Every finding on record at Quality Home Health Care, Inc.

The following reflects the findings of the Department of Public Health during a Recertification Survey at the agency address 969 South Village Oak drive, suite 206, Covina, CA 91724, from 10/20/2023 to 10/22/2023. Representing the Department of Public Health: Surveyor #22303, Health Facilities Evaluator Nurse Surveyor #19096 Health Facilities Evaluator Nurse Active Patients: 1 Unduplicated Admissions: 16 Sample Size: 7 Home Visit: 1

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), §485.542(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 failed to ensure the emergency preparedness plan and training for staff were done in an annual basis. This failure had the potential for the staffs to have the lack of knowledge to respond effectively during an emergency situation. During the review of the emergency preparedness plan for the home health agency (HHA) on 10/22/2023 at 12:30 p.m., the HHA did not have evidence the Emergency Preparedness training/disaster drill for all staff were done and did not have the evidence the emergency plan was reviewed annually. During an interview with Registered Nurse (RN 1) on 10/21/2023 at 11:45 a.m., RN 1 stated he had not received Emergency Preparedness/Disaster training from the HHA. During an interview with the Administrator on 10/22/2023 at 1 p.m., the Administrator confirmed and could not provide evidence of the RN 1's Emergency Preparedness/Disaster training and could not provide documented evidence the emergency preparedness plan had been reviewed. There was no documented evidence the governing body reviewed the policy Emergency Preparedness/Disaster plan annually. A review of the HHA's undated policy and procedure titled, "Emergency/Disaster Plan", indicated the purpose was to outline a planned, coordinated strategy to promote the safety and continuation of care and/or services to agency patients in the event of a disaster.

The following reflects the findings of the California Department of Public Health during a Re-Certification Survey at the agency address 969 South Village Oak drive, suite 206, Covina, CA 91724, from 10/20/2023 to 10/22/2023. Representing the California Department of Public Health: Surveyor #22303, Health Facilities Evaluator Nurse Surveyor #19096, Health Facilities Evaluator Nurse Active Patients - 1 Unduplicated Admissions - 16 Sample Size – 7 Home Visit - 1

Content of the comprehensive assessment CFR(s): 484.55(c) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient's status, and must include, at a minimum, the following information: This STANDARD is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure the comprehensive assessment (the required in-person clinical assessment of the patient's physical, functional, mental, psychosocial, and cognitive status to identify the needs of the patient and caregiver that will be addressed by the home health agency's services) for one of 7 sample patients (Patient 7), accurately reflected an existing left lower leg and right shin skin tears which required treatment. This deficient practice placed the patient at a high risk for wound infection and slow wound healing. A review of Patient 7's closed clinical record indicated a start of care (SOC) date of 9/9/21, with a diagnosis that included atopic dermatitis (an itchy inflammation of the skin). A review of Patient 7's plan of care (POC) dated from 9/9/21 to 11/7/21, included an order for the skilled nurse (SN) to visit twice daily for one day, daily for three days, twice a week for two weeks, once a week for seven weeks, to assess and evaluate the wound at each dressing change and as needed for signs and symptoms of infection. One of the SN interventions was to provide wound care at left lower leg and right shin skin tears as follows: cleanse with Normal Saline and apply Mupirocin ointment and cover with 4x4 dressing and secure with Kerlix and tape till healed. A review of Patient 7's comprehensive nursing assessment (the required in-person clinical assessment of the patient's physical, functional, mental, psychosocial, and cognitive status to identify the needs of the patient and caregiver that will be addressed by the home health agency's services) for recertification (to determine the need for nursing services) dated 9/9/21, under the integumentary (skin) status section, did not indicate documentation regarding the existing skin tears at left lower leg and right shin which required wound care. A review of Patient 7's Skilled Nursing Visit notes from dates 9/9/21 to 10/13/21, indicated the visiting nurse was providing wound care at left lower leg and right shin skin tears. During an interview with the Director of Patient Care Services (DPCS) on 10/22/23, at 11 a.m., she stated the visiting nurse who did the initial visit should have included a skin assessment on existing skin tears at the left lower leg and right shin. A review of the home health agency's undated policy and procedure, titled, "Wound Assessment," indicated, during initial and follow-up nursing visits, any non-intact skin areas shall be assessed and documented, to complete measurement of the wound (length, width, depth).

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency failed to ensure the existing skin tears at the left lower leg and right shin were assessed during home visit, failing to ensure interventions from the plan of care for one of 7 patients (Patient 7), were appropriate. This deficient practice placed the patient at a high risk to receive poor quality nursing care that could result to wound infection and slow wound healing. During a review of Patient 7's closed clinical record indicated a start of care (SOC) date of 9/9/21, with a diagnosis that included atopic dermatitis (an itchy inflammation of the skin). During a review of Patient 7's plan of care (POC) dated from 9/9/21 to 11/7/21, included an order for the skilled nurse (SN) to visit twice daily for one day, daily for three days, twice a week for two weeks, once a week for seven weeks, to assess and evaluate the wound at each dressing change and as needed for signs and symptoms of infection. One of the SN interventions was to provide wound care at left lower leg and right shin skin tears as follows: cleanse with Normal Saline, and apply Mupirocin ointment and cover with 4x4 dressing and secure with Kerlix and tape till healed. A review of Patient 7's Skilled Nursing Visit notes from dates 9/9/21 to 10/13/21, did not indicate documented evidence the SN had assessed the wound condition during the visits. During an interview on 10/22/2023 at 1 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated the visiting nurse should have done the skin assessment on every visit. During a review of the undated home health agency's policy and procedure titled, "Wound Assessment," indicated during initial and follow-up nursing visits, any non-intact skin areas shall be assessed and document, to complete measurement of the wound (length, width, depth).

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 interview and record review, the home health agency failed to ensure the physician’s order for the newly identified open wound at the left elbow was obtained prior to administration for one of seven sampled patients (Patient 6). This deficient practice placed the patient at a high risk to receive poor quality nursing care that could result to wound infection and slow wound healing. During a review of Patient 6's closed clinical record, indicated a start of care date (SOC) of 8/6/20, with diagnosis that included urinary tract infection (infection that affects part of the urinary tract). A review of Patient 6's Home Health Certification and Plan of Care (POC) for the certification period starting from 8/6/20 to 10/4/20, included an order for the skilled nurse (SN) to visits of twice a week for three weeks, once a week for six weeks, for assessment of all body system and medication compliance. One of the SN interventions was to provide wound care to existing skin tear on both lower legs as followed: cleanse with Normal Saline, apply Neosporin ointment, cover with gauze and tape daily. During a review of Patient 6's Skilled Nursing Note dated 9/30/20, indicated the visiting nurse performed wound care at left elbow skin tear as follows: cleansed with Normal Saline, applied Neosporin, covered with Hypafix tape. During a further review of Patient 6's closed clinical record indicated no documented evidence the license nurse obtained a wound care order to treat skin tear at patient's left elbow. During an interview on 10/22/2023 at 12 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated the visiting nurse should have obtained a new wound care order form the physician for left elbow skin tear.

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 interview, and record review, the home health agency failed to notify the physician promptly regarding the newly identified open wound at the left elbow for one out of seven sampled patients (Patient 6). This deficient practice placed the patient at a high risk for wound infection and slow wound healing. A review of Patient 6's closed clinical record indicated a start of care date (SOC) of 8/6/20, with diagnosis that included urinary tract infection (infection that affects part of the urinary tract). A review of Patient 6's Home Health Certification and Plan of Care (POC) for the certification period starting from 8/6/20 to 10/4/20, included an order for the skilled nurse (SN) to visits of twice a week for three weeks, once a week for six weeks, for assessment of all body system and medication compliance. One of the SN interventions was to provide wound care to existing skin tear on both lower legs as followed: cleanse with Normal Saline, apply Neosporin ointment, cover with gauze and tape daily. A review of Patient 6's Skilled Nursing Note dated 9/30/20, indicated the visiting nurse performed wound care at left elbow skin tear as follows: cleansed with Normal Saline, applied Neosporin, covered with Hypafix tape. A further review of Patient 6's closed clinical record indicated no communication note that the physician was notified of new identified skin tear at the left elbow area. During an interview on 10/22/2023, at 12 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated the visiting nurse should have notified the physician for the new identified wound at the left elbow found during the home visit. During a review of the home health agency's undated policy and procedure titled, "Plan of Care", indicated it is the staff member's responsibility to report any condition or problems to the physician. .