Every finding on record at Nhc/Op, LP

An onsite unannounced Emergency Preparedness Program Survey was conducted at NHC Home Health Greenwood from 04/29/24 to 05/02/24. The Home Health Agency is in compliance with the Medicare Conditions at 42 CFR 484.102 (Establishment of the Emergency Program).

An onsite unannounced Recertification Survey was conducted at NHC Home Health Greenwood from 04/29/24 to 05/02/24. The Home Health Agency is in substantial compliance with Medicare Conditions at 42 CFR PART 484 with standard level deficiencies cited.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record review and interview, the home health facility failed to ensure Physician orders for patients were followed for 1 of 2 patient wounds observed. (Patient #6) Findings include: Patient #6 was admitted to home health on 3/14/24 for a right lower extremity wound. Registered Nurse (RN) #4 visited the patient on 4/30/24 and reported he/she normally cleans the wound with saline but with no saline available, RN #4 stated he/she was going to clean the wound with soap and water then proceeded to do it before redressing. Record review on 4/30/24 at 10:15 AM of Patient #6 showed Physician orders read “cleanse with wound cleanser". RN #4 confirmed in an interview on 4/30/24 at 11:00 AM, he/she normally uses saline for the wound. During an interview on 5/02/24 at 9:30 AM, RN #4 confirmed he/she had been using saline for the wound cleansing throughout the course of treatment, not the wound cleanser prescribed.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency failed to ensure the medication lists was accurate for 3 of 4 home patient visits observed. (Patients #4, #5 and #6). Findings include: During a home visit on 4/30/24 at 11:20 AM of Patient #4 revealed Registered Nurse (RN) #3 was observed reconciling the patient's medications list with the medications Patient #4 was taking and discrepancies were revealed. The Medication list included Mucinex 10 milligrams daily the patient reports she/he is not taking. The patient is also using Clortrimazole and “Vein Formula” which is not listed on the patient’s Medication List. During an interview on 4/30/24 at 11:50 AM, RN #3 confirmed the findings. During a home visit on 4/30/24 at 10:15 AM of Patient #5 revealed Registered Nurse (RN) #4 was observed reconciling the patient's medication list with the medications Patient #5 was taking and discrepancies were revealed. The Medication list did not include Amlodipine 5 milligrams daily, Aspirin 325 milligrams daily and Hydrocodone 10-325 milligrams as needed every 8 hours which the patient is taking per the caregiver. During an interview on 4/30/24 at 10:55 AM, RN #4 confirmed the findings. Record review on 04/30/24 at 10:15 AM of Patient #6 revealed Pt #6 was admitted to the home health on 3/14/24 for a right lower extremity wound. The patient's order dated 3/11/2024 called for the patient to be seen twice a week for 7 weeks for wound care by the nurse. During a home visit on 4/30/24, RN #4 performed wound care for the patient and reported that he/she normally cleans the wound with saline but with no saline available, he/she proceeded to clean the wound with soap and water before redressing it. The Physician order reads “cleanse with wound cleanser, apply enzymatic salve 3 times a week”. During an interview on 5/02/24 at 9:30 AM, RN #4 stated that he/she had been using saline for the wound cleansing throughout the course of treatment, not the medicated wound cleanser prescribed.

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 home health facility failed to ensure staff are following standard precautions when examining patients in the home. For 2 of 4 home visits made, the Registered Nurse (RN) did not sanitize the stethoscope diaphragm before or after use on the patient. (Patients #4 and #7) Findings include: During a home visit on 04/30/24 at 11:20 AM observation of Patient #4 revealed the Registered Nurse (RN #3) took a stethoscope from his/her nursing bag and put it around his/her neck. RN #3 then put the stethoscope from his/her neck and placed it on the patient without first sanitizing it. After the examination, RN #3 took the stethoscope off of the patient and placed it around his/her neck and did not disinfect the stethoscope before replacing it back in a nursing bag. In an interview on 04/30/24 at 11:50 AM, RN #3 acknowledged the breach in standard precautions. During a home visit on 04/30/24 at 1:30 PM observation of Patient #7 revealed the Occupational Therapist (OT #8) took the stethoscope from the bag and placed it around his/her neck. OT #8 then took the stethoscope from his/her neck/hair and placed it on the patient’s chest without first sanitizing it. After examining the patient, OT#8 returned the stethoscope to his/her neck without sanitizing it, then proceeded to place it in his/her nursing bag. In an interview on 04/30/24 at 2:10 PM, OT#8 acknowledged by stating, “I know, I forgot”.