Every finding on record at Lhc California Home Health I, LLC

Based on observation, interview, and record review, the agency failed to ensure proper infection control procedures were followed during a home visit for one of 14 sampled patients (Patient 12) when:1.     Licensed Nurse (LN) 1 did not sanitize hands after changing gloves after direct patient care. 2.     LN 1 placed a dirty stethoscope on the home care bag. 3.     LN 1 did not air dry a cleaned stethoscope before placing it in the home care bag. 4.     LN 1 used gloves that were stored in her pockets, to provide direct patient care.These failures had the potential to result in transmission and spread of infection. --- During a review of Patient 12’s “Patient Information Report”, it indicated Patient 12’s start of care date was 10/25/24 with multiple diagnosis including cerebrovascular disease (a group of conditions that affect the blood vessels in the brain, leading to reduced blood flow and oxygen supply to the brain).During an observation on 10/15/25 at 11:15 a.m. in Patient 12’s home, LN 1 grabbed gloves out of her left and right pockets and put them on before providing care to Patient 12. LN 1 changed gloves during care and did not perform hand hygiene between glove changes. LN 1 assessed Patient 12’s heart and lungs sounds with a stethoscope and placed the stethoscope on the home care bag without sanitizing it. Then, LN 1 cleansed the stethoscope with an alcohol wipe and placed the stethoscope back inside the home care bag before allowing the stethoscope to air dry.During an interview on 10/15/25 at 11:40 a.m. with LN 1, LN1 acknowledged the risk for spreading infection when she stored gloves in her pocket, did not perform hand hygiene after changing gloves, placed a dirty stethoscope on top of the home care bag, and did not allow the stethoscope to air dry before placing the stethoscope back in the home care bag. During an interview on 10/16/25 at 11:30 a.m. with Patient Care Manager (PCM), PCM confirmed the expectation was for infection control procedures to be followed including storing gloves in a designated area in the home care bag for gloves, hand hygiene being performed after changing gloves, patient equipment cleaned and air dried before being placed in the home care bag, and not placing dirty equipment on the home care bag. PCM acknowledged risk for spread of infection when LN 1 did not follow infection control procedures during the home visit with Patient 12 on 10/15/25. During a review of the agency’s document titled, “Home Care Bag Protocol Job Aid”, revised 7/25/25, the documented indicated, “…The home care bag allows you to safely transport basic equipment and supplies necessary to perform a standard home visit. Use the home care bag to prevent potential spread of infection…Adherence to this protocol is mandatory…one area of the bag shall be dedicated to clean, reusable items…one area of the bag shall be dedicated to Personal Protective Equipment (PPE)…Perform hand hygiene prior to removing any equipment or supplies from the bag…Never return soiled items to the bag. Items such as…stethoscopes…shall be cleaned…and allowed to air dry prior to returning them to bag…”During a review of agency’s policy and procedure (P&P) titled, “Infection Control Plan,” dated Revised 8/1/16, the P&P indicated, “…Hand Hygiene Compliance: Prevent transmission of infection through proper adherence of hand hygiene…per Center for Disease Control guidelines…Prevent transmission of infection through proper use of PPE…Prevent transmission of infection through proper sanitation of medical equipment…”

Observed in Record Review. In 6 of 13 patient records reviewed, the hospice plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient's needs. In review of the record for HV#2, RR#4, RR#7, RR#9, and RR#10, the patient's plan of care included orders for Docusate Sodium, Senna, and Bisacodyl Suppository. All of these medications were ordered prn for bowel management/constipation with no clear indications for use (which medication to administer when). In RR#3, the patient's plan of care included Magnesium Hydroxide per G-tube, Sodium Phosphates Enema per rectum, Docusate Sodium per G-tube, and Bisacodyl suppository, with no clear indications for use of these four prn medications for constipation. This was reveiwed and confirmed with the Director of Hospice.

Observed in Patient Home. In 1 of 3 home visits conducted, the hospice aide did not provide services in accordance with physician orders in the plan of care. During HV#1, it was noted the aide provided a bed bath to the patient. The aide plan of care in the home folder indicated the patient was to receive a shower. When asked, the caregiver and aide stated the patient had a recent fall, was weaker, and was transitioned to a bed bath. The aide confirmed the RN Case Manager had not yet been notified regarding the change of patient's bath. Following the visit, the aide did contact the RN and Director of Hospice. This was reveiwed and confirmed with the Director of Hospice.

Observed in Record Review. In 1 of 1 live discharge patient records reveiwed, the organization did not provide information regarding the patient's care, treatment, or services to other service providers upon hospice discharge or transfer . In RR#4, it was noted the patient requested hospitalization for treatment. The hospice discharge summary/patient information was not made available to the receiving acute care facility or attending physician. This was reveiwed and confirmed with the Director of Hospice.