Every finding on record at Valley Children's Home Health

The following reflects the findings of the California Department of Public Health during a Partial Extended recertification survey conducted on 8/5/24 to 8/8/24. Sample Patients with Home Visits: 3 Sample Patients without Home Visits :5 The agency found to be in substantial compliance with the Conditions of Participation (COP).

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 agency failed to practice principles of minimizing cross contamination (the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect) for one of three sampled patients with home visit (Patient 3) when Registered Nurse (RN) 2 did not separate reusable personal equipment (stethoscope, thermometer and cellular phone) from gauze soiled with Patient 3’s body fluid. This failure increased the chance of RN 2 spreading hidden microorganism unintentionally between home visits. During an observation on 8/6/24, at 12:10 p.m., in Patient 3’s home, RN 2 placed barrier #1 on a stand and barrier #2 on the floor. RN 2 took out clean supplies from her bag and placed them on barrier #1 on a stand. RN 2 dropped her cellular phone on the barrier #2 on the floor. RN 2 took out a clean pair of gloves and placed them on her hands. RN 2 listened to Patient 3’s lungs and bowels by placing the stethoscope on Patient 3’s bare chest and abdomen. When she finished RN 2 dropped the stethoscope, she just used on barrier #2 on the floor. RN 2 checked Patient 3’s temperature by smearing the thermometer tip on Patient 3’s forehead. When she finished RN 2 dropped the thermometer, she just used on barrier #2 on the floor. RN 2 removed the old dressing around Patient 3’s central line (a narrow, flexible, hollow tube inserted into a large vein in the neck, upper chest or groin) in the chest. The old dressing contained old blood like stain mixed with body fluid. RN 2 dropped the soiled gauze (stained with body fluid she just removed from Patient 3’s chest) on top of the stethoscope, thermometer and the cellular phone. RN 2 removed the soiled gloves and placed them on the top of the trash pile on barrier #2. RN 2 continued piling disposable trash and berried the reusable personal equipment. At the end of the dressing change RN 2 sorted the stethoscope, thermometer and her cellular phone from the bottom of the trash pile. RN 2 wiped each equipment with Sani-Wipe (disposable disinfection wipe) then placed them back into her bag. During an interview on 8/8/24 at 12:45 p.m., with RN 2, RN 2 stated she did not separate the reusable personal equipment from soiled disposable dressing to minimize the contact. RN 2 stated she did not apply the concept of minimizing cross contamination by allowing the reusable equipment to get contaminated by gauze containing Patient 3’s body fluids. RN 2 stated even though she wiped the personal equipment with Sani-Wipe the best practice should had been not allowing the contact with the disposable soiled dressings. RN 2 stated she should have separated the reusable equipment from the soiled disposable trash to avoid the contact. During a review of the agency’s policy and procedure (P&P) titled, “Home Care, Clinician Bag Technique” dated 08/23, the P&P indicated,” The principles in clean bag technique are developed and utilized to maximize the efficient use of the clinician’s bag and to minimize the risk of transmitting infections between staff or patients.”

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on observation, interview and record review, the agency failed to follow Patient 2’s “Plan of Care (POC-a document that outlines the health conditions, specific care needs, and the current treatments of the patient),” for one of three sampled patients (Patient 2) when: 1.Respiratory Therapy (RT) 1 did not educate Patient 2’s parents to remove or rearrange the rug to provide Patient 2 a safe environment. This failure placed Patient 2 at risk for injury from tripping. 2. RT’s visit was not provided every 30 days as physician ordered with justification. This failure had the potential to harm Patient 2 by not ensuring the delivery of safe and efficient air exchange through the ventilator (a machine that helps your lungs to work) due to RT’s irregular equipment management and clinical assessment. 1. During a concurrent observation and interview on 8/6/24 at 10:30 a.m., with RT 1, Patient 2 was observed sitting on the couch in the living room with shoes on. Patient 2 had a tracheostomy (a surgical airway in which a hole is created through the front of the neck and into the windpipe), and a portable ventilator was attached via a long flexible ventilator tube enabling Patient 2 to ambulate. RT 1 reviewed the POC and received feedback from Patient 2’s parents. When RT 1 asked whether Patient 1 had fallen since her last visit they answered no but verbalized how active Patient 2 had become and had been walking around a lot. RT 1 advised Patient 2’s parents to observe Patient 2’s whereabout closely to prevent her from falling. A large rug was observed placed in the middle of the living room. One corner of the rug toward the kitchen was observed rolled up about two to three inches creating an uneven surface. RT 1 was standing in the kitchen directly across from the living room. RT 1 was not observed checking the floors for any fall risk. When RT 1 completed the visit and was ready to leave Patient 2’s home the uneven surface rug was brought up to RT 1’s attention. RT 1 looked at the rug and stated, “Oh my I did not see that. It is a tripping hazard and need to be removed.” During a review of Patient 2’s POC from 6/22/24 to 8/20/24, the POC indicated, “Care Plan Goals: …Maintain a safe… environment. Care Plan Intervention: Safety, fall risk…” During a review of the agency’s job description for “Respiratory Therapy” dated 1/25/22, the job description indicated, “…Using clinical judgement the individual will implement the plan of care and assess and manage the need for appropriate education related to at-home respiratory care that best meets learning needs of the patient and family…” 2. During a concurrent interview and record review on 8/7/24 at 10:30 a.m., with Registered Nurse (RN) 2, Patient 2’s RT visit frequency was reviewed. RT 1’s visit notes dated 6/19/24, the RT 1’s visit note indicated RT 1 made a home visit on 6/19/24 for recertification. Two visits were made on 7/22/24 and 8/6/24 after the recertification visit on 6/19/24. RN 2 stated according to the POC the second visit was due on 7/19/24. RN 2 stated two visits were already made for the certification period. RN 2 stated RT 1 did not make the visit interval every 30 days as physician ordered. RN 2 could not provide any documented justification for the altered visit interval. RN 2 stated the Clinical Manager oversaw RTs. The Clinical Manager was not available for an interview during survey. During a review of Patient 2’s POC from 6/22/24 to 8/20/24, the POC indicated, “Visit Sets Respiratory Therapy visits 1 visit every 30 days for 60 days.” During a review of the agency’s job description for “Respiratory Therapy” dated 1/25/22, the job description indicated, “…Individual will implement the plan of care…”