Every finding on record at Unique Health Care Solutions, LLC

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 104035 The following deficiencies are based on substantial allegation 104035. Unique Health Care Solutions is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies.

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 record review, interview and policy review, the facility failed to complete skilled nurse visits per the plan of care. This affected one (Patient #3) of three sampled patients. The facility census was 426. Findings include: Record review revealed Patient # 2 had a start of care date of 10/27/23. Patient #2's primary diagnosis was a below the knee amputation with a open wound above the stump. Skilled nursing was ordered for visits three times per week for dressing changes. Orders were received 1/29/24 for daily visits to complete dressing changes. Dressing changes were completed daily except for 02/07/24 or 2/09/24. During an interview on 02/22/24 at 3:00 PM, Staff C stated no missed visit notes were found for this patient for the dates 02/07/24 and 02/09/24. Review of the policy titled "Missed Visit Note", dated 10/01/16, instructed staff to complete a Missed Visit Form as soon as they are aware a client's visit will be missed. This staff member is responsible for notifying the appropriate persons to include their immediate supervisor, physician, case manager and/or family member as applicable.

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 record review, interview and policy review, the facility failed to ensure staff changed gloves during a wound treatment. This affected one (Patient #2) of three patients reviewed. The facility census was 426. Findings include: Record review revealed Patient # 2 had a start of care date of 10/27/23. Patient #2's primary diagnosis was a below the knee amputation with a open wound above amputation. Skilled nursing was ordered for visits three times per week for dressing changes. Orders were received 1/29/24 for daily visits to complete dressing changes. Another order was received on 02/15/24 from the wound care center to cleanse the wound with Vashe (sodium chloride solution with preservative to inhibit growth of microorganisms) and to cleanse the perimeter of the wound area. Allow the Vashe soaked gauze to sit on wound for five minutes and then pat dry, apply Iodoflex (an iodine treated dressing), Adaptic non-adhering dressing, then Mepilex boarder. A physician order was received on 02/16/24 for an alternative dressing to be completed with medi-honey until the Iodoflex is available. A home visit was completed with Staff E on 2/21/24 at 2:20 PM to observe wound care. Staff E stated new orders were received after Patient #2 went to the wound care clinic to wash with Vashe, apply Iodoflex but since this was not available to use medi honey. Staff E looked through the patients supplies but no medi-honey was present in the home. Staff E washed their hands at prior to the dressing change and applied gloves. The ACE bandage was removed from the left stump then the dressing was cut off using scissors from the patient's supply box. Measurements were completed of the wound. Staff E kept the same gloves on but applied a second glove over the right hand glove, washed the wound with Vashe on a two by two gauze pad, then used two more two by two gauze pads with Vashe solution, but didn't soak the wound according to the physician order. Adaptic was then applied. The Mepilex foam dressing was cut with same scissors used to cut off the old dressing and were not cleaned in between. Kerlix was applied, taped in place, then an ACE bandage was applied. The scissors were placed back in the patient's supply box without being cleaned. Staff E kept the same pair of gloves on for the entire procedure. Staff E was interviewed immediately following the dressing change, at 3:10 PM. Staff E stated they bring gloves to the house and there was no issue with glove supply. Staff E verified they did not remove the soiled gloves, but put another glove over their dominate hand when they cleansed the wound and did not soak the wound per order. Review of the policy titled "Wound Care", dated 10/01/16, instructed to perform hand hygiene (refer to Universal Precautions policy), lay out your supplies on a clean work surface, remove the old dressing then change your gloves. Apply the new dressing, take off and discard the gloves, wipe down the equipment and wash your hands. The policy titled "Universal Precautions", dated 10/01/16), instructed to wash hands with soap and water and gloves should be worn when coming in contact with blood or non-intact skin.

Partial Extended Survey Substantial Allegation Survey Substantial Allegation #70652 Substantial Allegation #70659 An entrance conference was completed on 5/23/22 at 8:50 AM at the facility with the Clinical Manager and nursing staff. An exit conference was completed on 5/24/22 at 5:10 PM. The following deficiencies are based on the allegations contained in the substantial allegation 70652 and 70659 completed on 05/24/22. Unique Health Care Solutions, 368328, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agency.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on medical record review, review of employee files, review of employee handbooks, review of PASSPORT code of ethics, client interview, and staff interview, the agency failed to ensure misappropriation of client property did not occur by staff in the form of accepting gifts, eating client's food, and being identified as the beneficiary of client life insurance policy. This affected one (Client # 2) out of four clients reviewed for misappropriation of property. The facility was providing services for 259 individuals. Review of the medical record for Client # 2 revealed a start of care (SOC) date of 4/13/20. The certification period reviewed was for 04/03/22-06/01/22. The primary diagnosis was listed as orthostatic hypotension, acute kidney failure and high blood pressure. The plan of care listed skilled nursing visits one time per week and home health aide (HHA) three times per week. Patient #2 was alert and oriented to person place and time. Review of a Concern Report received by the agency on 05/20/22 at 11:20 AM, revealed allegations of Staff E being the beneficiary of two insurance claims for Client #2, the client purchased a necklace for Staff E, both are having candle light dinners together, and allegedly Staff # E shoved a couch into someone and broke their toe. The personnel file for Staff E revealed a hire date of 10/01/16 as a home health aide. A form titled Acknowledgement of Employee Handbook was signed on 09/23/16. The last Passport Assisted Living and Individual Providers Code of Ethics was signed on 04/15/21. Review of the "Acknowledgement of Employee Handbook," on page #9 lists accepting tips, gratuities, loans or gifts of any kind from clients or their family members is strictly prohibited. Review of the "PASSPORT, Assisted Living and Individual Providers Code of Ethics," updated 11/08/20 revealed the provider shall not engage in any unethical, unprofessional, disrespectful or illegal behavior to include the following: Accepting, obtaining or attempting to obtain money or anything of value, including gifts or tips; engaging in behavior the reasonable person would interpret as inappropriate involvement in the individuals personal relationships; consuming the individual's food or drink; and engaging in behavior constituting a conflict of interest, or taking advantage of, or manipulating services resulting in an unintended advantage for personal gain that has detrimental results to the individual, the individual's family or caregivers, or another provider. Interview on 05/24/22 at 10:40 AM, Staff E stated Client #2 was on of two clients she provided care for. Staff E stated she had taken care of Client #2's wife for years before she died and Staff E started caring for Client #2 as far as cleaning, assisting with shower and taking him on walks. Staff E stated she received a heart necklace as a gift Client #2's wife wanted Staff E to have. Client #2's wife died before giving Staff E the necklace so Client#2 gave it to her after his wife died. Staff E stated she has eaten snacks with Client #2. Interview on 5/24/22 at 11:15 AM, Client #2 stated his wife wanted to buy her aide, Staff E, a Christmas gift but she passed away before buying the gift so Client #2 bought Staff E a cheap necklace at the beginning of this year and gave it to Staff E as a gift from his wife. Client #2 stated when his wife was dying Client #2 was on the phone with an insurance man who wanted to know who else to put on their life insurance policy as a beneficiary. Client #2 stated him and his wife didn't want to list their children so his wife said to put Staff E down, so he did. Client #2 stated Staff E was at the house that day and was aware. Interview on 05/24/22 at 5:00 PM, Staff A and Staff F stated they had interviewed Staff E. Both stated Staff E admitted she accepted a necklace from Client #2. Staff E informed Staff A and Staff F she has no idea of any insurance policy in her name and did not sign any policy. Staff A and F stated they did not ask Client # 2 if he/se has any insurance policy listing Staff E as beneficiary. Interview on on 05/24/22 at 5:10 PM, Staff A, Staff B, and Staff F verified Staff E accepted a necklace from her client, admitted to eating the client's snacks, and per the client interview was the beneficiary of a client's life insurance policy. This deficiency substantiates substantial allegation #70659.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the facility failed to list on the plan of care the frequency and duration of home health aide (HHA) visits. This affected two (#2 and #4) of four clients reviewed with the potential to affect all 259 patient's cared for by this agency. 1. Review of the medical record for Client # 2 revealed a start of care (SOC) date of 4/13/20. The certification period reviewed was for 04/03/22-06/01/22. The primary diagnosis was listed as orthostatic hypotension, acute kidney failure and high blood pressure (BP). The plan of care listed skilled nursing visits one time per week and HHA three times per week. There were no duration of hours for each visit on the plan of care. Review of the home health aide (HHA) visits revealed for the visits were routinely completed three times a week for four hours. The week of 04/03/22 the HHA visits were completed four days on 04/04/22 for four hours, 04/06/22 for two hours, 04/07/22 for two hours, and 04/08/22 for four hours. Interview on 05/25/22 at 2:30 PM, Staff B stated the hours are directed by the case manager and the agency does not list how many hours are to be provided on the plan of care. 2. Review of the medical record for Client #4 revealed a start of care of 08/10/17 with a diagnosis of cerebral infarct. The certification period reviewed was for 03/17/22-05/15/22. Skilled nursing was to be provided one time per week and HHA five times per week with no duration of time per each visit. Review of the visits revealed they were completed five days per week with some days having four hours and other days having two hours. Interview on 05/25/22 at 2:30 PM, Staff B stated the hours are directed by the case manager and the agency does not list how many hours are to be provided on the plan of care. Staff B verified the findings. This is a incidental deficiency discovered during the investigation.