Every finding on record at Vital Home Health Care

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 221 East Walnut Street suite 248, Pasadena, CA 91101 Representing the California Department of Public Health : Surveyor ID # 22303- RN - HFEN Surveyor ID # 09697 - RN - HFEN Active Patients - 68 Sample Size - 13 Home Visit - 4

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 staff was conducted at least annually. This failure had the potential to cause the HHA's staff to inabilities to act effectively when an emergency situation occur. Findings: During an interview with the Director of Patient Care Services (DPCS), on 4/8/22 at 5 p.m., she stated she did not conduct emergency preparedness training for all of the staff. During a record review, there was no documented emergency preparedness training provided to the HHA's staff. The HHA's undated policy and procedure titled, "Emergency Preparedness Plan" indicated 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 at this location: 221 East Walnut Street suite 248, Pasadena, CA 91101 Representing the California Department of Public Health : Surveyor ID # 22303- RN - HFEN Surveyor ID # 09697 - RN - HFEN Active Patients - 68 Sample Size - 13 Home Visit - 4

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the agency's skilled nurse failed to ensure the comprehensive assessment for pain management was incomplete for one of 13 sampled patients (Patient 8). There was no evidence of the patient's pain level and description of the pain. This deficient practice had the potential to affect the quality of care due to incomplete pain management. Findings: A review of Patient 8's clinical record disclosed a start of care of 4/1/22, with diagnoses of sepsis due to staphylococcus and thrombophlebitis. During the certification period of 4/1/22 through 5/30/22, there was an order for skilled nurse visit daily to provide antibiotic intravenous therapy. On 4/9/22, at 3 p.m., during home visit with registered nurse (RN 2), Patient 8 was observed sitting on his recliner chair. He was alert and verbally responsive. He was able communicate his needs. When interviewed regarding his pain issues, Patient 8 responded, it was manageable. The skilled nurse (RN) notes dated 4/3/22 and 4/4/22, indicated Patient 8 was assessed with daily pain. However, there was no documented evidence what pain level/description and what was implemented to relieve the pain. The agency's policy and procedure for pain management dated April 2015, indicated to assess the intensity of pain numerically, location duration and pain management/intervention, and evaluate effectiveness. On 4/10/22, at 2 p. m. during an interview, RN1 indicated the pain management should be completed per policy and procedure.

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 HHA failed to review and document all the medications, the patient is currently taking for one of 13 sampled patients (Patient 8). This deficient practice placed the patient at risk for drug interaction and harm by not knowing which medications the patient was taking Findings: A review of Patient 8's clinical record disclosed a start of care on 4/1/22, with diagnoses of sepsis due to staphylococcus and thrombophlebitis of unspecifies site. During the certification period dated 4/1/22 through 5/30/22, indicated for RN ( Registered Nurse) to provide antibiotic intravenous therapy daily until 4/9/22. During the concurrent observations and interview of home visit on 4/9/22, at 3 p.m., Patient 8 showed to the surveyor "Actos tablet 30 mg" ( the oral medications) he is taking currently. This medication was not documented on the patient's medication profile. Patient 8 indicated he had been taking this medication for a while. During an interview at 330 p.m., RN 2 indicated that she was supposed to review the patient's medication every visit. Review of the agency's policy dated April 2015, indicated to review the patient's medication every visit. This was confirmed by RN 1.

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 agency's skilled nurses failed to obtain a physician order for two insulin medications for one of 13 sampled patients (Patients 1). This deficient practice placed the patient at risk for hypoglycemic (low blood sugar) or hyperglycemic (elevated blood sugar) attacks. A review Patient 1's admission face sheet indicated a start of care date of 3/2/22, with a diagnoses of Type 2 Diabetes Mellitus (DM- disease that results in too much sugar circulating in the bloodstream). A review of 1's plan of care (POC) for the period of 3/2/22 to 4/30/22 indicated the skilled nurse (SN) to visit daily for ten days , then reassess. The POC indicated for the SN to perform vital signs, pain assessment, skin assessment, and assess and instruct patient/caregiver on insulin administration and diabetic management. During a home visit at Patient 1's residence with registered nurse (RN 1) on 4/9/22, at 11 a.m., Patient 1 was observed walking with steady gait without the use of assistive device. Patient 1’s current medications were reviewed with RN 1. One Ozempic insulin pen 2.5 units once a week and one Tresiba insulin pen 50 unit every morning placed in the medication container. When Patient 1 was asked when he started taking the Ozempic and Tresiba insulin medications, he stated he has been taking it for two weeks now. At 11:30 a.m., during an interview with RN 1, she stated the Ozempic and Tresiba insulin medications were just newly prescribed by Patient 1's physician. A further review of Patient 1's clinical chart indicated there are no physician's order written for the Ozempic and Tresiba insulin pen medications. On 4/10/22, at 11 a.m., during an interview with DPCS (director of patient care services), she stated that RN 1 should obtain orders for the Ozempic and Tresiba insulin pens. i

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 use of standard precautions, to prevent the transmission of infections and communicable diseases (COVID-19) by failing to conduct screening visitors for signs and symptoms of COVID-19, and tested fitting of N95 masks for patient care staff. This failure had the potential to spread infections to staff, visitors and patients. Findings: During an observation on 4/8/22, at 4 p.m., upon entrance to the HHA, there was no screening for COVID-19 signs and symptoms and no temperature check. An interview was conducted with the Director of Patient Care Services (DPCS) on 4/8/22, at 4:45 p.m., she stated that agency would have start screening employees and visitors for COVID-19 signs and symptoms including temperature check and document on a binder from now on. She also stated patient care staff had not been fit tested for N95 mask. She further stated fit testing is important because it ensures the mask fits well and this will control the spread of virus or infection. During a review of the infection control policy on 4/10/22, at 11:50 a.m., the HHA did not have a policy for COVID-19 screening procedures for staff and visitors. A review of the HHA’s undated policy and procedure titled, “CNHHA-COVIS-19”, indicated “Surgical mask or higher-level respirators e.g., N95’s…with good fit are highly recommended”. A review of the HHA’s undated policy and procedure titled, “Infection Control Procedures”, indicated “It is the policy of California Nurses Home Health Services to protect the clients and the health care workers from potential spread of infection.”

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 interview and record review , the home health agency (HHA) failed to follow the plan of care (POC) for one of 13 sampled patients (Patient 1), by failing to ensure the patient not given 9 units of Novolog insulin when the blood sugar level was at 300 mg/dl. (According to the sliding scale the patient was supposed to only get 4 units of Novolog insulin.) This failure resulted in the patient getting much too insulin which had the potential to affect the patient's progress in reaching the goal. Findings: A review Patient 1's admission face sheet indicated a start of care date of 3/2/22, with a diagnoses of type 2 diabetes mellitus (DM- disease that results in too much sugar circulating in the bloodstream). A review of Patient 1's plan of care (POC) for the period of 3/2/22 to 4/30/22 indicated the skilled nurse (SN) to visit daily for ten days , then reassess. The POC indicated for the SN to perform vital signs, pain assessment, skin assessment, and assess and instruct patient/caregiver on insulin administration and diabetic management. One of intervention was for the SN to instruct/teach patient and caregiver to administer Novolog flex pen 100 unit/ml 5 subcutaneous three times per day before meals and sliding scale as follows: Blood Sugar level 141-180= 2 units 181-240= 3 units 241-300= 4 units 301-350= 5 units 351-400= 6 units greater than 401= 6 units and call MD A review Patient 1's Nursing Visit Record dated 3/5/22, indicated a random blood sugar check prior to lunch was performed by the patient under the SN observation. The random blood sugar reading was 300 mg/dl, and the patient administered 9 units of Novolog instead of 4 units. On 4/10/22, at 11 a.m., during an interview with the director of patient care services (DPCS), she stated that Patient 1 should be administering 4 units of Novolog based on sliding scale and the visiting nurse should re-instruct the patient how to follow correct insulin dosage from sliding scale. The HHA'S undated policy titled, "Care Planning Process" indicated the purpose of a plan of care was to provide clinical direction for providing direct patient care.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the agency's administrator failed to notify the Department for the agency change of location. This failure resulted in the delay of the survey process. Findings: On 4/8/22, at 9 a.m., a recertification survey was conducted at 2500 E. Foothill Blvd., suite 501, Pasadena. This suite was closed and locked. The agency was called and a staff answered the phone and indicated the agency had moved to a new place (221 East Walnut Street, suite 248, Pasadena). The survey team proceeded to the new location. During an interview, registered nurse (RN 1) who was the administrator/DPCS, indicated that the agency moved to the new location in January 2022. According to the Administrator/DPCS, she had been trying to call Sacramento, but there was no response from them. She then tried to sent an application for change of location which was was dated 4/4/22. The Administrator further indicated that she was supposed to notify the Department for any changes within 10 days, but it did not happened due to the pandemic.