Every finding on record at Premium Health at Home Inc

A recertification survey was conducted by Healthcare Licensing and Surveys from 8/12/24 to 8/15/24 that included a review of emergency preparedness (EP) and it was determined that no deficiencies were identified pertaining to emergency preparedness.

Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency's overall management and operation, the provision of all home health services, fiscal operations, review of the agency's budget and its operational plans, and its quality assessment and performance improvement program. This STANDARD is not met as evidenced by: Based on staff interview and policy review, the agency's governing board failed to assume full legal authority and responsibility for the agency's overall management and operation. The census was 25. The findings were: 1. Review of the agency's policy and procedure manuals showed that the last review was conducted 8/3/2013. 2. Interview with the agency vice-president on 8/15/24 at 11:50 AM confirmed there was no evidence the board of directors had officially met within the last year and she was unsure of the last time the board met to conduct business. She further verified that the policies had been revised over the past 11 years but there was no evidence they had recently been reviewed and approved by the board of directors. 3. Review of the agency's policy, "The Governing Board", no date, showed, "The Governing Body (Board of Directors) manages the operation of Premium Health at Home INC...5. The Governing Body reviews and approves and enforces the policies and procedures of the agency...7. The Governing Body will meet as often as necessary but at least annually."

A complaint survey was conducted by Healthcare Licensing and Surveys from 9/1/2021/to 9/3/2021. The survey was prompted by complaint intake WY000003280. In addition, a COVID-19 focused infection control survey was conducted. Based on the findings of the survey team it was determined that no deficiencies were identified pertaining to the infection control survey.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on review of a computer screenshot, review of personnel records, review of agency schedules, medical record review, and staff interview, the facility failed to ensure patient rights were protected and promoted. Specifically, the agency failed to ensure patients were free from abuse (G430) for 1 of 6 sample patients (#4). This failure resulted in the determination the agency was not in compliance with Condition of Participation: Patient Rights. The findings were: Refer to G430 for agency failure to ensure patient #4 was protected from abuse a reasonable person would have found humiliating and intimidating.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on review of a computer screenshot, review of personnel records, review of agency schedules, medical record review, and staff interview, the agency failed to ensure patients were free from mental abuse a reasonable person would find humiliating and intimidating for 1 of 6 sample patient (#4). The findings were: 1. Review of a computer screenshot that was provided to Healthcare License and Surveys as supporting evidence to a complaint, showed a clear image of a young woman taking a picture of herself in the mirror with a cell phone. The picture was captioned and the caption read: "It ain't a birthday without some CAKE". Also showed in the picture is a clear image, from head to knees, of the posterior of a nude, elderly person entering the shower. The young woman was identified as home health aide (HHA) #2, and the photo was alleged to have been posted to social media in September of 2020. 2. Review of personnel records verified that HHA #2 was employed by the agency with a hire date of 7/15/20. HHA #2's date of birth was noted to be in September. Further review showed the HHA held certification as a nurse aide in Wyoming through the Wyoming Board of Nursing, with an additional endorsement as a home health aide. Review of training documentation showed the HHA received training in confidentiality and reporting abuse, neglect and/or exploitation. 3. Review of agency schedules verified HHA #2 was working on her birthday in September 2020, and review of visit notes from that day showed the HHA provided shower assistance to 2 patients. 4. Interview of HHA #2 on 9/3/21 at 10:05 AM revealed she was the young woman in the photograph. She identified the nude patient as patient #4 and confirmed she took the photograph and shared it on social media the same day. 5. Review of the medical record showed patient #4 was not currently receiving services from the agency. The patient had a primary diagnosis of dementia, and had received HHA assistance with showers from the agency. 6. Interview with the director of nursing and the office assistant on 9/3/21 at 10:20 AM revealed they were previously unaware of the photograph, and would begin an investigation immediately. 7. Interview with the agency owner on 9/3/21 at 10:40 AM confirmed HHA #2's employment would be terminated.

A recertification survey was conducted by Healthcare Licensing and Surveys from 8/16/21 through 8/18/21. 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 8/16/21 through 8/18/21. The following common abbreviations are used throughout this document: DON: Director of Nursing HHA: Home Health Aide OASIS: Outcome and Assessment Information Set POC: Plan of Care PT: Physical Therapist RN: Register Nurse Less commonly used abbreviations will be annotated in each deficiency.

Accuracy of encoded OASIS data CFR(s): 484.45(b) Standard: The encoded OASIS data must accurately reflect the patient's status at the time of assessment. This STANDARD is not met as evidenced by: Based on medical record review, and staff interview the agency failed to accurately reflect the patient's status in 1 of 7 sample patients (#3) at the time of assessment. The findings were: Review of OASIS data for the certification period 6/26/21 through 8/25/21 showed patient #3 had diagnoses which included pressure ulcer of left heel, stage 2, multiple fracture of ribs, left side, wedge compression fracture T9-T10 vertebra, and type 2 diabetic peripheral angiopath. The following concerns were identified: The agency failed to code the OASIS integumentary status correctly. The OASIS showed the patient did not have at least one unhealed pressure ulcer/injury at stage 2 or higher. In addition, the OASIS data showed no current number of unhealed pressure ulcers/injuries at each stage. Interview on 8/18/21 at 2:15 PM with the DON confirmed the OASIS data was inaccurate and it should have reflected the pressure ulcer.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on observation, staff interview, policy and procedure review, and review of Census for Medicare and Medicaid Services (CMS) guidance,the agency failed to develop a method for identifying infectious disease to include a patient screening process for COVID-19. This failure resulted in the omission of a COVID-19 screening for 2 of 3 patients (#6, #7) during a home visit. The findings were: 1. Observation on 8/17/21 at 3:00 PM during a home visit to patient #6 showed PTA #1 failed to screen the patient for COVID-19 prior to providing care. 2. Observation on 8/18/21 at 12 PM during a home visit to patient #7 showed HHA #3 failed to screen the patient for COVID-19 prior to providing care. 3. Interview 8/18/21 at 12:10 PM with the office administrator revealed the agency had no written policy or procedure, including a policy that identified communicable diseases such as COVID-19 in the home setting. 4. Review of the 3/10/20 CMS memorandum, with the subject "Guidelines for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs)" showed "...HHAs should be monitoring the health status of everyone (patients/residents/visitors/staff/etc.) in the homecare setting for signs or symptoms of COVID-19, per CDC (Centers for Disease Control). Prompt detection, triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, homecare personnel and visitors...When making a home visit, HHAs should identify patients at risk for having COVID-19 infection before or immediately upon arrival to the home ..."

12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This STANDARD is not met as evidenced by: Based on personnel record review, and staff interview the agency failed to provide 12 hours of annual in-service training for 2 of 6 sample staff (HHA #5, HHA #6). The findings were: 1. Review of HHA #5's personnel record showed a hire date of 8/17/20. Further review showed no records of 12 hours of in-service training during the 12 month period. 2. Review of HHA #6's personnel record showed a hire date of 7/23/20. Further review showed no records of 12 hours of in-service training during the 12 month period. 3. Interview with the DON on 8/18/21 at 2:50 PM confirmed the 12 hours of HHA in-service training were not done due to COVID.

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, and review of policy and procedure, the agency failed to ensure supplies available for use were not expired for 1 of 1 supply room. The findings were: 1. Observation of the supply room on 8/16/21 at 11:25 AM identified the following concerns: a. Two peripherally inserted central catheter (PICC)/Midline dressing change kits expired 2/29/20. b. One port access infusion set expired 9/2015. c. One 12 inch extension set, minbore, male/female luer lock with pinch clamp expired 1/2016. d. Twenty-eight blood collection needle vacutainer 21 gauge (ga) by 1-1/2 expired 1/31/20. e. Forty-six 5 milliliter (ml) single use syringes expired 6/2020. f. Seven 3 grams lubricating jelly of which 2 expired 1/2016 and 5 expired 7/31/21. g. Sixty-seven 0.3 grams triple antibiotic ointment expired 5/21. h. Seven 10 milliliter normal saline syringes expired 2/5/20. 2. Interview on 8/16/21 at 11:55 AM with the office administrator revealed the supplies were not checked frequently. 3. Review of policy "Management of Expired Supplies" (undated) showed "...Expired products are removed and disposed of at the agency level."