Huntsville Hospital 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 review of agency policies, observation, and staff interview, it was determined the agency failed to ensure staff followed infection control policies in one of seven home visits including Home Visit (HV) # 1. This deficient practice had the potential to negatively affect all patients served by the agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Date: 5/1/19 Purpose: To help prevent the spread of microorganisms and infection by cross contamination... 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 washing with soap and water or using an alcohol-based hand sanitizer: ...after contact with blood, bodily fluids or excretions, mucous membranes, non-intact skin, wound dressings HV # 1 was admitted to the agency on 1/30/25 with a primary diagnosis of Encounter for Surgical Aftercare Following Surgery on Digestive System. A Home Visit was conducted on 2/11/25 from 12:15 PM to 1:30 PM with Employee Identifier (EI) # 4, Registered Nurse, performing wound care for HV # 1. After removing the soiled wound dressing, EI # 4 failed to remove his/her gloves and perform hand hygiene. With the same gloves used to remove the old wound dressing and clean the wound, EI # 4 reached into the patient’s box of clean wound care supplies multiple times to retrieve supplies needed to perform wound care. An interview was conducted on 2/13/25 at 1:00 PM with EI # 1, Executive Director, who confirmed staff failed to follow the hand hygiene policy during the home visit.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on observation, review of medical records (MR), agency policy and procedure, and staff interviews, it was determined the agency failed to ensure staff developed an individualized Plan of Care (POC) to care for a patient’s gastrostomy tube (g-tube). This deficient practice affected Home Visit (HV # 4), and one of one open records reviewed of a patient with a g-tube and had the potential to affect all patients with g-tubes served by the agency. Findings include: Agency policy: Plan Of Care Policy number: 2.1.007 Revised date: 09/01/24 Purpose: To assure an appropriate POC is developed...for each patient... Policy: Each patient has an individualized POC developed in consultation with the patient, physician or authorized practitioner, and staff that integrates comprehensive assessment findings to address patient problems, needs, and goals, as well as to address specific services being provided. Procedure: ...2. The POC includes: ...Patient specific interventions... HV # 4 was admitted to the agency on 1/14/25 with diagnoses of Essential (Primary) Hypertension and Hypothyroidism, Unspecified. A HV was conducted on 2/11/25 at 3:02 PM with Employee Identifier (EI) # 3, Licensed Practical Nurse (LPN) to observe care provided. During the observation, it was noted that HV # 4 was receiving liquid nutrition through a gastrostomy tube. EI # 3 inspected the insertion site of the g-tube during the visit. No care was provided to the site. Review of the Home Health Certification (HHC) and POC dated 1/14/25 revealed documentation of DME (Durable Medical Equipment) and Supplies...DME-Feeding Pump, ... Feeding Tube Supplies. Further review of the HHC and POC revealed Nutritional Requirements: Tube Feeds. There was no documentation in the POC for care of the patient’s g-tube. An interview was conducted on 2/13/25 at 12:02 PM with EI # 1, Executive Director, who confirmed there was no documentation in the POC for care of the patient’s g-tube.”