30 p.m., she stated the agency recertified the patient for continuous patient teaching on diabetes management and to monitor the patient for safety issues. She further stated that she agreed the patient no longer needed skilled nursing services. A review of the agency's policy "Discharge Criteria and Process" indicated services will be terminated when the goals of home health have been attained or are no longer attainable.

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 ensure the patients' current medication profile match the medications the patients taking at home for three of seven sampled patients (Patients 1, 2 and 3 ). This failure has the potential to place the patients at risk for medication errors and adverse drug reactions. Findings: a. A review of Patient 1's Patient Information indicated, a start of care (SOC) date of 8/31/21, with diagnosis that included type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar). During a review of Patient 1's Plan of Care (POC), for the certification period from 12/29/21 to 2/26/22, included an order for skilled nurse (SN) to visit once a week for nine weeks. The POC indicated the SN was to review the patients medication regimen and provide education. Patient 1's medication profile dated 12/24/21, included Colace (medication for constipation) 1 tablet as needed for constipation. The profile also included Clonazepam (medication for anxiety) 0.5 milligrams (mg-unit of measurement) 1 tablet daily as needed. On 1/29/22, at 11 a.m., a home visit was conducted at Patient 1's residence with the Registered Nurse (RN). During a review of Patient 1's medications indicated a bottle of Colace 100 mg twice a day and as needed. The Clonazepam bottle indicated 0.5 mg twice daily and as needed. On 1/29/22 at 11:30 a.m., the RN stated the medications should be checked every visit with the medication profile to ensure its accuracy. He stated it was also to check the medications are being taken as ordered. b. A review of Patient 2's Patient Information indicated, a start of care (SOC) date of 12/1/21, with diagnoses that included hypertension (high blood pressure) and ataxia (a lack of muscle control or coordination of voluntary movements), During a review of Patient 2's POC, for the re-certification period from 12/1/22 to 1/29/22, included an order for the SN to visit once a week for seven weeks. The POC indicated the SN was to review the patients medication regimen and provide education. Patient 2's medication profile dated 12/1/21, included Colace 100 mg twice daily. On 1/29/22, at 12:30 p.m., a home visit was conducted at Patient 2's residence with the RN. During a review of Patient 2's medications indicated a bottle of Colace 100 mg twice a day and as needed. Patient 2 also takes Vitamin D 3, 1000 international units (IU- unit of measurement) every day. The profile did not include Vitamin D3. On 1/29/22 at 12:45 p.m., the RN confirmed the medication profile should include all the medications for Patient 2. c. A review of Patient 3's Patient Information indicated, a start of care (SOC) date of 12/4/21, with diagnosis that included spondylolisthesis (a condition in which one vertebrae slips out of place onto the bone below it). During a review of Patient 3's POC, for the certification period from 12/4/22 to 2/1/22, included an order for the SN to visit once a week for six weeks. The POC indicated the SN was to review the patients medication regimen and provide education. Patient 3's medication profile dated 12/1/21 did not include Vitamin D3, 1000 IU daily. On 1/29/22, at 2 p.m., a home visit was conducted at Patient 3's residence with the RN. During a review of Patient 3's medications indicated a bottle of Vitamin D3 1000 IU which Patient 3 takes daily. On 1/29/22 at 2:30 p.m., the RN confirmed the medication profile was not accurate and did not include Vitamin D3. The HHA's policy and procedure dated 11/2018 and titled " Medication Profile" indicated patients receiving medications will have a current. accurate medication profile in the clinical record.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on interview and record review, the registered nurse (RN 1) failed to notify the physician promptly of the patient's change of condition for one out of seven sampled patients (Patient 5). Patient 5 had elevated blood sugar (BS) readings that was checked by Licensed Vocational Nurse (LVN 1) on her 3 consecutive weekly visits. LVN 1 failed to inform the physician of patient's BS level elevated reading. This deficient practice had the potential to place the patient at risk for serious complications that could affect the patient's overall health status and quality of care. Findings: A review of Patient 5's clinical record indicated the start of care (SOC) date was 5/17/21, with diagnosis of diabetes mellitus ( a group of disease that result in too much sugar in the blood). A review of Patient 5's plan of care (POC) for certification period from 1/12/22 to 3/12/22, indicated an order for the Skilled Nurse (SN) to visit of once a week for 9 weeks, to continue to do skilled nursing assessment of all body system with emphasis on endocrine status (pancreas). One of the nursing intervention was to report to physician for any abnormal or significant change in the patient's condition. A review of Patient 5's Skilled Nursing Clinical Notes had the following BS readings: a. On 1/13/22, the BS reading was 196 mg (milligram) per dl (deciliter). b. On 1/18/22, the BS reading was 191 mg/dl. c. On 1/25/22, the BS reading was 208 mg/dl. There was no documented evidence to indicate the visiting nurse notified the physician of patient's elevated BS readings during her three visits. (Normal BS reading is 80-100 mg/dl.) On 1/30/22, at 1 p.m., during an interview with the director of nursing services (DPCS), she stated the patient's BS was elevated and the visiting nurse should have notified the physician to adjust her diabetes medication. The patient's medication record indicated an order dated 1/17/22 for the patient to take Metformin 1 gram by mouth daily. A review of Agency's policy "Reporting To Physician (undated)", indicated the patient's physician will be contacted on the same day when there is changes in the patient's condition.

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 screen the visitors for sign and symptom of COVID-19 (an acute serious respiratory illness), and failed to develop the policy and procedures for COVID-19. This failure had the potential to spread infection. Findings: During an observation on 1/28/22 at 3:30 p.m., upon entrance to the HHA, there was no screening for COVID-19 signs and symptoms and no temperature check. An interview was conducted with the Director of Patient Care Services (DPCS) on 1/28/22 at 4 p.m., she stated that agency screen employees and document screening on the computer, but she did not know she had to also screen visitors. During a review of the infection control policy on 1/30/22 at 11:30 a.m., the HHA did not have a policy for COVID-19. There was information regarding COVID-19 in a binder. The DPCS stated she would have to create a COVID-19 policy. She also stated she would have to follow up with the fit testing for all staff. She stated that most of the staff have been fit tested but she could not provide the evidence that the staff were fit tested. The HHA's policy and procedure dated 11/2018 and titled, "Infection Control Plan" indicated the organization will address surveillance, prevention, identification, control and reporting of infections, utilizing current scientific methods and epidemiologic principles.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to follow the plan of care (POC) for one of seven sampled patients (Patient 1) by failing to have evidence that the patient's blood sugar (BS) was being checked weekly. This failure resulted in the patient's BS not being monitored which had the potential to affect the patient's progress in reaching goals. Findings: A review of Patient 1's Patient Information indicated, a start of care (SOC) date of 8/31/21, with diagnosis that included type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar). During a review of Patient 1's Plan of Care (POC), for the certification period from 12/29/21 to 2/26/22, included an order for skilled nurse (SN) to visit once a week for nine weeks. The POC indicated the SN was to ensure safety measures by having a sharps needle disposal container, monitor blood glucose, and educate the patient on when to call for any significant findings. On 1/29/22, at 11 a.m., a home visit was conducted at Patient 1's residence with the Registered nurse (RN). During observations at a concurrent time and date, there was no sharps needle disposal container and no documentation of blood sugar values in the patient's folder. During an interview with the Registered nurse (RN) on 1/29/22 at 11:30 a.m., he stated the sharps needle disposal container should be in the patient's home, for the nurse to be able to dispose of the used needle after the blood glucose was checked. During an observation on 1/29/22 at 11:45 a.m., Patient 1 was observed with a dressing to the right forearm. During an interview with Patient 1 on 1/29/22 at 11:45 a.m., she stated that she had sustained a wound to the right arm a few days ago but didn't think she was suppose to call to notify the HHA. The RN stated that the wound was not reported to the HHA, but the nurse should be assessing the patient's skin every visit. The RN measured the right forearm wound, length 2 centimeters (cm-unit of measurement) by width 1.5 cm by depth 0 cm. The wound was observed red with sanguineous (leakage of fresh blood produced by an open wound) drainage. The HHA's policy and procedure dated 11/2018 and titled "Care Planning Process" indicated will be reflected in the specific services that will be provided and the associated actions planned and implemented to meet individualized patient problem and goals.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the family/caregiver was provided instructions about diabetes management care for one of 7 sampled patients (Patient 5). This deficient practice placed the patient at risk for complications of diabetes including sign and symptom of high and low blood sugar and how to treat this condition. Findings: A review of Patient 5's clinical record indicated the start of care (SOC) date was 5/17/21, with diagnosis of diabetes mellitus ( a group of disease that result in too much sugar in the blood). A review of Patient 5's plan of care (POC) for certification period from 1/12/22 to 3/12/22, indicated an order for the Skilled Nurse (SN) to visit of once a week for 9 weeks, to continue to do skilled nursing assessment of all body system with emphasis on endocrine status (pancreas). One of the nursing intervention was to re-instruct patient/caregiver needing further teaching on diabetic care management. A review of Patient 5's Skilled Nursing Clinical Notes dated 1/13, 1/18 and 1/25/22, indicated an documentation entry of patient teaching regarding Corona virus management for all 3 visit dates, and notes were copied from first visit and pasted on the other SN visits. There were no patient/caregiver teaching regarding the patient's disease process as written in the plan of care. On 1/30/22, at 11 a.m., during an interview with the director of patient care service, she stated the visiting nurse should have done patient teaching on diabetes management and not to copy and paste one teaching to the next visits notes.

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 interview and record review, the home health agency (HHA) failed to provide evidence to ensure a home health aide receive at least 12 hours of in-service training during each 12-month period . This failure had the potential to jeopardize the patient's safety and security due to the staff's lack of knowledge. Findings: On 1/30/22 at 11:30 a.m., a request was made to view the in-service training being provided for the field staff including a home health aide. During an interview with the Director of Patient Care Services on 1/30/22 at 11:30 a.m., she stated there has not been in-services training for the field staff and could not provide documentation. She confirmed the in-services should be provided monthly to all staff. There was no policy for in-service training.