Every finding on record at Salcare Home Health Services

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 56 Active Patients - 21 Sample Size - 7 Patients 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), §485.625(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 all staff received Emergency Preparedness disaster drill training. The staff's lack of knowledge and preparation is a potential risk in the delay to carry out immediate staff's response in the event an emergency crisis occurs. During a review of the Emergency Preparedness disaster drill training on 2/28/22 at 12:15 p.m., the HHA did not have evidence annual training had been provided to all staffs. During an interview with Director of Patient Care Services (DPCS) on 2/28/22, at 12:15 p.m., the DPCS stated the annual training had not been given to all staffs. The HHA's undated policy and procedure titled "Emergency Preparedness Policy" indicated the agency will have an identified plan in place to ensure the safety and well-being of clients and employees during periods of an emergency or disaster that might disrupt home health services.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 56 Active Patients - 21 Sample Size - 7 Patients 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) failed to maintain an accurate, and current medication profile for two of seven patients (Patients 1 and 4). This failure has the potential to result in putting the patient at risk for medication errors and adverse drug reactions. . A review of Patient 4's "Admission Profile" indicated, a start of care (SOC) date of 11/16/15, with a diagnosis that included Arnold Chiari syndrome (structural defects in the brain and spinal cord). During a review of Patient 4's Plan of Care (POC), for the re-certification period from 2/12/22 to 4/12/22, included an order for skilled nurse (SN) to visit seven days a week for twelve hours a day. The SN would assess medication regimen and compliance with patient and care giver. On 12/25/22, at 8:30 a.m., a home visit was conducted at Patient 4's residence with licensed vocational nurse ( LVN 1). During a review of Patient 4's medications indicated a bottle of keflex 500 milligrams (antibiotic, mg-unit of measurement) one tablet every 8 hours. The date of expiration for the medication was 2/25/22. The medication was not on Patient 4's medication profile. At 9:15 a.m., during an interview with LVN 1 , she stated the medication is kept in case it is needed but it is not listed on the medication profile She stated the medication profile should match the current medications ordered. She confirmed there should not be any expired medications. The agency's undated policy and procedure titled " Medication Profile" indicated the clinician will check all medications and document changes in the medication regimen. a. A review of Patient 1's clinical record indicated the start of care (SOC) date was 2/23/21, with diagnoses of quadriplegia (paralysis of all four limbs). A review of Patient 1's plan of care (POC) for certification period dated 2/18/22 to 4/18/22, indicated an order for the Skilled Nurse (SN) to visit 13 hours a day to assess medication regime and compliance with patient and care giver. one of the physician's order included in the plan of care was to administer Baclofen 5 mg (milligrams) two tabs three times daily. On 2/25/22, at 11:45 a.m., a home visit was conducted at Patient 1's residence with LVN 2 (license vocational nurse). Patient 1 was observed alert and oriented, and was ambulatory using a cane. When the current medications were reviewed comparing with the medication profile at 12 p.m., there was a bottle of Baclofen 10 mg 2 tabs three times a day with a refill date of 12/15/21. During an interview with Patient 1, she stated 2 tabs three times a day since three moths ago. On 2/25/22, at 12:35 p.m., during an interview with LVN 2, she stated she did not check the Baclofen medication at all. On 2/28/22, at 1:30 p.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse should check all patient's medications during their home visits.

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 licensed staff failed to administer treatments as ordered by the physician for one of seven patients with a boil (pus filled bump) at right groin area. (Patient 3). This deficient practice has the potential to delay healing process that could lead to further wound complications. A review of Patient 3's clinical record indicated a start of care dated 3/1/16, with primary diagnosis of diabetes mellitus ( a group of diseases that result in too much sugar in the blood). A review of Patient 3's plan of care from 1/29/22 to 3/29/22, included an order for SN (skilled nurse) 24 hours per month of respite care for 60 days, for skilled nurse to assess, perform and instruct wound care to right groin boil as follows: to cleanse with Dakins solution, fill with Santyl ointment, pack with Dakins soaked gauze roll packing and cover with dry dressing, secure with tape twice daily. A review of Patient 3's Skilled Nursing Visit Notes dated 2/22/22 and 2/24/22, indicated the visiting nurse provided wound care to right groin boil by cleaning and dressing wound with wet to dry dressing and secured it with tape. On 2/28/22, at 1:45 p.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse did not follow the correct wound care orders for Patient 3.

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 home health agency (HHA) failed to implement COVID-19 (an acute respiratory illness) infection control policy and procedure. This failure had the potential to spread infection to patients, family members, and staffs. On 2/25/22 at 1:15 p.m., an interview was conducted with the Director of Patient Care Services (DPCS) regarding evidence of staffs being fit tested before using the N 95 masks/respirators to protect and prevent the transmission of COVID 19 infection. The DPCS stated she could not provide evidence of staffs being fit tested for N 95 mask/respirator.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview , and record review , the home health agency (HHA) failed to follow the plan of care (POC) for two of seven patients (Patients 3 and 4). For Patient 3, this failure had the potential for the patient to have hypoglycemia status. For Patient 4, this failure had the potential to affect the patient's respiratory status. A review of Patient 4's "Admission Profile" indicated, a start of care (SOC) date of 11/16/15, with a diagnosis that included Arnold Chiari syndrome (structural defects in the brain and spinal cord). During a review of Patient 4's Plan of Care (POC), for the re-certification period from 2/12/22 to 4/12/22, included an order for skilled nurse (SN) to visit seven days a week for twelve hours a day. The SN would assess breathing status and provide tracheostomy care. On 12/25/22, at 8:30 a.m., a home visit was conducted at Patient 4's residence with licensed vocational nurse ( LVN 1). During this time it was observed the patient had a tracheostomy (a hole through the front of the neck and into the windpipe to keep it open for breathing). The patient did not have an ambu bag (a handheld tool that is used to deliver positive pressure ventilation) inside his room. At 9:15 a.m., during an interview with LVN 1 , she stated she could not find the ambu bag. She confirmed the importance of an ambu bag to provide air to the patient in case of an emergency. The agency's undated policy and procedure titled "Manuel Ventilation" indicated to keep available at the bedside when client needs mechanical ventilation. a. A review of Patient 3's clinical record indicated a start of care dated 3/1/16, with primary diagnosis of diabetes mellitus ( a group of diseases that result in too much sugar in the blood).A review of Patient 3's plan of care from 1/29/22 to 3/29/22, included an order for SN (skilled nurse) 24 hours per month of respite care for 60 days to administer insulin as follows: Humulin R injection solution 100 unit/ml-40 units every morning and evening subcutaneously; Insulin NPH subcutaneous suspension 100 unit/ml- 40 units every morning and evening. A review of Patient 3's Skilled Nursing Visit Note dated 2/22/22, at 6:30 a.m. to 7:30 a.m. and 2/24/22, at 6:30 p.m. to 7:30 p.m., indicated no documented evidence that the Humulin 40 units and NPH 40 units were administered to Patient 3 as ordered. On 2/28/22, at 1 p.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse administers the ordered insulin during their visits and she should have documented that she administered the insulin to the patient on her nursing notes.