Home Health Professionals Inc.

“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 clinical record review, observation during home visits, agency policy and procedure, Centers for Disease Control (CDC) article, and staff interview, it was determined the agency failed to ensure infection control practices were followed as evidenced by the nurses did not change gloves and sanitize hands during a wound dressing change for two (#2 and #3) of three (#1, #2, #3) dressing changes observed. This failed practice had the potential to affect all patients on census that receive wound care as this could result in a transmission of infection. Findings follow: Clinical record #2 with a SOC date of 07/21/26 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. On 07/28/26, during a home visit, the patient received a wound dressing change by the agency nurse. The nurse did not sanitize hands when she removed her gloves and applied the wound cleanser. She kept the same gloves on after cleaning the wound until she was completed with the wound dressing change. After removal of her gloves at that time, she did not use hand sanitizer. She cleaned up the area and gathered her items to leave the home and at that time, she used hand sanitizer. Clinical record #3 with a SOC date of 05/10/24 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. On 07/28/26, during a home visit, the patient received a wound dressing change by the agency nurse. The nurse did not remove gloves at any point during the dressing change and did not sanitize hands at any point during the wound dressing change. The agency policy and procedure titled, “Hand Hygiene” documented, “Purpose-To prevent cross-contamination and home care-acquired infections... Procedure-Hand decontamination using an alcohol-based hand rub should be performed: Before having direct contact with patients and after contact with a patient’s intact skin...” The 02/27/24 Centers for Disease (CDC) article titled, “Clinical Safety: Hand Hygiene for Healthcare Workers” documented, “.... when to clean your hands...after contact with blood, body fluids, or contaminated surfaces...When to change gloves and clean hands...If moving from work on a soiled body site to a clean body site on the same patient...” This article is located at Clinical Safety: Hand Hygiene for Healthcare Workers | Clean Hands | CDC On 07/29/26 at 4:00 p.m., the agency personnel were informed of the observations during the home visits. The Registered Nurse stated, “We have some work to do. We will have some more teaching on that.””

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on review of the clinical record, and staff interviews, the Agency failed to ensure the Patient received Physical Therapy services as ordered for one (#5) of ten (#1-#10) clinical records reviewed. This failed practice placed the Patient at potential risk for decreased mobility, and falls. Findings follow: Review of clinical record #5 with a Start of Care (SOC) date of 05/31/26 revealed a patient with a diagnosis of Transient Ischemic Attack (TIA), Encephalopathy, Hemiplegia, and Hypertension. The Home Health Certification and Plan of Care dated 05/31/26 - 07/29/26 documented an order for Physical Therapy 1 time a day for 1 visit, then 2 times a week for 4 weeks, then 1 time a week for 4 weeks. During clinical record review, it was noted the patient did not have Physical Therapy the week of 6/14/26 and also missed one visit during the week of 06/21/26. There was no corresponding note or documentation to determine why these visits were missed.On 07/29/26 at 4:00 p.m., the agency representative was asked to provide further documentation. The agency representative confirmed there was not any other documentation regarding the missed visits.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on clinical record review, agency policy and procedure, and staff interview, it was determined the agency failed to ensure the initial assessment visit was held within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician’s or allowed practitioner’s ordered start of care date for two (#5, and #9) of ten (#1 -#10) clinical records reviewed. This failed practice would cause a delay in the start of care and potentially cause a regression in the healing progress, a new health issue to remain unidentified, or a readmission to the hospital for new patients. Findings follow: Review of clinical record #5 with a Start of Care (SOC) date of 05/31/26 revealed a patient with a diagnosis of Transient Ischemic Attack (TIA), Encephalopathy, Hemiplegia, and Hypertension (HTN). The clinical record revealed a referral of 05/27/26 and the SOC was done by Physical Therapist on 05/31/26. Review of clinical record #9 with a SOC date of 04/07/26 revealed a patient with a diagnosis of Encephalopathy. The clinical record revealed a referral of 04/03/26 and the SOC was done by the Registered Nurse on 04/07/26. The agency’s policy and procedure titled, “Admission Criteria and Process” documented, “....The initial home visit will be made within 48 hours after the patient’s discharge from a facility or as ordered by the physician (or other authorized licensed independent practitioner) ...” On 07/29/26 at 4:00 p.m., the agency personnel were interviewed. They were asked for further documentation and what the process was for referrals. It was determined the agency did not have a clear process owner for this, and the nurse assigned would often “put them off” according to the staff interviewed.”

“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 clinical records, agency policy and procedure, observation during home visits and staff interview, the Skilled Nurse (SN) failed to include all medications the patient was taking during the drug regimen review in 3 (#1, #2, #3) of 10 (#1 - #17) clinical records reviewed. This failed practice had the potential to affect all patients currently on census in that the Clinician may be unaware of all medications being taken by the patients and could fail to identify and notify the Physician of potential reactions, ineffective drug therapy, interactions, duplicate drug therapy and noncompliance. Findings follow: Clinical record #1 with a SOC date of 06/24/26 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. There was no evidence of medication regimen review completed as the computer software program noted there were 5 possible medication interactions that had not been reconciled and Physician notified. Additionally, Daptomycin Intravenous Push (IVP) that was noted in the chart on 07/21/26, and observed during the home visit, was not on the current medication list, and therefore, had no medication regimen review completed. Clinical record #2 with a SOC date of 07/21/26 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. There was no evidence of medication regimen review completed as the computer software program noted there were 10 possible medication interactions that had not been reconciled and Physician notified. Clinical record #3 with a SOC date of 05/10/24 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. There was no evidence of medication regimen review completed as the computer software program noted there was 1 possible medication interaction that had not been reconciled and Physician notified. Additionally, the Assisted Living facility where the patient resided had an order for Losartan 50 mg (milligrams) daily dated 06/04/26 as noted during the home visit. This medication was not on the current medication list in the agency’s clinical record, therefore, had no medication regimen review completed. The agency’s policy and procedure titled, “Medication Profile” documented, “...A drug regimen review will be performed at the time of admission, when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with the addition a new medication...” On 07/29/26 at 4:00 p.m., the agency personnel were interviewed and asked for further documentation and what the process was for ensuring a complete medication regimen review. There was no further documentation provided. The Registered Nurse (RN) stated the nurse assigned to the patient would alert her to the interactions in the system and she would notify the Physician.”

“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 clinical record review, home visits, and staff interview, it was determined the agency failed to develop a patient specific written Plan of Care (POC) with current medications and patient specific interventions for meeting the patients’ needs in two (#1 and #3) of ten (#1-#10) clinical records reviewed. This failed practice had the potential to affect the quality of care received by all patients currently on census in that care may not be provided according to what the Physician had intended. Findings follow: Clinical record #1 with a SOC date of 06/24/26 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. On 07/28/26, during a home visit, the nurse administered Daptomycin Intravenous Push (IVP) for the patient. This medication was not on the most recent physician’s orders, but it was noted in a visit note dated 07/21/26. On 07/29/26, the agency personnel reviewed the electronic medical record and did not locate the physician’s order. This medication was not in the Home Health Certification and Plan of Care. Clinical record #3 with a SOC date of 05/10/24 and a Certification period of 06/29/26 - 08/27/26 revealed a patient with a diagnosis of Type 2 Diabetes Mellitus with a foot ulcer. On 07/28/26, during a home visit, the surveyor obtained the Assisted Living’s Medication Administration Record (MAR) for this patient. There was an order dated 06/04/26 for Losartan 50 mg (milligrams) daily. This medication was not listed in the most recent Home Health Certification and Plan of Care, nor the subsequent orders. The patient was asked how often his dressing is changed. He stated that he does it one day a week, the Home Health nurse does it one day a week, and the Wound Center does it one day a week. The Home Health Certification and Plan of Care documented the wound treatment to be completed but did not include how often. The wound healing center instructions dated 06/25/26 documented to change the dressing daily. On 07/29/26 at 4:00 p.m., the agency personnel were asked to provide any additional documentation, and none was provided.”