Every finding on record at Trusted Healthcare, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at the following location 310 E. Rowland St. Ste. B, Covina CA. 91723. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor # 44803, Health Facilities Evaluator Nurse Unduplicated Admissions: 53 Active Patients: 9 Sample Size: 7 Patients Home Visits: 3

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 interview and record review, the home health agency (HHA) failed to ensure the emergency preparedness training for staff were done in an annual basis. This failure had the potential for the staffs to lack the knowledge to respond effectively during an emergency situation. During a review of the emergency preparedness training on 5/23/22 at 1:45 p.m., the HHA did not have evidence of Emergency Preparedness training/disaster drill for all staffs. During an interview with the Director of Patient Care Services on 5/23/22 at 1:50 p.m., he stated he will ensure that all staffs will receive annual Emergency Preparedness and disaster drill training. The HHA's policy and procedure titled "Emergency Management Plan" indicated the annual training will be provided to all personnel.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at the agency' s new location at 310 E. Rowland St. Ste. B, Covina CA. 91723. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor # 44803, Health Facilities Evaluator Nurse Unduplicated Admissions: 53 Active Patients: 9 Sample Size: 7 Patients Home Visits: 3 A visit was made to Trusted Healthcare Inc. for the purpose of determining compliance with the California Code of Regulations, Title 22 for Home Health Agencies. The home health agency was approved for the change of location effective 5/23/22. Old Address: 35325 Date Palm drive, Ste. 152C Cathedral City, CA. 92234 New Address: 310 E. Rowland St. Ste. B Covina, CA. 91723.

Content of the comprehensive assessment CFR(s): 484.55(c) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient's status, and must include, at a minimum, the following information: This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to accurately complete the comprehensive assessment for one of seven patients (Patient 2). This failure had the potential to affect the patient's treatment and interventions. A review of Patient 2's Patient Profile indicated, a start of care (SOC) date of 2/15/22, with Type 2 Diabetes Mellitus (an impairment in the way the body regulates and uses sugar as a fuel) and multiple wounds. During a review of Patient 2's Plan of Care (POC), for the certification period from 4/16/22 to 6/14/22, included an order for skilled nurse (SN) to visit once a week for eight weeks. The SN was to assess and monitor skin condition. The physician's order dated 4/29 /22 indicated the following wound care treatments: Wound # 1- Bilateral buttock: cleanse wound bed with soap and water and apply triad wound dressing to wound. Wound # 2- Right lateral foot and wound # 3; left lateral malleolus (the bump that protrudes on the inner side of the ankle), apply 3M Cavilon and leave open to air. Wound # 4- Right lateral leg ; cleanse wound with soap and water and apply triad wound dressing to wound. During record review on 5/23/22 at 1:50 p.m., of Patient 5's "Comprehensive Nursing Assessment" dated 5/9/22, did not include documented evidence the assessment of the patient's skin was performed to identify the wounds on the buttocks, right foot, left foot, and right leg. During an interview with the Director of Patient Care Services (DPCS) on 5/23/22 at 1:50 p.m., he stated there should be measurements and documentation of Patient 2's wound/skin condition. The HHA"s policy and procedure dated 5/2022 and titled " Initial and Comprehensive Assessment" indicated a physical assessment including blood pressure, temperature, pulse, respiration, skin, pain status, height/weight, and nutritional status.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to maintain an accurate, and current medication profile for one of seven patients (Patient 5). This failure has the potential to result in putting the patient at risk for medication errors and adverse drug reactions. A review of Patient 5's Patient Profile indicated, a start of care (SOC) date of 5/6/22, with diagnoses that included surgical wound dressing and type 2 Diabetes Mellitus (an impairment in the way the body regulates and uses sugar [glucose] as fuel). During a review of Patient 5's Plan of Care (POC) for the certification period from 5/6/22 to 7/4/22, included an order for skilled nurse (SN) to visit three times a week . The SN was to assess and monitor medications for effectiveness, possible adverse effects and duplication. On 5/20/22, at 11:15 a.m., a home visit was conducted at Patient 5's residence with the Director of Patient Care Services (DPCS). Patient 5 was observed sitting comfortably on her bed. The DPCS conducted medication reconciliation and found medication irregularities/inconsistencies between the medication profile and medication prescriptions on the bottles as follows: Tacrolimus (medication to prevent organ rejection after transplant) 0.5 milligram (mg-unit of measurement) , 1 tablet twice a day. The Tacrolimus bottle label indicated 1 mg, 4 tablets twice a day. Patient 5 also had the following bottles of medication that were not on the medication profile such as; 1 bottle of Vitamin D3 (supplement) 50 mg every day; folic acid (supplement) 800 mcg every day; Vitamin B complex (supplement) 1 tablet every day and metoprolol (medication to treat high blood pressure, chest pain, and heart failure) 25 mg twice a day. During an interview on 5/20/22 at 12:50 p.m., with the DPCS, he stated the nurse should check the medications every visit to ensure the patient was taking the medications correctly. The HHA's policy and procedure dated 4/2023 and titled "Medication Profile" indicated the patient will have a current, accurate medication profile in the clinical record. The medication profile will be updated for each change to reflect current medications, new, and/or discontinued medications.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the skilled nurse (SN) failed to assess all body systems that included an existing surgical wound to the amputated third toe at left foot for one out of 7 patients (Patient 4). This deficient practice placed the patient's surgical wound at risk for infection that could lead to the delay of the healing process. A review of Patient 4's clinical record indicated start of care (SOC) dated 5/6/22, with diagnosis that included Type 2 diabetes mellitus ( high blood sugar level). A review of Patient 4's plan of care (POC) from 5/6/22 to 7/4/22, included an order for the skilled nurse (SN) to visit once a week for two weeks, twice a week for eight weeks. The SN was to assess all body systems and instruct the patient/primary caregiver on proper skin care to avoid new skin breakdown and infection. The POC included a nursing intervention to provide wound care to the amputated third toe at left foot as follows: surgical dressing changed with Betadine solution (antiseptic-prevent wound infection), 4x4 dressing and Kerlix, utilizing standard precautions and aseptic technique. On 5/20/22, at 12:30 p.m., during a joint home visit with Licensed Vocational Nurse (LVN) 1, Patient 4 was observed sitting in his couch with dressing on his left foot. The patient had an newly amputated third toe wound at left foot with no drainage. A review of Patient 4's LVN (license vocational nurse) Visit Notes dated 5/6/22 to 5/15/22, indicated the visiting nurse did not perform skin assessment to the amputated third toe wound at left foot during the SN visits. There was no documented evidence wound assessments were done. On 5/23/22, at 11 a.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse should have done an skin assessment on Patient 4's newly amputated third toe wound at left foot during the visits. According to the agency's policy and procedure "Wound Assessment (undated)," indicated during initial and follow-up nursing visits, any non-intact skin areas shall be assessed and document, to complete measurement of the wound (length, width, depth) shall be documented at least weekly.

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 home health agency (HHA) failed to verify the physician's order of Humulin N insulin (an intermediate acting insulin) for one of seven patients with Type 2 diabetes mellitus (Patient 2). This failure had the potential to not being able to detect early signs and symptoms of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) that could result in the delay to notify the physician to make the necessary adjustments of the medication. A review of Patient 2's Patient Profile indicated, a start of care (SOC) date of 2/15/22, with Type 2 Diabetes Mellitus and multiple wounds. During a review of Patient 2's Plan of Care (POC), for the certification period from 4/16/22 to 6/14/22, included an order for skilled nurse (SN) to visit once a week for eight weeks. The SN was to assess and monitor medications for effectiveness, possible adverse effects and duplication. The physician's order dated 4/14/22, indicated for Patient 2 to take Humulin N (used to control blood sugar) 100 units/milliliter (ml-unit of measurement) and check blood sugar daily before breakfast and dinner, inject 5 units at bedtime and increase by 1 unit daily until pre-breakfast blood. During an interview with the Director of Patient Care Services (DPCS) on 5/23/22 at 1:50 p.m., he stated there should be parameters for the physician's order. He stated the nurse should have clarified the order with the physician. The HHA"s policy and procedure dated 4/2020 and titled " Administration and Documentation of Medications" indicated licensed nursing personnel will administer and document only those medications which have been ordered as part of the plan of care and have been approved for safe administration and monitoring during a home visit.

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 record review, the home health agency (HHA) staff failed to change gloves during wound care treatment for one of seven patients (Patient 5). The agency also failed to implement COVID-19 (an acute respiratory illness) the agency's policy and procedure. These failures had the potential to spread infection. a. A review of Patient 5's Patient Profile indicated, a start of care (SOC) date of 5/6/22, with diagnoses that included surgical wound dressing and Type 2 Diabetes Mellitus (an impairment in the way the body regulates and uses sugar [glucose] as fuel). During a review of Patient 5's Plan of Care (POC), for the certification period from 5/6/22 to 7/4/22, included an order for skilled nurse (SN) to visit three times a week for wound care. The SN was to change the wound VAC (vacuum assisted closure) dressing three times a week and monitor for signs or symptoms of infection. On 5/20/22, at 11:15 a.m., a home visit was conducted at Patient 5's residence with the Director of Patient Care Services (DPCS). Patient 5 was observed sitting comfortably on her bed. The DPCS was observed removing the old wound VAC dressing of Patient 5. The DPCS did not change gloves after removing the wound VAC dressing and proceeded to clean the wound VAC with an antibacterial wipes. During a concurrent interview with the DPCS, he stated he should have changed his gloves prior to cleaning the wound VAC. b. During an observation on 5/19/22, at 10:30 a.m., upon entrance to the HHA there was no screening for COVID-19 signs and symptoms and no temperature check. An interview was conducted with the Director of Patient Care Services (DPCS) on 5/23/22, at 1:30 p.m., he stated they use to do screening but currently do not have any type of screening for office staff, field staff and visitors. DPCS stated they will implement temperature checks and screening for all staffs. The HHA's policy and procedure dated 1/2021 and titled "Coronavirus (COVID-19) Control Plan" indicated the risk assessment will include consideration of local, state and federal regulations. The policy indicated the agency will follow all current and updated CDC and CMS guidelines.

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 observation, interview, and record review, the skilled nurse (SN) failed to wash/sanitize her hands after cleaning the wound site while providing wound care for one of of seven sample patients (Patient 4). This deficient practice placed the patient at risk for wound infection that could delay the wound healing process. A review of Patient 4's clinical record indicated start of care (SOC) dated 5/6/22, with diagnosis that included Type 2 diabetes mellitus ( high blood sugar level). A review of Patient 4's plan of care (POC) from 5/6/22 to 7/4/22, included an order for the skilled nurse (SN) to visit once a week for two weeks, twice a week for eight weeks, to assess all body systems and instruct the patient/primary caregiver on proper skin care to avoid new skin breakdown and infection. one of the nursing intervention was to provide wound care to amputated third toe at left foot as follows: surgical dressing changed with Betadine, 4x4 dressing and kerlix, utilizing standard precautions and aseptic technique. On 5/20/22, at 12:30 p.m., during a joint home visit with Licensed Vocational Nurse (LVN) 1, Patient 4 was observed sitting in his couch with dressing on his left foot. During a wound care observation on 5/20/22, at 12:45 p.m., LVN 1 washed hands and put new pair of gloves, then removed the old dressing on the left foot. LVN 1 cleaned the amputated 3rd toe site with Betadine solution and wiped it down with 4 x 4 gauze three times, covered with dry dressing and wrapped with Kerlix roll gauze. LVN 1 did not removed gloves and washed her hands while doing the entire procedure. On 5/20/22, at 1 p.m., during an interview with LVN 1, she stated she forgot to wash her hands after touching the and cleaning the wound site. On 5/23/22, at 1 p.m., during an interview with the DPCS (director of patient care services), she stated LVN 1 should have washed her hands right after touching the wound site. A review of the agency's policy titled "Hand Hygiene and Compliance Program (undated)", indicated that staff should perform hand hygiene (wash hands) before and after direct patient care, when hands are soiled and after any contact with contaminated materials.