Every finding on record at Red Oak Home Health Services

The following reflects the findings of the Department of Public Health during a Recertification Survey.Representing the Department of Public HealthSurveyor ID #- RN-HFEN Surveyor ID #- 22303 RN-HFEN Unduplicated Admissions -103Active Patients -21Sample Size -7 PatientsHome Visit - 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 plan that included training for all staffs was evaluated and updated at least annually. This failure had the potential for the staffs to have a lack of knowledge to respond effectively during an emergency situation. During a review of the emergency preparedness plan and disaster training of the HHA, on 4/24/22 at 11:30 a.m., the HHA did not have evidence of Emergency Preparedness training/Disaster drill for all staff and did not have documented evidence of an emergency plan annual review. During an interview with the Administrator (ADM) on 4/24/22 at 11:51 p.m., the ADM stated that the Emergency preparedness/Disaster drill training for the staff was not been done annually. There was no documented evidence the governing body reviewed and evaluated the policy annually on Emergency Preparedness/Disaster. The HHA's undated policy and procedure titled, "Emergency Preparedness Plan," indicated “this emergency preparedness plan was designed to provide continuing care/service in the event of an emergency that would result in interruption of patient care services.”

The following reflects the findings of the Department of Public Health during a Recertification Survey.Representing the Department of Public HealthSurveyor ID #- RN-HFEN Surveyor ID #- 22303 RN-HFEN Unduplicated Admissions -103Active Patients -21Sample Size -7 PatientsHome Visit - 3

Written notice of patient's rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient's rights and responsibilities under this rule, and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This ELEMENT is not met as evidenced by: Based on interview, and record review, the home health agency (HHA) failed to ensure written notice of patient's rights, patient care, and responsibilities are provided and accessible in a language familiar to both patient and the primary caregiver (PCG) for two of seven sampled patients (Patients 1 and 2). This deficient practice has the potential for the patient and PCG to not fully understand their rights and responsibilities and will not be able to effectively participate in the plan of care to meet the patient's needs. 1. A review of Patient 1's "Personal Information", form indicated Patient 1's start of care date was 2/17/2022,with primary diagnoses which included hypertension ( high blood pressure), chronic diastolic congestive heart failure. The heart working under increased pressure causes some different heart disorders). For certification period of 2/15/2022 to 4/15/2022, the physician ordered for the Skilled nurse (SN) to visit 1 time a week for 6 weeks to assess, observe and evaluate cardiovascular, endocrine, nutrition/hydration, and therapeutic response and compliance to prescribed medication/diet regimen. During a joint home visit with LVN 1 and review of Patient 1's folder in the patient’s home on 4/23/22, at 11: 30 a.m., indicated the Informed Consent And treatment Authorization Form dated 2/17/2022, was written in English. Patient 1 was Russian speaking only. During an interview with Patient 1 through translation provided by LVN 1, he stated that he just signed the forms but he did not really know what she was signing for and she could not read or speak English. During a concurrent interview with the Director of Nurses, he stated they do have consent and packages in Russian language and would have to provide the patient with an updated home health package. 2. A review of Patient 2's "Personal Information", form indicated Patient 2's start of care date was 2/17/2022, with primary diagnoses of age related osteoporosis( the slowing down of new bone replacing old/damaged bone density due to age), hypertensive heart disease (heart working under increased pressure causes some different heart disorders). For the certification period of 2/15/2022 to 4/15/2022, the physician ordered for the Skilled nurse (SN) to visit 1 time a week for 6 weeks to assess, observe, and evaluate cardiovascular, endocrine, nutrition/hydration, and therapeutic response and compliance to prescribed medication/diet regimen. During a joint home visit with LVN 1, and review of Patient 2's folder in the patient’s home on 4/23/22, at 11: 30 a.m., indicated the Informed Consent And Treatment Authorization Form dated 2/17/2022, was written in English. Patient 2 was Russian speaking only. During an interview with Patient 2 through translation provided by LVN 1, he stated that he just signed the forms but he did not really know what she was signing for and she could not read or speak English. During an interview with the Director of Nurses, he stated they do have consent and packages in Russian language and would have to provide the patient with an updated home health package

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 staff failed to review all medications the patient is currently using for one of seven patients (Patient 1). This deficient practice has the potential of the patient not receiving the medication as prescribed by the physician. 1. A review of Patient 1's "Personal Information", form indicated Patient 1's start of care date was 2/17/2022, with primary diagnoses of hypertension ( high blood pressure), and chronic diastolic congestive heart failure (heart working under increased pressure causes some different heart disorders). For certification period of 2/15/2022 to 4/15/2022, the physician ordered for the Skilled nurse (SN) to visit 1 time a week for 6 weeks to assess, observe, and evaluate cardiovascular, endocrine ,nutrition/hydration, and therapeutic response and compliance to prescribed medication/diet regimen. On 4/23/2022, at 11:36 a.m., during a joint home visit with LVN 1, a review of Patient 1's medication indicated medications did not match of what was ordered by the physician as follows: 1. Patient 1's physician on 2/17/2022 , at 11:35 a.m., indicated an order for Myrebetriq (treatment for overactive bladder) 50 milligrams (mg) 24hr extended releases take 1 tablet by mouth once a day . The bottle in Patient 1's residence was Myrebetriq 25 mg. one tablet by mouth once a day. 2. Acetaminophen 325 mg. take 1- 2 tablet/s by mouth twice daily was documented on the physician's order on 2/17/2022, however on Patient 1 medication bottle indicated Acetaminophen ( medication used for pain) 325 mg. 1- 2 tablet/s by mouth twice a week. During a concurrent interview with Patient 1 translated by LVN 1, Patient 1 stated she could not read or speak English and did not know what was ordered. During a concurrent interview with the Director of Nurses, he stated the medication should be reviewed each home visit to ensure accuracy. A review of the agency's policy and procedure on Medication Profile} revised November 2020,stipulates, " During subsequent home visit, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregivers, as well s other clinicians, understand the medication regimen."

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the plan of care failed to include oxygen saturation (O2 sat- indicates the amount of oxygen traveling through the body with the red blood cells. Normal oxygen saturation is usually between 95% and 100% for most healthy adults) level parameters for the license nurse to notify the physician for any significant changes of the patient's O2 sat levels for one out of 7 patients (Patient 4). This deficient practice had the potential in the delay of healthcare response, treatment, and intervention that could result to complications to an already compromised patient's health status. A review of Patient 4's clinical record indicated a start of care (SOC) of 3/21/22, with diagnosis which included diabetes mellitus ( a group of disease that result in too much sugar in the blood). The Plan of Care (POC) for the certification period 3/21/22 to 5/19/22, included an order for Skilled Nurse (SN) frequency of twice a week for two weeks, once a week for seven weeks, to continue doing comprehensive skilled nursing assessment, observation and evaluation of respiratory status and compliance to prescribed medication/diet regimen. On 4/23/22, at 1 p.m., during a home visit at Patient 4's residence with LVN 1, Patient 4 was observed sitting in her couch with a walker parked next to her. During an interview with Patient 4, she stated she was having a hard time breathing when she walks using her walker for a short period of time. On 4/23/22, at 1:30 p.m., LVN 1 took the patient's Oxygen saturation (O2 sat) level in room air using her pulse oximeter with a reading of 95 percent on room air. When LVN 1 was asked when to call the physician for abnormal O2 sat level reading, LVN1 stated, when patient's O2 sat level is below 92 percent on room air. A further review of Patient 4's Plan of Care indicated no documented evidence that O2 management that pertains to O2 sat level parameters to look for as to when to notify the physician were included in the plan of care. During an interview with the Director of Patient Care Services (DPCS) on 4/24/22, at 11 a.m., she stated the O2 management should be added in Patient's 4 plan of care.

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 agency's skilled nurse (SN) failed to obtain a physician's orders to check the patient's oxygen saturation level every SN visits for one out of 7 patients (Patient 4). This deficient practice had the potential in the delay of healthcare response, treatment, and intervention that could result to complications to an already compromised patient's health status. A review of Patient 4's clinical record indicated a start of care (SOC) of 3/21/22, with diagnosis which included diabetes mellitus ( a group of disease that result in too much sugar in the blood). The Plan of Care (POC) for the certification period 3/21/22 to 5/19/22, included an order for Skilled Nurse (SN) frequency of twice a week for two weeks, once a week for seven weeks, to continue doing comprehensive skilled nursing assessment, observation and evaluation of respiratory status and compliance to prescribed medication/diet regimen. On 4/23/22, at 1 p.m., during a home visit at Patient 4's residence with LVN 1, Patient 4 was observed sitting in her couch with a walker parked next to her. During an interview with Patient 4, she stated she was having a hard time breathing when she walks using her walker for a short period of time. On 4/23/22, at 1:30 p.m., LVN 1 took the Patient 4's Oxygen saturation (O2 sat) level in room air using her pulse oximeter with a reading of 95 percent on room air. During a concurrent interview, LVN 1 was asked when to call the physician for abnormal O2 sat level reading, LVN 1 stated, the physician will be notified when patient's O2 sat level is below 92 percent on room air. Further review of Patient 4's clinical chart indicated no documented evidence of a physician's order for checking Oxygen saturation level using a pulse oximeter for every skilled nursing visits. On 4/24/22, at 11 a.m., during an interview with the DPCS, he stated there should have been a physician's order to check the patient's oxygen saturation level when the visiting nurses were doing it during their visits.

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 observation, interview, and record review, the home health agency (HHA) failed to screen the visitors for signs and symptoms of COVID-19 infection (an acute serious respiratory illness), and failed to develop the policy and procedures for COVID-19 prevention of the infection. This failure had the potential to spread infection. During an observation on 4/22/22, at 3:30 p.m., upon entrance to the HHA, there was no screening for COVID-19 signs and symptoms, and no temperature checks were performed to the visitors entering the facility. An interview was conducted with the Director of Patient Care Services (DPCS) on 4/22/22, at 4 p.m., she stated that agency screen employees and document screening on the computer, but she did not know she had to also screen visitors. During a review of the infection control policy on 4/24/22, at 1:30 p.m., the HHA did not have a policy for COVID-19 that included surveillance, identification, control, prevention, and investigation of this contagious disease. The DPCS stated she would have to create a COVID-19 policy. DPCS also stated she would have to follow up with the fit testing for all staff. DPCS stated that most of the staff have been fit tested but she could not provide the evidence that the staff were fit tested. The undated HHA's policy and procedure titled, "Infection Control Plan" indicated the organization will address surveillance, prevention, identification, control and reporting of infections, utilizing current scientific methods and epidemiologic principles.