Keller Home Care

“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 medial record (MR) review, observation, agency policy and procedure, and interview, it was determined the home health agency failed to ensure the skilled nurse (SN) performed hand hygiene (HH) and maintained sterile technique during peripherally inserted central catheter (PICC) line dressing change in accordance with the agency’s policy. This deficient practice affected Home Visit (HV) # 3, and had the potential to negatively affect all patients with PICC lines served by this agency. Findings include: Agency Policy: Dressing Change Procedure for Central Venous, Midline and Peripherally Inserted Central Catheters Policy Number: 10.027 Revised Date: 10/01/16 Purpose: To keep insertion sites clean, stabilize catheters and minimize the risk of infection. Policy: The nurse shall demonstrate competency and knowledge of dressing change procedures... Procedure: ...3. Perform hand hygiene and don clean gloves... ...5. Remove the old dressing... 6. Discard dressing in appropriate receptacle. 7. Remove gloves, perform hand hygiene, and don sterile gloves. 1. HV # 3 was admitted to the agency on 6/21/24, and recertified for care 2/16/25 to 4/16/25, with a primary diagnosis of Encounter for Adjustment and Management of (VAD) Vascular Access Device. A HV was conducted on 3/12/25 at 3:03 PM to observe the PICC line dressing change provided by Employee Identifier (EI) # 8, Registered Nurse (RN). EI # 9, RN, was also present during the HV. During the dressing change, EI # 8 donned sterile gloves without performing HH and removed the old PICC line dressing from HV # 3’s left arm. While wearing the same gloves, EI # 8 obtained a sterile chloraprep sponge applicator and cleaned the PICC line site, secured the sterile statlock, applied the sterile antimicrobial disk and covered the PICC line site with a sterile tegaderm dressing. EI # 8 failed to follow agency policy and remove the gloves, perform HH and don new sterile gloves after removing the old dressing. An interview was conducted on 3/14/25 at 10:37 AM with EI # 1, Regional Director, who confirmed the staff failed to follow the policy for PICC line dressing change.”

“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 with staff, it was determined the agency failed to ensure medications were reconciled in four of seven home visits (HV) conducted. This affected HV # 1, HV # 2, HV # 4, and HV # 7, and had the potential to negatively affect all patients served by the agency. Findings include: Agency Policy: Monitoring Medications Policy Number: 10.008 Date Revised: 7/1/2024 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... 3. HV # 4 was admitted to the agency on 1/22/25 with a primary diagnosis of Dislocation of Internal Left Hip Prosthesis, Subsequent Encounter. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 1/22/25 to 3/22/25 revealed orders for the Skilled Nurse (SN) to visit one time a week for five weeks, and Physical Therapy (PT) to visit one time a week for one week, two times a week for three weeks, and one time a week for five weeks. A HV was conducted on 3/12/25 at 3:30 PM to observe care provided by EI # 7, Licensed PT Assistant (LPTA). EI # 6, Patient Care Manager, was also present during the visit. During the HV, the CMR was compared to the medications the patient was currently taking. The following medications were listed on the CMR as current and not observed in the home: a. Memantine five mg tablet, take one tablet daily. b. Phenazopyridine 200 mg tablet, take one tablet three times daily as needed . c. Promethazine 6.25 mg/5 ml (milliliter) oral syrup, take five ml every six hours as needed. d. Qunol Mega COQ10 100 mg capsule, take one capsule daily. e. Tramadol 50 mg tablet, take two tablets every six hours as needed. Vitamin D3 50 microgram (mcg) capsule, take one capsule daily was also listed on the CMR. A 100 count bottle of Vitamin D3 25 mcg tablets with approximately 50 tablets remaining in the bottle was observed in the home. HV # 4 confirmed he/she was taking the 25 mcg strength tablet. EI # 6 confirmed during the HV the CMR was not reconciled with the current home medications. 4. HV # 7 was admitted to the agency on 1/8/25 with a primary diagnosis of Fracture of Unspecified Part of Neck of Left Femur, Subsequent For Closed Fracture With Routine Healing. A HV was conducted on 3/13/25 at 10:33 AM to observe care provided by EI # 10, Registered Nurse. EI # 6 was also present during the visit. During the HV, the CMR was compared to the medications the patient was currently taking. A 90 count bottle of Hydrochlorothiazide (HCTZ) 12.5 mg tablets with a fill date of 10/21/24 was observed in the home. HCTZ was not listed on the CMR. HV # 7 stated during the visit he/she was currently taking the HCTZ. EI # 6 confirmed during the HV the CMR was not reconciled with the current home medications. 2. HV # 2 was admitted to the agency on 2/27/25 with a primary diagnosis of Diverticulosis of the Large Intestine Without Perforation or Abscess with Bleeding. A HV was conducted on 3/12/25 at 1:35 PM to observe care provided by EI # 5, Occupational Therapist. During the HV, the CMR was compared to the medications the patient was currently taking. The following was observed: a. Clorazepate Dipotassium 3.75 mg tablets, take two times daily, was listed on the CMR but was not present in the home. b. Children’s Aspirin 81 mg chewable tablet, take one tablet daily, was discontinued on 3/6/25 and was still listed on the CMR. c. Clopidogrel 75 mg tablet, take one tablet daily, was discontinued on 2/26/25 and was still listed on the CMR. An interview was conducted on 3/14/25 at 10:30 AM with EI # 3, who confirmed staff failed to follow the policy for monitoring medications. 1. HV # 1 was admitted to the agency on 1/28/25 with resumption of care on 3/8/25 with a primary diagnosis of Chronic Obstructive Pulmonary Disease Unspecified. A HV was conducted on 3/12/25 at 11:10 AM to observe care provided by Employee Identifier (EI) # 4, Licensed Practical Nurse. EI # 3, Patient Care Manager (PCM) was also present during the HV. During the HV, the Client Medication Report (CMR) was compared to the medications the patient was currently taking. The following was observed: a. Melatonin 10 milligrams (mg) tablet take two gummies at bedtime was listed on the CMR. HV # 1 reported he/she could not recall taking the medication. b. Bupropion HCL (Hydrochloride) XL (extended release) 150 mg 24 hour tablet was observed in the home with fill date 12/3/24. HV #1 reported taking the medication. Bupropion was not on the CMR. An interview was conducted on 3/14/25 at 10:35 AM with EI # 1, Regional Director, who confirmed staff failed to follow the policy for monitoring medications.”