Every finding on record at Select Care Home Health Services Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location; 680 Wilshire Place, #302, Los Angeles, CA 90005 Representing the California Department of Public Health : Surveyor ID # 22303- RN - HFEN Surveyor ID # 09697 - RN - HFEN Active Patients - 78 Sample Size - 10 Home 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 training for staff are conducted at least annually. This failure had the potential for the staff to perform ineffectively during an emergency situation. Findings: During an interview with the Director of Patient Care Services (DPCS), on 4/3/22 at 11 a.m., she stated she did not conduct emergency preparedness training for all the staff. During record review there was no documented emergency preparedness training for the HHA staff. The HHA's undated policy and procedure titled, "Emergency Preparedness Plan Plan," indicated the plan uses the term "all hazard" to address all types of incidents. The incidents which may require action by home care and emergency service personnel to prevent or minimize loss of life or damage to property and environment.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location; 680 Wilshire Place, #302, Los Angeles, CA 90005 Representing the California Department of Public Health : Surveyor ID # 22303- RN - HFEN Surveyor ID # 25046 - RN - HFEN Active Patients - 78 Sample Size - 10 Home Visit - 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 interview, and record review, the Home Health Agency (HHA) failed to ensure the staffs are fit tested for the use of N95 (a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles) masks to prevent COVID-19 (an acute respiratory illness) transmission. This failure had the potential for an increased risk of cross contamination and spread of infection. Findings: During an interview with the Director of Patient Care Services (DPCS), on 4/3/22 at 12 p.m. , she could not provide evidence that all of the HHA staff were fit tested for N95 masks. The DPCS stated she will follow up with the fit testing for N95 masks to all staff to prevent the spread of COVID-19. The HHA's policy and procedure dated 4/2021 and titled, "COVID-19 Plan," indicated the goal of the organization is to prevent the transmission of COVID-19 in the workplace. The policy stated the agency will provide and ensure facemasks or higher level of respiratory protection will be worn by employees..

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the skilled nurse (SN) failed to label the intravenous (IV) bag while administering IV fluids to a patient for one out of seven patients (Patient 1). This deficient practices placed a risk for medication errors. Findings: A review of Patient 1's clinical record indicated the start of care (SOC) date was 3/29/2022, with diagnoses of bilateral labyrinthitis (inflammation of the inner ear or the nerves that connect the inner ear to the brain). A review of Patient 1's plan of care (POC) for certification period from 3/29/22 to 5/27/22, indicated an order for the SN to visit two times a day for five days then re-assess. The POC indicated for the SN to check vital signs and to do a comprehensive skilled nursing assessment/observation of the patient's all body systems focusing on effectiveness of IV hydration therapy and observe for infiltration (occur when fluid leaks out of the vein into surrounding soft tissue) on IV sites. One of the SN interventions was to administer D5 (sugar water) 1/2 Normal saline (NS, salt water) 500 milliliters (ml) mixed with multivitamin (MVI) 10 ml to run over three hours via peripheral line (a small, short plastic catheter that is placed through the skin into a vein) daily for five days. On 4/2/22, at 11:30 a.m., a home visit was conducted at Patient 1's residence with Registered Nurse (RN1). Patient 1 was observed lying in bed asleep. there was an IV piggyback (medication that is administered through the IV) of D5 1/2 NS 500 ml hanging and infusing by peripheral line running at 100 cc/hour connected to an IV heplock (a type of venous access) at the patient's right antecubital area (refers to the space inside the crook of the elbow). The IV piggyback had no label of date and time the IV bag was hung and did not have the name of medication that was mixed with the IV fluid. On 4/2/22 at 12 p.m., during an interview with RN 1, she stated she forgot to put a label on the IV fluid bag. On 4/3/22, at 11 a.m., during an interview with the director of patient care services (DPCS), she stated RN 1 should labelled the IV fluid bag when administering medications to the patient. A review of the hospice agency's policy, " IV Infusion Policy", undated indicated that parenteral medications/fluids administered through IV bag should have a label of date and time when hang, the name of medication mixed with the IV fluids, and rate of infusion at all times to prevent medication errors.