Every finding on record at Sierra Health Care Center

On behalf of the Centers for Medicare and Medicaid Services (CMS), an unannounced on-site Recertification survey conducted at Sierra Home Care, Home Health Agency (HHA) on 09/14/2021 resulted in noncompliance under 42 CFR 484.102 with the following standard-level deficiency cited.

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 record review and interview, the facility failed to maintain and update the Emergency Preparedness manual (binder) with the current annual Hazard Vulnerability Analysis (HVA) (used to show hazards or risks that can impact a healthcare facility and the surrounding community.) This deficient practice can delay the ability to offer continued patient care by not evaluating the damage and severity of impact a disaster could cause the facility in an emergent (unpredictable or unforeseen) situation. The findings are: A. Record review of the Emergency/Disaster Manual, undated, revealed the following: 1. No current copy of a dated Hazard Vulnerability Analysis (HVA.) B. Record review of Agency Facility-Based and Community-Based Risk Assessment Policy, dated June 2017, revealed, Under Procedure section, Item 1. "Hazard Vulnerability Analysis (HVA) will be conducted and evaluated annually." C. On 09/14/2021 at 10:15 am during an interview, Staff (S)#1 (Administrator), S#2 (Clinical Manager), and S#3 (Executive Director) confirmed there was no current Hazard Vulnerability Analysis (HVA) in the Emergency Preparedness manual.

On behalf of the Centers for Medicare and Medicaid Services (CMS), an unannounced on-site Recertification survey conducted at Sierra Home Care, Home Health Agency (HHA) on 09/14/2021 resulted in noncompliance under 42 CFR 484, Subpart A through C with the following standard-level deficiencies cited.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based upon record review and interview the agency failed to obtain a signed consent for treatment for 4 (P1 through 4) of 8 (P1 through 8) patients medical charts sampled. This failed practice is likely to not allow the patient the ability to participate in, be informed about or able to refuse treatment in advance. Findings are: A. Record review of Patient (P) P1 through P4's charts revealed no documentation of a signed consent or any documentation of the patient being informed of the planned services or care at the time of admission. B. On 09/14/2021 at 11:00 am during inter with Staff (S) S2 (Clinical Manager), confirmed that P1 through P4 did not have signed consents in the patient's charts.

12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure HHA (Home Health Aide) Aides had the required 12 hours of in-service training (In person training) for 3 Staff (S#8, S#10, S#11) of 3 (S#8, S#10, S#11) staff personnel files reviewed. This failed practice is likely to not allow the home health aides the opportunity to provide optimal patient care that is current and updated following clinical carebest practices. Findings are: A. Record review of Staff (S#) 8''s personnel file revealed that S#8 had 7 hours of training from 8/2020 to 8/2021. B. Record review of Staff (S#) 10's personnel file revealed that S#10 had 7 hours of training from 8/2020 to 8/2021. C. Record review of Staff (S#) 11's personnel file revealed that S#11 had 11.25 hours of training from 8/2020 to 8/2021. D. On 9/14/2021 at 11:00 am during interview with Staff (S#) 2 (Clinic Manager) confirmed that the aide's have not completed the required 12 hours of training within the past 12 months.