Every finding on record at Verdugo Hills Home Care, Inc

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 plan and training for staff were done in an annual basis. This failure had the potential to affect the responsiveness of staff during an emergency situation. During a review of the emergency preparedness plan of the HHA on 12/12/21 at 11 a.m., the HHA did not have evidence of Emergency Preparedness training/disaster drill for all staff. During an interview with the Director of Patient Care Services (DPCS) on 12/12/21 at 11:05 a.m., the DPCS confirmed that she did not have any documented evidence of the annual Emergency Preparedness training/disaster drill for all staff. The HHA's undated policy and procedure titled " Emergency Preparedness Policy", indicated the Emergency Preparedness training should be conducted annually and there should be documentation of training.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 35893, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions -273 Active Patients -55 Sample Size - 7 Patients 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 observation, interview and record review, the home health agency failed to maintain an accurate, current medication profiles for three of seven patients (Patients 1, 3, & 4). This failure had the potential to cause unnecessary drugs received, adverse drug reactions and interactions with other medications that can affect the health of the affected patients. During the home visit conducted on 12/11/2021 at 11:45 a.m., at Patient 1's residence with RN 1, Patient 1 was alert and oriented and was sitting on a chair next to the dining table. During a review of Patient 1’s current medications and the medication profile at 12:20 p.m., a bottle labeled Gabapentin 600 milligrams (mg) 2 tabs three times daily was observed. During a concurrent interview, Patient 1 stated she was taking the Gabapentin medication two tablets four times a day and had been taking it since she was admitted to the home health services. During a concurrent interview with RN 1, RN 1 stated she was aware that Patient 1 was taking the Gabapentin medication four times a day but forgot to update their medication profile. During a review of the home health certification period for 11/3/2021 to 1/1/2022 and plan of care (POC) for Patient 1, it indicated a diagnosis of left elbow olectranon bursitis (inflammation or by swelling, redness and pain at the tip of the elbow). The POC also indicated Skilled Nurse (SN) visits of four times a week for two weeks, two times a week for four weeks and as needed for acute medical changes, to perform skilled observation and assessment of vital sign and all body systems and medication/dietary regimen. The SN was to teach, instruct medication, adverse reactions. The medication list and the POC did not indicate an order of Gabapentin, however the medication profile indicated Gabapentin 600 mg. 2 tabs, three times daily. During an interview on 12/12/2021 at 10:30 a.m., the Director of Patient Care Services (DPCS) stated, "The medication reconciliation should have been done on each visit, the medication profile updated and the patient/caregiver should have been educated accordingly. During a home visit on 12/11/2021 at 12:45 p.m. at Patient 3's residence with RN 2, Patient 3 was alert and oriented, was sitting on a chair in the family room while Family Member 1 was at the dining table arranging the patient's medications to be reviewed. During a review of Patient 3's current medications and the medication profile provided by the agency; the following medication bottles were observed: a. Allopurinol 300 mg one tab twice daily (anti gout) b. Dexamethasone 4 mg one tab twice daily. c. Famotidine 40 mg tab daily d. Furosemide 20 mg one tab daily. During an interview with Family Member 1 (FM 1) on 12/11/2021 at 1 p.m., FM 1 stated that Patient 3 takes the Allopurinol medication once a day two months ago. FM 1 also stated that the patient no longer takes the Dexamethasone, Famotidine and Furosemide medications since July 2021. During an interview on 12/11/2021 at 1:15 p.m., RN 2 stated that she was not aware of the medication changes for Patient 3. A review of Patient 3's home health certification and POC for the period 10/23/2021 to 12/21/2021, indicated a start of care on 6/25/2021, with diagnosis that included malignant neoplasm (cancerous tumor) of unspecified part. The medication orders included Allopurinol 300 mg. 1 tablet orally twice a day, dexamethasone 4 mg. 1 tablet orally twice a day (BID) to be taken 1 day before chemo procedure, day of chemo, and the day after chemo for each chemo therapy, famotidine 40 mg. 1 tablet orally daily, furosemide 20 mg. 1 tablet orally daily. The POC included Skilled Nurse (SN) visits of once a week for one week, once a week for eight weeks and two as needed for medical changes, to perform skilled observation and assessment of vital sign and all body systems and medication/dietary regimen. The SN was to teach/instruct medication, adverse reactions. The medication profile for Patient 3 indicated allopurinol 300 mg. tablet orally BID, dexamethasone 4 mg tablet orally 1 tablet BID to be taken 1 day before chemo procedure, day of chemo, and the day after chemo for each chemo treatment, famotidine 40 mg tablet orally daily, furosemide 20 mg tablet orally daily. During an interview on 12/12/2021 at 10:30 a.m., DPCS stated, "The medication reconciliation should have been done on each visit, the medication profile updated, and the patient/caregiver educated accordingly. A review of the agency's policy and procedure titled "Medication Profile", revised April 2010 indicated the medication profiles will be updated for each change to reflect current medications, new and/or discontinued medications. During a home visit on 12/11/2021 at 11 a.m. at Patient 4's residence, Registered Nurse (RN 1) was observed checking the medications. At the bedside of Patient 4, a container of Imodium 2milligrams (mg) (antidiarrheal medicine), Simethicone 125 mg. (medicine for gas or bloating) were observed. RN 1 checked and confirmed the medications did not have any physician orders. RN 1 also stated that the medications should have been checked every home visit by the licensed nurses. During a review of the home health certification and plan of care (POC) for 11/10/2021 to 1/8/2022 for Patient 4, it indicated a start of care of 9/11/2021 with a diagnosis that included cellulitis (inflammation) of right lower leg. The POC for Patient 4 indicated an order for the skilled nurse visit to visit twice weekly and to instruct patient and caregiver on new, changed medications, its side effects, precautions, use, actions. A review of Patient 4's physician's order dated 10/12/2021, indicated an order for Imodium A-D 2 mg, 1 tablet three times a day by mouth. The order did not indicate for simethicone. A review of the agency’s policy and procedure titled "Medication Profile", revised April 2010, indicated patient receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. It also indicated, medication profiles will be updated for each change to reflect current medications, new, and /or discontinued medications.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on observation, interview and record review the home health agency (HHA) failed to follow the physician’s order for the wound management, for one of seven patients, Patient 4. This failure had the potential to affect the patient's wound healing and progress. During an observation on 12/11/2021 at 11 a.m., Registered Nurse (RN 1) was changing Patient 4’s dressing on the bilateral feet. The dressing was observed with minimal drainage. During the procedure, RN 1 was observed applying a foam dressing. A review of Patient 4’s home health certification and plan of care (POC) for certification period 11/10/2021 to 1/8/2022, indicated a physician’s order to cleanse bilateral lower extremities with normal saline, apply gentamicin, cover with border foam and coban (an elastic wrap that provides sustained therapeutic compression). The POC for Patient 4 also indicated a diagnosis of cellulitis (inflammation) on the right lower limb. During a concurrent interview, RN 1 stated “The order for coban should have been removed since we have never used the coban”. During an interview on 12/12/2021 at 12 p.m., the Director of Patient Care Services stated the order for wound dressing should have been followed. Review of the agency’s policy and procedure titled "Wound Assessment /Management", reviewed 6/2012, indicated the staff will provide wound care according to the physician specific orders.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency failed to ensure that hand hygiene was performed during wound care for one of seven sampled patients, Patient 1. This deficient practice placed the Patient 1’s wounds at risk for infections. On 12/11/2021 at 11:45 a.m., a home visit was conducted at Patient 1's residence with Registered Nurse 1 (RN 1). Patient 1 was alert and oriented and was sitting at a chair next to the dining table with left elbow covered with dressing. During the observation, RN 1 washed her hands, put on a new pair of gloves, picked up a clean pair of gauze, wet the gauze with normal saline and wiped the open wound on left elbow. Then, with the same gloves, RN 1 was observed picked up another clean pair of gauze, wet it with normal saline and wiped the open wound area. During an interview on 12/11/2021 at 11:55 a.m., RN 1 stated she forgot to wash her hands in between wiping and cleaning the open wound. A review of Patient 1's Plan of Care (POC) for the certification period from 11/3/2021 to 1/1/2022, indicated a start of care date of 11/3/2021, with diagnosis that included left elbow olectranon bursitis (inflammation or swelling, redness and pain at the tip of the elbow). The POC indicated Skilled Nurse (SN) visits of four times a week for two weeks, two times a week for four weeks and two as needed for acute medical changes, perform skilled observation and assessment of vital signs and all body systems, and medication/dietary regimen. One of the SN intervention was to provide wound treatment at left elbow, to cleanse and irrigate inside the undermining wound with normal saline pack with iodoform, cover with 4x4 gauze, and abdominal pads and rolled gauze then secure with tape and coban. During an interview on 12/12/2021 at 11 a.m., the Director of Patient Care Services (DPCS) stated RN 1 should have washed her hands and put on new gloves before picking up a new set of clean gauze. A review of the agency's undated document titled "Infection Control During Wound Dressing Change", indicated hand hygiene if contaminated and dirty gloves are removed, hand hygiene with hand sanitizer or soap an A review of Patient 1's Plan of Care (POC) for the certification period from 11/3/21 through 1/1/22, indicated the start of care date was 11/3/21, with diagnosis that included left elbow olectranon bursitis (condition characterized by swelling , redness and pain at the tip of the elbow). The POC included Skilled Nurse (SN) visits of four times a week for two weeks, two times a week for four weeks and two as needed for actual medical changes, to perform skilled observation and assessment of vital sign and all body systems and medication/dietary regimen. One of the SN intervention was to provide wound treatment at left elbow as follows: to cleanse and irrigate inside the undermining wound with Normal Saline pack with iodoform, cover with 4x4 gauze, and ABD padsand rolledd gauze then secure with tape and coban. On 12/11/21, at 11:45 a.m., A home visit was conducted at the Patient 1's residence with RN 1. Patient 1 was alert and oriented, and was sitting at a chair next to the dining table. RN 1 was observed initially washing her hands, then putting on a new pair of gloves, picked up a clean pair of gauze, wet the gauze with normal saline and wiped the open wound at left elbow. RN 1 again picked up another clean pair of gauze, wet it normal saline and wiped the open wound area and the procedure was done for 4 times without removing her old gloves and washing her hands in between cleansing the wound. At 11:55 a.m., during an interview with RN 1, she stated she forgot to wash her hands in between wiping and cleaning the open wound. On 12/12/21, at 11 a.m., during an interview with the Director of Patient Care Services (DPCS), she stated, RN 1 should wash her hands as per the agency's policy. A review of the agency's policy titled "Hand Hygiene and Compliance Program (undated)", indicated that staff should perform hand hygiene (wash hands) before and after direct patient care, when hands are soiled and after any contact with contaminated materials.