Every finding on record at Partners Home Health Care, Inc

The following reflects the findings of the California Department of Public Health during a Recertification survey at this location: 554 E. Foothill Blvd., San Dimas , CA 91773. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 44802, Health Facilities Evaluator Nurse Unduplicated Admissions - 745 Active Patients - 136 Sample Size - 17 Home Visits- 7

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/drill for all office and field staffs are conducted in an annual basis. This failure had the potential for the staff to lack the knowledge to respond effectively during a emergency/disaster situation. Findings: During a review of the home health agency (HHA) In-service training for Emergency preparedness indicated the Administrator (Admin) affixed her signature indicating the HHA mailed handouts/pamphlets to their field staffs. During an interview with the Admin on 7/29/22, at 4:17 p.m., stated the HHA was not able to conduct the In-services for Emergency Preparedness training/disaster drill for all office and field staffs. Admin also stated there was no means in tracking all the staffs had received the in-services handouts or pamphlets mailed to them. The HHA's policy and procedure titled "Emergency Management Plan" indicated all staff members will be oriented to the emergency preparedness plan and their responsibilities will be reviewed annually. Annually, the specific plan will be evaluated via drill to see any improvement needed. A post-event assessment will be completed after any initiation of the emergency plan, and improvements will be made appropriate. Additionally, the plan will be reviewed annually.

The following reflects the findings of the California Department of Public Health during a Home Health Recertification Survey at the agency's new location: 554 E. Foothill Blvd., San Dimas, CA 91773 Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 44802, Health Facilities Evaluator Nurse Unduplicated Admissions - 745 Active Patients - 136 Sample Size - 17 Home Visits- 7 Old address: 815 S Central Ave Suite 26 Glendale, Ca 91204 New address: 554 E. Foothill Blvd., San Dimas , CA 91773 An onsite visit was also made to Partners Home Health Care, Inc for the purpose of determining compliance with the California Code of Regulations, Title 22 for home health agency. The agency was was approved for the change of ownership and change of location effective 7/31/22.

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 maintain a current medication profiles for seven of 17 patients (Patients 1, 2, 3, 9, 10, 11, and 12). This failure placed the patients at risk for medication errors and adverse drug reactions which can be life threatening. d. A review of Patient 9’s document titled “Home Health Certification and Plan of Care “for the certification period of 7/4/2022 to 9/1/2022 indicated that Patient 9 is an 87 year old male with a start of care (SOC) date of 7/4/2022 with the medical diagnosis of hypertensive chronic kidney disease ( is elevated blood pressure caused by kidney disease. It can usually be controlled by blood pressure drugs) and Type 2 diabetes (A chronic condition that affects the way the body processes blood sugar). Patient 9 is homebound, has poor endurance, have a hard time walking and mostly in bed or chair, unable to leave home unassisted. A review of Patient 9’s plan of care indicated skilled nursing (SN) visit frequency is 2 times a week for 2 weeks and once a week for 7 weeks. SN to assess vital signs ( blood pressure, temperature, heart and breathing rate)SN to check low or high blood sugar level, signs and symptoms of high or low blood pressure, breathing patterns, check, measure, appearance, drainage, color surrounding tissue, healing process of pressure ulcer on buttock. On 7/30/22 at 12:01 p.m., Arrived at Patient 9’s home, daughter obliged for a phone visit instead. On medication phone review, daughter stated that the patient is not taking the following medications and is not present at the home. Tramadol 50 milligrams (mg-a unit of measure) 1 tablet every 6 hours as needed for painNitrostat 0.4 mg under the tongue as needed for chest pain.Tylenol 1 grain (gr- equals to 60 mg) 2 tablets every 4 hours as needed for painInsulin Humalog inject thru the skin if blood sugar is: 150-200 mg/dl (milligram per deciliter (dl-unit of fluid measurement) give 2 units(measurement ); 201-250 mg/dl, give 4 units; 251-300 mg/dl. give 6 units; 301-350 mg/dl, give 8 units and 351-400 mg/dl, give 10 units of insulin. Ferrous Sulfate 325 mg 1 tablet daily for supplement. Per daughter, insulin was changed to Tradjenta 5 mg 1 tab daily, tramadol, nitrostat and Tylenol are not taken by the patient for a few months now. During a phone interview of Licensed Vocational Nurse 3 (LVN 3) on 7/31/22 at 2:37 p.m., LVN 3 stated that she reviews medication every visit. LVN 3 further stated that she sends a message to the case manager for updates in medication. During a concurrent interview with the Administrator (Admin) and Director of Patient Care designee (DPCS designee) on 7/31/22 at 1:25 p.m., both stated the skilled nurses should review the medications every visit. e. A review of Patient 10’s document titled “Home Health Certification and Plan of Care “for the certification period of 6/8/22 to 8/6/22 indicated that Patient 10 is an 82-year-old female with a start of care (SOC) date of 8/12/21 with the medical diagnosis of stroke (is a cerebral infarction occurs because of disrupted blood flow to the brain due to problems with the blood vessels that supply it. A lack of adequate blood supply to brain cells deprives them of oxygen and vital nutrients which can cause parts of the brain to die off.) and epilepsy (is a brain disorder that causes recurring, unprovoked seizures). Patient 10 is homebound, has poor endurance, have a hard time walking and mostly in bed or chair, unable to leave home unassisted. A review of Patient 10’s plan of care indicated skilled nursing (SN) visit frequency of once a week for 9 weeks. SN to assess vital signs (blood pressure, temperature, heart and breathing rate) SN to check suprapubic catheter (a tube drains urine from your bladder. It is inserted into your bladder through a small hole in your belly), signs and symptoms of high or low blood pressure, breathing patterns, level of consciousness, signs and symptoms of infection and compliance with prescribed medication and diet regimen. A home visit was conducted on 7/30/22 at 11:30 a.m., with Patient 10’s family member 1 (FM 1) stated that the nurse does not check medications every visit. FM 1 stated he bought supplements from Costco and prints out his own medication list. During a medication review with FM 1, Patient 10’s medication is as follows: Diazepam 10 mg 1 tablet three times a day as needed. FM 1 stated patient 10 takes 1 tablet at bedtime for anxietyEliquis 2.5 mg 1 tablet twice daily for stroke prophylaxisSynthroid 150 micrograms (mcg- unit of measurement) 1 tablet daily for low thyroid hormoneLosartan 50 mg/12.5 mg 1 tablet daily for high blood pressure. The medication label indicated 100 mg/12.5 mg 1 tablet daily.Divalproex Sodium ER (extended release) 500 mg 1 tablet daily for epilepsyMagnesium 400 mg 1 tablet daily for supplementPantoprazole Sodium ER 40 mg 1 tablet daily for heartburnDilantin 100 mg 1 tablet twice daily changed to three times daily for epilepsyVitamin C 1000 mg daily for supplementZinc 50 mg 1 tablet daily for supplementMultivitamins 1 tablet daily for supplement COQ10 300 mg 1 tablet daily for supplement Vitamin D3 5000 units 1 tablet daily. FM 1 bought 1000 units per tablet. FM 1’s list showed 1 tablet in the morning and 1 tablet at night equals only 2000 units daily as supplementIron 65 mg 1 tablet daily as supplementTurmeric 500mg 1 tablet daily for supplement. FM 1 showed Turmeric 1000 mg on bottle. Myrbetriq 50 mg ER daily for overactive bladder. During a medication review and interview with FM 1 stated the following medications are being taken by Patient 10: Tylenol 500 mg/Diphenhydramine 25 mg 2 tablets in the morning and 2 tablets at night for pain. Total of Tylenol 1000 mg/Diphenhydramine 50 mg every morning and at night. FM stated, “It works for her pain.” Probiotic 10 mg 1 tablet in the morning and 1 tablet in the afternoon. Cymbalta 60 mg 2 capsules daily for depressionTramadol 50 mg 1 tablet every 6 hours as needed for painGrapeseed oil 1 capsule daily for supplementVitamin B complex 1 capsule daily for supplement. During a phone interview on 7/31/22 at 2:32 p.m., with LVN 2, stated he checks medication every visit. LVN 2 further confirmed that he asks Patient 10’s husband for new prescriptions and add it to medication profile. f. A review of Patient 11’s document titled “Home Health Certification and Plan of Care” for the certification period of 6/26/22 to 8/24/22 indicated that Patient 11 is a 68-year-old male with a start of care (SOC) date of 4/27/22 with the medical diagnosis of type 2 diabetes and pulmonary embolism (a condition in which one or more arteries in the lungs become blocked by a blood clot). Patient 11 is homebound, has poor endurance, use a cane for walking, requires blood sugar checking and insulin administration twice a day and unable to leave home unassisted. A review of Patient 11’s plan of care indicated skilled nursing (SN) visit frequency of twice a day for 60 days. SN to assess vital signs (blood pressure, temperature, heart and breathing rate) SN to check blood sugar and signs and symptoms of high or low blood sugar and high and low blood pressure, breathing patterns, level of consciousness, signs and symptoms of infection and compliance with prescribed medication and diet regimen. During a home visit and review of Patient 11’s medication profile on 7/30/22 at 8:30 a.m., revealed the following medications: Colace 100 mg every 12 hours for constipationTylenol 325 mg 1 tablet every 4 hours as needed for painRisperidone 2 mg 1 tablet daily irritability, on facility’s medication list, Patient 11 is currently taking Risperidone 0.5 mg 1 tablet dailyFarxiga 5 mg 1 tablet daily for heart failure finished on 7/29/22Basaglar 100 units/ml (milliliter-ml unit of liquid measurement) inject 30 units under the skin at night for diabetes. On facility medication list indicated finished on 7/15/22Humalog 100 units/ml pen injector 10 units under the skin twice a dayAspirin 81 mg 1 tablet daily for stroke prophylaxisVitamin D 2000 units 1 tablet daily as supplementFinasteride 5 mg 1 tablet daily for enlarged prostate Tolterodine 4 mg 1 capsule daily for overactive bladderDuloxetine 60 mg 1 capsule twice daily for neuropathy (is damage or dysfunction of one or more nerves that typically results in numbness, tingling, muscle weakness and pain)Gabapentin 300 mg 1 tablet twice daily for neuropathyFlomax 0.4 mg 1 capsule daily for urinationAtorvastatin 40 mg 1 tablet at bedtime for high cholesterolXarelto 20 mg 1 tablet daily for blood clots. Not documented in the HHA’s plan of care During an interview on 7/30/22 at 8:30 a.m., with Registered Nurse 1 (RN 2) stated she is not the regular nurse who visits the patient. RN 2 further stated she should review the medication profile every visit. During an interview on 7/31/22 at 1:25 p.m., with the DPCS designee, stated “As much as I want them to, they should check the medication at least daily even if the patient is seen twice daily”. g. A review of Patient 12’s document titled “Home Health Certification and Plan of Care” for the certification period of 7/18/22 to 9/15/22 indicated that Patient 12 is a 74-year-old male with a start of care (SOC) date of 7/18/22 with the medical diagnosis of hypertensive heart disease (refers to heart problems that occur because of high blood pressure that is present over a long time). Patient 12 is homebound, has poor endurance, use a walker to walk for short distances, requires blood testing for long term anticoagulant use and unable to leave home unassisted. A review of Patient 12’s plan of care indicated skilled nursing (SN) visit frequency is for evaluation only. SN to perform skilled assessment and evaluation of all bodily systems, patient/caregiver compliance with medication regimen, assess and establish home bound status of patient, check and instruct on current medications, home safety, precautionary measures and signs and symptoms to report to physician. Physical therapy visits once a week for 1 week Frequency of visits to follow post evaluation/ assessment. A home visit was conducted with RN 2 on 7/30/22 at 1:00 p.m., during a medication review one medication was not documented on the medication profile: Metoprolol 25mg 1 tablet daily for high blood pressure. On concurrent interview with FM 2 stated “What he has on the box are his current medications”. During an interview with RN 2 on 7/31/22 at 1:45 p.m., RN 2 stated that she should checks patients medication every visit. A review of the HHA’s document titled “Medication Reconciliation” reviewed 1/10/22 revised February 2021 indicated that the agency will reconcile patient’s medications at time of admission and on an ongoing basis in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, duplicate drug therapy and noncompliance with drug therapy. Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication. The patient’s medication list in the home will also be updated. a. A review of Patient 1's profile indicated a Start of Care (SOC) on 7/9/2022, with primary diagnosis of encounter for attention to colostomy (a surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall), constipation and malignant neoplasm (cancer) of the bladder. A review of Patient 1's Plan of Care (POC) for certification period 7/9/2022 to 9/6/2022, included an order for a Skilled Nurse (SN) to visit once a week for the first week, twice a week for three weeks and then once a week for five weeks to perform skilled observation and assessment of vital signs, colostomy site, and compliance and effectiveness of medications, actions and side effects, dosage and frequency. On 7/30/2022, at 10:30 am, a home visit was conducted with Registered Nurse (RN 1) at Patient 1’s home residence. Patient 1 was alert, oriented and was laying on a sofa in the living room. RN 1 checked Patient 1’s vital signs and assessed Patient 1’s colostomy site. RN 1 was observed not checking or ask Patient 1’s current medications. During an interview at 11:00 am, RN 1 stated that she does not check the medications every visit. RN 1 stated that she asks the patients, or the patient will tell her if they have any new medications. b. A review of Patient 2's profile indicated a Start of Care (SOC) on 2/23/2022, with primary diagnosis of hypertensive chronic kidney disease and heart transplant. A review of Patient 1's Plan of Care (POC) for the certification period 06/23/2022 to 8/21/2022, included an order for a Skilled Nurse (SN) visit to visit once a week for nine weeks to perform skilled observation and assessment of vital signs, assess cardiopulmonary and renal status, and compliance and effectiveness of medications, actions and side effects, dosage and frequency. On 7/30/2022 at 11:15 a.m., a tele visit (virtual) communication was conducted with LVN 1 at Patient 2’s residence. Patient 2 was sitting on her couch in her living room. LVN 1 assessed Patient 2's vital signs, performed cardiopulmonary (heart and lung) assessment, and checked medications. During an observation and interview on 7/30/2022 at 11:30 a.m., LVN 1 stated Patient 2 was taking Cellcept (immunosuppressant medication to prevent rejection following organ transplant) 250 mg/capsule, take 2 capsules by mouth in the morning at 8 am and 2 capsules in the evening at 8 pm. However a review of the Medication Profile indicated Cellcept 250 mg/capsule, take 2 capsules by mouth in the morning at 8 am and 2 capsules in the evening at 8 pm, was discontinued on 6/19/2022. There was no review conducted by the skilled nurse to ensure the accuracy of the medication profile by reconciling the actual patient's medication currently taken at home. During an interview on 7/30/2022, at 11:37 a.m., Patient 2 stated the SN does not do it every visit because her medications have not changed. c. A review of Patient 3's profile indicated a Start of Care (SOC) on 6/14/2022, with primary diagnosis of attention to ileostomy and malignant neoplasm (cancer) of the colon. A review of Patient 3's Plan of Care (POC) for certification period 6/14/2022 to 8/12/2022 included an order for a Skilled Nurse (SN) visit to visit once a week for nine weeks to perform skilled observation and assessment of vital signs, assess cardiopulmonary and renal status, and compliance and effectiveness of medications, actions and side effects, dosage and frequency. On 7/30/2022, at 9:00 a.m., a home visit was conducted with RN 1 at Patient 3’s residence. Patient 3 was observed alert and oriented. RN 1 assessed Patient 3's colostomy site. During an interview on 7/30/2022 at 9:40 a.m., Patient 3 stated she only takes three pills as follows: Pantoprazole, 40 mg, DR, 1 tablet by mouth daily Synthroid, 75 mcg, 1 tablet by mouth daily Zinc, 30 mg, 1 tablet by mouth daily Patient 3 further stated she stopped taking the following medications identified in the Medication Profile as follows: -Betamethasone-Clotrimazole, 0.05%-1% topical cream, apply to affected area as directed -Progesterone, 100 mg, 1 capsule by mouth daily -Tramadol, 50 mg, 1 tablet by mouth every 6 hours as needed for pain -Mesalamine, 800mg, DR, 2 tables by mouth 3 times a day -Tarconazole 0.4 % vaginal cream, apply as directed by physician -Cholecalciferol, 400 units, 1 tablet by mouth daily There was no documented evidence the SN updated Patient 3's medication profile. During an interview on 7/31/20, at 12:45 pm, the Registered Nurse Supervisor (RNS) stated the SN should reconcile medications every visit and after the home visit, should call the HHA or physician to notify them of the update. A review of the HHA’s policy, Medication Profile dated 2/2021, indicated the agency will reconcile patient’s medication at the time of admission and on and ongoing basis 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.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to develop and implement an individualized plan of care (POC) for 3 of 3 patients receiving anticoagulant (blood thinners-to prevent and treat blood clots) medications in a sample of 7 patients (Patients 1, 9 and 12). This failure had the potential to cause serious complications that could affect the patients health status and well being. b. A review of Patient 9's profile indicated a Start of Care (SOC) on 7/4/2022, with primary diagnosis of hypertensive chronic kidney disease (is high blood pressure caused by the narrowing of your arteries that carry blood to your kidneys ), type 2 diabetes mellitus (is an impairment in the way the body regulates and uses sugar (glucose) as a fuel). A review of Patient 9's Plan of Care (POC) for certification period 7/4/2022 to 9/1/2022, included an order for a SN to visit twice a week for two weeks, once a week for for seven weeks to perform skilled observation and assessment of vital signs, pain and comfort status, wound care and assessment and compliance and effectiveness of medications, actions and side effects, dosage and frequency. A review of Patient 9's Medication Profile file indicated Aspirin (anticoagulant) 81 mg 1 tablet by mouth daily for cerebrovascular accident prophylaxis. On 7/30/2022 at 12:02 p.m., a phone/home visit was conducted with the Durable power of Attorney (DPOA) at Patient 9’s residence. Patient 9's DPOA refused the survey team to go inside home. DPOA stated the patient was asleep inside his room after physical therapy today. DPOA conducted medication review while on the phone. Per DPOA stated Patient 9 has been on long term Aspirin use and has a wound on his buttocks. Further review of Patient 9's clinical record indicated no evidence a care plan was developed for the anticoagulant medications taken by the patient. c. A review of Patient 12's profile indicated a SOC on 7/18/2022, with primary diagnosis of hypertensive chronic kidney disease (is high blood pressure caused by the narrowing of your arteries that carry blood to your kidneys) and long term use of anticoagulants. A review of Patient 12's POC for certification period 7/18/2022 to 9/15/2022, included an order for a SN for evaluation only. Physical Therapy once a week for one week. Frequency of visits to follow after evaluation/assessment. A review of Patient 12's Medication Profile file indicated Coumadin (anticoagulant) 2 mg 1 tablet by mouth daily for cerebrovascular accident prophylaxis. There was no care plan developed for the use of Coumadin medication. During the concurrent interview and record review on 7/31/2022, the DPCS designee (Director of Patient Care Designee ) stated the HHA did not have a policy for anticoagulant use. DPCS designee stated they use Mosby and handed a copy of the reference the HHA use signed and dated on 7/31/22. On review of the said reference indicated to instruct the patient/caregiver to report any signs of bleeding, black colored stools, or blood in the urine. If bleeding occurs, instruct the patient/caregiver to hold a pressure dressing to the site and to notify the HHA and the physician. Instruct the patient /caregiver in Coumadin administration to include the following bleeding precautions: 1. No rectal temperatures, enemas, suppositories 2. Do not use a straight razor or nail clippers. 3. Use a soft toothbrush 4. Wear slippers when walking, protect the feet 5. Do not pick at scabs or wounds 6. Avoid activities that may cause cuts or bruising 7. Avoid aspirin containing drugs; take coumadin at the same time each day Findings: a. A review of Patient 1's profile indicated a Start of Care (SOC) on 7/9/2022, with primary diagnosis of encounter for attention to colostomy (a surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall), constipation and malignant neoplasm (cancer) of the bladder. A review of Patient 1's Plan of Care (POC) for certification period 7/9/2022 to 9/6/2022, included an order for a Skilled Nurse (SN) to visit once a week for the first week, twice a week for three weeks and then once a week for five weeks to perform skilled observation and assessment of vital signs, colostomy site, and compliance and effectiveness of medications, actions and side effects, dosage and frequency. On 7/30/2022 at 10:30 am, a home visit was conducted with Registered Nurse (RN 1) at Patient 1’s residence. Patient 1 was alert, oriented and was lying on a sofa in the living room. RN 1 checked Patient 1’s vital signs and assessed Patient 1’s colostomy site. A review of Patient 1's Medication Profile file indicated Apixaban (anticoagulant) 5 milligrams (mg) 2 tablets by mouth twice a day till 07/11/2022 then 1 tablet by mouth twice a day thereafter. Further review of Patient 1's clinical record indicated no care plan was developed identifying the use of the anticoagulant medications. During an interview on 7/31/2022 at 1:25 pm, the Administrator (ADM) stated patients on an anticoagulant should have a care plan to check for signs and symptoms of bleeding.

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, interview, and record review, the home health agency (HHA) failed to implement Coronavirus Disease 19 (COVID-19, a respiratory viral infection that affects primarily the lungs and results in cough and difficulty breathing) screening policy and procedure. This failure had the potential to spread infection to staffs, patients, and visitors. During an observation on 7/29/2022, at 2:15 pm, there was no screening for COVID-19 signs and symptoms (fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea) or temperature check performed upon entry to the HHA. During an interview on 7/29/2022, at 5:45 pm, the Administrator (ADM) stated they followed the Centers of Disease Control Guidelines but had stopped screening staff for COVID-19 signs and symptoms and temperature daily in March 2022 because everyone was fully vaccinated or had COVID-19. The ADM stated they only tracked staff who were COVID-19 positive and staff who were exposed. The ADM stated their previous process for screening for COVID-19 signs and symptoms was important because they needed to know when the symptoms started as part of the exposure monitoring. ADM stated that COVID-19 symptoms should be tracked because staff who have symptoms may not test positive for COVID-19 because of the viral incubation period. ADM stated someone could test negative and have COVID-19 symptoms but then test positive a couple days later. A review of the Centers for Disease Control Guidelines, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, dated 2/2/2022, indicated recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic which included establishing a process to identify anyone entering the facility, regardless of their vaccination status, who as any of the following three criteria so that they can be properly managed: 1) a positive viral test for SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2, the virus that causes a respiratory disease COVID-19) , 2) symptoms of COVID-19 or 3) close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for healthcare personnel). The guidance indicated it applied to all United States settings where healthcare is delivered, including home health.