Every finding on record at Sunshine Home Healthcare, LLC

An unannounced Home Health Agency Medicare Medicaid recertification survey was conducted December 12-14, 2022 by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Medicare Medicaid Home Health Agency recertification survey was conducted December 12-14, 2022 at the above captioned agency by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. The agency reported 295 unduplicated admissions in the last twelve (12) months with an active census of 45 patients. The following were completed/reviewed in conjunction with the survey: Three home visits, nine (9) clinical records, eight (8) personnel files, review of selected policies and procedures, the agency's complaint log, emergency preparedness plan, and staff Covid vaccination records. Interviews were also conducted. The agency was found to be out of compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies (HHAs). Deficiencies were identified and cited in this report.

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 observation, staff interview and document review, it was determined the agency failed to ensure all services and treatments were administered only as ordered by a physician in one (1) of nine (9) clinical records reviewed in the survey sample (clinical record # 1). The findings were: The electronic clinical records were reviewed in read only mode on 12/12/2022 through 12/14/2022. Clinical record #1 was reviewed for the recertification period of 12/06/2022 through 2/02/2022. The primary diagnosis listed on the plan of care was pressure ulcer of sacral region, stage 2. The plan of care failed to contain wound care orders to address the pressure ulcer. The clinical record was reviewed for additional orders after the recertification period and no orders for wound care had been entered. Observation during a home visit to observe care to patient #1 was conducted on 12/12/2022 at 11:45 am. The clinical manager, staff #2, performed wound care to the patient’s sacral area in addition to wounds on the right and left calf area. Wound care to the sacral area consisted of cleanse with normal saline using sterile 4x4 gauze, patted dry, covered with hydrocolloid dressing, tegaderm 6x6. The right and left lower calf were cleansed with normal saline, patted dry, applied triamcinolone acetonide ointment, covered with 4x4 sterile gauze and wrapped with rolled bandage, taped and applied a tubular elastic bandage retainer. An interview was conducted on 12/13/2022 at 2:30 pm with the Administrator, staff #1 and the Director of Nursing, staff #3 to review the findings. Staff #1 stated, not sure why the orders did not pull over from the previous certification period when the patient was recertified. A review of the policy Care Planning Process Policy No. 2-018.1 was reviewed in the agency on 12/13/2022. The policy reads in part: the plan of care will include, but not limited to specific services to be provided, actions to be taken to meet the patients' goals.

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, staff interviews and a review of agency documents it was determined the agency staff failed to follow infection control guidelines when performing wound care for one (1) of one (1) wound care observed during home visits (clinical record#1). The findings were: A home with was conducted with the clinical manager, staff member #2, to observe wound care to patient #1 on 12/12/2022 at 11:45 am. The clinical manager, staff member #2, entered the patient's home, placed the nursing bag on a chair using a protective barrier and proceeded to the bathroom to perform hand hygiene. Staff member #2 failed to set up a clean barrier containing the needed supplies for wound care and immediately began wound care procedures. The staff member donned sterile gloves and proceeded to remove a soiled dressing on the patient's left calf area and placed it in the trash. Without changing gloves or performing hand hygiene, the nurse continued with cleaning the wound and applying a clean dressing. The staff member reached into the box of clean supplies multiple times to obtain supplies, contaminating the clean supplies in the box with the dirty gloves. At the conclusion of care to the first wound, care began on wound two (2) of the right calf with the removal of the dirty dressing, cleaning of the wound and application of the clean dressing, all while still wearing the dirty gloves from the care of wound #1. The staff member again entered the box of supplies during care without changing gloves. At the conclusion of care to the second wound, care began on wound three (3) of the sacral area with the removal of the dirty dressing, cleaning of the wound and application of the clean dressing, all while still wearing the dirty gloves from the care of wound #1. Following the conclusion of all wound care the staff member proceeded to remove supplies from the skilled nursing bag to include a blood pressure cuff and obtained the patients' blood pressure while still wearing the soiled gloves. An interview was conducted with the administrator, staff #1 and director of nursing, staff #3 on 12/13/2022 at 2:30 PM to review the findings of the home visit. Both acknowledged the findings were against agency policy and were not in line with infection control guidelines. A review of the agencies policy on Infection Prevention and Control Policy No. 9-007.2 was reviewed in the agency on 12/13/2022. The policy stated in part: Gloves are to be changed 1. between tasks and procedures on the same patient, 3. after removing an old dressing. A review of the agencies policy on Hand Hygiene Policy No. 9-0009.1 was reviewed in the agency on 12/13/2022. The policy stated in part: hand decontamination using an alcohol-based hand rub should be performed: 1. after contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings. 2. When moving from a contaminated body site to a clean body site during patient care. 3. After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. 4. After removing gloves. Fundamentals of Nursing Mosby, Potter and Perry, 7th Edition St. Louis Missouri, page 645 states in part: modes of transmission for infection are indirect contact-personal contact of susceptible host with contaminated inanimate object (e.g.,needles or sharp objects, dressings, environment). In this case, the gloves would have been contaminated after touching the dressing and wound and the gloves should have been changed each time with hand hygiene performed when going from a dirty to clean area and when going from one wound to the next.

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 document review and staff interview, it was determined the agency failed to send the patient's discharge summary to the primary care physician or primary care practitioner within 5 business days from the date of the final visit for three (3) of three (3) discharged patients in the survey sample (clinical record #3, 7, and 8) The findings were: The electronic clinical records were reviewed in read-only mode from 12/12/2022 through 12-14/2022. Clinical record #3 had a discharge date of 12/05/2022 and a discharge order dated 12/05/2022 that stated Discharge summary available upon request. Clinical record #7 had a discharge date of 9/08/2022 and no evidence the discharge summary was sent to the physician. Clinical record #8 had a discharge date of 11/10/2022 and a discharge order dated 11/10/2022 that stated Discharge summary available upon request. An interview with the Director of Nursing, staff #3 on 12/14/2022 at 10:50 am revealed the agency is following their policy which is to send the discharge summary upon request. A review of the discharge summary policy No. 2-043.1 stated in part: A copy of the discharge summary will be provided to the patient's physician when requested.