Every finding on record at Uhs Corona, Inc.

The following reflects the findings of the California Department of Public Health during a Standard Recertification Survey conducted on June 6, 2022, to June 9, 2022. The inspection included the Emergency Preparedness requirements under CFR §484.102(b)(6)-E0024. The facility was found to be in compliance with CFR 42 §484.102(b)(c), Requirements for Emergency Preparedness for Home Health Agencies (HHA). Representing the Department of Public Health: Surveyor: 35229, (HFEN) Health Facilities Evaluator Nurse; and Surveyor: 32192, HFEN. The total current census was 55.

The following reflects the findings of a Recertification Survey conducted on June 6, 2022, to June 9, 2022. Representing the California Department of Public Health: Surveyor Federal ID: 35229, HFEN (Health Facilities Evaluation Nurse); and Surveyor Federal ID: 32192, HFEN. The total home visits was four. The total record reviews without home visits was five. The total sample size was 11. The total unduplicated admissions in last year was 352. The total current census was 55.

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 agency failed to ensure the Medication Profile were updated, for four of eleven sampled patients (Patient's 1, 2, 9, and 10) reviewed for drug regimen reviews. This agency failure increased the potential for the patients to not receive medications as ordered by the physician, placing the patients at risk for side effects, drug interactions, duplicate drug therapy, an increase in symptoms the medication was prescribed for, and possible non-compliance with physician's orders and medication effectiveness. 1. On June 7, 2022, Patient 1's medical record was reviewed. Patient 1 was admitted to home health services on May 30, 2022, with diagnoses which included non-pressure chronic ulcer of the right ankle (open wound on right ankle) and peripheral vascular disease (PVD – narrowing, blockage, or spasms in a blood vessel). The certification period was May 30, 2022, through July 28, 2022. The Plan of Care (POC) dated May 30, 2022, indicated, “...SN (Skilled Nurse) to assess medication compliance and reconcile all medications every visit..." On June 7, 2022, beginning at 8:55 a.m., to 10:20 a.m., a home skilled nurse visit for Patient 1 was conducted with Registered Nurse (RN) 1. During the in-home visit, Patient 1's Medication Profile list was reviewed with RN 1 and Patient 1. The medication on-hand was compared to the agency’s medication profile. One bottle was observed with a pharmacy prescription label which indicated, "Plental (medication to treat blood flow problem in the legs) 100 mg (milligram - unit of measurement) 1 tablet every morning and evening.” In a concurrent interview with Patient 1, he stated he had been taking the medication for a year. The Plental medication was not listed on Patient 1’s Medication Profile list. In a concurrent interview with RN 1, he stated the Plental medication should have been included in Patient 1’s medication profile list. On June 7, 2022, at 2:25 p.m., the Home Health Nurse Manager (HHNM) was interviewed. She stated all medications taken by the patient should be in the Medication Profile list. She stated the Plental medication should have been added to Patient 1’s medication profile list. 2. On June 7, 2022, Patient 2's medical record was reviewed. Patient 2 was admitted to home health services on May 24, 2022, with diagnoses which included pulmonary embolism with acute cor pulmonale (blood clot in the lungs), atrial fibrillation (fast and irregular heart beat), and hypertension (elevated blood pressure). The certification period was May 24, 2022, through July 22, 2022. The Plan of Care (POC) dated May 24, 2022, indicated, “...SN (Skilled Nurse) to assess medication compliance and reconcile all medications every visit..." On June 7, 2022, beginning at 10:30 a.m., to 12:10 p.m., a home skilled visit for Patient 2 was conducted with Physical Therapist (PT) 1. Patient 2 was being seen by PT 1 for therapeutic exercises, transfer training, and gait balance walking. During the in-home visit, Patient 2's Medication Profile list for May 24, 2022 to July 22, 2022, was reviewed with PT 1 and Patient 2. The medication on-hand was compared to the agency’s medication profile. The following medications were included in Patient 2's Medication Profile list and was observed not available during the in-home visit agency: - “Ipratropium-Albuterol Inhalation (medication to treat shortness of breath) 0.5-2.25 (3) MG /3ML (milliliter – unit of measurement) Do (sic) via HHN (Hand Held Nebulizer – a machine that turns liquid medication into mist to be inhaled into the lungs) Q (every) six hours as needed for wheezing and SOB (shortness of breath).” There was no nebulizer machine available for Patient 2 to use. In a concurrent interview with Patient 2, she stated the ipratropium-albuterol inhalation medication and the nebulizer machine were ordered last week and still were not available; and - “Calcium Carbonate Antacid (medication to treat stomach acid) Oral 500 MG 1 Tab (tablet) every eight hours as needed for heartburn (stomach acid flows back into the esophagus).” The calcium carbonate antacid medication was not available for Patient 2 if needed. In a concurrent interview with Patient 2, she did not know where the bottle of calcium carbonate antacid was. The following medications were observed available at hand but were not included on Patient 2's Medication Profile: - One bottle of “Focal Point Plus” (memory supplement); In a concurrent interview with Patient 2, she stated she had been taking the medication for a month; - One box of “Cranberry tablets” (supplement to prevent urinary infection); In a concurrent interview with Patient 2, she stated she had been taking the medication for two to three months. bel on the bo - One carton with a pharmacy prescription label which indicated, “Nitroglycerine (medication to treat chest pain) 0.4MG SL (sublingual – under the tongue), place 1 (one) tablet under the tongue every 5 (five) minutes as needed for chest ," with an expiration date of May 31, 2022. On June 7, 2022, at 2:35 p.m., the HHNM was interviewed. She stated the medication reconciliation needed to be done at each nursing visit, and any changes in the patient’s medications being administered or any new medications should be updated. She stated the patient's physician should be notified to obtain further order. She stated there should be an ipratropium-albuterol inhalation medication, a nebulizer machine, and calcium carbonate medication, available for Patient 2 according to the physician's order. She further stated there should be no expired medications readily available for use. 3. On June 7, 2022, Patient 9’s medical record was reviewed. Patient 9 was admitted to the home health agency on April 16, 2022, with diagnoses which included pyonephrosis (an infection of the kidney). The certification period was April 16, 2022, through June 14, 2022. The Plan of Care (POC), dated April 16, 2022, indicated, “...SN (Skilled Nurse) to assess medication compliance and reconcile all medications every visit..." On June 8, 2022, at 10:59 a.m., a home skilled nurse visit for Patient 9 was conducted with Registered Nurse (RN) 2. Patient 9 was observed sitting in her wheelchair and listening to music during the home visit. During the home visit, Patient 9's Medication Profile list was reviewed with RN 2 and Patient 9. The medication on hand was compared to the Agency's Medication Profile list. In a concurrent interview with Patient 9, she stated she had been taking her medications as needed. The following medications were observed available at hand and were not included in Patient 9's medication profile list: - One plastic bottle of oxymetazoline HCL (hydrochloride) nasal spray 0.05% (percent) (medication to treat nasal congestion). In a concurrent interview with Patient 9, she stated she had been using the nasal spray one drop daily or twice a day as needed even before she was admitted to home health services on April 16, 2022; and - One bottle of Gentian Violet (dietary supplement) 500 mg; In a concurrent interview with Patient 9, she stated she takes gentian violet tablet once a day as needed. On June 8, 2022, at 11:50 a.m., RN 2 was interviewed. She confirmed Patient 9's Gentian Violet 500 mg medication was not documented on the in-home Medication Profile correctly. The following medications were documented in Patient 9's medication profile list to be given daily and not as needed: a. - “Harmony D-mannose (vitamin taken to cleanse and promote healthy urinary function) 1 tab (tablet) daily...;" b. - “UTI (urinary tract infection) don't think so (vitamin) 36 mg 1 tab daily...;" c. - “Activated Charcoal (adsorbs ingested toxins within the gastrointestinal tract preventing the systemic absorption of that toxin) 1200 mg 1 tab daily...;" and d. -"Gentian Violet External (herb used to treat some types of fungus infections) 1% 1 ml daily...;" Patient 9's medication profile list included, "Essential digestive enzymes (herb used for digestion, gas, constipation, and bloating relief), 800 mg 1 tab PO (by mouth) daily." There was no bottle of essential digestive enzymes in Patient 9's home. In a concurrent interview, Patient 9 stated she took the essential digestive enzyme 800 mg 1 tab PO last on April 20, 2022, and no longer took the essential digestive enzyme because it gave her unwanted side effects. On June 8, 2022, at 11:50 a.m., RN 2 was interviewed. RN 2 stated she needed to look at each medication individually and compare them to the medication profile to make sure the medications are current and administered according to the correct frequency and notify the patient's primary care physician. She stated she was looking at the medication profile on the agency computer and not the individual bottles located in the patient's home at every skilled nursing visit. She confirmed the medication profile frequency of administration was not listed correctly and should be as needed, the nasal spray was not listed, and the essential digestive enzyme was not discontinued on the medication profile for Patient 9. Patient 9's Medication Profile list was not reviewed and updated during the weekly nursing visits since she was admitted to home health services on April 16, 2022 (eight weekly skilled visits) On June 9, 2022, at 9:26 a.m., the Interim Director (ID) was interviewed. She stated the nurses should have visually checked the patient's medications at hand and compare them to the Agency Medication Profile. She stated the medication reconciliation needs to be conducted at each skilled nursing visit for any changes in medications administered and the patient's physician should be notified. 4. On June 7, 2022, Patient 10’s medical record was reviewed. Patient 10 was admitted to the home health agency on May 3, 2022, with diagnoses which included aftercare following joint replacement surgery and osteomyelitis (inflammation or swelling that occurs in the bone). The certification period was May 3, 2022, through July 1, 2022. The Plan of Care (POC) with certification period dated May 3, 2022, to July 1, 2022, was reviewed. The document indicated, “SN (Skilled Nurse) to assess medication compliance and reconcile all medications every visit." On June 8, 2022, at 1:09 p.m., a home skilled nurse visit was conducted with Registered Nurse (RN) 3 for Patient 10. Patient 10 was observed sitting at the dining room table during the home visit. During the home visit, Patient 10's Medication Profile list was reviewed with RN 3 and Patient 10. The medication on hand was compared to the Agency's Medication Profile list. Patient 10's Medication Profile list included, "Vitamin D3 oral 25 mcg (microgram - unit of measurement) (1000 units) 1 (one) cap (capsule) daily." One bottle of Vitamin D3 125 mcg (5000 IU - international units [unit of measurement]) was found in Patient 10's home. In a concurrent interview with Patient 10, he stated he was not sure when he had started to take Vitamin D3 125 mcg daily instead of Vitamin D3 25 mcg. On June 8, 2022, at 2:09 p.m., RN 3 was interviewed. She stated she did not realize she needed to look at each bubble pack, vitamin, or medication individually during each skilled nursing visit and compare them to the Agency's Medication Profile. On June 9, 2022, at 9:26 a.m., the Interim Director (ID) was interviewed. She stated the nurses should have visually checked at the patient's medications at hand and compare them to the Agency's Medication Profile. She stated the medication reconciliation needs to be conducted at each skilled nursing visit for any changes in medications administered and the patient's physician should be notified for any changes. The agency’s policy and procedure titled, "Medication Management," dated March 2021, was reviewed. The policy indicated, "...On-going medication management of the patient uses collaborative approach between, physicians, patients/families/caregivers, and pharmacist when indicated...The clinician will review all medications the patient is currently using in order to identify any major adverse and significant drug interactions by doing drug reconciliation and reporting it to the physician…The clinician will assess adherence to the prescribed medication regimen and the effect of the medication on the patient at every visit…" The agency’s policy and procedure titled, "Initial Assessments/Evaluation," dated March 2021, was reviewed. The policy indicated, "…Prescribed, over-the-counter and herbal medications including dose, route and frequency. The clinician will review all the medications the patient is currently using to identify any potential adverse effects and drug interactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy and noncompliance with drug therapy…”

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure: 1. Outdated medical supplies were disposed and not readily available for use. In addition, the facility failed to document information indicating the date and time the inventory inspection was conducted; and 2. There were no expired medications, for one of four sampled patients for home visit review (Patient 2). These agency failures had the potential for staff to use expired supplies and medications on medically compromised home health patients, and for Patient 2 to receive expired medications. 1. On June 6, 2022, at 9:59 a.m., during an inspection of the inventory of the home health medical supplies with the Home Health Nurse Manager (HHNM), the following medical supplies were observed expired and readily available for use: - One bottle of sterile water for irrigation, expired April 2022; - Three boxes containing 100 packets per box of bleach wipes, expired January 31, 2022; and - Four packs of vacutainer blood collection set (device used to collect blood specimen), expired April 30, 2022. During a concurrent interview with the HHNM, she stated the Medical Records/Billing inspected the medical supplies weekly and ordered supplies three times per week. She stated when the medical supplies are expired, the items were to be disposed of and the Medical Records/Billing orders new items. The HHNM confirmed the medical supplies listed above were expired and should be disposed not readily available for use. On June 7, 2022, at 8:28 a.m., the Medical Records/Billing was interviewed. She stated she checked the medical supplies twice a week, usually on Wednesdays and Fridays. She stated she did not have an inventory list and did not document any inventory inspection conducted. The agency's policy and procedure titled, "Event Related Sterility: Expiration Dates for Sterile items," dated July 2021, was reviewed. The policy indicated, "...Medications, antiseptics and other materials inside the pack that have manufacturers' expiration dates, these will need to be assessed prior to use of the contents of the package..." 2. On June 7, 2022, beginning at 10:30 a.m., to 12:10 p.m., a home visit for Patient 2 was conducted with Physical Therapist (PT) 1. On June 7, 2022, the medical record was reviewed for Patient 2. Patient 2 was admitted to home health services on May 24, 2022, with diagnoses included pulmonary embolism with acute cor pulmonale (blood clot in the lungs), atrial fibrillation (fast and irregular heart beat), hypertension (elevated blood pressure), and chronic kidney disease (disorder of the kidney). The certification period was May 24, 2022, through July 22, 2022. The Plan of Care (POC) dated May 24, 2022, was reviewed. The document indicated, “...SN (Skilled Nurse) to assess medication compliance and reconcile all medications every visit..." During the in-home visit, the Agency’s Medication Profile list for Patient 2 was reviewed with PT 1 and Patient 2. The following medications were found expired and readily available for use: - “Nitroglycerine (medication to treat chest pain) 0.4 MG (milligram – unit of measurement ) SL (sublingual – under the tongue), place one tablet under the tongue every five minutes as needed for chest pain,” with an expiration date of May 31, 2022; - One small bottle of Tylenol (medication for pain) Extra strength 500 mg tablet, with an expiration date of September 2020; - One bottle of acetaminophen (medication for pain) 325 mg tablet, with an expiration date of September 2019; and - One bottle of Caltrate 600+D3 (calcium supplement) tablet, with an expiration date of November 2018. On June 7, 2022, at 2:35 p.m., the HHNM was interviewed. She stated the medication reconciliation needs to be done at each nursing visit. She stated the licensed nurses should check all medications for the expiration date. She stated all medication should be separated from the current medications for the patients and give instruction to the patient or family member to discard all expired medications. The agency’s policy and procedure titled, "Safe/Effective Use of Medication Education," dated April 2021, was reviewed. The policy indicated, "…The components of the medication assessment, included in the Medication Administration Guideline form, determine patient/family/caregiver knowledge and skill related to medication administration shall include, but are not limited to…Proper storage and expiration dating of the medications…Proper disposal of unused or expired medications…”