Every finding on record at Wyoming Home Health Inc Dba/Home and Care Gillette

An emergency preparedness survey was conducted by Healthcare Licensing and Surveys on 5/13/21. Based upon the findings of the survey team, it was determined the agency was in compliance with all requirements

A recertification survey was conducted by Healthcare Licensing and Surveys from 5/10/21 to 5/13/21. Also reviewd in the course of the survey was complaint intake WY00003181. The following common abbreviations are used throughout this document: HHA: Home Health Aide OASIS: Outcome and Assessment Information Set OT: Occupational Therapist POC: Plan of Care RN: Registered Nurse Less commonly used abbreviations will be annotated in each deficiency.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on medical record review, and staff interview, the agency failed to ensure the initial assessment visit was completed within 48 hours of the referral for 2 of 7 sample client (#7). The findings were: Review of the physician's written order dated 11/16/20 and fax dated 11/17/20 showed client #1 was to receive skilled nursing, HHA services, and Occupational Therapy (OT) services. Review of the OASIS assessment for the client showed the initial assessment visit was completed on 11/30/20, 14 days after the referral was received. Review of the medical record showed no evidence the physician was notified of the delayed initial assessment visit. 2. Review of the physician's written order dated 9/27/19 showed client #7 was to receive skilled nursing services and HHA services. Review of the OASIS assessment for the client showed the initial assessment visit was completed on 9/30/19, 3 days after the referral was received. Review of the medical record showed no evidence the physician was notified of the delayed initial assessment visit. 3. Interview with the administrator on 5/13/21 at 8:45 AM revealed the agency was unable to explain the delays in the start of care.

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, staff interview, and policy review, the agency failed to ensure equipment used for a home visit was cleaned effectively during 3 random observations of client care (#3, #4, #5) The findings were: 1. Observation on 5/12/21 at 8:15 AM showed HHA #1 was providing care to client #3. The HHA took the clients' vital signs with a pulse oximeter, blood pressure (BP) cuff and stethoscope, and thermometer. The HHA did a quick swipe across the equipment using medium Alcohol Prep pads to clean the equipment. Interview at that time with the HHA revealed it was the agency's expectation for staff to clean the equipment with 70% alcohol. Further, s/he revealed s/he was unaware of any required wet time. 2. Observation on 5/12/21 at 9:30 AM showed RN #1 was providing care to client #5. The RN had used his/her pulse oximeter, BP cuff and stethoscope, and thermometer to take the client's vital signs. The nurse did a quick swipe using medium 70% isopropyl alcohol wipes on some of the equipment, and then used "Techspray" Isopropyl alcohol wipes to clean the rest. Interview at that time with the nurse revealed s/he was unaware of any required wet time. 3. Observation on 5/12/21 at 10:45 AM showed Physical Therapy (PT) #1 was providing care to client #4. The therapist set his/her bag down the the client's floor with no barrier between the two. Continued observation showed the therapist failed to clean the bag. Interview with the therapist on 5/12/21 at 11:33 AM revealed s/he did not have a barrier to place under the barrier. 4. Review of the CDC web page named "https://www.cdc.gov/infectioncontrol/guidelines/disinfection/tables/table1.html" accessed on 5/23/21 showed Ethyl or isopropyl alcohol (70 - 90%) had intermediate disinfection with an exposure (wet) time of greater than or equal to 1 minute. 5. Review of policy "Bag Technique: Nursing" effective date: 1/2017 showed "...1...d. Never place visit bag on floor."

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure care plan instructions for HHAs included all the appropriate information to care for the client in 2 of 4 sample patients (#3, #7) with HHA services. The findings were: 1. Review of client #3 HHA POC dated 3/1/21 to 2/28/22 showed diagnoses that included unspecified dementia with behavioral disturbances, weakness, and history of falls. Further review showed the POC failed to provide the client's safety measures and code status. 2. Review of client #7 HHA POC dated 3/23/21 to 5/21/21 showed diagnoses that included hemiplegia, other sequelae of cerebral infarction, repeated falls, and dysarthria following cerebral infarction. Further review showed the POC failed to provide the client's safety measures and code status. 3. Interview on 5/11/21 at 8:15 AM with HHA #1 revealed the safety measures and code status were not included on the HHA POC. Further, s/he stated s/he just knew what they were. Interview on 5/13/21 at 10 AM with the administrator confirmed the safety measures and code status were not on the clients' HHA POCs.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation and staff interview the agency failed to ensure supplies available for use were not expired for 1 of 1 supply room. The findings were: 1. Observation of the supply room on 5/10/21 at 2 PM identified the following concerns: a. One BARD Toomey syringe (70 cc syringe with catheter tip and Luer Tip Adapter) expired 12/2004. b. One Hopkin Premium Spill Kit expired 11/23/16. c. Eight 1000 ml Covidien Kangaroo Joey Pump Set expired 2/28/21. d. Nineteen 0.18 ounces Curad vitamin A & D ointment expired 10/2020. e. Eleven Medline Providone-Iodine triple pack swabsticks of which 2 expired 4/2016 and 9 expired 9/20/18. f. Sixteen Medline Providone-Iodine single pack swabsticks expired 12/2017. 2. Interview with the administrator on 5/11/21 at 2:40 PM confirmed the medical supplies were for client use. Further, the administrator revealed the agency did not have a system in place for checking for expirations, nor did the agency have a policy.