Every finding on record at Visiting Nurse Association of Florida Inc

During the Health Recertification survey commenced on 05/14/2024 and concluded on 05/16/2024 at Visiting Nurse Association Of Florida, a Home Health Agency provider, Emergency Preparedness was reviewed. Visiting Nurse Association Of Florida was in compliance with Emergency Preparedness per 42 Code of Federal Regulations (CFR), Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was commenced on 05/14/2024 and concluded on 05/16/2024 at Visiting Nurse Association Of Florida Inc., located at 2400 S.E. Monterey Road Ste. 300 Stuart, FL 34996., Home Health Agency provider. The Home Health Agency was not in compliance with 42 Code of Federal Regulations (CFR) Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

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 the Home Health Agency (HHA)'s Policy review, observation, and interview, the HHA failed to follow their infection control process as evidenced by the failure to ensure appropriate hand hygiene and glove changes during wound care for 1 of 6 sampled patients observed during a home visit (Patient #11). The findings include: Review of the HHA's Policy titled, " Hand Hygiene Policy" dated 02/27/20 documents, "The agency implements standards from the Centers For Disease Control And Prevention (CDC) and World Health Organization (WHO) to determine the spread of infections by ensuring all clinical staff are performing proper hand hygiene. Infection control is a prime concern of the agency and shall be stressed not only to staff, but patients and caregivers by a process of ongoing assessment and instruction. Hand hygiene must be performed: before and after touching patient's intact skin, before donning sterile gloves. After removing gloves. Before and after performing a procedure, e.g. wound care." Review of the record reveals Patient #11 was admitted to the HHA 's services on 05/02/2024 for the provision of Skilled Nursing and Physical Therapy. Review of the Plan of Care dated 05/02/24 documents orders for the Skilled Nurse to perform/instruct/reinforce/patient care giver procedures of wound care to right arm. Cleanse with Normal Saline, pat dry, apply Xeroform (type of Petroleum dressing), and foam bandage two times a week until healed. On 05/16/24 at 10:11 AM, a home visit was conducted to observe the patient's wound care accompanied by the Administrator and Staff A, a License Practical Nurse; observation reveals Staff A sanitized their hands prior to the care; donned two pairs of gloves on each hand, removed the patient's old (wound) dressing, then removed their first pair of gloves, applied new gloves on top of the gloves Staff A already had on, without hand hygiene after the glove's removal and then performed the ordered wound care. On 05/16/24 at 12:02 PM an interview was conducted with DON who stated that she was not sure why the nurse "doubled" their gloves and did not perform hand hygiene after the removal of their first pair of gloves; the DON was asked to telephone Staff A and when Staff A responded, the DON stated that Staff A is in a patient's home, could not answer the telephone call and the DON sent Staff A a message to call back when Staff A is able. On 05/16/24 at 12:57 PM, an interview was held with Staff A; when asked what the reasoning was for wearing double gloves and why they didn’t conduct hand hygiene after glove removal, Staff A stated that their hands sweat a lot which makes it difficult to apply the gloves, they always stick to their hands and acknowledged that they didn’t conduct hand hygiene after the glove removal and before applying new gloves.

During the Recertification survey conducted on 04/26/2021 through 04/28/2021 at the Visiting Nurse Association of Florida Inc., a Home Health Agency, Emergency Preparedness was reviewed. The Visiting Nurse Association of Florida Inc. is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification and Focused Infection Control survey was conducted on 04/26/2021 through 04/28/2021 at the Visiting Nurse Association of Florida Inc., Home Health Agency provider's Parent location, 2400 S.E. Monterey Road, Suite 300, Stuart, FL 34996. The provider was not in compliance with 42 CFR Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Within 48 hours of the patient's return CFR(s): 484.55(d)(2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to ensure an updated Comprehensive Assessment was completed within 48 hours of return home from a hospital admission of 24 hours or more, for 1 of 2 sampled patients reviewed with a hospital admission (Patient #15). The findings included: Review of the record revealed Patient #15 was admitted to the HHA's services on 11/18/20. Review of the HHA's documentation reveals Patient #15 received "emergent care" related to a medication issue. Review of the "Coordination Notes," for Patient #15 dated Wednesday 12/23/20 and Thursday 12/24/20 document Patient #15 "went to the Emergency Room over the weekend" related to medication complications. The "Coordination Note," dated 12/24/20 documented Patient #15 returned home on Tuesday 12/22/20. Review of the "Discharge Assessment" documented Patient #15 had a hospital emergent visit with subsequent admission. Further review of the record lacked any updated "Comprehensive Assessment Resumption of Care assessment." During a telephone interview on 04/28/21 at 10:12 AM, the Administrator/Alternate Director of Nursing, was informed the "Coordination Notes," for Patient #15 documented the patient went to the hospital over the weekend of 12/19/20 through 12/20/20 and returned home on 12/22/20 and that there was no "Resumption of Care Assessment," in the Electronic Medical Record (EMR). During a subsequent telephone interview on 04/28/21 at 10:30 AM, the Administrator/Alternate Director of Nursing agreed with the findings and further stated she was able to access the hospital's EPIC system (Electronic System Used for Referrals) which documented Patient #15 was admitted to the hospital on 12/20/20 at 4:33 AM, was discharged on 12/22/20 and the Administrator/Alternate Director of Nursing stated she was unsure as to how the assessment was missed.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to ensure the individualized Plan of Care for 1 of 17 sampled patients included the ordered treatments (Patient #5). The findings included: Review of the record revealed Patient #5 was admitted to the HHA's services on 07/06/20 with ... (primary diagnosis) requiring Home Health services. Review of the current Plan of Care, for the certification period of 03/03/21 through 05/01/21 documented the Skilled Nurse was to instruct in management of the ... (primary diagnosis), assess the status of the skin and teach skin care for the prevention of pressure ulcers and skin breakdown and this Plan of Care lacked any type of treatment for the patient's ... (primary diagnosis). During a telephone interview on 04/27/21 at 3:49 PM, Staff A, who was both a trained Physical Therapy Assistant (PTA), for the patient's ... (primary diagnosis) and a Licensed Practical Nurse (LPN), was asked how she knows what to do for the home care patients; Staff A explained she would review the Electronic Medical Record (EMR) the evening before her visit, to review the order history, which would include the Plan of Care, coordination notes, attachments and referrals and would contact a Clinical Manager if she had any questions; when asked specifically about the care for Patient #5, Staff A explained she sees the patient for the ... (primary diagnosis) therapy, which includes Manual ... (primary diagnosis) Drainage and compression wraps; Staff A stated there were different types of wraps and that she would need a physician's order for the care and treatment and Staff A explained Patient #5 was being followed by a "Wound Care Center." During an interview on 04/27/21 at 4:10 PM, Staff B, the Clinical Manager for Patient #5 was shown the patient's current Plan of Care; upon review, the Clinical Manager agreed the Plan of Care lacked the ... (primary diagnosis) treatments ordered by the "Wound Care Center," for Patient #5, and agreed those orders should be on the HHA's Plan of Care. Review of the previous Plans of Care, for Patient #5 since the admission date of 07/06/20 also lacked the ordered ... (primary diagnosis) treatments.