Every finding on record at Xl Care, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey at this location: 20350 Ventura , Ste 140 Woodland Hills CA 91364 Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # , Health Facilities Evaluator Nurse Unduplicated Admissions - 191 Active Patients - 54 Sample Size - 7 Home Visits- 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 (HHA) failed to review all current medication the patient is currently taking and maintain an accurate medication profile for 2 of 7 patients (Patients 1 and 2). This failure has the potential to result in placing the patient at risk for medication errors and adverse drug reactions. 1. A Review of Patient 1’s admission record Start of Care (SOC) at 6/8/22, certification period 6/8/22 to 8/6/22 with a medical diagnosis of malignant neoplasm (another term for a cancerous tumor) of lower third of esophagus (The muscular tube through which food passes from the throat to the stomach) During a review of Patient 1's Plan of Care (POC), for the re-certification period from 6/8/22 to 8/6/22, included an order for skilled nurse (SN) to visit twice per day for one week, then three times a week for one week and once a week for one week, then reassess per physician’s order. On 6/11/2022, at 2:15 p.m., during a medication review with Registered Nurse (RN) indicated an order for Carvedilol 12.5 mg 25mg (milligram- a unit of measure) twice per day on electronic medical record. Patient 1’s daughter showed that Patient 1 had a bottle of Carvedilol 6.25mg twice a day. On 6/11/2022 at 2:15 p.m., RN stated that she checked patient's medication every visits. 2. A review of Patient 2’s admission record SOC at 12/21/2019 with certification period of 6/8/2022 to 8/6/2022 with a medical diagnoses of chronic kidney disease (long-term condition where the kidneys don't work as well as they should. It's a common condition often associated with getting older) and heart failure (a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood). During a review of Patient 2's Plan of Care (POC), for the re-certification period from 6/8/2022 to 8/6/2022, included an order for skilled nurse (SN) to visit once a week for 9 weeks. On 6/11/2022 at 12:00 p.m., during a medication review with LVN indicated Patient 2 had an order of the following medications: Lidocaine 4% External as needed apply small amount to left knee every 6 hours as needed for left knee pain and Lidocaine 5% was found at patient’s home. Nystatin powder 100,000 units per gram bottle was found to be expired dated 5/2021. Patient 2's husband stated " I don't want to waste the medicine since she still has is, she use it." On 6/11/2022 at 12:00 p.m., during a medication review with LVN indicated the Patient 2 had an order of Tylenol 325mg 2 tablets four times a day as needed for pain and Tylenol 500 mg was found at patient's home. Patient 2's husband stated that he gave 2 tablets once a day equivalent to 1000 mg as needed for pain. Patient 2’s husband also stated that his son bought the medication over the counter. On 6/11/2022 at 12:30 p.m., during an interview with LVN stated he should have notified the doctor to clarify the medication and asked for a new order. LVN also stated that he checked the patient's medication every visit. A review of Patient 2’s plan of care risk factors reported or observed to have difficulty complying with any medical instructions (for example medications, diet, exercise) in the past 3 months. Patient is at risk for bleeding, pressure in juries, GI (gastrointestinal) complications, diabetic complications, falls with injury, CV(cardiovascular) complications, fluctuating blood pressure, unstable vital signs, unstable vital signs. SN to teach use, purpose, and side effects of medications, assess effectiveness and compliance. SN to remove any duplicate or expired medications to prevent confusion with medication regimen. SN to report to physician if drug therapy appears to be ineffective. A review of the HHA’s document titled “Plan of Care” policy number:200-06 revised 1/13/2018 indicated the individualized plan of care must include all medications and treatments/procedures, including: a description of the medications including the name, dosage, frequency, route of administration, and an indication if medication is new or changed. A review of the HHA’s document titled “Monitoring Patients Response/reporting to Physician” Policy no. 4-012.1 Revised April 2019 indicated during each home visit, the clinician will monitor the patient’s response to care against the established goals including, but not limited to care interventions and treatments, medications, teaching. A review of the HHA’s document titled “Medication Monitoring” Policy No. 4-039.1 revised April 2019 indicated that ongoing patient medication monitoring will use a collaborative approach between clinicians, physicians, pharmacists, patients and families/caregivers. The information obtained through patient medication monitoring will be documented in the patient’s clinical record and if applicable, in the pharmacy record. A review of the HHA’s document titled “Medication profile” Policy No.4-024.1 indicated the purpose is to define the use of medication profile in evaluating a patients, medication regimen including (OTC) over the counter medications, nutrition supplements, herbal remedies , vitamins and minerals. Patient receiving medication s administered by the organization will have current, accurate medication profile in the clinical record.

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 interview, and record review, the Home Health Agency (HHA) failed to ensure the staffs are fit tested for the use of N95 (a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles) masks to prevent COVID-19 (an acute respiratory illness) transmission. This failure had the potential for an increased risk of cross contamination and spread of infection. During an interview with the Director of Patient Care Services (DPCS), on 6/10//22 at 5:00 p.m. , stated all of the HHA staff were not fit tested for N95 masks. The DPCS stated they gathered in the conference room around the table and DPCS placed different kinds of N95 on the table and watched "you tube" on how to wear an N95. DPCS stated that staff pick the kind N95 that was most comfortable for them to wear. During a home visit observation and interview with the Registered Nurse (RN), on 6/11/2022 at 2:40 p.m., RN stated that she did not have N95 fit testing. RN was wearing NIOSH 3M 9210 that she got from the HHA. The HHA's policy and procedure titled, "Infection Control/Expanded Precautions, Policy No. 6.008.1, 6.008.2" revised April 2019, indicated Airborne Precautions as recommended by the Centers for disease control. NIOSH-certified N95 respiratory mask should be worn by personnel for patients with suspected or known active pulmonary or laryngeal TB. Droplet precautions are used for patients with known or suspected serious illnesses transmitted by large particle droplets. Diseases which require droplet precautions are: hemophilus Influenzae Type B, Neisseria Meningitides, Diphtheria, Mycoplasma Pneumonia, Pertussis, Pneumonic plague, Staphylococcal group A Serious viral infections spread by droplet transmissions: Adenovirus, Influenza, Mumps, parvovirus B19 Rubella , SARS Covid-19.