Every finding on record at Prime Nursing Services

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 163 Active Patients - 57 Sample Size - 7 Patients Home Visits – 3

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 policy was reviewed on an annual basis. The facility's policy had not been reviewed since 2017. This failure had the potential to affect the training of staff for current emergency procedures. Findings: During a review of the emergency preparedness policy of the HHA on 1/16/21 at 11:30 p.m., the HHA did not have evidence of an annual review of the policy. A review of the HHA's policy and procedure titled "Emergency Preparedness Policy" dated 7/10/17 the agency will have an identified plan in place to ensure the safety and well being of clients and employees during an emergency. During an interview with the Administrator on 1/16/22 at 12 p.m., she stated the policy is reviewed annually but stated she could not provide evidence of the policy review. There was no documented evidence the governing body reviewed the emergency preparedness policy annually.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 163 Active Patients - 57 Sample Size - 7 Patients Home Visits – 3

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 an accurate, current medication profile for one of 7 sampled patients (Patient 1). Patient 1 had an order for Carbidopa 10-100 milligrams (mg) to be administered one tablet twice daily, the patient received Carbidopa 25-100 mg. This failure resulted in medication errors which put the patient at risk for adverse drug reactions. Findings: A review of Patient 1's clinical record indicated a start of care dated 8/18/21, with primary diagnosis of left lower leg laceration without foreign body. A review of Patient 1's plan of care from 12/16/2 1 to 2/13/22, included an order for SN (skilled nurse) visits of once a week one week, twice a week for 8 weeks. The SN was to assess activities of daily living (ADLs) and home safety, knowledge on disease process and management, medication, and compliance. SN was also to instruct on signs and symptoms of adverse reaction to report to medical doctor (MD). One of the physician's order included in the plan of care was to administer Carbidopa (treat symptoms of Parkinson's disease)10-100 mg (milligrams) one tab twice daily and Xarelto 20 mg one tab daily. On 1/15/22, at 1 p.m., a home visit was conducted at Patient 1's residence with LVN 1. Patient 1 was observed sitting on her wheelchair at her bedroom. During a review of Patient 1's medications indicated a bottle of Carbidopa 25-100 mg one tab twice daily. On 1/15/22, at 1:30 p.m., during an interview with Medication Technician 1, she stated she was giving the Carbidopa 25-100 mg medication since 11/30/21. She further stated the Xarelto 20 mg medication was discontinued on 12/3/21.On 1/16/22, at 12 p.m., during an interview with the DPCS (director of nursing services), she stated that LVN 1 should have been checking the patient's medications on her visits.

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 observation, interview and record review, the skilled nurses failed to administer drugs and treatments as ordered by the physician for one of 7 sampled patients (Patient 1). Skilled Nurse (SN) provided wound treatment to Patient 1 without a physician's order. This deficient practice had the potential to cause the delay in wound healing or worsening of the pressure ulcer. Findings: A review of Patient 1's clinical record indicated a start of care dated 8/18/21, with primary diagnosis of left lower leg laceration without foreign body. A review of Patient 1's plan of care from 12/16/21 to 2/13/22, included an order for SN (skilled nurse) visits of once a week one week, twice a week for 8 weeks. The SN was to do assessment/evaluation and proper management of patient's condition related to laceration without foreign body on left lower leg, to perform wound treatment as follows: cleanse with Normal Saline, pat dry with non-sterile gauze, apply Triple Antibiotic ointment, then with Adaptic 4x4 gauze, cover with island dressing and wrap with Kerlix twice per week and as needed. On 1/15/22, at 1 p.m., a home visit was conducted at Patient 1's residence with LVN 1. Patient 1 was observed sitting on her wheelchair at her bedroom. The patient had a gauze dressing with no drainage on her left wrist. At 1:40 p.m., during an interview with the patient's Medication Technician 1, she stated the patient had the left wrist open wound skin laceration two days ago while she accidentally bumped her wrist to the side rails. At 1:45 p.m., during an interview with LVN1, she stated the last time she visited Patient 1 was 1/10/22, and she did not have the left wrist open wound on that visit. On 1/16/22, at 1:30 p.m., during a review of Patient 1's Skilled Nursing Visit dated 1/15/22, indicated that LVN 1 provided wound treatment at left lower arm skin tear as follows: cleansed with Normal Saline, pat dry, applied Triple Antibiotic ointment, applied Adaptic Island dressing and wrapped with Kerlix and tape. A further review of Patient 1's clinical record indicated there was no physician's order for wound treatment at patient's left lower arm skin tear wound. On 1/16/21. at 1:45 p.m., during an interview with the DPCS (director of patient care services), she stated LVN 1 did not notify the physician regarding Patient 1's new wound at left lower arm but she will be calling the physician today to obtain the wound treatment order.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the license vocational nurse (LVN 1) failed to notify the physician promptly of the patient's change of condition for one out of 7 sampled patients (Patient 1). Patient 1 had a new existing open wound at left wrist. LVN 1 failed to inform the physician of the patient's existing left wrist open wound. This deficient practice had the potential to place the patient at risk for serious complications that could affect the patient's overall health status and quality of care. Findings: A review of Patient 1's clinical record indicated a start of care dated 8/18/21, with primary diagnosis of left lower leg laceration without foreign body. A review of Patient 1's plan of care from 12/16/21 to 2/13/22, included an order for SN (skilled nurse) visits of once a week one week, twice a week for 8 weeks. The SN was to do assessment/evaluation and proper management of patient's condition related to laceration without foreign body on left lower leg, to perform wound treatment as follows: cleanse with Normal Saline, pat dry with non-sterile gauze, apply Triple Antibiotic ointment, then with Adaptic 4x4 gauze, cover with island dressing and wrap with Kerlix twice per week and as needed. On 1/15/22, at 1 p.m., a home visit was conducted at Patient 1's residence with LVN 1. Patient 1 was observed sitting on her wheelchair at her bedroom. The patient had a gauze dressing with no drainage on her left wrist. At 1:40 p.m., during an interview with the patient's Medication Technician 1, she stated the patient had the left wrist open wound skin laceration two days ago while she accidentally bumped her wrist to the side rails. At 1:45 p.m., during an interview with LVN1, she stated the last time she visited Patient 1 was 1/10/22, and she did not have the left wrist open wound on that visit. On 1/16/22, at 10 a.m., during a further review of Patient 1's clinical record indicated that there was no was documented evidence that LVN 1 notified the physician or the agency regarding Patient 1's newly existing left wrist open wound. On 1/16/21. at 10:30 a.m., during an interview with the DPCS (director of patient care services), she stated she was not aware that Patient 1 has a new open wound at her left wrist. A review of Agency's policy "Reporting To Physician (undated)", indicated the patient's physician will be contacted on the same day when there is changes in the patient's condition.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to follow the plan of care for one of seven sampled patients (7) by failing to perform skin assessment and bilateral lower extremities assessment. This failure had the potential to affect the patient's treatment and achievement of goals. Findings: A review of Patient 7's "Patient Information" sheet, indicated, a start of care (SOC) date of 11/24/21, with a diagnosis that included venous insufficiency and bilateral lower limb cellulitis (bacterial skin infection). During a review of Patient 7's plan of care (POC), for the certification period from 11/26/21 to 1/24/22, included an order for skilled nurse (SN) to visit. The POC indicated the SN was to assess skin for breakdown and infection, assessment/evaluation with proper management of patient's conditions related to venous insufficiency, cellulitis to bilateral lower extremities. On 1/15/22 at 11 a.m., a home visit was conducted at Patient 7's residence with licensed vocational nurse (LVN 1). During the visit the nurse checked the patient's vital signs and listened to patient's lungs. It was observed the LVN did not perform a skin assessment and did not assess bilateral lower extremities. During an interview with LVN 1 on 1/15/22, at 11:15 a.m., she stated she should have done a complete head to toe assessment of the patient as indicated in the plan of care. The HHA's policy and procedure dated 3/19/2019 and titled " Plan of Care" indicated the POC should be individualized and provide guidelines for agency staff for all clients admitted to the agency.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to submit nursing notes within the timeframe as indicated in the facility's policy for two of seven sampled patients ( Patients 6 and 7). This failure had the potential to delay the patient's treatment. Findings: a. A review of Patient 6's "Patient Information" sheet, indicated, a start of care (SOC) date of 3/29/21, with a diagnosis that included type 2 diabetes mellitus (a condition that affects the way the body processes sugar). During a review of Patient 6's plan of care (POC), for the certification period from 11/24/21 to 1/22/22, included an order for skilled nurse (SN) to visit daily. The POC indicated the SN to provide skilled assessment/evaluation and proper management of patient's conditions. One 1/14/22, a review of Patient 6's nurse notes indicated no notes for a week prior to 1/11/22. b. A review of Patient 7's "Patient Information" sheet, indicated, a start of care (SOC) date of 11/24/21, with a diagnosis that included venous insufficiency and bilateral lower limb cellulitis (bacterial skin infection). During a review of Patient 7's POC, for the certification period from 11/26/21 to 1/24/22, included an order for skilled nurse (SN) to visit. The POC indicated the SN to provide skilled assessment/evaluation and proper management of patient's conditions. One 1/14/22, a review of Patient 7's nurse notes indicated no notes for a week prior to 1/11/22. During an interview with the Administrator on 1/14/22 at 5 p.m., she stated that the nurse's notes for Patient's 6 & 7 were submitted a week late. She stated the nurse's notes are submitted every Tuesday and should have been submitted on 1/11/22. The HHA's policy and procedure dated 3/2019 and titled "Submission of Note" indicated all clinical notes are to be submitted by Tuesday every week for the previous week Sunday through Saturday.