Every finding on record at Newstart Home Care Services Inc

A Recertification Survey entrance conference was conducted on 06/06/2023 with the Administrator at 9:37 AM. Census L&CHHS: 4 LHHS: 0 An exit conference was conducted on 06/08/2023 with the Administrator and LVN at 2:12 PM. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies.

A Recertification Survey entrance conference was conducted on 06/06/2023 with the Administrator at 9:37 AM. Census L&CHHS: 4 LHHS: 0 An exit conference was conducted on 06/08/2023 with the Administrator and LVN at 2:12 PM. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies.

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 agency failed to review all current client medications for 2 of 2 clients (Client #1 and Client #3). This failure caused the agency to be out of compliance and puts clients at risk for adverse health events and reduced healing. The findings include: Medication lists were not current for 2 of 2 clients (Client #1 and Client #3) during home visits. Client #1 was interviewed on 6/7/2023 at 10:31 AM and stated that they were taking multiple medications not listed on the medication list and that they had stopped many of the medications still on the list. Doses, medication form, and frequencies were incorrect for many medications for Client#1. The plan of care indicated Client #1’s medications Meloxican 15 mg Tablet, Potassium Chloride 10 MEQ daily, Oxybutinin Chloride 10 mg tablet daily, Trazadone Hydrochloride 100 MG tablet daily,Triamcinolone acetonide 0.1 mg/.1G Cream daily, Valium 2 MG daily as needed, Valsartan 80 MG BID, Myrbetriq 25 MG daily, B-12 1000 UG Tablet daily, and Gemtesa 75 MG daily. Client #1 indicated that she did not take nor did she have Meloxicam, Potassium Chloride, Trazadone Hydrochloride, Triamcinolone acetonide, Valium, Myrbetriq, or Gemtesa. Client #1 indicated that she takes Oxybutinin 5 mg tablet twice daily, Valsartan 160 mg tablet twice daily, B-12 1000 UG liquid daily, Restasis twice daily for dry eye, hydrochlorothiazide 12.5 mg tablet once daily, hydrocortisone 2.5%, and a probiotic as needed.The medication list for Client #3 contained many medications that she was not taking and did not have in the home. Client #3 was interviewed on 6/7/2023 at 11:25 AM to confirm medication list. Plan of care included Amlodipine 10 mg daily, Lipitor 20 mg daily. Client #3’s available medications included Amlodipine 5 mg daily and Lipitor 10 mg daily. Client #3 also possessed and stated that she was currently taking a probiotic, tacrolimus 1 mg, magnesium-oxide 400 mg, pantoprazole 40 mg, tradjenta 5 mg, azithromycin 250 mg, fero-sul, mycophenolate 500 mg, propranolol, and vitamin D3. None of these medications are listed in the plan of care or medication list. LVN stated on 6/7/23 at 11:25 AM that she had sent a list in to the agency for Client #3 and that she was uncertain why it was not updated. The administrator on 6/8/23 at 11:28 AM stated that medication lists should be updated whenever there is a new medication or whenever re-certification occurs. Agency policy titled “Medication Administration” stated “(1) The nurse will check all medications that the patient is taking on every visit to determine accuracy against physician orders. (2) All medications including over the counter medications and home remedies will be recorded on the Medication Profile and/or change orders.”

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, record review, and interview, the agency failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases regarding reusable medical equipment between each patient and when soiled for 2 of 2 Clients (Client#1 and Client #3) for which home visits were completed in that LVN did not sanitize their stethoscope before or after client assessments. This failure caused the agency to be out of compliance and puts clients at a greater risk of infection. The findings include: Observations and home visits on 6/7/23, at 10:31 AM and 11:10 AM respectively, of 2 of 2 Client home visits ] (Client#1 and Client #3), LVN did not sanitize their stethoscope before or after client assessments. During an interview on 6/7/2023 at 11:30 AM with LVN When asked about the procedure for disinfecting multiuse items such as stethoscopes, LVN stated “You are right, I should have cleaned my stethoscope before and between patients. The policy is to use alcohol wipes and I just forgot.” Administrator was interviewed on 6/8/2023 at 11:28 AM determine if a policy existed for sanitizing multi-use equipment items. Administrator responded “I don’t know, I’d have to look.” Administrator never provided a policy covering sanitization of equipment used for multiple patients. Policy titled “Infection & Exposure Control Program,” not dated, was reviewed. The policy described procedures for cleaning items visibly soiled with blood or other secretions, but did not describe multi-use items. Record review of the Centers for Disease Control (CDC) website https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf (2019) revealed in part, “within ambulatory and home care settings, non-critical items such as stethoscopes, blood pressure cuffs, and crutches should be sanitized between patients to prevent the spread of infection (Rutala et al., 2019). Non-critical items can contribute to secondary transmission of disease and infection by contaminating hands of healthcare workers and through contact of subsequent clients (Rutala et al., 2019).”