Alabama Homecare

“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 observations, agency policy and procedure, and interviews it was determined the agency failed to ensure staff followed infection control policies. This deficient practice affected one of one observation of wound care including Home Visit (HV) # 1 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revised: 5/1/19 Purpose: To help prevent the spread of microorganisms and infection by cross contamination and to provide practice guidelines. Policy: Staff are required to perform hand hygiene ... at specified time points... Procedure: 1. Staff performs hand hygiene... b. before performing an aseptic task (...wound care). c. after contact with ... wound dressings, or contaminated surfaces. d. if moving from a contaminated body site to a clean body site during patient care... 1. HV # 1 was admitted on 7/17/24 and recertified from 7/12/25 to 9/9/25 with diagnoses including Chronic Venous Hypertension and Non-Pressure Ulcer of Left Calf. Review of the Home Health Certification and Plan of Care dated 7/12/25 revealed physician’s orders for Skilled Nurse (SN) two visits per week for eight weeks then one visit per week for one week to provide wound care. Review of the Physician Order dated 7/15/25 revealed orders for SN to perform wound care to wound to mid calf, left venous stasis ulcer twice a week. Cleanse with wound cleanser, apply Calcium Alginate, cover with ABD pad, wrap with Kerlix and Coban, using sterile technique. A HV was conducted on 9/2/25 at 12:18 PM to observe wound care provided by Employee Identifier (EI) # 2, Registered Nurse. EI # 2 obtained vital signs including blood pressure, temperature, and pulse oximetry and listened to breath sounds using his/her stethoscope. While disinfecting the reusable items with 70 % alcohol wipes, EI # 2 dropped the wipes onto the floor, picked up the contaminated disinfecting wipes from the floor, then continued to clean the items with the contaminated wipes. EI # 2 failed to dispose of the contaminated wipes or perform hand hygiene after picking up the contaminated wipes before continuing to disinfect the re-useable items. EI # 2 performed hand hygiene, applied non-sterile gloves, then obtained measurements from each ankle. EI # 2 then removed the ABD pad and Calcium Alginate dressings from the sterile packages while touching both sides of the dressing material, then applied the dressings to the wound. EI # 2 failed to removed gloves and perform hand hygiene when moving from a contaminated site to a clean site and failed to perform wound care using sterile technique as ordered. An interview was conducted on 9/4/25 at 11:25 AM with EI # 1, Executive Director, who confirmed the staff failed to follow agency policy to prevent the spread of infections.”

“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 observations, medical record (MR) review, agency policy and procedure, and interviews with staff, it was determined the agency failed to ensure an accurate medication list was maintained for each patient. This affected three of three home visit (HV) patients, including HV # 2, HV # 3, and HV # 1, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Monitoring Medications Policy Number: 10.008 Revised: 7/1/24 Purpose: To provide a process to ensure continuous monitoring of medications in the patient’s home. Policy: A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode... Procedure: ...2. All clinicians participating in the patient’s care are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care. During the patient’s episode of care the following will occur: ...i. Compare medications patient is currently taking with medications ordered for the patient in order to identify and resolve discrepancies. 3. HV # 1 was admitted on 7/12/24 and recertified from 7/12/25 to 9/9/25 with diagnoses including Chronic Venous Hypertension and Non-Pressure Ulcer of Left Calf. Review of the Home Health Certification and POC dated 7/12/25 revealed physician’s orders for SN two visits per week for eight weeks then one visit per week for one week. A HV was conducted on 9/2/25 at 12:18 PM to observe care provided by EI # 2, Registered Nurse (RN). During the HV, a review of the medications was conducted with EI # 2 and HV # 1. The following is a list of the discrepancies: Bidil 20 mg tablet, take one every eight hours was on the ML but not in the home. HV # 1 stated he/she had not been taken the medication “in a long while.” An interview was conducted on 9/4/25 at 11:25 AM with EI # 1 who confirmed the medications had not been reconciled per agency policy. 1. HV # 2 was admitted on 6/30/25 with diagnoses including Other Disorders of Vestibular Function, Left Ear and Benign Neoplasm of Cranial Nerves. Review of the Home Health Certification and Plan of Care (POC) dated 6/30/25 revealed physician orders for Skilled Nurse (SN) one visit a week for eight weeks, and Physical Therapy (PT) two visits a week for four weeks, then one visit a week for five weeks. A HV was conducted on 9/2/25 at 12:46 PM to observe care provided by Employee Identifier (EI) # 4, Physical Therapist. During the HV, EI # 4 reviewed the medications with HV # 2 and compared the medications with the Client Medication Report (CMR) dated 9/2/25. The following is a list of the discrepancies: Lumigan 0.01% Eye Drops one drop in each eye at bedtime, prescription was dated 8/11/25, was in the home but not on the CMR. HV # 2 stated he/she was currently using one drop in each eye at bedtime. Eye Health Complex Dietary Supplement one tablet every morning and bedtime, was in the home but not on the CMR. HV # 2 stated he/she had been, “taking a while.” Align Probiotic Digestive Support one capsule daily was in the home but not on the CMR. HV # 2 stated he/she had been, “taking a while.” Tylenol Extra Strength 500 milligrams (mg) one to two tablets as needed for pain was in the home but not on the CMR. HV # 2 stated he/she had been, “taking a while.” Levothyroxine 88 micrograms (mcg) one tablet 30 minutes before breakfast was on the CMR, but Levothyroxine 75 mcg one tablet 30 minutes before breakfast was in the home and prescription was dated 7/11/25. HV # 2 stated he/she was currently taking 75 mcg one tablet 30 minutes before breakfast Magnesium Citrate, Magnesium Oxide 250 mg capsule three capsules daily was on the CMR, but Magnesium 250 mg tablet one daily was in the home. HV # 2 stated he/she had been taking since “approximately June.” An interview was conducted on 9/4/25 at 10:59 AM with EI # 1, Executive Director (ED) who confirmed the medications were not reconciled per agency policy and procedure and physician’s orders. 2. HV # 3 was admitted on 1/30/25 and recertified from 7/29/25 to 9/26/25 with diagnoses including Encounter for Fitting and Adjustment of Urinary Device and Hypertensive Heart Disease with Heart Failure. Review of the Home Health Certification and POC dated 7/16/25 revealed orders for SN one visit a week for one week, then one visit every five weeks. A HV was conducted on 9/3/25 at 10:16 AM to observe care provided by EI # 3, SN. During the HV, EI # 3 reviewed the medications with HV # 3’s caregiver and compared the medications with the Medicine List (ML) dated 9/2/25. The following is a list of the discrepancies: Vinco Multi-Vitamin Women’s two tablets daily was in the home but not on the ML. HV # 3’s caregiver said he/she had been taking for several months. Magnesium Taurate 125 mg one capsule two times daily was in the home but not on the ML. HV # 3’s caregiver said he/she had been taking for several months. Calcium Citrate plus D 3 (Cholecalciferol) 650 mg Calcium plus 25 mcg Vitamin D 3 one to two tablets twice a day with food was in the home but not on the ML. HV # 3’s caregiver said he/she had been taking for several months. Cyanocobalamin 1,000 mcg/ML (Milliliter) inject 1 ML in muscle once every two months, prescription dated 4/21/25 was in the home but not on the ML. Sodium Chloride 1,000 mg Soluble Tablet one tablet daily was on the ML but HV # 3’s caregiver said he/she had “been off three months.” An interview was conducted on 9/4/25 at 10:58 AM with EI # 1, Executive Director (ED) who confirmed the medications were not reconciled per agency policy and procedure and physician’s orders.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on observations, agency policy and procedure, medical record (MR) review, and interviews with staff, it was determined the agency failed to ensure: 1. Wound care was provided as ordered. 2. Sterile procedure was performed as ordered. These deficient practices affected two of three MR’s reviewed of patients with wound care orders including HV # 1, MR # 2, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Plan of Care (POC) Policy Number: 2.1.007 Revised Date: 9/1/24 Purpose: ...To ensure that physician/authorized practitioner’s orders are followed. Policy: Each patient has an individualized Plan of Care (POC) developed in consultation with the patient, physician or authorized practitioner... Procedure: ...2.The POC includes: ...n. All patient care orders. ...13. Staff reviews the patient’s chart periodically to ensure compliance with physician/authorized practitioner’s orders. 1. HV # 1 was admitted on 7/17/24 and recertified from 7/12/25 to 9/9/25 with diagnoses including Chronic Venous Hypertension and Non-Pressure Chronic Ulcer of Left Calf. Review of the Home Health Certification and Plan of Care dated 7/12/25 revealed physician’s orders for Skilled Nurse (SN) two visits per week for eight weeks then one visit per week for one week for wound care. Review of the Physician Order dated 7/15/25 revealed physician’s orders for wound care to left venous ulcer, cleanse with wound cleanser, apply Calcium Alginate, cover with ABD pad, wrap with Kerlix and Coban, using sterile technique. Review of the 13 SN Visit Note Reports dated 7/15/25 through 8/29/25 revealed no documentation sterile technique was observed during each wound care dressing change. A HV was conducted on 9/2/25 at 12:18 PM to observe wound care provided by Employee Identifier (EI) # 2, Registered Nurse. HV # 1 had removed the wound dressing prior to the SN visit. EI # 2 removed the ABD pad and Calcium Alginate from the sterile packages while wearing non-sterile gloves, touching both side of the dressing material with the gloved hands. EI # 2 then placed the wound dressing over the wound and wrapped with Kerlix and Coban dressing. EI # 2 failed to cleanse the wound with wound cleanser and failed to observe sterile technique while performing the wound care per physician’s orders. An interview was conducted on 9/4/25 at 11:25 AM with EI # 1, Executive Director, who confirmed the staff failed to follow the physician’s orders for wound care. 2. MR # 2 was admitted on 4/25/25 and recertified from 6/24/25 to 8/22/25 with diagnoses including Local Infection of the Skin and Subcutaneous Tissue and Encounter for Adjustment and Management of Vascular Access Device. Review of the Home Health Certification and Plan of Care dated 6/24/25 revealed physician’s orders for SN one visit per week for eight weeks, SN to perform site care for infusion access device PICC (Peripherally inserted central catheter) to right upper arm with Tegaderm dressing once per week. Cleanse site with Chloraprep, may use alcohol if needed, secure with StatLock. Change injection cap once a week and with each lab draw. Change extension tubing once per week and with lab draw. Review of the SN Visit Note Report (VNR) dated 7/8/25 revealed the nurse documented labs were drawn. There was no documentation PICC line care was performed and no documentation the caps or extension tubing was changed. Review of the SN VNR dated 7/14/25, 7/21/25, 7/28/25, revealed labs were withdrawn from the PICC line. There was no documentation the caps or extension tubing was changed. An interview was conducted on 9/4/25 at 11:05 AM with EI # 1 who confirmed the staff failed to follow physician’s orders for PICC line care.”