Every finding on record at Rady's Children Hospital-San Diego

The following reflects the findings of the California Department of Public Health during the Emergency Preparedness survey from 4/3/23 through 4/6/23. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 36471 and HFEN 40615. No deficiencies were identified from this survey.

The following reflects the findings of the California Department of Public Health during a home health recertification survey conducted from 4/3/23 through 4/6/23. The agency reported 592 unduplicated admissions for the last 12 months. The total number of sampled patients was 13, and 5 home visits were conducted. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 36471 and HFEN 40615. Deficiencies were identified during this survey.

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 agency failed to ensure the wound and cardiac assessments were completed per the plan of care for two of 13 sampled patients (9,10). As a result, patient health and safety were at risk. Findings: 1. Per the Home Health Certification and Plan of Care, dated 2/28/23 through 4/28/23, Patient 9 was admitted to the agency on 2/28/23 with diagnoses to include pilonidal cyst (boil) with abscess. On 4/5/23 at 10:30 A.M., a concurrent interview and record review was conducted with the Registered Nurse Coordinator (RNC). The RNC stated there were no wound measurements documented in patient 9’s clinical records for the following dates: 3/9/23,3/11/23, and 3/18/23. On 4/5/23 at 11:40 A.M., an interview was conducted with the RNC. The RNC stated nurses were expected to measure the wound at every visit and document in patient’s clinical record to monitor the effectiveness of the treatment and healing of the wound. On 4/5/23 at 2:30 P.M., a phone interview was conducted with Registered Nurse (RN) 5. RN 5 stated at each visit with patient 9, the nurses should measure the wound and document in the patient’s clinical record. RN 5 stated she should have measured the wound and documented in the clinical record at each visit but did not in some of the visits. On 4/5/23 at 4:45 P.M., an interview was conducted with the Clinical Services Manager (CSM). The CSM stated staff were expected to follow the physician’s order and plan of care. Per the agency’s policy and procedure, titled Care Coordination, dated May 2022, indicated “… Care coordination is provided to assure continuity of care for all patients of [ name of the agency] … 2.5.2. The visiting RN/therapist shall be responsible for updating documentation and communicating between home health staff and the patient's physician as necessary.” 2. Per the Home Health Certification and Plan of Care, dated 2/7/23 through 4/7/23, Patient 10 was admitted to the agency on 12/9/22 with diagnoses to include discordant atrioventricular connection (congenital heart abnormalities). On 4/5/23 at 1:50 P.M., a concurrent interview and record review was conducted with the RNC . The RNC stated there was no oxygen saturation (oxygen level in the blood) reading documented in patient 10’s clinical record for 3/17/23. On 4/5/23 at 2:40 P.M., an interview was conducted with the RNC. The RNC stated, staff should have obtained patient 10’s oxygen saturation level and documented to make sure the reading was within the physician’s expected range. On 4/5/23 at 4:40 P.M., a phone interview was conducted with RN 6. RN 6 stated at each visit with patient 10, the oxygen saturation level should be checked and documented but missed . RN 6 stated it was important to check and document the oxygen saturation to monitor the patient’s lung capacity. Per the agency’s policy and procedure, titled Care Coordination, dated May 2022, indicated “… Care coordination is provided to assure continuity of care for all patients of [ name of the agency] … 2.5.2. The visiting RN/therapist shall be responsible for updating documentation and communicating between home health staff and the patient's physician as necessary.”

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, interview, and record review, the agency failed to ensure the Registered Nurse (RN) followed the infection control standards practices for one of five home visits conducted when the RN applied hand gel on gloved hands and used a device commingled with the sanitized device. This failure increased the risk of cross-contamination between staff and patient. Findings: Per the Home Health Certification and Plan of Care, dated 3/27/23 through 5/5/23, Patient 1 was admitted to the agency on 3/27/23 with diagnoses that included a malignant neoplasm (cancer) of the adrenal gland (part of the kidney). On 4/4/23 at 10 A.M., RN 2 was observed putting gloves on both hands, gathering equipment, and applying hand sanitizer to gloved hands. RN 2 was observed using the hand sanitizer on gloved hands twice more. Furthermore, RN 2 assessed Patient 1 using the thermometer and stethoscope. RN 2 placed the devices on top of the barrier. After Patient 1's treatment session, RN 2 wiped the thermometer and set it on the uncleaned stethoscope. RN 2 then took the stethoscope, disinfected the device, and returned them to the same barrier along with the thermometer, instead of using a new barrier after disinfecting the devices. On 4/4/23 at 10:45 A.M., an interview was conducted with RN 2. RN 2 stated it was her habit to sanitize gloved hands and was not the agency's practice. RN 2 stated the teaching was to sanitize hands. In addition, RN 2 stated the sanitized thermometer touched the soiled stethoscope and should not have been to prevent cross-contamination. On 4/5/23 at 4:30 P.M., an interview was conducted with the Clinical Service Manager (CSM). The CSM stated the staff should sanitize their hands and not gloved hands to prevent cross-contamination. The CSM further stated the staff should have clean and dirty barriers or a clear separation between clean and dirty on the barrier to avoid contamination of the devices. Per the agency's policy and procedure, titled Infection Control Surveillance and Control Plan 2023, dated 1/23, "...4.5.2. Work areas...will be kept clean and set up in a safe manner..." Per the agency's policy and procedure, titled Hand Hygiene, dated 2/23, "...1. HAND HYGIENE TECHNIQUE A. When decontaminating hands with a waterless antiseptic agent such as an alcohol-based hand rub, apply product to palm of one hand and rub hands together...Decontaminate hands before and after using gloves..."