Every finding on record at Serve Link Home Care, Inc

The Emergency Preparedness regulations were reviewed as part of the Medicare recertification survey completed on 01/29/2025. During the survey it was determined the home health provider is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Providers.

A partial extended survey for Medicare recertification for the home health provider was completed on 01/29/2025. The provider had 33 current patients.

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 policy review, home visit observation, and interview, the home health provider failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases in, but not limited to, one of three home visit observations conducted (Record/Patient #3). This deficient practice has the potential to affect all the patients served by the home health provider. Findings included: Review of the document titled, “Infection Prevention and Control in the Home Setting,” dated 05/2024, showed in part that hand hygiene will be performed after contact with the patient or objects in the immediate vicinity of the patient. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 02/02/2024. The primary diagnosis for home health services, effective 12/27/2024, was hypertensive heart disease (a group of heart problems caused by long-term high blood pressure) with chronic kidney disease (a long-term condition where the kidneys gradually lose their ability to filter waste products from the blood) including heart failure (a decrease in the ability of the heart to pump blood). The patient had a complicated medication regimen and required skilled nursing visits weekly to prefill his/her medication planner. The patient resided alone in his/her own home with the assistance of paid caregivers two to three times per week to assist with activities of daily living, bathing, and errands. During a home visit observation on 01/28/2025 at 09:15 AM registered nurse (RN)-A: - Performed hand hygiene, placed a protective drape on the table, entered the clean area of his/her nursing bag and retrieved his/her blood pressure cuff, thermometer, pulse oximeter (a device used to measure oxygen levels in the blood), stethoscope (a device used to listen to heart and lung sounds), and a package of cleansing wipes; - He/she placed the items on the protective drape; - He/she then performed a physical assessment, checked the patient’s blood pressure, temperature, oxygen saturation reading, and listened to the patient’s lungs and abdomen with his/her stethoscope; - He/she placed the contaminated equipment on the protective drape after use; - During the assessment of the patient, the nurse failed to perform hand hygiene before he/she: * Entered his/her nursing bag; * Retrieved a plastic bag that contained gloves; * Opened the bag of gloves; * Retrieved a pair of gloves; * Resealed the bag; * Failed to disinfect the outside of the plastic bag; and * Returned the contaminated bag of gloves to the clean area of the nursing bag; and - After he/she performed his/her physical assessment of the patient, he/she failed to perform hand hygiene before: * He/she retrieved the package of cleansing wipes off of the drape; * Opened the package that contained the cleansing wipes; * Retrieved a cleansing wipe from the package; * Cleansed the medical equipment used during his/her assessment of the patient; * He/she then placed the cleansed medical equipment into the clean area of his/her nursing bag, and * Failed to clean the outside of the cleansing wipe container before he/she placed it into the clean area of the nursing bag. During an interview immediately following the home visit on 01/28/2025 at 09:50 AM, RN-A acknowledged that he/she should have performed hand hygiene prior to cleaning his/her used medical equipment, cleansed the outside of the cleansing wipes package prior to returning it to the nursing bag, and before he/she retrieved gloves from his/her nursing bag.

A partial extended survey for Medicare certification for Serve Link Home Care, Inc., was completed on 03/177/2022. The agency had 39 current patients. The Emergency Preparedness regulations were also reviewed as part of the Medicare certification survey. Three (3) standard level deficiency was identified. A COVID-19 Focused Infection Control Survey was completed in conjunction with the survey. No deficiencies were identified related to the Focused Infection Control Survey.

HHA- Procedures for Follow up Staff/Pts. CFR(s): 484.102(b)(3) §484.102(b)(3) Condition of Participation: [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (3) The procedures to follow up with on-duty staff and patients to determine services that are needed, in the event that there is an interruption in services during or due to an emergency. The HHA must inform State and local officials of any on-duty staff or patients that they are unable to contact. This STANDARD is not met as evidenced by: Based on review of the Serve Link Home Care, Inc. Emergency Operations Plan (EOP), observation and interview, the agency failed to establish and maintain an emergency preparedness program that meets federal requirements, and must include procedures to follow up with patients to determine services needed, if there is an interruption of services. The cumulative effect of this deficient practice has the potential to affect the quality of care and safety of all agency patients. Findings included: Review of the agency's policy titled "Emergency Operations Plan," effective 11/15/17, and revised 11/2018, showed the case manager /clinical supervisor is responsible for maintaining an updated and current log of patients with special needs and the log should be updated at least weekly and more frequently as necessary. Observation on 03/15/2022 at approximately 10:00 AM, showed the patient list was last updated on 01/25/2022. During an interview on 03/15/2022 at 01:35 AM, registered nurse (RN) A stated: - The patient census is to be updated weekly; - The director of nursing (DON) updates the list; and - The list was last updated 01/25/2022.

Emergency Officials Contact Information CFR(s): 484.102(c)(2) §403.748(c)(2), §416.54(c)(2), §418.113(c)(2), §441.184(c)(2), §460.84(c)(2), §482.15(c)(2), §483.73(c)(2), §483.475(c)(2), §484.102(c)(2), §485.68(c)(2), §485.625(c)(2), §485.727(c)(2), §485.920(c)(2), §486.360(c)(2), §491.12(c)(2), §494.62(c)(2). [(c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. *[For LTC Facilities at §483.73(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) The State Licensing and Certification Agency. (iii) The Office of the State Long-Term Care Ombudsman. (iv) Other sources of assistance. *[For ICF/IIDs at §483.475(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. (iii) The State Licensing and Certification Agency. (iv) The State Protection and Advocacy Agency. This STANDARD is not met as evidenced by: Based on review of the agency's Emergency Preparedness (EP) binder, and interview, the agency failed to ensure contact information was included and updated for federal and state emergency preparedness staff. This deficient practice has the potential to adversely affect the care and safety of all patients served by the agency during an emergency. Findings included: Review of the agency's EP binder showed no contact information for federal or state EP staff. Findings were reviewed with registered nurse RN) A on 03/15/2022 at 01:41 PM, and she stated there was no federal emergency management agency (FEMA) contact information, and no state emergency management agency contact information in the EP binder.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on policy review, personnel file review, and interview, the agency failed to ensure that training in emergency preparedness was completed every two years after hire, for three employees (Aide's #1, #2 and #3) of three home health aide files reviewed. This deficient practice has the potential to affect the care and services provided to all patients during an emergency. Findings included: Review of the agency's policy titled "Emergency Operations Plan," effective 11/15/17, and revised 11/2018, showed staff shall attend orientation upon hire and an annual update of their specific roles and responsibilities and the skills they require to perform their duties during an emergency. EMPLOYEE #1 (E1): Review of E1's personnel file showed a hire date of 11/13/97. There was no evidence to show that emergency preparedness training had been completed every two years after orientation. EMPLOYEE #2 (E2): Review of E2’s personnel file showed a hire date of 04/08/19. There was no evidence to show that emergency preparedness training had been completed every two years after orientation. EMPLOYEE #3 (E3): Review of E3’s personnel file showed a hire date of 08/27/12. There was no evidence to show that emergency preparedness training had been completed every two years after orientation. The findings were reviewed with registered nurse (RN) A on 03/16/22 at approximately 2:50 PM. No additional information was provided by survey exit.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on review of the current patient rights information, home visit observation, and interview, the agency failed to ensure staff provided a written visit schedule to patients that included what discipline was visiting, when the discipline would visit, and the frequency of visits in two (Records/Patients #1 and #3) of three home visits. This deficient practice has the potential to affect all patients served by the agency Findings included: Review of the current Patient Bill of Rights and Responsibilities left in patient home admission packet showed: - The home health agency must advise the patient in advance of the disciplines that will furnish care and the frequency of visits proposed to be furnished. RECORD/PATIENT #1: Review of the admission packet during a home visit observation on 03/15/2022 at 12:45 PM, showed: - The agency's patient rights information showed the agency must advise the patient in advance of the disciplines that will furnish care and the frequency of visits proposed to be furnished; - A copy of the calendar to be used to record discipline visits for the patients did not have skilled nurse marked; and - The back of the admission booklet has designated lines to list: “Your Professional Home Care Staff”: * Nurse - left blank; and * Team leader - left blank. RECORD/PATIENT #3: Review of the admission packet during a home visit observation on 03/16/2022 at 11:35 AM showed: - The agency's patient rights information showed the agency must advise the patient in advance of the disciplines that will furnish care and the frequency of visits proposed to be furnished; - A blank copy of the calendar to be used to record discipline visits for the patients; and - The back of the admission booklet has designated lines to list: “Your Professional Home Care Staff” and all lines were blank for all staff. During interview on 03/17/2022 at 12:54 PM, the director of nursing stated that all disciplines and frequencies should be filled in on the patient’s calendar and admission booklet.

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 review of the agency's policy, the facility failed to continue implementing their program to protect visitors and staff who entered the home health agency office from those that have chosen not to be vaccinated against the COVID-19. This deficient practice has the potential to affect infection control needs for all visitors/non-employees, employees and patients served by the agency. Findings included: Review of the agency's policy titled, "COVID-19 Vaccination Policy," effective 11/16/2021, and updated 01/18/2022, showed: - It is the policy that all eligible staff must receive the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services, unless an exemption is granted based on recognized medical conditions or sincere religious beliefs consistent with federal law by December 5, 2021, and be fully vaccinated by January 4, 2022; - The process will include ensuring staff implement precautions to mitigate the transmission and spread of COVID-19 who are not vaccinated; - The quality assurance (QA) registered nurse (RN) or designee will complete a roster of all eligible staff and current vaccination status; - The QA RN will identify employees who do not meet the definition of fully vaccinated; - The QA RN or designee will educate all employees who are not fully vaccinated additional precautions and measures to mitigate the spread of COVID-19 for all staff that are not fully vaccinated; * Personal protective equipment as indicated or needed; and * All staff will wear an approved N95 or equivalent mask on all home visits with patients and when physically around others in the office setting. Review of the Serve Link Home Health Staff, Vaccinated and Unvaccinated record showed the following: - Clerical B unvaccinated with a religious waiver; - RN C unvaccinated with a religious waiver; and - RN D vaccinated. Observation on 03/14/2022 at 09:30 AM showed: - Signage on the front door of the agency to instruct unvaccinated to wear a mask to enter the building” - Clerical B in the agency unmasked; - RN C in the agency unmasked; and - The surveyors entered the agency with appropriate face masks in place. The surveyors were greeted by staff, introductions were made and staff escorted the surveyors to a conference room. Observation on 03/15/2022 at 12:42 PM showed, RN C walking throughout the agency unmasked with Clerical B and RN D in the agency. Observation on 03/17/2022 showed: - 10:16 AM Clerical B unmasked sitting at front desk obtaining papers for state agency surveyor; and - 12:00 PM Clerical B unmasked delivering papers to the state agency surveyors. During interview on 03/17/2022 at 12:54 PM, the DON stated unvaccinated staff are to wear a face mask in the agency.

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 policy review, clinical record review, and interview, the agency failed to ensure staff provided services as ordered by the physician in one (Record/Patient #5) of five full clinical records reviewed. This deficient practice has the potential to affect all patients served by the agency. Findings included: Review of the agency's policy titled "Physician’s Orders," effective October 1996, and updated 10/07/2004, showed: - Care or services is provided in accordance with the physician’s orders; and - The plan of care is based on the patient’s immediate and long-term needs. RECORD/PATIENT #5: Review of the skilled admission nurse’s note dated 02/21/2022 showed: - Primary admitting diagnosis of Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) (dangerous condition resulting from very high blood glucose levels.) Review of the patient medication record dated 02/21/2022 through 04/21/2022, showed: - Toujeo SoloStar (insulin) subcutaneous (SQ) 300 unit (U)/milliliter (ml) 24U, administer 24U under skin SQ daily. Side effects may include: low blood sugar. Review of the skilled nursing visit dated 02/28/2022 showed: - The patient checks his/her own blood sugar and logs results; - Nurse reviews log at each visit; and - Reviewed blood sugar log and how patient corrects them when low. Patient is having several low blood sugars. Notified physicians nurse via phone and also sent a fax with a blood sugar log attached. Review of a physician order dated 03/01/2022 showed: - Decrease Toujeo (insulin) to 20 units subcutaneous daily. Review of the patient medication record dated 02/21/2022 through 04/21/2022, showed: - Toujeo SoloStar SQ administer 24U SQ daily. Side effects may include: low blood sugar. Review of the occupational therapy (OT) progress note dated 03/04/2022 showed: - Patient reports his/her blood sugar this morning was 57 (the normal range before a meal is 80 to 130, and two hours after start of a meal less than 180), he/she has since ate and reports no issues; and - Informed patient’s low blood sugar again this morning prior to OT and complaint of itching all over to skilled nursing. Review of the physical therapy (PT) progress note dated 03/07/2022 showed: - Patient states blood sugar this morning was 221, but states he/she ate before bedtime last night. The lowest over the weekend was 59; and - Informed registered nurse (RN) with agency, physical therapist assistant (PTA), certified occupational therapy assistant (COTA) and occupational therapist registered (OTR) of PT discharge this date, patient’s blood sugars today, and medication changes. During an interview on 03/17/2022 at 12:54 PM, the director of nursing stated she would research that and send information if found. No additional information was provided to clarify why Toujeo insulin was not changed to 20U.

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 state law, the agency policy, employee file review, and interview, the agency failed to ensure all staff had the Employee Disqualification List (EDL) checked prior to hire for three (Employee's #4, #5 and #7) of four employee files reviewed, and failed to ensure all staff had the Family Care Safety Registry (FCSR) checked prior to date of first patient contact, in three (Employee's #4, #5 and #7) of four employee files reviewed. This deficient practice has the potential to affect all patients served by the agency. Findings included: Review of Section 192.2490.12 RSMo: "No person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) and (7) of subsection 11 of this section shall knowingly employ any person who is on the employee disqualification list." Review of Section 192.2495.6, RSMo: "A provider is guilty of a Class A misdemeanor if the provider knowingly hires or retains person to have contact with patients or residents and the person has been found guilty in this state or any other states or has been found guilty of a crime, which if committed in Missouri would be a Class A or B felony violation of Chapter 565, 566, or 569, or any violation of Subsection 4 of section 198.070 or section 568.020." Review of the agency's policy titled, “Criminal Background Checks”, dated 11/26/2019, showed background checks shall be conducted through FCSR through the State of Missouri prior to hire. EMPLOYEE #4 (E4): Review of the E4's personnel file showed: - Physical therapist (PT): - Date of hire: 06/09/2020; - Date of first patient contact: No date documented; - Failed to show EDL results prior to hire; and - Failed to show FCSR results prior to patient contact. EMPLOYEE #5 (E5): Review of the E5's personnel file showed: - Registered nurse (RN); - Date of hire: 10/08/2021; - Date of first patient contact: 10/12/2021; - Failed to show EDL results prior to hire; and - Failed to show FCSR results prior to patient contact. EMPLOYEE #7 (E7): Review of the E7's personnel file showed: - RN; - Date of hire: 01/20/2022; - Date of first patient contact: 01/31/2022; - Failed to show EDL results prior to hire; and - Failed to show FCSR results prior to hire per facility policy. During an interview on 03/16/2022 at 2:50 PM, RN A stated that the human resource staff was new to the position, and he/she did not know what needed to be done prior to hire. During an interview on 03/17/2022 at 1:23 PM, the DON stated the FCSR is to be done prior to staff having patient contact, and the EDL check should be done prior to hire.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the agency failed to ensure a complete, comprehensive discharge summary containing relevant information was sent to the patient’s physician within five business days for one (Record/Patient #7) of two discharge records reviewed. This deficient practice has the potential to affect all patients served by the agency. Findings included: Review of the agency's undated policy titled, "Discharge, Transfer and Referral Policy,” showed: - A discharge summary will be sent within the timeframes specified by federal regulations to your the primary care practitioner, other health care professional and/or facility that will be providing care and services to you after discharge from our agency; and - The summary will include all necessary medical information pertaining to your illness and current course of treatment, post-discharge care goals and treatment preferences. RECORD/PATIENT #7: Review of the clinical record showed the patient was admitted to the agency on 02/20/2022 with diagnosis of critical illness myopathy (a disease of limb and respiratory muscles). Review of the discharge summary fax cover sheet dated 03/09/2022, showed in part, the patient was discharged from skilled nursing services on 03/02/2022, and the discharge summary was sent to the physician on 03/09/2022. The discharge summary was sent seven days after the patient was discharged from skilled nursing services and did not include a current medication list. During an interview on 03/17/2022 at 12:54 PM, the director of nursing stated that she would expect the discharge summary to be sent to the physician within five days from discharge.