Enhabit Home Health

“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 hand hygiene and glove use during wound care for one patient (#3), out of one 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 10/14-21/24 revealed Patient #3 had a primary diagnosis of unspecified open wound of left upper arm with a Start of Care date of 9/4/24. During a home visit observation on 10/16/24 at 8:00 AM, LN #1 was observed to sanitize hands, apply gloves, and then remove a dressing from Patient #3’s left upper arm. After this dressing removal and while wearing the same gloves, LN #1 was observed to cleanse the wound area with wound wash. Then LN #1 discarded his/her gloves and sanitized his/her hands before proceeding to dress the wound with a xerofoam dressing and then cover with a gauze dressing. During an interview on 10/17/24 at 10:47 AM, the Clinical Team Lead stated that LN #1 should have removed the soiled gloves and cleansed his/her hands after removing a soiled dressing and proceeding to a clean task. Review of the agency policy “Hand Hygiene,” revised 7/10/24, revealed, “It is the policy that Agency’s employees and contracted staff will follow the CDC Guidelines regarding hand hygiene...At a minimum, personnel will perform hand hygiene in the following instances...After any contact with patient excretions [feces, urine] or secretions [from wounds...] or with articles/surfaces contaminated by secretions or excretions.” Review of the agency policy “Infection Surveillance Exposure Control Plan,” dated 10/9/23, revealed, “Disposable gloves will be replaced as soon as possible when contaminated.””

“Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient’s status, and must include, at a minimum, the following information: (1) The patient’s current health, psychosocial, functional, and cognitive status; This Element is not met as evidenced by: Based on record review and interview, the facility failed to ensure the comprehensive assessment accurately reflected the patient’s status for one patient (#3) out of six active patient records reviewed. This failed practice had the potential to affect the skilled professionals’ knowledge of immediate needs of the patient, placing the patient at risk for improper or less than optimal care which had the potential to effect the patient’s overall physical, mental, and psychosocial well-being. Findings: Record review on 10/14-21/24 revealed Patient #3 had a primary diagnosis of unspecified open wound of left upper arm with a Start of Care date of 9/4/24 and a Home Health Certification and Plan of Care for the certification period of 9/6/24 to 11/4/24. A Billable Admission OASIS (the Outcome and Assessment Information set) Data Collection Visit Note Report dated 9/6/24 and completed by the Clinical Team Lead failed to include an accurate infusion assessment in this assessment report. This report failed to include the presence of a central venous catheter (a device that’s inserted into a large vein and used for hemodialysis, a treatment provided to filter waste and extra fluid from the blood) in place on the patient’s right chest. During a home visit observation on 10/16/24 at 8:00 AM, Patient #3 was observed to have a Central Venous Catheter positioned on the right chest area. During an interview on 10/21/24 at 11:37 AM, the Clinical Team Lead stated, when asked if the initial/comprehensive assessment included a description or assessment of the Central Venous Catheter, that there was no assessment of the Central Venous Catheter on the patient’s right chest area on the Billable admission, OASIS Data Collection Visit note report, dated 9/6/24. Review of the agency policy “Admission Process and Patient Assessment,” revised date 10/20/2023 revealed, “The initial admission evaluation/assessment will be performed in the patient’s home by the appropriate licensed professional within 48 hours of the referral or patient’s return from an inpatient stay or on the physician’s ordered start of care...During the initial evaluation/assessment, the admitting professional evaluates the patient and situation, using the admission criteria, and decides to admit or decline the patient for services...as part of the admission process, the admitting professional completes the medication profile and OASIS assessment, and selects the appropriate nursing diagnosis problems.””