Every finding on record at Spokane Home Care Services, LLC

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 Part 484 conducted this health and safety survey. Examination number: 2024-502 Dates Onsite: 06/24-27/24 This survey was conducted by: Surveyor #5 Surveyor #6 DOH staff found the facility in substantial compliance with all Conditions of Participation except those standard-level deficiencies listed below. . . . . . . .

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to transmit discharged patient data to the Centers for Medicare and Medicaid Services (CMS) database in a timely manner for 464 of 3046 records transmitted between 05/01/23 and 05/31/24. Failure to transmit patient data timely could result in inaccurate data and cause delays for patients to receive full benefits. 1. As part of the pre-survey preparation, Surveyor #5 reviewed the "HHA Error Summary by Agency" report from 05/01/23 and 05/31/24 generated from the iqies.cms.gov site. The review showed that the agency had 464 of 3046 patient assessments that were not submitted in a timely manner. This resulted in a 15.23% late submission error rate. 2. On 06/25/24 at 12:00 PM, Surveyor #5 interviewed the Executive Director (Staff #501) regarding the error rate. Staff #501 stated that they had no awareness of any late submissions but that the reports are reviewed by the cooperate office. Staff #501 stated that they notified the cooperate office about the error percentage and that they will review the information to determine why the report is showing late submissions.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to operationalize infection control policies and procedures consistent with state regulations that included conducting tuberculosis (TB) risk assessments at hire for 2 of 2 contractors that provided direct patient care (#508 and #509). Failure to perform TB risk assessments of staff may result in the risk of patients' exposure to tuberculosis (TB). Reference: WAC 246-335-525 PERSONNEL, CONTRACTOR, AND VOLUNTEER POLICIES - The applicant or licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (15)(c)(i) Infection control practices, communicable disease testing, and vaccinations. Policies and procedures must include, at minimum: Conducting a TB risk assessment for all new employees upon hire. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine the agency's responsibility to conduct TB testing of new employees. If TB testing is required, follow the department's tuberculosis risk assessment form testing recommendations; Findings included: 1. Document review of the agency's policy titled, "Patient Care Contracted Workers Requirement," (last revised 06/01/24) showed that during the pre-screening process the agency would obtain health screenings as required by state law and maintain the documents in a medical file. 2. Surveyor #5 reviewed the employee file for a contracted Registered Nurse (RN) (Staff #508). The record showed that Staff #508 was hired on 06/10/24. The record showed no evidence that a Department of Health TB risk assessment was conducted on hire by the agency. Surveyor #5 reviewed the employee file for a contracted Registered Nurse (RN) (Staff #509). The record showed that Staff #509 was hired on 06/03/24. The record showed no evidence that a Department of Health TB risk assessment was conducted on hire by the agency. 3.On 06/25/24 at 1:00 PM, Surveyor #5 interviewed the agency's Business Office Manager (Staff #502) regarding the state requirement to perform a TB risk assessment on hire for contacted staff. Staff #502 stated that they were unaware that the agency was required to complete the TB risk assessments on contracted employees.

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 Part 484 conducted this health and safety survey. Examination number: 2021-608 Dates Onsite: 08/18/21-08/23/21 This survey was conducted by: Surveyor #4 Surveyor #5 DOH staff found the facility in substantial compliance with all Conditions of Participation except those standard-level deficiencies listed below. DOH recommends recertification based on an acceptable plan of correction. .

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: . Based on record review and interview, the agency failed to conduct the initial patient assessment in a timely manner for 3 of 17 patients (#402, #501, #514). Failure to conduct the initial assessment in a timely manner places patients at risk for having immediate care and support needs go unmet. Findings included: 1. Record review for Patient's #501, #514, and #402 showed: a. Patient #501 had a referal date of 08/01/21. A Physical Therapist did not complete the initial assessment until 08/04/21. There was no documentation in the record that showed the patient's physician received notification related to the delayed start of care. b. Patient #514 had a referal date of 03/12/21. A Physical Therapist did not complete the initial assessment until 03/16/21. There was no documentation in the record that showed the patient's physician received notification related to the delayed start of care. c. Patient #402 had a referal date of 08/06/21. An initial assessment was not completed within 48-hours. The physician was not notified until 08/10/21 that care had not been started. 2. On 08/20/21 at 3:15 PM, Surveyor #4 and Surveyor #5 interviewed the Performance Improvement Coordinator (Staff #502) about the timely initiation of care for patient #402, and #501. Staff #502 verified there was a greater than 48-hour delay in completing the initial assessment. 3. On 08/23/21 at 12:50 PM, Surveyor #5 interviewed the Area Executive Director (Staff #503) about the timely initiation of care for Patient #514. Staff #503 verified there was a greater than 48-hour delay in completing the initial assessment. .

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 interview and record review, the agency failed to follow physician's orders for frequency of visits for 4 of 17 patients (#501, #504, #506, #517). Failue to complete the frequency of visits as ordered by a physician, places patients at risk of harm from a delay in meeting their care planned goals. Findings included: 1. Record review for Patients #501, #504, #506, and #517 showed: a. Patient #501 had physician orders for a physical therapist (PT) visit to be completed twice in the first week of care and a home health aid (HHA) visit was to be completed in the second week of care. The record showed only one PT visit occured during the first week of care and no HHA visit occurred during the second week of care. There was no documentation in the record regarding the missed visits. b. Patient #504 had physician orders for a skilled nurse (SN) visit was to be completed twice in the fifth week of care. The record showed only one SN visit was completed during this time. There was no documentation in the record regarding the missed visit. c. Patient #506 had physician orders for a home health aid (HHA) visit once in the sixth week of care. The record did not show a visit was completed by a HHA during this time. There was no documentation in the record regarding the missed visit. d. Discharged Patient #517 had physician orders for a physical therapist (PT) visit be completed twice in the second and sixth weeks of care and a skilled nursing (SN) visit was to be completed in the sixth week of care. The record showed only one PT visit occurred in the second week of care and no visit occurred in the sixth week of care. The record showed no SN visit occurred in the sixth week of care. There was no documentation in the record regarding the missed visits. 2. On 08/20/21 at 3:15 PM, Surveyor #5 interviewed the Performance Improvement Coordinator (Staff #502) about the missed visits for Patients (#501, #504, and #506). Staff #502 verified the frequency of visits were not completed as ordered. 3. On 08/23/21 at 12:50 PM, Surveyor #5 interviewed the Area Executitive Director (Staff #503) about the missed visits for Patient #517. Staff #503 verified the frequency of visits were not completed as ordered. .

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, document review, and interview, the agency failed to properly prevent COVID-19 through failure to ensure that staff wore eye protection consistent with Washington State regulations for 3 of 9 Home Health staff (Staff #403, #408, #501, #504). Failure to ensure staff wear eye protection when performing patient care, risks staff and patients' exposure to infectious organisms including COVID-19. References: WAC 246-335-525(15) personnel, contractor, and volunteer policies. The applicant or licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (15) Infection control practices, communicable disease testing, and vaccinations. Policies and procedures must include, at minimum: (a) Standard precautions such as hand hygiene, respiratory hygiene and cough etiquette, and personal protective equipment; WAC 206-800-160 You must make sure that your employees have, use, and care for the appropriate personal protective equipment (PPE). PPE is an item or items used to protect the eyes, face, head, body, arms, hands, legs, and feet such as goggles, helmets, head covers, gloves, rubber slickers, disposable coveralls, safety shoes, protective shields, and barriers. WAC 296-800-16040 You must require your employees to use necessary PPE on the job. Findings included: 1. Document review of the guidance document issued by the Department of Health (DOH) and Labor & Industries (L&I) titled, "L&I and DOH Respirator and PPE for In-Home Care Agencies: Employer responsibilities for respiratory protection program and provision of personal protective equipment (PPE)," (DOH 420-329) issued March 30, 2021 showed that In-home care agencies are required to develop and maintain a Respiratory Protection Program (RPP) under WAC 296-842-12005. The document also showed that agencies are required to provide gowns, gloves, and eye protection to staff who are entering patient's homes. The document further stated that staff must wear eye protection when there is moderate to substantial community transmission of COVID-19. The document defined eye protection as, goggles or a face shield that covers the front and sides of the face. The document stated that personal eyeglasses are not PPE and do not provide adequate eye protection. Document review of the guidance document issued by the Department of Health (DOH) titled, "COVID-19 Guidance for Home Care, Home Health, and Hospice Agencies," (DOH 420-299) updated June 09, 2021 showed when COVID-19 community transmission case rate is greater than 25 per 100,000, in 2 weeks, health care workers (HCW) are to wear a surgical face mask and eye protection for ALL patient care encounters, regardless of patient/client COVID-19 status. According to DOH COVID-19 cases and testing for Spokane County, the 2-week transmission rate at the time of survey was 587.9 per 100,000. 2. On 08/18/21 at 1:00 PM, Surveyor #5 conducted a home visit with a Physical Therapist (Staff #504) and the Clinical Supervisor (Staff #501). Staff #504 and #501 failed to wear approved eye protection during the home visit with Patient #501. a. On 08/19/21 at 2:30 PM, Surveyor #4 conducted a home visit with a Physical Therapist (Staff #408). Staff #408 failed to wear approved eye protection during the home visit with Patient #405. b. On 08/20/21 at 11:00 AM, Surveyor #4 conducted a home visit with a Speech Therapist (Staff #409) and the Area Executive Director (Staff #403). Staff #403 failed to wear approved eye protection during the home visit with Patient #407. 3. On 08/20/21 at 2:15 PM, Surveyor #4 and Surveyor #5 interviewed the Performance Improvement Coordinator (Staff #502), about the staff use of eye protection during home visits. Staff #502 stated that the agency has the equipment and will ensure all PPE is utilized based on the guidance and agency policy. .

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: . Based on observation and interview, the agency failed to follow its patient infection identification program for COVID-19. Failure to follow the infection identification program places patients and staff at risk for late identification and transmission of communicable disease. Findings included: 1. Surveyor #5 went on a home visit with a licensed practical nurse (Staff #507) on 08/19/21 at 11:00 AM. The surveyor observed Staff #507 as they provided care to patient #504. Staff #507 failed to screen the patient for COVID-19 until after provision of hands-on care. 2. Surveyor #5 went on a home visit with a home health aid (Staff #10) on 08/20/21 at 10:30 AM. The surveyor observed Staff #10 provide care to patient #506 without asking the patient any COVID-19 screening questions. 3. On 08/20/21 at 2:15 PM, Surveyor #5 asked the Performance Improvement Coordinator (Staff #502) about the agency's program for COVID-19 screening for patients. Staff #502 stated that the COVID-19 screening questions are asked at the beginning of the home visit to immediately identify a known or suspected positve COVID-19 patient before care is performed. .

Licensing CFR(s): 484.100(b) (b) Standard: Licensing. The HHA, its branches, and all persons furnishing services to patients must be licensed, certified, or registered, as applicable, in accordance with the state licensing authority as meeting those requirements. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to implement policies and procedures consistent with state licensing requirements for 6 of 13 staff reviewed, through failure to complete approved disclosure statements and criminal background checks for 2 staff (Staff #411 and #412) (Item 1), failure to renew disclosure statements and background checks every two years for 2 staff (Staff #409 and #410) (Item 2), and failure to complete approved disclosure statements for 2 staff (#406 and #408) (Item 3). Failure to maintain compliance with state licensing requirements puts patients at risk for harm from abuse and neglect. References: Washington Administrative WAC 246-335-525 (6) Personnel, contractor, and volunteer policies. The licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (6) Criminal history background checks and disclosure statements for personnel, contractors, volunteers, students, and any other individual associated with the licensee having direct contact with children under sixteen years of age, people with developmental disabilities or vulnerable persons, according to RCW 43.43.830 through 43.43.842 and the following: (a) Criminal history background checks must be processed through the Washington state patrol; (b) Disclosure statements must be approved by the department; and (c) All criminal history background checks and disclosure statements required under this chapter must be renewed within two years from the date of the previous check. Findings included: Item 1- Disclosure Statements and Initial Background Checks 1. Document review of the agency policy titled, "Agency policy 6.014, Patient Care Contracted Workers Requirement," (no review date) showed that the agency was to complete a criminal history background check on all contracted individuals and that personnel records must contain up to date information based on state and/or federal law, regulation, and company policy. 2. On 08/23/21, Surveyor #4 reviewed the personnel files for two Registered Nurses (Staff #411 and Staff #412) and an Occupational Therapist (#405). The review showed: a. Staff #411 was contracted from another agency and started working for the agency on 08/09/21. The file contained a disclosure statement and background check from a private company. There was no approved disclosure statement or Washington state patrol background check documented in the personnel file. b. Staff #412 was contracted from another agency and started working for the agency on 07/12/21. The file contained a disclosure statement and background check from a private company. There was no approved disclosure statement or Washington state patrol background check documented in the personnel file. 3. Surveyor #4 interviewed the Business Manager (Staff #413) on 08/23/21 at 10:30 AM, about the missing disclosure statements and background checks for contracted staff. Staff #413 verified the agency had accepted background checks and disclosure statements from unapproved sources for Staff #411 and #412 and also stated that it was the agency's policy to complete approved background checks and disclosure statements on all staff including contracted employees. Item 2- Renewal of Disclosure Statements and Background Checks 1. On 08/23/21 Surveyor #4 reviewed the personnel files for 2 staff that had worked for the agency for more than 2 years (Staff #409 and Staff #410). The review showed: a. Staff #409 had a hire date of 11/28/11. The date of the last completed disclosure statement was 02/22/17 (over 4 years ago) and the last background check was completed on 01/19/16 (over 5 years ago). b. Staff #410 had a hire date of 12/10/12. The date of the last completed disclosure statement was 06/07/19 (over 2 years ago) and the last background check was completed on 11/30/18 (over 2 years ago). 2. Surveyor #4 interviewed the Business Manager (Staff #413) on 08/23/21 at 10:30 AM, about the failure to renew disclosure statements and background checks for current staff. Staff #413 verified that the agency failed to complete disclosure statements and/or background checks at two-year intervals for Staff #409 and #410. Item 3- Lack of Approved Disclosure Statements 1. On 08/23/21 Surveyor #4 reviewed the personnel files for Staff #406 and #408. The review showed that Staff #406 had a hire date of 07/11/21 and Staff #408 had a hire date of 12/07/20. Neither personnel file contained a department-approved disclosure statement. 2. Surveyor #4 interviewed the Business Manager (Staff #413) on 08/23/21 at 10:30 AM, about the lack of department-approved disclosure statements. Staff #413 verified the documents in the personnel files.