Alabama Homecare Hamilton

“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, review of agency policy and procedure, and staff interview, it was determined the agency failed to ensure staff performed hand hygiene per agency policy. This did affect one of three home visits including HV # 1, and had the potential to affect all patients served by the agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revision Date: 5/1/19 Policy: Staff are required to perform hand hygiene prior to, at specified time points during, and following patient contact. Procedure: 1. Staff performs hand hygiene... Before direct contact with patients, before performing an aseptic task (... wound care), after contact with... non-intact skin, wound dressings, contaminated surfaces, if moving from a contaminated body site to a clean body site during patient care, after contact with inanimate objects in the immediate vicinity of the patient, before and after removal of personal protective equipment, at the conclusion of the visit... 8. Other Aspects of Hand Hygiene: ...Change gloves during patient care if moving from a contaminated body site to a clean body site... 1. HV # 1 was admitted to the agency on 3/17/25 with a primary diagnosis of Type 2 Diabetes with foot ulcer. A HV was conducted on 7/1/25 at 11:00 AM with Employee Identifier (EI) # 3, Licensed Practical Nurse, to observe wound care provided. During the HV, the following was observed: 1. EI # 3 failed to perform hand hygiene, after removing his/her gloves, four times. 2. After obtaining the patient’s vital signs, EI # 3 donned gloves without performing hand hygiene. 3. During wound care, EI # 3 reached into the box of clean supplies with gloves used to perform wound care. EI # 3 failed to remove his/her gloves and perform hand hygiene prior to obtaining clean supplies. An interview was conducted on 7/2/25 at 11:50 AM with EI # 1, Executive Director, who confirmed staff failed to perform hand hygiene per the agency policy.”

“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 review of medical records (MR), observations, agency policy and procedure and interviews, it was determined the agency failed to keep the medication profile current. This policy did affect one of three home visits (HV) including HV # 1, and one of two active MRs reviewed including MR # 2 and had the potential to affect all persons served by the agency. Findings include: Agency Policy: Monitoring Medications Policy Number: 10.008 Date 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: 1a...Compare medication list...to actual medications the patient is taking. 1b. Review all medications including over the counter (OTC) medications, vitamins, herbs, and herbal products, creams, and topical ointments. 2. MR # 2 was admitted to the agency on 6/3/25 with a primary diagnosis of Chronic Obstructive Pulmonary Disease with Acute Exacerbation. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 6/3/25 to 8/1/25 revealed orders for the SN to visit once a week for nine weeks. Further review of the HHC and POC revealed orders for the SN to instruct regarding oxygen management including administration, skin care, care of equipment, proper storage and safety. A review of the Medication List revealed no documentation of oxygen listed as a medication. An interview was conducted on 7/2/15 at 11:50 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed oxygen should have been listed on the medication list and staff failed to keep the medication profile current. 1. HV # 1 was admitted to the agency on 3/17/25 with a primary diagnosis of Type 2 Diabetes with foot ulcer. A review of the Plan of Care (POC) for the certification period dated 5/16/25 to 7/14/25 revealed skilled nurse (SN) visits ordered once a week for eight weeks. A HV was conducted on 7/1/25 at 11:00 AM with Employee Identifier (EI) # 3, Licensed Practical Nurse, performing wound care. During the HV, a review of the medication profile revealed two medications on the medication profile the patient stated they “no longer take”. a. ED A-HIST 4 milligram (mg) - 10 mg tablet, one tablet every 6-8 hours as needed for congestion, with a start date of 3/25/25 was listed on the patient medications. The bottle was not present in the patient’s home. When asked by the nurse if he had any of the medication, he stated the prescription ran out about a month ago and he/she had not gotten it refilled. b. Methocarbamol 750 mg tablet, one to two tablets every eight hours as needed for muscle spasms, with a start date of 6/4/25 was listed on the patient medications. The bottle was not present in the patient’s home. When asked by the nurse if he had any of the medication, he stated it did not work for him and he flushed the remaining pills down the toilet a few days after they were prescribed. An interview was conducted on 7/12/25 at 12:15 PM with EI # 1, Executive Director, who confirmed staff failed to follow agency policy for medication reconciliation and failed to keep the medication profile current.”