Lhc Homecare of South Alabama

“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 medical records (MR), observations, agency policy and procedure, and interviews with staff, it was determined the agency failed to ensure agency policy and procedure for infection prevention were followed. This deficient practice did affect three of seven home visits (HV) including HV # 4, HV # 5, and HV # 7, and had the potential to affect all patients receiving care by this agency. Agency Policy: Cleaning of Re-Useable Equipment Policy Number: 8.006 Revised: 6/1/22 Purpose: To ensure equipment required for patient care is clean and sanitized to prevent the spread of infections. Equipment that comes in contact with non-intact skin will undergo intermediate level disinfection. Definition: Intermediate-Level Disinfection: destroys vegetative bacteria, mycobacterium tuberculosis and most fungi. It neutralizes most viruses but does not kill bacterial spores. Agency Policy and Procedure: 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 prior to, at specified points during, and following patient contact. Hand hygiene will be performed using soap and water or an alcohol-based hand sanitizer. Procedure: 1...f. before and after removal of personal protective equipment (PPE). 3. HV # 7 was admitted on 3/14/25 with diagnoses including Chronic Diastolic (Congestive) Heart Failure, Chronic Kidney Disease, and Cellulitis of Left Lower Limb. Review of the Home Health Certification and Plan of Care dated 3/14/25 revealed physician’s orders for SN one visit per week for nine weeks to perform procedure of wound care to wound # 1, distal pretibial venous stasis ulcer, # 2 distal lower leg venous stasis ulcer, and wound # 3 distal lower leg venous stasis ulcer. A HV was conducted on 4/9/25 at 9:25 AM to observe wound care provided by EI # 5, Registered Nurse. EI # 5 removed dressing from left lower leg with gloved hands then removed the gloves, failed to perform hand hygiene, and donned new gloves and measured the wound. EI # 5 then cleansed the wound with 4 x 4 soaked with normal saline, removed the gloves then donned new gloves and applied clean dressing to the wound. EI # 5 failed to perform hand hygiene after removing contaminated gloves. An interview was conducted on 4/10/25 at 3:50 PM with EI # 1, who confirmed the staff failed to follow agency hand hygiene policy. 1. HV # 4 was admitted on 3/15/25 with diagnoses including Non-ST Elevation (NSTEMI) Myocardial Infarction, and Type 2 Diabetes Mellitus (DM) with Foot Ulcer. Review of the Home Health Certification and Plan of Care dated 3/15/25 revealed physician’s orders for Skilled Nurse (SN) one visit per week for one week then two visits per week for eight weeks to perform procedure of wound care to wound # 5, left mid-dorsum, surgical incision, # 6, right mid-edge foot, diabetic ulcer, and wound # 7, right posterior edge foot, diabetic ulcer. A HV was conducted on 4/8/25 at 11:35 AM with Employee Identifier (EI) # 3, Licensed Practical Nurse (LPN) to observe wound care. EI # 3 performed hand hygiene, donned gloves, removed soiled bandage from patient’s right foot wound with bandage scissors, and placed scissors on table with clean wound supplies. EI # 3 picked up the bandage scissors from table, cut clean wound dressing, and applied to wound bed on right foot. EI # 3 failed to cleanse the bandage scissors after removing soiled bandage, and prior to cutting wound dressing. An interview was conducted on 4/10/25 at 3:20 PM with EI # 1, Executive Director (ED) who confirmed staff failed to follow the agency policy for cleaning of re-useable equipment. 2. HV # 5 was admitted on 11/26/24 with diagnoses including Other Complications of Procedures, Necrotic, and Type 2 DM with Other Specified Complication. Review of the Home Health Certification and Plan of Care dated 3/26/25 revealed physician’s orders for SN one visit per week for one week, then two visits per week for eight weeks to perform procedure of wound care to wound # 2, left fifth toe, diabetic ulcer. A HV was conducted on 4/9/25 at 9:05 AM with EI # 4, Registered Nurse (RN) to observe wound care. EI # 4 performed hand hygiene, donned gloves, removed soiled bandage from patient’s left foot wound with bandage scissors, and placed scissors on table with clean wound supplies. EI # 4 picked up the bandage scissors from table, cut clean wound dressing, and applied to wound bed on left foot. EI # 4 failed to cleanse the bandage scissors after removing soiled bandage, and prior to cutting wound dressing. An interview was conducted on 4/10/25 at 3:22 PM with EI # 1, who confirmed staff failed to follow the agency policy for cleaning of re-useable equipment.”

“Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This Element is not met as evidenced by: Based on medical record review, agency policy, and interview with staff, it was determined the agency failed to ensure wounds were assessed and measured per agency policy. This deficient practice affected one of nine patients reviewed with wounds including Home Visit (HV) # 7 and had the potential to affect all patients with wounds. Agency Policy: Wound Assessment, Documentation, and Photography Policy Number: 2.2.001 Revised: 9/1/24 Purpose: To ensure the accurate and consistent assessment and documentation of wounds. Policy: Upon initial and subsequently as indicated below, all wounds will be assessed with appropriate documentation in the medical record... Unless otherwise ordered by the physician, the qualified clinician ... will assess wounds at least: Weekly for patients ... receiving daily wound care performed by the agency, have an infected wound... Every other week for patients receiving wound care by the agency at least at a frequency less than daily... The assessment includes measurement of the length, width, and depth... 1. HV # 7 was admitted on 3/14/25 with diagnoses including Chronic Diastolic (Congestive) Heart Failure, Chronic Kidney Disease, and Cellulitis of Left Lower Limb. Review of the Home Health Certification and Plan of Care dated 3/14/25 revealed physician’s orders for Skilled Nurse (SN) 3 times a week for eight weeks to perform procedure of wound care to wound # 1, distal pretibial venous stasis ulcer, wound # 2 distal lower leg venous stasis ulcer, and wound # 3, distal lower leg venous stasis ulcer. Review of the SN Visit Note Reports for the week of 3/16/25, 3/23/25 and 3/30/25 revealed no documentation of each of the wound measurements. An interview was conducted on 4/10/25 at 3:40 PM with Employee Identifier # 1, Executive Director, who confirmed the staff failed to measure wounds per agency policy.”

“Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This Element is not met as evidenced by: Based on review of Medical Records, agency policy and procedure, and interview, it was determined the agency failed to ensure wound care education with return demonstration was provided. This deficient practice affected two of nine patients with wounds reviewed including Home Visit (HV) # 1, HV # 2, and had the potential to affect all patients requiring wound care education. Findings include: Agency Policy: Patient Education Policy Number: 3.001 Revised: 11/1/17 ...Policy: The agency plans, supports, and coordinates patient and caregiver education designed to promote optimal patient health... Procedure: ...3. The patient and caregiver receive ongoing information specific to the identified needs...including... b. Patient/caregiver plan of care responsibilities... 1. HV # 1 was admitted on 2/2/25 with diagnoses including Displaced Fracture of Left Tuberosity, Unspecified Fracture of Left Patella, and Essential (Primary) Hypertension. Review of the Home Health Certification and Plan of Care revealed physician’s orders for Skilled Nurse (SN) one visit per week for nine weeks to perform/instruct patient/caregiver the procedure for wound care to pressure ulcer of the coccyx. Patient/caregiver to cleanse wound with warm soap and water, pat dry with clean towel, and cover with foam dressing daily. Review of the SN Visit Note Reports from 2/2/25 through 2/20/25 revealed no documentation the patient or caregiver was provided instructions for wound care or return demonstration. The wound was healed on 2/20/25 and the wound care was discontinued. An interview was conducted on 4/10/25 at 3:20 PM with Employee Identifier (EI) # 1, Executive Director, who confirmed the staff failed to provide patient and or caregiver education for care of the wound. 2. HV # 2 was admitted on 3/8/25 with diagnoses including Encounter for Change or Removal of Nonsurgical Wound Dressing, and Abrasion of Left Upper Arm. Review of the Home Health Certification and Plan of Care dated 3/8/25 revealed physician’s orders for SN one visit per week for nine weeks. SN to perform/instruct patient/caregiver procedure of wound care to wound # 8 mid forearm and wound # 9 left elbow, cleanse with warm soap and water, dry using a clean towel, and leave open to air. Review of the SN Visit Note Reports dated 3/8/25 through 4/3/25 revealed no documentation the patient or caregiver was provided education for the care of the wounds. An interview was conducted on 4/10/25 at 3:45 PM with EI # 1 who confirmed the staff failed to provide patient and or caregiver education for care of the wounds.”