Every finding on record at Promise Care of Hudson County LLC

The facility is in substantial compliance with 42 CFR Part 484 Emergency Preparedness. No citations were identified.

This was a Federal Recertification, Federal COVID-19 Infection Control Audit, and State Relicensure survey that was conducted on November 8, 2021 to November 10, 2021. The facility was found to be in substantial compliance with 42 CFR 484 Conditions of Participation for Home Health Agencies. Standard Level deficiencies were identified. The facility was found to not be in compliance with N.J.A.C. Title 8 Chapter 42- Licensing Standards for Home Health Agencies. Home Visits: 5 Total Medical Records Reviewed: 13

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: A. Based on staff interview, review of one (1) of one (1) medical record (#6) with a home health aide ordered, and review of facility policy and procedure, it was determined the facility failed to ensure home health aide services are provided in conformance with physicians orders. Findings include: Reference: Facility policy titled, "Physician's Orders" states, "...Orders for treatment not on the Plan of Care must be secured prior to: 1. Any change/variation from the original Plan of Care... 3. Delay in start of Care..." 1. Upon review of Medical Record #6, the following was noted: a. The patients start of care was 10/17/21. The Home Health Aide was ordered two times a week for seven weeks. (i) The patient did not receive home health aide services from 10/17/21 through 10/29/21. b. On 10/29/21, a physician order states, "Delay in Home Health Aide Services until November 3, 2021." (i) The patient did not receive home health aide services from 11/3/21 through 11/9/21. The patient was admitted to the hospital on 11/9/21. 2. The above findings were confirmed with Staff #17 on 11/10/21 at 1:00 PM. N.J.A.C. 8:42-6.2(a)2 B. Based on the review of one (1) out of four (4) medical records (#8), review of facility policy and procedure, and staff interview, it was determined that the facility failed to ensure that the physician is notified of a change in the patient's plan of care. Findings include: Reference: Facility policy titled, "Provision of Care" states, "...It is the policy of the Home Health Agency to secure written orders for all clients... The agency accepts physician certification and recertification of plans of care, as well as signed orders changing the plan of care... PROCESS: Orders for treatment not on the Plan of Care must be secured prior to: 1. Any change/variation from the original Plan of Care... 2. Missed visits with change in frequency..." 1. The medical record of Patient #8 was reviewed, and the following was identified: a. A Start of Care (SoC) for 9/22/21 b. An order for Skilled Nurse (SN) visits written on 9/22/21 for a frequency of "1WK6" (1 time per week for 6 weeks) c. During the week of 10/10/21 to 10/16/21, the calendar identified that an SN visit was scheduled for 10/13/21, but the medical record lacked a visit note indicating that a SN visit was made. 2. An interview on 11/9/21 at 1:29 PM with Staff #17, a manager, confirmed the above findings and that the medical record lacked further documentation of communication to the physician regarding the missed visit on 10/13/21. N.J.A.C. 8.42-6.2(a)(6)

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on review of two (2) of two (2) medical records (#3, #13) reviewed to assess coordination of care, staff interviews, caregiver interview, and review of facility policy and procedure, it was determined the facility failed to ensure that coordination of care with the medical social worker (MSW) is conducted to meet the needs of the patient. Findings include: Reference: Facility policy, "Care Coordination" states, "... 3. Coordinate care delivery to meet the patient's needs and involve the patient and caregivers as appropriate in coordination of care activities." 1. During a home visit for Patient #3 on 11/8/21 at 12:35 PM, Staff #3 stated that the patient's son called him/her and stated that the patient was having a hard time with his/her illness. Staff #3 stated, "The patient's not doing well. He's been in and out of the hospital for his diabetes. He's having a hard time mentally because he's so young and he's worried what will happen if he can't do his job while he's sick. He's the superintendent of the building he lives in. I'm also trying to help him find an endocrinologist. There's not a lot of them in this area. One didn't take his insurance and another gave him an appointment in March. He's having a tough time." 2. Review of the medical record of Patient #3 lacked evidence that Staff #3, who indicated that he/she was aware that the patient "was not doing well" mentally, notified the physician or coordinated care with the MSW to assist with the mental and emotional needs of the patient. 3. Upon interview on 11/10/21 at 11:30 AM, Staff #1 indicated that Patient #3 should have been referred to a social worker. 4. During a home visit for Patient #13 on 11/9/21, in the presence of Staff #15, a caregiver interview was conducted at 12:20 PM. Patient #13's caregiver indicated that she needed a home health aide (HHA) because caring for her spouse was hard and she needed help. The patient's caregiver was asked if she notified the nurse that she needed an HHA. The patient's caregiver stated, "A nurse only came one time. I told her last Thursday about needing help, but I haven't heard anything since. I also told 'that guy.' He doesn't speak Spanish, so I don't know his name." 5. Review of Medical Record #13 revealed the following: a. Client Coordination Note dated 11/3/21 states, "MSW had visit with patient and caregiver. Patient would benefit from referral for PCA at this time. MSW reviewed Medicaid eligibility and guidelines, patient eligible at this time. MSW referred patient at visit to Hudson County ABD Medicaid Office for application to be sent to patient home via mail. ... ." b. There was no evidence in the medical record that the MSW coordinated care with the nurse or physician to notify them that the patient or caregiver was requesting HHA services. c. There was no evidence in the medical record that HHA services were ordered or conducted for Patient #13. 6. Upon interview on 11/9/21 at 11:30 AM, Staff #2 confirmed that the facility uses a staffing agency for home health aides. He/she stated, "We use [name of staffing agency] for HHA services. We have been trying to recruit, but we cannot find anyone. We don't have any of our own HHAs." 7. Upon interview on 11/10/21 at 11:00 AM, Staff #1 indicated that a PCA was a companion service provided through Medicaid for qualifying families. Staff #1 stated that if a family requests HHA services, and the facility is unsuccessful obtaining an HHA through the staffing agency, they will refer the patient for PCA services through the Medicaid office. He/she stated that staff will complete coordination notes indicating their attempts to get an HHA through the staffing agency and subsequent referral for PCA services, if needed. 8. Upon interview on 11/10/21 at 11:00 AM, Staff #1 confirmed that there was no evidence that an attempt was made to provide Patient #13 with HHA services through the staffing agency. N.J.A.C. 8:42-7.3(b)2

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, and review of nationally recognized infection control guidelines, it was determined the facility failed to adhere to acceptable standards of practice for hand hygiene during wound care. Findings include: Reference: Guideline for Hand Hygiene in Health Care Settings: Recommendation of the Healthcare Infection Control Practices Advisory Committee [HICPAC] and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, published in the CDC (Centers for Disease Control and Prevention) Morbidity and Mortality Weekly Report at MMWR 2002; 51 (No. RR-16) states, "... Recommendations: 1. Indications for Handwashing and Hand antisepsis... I. Decontaminate hands after contact with inanimate objects... in the immediate vicinity of the patient." 1. During a home visit for Patient #3, on 11/8/21, the following was observed: a. At 12:57 PM, Staff #3 was performing wound care on the patient's left heel. Staff #3 placed a plastic bag on the floor near him/her to use for trash. With gloved hands, Staff #3 used saline to clean the wound, then took his/her left hand and moved the plastic bag closer to him/her. Staff #3 then continued with wound care. b. Staff #3 failed to doff his/her contaminated gloves and perform hand hygiene prior to resuming wound care. 2. Staff #1 and Staff #2 confirmed the above finding on 11/10/21 at 11:00 AM. N.J.A.C. 8:42-12.3(a)

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 staff interview and review of Centers of Disease Control and Prevention (CDC) guidance, it was determined that the facility failed to ensure that a process for notifying the local health department about known or suspected cases of COVID-19 within the facility, is developed. Findings include: Reference: Centers for Disease Control and Prevention (CDC), Clinical Questions about COVID-19: Questions and Answers, https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html, updated November 17, 2021 states, "... Healthcare facilities should have a process for notifying the health department about known or suspected cases of SARS-CoV-2 infection, and should establish a plan, in consultation with local public health authorities, for how exposures in a healthcare facility will be investigated... ." 1. Upon interview on 11/10/21 at 10:00 AM, Staff #1 confirmed that the facility does not have a process or plan for reporting known or suspected cases of COVID-19 to the local health department. Staff #1 stated, "Because we don't test here and symptomatic patients and staff are tested elsewhere, we did not think we needed to report to the local health department." N.J.A.C. 8:42-12.2(b)2

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 medical record review, staff interview, and review of facility policy and procedure, it was determined that the facility failed to ensure that wound care assessment is completed in accordance with physician order and facility policy in one (1) out of four (4) medical records (#4) reviewed. Findings include: Reference: Facility policy titled, "Wound Care" states, "...Skilled nursing or an educated caregiver will perform wound care per specific MD [Medical Doctor] order. CONSIDERATIONS: 1. Wounds to be measured weekly and recorded. The scheduled nurse should review the previous SN [skilled nurse] full visit note to confirm that measurements were documented. If no measurements are documented at first visit then measurements must be obtained during current visit....." 1. Patient #4 was admitted to the Home Health Agency (HHA) for wound care of bilateral lower extremity stasis ulcers. The medical record of Patient #4 was reviewed, the following was identified: a. A physician order written at the Start of Care (SoC) on 3/4/21 stating, "Skilled Nurse to Observe and assess integumentary status to identify changes and intervene to minimize complications....." b. A visit note for a SN visit conducted on 3/4/21 by Staff #9 documented the wound assessment for both bilateral leg ulcers "Measurements Taken No Reason For Measurements Not Taken Unable..." c. The next SN visit was conducted on 3/10/21 by Staff #18. The following was documented in the visit notes: (i) "...Was Integumentary Assessed/Observed Yes Indicate Integumentary Findings... No Problems Identified..." (ii) The wound assessment for both bilateral leg ulcers "Measurements Taken No Reason For Measurements Not Taken Unable..." 2. An interview with Staff #17 on 11/10/21 at 11:13 AM, confirmed that above findings, and Staff #17 also confirmed that Patient #4 had Integumentary System issues, and wound measurements should have been taken. N.J.A.C. 8.42-7.3(d)(4)