Every finding on record at St Mary's Home Health Services, Inc

The following reflects the findings of the California Department of Public Health during an investigation for Complaint CA00689157. The inspection was limited to the specific incident investigated and does not represent the findings of a full inspection of the facility. Representing the Department : Federal ID 27390, Health Facilities Evaluator Nurse. One deficiency was issued for Complaint CA00689157

Strengths, goals, and care preferences CFR(s): 484.55(c)(2) The patient's strengths, goals, and care preferences, including information that may be used to demonstrate the patient's progress toward achievement of the goals identified by the patient and the measurable outcomes identified by the HHA; This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to identify and utilize Patient 1's family member (FM) 1's strengths in support of patient-centered care, when Registered Nurse (RN) 1 ignored FM 1's knowledge of Patient 1's history of high blood pressure and suggestion for wound assessment during RN 1's initial comprehensive assessment. This failure negatively impacted FM 1's ability to participate in Patient 1's patient-centered care planning and resulted in Patient 1 being discharged from the agency within a week from the start of care (SOC). Findings: During a phone interview with FM 1, on 5/19/20 at 3:20 p.m., FM 1 stated RN 1 abandoned Patient 1 on 5/18/20 by refusing to see Patient 1 and left without providing wound care to Patient 1's buttocks. When FM 1 was asked how Patient 1 was doing, he stated Patient 1 had received wound care from a different agency the next day and he was happy with the new agency's service. FM 1 stated RN 1 made three home visits on 5/11/20, 5/12/20, and 5/18/20. FM 1 stated when she came for a visit on 5/18/20, he gave RN 1 specific instructions to follow prior to seeing Patient 1. FM 1 stated RN 1 got upset and left without seeing Patient 1. FM 1 stated RN 1 probably found out the complaint he made to the director of patient care services (DPCS) about her assessment skills. FM 1 stated, on 5/11/20, during RN 1's first visit, he questioned whether RN 1's blood pressure (BP) measurement of Patient 1 was correct. FM 1 stated an expectation that Patient 1's blood pressure would be high (usually 130-140 [top number]), but FM 1 said the blood pressure was 124/60; which was within the normal limits. FM 1 expected RN 1 to consider his suggestion and recheck the BP. FM 1 stated, instead RN 1 cut him off by saying she had been doing her job for a long time and she knew what she was doing. FM 1 stated he had been checking Patient 1's BP and his measurement had never been in the normal range like RN 1's. FM 1 also stated RN 1 got very defensive and argumentative when he pointed out that she did not take a measurement nor a picture of the pressure ulcer on Patient 1's buttocks. FM 1 stated, after the visit on 5/11/20, he was not happy with RN 1's visit and he called the DPCS and complained. FM 1 stated the visit on 5/12/20 went well, but during the visit on 5/18/20, FM 1 stated RN 1 refused to provide care to Patient 1 and walked out. During a phone interview with the DPCS, on 5/26/20 at 10 a.m., the DPCS stated she was well aware of FM 1's complaint about RN 1. The DPCS stated she received a phone call from RN 1 on 5/11/20 immediately after her first visit informing her that FM 1 was overbearing and rude. RN 1 told her FM 1 constantly interrupted and dictated to her what to do during the assessment. The DPCS stated on 5/18/20, RN 1 called and notified her that she could not provide care to Patient 1 due to FM 1's harassment. RN 1 stated FM 1 demanded she sign that she would implement the items on a list he presented before entering Patient 1's room. RN 1 stated the situation got escalated and she did not have a choice but to leave. The DPCS stated she contacted Patient 1's physician and the physician immediately referred Patient 1 to a different agency. During a phone interview with RN 1, on 5/26/20 at 11:02 a.m., RN 1 stated she visited Patient 1's home on 5/11/20, 5/12/20 and 5/18/20. She stated FM 1 was very knowledgeable of patient care and did not require too much education. RN 1 stated FM 1 told RN 1 his sisters included an RN and a Nurse Practitioner. RN 1 stated FM 1 was overbearing and dictated the entire assessment on 5/11/20. RN 1 stated she was offended by FM 1's negative comments about the way she assessed Patient 1. RN 1 stated she needed to remind FM 1 she was not an ICU (intensive care unit) nurse nor a physician. RN 1 stated FM 1 demanded her to diagnose whether Patient 1 had pneumonia or not. RN 1 stated she told FM 1 she was not a doctor and it was not her scope of practice (to diagnose a patient). RN 1 stated she managed to complete the initial assessment in the midst FM 1's interruptions. When asked about FM 1's concern about a possible inaccurate BP measurement, RN 1 stated she ignored FM 1's comment and did not recheck Patient 1's blood pressure to clarify the doubt. When asked about Patient 1's pressure ulcer on her buttocks, RN 1 stated she did not measure the wound with a paper ruler but estimated the size. RN 1 also stated she forgot to take a picture of the wound. RN 1 stated she got very distracted by FM 1's interruptions. When asked about the visit that occurred on 5/18/20, RN 1 stated FM 1 would not let her see Patient 1 unless RN 1 agreed to do everything on the list he made. RN 1 stated she explained him she was not a doctor and the things he requested was not within the scope of her practice. RN 1 stated she left Patient 1's home and notified the DPCS immediately. During a review of Patient 1's "Plan of Care" certification period from 5/11/20 to 7/9/20, it included diagnoses of pressure ulcer (injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin) of the sacral region (at the bottom of the spine), pneumonitis (inflammation in the lungs) and hypertension (high blood pressure). During a review of Patient 1's clinical record titled, "Start of Care" (date) indicated the size of Patient 1's wound on the coccyx was recorded as 2 cm (centimeter-metric unit of length) x 2 cm x 0.1 cm, and Patient 1's lung sounds were recorded as "diminished throughout." During a review of documentation dated 5/18/20 titled, "K-mail (internal Email)" addressed to the DPCS indicated, "Regarding [Patient 1] please discharge patient from home health service. Today I was prevented from seeing the patient by [FM 1]. He stopped me in a foyer with a Post-it note in hand to discuss the services I should be providing [Patient 1] as per his recent conversation with the [DPCS]. He would not let me proceed to her bedroom until we talked about all the list items..." During a review of agency's undated policy and procedure titled, "wounds" indicated, "...measurements and pictures should be taken once a week on the 1st visit..." During a review of the agency's undated job description for the RN indicated, "...plan and direct services to meet the needs of individuals and families within their homes... Uses health assessment data to determine nursing diagnosis..."