Elite Home Health

“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 during home visits, staff interviews and review of infection control guidelines, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 1 (#6) of 7 (#6 - #12) home visits conducted. This failed practice had the potential to place all patients with wound care at risk for complications, infection, and rehospitalization. On 11/06/2024 at 10:02 AM, a home visit was conducted to observe wound care for patient #6. Surveyor observed Skilled Nurse (SN) #1 re-using an opened bottle of saline with a date of 11/05/2024 written on the top in large letters to clean the patients wound. Surveyor asked the SN when the bottle of saline would be discarded. SN stated, “today.” The manufacturer’s label on the bottle read, “...Discard after use.” According to the Tyco Healthcare at http://www.lvhn.org/sites/default/files/uploads/research_education/EmergencyMedicineMedStudents/WoundCleansing.pdf, saline solutions begin to show bacteria growth within 24 hours of opening.”

“Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient’s behavior, the behavior of other persons in the patient’s home, or situation; This Element is not met as evidenced by: Based on clinical record review, administrative document review, and staff interview, it was determined the Agency failed to make efforts to resolve problems presented by a patient’s caregiver and potentially prevent a discharge for cause for 1 (#13) of 5 (#13 - #17) closed records reviewed. This failed practice had the potential to affect all patients on census that they or their caregiver presents with behaviors, or an unsafe environment becomes evident. Findings follow: Review of clinical record #13 with a start of care date of 02/24/24 revealed a patient with a diagnosis of Hypertensive Heart Disease with Heart Failure. A physician order dated 06/06/24 documented, “Patient to be desk discharged on 6/6/24 due to unsafe home environment for staff.” A client coordination note report dated 05/30/24 documented a late entry note for 05/22/24 which involved a verbal argument and some physical altercation (pushing) between the patient’s caregiver (male) and a female. This occurred at a workshop behind the home. A Discharge-Transfer Summary Report documented the patient was discharged to home or self-care and the reason was unsafe home environment. There was no documentation of explanation nor any interventions to resolve the problem behavior observed. On 11/06/24 at 2:45 p.m., the Executive Director was informed of the concerns regarding this discharge and asked to provide any further information. On 11/07/24 at 10:00 a.m., the Administrator provided a late entry Client Coordination Note Report dated 11/06/24 at 3:50 p.m., which documented APS (Adult Protective Service) had been contacted prior to the incident on 05/22/24 due to potential neglect as the living conditions were poor. The coordination note further documented that APS was contacted after the 05/22/24 incident was observed. There were no further interventions at that time. The family and physician were notified of the discharge. The Executive Director provided a Policy and Procedure titled “Patient Discharge/Transfer Process” documented, “...In the event a discharge for cause (i.e. disruptive, abusive, or uncooperative behavior interfering with delivery of care) is being considered, the agency will: ...b. Attempt to resolve problem(s) presented by patient’s behavior or other individual’s behavior in home or situation...d. Ensure the issue of concern and efforts to resolve problems is documented in the medical record. The clinical record will reflect identification of the problems encountered; assessment of the situation; communication with the physician responsible for the plan of care; a plan to resolve issues and results of the plan implementation...””

“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 clinical record review, observations during home visits and staff interviews, it was determined the Agency did not include all current medications in the patient’s clinical record in 7 (#1, #3, #4, #7, #8, #9, and #16) of 17 (#1-#17) clinical records reviewed. This omission had the potential to a delay identification of adverse effects such as drug interactions, significant side effects or could result in possible hospitalization. Findings follow: Review of clinical records #3, #4, #7, #8, #9, and #16 revealed there was no documentation of drug interaction, significant side effects review for the use of oxygen. Review of clinical records #1 revealed there was no documentation of drug interactions, significant side effects review for the use of medical marijuana. Review of clinical records #16 revealed there was no documentation of drug interactions, significant side effects review for the use of Vitamin B-12 and Women’s daily Probiotic. The computer system utilized by the Agency had these medications highlighted in blue to indicate these have not been automatically checked for drug-drug interactions and for significant side effects. Therefore, the physician had not been contacted. On 11/07/24 at 10:00 a.m., the Executive Director confirmed these medications had not been thoroughly reviewed by manual means, documented, and physician informed as required.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on clinical record review and staff interview, it was determined the Agency failed to ensure documentation, including late entry documentation, of unusual events was completed timely for 1 (#13) of 17 (#1 - #17) clinical records reviewed. This failed practice had the potential to affect all patients on census in that direct caregivers would not have a full and accurate patient file to reference and use for care planning. Findings follow: Review of Clinical Record #13 with a start of care date of 02/24/24 revealed a patient with a diagnosis of Hypertensive heart disease with heart failure. A physician order dated 06/06/24 documented, “Patient to be desk discharged on 6/6/24 due to unsafe home environment for staff.” This decision to discharge was based off an event dated 05/22/24. On 11/06/24 at 3:05 p.m., the Executive Director was informed of the concerns regarding this discharge and asked to provide any further information. On 11/07/24 at 10:00 a.m., the Executive Director provided a late entry Client Coordination Note Report dated 11/06/24 at 3:50 p.m. This was 5 months and 2 weeks after the original event on 05/22/24. The Executive Director provided a Policy and Procedure titled “Information Management” which documented the electronic system would be synchronized within 24 hours of visit and it shall be “...written on day of service and incorporated into medical record no less often than 14 days...””