Every finding on record at Rodan Home Health Services, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 2140 WEST OLYMPIC BLVD SUITE 501 LOS ANGELES, CA 90006 Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 52 Active Patients - 24 Sample Size - 7 Home Visits- 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), §485.542(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 (HHA) 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 lack the knowledge to respond effectively during an emergency situation. Findings: During a review of the emergency preparedness plan of the HHA on 3/12/23, at 12:30 p.m., the HHA did not have documented evidence of Emergency Preparedness training/disaster drill for all staffs and did not have evidence of emergency plan annual review. During an interview with director of patient care services (DPCS) on 3/12/23, at 1 p.m., she stated she had not received Emergency Preparedness/Disaster training plan from the HHA. There was no documented evidence the governing body reviewed the policy annually on Emergency Preparedness/Disaster 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 Recertification Survey at this location: 2140 WEST OLYMPIC BLVD SUITE 501 LOS ANGELES, CA 90006 Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 52 Active Patients - 24 Sample Size - 7 Home Visits- 3

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 (HHA) staff failed to review all medications the patient is taking by reconciling the current medications with the medication profile for 2 out of 7 sample patients (Patients 2 and 3). This deficient practice had the potential to place the patients at risk for medication errors and serious adverse drug effects. 3. A review of the HHA's document titled " Home Health Certification and Plan of Care" for the certification period of 2/22/23 to 4/22/23 indicated that Patient 3 is a 96-year-old female with a start of care date of 12/24/22 with the medical diagnosis of intervertebral disk degeneration (a condition of the discs between vertebrae with loss of cushioning, fragmentation and herniation related to aging) and low back pain. Skilled nurse (SN) visit for evaluation and as needed. Skilled observation of vital signs including pain and blood pressure level this visit. Physical therapy visits once a week for 1 week, twice a week for 2 weeks then once a week for 5 weeks for further balance and functional mobility. SN to continue to assess: musculoskeletal status, endocrine status, integumentary status, neurological/mental status, genitourinary and gastrointestinal status, sensory status, home safety/fall prevention, signs and symptoms of infection, pain level and comfort. Assess pain and adequacy of relief measures and when to call physician on reportable changes in conditions as well as readiness for discharge. During a joint visit observation with the registered nurse (RN) on 3/11/23 at 10:00 a.m., Patient 3 is alert and oriented to name, place and person. Complained of 6/10 pain. Patient 3 is ambulatory and slow with assistive device. Able to make needs known. Patient 3's granddaughter at bedside. RN started her visit. During the medication review of Patient 3’s medication with RN on the same date, The following medication discrepancies were found on the medication profile: Aspercreme Lidocaine cream(used to help relieve nerve pain) apply topically on lower back as needed. Patient 3's granddaughter stated that she bought it to help relieve her pain on the lower back. Granddaughter also stated that she used it twice at bedtime. Granddaughter also stated that patient 3 was hospitalized several times for falling and suffered a lumbar ( lower back) fracture (broken bone) on the L1,4 and 5 and wears a lumbosacral brace for back pain support. During an interview with the RN on 3/11/23 at the same time, she stated that she only visit the patient during recertification and resumption of care. RN also stated that is the only time she conducts medication review. During an interview with the granddaughter on 3/11/23 stated that there is only a physical therapist (PT) that comes in every visit. The PT checks the vital signs and perform exercises. Granddaughter stated PT does not check medications. Granddaughter also stated that there is no nurse that comes in every week or call to verify medications. During an interview with the Administrator (ADMIN) and the Director of Nursing (DON), both stated they are both new in the agency. Admin stated that the RN during the visit should have called the doctor to verify correct medication. The DON stated that the PT does not check medications for them. A review of the HHA's policy titled "Pain Assessment" revised 10/22, indicated pain that is not controlled with current regimen will be communicated to the physician to obtain orders for a more effective regimen. A review of the HHA's policy titled "Pain Management" revised 10/22, indicated that Pain will be assessed as apart of every patient contact if the patient reports pain or is at risk for pain. Patients who reports pain will receive further assessment and appropriate management. A review of the HHA's policy titled " Medication Monitoring" revised 10/22, indicated the clinician will assess the effect of medications on the patient. the assessment will identify drug interactions, duplicative drug therapy and non-compliance with drug therapy. A review of Patient 's Plan of Care (POC) for the certification period from 1/31/23 through 3/31/23, indicated the Start of Care date was 1/31/23, with diagnosis that included spinal stenosis (narrowing of the spinal canal). The POC indicated the Skilled Nurse (SN) was to visit once for evaluation and the physical therapist (PT) once a week for nine weeks to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. The SN was to teach and instruct about medications and adverse reactions. On 3/11/23, at 11:30 a.m., a home visit was conducted at Patient 2's residence with RN 1 (registered nurse). Patient 2 was alert and oriented and sitting on a chair at dining area. At 11:45 a.m., a review was conducted of Patient 2's current medications comparing with the medication profile provided by the agency. It was observed Patient 2 had a bottle of Cilostalol 100 mg (milligrams) one tab twice a day with an expiration date of 1/13/23. This medication was included in the medication profile. At 12 p.m., during an interview with Patient 2, she stated takes Cilostalol 100 mg twice a day. She also stated that the visiting nurse nor the PT told her the Cilostalol medication was expired. On 3/12/23, at 11 a.m., during an interview with the DPCS, she stated the visiting nurse or PT should be checking the patient's medications during their visits. A review of the HHA's document titled " Clinical policy and Procedures Manual: Medication Profile", indicated Patient's receiving medications will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications.

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 observation, interview and record review, the agency staff failed to ensure care followed the written plan of care for one of 7 patients (Patient 2). The visiting nurse failed to do pain assessment and to provide adequate pain management when the patient experienced severe pain. This deficient practice placed the patient at a potential risk for uncontrolled pain which could affect the overall health status. Findings: A review of Patient 's Plan of Care (POC) for the certification period from 1/31/23 through 3/31/23, indicated the start of care date was 1/31/23, with diagnosis that included spinal stenosis (narrowing of the spinal canal). The POC indicated the Skilled Nurse (SN) was to visit once for evaluation and the physical therapist (PT) once a week for nine weeks to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. The SN and PT was to teach and instruct about pain management and use of round the clock pain medication. On 3/11/23, at 11:30 a.m., a home visit was conducted at Patient 2's residence with RN 1 (registered nurse). Patient 2 was alert and oriented and sitting on a chair at dining area. When Patient 2 was asked if she has pain, she stated she has 4 to 5 (moderate to moderately strong) pain level out of 10 pain scale at her right foot, right leg and back every day. A review of Patient 2's Physical Therapy Clinical Note dated 2/3, 2/9,2/16, 2/24/23, 3/1, and 3/9/23, indicated no documented evidence of a pain assessment being done during the visits. On 3/12/23, at 11 a.m., during an interview with the DPCS, she stated the visiting nurse or PT should be doing a pain assessment during their visits to determine if patient is in pain and to provide pain management if needed. A review of the agency's policy of "Pain Assessment and Management", indicated the patient shall be evaluated regarding the effectiveness of and/or needs for pain management. Pain management involves on-going pain assessment, evaluation of interventions, coordination with the physician and patient/caregiver education regarding pain management. Assessment of pain includes the collection of data including description of pain intensity using 1-10 scale appropriate to the patient's ability to describe pain.

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 observation, interview, and record review, skilled nurse (SN) failed to notify the physician regarding the patient's complaint of pain to right foot, right leg, and back with a pain level of 4 to 5 (moderate to moderately strong pain) out of 10 for one out of 7 sample patients (Patient 2). This deficient practice has the potential to cause unresolved pain that could result to patient's discomfort affecting the patient's quality of life. Findings: A review of Patient 's Plan of Care (POC) for the certification period from 1/31/23 through 3/31/23, indicated the Start of Care date was 1/31/23, with diagnosis that included spinal stenosis (narrowing of the spinal canal). The POC indicated the Skilled Nurse (SN) was to visit once for evaluation and the physical therapist (PT) once a week for nine weeks to perform skilled observation and assessment of vital signs and all body systems and medication and dietary regimen. The SN and PT was to teach and instruct about pain management and use of round the clock pain medication. One of the physician's orders was to administer Pregabalin 25 mg (milligrams) one cap three times a day for neuropathic pain. On 3/11/23, at 11:30 a.m., a home visit was conducted at Patient 2's residence with RN 1 (registered nurse). Patient 2 was alert and oriented and sitting on a chair at dining area. During an interview Patient 2 was asked if she has pain, she stated she has 4 to 5 out of 10 pain scale at her right foot, right leg and back every day. She also stated that she told the visiting nurse and PT that her Pregabalin 25 mg medication does not relieve her pain. A further review of Patient 2's clinical record indicated no documented evidence the physician was notified. On 3/12/23, at 12 p.m., during an interview with the DPCS, she stated she could not find any communication note to justify the physician was notified regarding Patient 2's existing pain not relieved by her pain medication. A review of Agency's policy "Change of Condition (undated)," indicated the clinician is responsible for any specific treatment would notify the attending physician of significant changes in the patient's condition.

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to coordinate care and services to meet the individualized care needs for 5 out of 7 sampled patients ( Patients 3, 4, 5, 6, and 7) This deficient practice resulted in the HHA's inability to develop and implement the individualized plans of care for the management of pain manifested by the patients. Findings: Findings: A review of the HHA's document titled " Home Health Certification and Plan of Care" for the certification period of 2/22/23 to 4/22/23 indicated Patient 3's start of care date of 12/24/22, with the medical diagnosis of intervertebral disk degeneration (a condition of the discs between vertebrae with loss of cushioning, fragmentation and herniation related to aging) and low back pain. Skilled nurse (SN) visits for evaluation and as needed. Skilled observation of vital signs including pain and blood pressure level this visit. Physical therapy visits once a week for 1 week, twice a week for 2 weeks then once a week for 5 weeks for further balance and functional mobility. SN to continue to assess musculoskeletal status, endocrine status, integumentary status, neurological/mental status, genitourinary and gastrointestinal status, sensory status, home safety/fall prevention, signs and symptoms of infection, pain level and comfort. Assess pain and adequacy of relief measures and when to call physician on reportable changes in conditions as well as readiness for discharge. During a joint visit observation with the registered nurse (RN) on 3/11/23, at 10 a.m., Patient 3 was alert and oriented to name, place and person. Patient 3 complained of 6/10 pain. Patient 3 was ambulatory and slow with assistive device. Able to make needs known. Patient 3's granddaughter at bedside. During the interview with Patient 3’s granddaughter with RN on the same date, stated that she gave medicine for pain twice at bedtime. Granddaughter also stated that Patient 3 was hospitalized several times for falling and suffered a lumbar (lower back) fracture (broken bone) on the L1,4 and 5 and wears a lumbosacral brace for back pain support. Granddaughter stated Patient 3 always complains of low back pain after she was hospitalized. Granddaughter further stated that there was only a physical therapist (PT) that comes in every visit. The PT checked the vital signs and performed exercises. During an interview with the Administrator (ADMIN) and the Director of Nursing (DON), both stated they were new in the agency. Admin stated that the PT during the visit should have assessed pain level pre and post physical therapy exercises and documented in their notes. 2. A review of the HHA's document titled " Home Health Certification and Plan of Care" for the certification period of 2/26/23 to 4/26/23 indicated that Patient 4's start of care date of 10/29/22 with the medical diagnosis of spinal stenosis (a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older) and multiple myeloma (a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys, and red blood cell count). Skilled nurse (SN) visit for evaluation and as needed. Skilled observation of vital signs including pain and blood pressure level this visit. Physical therapy visits once a week for 1 week, twice a week for 2 weeks then once a week for 5 weeks for further balance and functional mobility. SN to continue to assess: musculoskeletal status, endocrine status, integumentary status, neurological/mental status, genitourinary and gastrointestinal status, sensory status, home safety/fall prevention, signs and symptoms of infection, pain level and comfort. Assess pain and adequacy of relief measures and when to call physician on reportable changes in conditions as well as readiness for discharge. A review of Patient 4's Plan of Care indicated SN/PT to continue to report or call physician if: increased limitations of movement, immobility, inability to perform activities of daily living, intolerance pain of more than 7 out of 10 scale, unrelieved by current medication. 3. A review of the HHA's document titled " Home Health Certification and Plan of Care" for the certification period of 1/19/23 to 3/19/23 indicated Patient 5's start of care date of 9/21/22 with the medical diagnosis of Parkinson's disease (a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves) and low back pain. Skilled nurse (SN) visits for evaluation and as needed. Skilled observation of vital signs including pain and blood pressure level this visit. Physical therapy visits once a week for twice a week for 3 weeks then once a week for 4 weeks for further balance and functional mobility. SN to continue to assess musculoskeletal status, endocrine status, integumentary status, neurological/mental status, genitourinary and gastrointestinal status, sensory status, home safety/fall prevention, signs and symptoms of infection, pain level and comfort. Assess pain and adequacy of relief measures and when to call physician on reportable changes in conditions as well as readiness for discharge. A review of Patient 5's Plan of Care indicated SN/PT to continue to report or call physician if: increased limitations of movement, immobility, inability to perform activities of daily living, intolerance pain of more than 7 out of 10 scale, unrelieved by current medication. 4. A review of the HHA's document titled " Home Health Certification and Plan of Care" for the certification period of 8/20/22 to 10/18/22 indicated that Patient 6's start of care date of 9/21/22 with the medical diagnosis of unspecified fracture of the femur and low back pain. Skilled nurse (SN) visits for evaluation and as needed. Skilled observation of vital signs including pain and blood pressure level this visit. Physical therapy visits once a week for once a week for 8 weeks for further balance and functional mobility. SN to continue to assess musculoskeletal status, endocrine status, integumentary status, neurological/mental status, genitourinary and gastrointestinal status, sensory status, home safety/fall prevention, signs and symptoms of infection, pain level and comfort. Assess pain and adequacy of relief measures and when to call physician on reportable changes in conditions as well as readiness for discharge. A review of Patient 6's Plan of Care indicated SN/PT to continue to report or call physician if: increased limitations of movement, immobility, inability to perform activities of daily living, intolerance pain of more than 7 out of 10 scale, unrelieved by current medication. 5. A review of the HHA's document titled " Home Health Certification and Plan of Care" for the certification period of 11/27/22 to 1/25/23 indicated Patient 7's start of care date of 9/28/22 with the medical diagnosis of left side hemiplegia and hemiparesis (Loss of strength in the arm, leg, and sometimes face on one side of the body. Hemiplegia refers to a severe or complete loss of strength, whereas hemiparesis refers to a relatively mild loss of strength) leg pain and pacemaker (a small device that's placed (implanted) in the chest to help control the heartbeat). Skilled nurse (SN) visits for evaluation and as needed. Skilled observation of vital signs including pain and blood pressure level this visit. Physical therapy visits once a week for once a week for 8 weeks for further balance and functional mobility. SN to continue to assess: musculoskeletal status, endocrine status, integumentary status, neurological/mental status, genitourinary and gastrointestinal status, sensory status, home safety/fall prevention, signs and symptoms of infection, pain level and comfort. Assess pain and adequacy of relief measures and when to call physician on reportable changes in conditions as well as readiness for discharge. Certified Home health Aide (CHHA) service weekly for personal care/hygiene, ADL and other assigned tasks as per CHHA practice standard. A review of Patient 7's Plan of Care indicated SN/PT to continue to report or call physician if: increased limitations of movement, immobility, inability to perform activities of daily living, intolerance pain of more than 7 out of 10 scale, unrelieved by current medication. A review of Patient 7's Home Health Aide Visit Record dated 12/20/22,12/27/22, 1/3/23,1/10/23 and 1/17/23 showed no pain assessment during the home health aide visit. CHHA A review of the HHA's policy titled " Care Planning Process" revised 10/22 indicated that all clinicians will consider the conclusions of initial and ongoing assessments in their care planning process, including, but not limited to: individualized patient needs and resultant problems related to care of a patient, functional status, family/caregiver support systems, change is patients condition, pain and symptom management, as appropriate. A review of the HHA's policy titled "Ongoing Assessments" revised 10/22 indicated that during each home visit, the clinician or other discipline will re-evaluate the patient according to the problems identified during the initial and subsequent visits. Using the standards of care identified by the organization, the clinician will reassess the patient as appropriate) for: pain status, when applicable, including responses to pain interventions and progress toward pain management goals including functional ability.