Every finding on record at USA Home Health, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location; 1415 E Colorado Street, Unit 206, Glendale, CA91205 Representing the California Department of Public Health : Surveyor ID # 22303- RN - HFEN Surveyor ID # 25046 - RN - HFEN Active Patients - 27 Sample Size - 7 Home Visit - 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 staffs are conducted at least annually as required. This failure had the potential for the staff to perform ineffectively during an emergency situation. During an interview with the Director of Patient Care Services (DPCS), on 2/20/22 at 11:30 a.m., stated she did not conduct emergency preparedness training for all the staff. During record review there was no documented emergency preparedness training for the HHA staff. The HHA's undated policy and procedure titled "Emergency Preparedness Plan Plan" the plan uses the term "all hazard" to address all types of incidents. The incidents which may require action by home care and emergency service personnel to prevent or minimize loss of life or damage to property and environment.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the Department of Public Health: Surveyor ID # 22303- RN - HFEN Surveyor ID # 25046 - RN - HFEN Active Patients - 27 Sample Size - 7 Home Visit - 3

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 interview and record review, the Home Health Agency (HHA) failed to review and identify the potential adverse effects or side effects of psychotropic (drugs that affect a person's mental health) medication, and provide instructions to the patient and or primary caregiver (PCG) for one of 7 sampled patients (5) who was high risk for falls. This deficient practice has the potential to result in fall injuries to the patient. A review of Patient 5's clinical record disclosed a start of care (SOC) dated 12/2/2021, with diagnoses which included dementia, generalized muscle weakness and unsteadiness on feet. A review of the “Comprehensive Adult Nursing Assessment” dated 12/2/2021, indicated Patient 5's fall risk assessment was a "6". It was indicated the score of 4 or more is considered at risk for falling. The Plan of Care (POC) for the certification period from 1/31/2022 to 3/31/2022, included order for the Skilled Nurse (SN) visit once a week for 9 weeks. The SN was to assess/monitor for medication effectiveness, possible side effects, duplication. The SN was to instruct patient/PCG on medication management including action/potential adverse reactions of medications and compliance. The POC included order for medications included Risperidone (treat mental disorder) 0.5 milligram (mg) two tablets daily. A review of the medication profile indicated the order for Risperidone 0.5 mg two tablets daily dated 1/27/2022. It was not indicated in the medication profile the actions and side effects of Risperidone medication. A review of Patient 5’s clinical record indicated there was no documented evidence the agency staff had provided instructions regarding actions and side effects of Risperidone, and safety measures to prevent injuries when adverse actions to the medications happens. On 2/20/2022, at 12:05 p.m., during an interview with the Director of Patient Care Services (DPCS), she stated the staff should have given instructions to the patient/PCG of the actions and side effects of Risperidone. A review of the agency’s undated policy titled “Medication Management” indicated the medications in the home are reviewed with client/family to determine current medications and client understanding of the medications actions and side effects. The clients will be instructed to report perceptions of side effects and/or the effectiveness of the medication.

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 Home Health Agency (HHA) failed to follow a written plan of care established by the physician by not assessing the patient's oxygen saturation (the fraction of oxygen-saturated hemoglobin relative to total hemoglobin in the blood- normal pulse oximeter readings usually range from 95 to 100 percent) for one of 7 sample patients (Patient 4). This deficient practice has the potential for the patient's therapeutic/non therapeutic oxygen levels will not be identified and mitigated that could lead to respiratory distress. A review of Patient 4's clinical record disclosed a start of care (SOC) dated 6/11/2021, with diagnoses which included diabetes mellitus II (A chronic condition that affects the way the body processes blood sugar), atherosclerotic heart disease, and chronic obstructive pulmonary disease (COPD - chronic inflammatory lung disease). The Plan of Care (POC) for the certification period from 12/8/2021 to 2/5/2022, included order for the Skilled Nurse (SN) visit once a week for 9 weeks. The SN was to perform comprehensive skilled nursing assessment on all body systems. The SN was to check oxygen saturation level via finger pulse oximeter every visit and report the physician if oxygen saturation level was less than 92 percent. On 2/19/2022, at 10 a.m., during a home visit with Registered Nurse 1 (RN 1), Patient 4 was observed alert and oriented, and ambulatory. Patient 4 denied shortness of breath (SOB) that moment but stated he had SOB on exertion. A review of Patient 4’s clinical record indicated there was no documented evidence the patient’s oxygen saturation was assessed during the benefit period from 12/8/2021 to 2/5/2022. On 2/20/2022, at 12:05 p.m., during an interview with the Director of Patient Care Services (DPCS), she was not able to provide the documented evidence Patient 4’s oxygen saturation was assessed except on 12/28/2021, and 1/18/2022. The DPCS stated Patient 4’s oxygen saturation rate should have been monitored as indicated in the POC to report the physician when the oxygen saturation rate was less than 92 percent. A review of the agency’s undated policy titled “Plan of Care” indicated planning for care is a dynamic process that addresses the care, treatment and services to be provided.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to provide instruction regarding opened Humulin R insulin, which expires 30 days after it was opened for one of 7 sampled patients (4). This deficient practice could cause the patient to use insulin which was expired and could have potential risk of hyperglycemia (an excess of glucose in the bloodstream)/hypoglycemia (deficiency of glucose in the bloodstream). A review of Patient 4's clinical record disclosed a start of care (SOC) dated 6/11/2021, with diagnoses which included Diabetes Mellitus II (DM II-A chronic condition that affects the way the body processes blood sugar) with hyperglycemia, Atherosclerotic heart disease, and chronic obstructive pulmonary disease (COPD - chronic inflammatory lung disease). The Plan of Care (POC) for the certification period from 12/8/2021 to 2/5/2022, included an order for the Skilled Nurse (SN) visit once a week for 9 weeks. The SN was to perform comprehensive skilled nursing assessment on all body systems and to instruct the patient/primary caregiver (PCG) knowledge on medication management. The SN was to assess/monitor signs and symptoms and any complications related DM, compliance, and effectiveness of medication therapy. The POC included the physician's order of Humulin R 100 units/milliliter solution for injection subcutaneous sliding scale three times daily (before breakfast, lunch, dinner) as follows: 150 milligram (mg)/deciliter (dl) to 200 mg/dl =2 units 201 mg/dl to 250 mg/dl =4 units 251 mg/dl to 300 mg/dl =6 units 301 mg/dl and above = 8 units On 2/19/2022, at 10 a.m., during a home visit with Registered Nurse 1 (RN 1), Patient 4 was observed alert and oriented, and was able to communicate well. On 2/19/2022, at 10:35 a.m., during a review of Patient 4's current medications in the patient’s home comparing with the medication profile, one vial of Humulin R (100 unit/ml) was observed opened without label when it was opened. During a concurrent interview with Patient 4, he stated he did not remember when he opened the Humulin insulin vial. Patient 4 stated he did not remember whether anybody had instructed him about how long that insulin was okay to be used after it was opened, and nobody instructed him to label the insulin with the opened date. At 11 a.m., during an interview with RN 1, she stated Humulin R insulin was good to be used within 30 days after it was opened, and the opened date should have been labeled. RN 1 further stated the SN should have instructed the patient/PCG that Humulin R insulin was good to be used within 30 days after it was opened, and the opened date should have been labeled. A review of the agency's guideline of the "Insulin Administration” dated August 2002 indicated to check opening date on the insulin vial. Discard vial after 30 days from opening date.

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 interview, and record review, the Home Health Agency (HHA) failed to ensure the staffs are fit tested for the use of N95 masks to prevent COVID-19 (an acute respiratory illness) transmission. This failure had the potential for an increased risk of cross contamination and spread of infection. An interview was conducted with the Director of Patient Care Services (DPCS) on 2/20/22 at 12 p.m. , she could not provide evidence that all of the HHA staff were fit tested for N95 masks. DPCS stated she will follow up with the fit testing for N95 masks to all staff to prevent the spread of COVID-19. The HHA's policy and procedure dated 4/2021 and titled "COVID-19 Plan", indicated the goal of the organization is to prevent the transmission of COVID-19 in the workplace. The policy stated the agency will provide and ensure facemasks or higher level of respiratory protection will be worn by employees..

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the HHA skilled nurse (SN) failed to ensure the Plan of Care (POC) was developed to calibrate the glucometer (device used to determine the approximate concentration of glucose in the blood) periodically as indicated in the Manual/User Guide for one of 7 sample patients (4). This deficient practice has the potential to cause an inaccurate blood sugar reading that could affect the patient's health status. A review of Patient 4's clinical record disclosed a start of care (SOC) dated 6/11/2021, with diagnoses which included Diabetes Mellitus II (DM II-A chronic condition that affects the way the body processes blood sugar) with hyperglycemia, Atherosclerotic heart disease, and chronic obstructive pulmonary disease (COPD - chronic inflammatory lung disease). The Plan of Care (POC) for the certification period from 12/8/2021 to 2/5/2022, included order for the Skilled Nurse (SN) visit once a week for 9 weeks. The SN was to perform comprehensive skilled nursing assessment on all body systems, and to check blood sugar level using the patient’s glucometer machine. The POC indicated that per manufacture policy, no calibration was needed. On 2/19/2022, at 10 a.m., during a home visit with Registered Nurse 1 (RN 1), Patient 4 was observed alert and oriented, and was able to communicate well. At 10: 30 a.m., RN 1 checked Patient 4’s blood sugar level using the patient’s glucometer. When Patient 4 was asked when his glucometer was calibrated, Patient 4 did not know his glucometer was to be calibrated periodically. Patient 4 stated he had been using his glucometer for 4 years, but nobody had calibrated his glucometer. During an interview with RN 1 at the same time, she was not sure whether Patient 4’s glucometer needed to be calibrated periodically and stated she would follow up with the manufacture guideline of Patient 4’s glucometer. A review of the Manual/User Guide of Patient 4’s glucometer indicated to perform control solution test as follows: *Whenever open a new vial of test strips (Write the discard date on the vial when you first open it -3 months after first opening the vial) * If you suspect the meter and test strips are not working properly *If you have had repeated unexpected blood glucose results. *If you drop or damage the meter On 2/20/2022, at 12:05 p.m., during an interview with the Director of Patient Care Services (DPCS), she stated the POC should have been developed based on accurate information (regarding calibration) as indicated in the manufacture guideline.