Every finding on record at New Dimension H C

The following reflects the findings of the California Department of Public Health during Recertification Survey, Change of location (CHOL) survey, and Change of Ownership (CHOW) survey from 4/11/2022 to 4/13/2022 at the new location at 2490 Honolulu Ave, Ste.120, Montrose, CA, 91020-1800. Representing the Department of Public Health: Surveyor ID #25046, Health Facilities Evaluator Nurse Surveyor ID # 43979, Health Facilities Evaluator Nurse Surveyor ID #44186, Health Facilities Evaluator Nurse Census:43 Sample Size: 7 Home Visits: 3 Record Review: 2 Closed Records: 2 The home health agency was approved for the change of location as well as the change of ownership. effective 4/13/2022. Old Address: 1212 E. Main St. Suite 4, Alhambra, CA, 91801 New Address: 2490 Honolulu Ave, Ste.120, Montrose, CA, 91020-1800.

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 update the medication profile to reflect the current medications for two of seven sampled patients (Patients 1 and 6). This deficient practice had the potential to put the patient at risk for medication errors and serious adverse drug reactions. Findings: b. A review of Patient 6's clinical record indicated a start of care date of 12/09/21, with diagnoses including right knee osteoarthritis (inflammation of one or more joints, causing pain and stiffness mainly affects joints in your hands, knees, hips and spine), and hypertensive heart disease with heart failure (refers to heart problems that occur because of high blood pressure). A review of Patient 6's Home Health Certification and Plan of Care (POC) for the recertification period from 04/08/22 to 06/06/22, included an order to provide skilled nurse (SN) visits once a week to perform comprehensive assessment, observation and evaluation of all body systems, to assess nutritional status and competency and compliance with dietary and medication regimen. During a joint home visit with the License Vocational Nurse (LVN 1) on 04/12/22 at 11:40 a.m., Patient 6 was observed laying in bed comfortably with her caregiver (CG 1) present at bedside. At 12:15 p.m., a concurrent review of Patient 6's medications was conducted with LVN 1 and an interview with CG 1. The following was observed: 1. The medication profile indicated the patient was taking Chlordiazepoxide-Clinidium 5-2.5mg one tablet every night at bedtime started on 02/02/22. CG 1 stated Patient 6 stopped taking this medication for about one to two months per physician’s order. 2. CG 1 stated Patient 6 is taking Colace 100 mg capsule twice a day for about six months for bowel management. The medication profile did not contain this medication. 3. CG 1 stated Patient 6 is taking Tylenol 650 mg tablet twice a day as needed for pain. The medication profile did not contain this medication. During an interview. with the Director of Patient Care Services (DPCS), on 04/13/22 at 11:50 a.m., the DPCS stated the skilled nurse should check the patient's medications on every visit for changes and the medication profile be updated to reflect the changes. A review of the agency's policy and procedure titled "Medication Profile", revised April 2019, indicated patients receiving medications will have a current, accurate medication profile in the clinical record. The policy indicated medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications. A review of Patient 1's clinical record disclosed a start of care (SOC) dated 3/18/2022, with diagnoses which included removal of surgical wound and gangrene. The Plan of Care (POC) for the certification period from 3/18/2022 to 5/16/2022, included order for the Skilled Nurse (SN) visit once a week for one week, twice a week for four weeks, and once a week for four weeks for skilled nursing evaluation and assessment of all body systems and to assess competency and compliance with dietary and medication regimen. On 4/12/2022, at 10:30 a.m., during a joint home visit with Registered Nurse 1 (RN 1), Patient 3 was observed sitting in a wheelchair. Patient 1 was alert and oriented, and able to communicate well. At 10:55 a.m., Patient 1's medications were reviewed with RN 1. A review of the medication profile indicated the patient was to take Hydrocodone-Acetaminophen [5-325 milligram (mg)] one tablet, every 8 hours, while the patient did not have Hydrocodone-Acetaminophen (5-325 mg) at home. During an interview with Patient 1 at the same time, he stated Hydrocodone-Acetaminophen (5-325 mg) had been discontinued. Instead, he had been taking Morphine Sulfate 15 mg every 12 hours since admission to the agency. On 4/12/2022, at 11”10 a.m., during an interview with RN 1, he stated the medication profile should have been updated to reflect the changes after clarified with the physician. A review of the agency's policy and procedure titled "Medication Profile", revised April 2019, indicated patients receiving medications will have a current, accurate medication profile in the clinical record. The policy indicated medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications.

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 staff failed to assess the wound status and size of the right foot for one of 7 sampled patients (1). This deficient practice can cause delayed wound healing, a decline in the condition of the wound, and could put the patient at risk for infection on the wound site. Findings: A review of Patient 1's clinical record disclosed a start of care (SOC) dated 3/18/2022, with diagnoses which included removal of surgical wound and gangrene. The Plan of Care (POC) for the certification period from 3/18/2022 to 5/16/2022, included order for the Skilled Nurse (SN) visit once a week for one week, twice a week for four weeks, and once a week for four weeks for skilled nursing evaluation and assessment of all body systems with emphasis on integumentary status. The POC indicated the SN was to perform wound care to the right foot, to cleanse with normal saline and pat dry. It indicated the patient will be seen by the wound specialist. On 4/12/2022, at 10:30 a.m., during a joint home visit with Registered Nurse 1 (RN 1), Patient 3 was observed sitting in a wheelchair. At 10:40 a.m., RN 1 removed the old dressing from the patient's right foot and measured the wounds on the right plantar to be 1.5 cm by 1.5 cm by 0.5 cm and on the right lateral foot to be 0.25 cm by 0.1 cm. A review of the wound physician’s note dated 3/30/2022 indicated Patient 1 had wounds on the right plantar [2.2 centimeter (cm) by 2.5 cm by1.4 cm – after debridement] and on the tight lateral foot (2.6 cm by 1.6 cm by 0.5 cm- after debridement). A review of the wound physician’s note dated 4/5/2022 indicated Patient 1 had wounds on the right plantar (2.1 cm by 2.2 cm by1.3 cm - after debridement) and on the right lateral foot (2.5 cm by 1.5 cm by 0.5 cm -after debridement). A review of the Skilled Nursing Visit Note dated 3/22/2022, 3/25/2022, 3/29/2022, 4/1/2022, 4/4/2022, 4/8/2022 indicated there was no documented evidence the wound of right plantar was assessed with wound status, measurement, drainage tissue of wound base and surrounding. and there was no documented evidence the wounds on the right lateral foot was measured in size. On 4/12/2022, at 1:35 p.m., during an interview with the Director of Patient Care Services (DPCS), she stated the SN should have done a proper assessment including status and size of Patient 1's right lateral foot and right plantar wounds. A review of the agency’s policy titled Wound Assessment revised on April 2019 indicated wound condition will be assessed and documented with each clinician visit for all open wounds. Wound measurement and photograph for open wounds are documented weekly.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the Administrator maintained responsibility for the day-to-day operations of the agency. The four currently active contracted certified home health aides (CHHA1, CHHA2, CHHA3, and CHHA4) had no documentation in their personnel files to indicate they were monitored, evaluated, and audited as per the HHA’s policy and procedure. This failure had the potential to result in placing the patients at risk to receive possible unsafe and ineffective care practices. Findings: During an interview on 4/13/2022 at 10 a.m. with the Director of Patient Care Services (DPCS), DPCS stated that there were four contracted CHHA working with the HHA. DPCS stated that they did not have employee files for these four CHHAs. When asked how they monitor, evaluate, and audit the contracted CHHA, the DPCS stated that the CHHA Contractor had their own employee files and verify everything. During an interview on 4/13/2022 at 12 p.m. with the HHA Human Resource (HR), HR stated that they did not have employee files for the four CHHA they were using. A review of HHA’s policy and procedure titled, “Written Agreements for Contracted Services” dated April 2019 indicated, “The organization will retain responsibility for evaluating services, maintaining professional management responsibility, and ensuring continuity of care… Administrator… will monitor, evaluate, and audit the contracted services to ensure that they are being provided according to the contract.”