Every finding on record at Universal Home Care, Inc.

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 151 N. San Vicente Blvd., Beverly Hills, CA. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 19096, Health Facilities Evaluator Nurse Surveyor # 44290, Health Facilities Evaluator Nurse Unduplicated Admissions - 1200 Active Patients - 172 Sample Size - 17 Home Visits- 7 .

Have a confidential clinical record CFR(s): 484.50(c)(6) Have a confidential clinical record. Access to or release of patient information and clinical records is permitted in accordance with 45 CFR parts 160 and 164. This ELEMENT is not met as evidenced by: Based on record review and interview the Home Health Agency (HHA) failed to ensure confidentiality of the clinical records are maintained for one out of 18 sampled patients (Patient 18). Patient 18’s electronic protected health information (ePHI) was found in Patient 11’s electronic medical record (EMR). This deficient practice caused Patient 18’s personal health information to be accessed by unauthorized individuals not responsible for their care. Findings: During a record review of Patient 11’s plan of care (POC) for certification period of 4/11/22-5/9/22, indicated that Patient 11’s start of care (SOC) was on 4/11/22 for diagnosis of nephrostomy (artificial opening of urinary tract to the skin). During review of Patient 11’s electronic medical record (EMR), a medical record for Patient 18 dated 5/10/22, was found that included medical information such as name, date of birth, doctor notes, medical history, and lab results. A review of Patient 18’s POC for certification period of 4/22/22- 6/20/22, indicated that Patient 18’s SOC was on 4/22/22 with diagnosis of cellulitis (bacterial skin infection) of the abdominal wall. The POC included skilled nursing services needed to treatment of the infection. A review of Patient 18’s discharge summary dated 6/16/22, indicated Patient 18 was discharged from the HHA due to discharge goals are being met. During an interview on 8/22/22, at 10:50 am, the Director of Nursing (DON) stated someone uploaded Patient 18’s records in the wrong chart by mistake. Their process for uploading electronic document into the electronic medical charts is that the person who receives the electronic submission to double check the records to make sure the right file is being placed in correct chart. This is to ensure patients privacy rights are being followed. A review of the HHA’s policy and procedure (P&P) titled, Computer Security Procedures, dated 12/27/18, indicated that the administrator of Universal Home Care, Inc., as the designated Privacy Officer, is responsible for ensuring and maintaining computer security procedures that are aimed at preserving the privacy, integrity, and security of each patient's medical record and other proprietary data and information.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on interview, and record review, the agency failed to ensure Patient caregiver, was informed of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs for one of 17 patients (Patient 14). This deficient practice has the potential for the PCG to lack knowledge to file complaints or grievances related to the care provided to the patient. Findings: Patient 14's electronic record was reviewed . Review of Patient 14's plan of care (POC) for the certification period of 8/4/2022 to 10/2/2022, indicated the start of care (SOC) date of 8/14/2022, with diagnoses which included right heel decubitus s/p right leg Angiogram( a medical imaging technique used to visualize the inside blood vessels and organs of the body with particular interest), angioplasty, (A procedure that creates more space inside an artery that has plaque build up inside of the arteries, and Failure to Thrive, ( A decline seen in older adults resulting in downward spiral of poor nutrition, weight loss, inactivity, depression and decreasing functional ability. During a home visit, Patient 14's PCG was asked if she knew about the State toll free hotline to file complaints she stated she needed that number to file a complaint against a skilled nursing facility. Patient 14's PCG stated she did not know about the hot line. During an interview with the Administrator and DPCS on 8/22, 2022, at arounD 12:00 pm., both stated the patients and PCG are informed about the hotline during the initial assessment.

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 maintain an updated medication profile for 2 out of 17 sampled patients. (Patient 3 and Patient 14). This failure had the potential for the patients to manifest signs and symptoms of adverse action of the medication, side effects, and drug interactions. A review of Patient 3’s “Patient Profile” indicated Start of Care (SOC) date of 3/1/22 with a certification period of 6/28/22 to 8/27/22. Patient 1 is a 60-year-old male patient living alone at home with the diagnosis of paraplegia (paralysis of the legs and lower body, typically caused by spinal injury or disease). Skilled nurse (SN) visits every three weeks for catheter change. A home visit was conducted on 8/18/2022 at 1:15 p.m., with Licensed Vocational Nurse 1 (LVN 1). Patient 1 was sitting on his wheelchair, alert and oriented to name, and place and time, ambulates using a wheelchair, not in any respiratory distress noted. LVN 1 started her visit. During medication review with Patient 3 and Licensed Vocational Nurse 1 (LVN 1) noted that the following medications were not listed on the medication profile: Ibuprofen 800 mg (milligram- a unit of measurement) every 4 to 6 hours as needed for painGuai-Aid expectorant 650 mg twice a day for cough. Patient 3 stated “I’ve been taking it fir a few months now”Meloxicam 7.5 mg twice daily as needed for painD-Mannose 750 mg daily for UTI Vitamin C 1000 mg daily as supplement The following discrepancies were noted on Patient 3’s medication profile: Oxybutynin 5 mg 1 tablet twice daily was changed to every 8 hours for neurogenic bladder (the nerves that carry messages back-and-forth between the bladder and the spinal cord and brain don't work the way they should).Naproxen Sodium Extended release 750 mg 1 tablet every 4-6 hours as needed. Patient stated “I stopped taking that since February 2022” During an interview with LVN 1 on 8/18/22 at 1:30 p.m., LVN stated to review medications every visit. During an interview with the Director of Nursing (DON) case manager (CM) on 8/22/22 at 11:50 a.m., stated the nurse reviews medications every three weeks or every visit. 2. A review of Patient 4’s “Patient Profile” indicated SOC date of 5/11/22 with a certification period of 7/10/22 to 9/7/22. Patient 1 is an 84-year-old female patient living at home with the diagnosis Stage 4 Pressure ulcer (a deep wound that reaches the muscles, ligaments, or bones. They often cause residents to suffer extreme pain, infection, invasive surgeries, or even death) and adjustment of urinary device (a device which aids a person to urinate). SN visits 5 times a week for 8 weeks. A home visit was conducted on 8/18/2022 at 10:20 a.m., with Registered Nurse 1 (RN 1). Patient 4 was lying in hospital bed, alert and oriented to name, person and place, mostly spanish speaking, not in any respiratory distress. RN 1 started her visit. During medication review with RN 1, the following medications were missing on Patient 4’s medication profile: Ceruvite Senior 1 tablet daily as supplementVitamin D3 1000 units (unit- a unit of measurement) 1 tablet daily as supplementLinzess 145 mcg (microgram- a unit of measurement) 1 capsule for constipationProstat 2 tablespoons daily for supplement. The following discrepancies were noted in the medication profile: Fluocinonide Cr 0.05% thin layer to wound base. RN 1 stated was discontinued on 6/23/22 did not indicate discontinued on the medication profile.Vitamin D3 kids 400 units 1 tablet daily as supplement was changed to 1000 units. Milk of magnesia 30 ml twice a day every Monday and Thursday; daily if no bowel movement in 2 days. RN stated she takes 1 teaspoon every Monday, Thursday and Saturday twice daily and 1 teaspoon daily if with no bowel movement. A review of the HHA’s document titled “Medication Management” dated 2019 indicated medication reconciliation(Verify, Validate, Clarify) Ask to SEE ALL MEDICATIONS the patient is taking. This included prescription, over-the-counter, topical, herbal, vitamins/nutritional supplements, drops. Medication profile: check-Info-interactions for information, interactions, and contraindications. Fill in date teaching performed as your review and teach patient. At each visit- update the medication profile in the home when changes or additions occur. Ask if there has been a physician visit and/or if there are new or changes to their medications. Patient 14's electronic record was reviewed . Review of patient 14's plan of care (POC) for the certification period of 8/4/2022 to 10/2/2022, indicated the start of care (SOC) date of 8/14/2022, with diagnoses which included right heel decubitus s/p right leg angiogram (a medical imaging technique used to visualize the inside blood vessels and organs of the body with particular interest), Angioplasty (A procedure that creates more space inside an artery that has plaque build up inside of the arteries, and Failure to Thrive, ( A decline seen in older adults resulting in downward spiral of poor nutrition, weight loss, inactivity, depression and decreasing functional ability. The POC included a physician's order for physical therapy to evaluate and development plan of care for treatment. During a home visit during an interview and medication review of Patient 14's medication with the caregiver (PCG) revealed discrepancies with Patient 14's medication currently taken and what was listed in the patient's medication profile. A review of Patient 14's medication profile indicated to take Simvastatin (treat high cholesterol levels) 40 mg once a day. Review of the medication bottle indicated Simvastatin 20 mg daily. During an interview with the home health agency's supervisor on 8/22/2022, at 12 p.m., she stated all medication were reviewed however the Patient 14's PCG stated has multiple bubble packs of medication from his recent stay in the skilled nursing facility that she was administering Patient 14 medications that needed to be updated. A review of patient 17's plan of care (POC) for the certification period of 7/19/2022 to 9/16/2022, indicated the start of care (SOC) date of 7/19/2022, with diagnoses which included Encounter for change/removal of nonsurgical wound dressing , pressure ulcer of right buttocks, stage 2 and pressure ulcer of left buttocks, stage 2. The POC included for skilled nurse (SN) to visit 3 times a week for 4 weeks to assess/provide wound care to left and right buttocks and to assess/instruct patient caregivers medication compliance. During a review of Patient 17's medication profile from the agency and the medications in Patient 17's room indicated the over the counter TUMs and Asper care Lidocaine 4% cream was not listed on patient 17's medication profile. During an interview with the administrator and DPCS, stated the SN was very thorough and that the SN had a hard time with the patients current medication in the home due to staff not updating her the patient's medications.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the HHA failed to ensure proper coordination of services and care planning for 1 of 17 sampled residents. (Patient 3) This deficient practice had the potential in the delay of required necessary services included in the plan of care. Findings: A review of Patient 3’s “Patient Profile” indicated Start of Care (SOC) date of 3/1/22 with a certification period of 6/28/2222 to 8/27/22. Patient 3 is living alone at home with the diagnosis of paraplegia (paralysis of the legs and lower body, typically caused by spinal injury or disease). A home visit was conducted on 8/18/2022, at 1:15 p.m., with Licensed Vocational Nurse 1 (LVN 1). Patient 1 was sitting on his wheelchair, alert and oriented to name, and place and time, ambulates using a wheelchair, not in any respiratory distress noted. LVN 1 started her visit. On 8/18/22 at 1:15 p.m., during a home visit observation with LVN 1, LVN 1 asked patient regarding his skin discoloration on his left lower leg. Patient 3 answered “I forgot to ask my doctor when I went there today.” On concurrent interview with LVN 1 stated she told patient to ask his doctor for dermatologist referral for the skin discoloration on her previous visit. On 8/18/22 at 1:15 p.m., during an interview with Patient 3 stated he has multiple doctors that he goes to for a long time since he had spinal cord injury since the age of 17 years old. Patient 3 stated he has upcoming surgery for his wrist for his carpal tunnel and expressed concerns after surgery. When asked about other services that the home health agency (HHA) provides, Patient 3 stated “I did not know that they have social worker services. I did not know that they can provide other services other than changing my catheter.” On 8/22/22, at 11:50 am, during a concurrent interview with the case manager (CM) and Director of nursing services (DON) stated that admission nurses inform the patients of their benefits for home health. DON stated that the nurses explained these services upon admission and patients may forget that it was explained and offered to him during his admission.” CM stated care planning is only with the primary doctor who referred Patient 3 to home health service. A review of Patient 3’s “Skilled Nurse Visit Notes Care Coordination” dated 5/23/22, 6/13/22, 7/4/22, 7/25/22, and 8/15/22, did not have any written notes that any care coordination for other services such as physical therapy(PT), case manager(CM), medical social worker (MSW) or other were documented on the medical record. A review of the HHA’s administrative policy/procedure manual titled “Care Planning Process 1.E.1” written on 11/05/95 and revised 1/10/2010 indicated that the patient care planning process , individualized to address each patient’s problems and care needs for service, is ongoing from the time of referral until discharge or transfer activities are completed. The goals of the patient and family are included in the care planning process. Factors in the care planning services include but are not limited to: Referral information and orders, coordination with the patient, family and physician regarding the plan of care/treatment. Care coordination on admission, recertification, discharge or transfer and as problems arise. Coordination with the physician and appropriate agency personnel for updates and/or changes needed for the plan of care/treatment. Ongoing case coordination and supervision to assure the actions and goals of individual services are complimentary and reflect cooperative care planning. Care or services coordinated with other involved organizations and individuals. The care planning process includes getting physician orders which are then included in the plan of care and supplemental physician orders, when appropriate that are related to the patient’s medical condition for which he/she is admitted to home health or continues to need home health services.