Every finding on record at Vhsnj at Home, LLC

Survey date: February 28- March 1, 2024 Visiting Health Services of New Jersey is in compliance with Appendix Z-Emergency Preparedness for All Provider and Supplier Types, Interpretive Guidance 484.22, Conditions of Participation for Home Health Agencies, for this survey.

This was a Federal Re-Certification Survey conducted at Visiting Health Services of New Jersey, February 28- March 1, 2024, to determine compliance with 42 CFR Part 484, Subpart B Conditions of Participation for Home Health Agencies. Standard level deficiencies were cited in conjunction with this survey.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on medical record review, facility policy review, and staff interview, it was determined the facility failed to ensure that services ordered by the physician are provided as indicated in the plan of care. Facility policy titled, “Verification of Physician Orders”, revised 3/22, states, “…NOTICES TO THE PHYSICIAN … 2. If fewer visits are provided during the week than ordered, the physician will be notified with documentation in the clinical record that the physician is aware of the missed visits unless the physician has authorized missed visits under specified circumstances (for example, the plan of care indicates that the office may skip nursing visits on the day of physician visits or that home health aide visits may be skipped when the patient’s daughter is in the home to provide personal care). …” Findings include: On 2/29/24 during a review of Patient (P) 8’s medical record the “Home Health Plan of Care” for P8 for the certification period of 1/21/24 - 3/20/24, revealed the following: The section labeled Visit Sets stated, “… Speech Language Pathology[SLP]: 1 visit every 6 days for 6 days from 1/29/2024 to 2/3/2024, Comments: ST [Speech Therapy] evaluation for cognition; 1 visit every week for one week from 2/4/24 to 2/9/24; 2 visits per week for three weeks from 2/11/24 to 3/1/24. …” The week of 2/18/24, P8’s medical record indicated that no SLP visits were made. An “Inconvenience Visit Note was documented on 2/20/24 that stated, “… All Conversations …2/20/24 Inconvenience Visit: approx. [approximately] 2 minutes from pt [patient] house. Spouse cancelled because family dog just passed away. Re-scheduled for Thursday. …” On 2/29/24 at 3:02 PM, S1 (RN Director) explained that an Inconvenience Visit note is completed when the patient cancels the visit when the clinician is en-route. S1 explained that the clinician should complete a missed visit note in addition to the inconvenience note. The medical record for P8 does not contain evidence that the physician was notified of the missed visit on 2/20/24. On 3/1/24, during a review of P9’s medical record, the “Home Health Plan of Care” for P9, for the certification period of 1/29/24- 3/28/24, revealed the following: The section labeled Visit Sets stated, “… Speech Language Pathology[SLP]: 1 visit every 6 days for 6 days from 1/29/2024 to 2/3/2024, Comments: Eval [evaluate] and treat; 1 visit every 6 days for 6 days 2/4/2024 to 2/9/2024, Comments: Extension of SLP Eval and treat; 1 visit every week for 1 week 2/11/2024 to 2/16/2024; 1 visit every week for 3 weeks 2/18/2024 …” The Week of 2/4/24, P9’s medical record indicated that a SLP visit was missed. The “2/6/2024 SLP Missed Visit Note” lacks documentation that a physician was notified of the missed visit scheduled for 2/6/24. The “2/6/2024 SLP Missed Visits Notes” states, “…All Conversations (Oldest Message First) February 29,2024 [name of clinician], SLP to [name] RN 2/6/24 called Dr. [name] office and spoke with [name] to report a MV [missed visit]. 2/29/24 23:08 [11:08 PM]. …” On 3/1/24 at 10:07 AM, during an interview with S1 (RN Director), he/she confirmed that documentation of notification of a missed visit is expected to occur within 24 hours and that this SLP did not meet that expectation. N.J.A.C. 8:42-6.2(a)(6)

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 review of facility policy and procedure, observations, and staff interview, it was determined the facility failed to implement its policy and procedures regarding cleaning and disinfecting of equipment, to prevent the transmission of infections and communicable diseases. Facility Policy titled, “Cleaning & Disinfecting Guidelines for Patient Care Equipment” last revised 03/2022, states, “…Procedure … 3. Separation must be maintained between clean and soiled equipment to prevent cross contamination. … 4. …Patient care equipment should be wiped to thoroughly wet the surface (contact time) and remain wet for the time frame specific to the product’s instructions, before drying and returning to the clinician’s bag. …6. Follow the manufacturer’s instructions for equipment use, transportation, storage, and cleaning/disinfection. …” Manufacturer instructions for use (IFU) the Sani-Cloth Germicidal Disposable Wipes, located on the package, states, “… use a wipe to remove visible soil prior to disinfecting. Unfold a clean wipe and thoroughly wet surface. Allow surface to remain wet for two (2) minutes. Let air dry…” On 2/28/24 at 12:18 PM, during a home visit with P2, Staff (S) 6 (Physical Therapist), was observed opening two clean barriers and placing them near the patient’s side. S6 then placed an unused blood pressure cuff, pulse oximeter, and thermometer on one barrier (clean). After using the equipment on P2, S6 then placed the used equipment onto an unused barrier (dirty). S6 then individually disinfected each used item with Sani-Cloth Germicidal Disposable Wipes and was observed placing disinfected/clean items back onto the same (dirty) barrier to dry. There was no clear and distinct separation between clean and soiled/used equipment observed. Additionally, after disinfecting the blood pressure cuff, S6 immediately rolled up the blood pressure cuff, not allowing the disinfectant to dry on the surface, for the recommended time, as per the manufacturer’s instructions (two minutes). On 2/29/24 at 10:50 AM, during a home visit with P4, S9 (Registered Nurse), was observed cleaning/disinfecting the used blood pressure cuff with a Sani-Cloth Wipe and then immediately rolled up the cuff, not allowing the disinfectant to dry on the surface for the recommended time. On 3/1/2024 at 12:24 PM, an interview was conducted with S3 (Director of Quality) and S12 (Registered Nurse - Staff Development) in which the process of cleaning equipment was discussed. S3 explained the staff is educated to clean the blood pressure cuff and allow it to dry (according to manufacturer’s guidelines), prior to rolling them and placing them back in their bags for storage. S3 indicated the staff should not be rolling the blood pressure cuffs up immediately after cleaning them because it does not give the disinfectant time to dry properly. S12 confirmed this by stating “the blood pressure cuff should be left open so you can see the surface and ensure the disinfectant has dried." N.J.A.C. 8:42-12.2(b)

This was a Federal Complaint Investigation conducted on March 24, 2021, that resulted in Standard Level deficiencies. Visiting Health Services of New Jersey is in compliance with 42 CFR Part 484, Subpart B, Conditions of Participation for Home Health Agencies based on these complaint investigations only (NJ00141097 and NJ00143188).

Patient's needs CFR(s): 484.55(c)(4) The patient's medical, nursing, rehabilitative, social, and discharge planning needs; This ELEMENT is not met as evidenced by: (NJ00141097) Based on staff interviews, review of one (1) of one (1) medical record, and review of facility policy and procedure, it was determined the facility failed to ensure that patients who require long term planning receive a visit from a medical social worker. Findings include: Reference: Facility policy titled, Initial and Comprehensive Assessments, states, " ... The assessment will be patient-specific and comprehensive to include the patient's need for home health care, rehabilitative care, social services, and discharge planning ..." 1. Upon review of Medical Record #2, the following was noted: a. The Admission Narrative dated 6/23/20, states, "... MSW (Medical Social Worker) requested for long term planning ..." b. Patient #2 was discharged on 10/16/21. c. The patient did not receive a visit from a medical social worker. 2. The above finding was confirmed with Staff #1 and Staff #4.

Discharge plans communication CFR(s): 484.60(c)(3)(ii) (ii) Any revisions related to plans for the patient's discharge must be communicated to the patient, representative, caregiver, all physicians or allowed practitioner's issuing orders for the HHA plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any). This ELEMENT is not met as evidenced by: (NJ00141097 and NJ00143188) Based on staff interviews, review of two (2) of three (3) medical records, and review of facility policy and procedure, it was determined the facility failed to ensure that discharge planning was implemented according to facility policy. Findings include: Reference: Facility policy, Patient Education Related to Discharge Planning, states, " ... The home health aide staff and interdisciplinary team member assist patient regarding their discharge by ... Consulting with the patient and family regarding the need for discharge instruction. ..." 1. Upon review of Medical Record #1, the following was noted: a. Patient #1 was discharged on 1/29/21. b. Patient #1 was not consulted regarding the need for discharge instructions. 2. Upon review of Medical Record #2, the following was noted: a. Patient #2 was discharged on 10/16/20. b. Patient #2 was not consulted regarding the need for discharge instructions. 3. The above findings were confirmed with Staff #1 and Staff #4.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: (NJ00143188) Based on staff interviews, review of facility documents, and review of one (1) of three (3) medical records, it was determined the facility failed to ensure professional staff reviews the referral documents prior to the initial assessment of the patient. Findings include: Reference: Facility document titled, Home Care Orientation Nursing/Therapist Checklist, states, " ...Orientee demonstrates ability to access scanned information in chart review task-media tab ..." 1. Upon review of Medical Record #1, the following was noted: a. The initial and comprehensive assessment was completed on 1/25/21. b. Staff #1 stated that prior to the home visit, the Registered Nurse (RN) was unable to access the referral documents that had been scanned into the chart and did not review the referral information. The referral information included the following: i. Current diagnoses ii. History and Physical iii. Physician Progress Notes iv. Physical Therapy Notes v. Current list of medications vi. Current information regarding the Foley Catheter vii. Current information regarding the patient's wound viii. Physician orders for wound care, physical therapy, and blood work c. Staff #1 stated that the RN should have reviewed the referral documents prior to the initial home visit. 2. The above findings were confirmed with Staff #1 and Staff #4.