Every finding on record at Senior Focus Health Systems LLC

A recertification survey was completed from 6/27/2022 to 6/28/2022 at Seacoast Home Health. The agency was not in compliance with the Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

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 interviews and record reviews, the agency failed to ensure that patient's individualized plan of care (POC) included a description of the patient's risk for emergency department visits and re-hospitalization for 10 (#1, #2, #3. #4, #5, #6, #7, #8, #9 and #10) patients out of 10 sampled. Findings included: A review of the medical records revealed the care plans for patients #1, #2, and #3. #4, #5, #6, #7, #8, #9 and #10 did not contain the required description of the patient's risk for emergency department visits and hospital re-admission and all necessary interventions to address the underlying risk factors. During an interview with the administrator on 6/28/2022 at 11:48 a.m., she confirmed the POCs did not contain the required information.

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 observations, interviews, and record reviews, the agency failed to follow its hand hygiene and bag technique policy during wound care for 1 (#3) and during colostomy care for 1 (#4) patient out of 2 home care visits conducted. Findings included: A review of the medical record for patient #4 revealed a certification period of 5/21/2022 to 7/10/2022 with a primary diagnosis of Encounter for attention to colostomy. The plan of care signed by the physician ordered skilled nursing (SN) effective 5/23/2022 1 week 9 with 3 PRN (as needed) visits for ostomy complications. The POC does not have specific orders for nursing to change the ostomy bag. A wound care observation for patient #4 was conducted on 6/28/2022 at 1:00 p.m. with Staff B, Registered Nurse (RN). Staff B entered the patient's home and set her nursing bag on a non-permeable barrier, removed her hand sanitizer from the side pocket of her bag, sanitized her hands, and donned gloves. Staff B completed a head-to-toe nursing assessment. Staff B removed the patient's socks, checked his feet, and then put the patient's socks back on. Staff B then assisted patient #4 with his pants and had him lie on the bed. Without using hand sanitizer or changing gloves, Staff B removed the patient's colostomy bag, which was so full that it had separated from the wafer around the stoma. Staff B noted the stool all over the patient's abdomen, pubic area, and down his left leg. Staff B removed the bag and wafer. Staff B attempted to clean the dried stool off of the patient. Staff B searched the patient's room for colostomy supplies with the same pair of gloves. Staff B, with gloves on, went in and out of her nursing bag three times to pull out colostomy supplies. Finally, Staff B notified the Assisted Living Facility Director (ALF) that she needed colostomy supplies for patient #4. While waiting for the colostomy supplies, Staff B removed her gloves. The ALF Director brought in the colostomy supplies, and Staff B donned a pair of gloves and put on the new colostomy wafer and bag. Staff B then assisted patient #4 sitting on the side of the bed. Staff B then removed her gloves, rolled them up in a ball, and rolled them between her hands. Staff B then reached up, dragged her mask below her nose, and rubbed her nose. Staff B then cleansed her hands with sanitizer. A review of the plan of care for patient #3 for the certification period 5/05/2022 to 7/03/2022 with pertinent diagnoses of Alzheimer's Disease and frequent falls. The plan of care signed by the physician for physical therapy 1 week 1, 2 week 2, 1 week 5. A physician telephone order dated 6/09/2022. SN effective 6/09/2022, Order Details: right lower leg skin tear -cleanse with wound cleanser and pat dry. Apply foam dressing each visit until healed. A wound care observation for patient #3 was conducted on 6/28/2022 at 1:53 p.m. with Staff B, RN. Patient #3 was in the small dining area on the memory care unit in her wheelchair. Staff B placed her nursing bag on the top of a dining room table without a non-permeable barrier. Staff B donned a pair of gloves without using hand sanitizer. Staff B completed a head-to-toe assessment of patient #3. Staff B removed the sock on the patient's left leg and her right leg. Staff B removed the old dressing to the patient's right lower leg and placed it in a bag. Then Staff B went into her nursing bag and pulled out gauze and wound wash. Staff B sprayed the wound wash on the gauze and then patted the moistened gauze across the wound to the non-affected area and then back across the injury. Staff B then took her phone out of her uniform pocket and took a picture of the wound. Then Staff B reached into her nursing bag for a cotton tip applicator and measured the wound (2.1 x1.6 x 0.2). Staff B then went into her nursing bag for her scissors and a sheet of calcium alginate. With her scissors, she cut a small piece of the calcium alginate and put it on the patient's wound, then covered it with a padded foam dressing. Then staff B reached into her uniform pocket for a black marker, and then she dated the wound dressing. After completing wound care, Staff B removed her gloves, donned a new pair, and assisted the patient from a sit-to-stand position to assess skin integrity. Staff B then removed her gloves. During an interview on 6/27/2022 at 2:20 p.m., Staff B, RN, confirmed she had not sanitized her hands or donned new gloves during the colostomy care for patient #4 or during the dressing change for patient #3. Staff B could not identify her nursing bag's clean or dirty side. A review of the employee file for Staff B's hire date was 2/15/2022. The Director of Nursing did not complete the nursing competency. There was no documentation of competency for bag technique or hand washing. During an interview on 6/28/2022 at 11:19 a.m., the administrator confirmed the agency policy was to sanitize before and after gloves changes. "Staff should change gloves after removal of the dressing." A review of the agency policy titled Hand Hygiene with a revised date of November 2021 documents the Purpose: To prevent cross-contamination and home care-acquired infections. Procedure: 3. Hand decontamination using an alcohol-based hand rub should be performed: A. Before having direct contact with patients. G. After removing gloves. A review of the agency policy titled Bag Technique with a revised date of November 2021 documents the Purpose: To describe the procedure for maintaining a clean nursing bag/computer bag and preventing recross-contamination. Bag Technique: 1. The bag will be placed on a clean surface (i.e., a surface that can be easily disinfected) in the car and in the home.2. Prior to administering care, alcohol-based hand rub or soap and paper towels will be removed, and hands will be washed. …Handwashing will always be completed before opening the bag. 4. After hand washing, the supplies and/or equipment needed for the visit will be removed from the bag. 4. The bag will contain a designated clean and dirty area. The clean area contains unused or cleaned supplies/equipment, and the dirty area is designated for contaminated materials (i.e., used equipment, etc.) 5. When the visit is completed, reusable equipment will be cleansed using alcohol, soap, water, or other appropriate solution, hands will be washed, and equipment and supplies will be returned to the bag. 6. Hands will be decontaminated prior to returning clean equipment to the bag. ..