Fairbanks Memorial Hospital Home Care

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on record review, observation, and interview, the agency failed to ensure Licensed Nurse (LN) #1 followed the physician orders on the plan of care in 1 (Patient #2) of 5 active records reviewed with skilled nursing services. This failed practice had the potential to affect the safety and effectiveness of the skilled nursing services Patient #2 received. Findings: Record review on 4/1-4/25 revealed Patient #2 had a start of care (SOC) date of 1/3/25 with a certification period of 3/4/25-5/2/25. The patient’s principal diagnosis was encounter for orthopedic after care following surgical amputation. Further review revealed a Home Health Certification and Plan of care for the Certification Period of 3/4/25-5/4/25 was signed by the physician on 3/7/25. This plan of care revealed, “Skilled Nurse to perform physical assessment on each visit ... Notify physician if heart rate lower than 60 or greater than 100. Systolic blood pressure less than 90 or greater than 150. Diastolic blood pressure less than 50 or greater than 100. Temp 101 F or greater. Pulse oximeter of 90% or less on room air.” Review of the Skilled Nursing Visit note, dated 3/5/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 3/7/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 3/12/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 3/14/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 3/19/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2 Review of the Skilled Nursing Visit note, dated 3/21/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 3/24/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 3/26/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nurse Visit note, dated 3/28/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. Review of the Skilled Nursing Visit note, dated 4/2/25 and signed by LN #1, revealed a lack of blood pressure, temperature, or respiration assessment for Patient #2. During an observation on 4/2/25 at 12:30 PM, LN #1 was observed to complete a physical assessment and wound care with Patient #2. LN #1 did not complete a blood pressure assessment, respiratory assessment or temperature assessment for this patient at this visit. During an interview on 4/4/25 at 9:46 AM, when asked why the home visit observation and clinical records lacked vital signs assessments, the RN Senior Manager stated that the vital sign assessments were not completed consistently. Review of the facility’s policy, “Home Health: Plan of Care,” effective date 3/18/25, revealed, “The plan describes the specific services to be provided and action to be taken including type, frequency, and duration of care/services.””

“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 record review, observation, and interview, the home health agency failed to ensure acceptable professional standards for infection control occurred. Specifically, the facility failed to ensure Licensed Nurse (LN) #1 performed acceptable professional standards for cleaning soiled equipment during wound care for 1 patient (#2) out of 1 patient observed for wound care. This failed practice placed this patient at risk for the spread of infectious diseases during wound care, which could affect the patient’s overall health and wellbeing. Findings: Record review on 4/1-4/25 revealed Patient #2 had a start of care (SOC) date of 1/3/25 with a certification period of 3/4/25-5/2/25. The patient’s principal diagnosis was encounter for orthopedic after care following surgical amputation. During an observation on 4/2/25 at 12:48 PM, LN #1 completed a wound vac dressing change for Patient #2. LN #1, with gloved hands, was observed to remove scissors from his/her nursing bag and then cut the dressing off from around Patient #2’s right foot. After LN #1 discarded the soiled dressing and placed the soiled scissors on a clean field placed in front of the patient, LN #1 was observed to remove his/her soiled gloves and cleanse his/her hands and don (put on) clean gloves. LN #1 cleansed the wound with normal saline and then used skin prep around the wound. LN #1 used the soiled scissors to cut the drape into pieces and then cut black foam. These pieces of black foam and drape were placed over the wound. LN #1 used another pair of scissors from a supply box to open a small area on the drape and then applied a pad with tubing attached to the wound dressing and then attached to the wound vac. The wound vac was turned on and the machine supplied negative pressure to the wound successfully. During an interview on 4/2/25 at 3:44 PM, LN #1 agreed that the scissors should have been cleaned after being used on the soiled dressing and prior to clean tasks being completed. Review of the facility’s policy, “Disinfection, patient care equipment, home care,” reviewed November 17, 2024, revealed, “Improper disinfection of patient care equipment in the home environment may expose a patient to a new infection or spread an infection from one patient to another.” Review of the facility’s policy, “General Infection Prevention Policy,” reviewed 2/6/24, revealed, “Cleaning of patient/resident care equipment and the environment is performed to prevent transmission of infection.””

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the coordination of care with all agencies providing services for 1 patient (#4), out of 6 active clinical records reviewed. This failed practice had the potential for the agency to not coordinate services provided to the patient and to not identify the patient’s needs and treatment effectiveness. . . Findings: Record # 4 Record review on 4/1-4/25 revealed Patient #4 had a Start of care (SOC) date of 2/13/24 with a certification period of 2/13/25 to 4/13/25 and discharge date of 4/2/25. The patient’s principal diagnosis was age-related osteoporosis with current pathological fracture vertebra(e) subsequent encounter for fracture with routine healing. This record failed to include coordination of care between a personal care agency and the agency. Further review revealed a RN SOC Oasis-E1 or Start of care assessment dated 2/13/25 and completed by Licensed Nurse (LN ) #3. This document revealed, “Support systems family members, Other Caregivers through [personal services agency.]” Further review revealed a communication note completed by LN #3, dated 2/18/25 at 4:56 PM, revealed, “Patient’s spouse and [other family members] are very involved in [his/her] care and [he/she] also has a caregiver all week.” During an interview on 4/2/25 at 9:40 AM, when asked if the agency provided coordination of care between the personal services agency and this agency, LN #3 stated no coordination of care had occurred between the two agencies. During an interview on 4/4/25 at 9:45 AM, the RN Senior Manager stated that coordination of care between the personal services agency and home health agency was not found in the clinical record. Review of the facility’s policy, “Coordination of Care/Services” effective date 2/12/25, revealed, “Policy...To ensure continuity of care to the patient, the individual coordinating care is responsible for assuring communication between per persons involved in the care/services within the agency and with outside communication between persons involved in the care/services within the agency and with outside organizations providing care or services. This is accomplished through a ‘hands off’ approach which allows an opportunity to ask and respond to questions.””