Trinity Home Health of Arkansas

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: The HHA must follow accepted standards of assessment and formulate individualized Plan of Care with the Physician or Practitioner to fulfill the needs of each patient and assure each patient gets the care they need in each individuals situation or ability to communicate. Findings Follows: Based on clinical record review, it was determined the HHA (Home Health Agency) failed to create an individualized POC (Plan of Care) in 1 (#2) of 18 (#1-#18) charts reviewed. If not corrected, this has the ability to impact all patients on census who cannot communicate verbally by creating a barrier to, and thus leaving out, the patient’s ability to be an integral part of creating their plan of care with their healthcare team. 1.A Plan of Care with certification dates from 01/07/2025-03/07/2025. Per the Psychosocial section ...”the patient is nonverbal.” This same POC had SN (Skilled Nurse) Intervention to ...”report to physician unrelieved pain of >7 on 0-10 scale.” 2. Skilled Nurse Visit note dated 01/08/2025 had documentation that, “...Patient is nonverbal and doesn’t respond to skilled nurse by movements or eye contact.” 3. Skilled Nurse Visit note dated 01/26/25 showed the nurse instructed “patient/cg (caregiver)...to report pain levels of 7/10 or higher to SN.””

“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 observations during home visits, staff interview, review of the Agency’s Infection Control Plan, Agency Policy for providing PICC care, Center for Disease Control (CDC) guidelines, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 1 (#1) of 7 home visits observed (#1-#7). This failed practice had the potential to place the patient at risk for a PICC (Peripheral Inserted Central Catheter) or systemic infection. The deficient practice identified, if continued, potentially placed all patients with PICC’s at risk of adverse outcomes and hospitalization. During a home visit on 03/05/2025 at 11:10 AM, this surveyor observed the SN (Skilled Nurse) attempt to perform a sterile PICC Dressing Change for Patient #1. Patient #1 was seated in a dining room chair with his head turned to the right. SN opened the PICC dressing kit set in a sterile fashion. She handed Patient #1 a mask and assured he had placed it over his mouth and nose correctly, then SN donned a mask as well. SN donned clean gloves and began swabbing the edges of the transparent dressing covering the PICC to loosen the old dressing. SN then removed the old transparent dressing and the soiled Bio-patch (an antimicrobial foam disc that fits around the PICC tube where it enters the patient’s arm). SN then changed into sterile gloves and began scrubbing the area where the transparent dressing was, as well as around the PICC tube itself. SN then returned back to the sterile field to retrieve tape to secure the PICC as the Stat-Loc (an adhesive device meant to stick to the skin while also holding the PICC catheter tube secure so it won’t be pulled out accidentally) was removed during the cleaning. SN secured the PICC tube to the patient’s skin. SN went back to the sterile field to retrieve a paper measuring tape (used to assure the PICC hasn’t accidentally been pulled out partially and to measure the circumference on the patient’s arm (this is part of a standard practice to assure there is no swelling to the arm where the PICC is). SN turned back towards the patient to measure the arm, but SN dropped the paper measuring tape. SN retrieved the tape with the sterile gloves. SN then changed into clean gloves, opened an alcohol wipe and began cleaning the PICC area, thus contaminating the area by wearing clean gloves. SN continued to place a new stat-loc and Bio-patch, then a sterile transparent dressing. This surveyor alerted Agency Administration about the lack of sterility of the dressing and a different SN was sent to change the dressing. During an interview with agency staff #1, Infection Control Policy and the Agency written PICC procedure were obtained. Agency Staff #1 concurred that PICC care is a sterile procedure.”