Alabama Homecare Fort Payne

“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 observation, agency Policy and Procedures, and staff interview it was determined the agency failed to ensure the staff followed agency policy for infection prevention. This did affect two of five Home Visits (HV) including HV # 5, and HV # 4, and had the potential to affect all patients served by this agency. Findings include: Agency Policy: Hand Hygiene Policy number: 8.004 Revision date: 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 prior to, at specified time points during and following patient contact... Procedure: Staff performs hand hygiene by handwashing with soap and water or alcohol based hand sanitizer: a. before direct contact with patients b. before performing an aseptic task ( e.g., insertion of invasive devices, wound care) c. after contact with blood, body fluids, or excretions, mucus membranes, non-intact skin, wound dressings, contaminated surfaces. d. if moving from a contaminated body site to a clean sire during patient care. e. after contact with inanimate objects ( including medical equipment...) in the immediate vicinity of the patient. f. before and after removal of personal protectant equipment. g. at the conclusion of the visit after contact with the patient’s intact skin ( e.g., when taking vital signs, and lifting a patient)... Agency Policy: Cleaning of Re-Useable Equipment Policy number: 8.006 Revision date: 6/1/25 Purpose: To assure equipment required for patient care is clean and sanitized to prevent the spread of infections. Policy: Equipment used for more than one patient is cleaned between each patient use. Agency Policy: Removal of Midline and Peripherally Inserted Catheters Policy number: 10.0.28 Revision date: 2/1/14 Purpose: To safely remove Midline and Peripherally Inserted Catheters (PICC) and midline catheters with minimal trauma to the vein... Procedure: ...8. Remove catheter dressing and discard in an appropriate receptacle 9. Remove clean gloves, perform hand hygiene, and don sterile gloves 10. Remove the securing device... 13. Using the dominant hand gently withdraw catheter... 1. HV # 5 was admitted to the agency on 8/27/25 with a diagnosis of Type Two Diabetes Mellitus (DM) with Foot Ulcer. A review of the Home Health Certification and Plan of Care (POC) dated 8/27/25 revealed an order for Skilled Nursing (SN) two times a week for two weeks and one time a week for seven weeks and two as needed visits for wound and DM complications. Further review of the POC, dated 8/27/25, revealed orders for wound care to the right and left plantar foot chronic non pressure ulcer: cleanse with wound cleanser, pat dry, apply betadine moistened gauze to wound bed, cover with dry gauze, apply abdominal pad (ABD) to forefoot for extra padding, wrap with Kerlix (rolled gauze) secure with Coflex (self adherent wrap) using clean technique. Patient/caregiver to perform daily in the absence of the SN and SN to perform each skilled nurse visit. A home visit was conducted on 9/3/25 with Employee Identifier (EI) # 2, Registered Nurse (RN) to observe care provided to wounds on the right and left feet. During the home visit the staff failed to perform hand hygiene before putting on clean gloves. The staff placed the disinfectant wipe container on the barrier with the wound care supplies then touched the wipe container during the wound care with used gloves. The staff reached into the patient’s clean supplies with used gloves to retrieve gauze. After the dressings were placed on the patient and before removing the used gloves, the staff touched objects in the patient home. The staff placed the disinfectant wipe container in the clinician bag without cleaning it. An interview was conducted on 9/5/25 at 8:43 AM with EI # 1, Executive Director, who confirmed the staff failed to follow the agency policies regarding infection control. 2. HV # 4 was admitted to the agency on 7/30/25 with diagnoses including Type Two Diabetes Mellitus with Other Specified Complication, Other Chronic Osteomyelitis Left Ankle and Foot, and Encounter for Adjustment and Management of Vascular Access Device. A review of the POC dated 7/30/25 revealed an order for a SN visit one time a week for nine weeks. SN to perform site care for infusion access device (PICC) to right upper arm. A review of physician’s order dated 9/3/25 revealed an order to discontinue PICC Line and discharge the patient due to no further skill remains for nursing in home. A HV was conducted on 9/4/25 at 8:57 AM with EI # 3, RN, to observe the PICC removal and care provided. EI # 4, Patient Care Manager was also present during the visit. During the HV the staff wore clean gloves and failed to wear sterile gloves when removing the securing device and the PICC line from the patient’s right arm. An interview was conducted on 9/5/25 at 9:29 AM with EI # 1 who confirmed the staff failed to follow agency policy and don sterile gloves before removing the securing device and PICC line.”

“Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This Standard is not met as evidenced by: Based on Medical Record (MR) review, The Alabama Board of Nursing Chapter 610-x-6: Standards of Nursing Practice, and staff interview it was determined the agency failed to ensure the staff documented accurately and completely in the patient’s MR. This affected Home Visit (HV) # 4, one of one Peripherally Inserted Catheters (PICC) line MRs reviewed, and had the potential to affect all patient’s with PICCs served by this agency. Findings include: Alabama Board of Nursing Chapter 610-x-6: Standards of Nursing Practice 610-X-6-.06 Documentation Standards (1) The standards of documentation of nursing care provided to patients by registered nurses or licensed practical nurses are based on principles of documentation regardless of the documentation format. (2) Documentation of nursing care shall be: (a) Legible (b) Accurate (c) Complete. Complete documentation includes reporting and documenting on appropriate records a patient’s status, including signs and symptoms, response, treatments, medications, other nursing care rendered, communication of pertinent information to other health team members, and unusual occurrences involving the patient... “ 1. HV # 4 was admitted to the agency on 7/30/25 with diagnoses including Type Two Diabetes Mellitus with Other Specified Complication, Other Chronic Osteomyelitis Left Ankle and Foot, and Encounter for Adjustment and Management of Vascular Access Device. A review of the Home Health Certification and Plan of Care (POC) dated 7/30/25 revealed an order for the Skilled Nurse (SN) one time a week for nine weeks. SN to perform site care for infusion access device PICC to right upper arm with sterile transparent dressing changes once a week and as needed for loose or soiled dressing. A review of the Visit Note Report dated 8/4/25 revealed the staff documented the external PICC/midline catheter measurement of 13.5 centimeters (cm). A review of the Visit Note Report dated 8/11/25 revealed the staff documented the external catheter measurement was 17 cm. Further review revealed in the Visit Note Report dated 8/18/25 the staff documented the external catheter measurement was 15 cm. During an interview with Employee Identifier (EI) # 1, Executive Director, he/she reported the staff failed to document the measurement in the MR correctly, and confirmed there was no change in the measurement of the external catheter. A review of the Visit Note Report dated 9/1/25 revealed the staff failed to document the Mid arm circumference during the visit. An interview was conducted on 9/5/25 at 9:29 AM with EI # 1, who confirmed with staff failed to document accurately and completely in the patient MR.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on Medical Record (MR) review and staff interview, it was determined the agency failed to ensure the staff followed physician’s orders. This affected MR # 6 and MR # 5, two of nine active MR’s reviewed and had the potential to affect all patients served by this agency. Findings include: 2. MR # 5 was admitted to the agency on 3/7/25 with diagnoses including Type 2 Diabetes Mellitus with Hypoglycemia without Coma and Long Term use of Insulin. Review of the Home Health Certification (HHC) and POC dated 3/7/25 to 5/5/25 contained orders for the SN to obtain ankle circumference every visit by measuring one inch above the ankle’s bony prominence and notify the RN /Physician of increase of two centimeters within one day. Review of the 3/11/25 SN Visit Note Report revealed the SN failed to obtain ankle measurements. An interview was conducted on 9/5/25 at 8:46 AM with EI # 1, who confirmed the SN failed to obtain ankle measurements. 1. MR # 6 was admitted to the agency on 2/7/25 with diagnoses including Pressure Ulcer of Right Buttock, Stage Two, Pressure Ulcer of Left Buttock, Stage Two, and Type Two Diabetes Mellitus without Complications. A review of the Home Health Certification (HHC) and Plan of Care (POC) dated 2/7/25 revealed an order for the Skilled Nurse (SN) to perform/instruct patient/caregiver procedure of wound care to right and left buttock, cleanse with wound cleanser using gauze, pat dry, apply mupirocin using cotton tipped applicator. Cover with bordered gauze using clean technique. A review of the MR revealed a physician’s order dated 3/3/25 for the SN to instruct patient/caregiver on blood glucose testing, frequency for blood glucose testing daily: Therapeutic Capillary Blood Glucose (CBG) range 75 Milligrams per deciliter (mg/dL) to 150 mg/dL. Goal: Patients CBG will be maintained within prescribed therapeutic range by 3/30/25. A review of the Visit Note Reports dated 2/17/25, 2/25/25, 3/4/25, 3/11/25, 3/18/25, and 3/25/25 revealed the SN documented the use of bordered foam gauze instead of the ordered bordered gauze. A review of the Visit Note Report dated 3/25/25 revealed the SN documented, “Patient is on pill form diabetic medication and is not required to check his/her blood sugar per physician relies on his/her hemoglobin A1c.” The SN failed to document the CBG as ordered. An interview was conducted on 9/5/25 at 9:04 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed the staff did not follow the physician’s order for wound care and CBG daily checks.”