Every finding on record at Open Arms Home Health Care - Waterloo, LLC

As directed by the Centers for Medicare and Medicaid Services (CMS) Kansas City Location, the Department of Inspections, Appeals and Licensing conducted an unannounced complaint survey for complaint #3016950-C from 6/29/26 to 7/1/26. The complaint survey identified the following: Condition of Participation 42 CFR 484.65 QAPI (Quality assessment and performance improvement), was investigated and no condition level deficiency was identified and one standard level deficiency was identified (G644). The agency reported a census of 38 patients at the time of the survey.

Program data CFR(s): 484.65(b)(1),(2),(3) Standard: Program data. (1) The program must utilize quality indicator data, including measures derived from OASIS, where applicable, and other relevant data, in the design of its program. (2) The HHA must use the data collected to- (i) Monitor the effectiveness and safety of services and quality of care; and (ii) Identify opportunities for improvement. (3) The frequency and detail of the data collection must be approved by the HHA's governing body. This STANDARD is not met as evidenced by: Based on agency staff interview, daily communication sheets and bed bug log, the agency failed to use other relevant data when designing it's Quality Assessment and Performance Improvement (QAPI) program. Failure to identify relevant data that monitors effectiveness and safety of services and quality of care, along with identifying opportunities for improvement, place the agency patients at risk of receiving inappropriate care for identified needs. Findings include: During an Interview on 6/30/26 at 11:30 AM, Staff C, RN Case Manager, reported the facility has had bed bugs for 3 years. In the past, she took the bed bugs to her home from the assisted living facility (ALF) and agency President paid to have the pest control company treat her house. She currently undresses and changes her clothes when she gets home to limit the chance of taking bed bugs home again. She immediately does laundry of her clothes worn that day to limit transmission. During an interview on 6/30/26 at 3:45 PM, Administrator reported bed bugs have been in the ALF building on and off for the last 3 years. The ALF keeps a list of all residents effected by bed bugs, the home health agency does not. The list is updated monthly when pest control company comes into the ALF building. Home health staff are notified of residents with bed bugs in their apartments by reviewing a communication log that is updated daily. Staff are responsible for reading the updated list. Staff are educated at staff meetings regarding transmission of bed bugs, treatments provided for apartments with bed bugs and proper PPE (personal protective equipment) such as long gowns and booties for staff to use. Staff providing homemaking services are instructed to vacuum very good. When the vacuum canister is emptied to wipe it out. The vacuum canister is emptied in dumpster immediately. The pest control company was last in the ALF about 2 weeks ago. During an interview on 7/1/26 at 9:15 AM, Corporate Administrator reported home health agency has not tracked patients with bed bug infestations. Bed bugs are prevalent in the Waterloo community, such as local casino and on public buses, it is not feasible for the agency to prevent home health patients from using public buses. Home health patients use the public buses and bring the bed bugs back into the building. Teaching is being done with staff and residents of the ALF. This is being tracked internally but is not part of the home health QAPI program. Corporate staff are aware of the issue and review at the corporate level. Screenings are being done to find bed bugs before it gets bad, The pest control company is bringing in bed bug detecting dogs monthly to help detect bed bugs early. Daily Communication Sheet, dated 6/16/26, identified the following apartments were treated yesterday (6/15/26) for bed bugs: a. Patient #7- apartment #124 b. Patient #8- apartment #203 c. Patient #9- apartment #205 d. Patient # 10- apartment #216 Daily Communication Sheet, dated 6/23/26, identified pest control company at ALF: chemically treating Patient # 11 apartment 324. Apartments that were determined to be cleared from bed bugs: a. Patient #7- apartment #124 b. Patient #8- apartment #203 c. Patient #9- apartment #205 d. Patient #10-apartment #216 e. Patient #12- apartment #106 f. Patient #1- apartment #305 Undated Bed Bug Log, emailed to surveyor on 7/1/26 at 10:38 AM, identified 6 apartments with date bed bugs found and date bed bugs treated columns, all dates were for June 2026. a. Patient #7- apartment #124 b. Patient #8- apartment #203 c. Patient #9- apartment #205 d. Patient #10- apartment #216 e. Patient #11-apartment #324 f. Patient #12- apartment #106 The agency failed to identify the bed bug infestation in the QAPI plan. The above findings were reviewed with Administrator and Corporate Administrator.