Every finding on record at Premier Home Health Inc

An Emergency Preparedness survey was conducted by Healthcare Licensing and Surveys on 2/6/25. Based upon the findings of the survey, it was determined that no deficiencies were identified pertaining to the Emergency Preparedness Rule.

A recertification survey was conducted by Healthcare Licensing and Surveys from 2/3/25 to 2/6/25.

Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and client and spouse interview, the agency failed to ensure physician orders integrated into the patient care for Occupational Therapy for 1 of 7 clients reviewed (#5). The findings were: Review of the medical record for client #5 showed the client's start of care was dated 8/7/24. The client's diagnoses included pressure ulcer of right ankle, unstageable, hereditary motor and sensory neuropathy, and chronic pain syndrome. Review of the plan of care (POC) dated 12/5/24 to 2/2/25 showed "Safety Measures: Fall Precaution/Transfer Safety, Keep Pathways Clear, and Proper use of Assistive Devices." The Rehabilitation Potential showed good. The following concerns were identified: 1. Review of the 8/7/24 to 10/5/24 POC showed the "Physician Certification and Signature, I certify that this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy (PT) and/or speech therapy or continues to need occupational therapy (OT)..." dated 9/17/24. 2. Review of the physician orders dated 8/7/24 showed orders for PT and OT. Review of the client's therapy notes failed to show OT notes. 3. Review of the physician orders dated 1/29/25 showed orders for PT and OT. Review of the client's therapy notes failed to show OT notes. 4. Interview with the client and spouse on 2/4/25 at 1:30 PM revealed OT still had not come. They stated they were still waiting for OT; the physician ordered the service when they started with the agency and again recently. The client stated s/he needed help with transferring. 5. Interview with the administrator on 2/5/25 at 9:45 AM verified there were no notes of why there was no OT services, and why services were not provided.

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, staff interview and policy and procedure review, the agency failed to ensure infection prevention practices were performed during 1 of 3 client home visits (#6) while providing cares. The findings were: 1. Review of the Plan of Care (POC) certification period 1/16/25 to 3/16/25 for client #6 showed durable medical equipment (DME) and Supplies included wound care, 4 by 4 gauze, wound cleanser, foam dressing, and gloves. The rehabilitation potential was good. The orders and goals included "Wound Care to Left elbow traumatic partial thickness wound: Observation and Assessment Wound for Signs and Symptoms of infection and report to MD. The frequency was weekly and as needed. Clean wound with normal saline or non-cytotoxic wound cleanser. Dress with tegaderm or foam dressing as appropriate for drainage and depth..." The following concerns were identified: a. Observation on 2/5/25 at 11 AM with RN #1 showed the nurse providing wound care. She preformed hand hygiene, donned gloves, opened the dressing package, cleansed the wound. She continued on to dressing the wound without doffing gloves, hand hygiene, and donning clean gloves. b. Interview with the nurse on 2/5/25 at 12:05 PM confirmed she had failed to changes gloves between dirty and clean dressing change. c. Interview with the administrator on 2/6/25 at 10:15 AM revealed it was the agency's expectation for staff to change gloves between dirty and clean wound care dressing change. 2. Review of policy/procedure "Universal Precautions for Patient and Caregivers/Fluid Precautions" faxed on 2/7/25 at 3:113 PM from agency showed "...Wash or sanitize hands before and after donning and doffing gloves. Apply clean gloves prior to applying fresh dressing..."

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation, staff interview, professional standard review, and policy and procedure review, the agency failed to ensure supplies available for client use were not expired for 1 of 1 supply room. The findings were: 1.Observation of the supply room on 2/4/25 at 9:35 AM showed the following concerns: a. 6 Kendall silicone bordered lite dressing 6 by 6 inch expired 12/19/24. b. 10 Kendal silicone bordered lite foam dressing 4 by 4 inch expired 9/16/24. c. 130 Kendall silicone bordered lite foam dressing 2 by 5 inch expired 11/16/24. d. 84 Kendall silicone bordered lite foam dressing 1.6 by 2 inch expired 12/19/24. e. 1 Dover 100 percent silicone foley tray with coude' tip expired 10/1/22. f. 48 BD 14 French intermittent catheter expired 10/31/24. g. Heparin lock flush solution 30 USP units per 3 milliliter 23 expired 11/2024, 4 expired 9/2024, and 16 expired 2/2024. 2. Interview with the administrator on 2/4/25 at 10:15 AM revealed the supplies were checked monthly for expirations, and they were for client use. She confirmed the identified supplies were out of date.

A recertification survey was conducted by Healthcare Licensing and Surveys from 1/31/22 to 2/2/22. In addition, a COVID-19 focused infection control survey, which included a review of emergency preparedness requirements was conducted by Healthcare Licensing and Surveys from 1/31/2022 to 2/2/2022.

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, staff interviews, review of manufacturer's instructions, and review of policy and procedure, the agency failed to implement measures to prevent infection for 2 of 3 home visit observations (Patients [Pt] #5, #6). The findings were: 1. Observation on 2/2/22 at 9:50 AM showed RN #3 took Pt #5's vital signs with a stethoscope, blood pressure (BP) cuff, pulse oximeter and a thermometer. Further observation showed the RN quickly cleaned the equipment with a Sani-Cloth and placed the items back into the nursing bag. Interview with the RN at that time revealed the nurse was unsure of the wet time needed to properly disinfect the equipment. Review of the instruction on the Sani-Cloth packaging showed the equipment "must remain wet for a full 2 minutes" to properly disinfect between uses. 2. Observation on 2/2/22 at 10:45 AM showed RN #3 took Pt # 6's vital signs with a stethoscope, BP cuff, pulse oximeter and a thermometer. Further observation showed RN cleaned the equipment vigorously for about 15 seconds each and left to air dry. 3. Review of policy "Cleaning of Homecare Bags and Equipment" dated 7/1/2021 showed, "...Procedure:...staff will cleanse the bell of their stethoscope, thermometer...any other equipment used in patient care...with...Sani-Cloth germicidal wipe or other agency approved germicidal disposable wipe...after each use and prior to replacing in bag". 4. Interview with Administrator 2/1/22 at 1:05 PM verified teaching specific to reading and following the manufacturer's instruction for disinfection of equipment had not been done with employees.

Supervision of home health aides CFR(s): 484.80(h) Standard: Supervision of home health aides. This STANDARD is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure supervision of home health aides (HHA) for 1 of 2 (Patient [POt] #6) sample patients that received HHA services. The findings were: 1. Review of the plan of care for Pt #6 dated 11/30/21-1/28/22 showed orders for skilled nursing services. In addition, a home health aide (HHA) was ordered 2 times a week. Further review of the patient's medical record verified Pt #6 received skilled services and HHA care. However, there was no evidence of HHA supervisory visits during the certification period. 2. Interview with the Administrator on 2/2/22 at 1:30 PM verified there were no HHA supervisory visits made for Pt #6 between the dates of 11/30/21-1/28/22 and confirmed that this practice was likely deficient for other patients that received HHA services.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation and staff interview the agency failed to ensure supplies available for patient use were not expired. The findings were: 1. Observation of supply storage on 2/2/22 at 11:30 AM identified the following concerns: a. Ten BD SmartSite needle-free IV valves expired 12/7/21. b. Twenty prefilled, unit dosed, heparin syringes expired 11/30/21. c. Twenty-five, 21 gauge vacutainer blood collection sets expired 12/2021. d. One Bard latex free extension tube with connector expired 12/2021. 2. Interview with Administrator at that time confirmed the supplies were available for patient use and the supplies were past expiration date. The supplies were immediately removed from the supply storage.