Every finding on record at Rice County Phns

A survey for compliance with CMS Appendix Z Emergency Preparedness Requirements, was conducted on 5/13/25-5/14/25 during a recertification survey. The facility is in compliance with the Appendix Z Emergency Preparedness Requirements.

On 5/13/25-5/14/25 a recertification survey was conducted. This resulted in a partial extended survey at Rice County PHNS. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. Unduplicated census previous 12 months: 31 Total home visits conducted: 3 Parent location: 320 3rd St NW Ste #1, Faribault, MN 55021 Hours of Operation: 8-4:30 pm List total number of records reviewed: 8

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on interview and document review, the facility failed to report all OASIS data collected in accordance with federal regulations. The total number of records submitted beyond the 30 days was 11. On the OASIS Error Detail Report period from 5/1/24 to 5/12/25, the agency had an error code of -3330: record submitted late. The description included the submission was more than 30 days after completion on the new record. During an interview on 5/14/25 at 8:50 a.m., the office administrative supervisor (OAS) stated the agency's normal OASIS assessment process was to have the nurses let her know when the OASIS was completed, then she would submit it. OAS indicated the nurses did not get them completed timely sometimes. The OAS indicated she took the job duty over when the previous office staff member retired August 2024. She indicated she was told that the only ones that were important were the Medicare payers. Agency Comprehensive Assessment/OASIS Data Collection policy updated December 2019, indicated "OASIS data is encoded and transmitted according to OASIS regulation. OASIS data is encoded and transmitted on Medicare and Medicaid patients only."

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 document review, the agency failed to identify and update all prescription and non-prescription medications for 1 of 2 patients (P2) reviewed during home visits. P2's start of care (SOC) date was 5/1/24 with diagnoses of type 2 diabetes mellitus, major depressive disorder, obesity and hypertension. P2's plan of care (POC) certification dates of 4/26/25 to 6/24/25, indicated skilled nurse visit (SNV) 1-2 times per week to assess client condition and set up oral medications for one week, reorder medications, teach and monitor compliance regarding medications, review blood sugar readings, diabetic education, importance of taking medications regularly and also setting up insulin pens for one week at a time. During home visit observation with registered nurse (RN)-A on 5/14/25 at 11:00 a.m., surveyor reviewed each medication bottle RN-A set up in the weekly medication boxes for accuracy. Surveyor asked about the other medications listed on P2's medication profile. RN-A located the cetrizine10 milligram (mg) one tab by mouth (po) daily (qd) as needed (prn) that was listed on P2's medication profile in his cabinet and handed to the surveyor. The cetrizine had expired January 2020. Also located in the cabinet: Equate acetaminophen 500 mg tablets, expiration date of November 2018; Arthritis Pain 650 mg tablets, expiration date of September 2013; Fastmax Mucinex Liquid, expiration date of May 2025; Equate Tums 1000 mg, expiration date of June 2024; Equate acetaminophen pm, expiration date of February 2015; Pepto Bismol chewable tabs, expiration date of December 2021; Spring Valley Daily Gummy Fibers 4 mg, expiration date of December 2020. P2 stated he had taken these medications in the cabinet for various reasons when needed. RN-A proceeded to collect all of the expired medications and stated she would remove them from P2's home. When interviewed on 5/14/25 at 2:30 p.pm., RN-A stated, "it is my responsibility to check client cabinets, and I had not taken the time to check the expiration dates. I do normally ask if they have been to the physician and if they have had any medication changes, I just hadn't done that." Agency Medication Reconciliation Policy, effective 1/1/17, indicated an accurate list of medications will be determined for all clients upon admission and maintained throughout all episodes of care. The policy further indicated the comprehensive assessment will include a review of all medications and over the counter medications the client is currently using in order to identify any potential adverse effects and drug interactions.

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 document review, the agency failed to ensure staff followed accepted standards of infection control practices during home care observation visits for 1 of 2 residents (P2). Agency staff failed to clean reusable supplies (blood pressure cuff and stethoscope) after completion of the home visit to prevent against potential infectious disease exposure. P2’s start of care (SOC) to the agency was 5/1/24, with diagnoses diabetes mellitus type 2 (DM2), major depressive disorder, obesity and hypertension. P2's plan of care (POC) had certification dates of 4/26/25 to 6/24/25. During observation on 5/14/25 at 11:00 a.m., registered nurse (RN)-A entered P2 home with backpack bag and walked into to kitchen of P2 home. After hand sanitization, RN-A proceeded to set up medications and perform an assessment of P2, which included obtaining a blood pressure and auscultated lung and bowel sounds. RN-A then placed the blood pressure cuff and stethoscope back in her backpack bag without sanitizing the items. During interview with RN-A on 5/14/25 at 2:30 p.m., RN-A verified she did not sanitize her stethoscope or blood pressure cuff after completing the visit for P2. She stated, "I normally do it, but just didn't do it today. I know it probably doesn't matter, but I did clean it before my next client." During interview with home care supervisor, on 5/14/25 at 2:45 p.m., stated expectation of all home care staff is to wipe down equipment after each use per their policy. Agency undated Bag/Equipment Cleaning policy identified, “Staff members will be responsible for cleaning the reusable and/or multiple client use equipment and supplies from the nurse's bag." The policy further indicated stethoscopes should be cleaned with alcohol wipes with each use and BP gauges and tubing should be wipes with alcohol or germicide detergent as needed.

A survey for compliance with CMS Appendix Z Emergency Preparedness Requirements, was conducted on 2/6/23-2/8/23 during a recertification survey. The facility is in compliance with the Appendix Z Emergency Preparedness Requirements.

On 2/6/23-2/8/23 a recertification survey was conducted. This resulted in a partial extended survey at Rice County Public Health Nursing Service. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. Unduplicated census previous 12 months: 50 Total home visits conducted: 3 Parent location: 320 3rd St NW #1, Faribault, MN 55021 Hours of Operation: 8:00 a.m. to 4:30 p.m. Total number of records reviewed: 7

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 document review the agency failed to ensure medications were set up for patients only as ordered by the physician for 1 of 2 patients (P5) reviewed for medication set up. P5 had a start of care (SOC) date of 6/4/2019. P5’s plan of care (POC) with certification dates of 1/14/23-3/14/23 identified diagnoses of heart disease, diabetes mellitus and spinal stenosis (narrowing of the spinal column which may cause pain). The POC identified P5 required skilled nursing visits (SNV) every one-two weeks for medication set up and assessment of general condition. On 2/7/23, during a home visit at 10:00 a.m. P5’s medications were reviewed with registered nurse (RN)-A which RN-A set up P5’s medications into pill boxes. When setting up P5’s medications, RN-A referred to a medication list dated 2/7/23. According to this list, P5 was to have Tylenol PM 500-25mg one tab set up at bedtime. RN-A was observed setting up two tabs into each bedtime slot in P5’s medication planner. RN-A did not count medications to ensure accuracy when she finished setting up the planner. On 2/7/23, at 10:12 a.m. RN-A confirmed the information on the medication list dated 2/7/23, and on the medication bottle directed P5 to receive one tab daily at bedtime. RN-A also confirmed she set up two tabs in each of the bedtime slots in P5’s medication planner and that she did not count medications in the planner to check for accuracy. RN-A stated she looked at the order above the Tyelnol PM which was for Tylenol. This order indicated one-two tabs as needed. RN-A adjusted the Tylenol PM so it was filled correctly. On 2/8/23, at 2:49 p.m. nursing supervisor (NS)-A stated she expected the nurses followed the provider’s order when setting up medications. It was best practice to count random boxes in the planner for accuracy when medication set up was completed. Facility policy Medication Management update 11/2017, indicated medication set up is a service provided by skilled nursing but did not indicate the process to be followed.

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 document review, the agency failed to ensure appropriate infection control prevention measures including glove use, were followed for 1 of 1 patient (P5) observed when a continuous glucose monitoring device was changed by agency nurse. P5’s P5 had a start of care (SOC) date of 6/4/2019. P5’s plan of care (POC) with certification dates of 1/14/23-3/14/23 identified diagnoses of heart disease, diabetes mellitus and spinal stenosis (narrowing of the spinal column which may cause pain). The POC identified P5 required skilled nursing visits (SNV) every one-two weeks for medication set up and assessment of general condition. On 2/7/23, at 10:24 a.m. during a home visit registered nurse (RN)-A was observed to complete hand hygiene with hand sanitizer. RN-A did not put on gloves. RN-A used an alcohol wipe to clean an area on P5’s left bicep. RN-A then removed the used continuous glucose monitoring device from P5’s right bicep. RN-A placed the device into a sharp safe container. RN-A used hand sanitizer to clean her hands before applying the new continuous glucose monitoring device to P5’s left bicep. RN-A did not use gloves during this entire observation. On 2/7/23, at 10:30 a.m. RN-A stated she usually wears gloves when handling items which are inserting into the skin, such as the continuous glucose monitoring device, but forgot to during this observation. RN-A stated it is important to wear gloves to prevent possible exposure to contaminated items. RN-A stated it was possible there was blood on the used device. On 2/8/23, at 2:49 p.m. nursing supervisor (NS)-A stated she expected nurses to wear gloves when handling sharp items which may be contaminated with blood or other bodily fluids. NS-A stated the risk of contact with blood is high when working with sharp objects. Agency policy, Communicable Disease, updated 11/2022, instructed staff: gloves should be worn for touching any body fluids (urine, saliva, vomit, blood, ect.) or non-intact skin for all patients; for handling items of surfaces soiled with blood, for performing venipuncture and other vascular access procedures.