Every finding on record at Providence Medical Center, Inc.

Providence Medical Center Home Health is in compliance with 42 CFR 484.102 Condition of Participation for Home Health Agencies.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, the observation of the provision of cares, and staff interview, the agency failed to ensure all orders for medications and/or treatments are included on the patients plan of care for 2 of 7 clinical records reviewed (Patient-1 and Patient-2). The census was 13. A. Review of the agency policy and procedure titled, Medication Policy, revised 8/12/11, revealed the medication, including dosage/strength, frequency, method of administration, special precautions or instructions, permission from the physician for the patient or caregiver to be instructed on and administer medication, will be included on the plan of care. It also revealed orders are to be renewed every 60 days and included on the plan of care. B. Review of the agency policy and procedure titled, Plan of Care, revised 7/10/16, revealed medications, treatments, and procedures are to be included in the plan of care along with who is responsible for performance of the treatment or procedure. C. The observation of the provision of cares revealed: 1. During a visit to Patient-1's home on 4/5/22 at 7:45 AM, Patient-1 was observed to administer a liquid into [gender] suprapubic catheter (a tube inserted into the bladder through the abdomen to drain urine). The patient reported it was an acetic solution used to keep the catheter from becoming plugged. During the same visit, Patient-1's spouse was observed to apply mupirocin ointment (an antibiotic ointment) to a biopsy site on the patient's left foot. 2. During a visit to Patient-2's home on 4/5/22 at 1:05 PM, the registered nurse was observed to obtain a blood sample from Patient-2. D. Review of Patient 1's Clinical record revealed: 1. A nurse visit noted dated 2/16/22. The nurse documented in the note that the patient was flushing the catheter at least weekly with an acetic acid solution to prevent it from clogging. 2. A nurse visit noted dated 2/11/22. The nurse documented in the note that the patient saw a dermatologist for the biopsy site (on the left foot) and the patient was instructed to apply an triple antibiotic ointment on the biopsy site. 3. The Home Health Certification and Plan of Care (POC) for the certification period of 2/18/22 through 4/18/22 did not include orders for the acetic acid solution for the catheter flushes, including who was to perform the task and how often the task was to be performed. The POC also did not include orders, including frequency and duration for applying the triple antibiotic ointment (or mupirocin as being used by the patient). E. Review of Patient-2's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 2/5/22 through 4/5/22 included orders for skilled nurse 1 time per month for intravenous infusion and lab work every other month. The POC did not include orders for the specific laboratory specimens to be drawn. 2. A nurse visit note dated 2/9/22. The nurse documented blood was drawn. It does not specify what the laboratory specimens were. 3. A laboratory sheet indicating a complete blood count (CBC) and a general chemistry results were faxed to the physician on 4/6/22. F. During an interview on 4/6/22 at 12:30 PM, the Administrator confirmed Patient-1's POC did not include orders for the catheter flush or the triple antibiotic ointment, including directions, frequency, duration and who was to perform the task. The Administrator also confirmed Patient- 2's POC did not include the type of lab specimens to be drawn. The Administrator confirmed the agency did not follow the policy and procedures to include medication/treatment/procedures, dosage/strength, frequency, method of administration, special precautions or instructions, permission from the physician for the patient or caregiver to be instructed on and administer medication, on the plan of care.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to have a process in place to include on the revised/updated plan of care, the patients progress towards the measurable outcomes and goals identified by the patient and the home health agency for 3 of 3 clinical records reviewed who had a revised/updated plan of care (Paitent-1, 2, and 5). The total sample size was 7. The census was 13. Findings are: A. Review of the agency policy and procedure titled, Plan of Care, revised 7/10/16, revealed a summary report was to be included on the plan of care every 60 days. It does not specify to include the patient's progress towards the measurable outcomes and goals identified by the patient and the home health agency. B. Review of clinical records revealed: 1. Patient-1's Home Health Certification and Plan of Care for the certification periods of 12/20/21 through 2/17/22 and 2/18/22 through 4/18/22 did not include the patients progress towards the measurable outcomes and goals identified by the patient and the home health agency. 2. Review of Patient-2's Home Health Certification and Plan of Care for the certification periods of 12/7/21 through 2/4/22 and 2/5/22 through 4/5/22 did not include the patients progress towards the measurable outcomes and goals identified by the patient and the home health agency. 3. Review of Patient-5's Home Health Certification and Plan of Care for the certification periods of 1/28/22 through 3/28/22 and 3/29/22 through 5/27/22 did not include the patients progress towards the measurable outcomes and goals identified by the patient and the home health agency. C. During an interview on 4/6/22 at 12:30 PM, the Administrator confirmed the agency did not include the patients progress towards the measurable outcomes and goals identified by the patient and the home health agency on revised/updated plan of care for Patient-1, 2, and 5. The Administrator also confirmed the agency did not have a process in place to include the progress towards the measurable outcomes and goals identified by the patient and the home health agency on revised/updated plan of care for any agency patients who had a revised/updated plan of care.

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 record review, policy and procedure review, the observation of the provision of cares, and staff interview, the agency failed to ensure agency staff followed the agency policy and procedures for proper hand hygiene and/or glove use to prevent the spread of potential infections during the provision of cares by agency staff to 2 of 3 agency patient's (Patient-1 and Patient 2). The sample size was 3 observations of the provision of cares. The total sample size was 7. The census was 13. Findings are: A. Review of the agency policy and procedure titled, Standard Precautions, Home Care, reviewed 8/20/21, revealed: 1. Agency staff are to perform hand hygiene before and after patient care, before putting on and after removing gloves, before handling an invasive device, when moving from contaminated body site to clean body site, after contact with body fluids, excretions, mucous membranes, nonintact skin, wound dressings and after contact with inanimate objects in the patient's environment. 2. Agency staff are to wear gloves if they are to come in contact with blood, specimens, tissue, body fluids, secretions, excretions, mucous membranes, broken skin, or contaminated surfaces or objects. 3. Gloves are to be removed, hand hygiene performed, and new gloves applied when damaged, soiled, moving from contaminated to clean site during patient care to reduce the risk of cross-contamination of potentially infectious organisms. B. Review of the agency policy and procedure titled, Venipuncture, Home Care, revised 8/20/21, revealed when performing a venipuncture (accessing a vein with a needle as for a lab draw) the steps to follow (in order) included gather necessary supplies, perform hand hygiene, prepare supplies on a barrier, perform hand hygiene, apply gloves, prepare the puncture site and complete the venipuncture, remove gloves and then perform hand hygiene again. C. Review of Patient-1s clinical record revealed The Home Health Certification and Plan of Care for the certification periods of 12/20/21 through 2/17/22 and 2/18/22 through 4/18/22 included orders for Home Health Aide (HHA) 1 time a week for 1 week, then 2 times a week for 8 weeks for assistance with bathing and activities of daily living. D. Review of Patient-2 clinical record revealed The Home Health Certification and Plan of Care include orders for Skilled Nurse services 1 time per month for intravenous infusion and every other month for lab draws. E. The observation of the provision of transferring, toileting, showering, and dressing, and applying lotion by Staff-C to Patient-1 on 4/5/22 from 7:45 AM- 8:45 AM revealed Staff- C failed to remove gloves after toileting the patient and prior to transferring the patient to the shower bench with a mechanical lift, prior to washing the patient's hair after toileting and transferring, after assisting with bathing tasks and prior to drying the patient, after contact with the catheter bag and prior to re-transferring the patient with the mechanical lift from the shower bench to a wheelchair, and prior to applying lotion to patient's clean skin. (Failed to perform hand hygiene and change gloves 5 times during the tasks listed). F. The observation of the provision of a venipuncture for a lab specimen by Registered Nurse (RN)-D to Patient-2 on 4/5/22 at 1:05 PM revealed RN-D failed to perform hand hygiene and/or apply new gloves after gathering supplies for the venipuncture and prior to preparing the supplies for use and placing onto a protective barrier, and prior to preparing the venipuncture site for the venipuncture and completing the venipuncture to draw the needed blood specimen. (Failed to perform hand hygiene and/or change gloves 2 times). G. During an interview on 4/5/22 at 4:10 PM, the Administrator confirmed Staff- C, and RN-D did not follow the agency's policies and procedures for performing hand hygiene and proper glove use during the tasks provided to Patient-1 and Patient-2 respectively.