Central Coast VNA & Hospice, Inc.

“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: Based on interview and record review, the home health agency (HHA) failed to ensure home health services were provided according to the plan of care for one of seventeen patients (Patient 3) when the physician was not notified of three missed physical therapy (PT) visits. This failure had the potential to compromise patient care. Review of Patient 3’s Patient Profile (written document of patient information), for the certification period, 10/18/23 through 12/16/23, indicated a start of care date (SOC) of 10/18/23, and diagnoses of myalgia (pain in a muscle or group of muscles). Review of Patient 3’s plan of care (POC, written document summarizing current treatments), for the certification period, 10/18/23 through 12/16/23, indicated disciplines ordered were physical therapy (PT) services two times per week times two weeks, effective 10/22/23 and one time per week for three weeks effective,11/5/23. Review of Patient 3’s Patient Schedule (calendar of visits), for the certification period, 10/18/23 through 12/16/23, indicated within the provided order frequency set, there were missed PT visits the week of 10/29/23, 11/5/23 and 11/12/23. There was no documentation in the clinical record Patient 3’s physician had been notified about the missed PT visits or an attempt had been made to reschedule the missed visits. During a concurrent interview and record review, on 7/24/24 at 11:35 a.m., with the director of patient care services (DPCS), DPCS acknowledged the missed PT visits and she stated the clinician should have notified the doctor. Review of the HHA’s policy and procedure titled, “Coordination of Care,” revised October 2017, indicated “physicians will be notified of all missed visits that occur for every service ordered throughout the plan of care” and…” documentation of the MD notification will be contained within the chart.””

“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, interview and record review, the home health agency failed to follow accepted standards of practice to prevent the spread of infection when: 1. Expired medical supplies were found in the medical supply room; and 2. For Patient 16, Registered Nurse A (RN A) did not perform hand hygiene after she measured Patient 16’s pressure ulcer (injury to the skin from prolonged pressure on the skin) on her left hip and before she reached into her nurse therapy bag for clean supplies. These failures had the potential to lead to the spread of infection. Review of Patient 16’s Patient Profile (written document of patient information) for the certification period, 7/19/24 through 9/16/24, indicated a start of care date of 7/19/24, and a diagnosis of pressure ulcer of the left hip. Review of Patient 16’s plan of care (POC, written document summarizing current treatments), for the certification period, 7/19/24 through 9/16/24, indicated disciplines ordered were skilled nursing (SN) one time per week times one week, effective 7/19/24, two times per week times one week, effective 7/21/24, and one time per week times six weeks, effective 7/28/24. POC further indicated SN will perform wound care/dressing change to left hip and assess the size weekly. During a concurrent observation and interview at a home visit, on 7/23/24 at 9:30 a.m., with Patient 16 and registered nurse A (RN A), RN A measured Patient 16’s left hip pressure ulcer. RN A did not perform hand hygiene after she measured Patient 16’s wound and before she reached into her nurse therapy bag for clean wound dressing supplies. During an interview, on 7/25/24 at 10:20 a.m., with the director of patient care services (DPCS), DPCS stated RN A should have performed hand hygiene after she measured Patient 16’s wound and before she reached into her bag. Review of the HHA’s policy and procedure titled, Hand Hygiene Policy and Compliance Program,” revised October 2017, indicated “hand hygiene will be done by all employees to reduce the transfer of microbes to patients and to prevent the growth of microorganisms” and... “indications for staff performing hand hygiene are: before re-entering nursing bag or patient’s clean supplies.” 1. During an observation on 7/22/24, at 9:10 a.m., in the medical supply room, there was one box, of adhesive remover pads (used to easily and painlessly remove medical tape and tape residue from the skin), with an expiration date of 12/1/2020. Some of the adhesive remover pads in the box had a manufacturing date of 8/6/2021. During an observation on 7/22/24, at 9:20 a.m., in the medical supply room, there was one box of alcohol prep pads (used to protect the body from potentially harmful germs when an injection is administered), with an expiration date of 3/29/23. During a concurrent observation and interview on 7/22/24, at 9:27 a.m., with the revenue cycled manager (RCM), RCM acknowledged the expired medical supplies and stated they should have been removed from the medical supply room. RCM removed the expired boxes of adhesive remover pads and expired alcohol prep pads. During an interview on 7/24/24, at 9:50a.m., with the director of patient care services (DPCS), DPCS acknowledged the expired medical supplies should have been removed from the medical supply room. DPCS stated clinicians should have informed office staff the medical supplies were expired and removed them from the supply room. Review of the home health agency’s policy and procedure titled, “Supply Maintenance,” revised October 2017, indicated, “All medical supplies, especially sterile items, will be properly stored in a clean, dry area and handled in a sanitary manner protected from potential contamination as indicated by the manufacturer. Supply closets will be inspected monthly to remove expired supplies if present.””

“State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This Element is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to ensure one of seven home visit patients (Patient 16) was informed of the California Department of Public Health (CDPH) toll-free home health hotline telephone number and it’s purpose for filing complaints. This failure had the potential to delay the complaint process and compromise patients’ rights. Findings: Review of Patient 16’s Patient Profile (written document of patient information) for the certification period, 7/19/24 through 9/16/24, indicated a start of care date of 7/19/24, and a diagnosis of pressure ulcer (injury to the skin from prolonged pressure on the skin) of the left hip. Further review indicated Patient 16’s family member (FM) was her durable power of attorney (DPOA, action taken to act on someone’s behalf in the event they can not make financial and legal decisions). Review of Patient 16’s plan of care (POC, written document summarizing current treatments), for the certification period, 7/19/24 through 9/16/24, indicated disciplines ordered were skilled nursing (SN) one time per week times one week, effective 7/19/24, two times per week times one week, effective 7/21/24, and one time per week times six weeks, effective 7/28/24. During a concurrent observation and interview, at a home visit, on 7/23/24 at 9:30 a.m., with Patient 16 and registered nurse A (RN A), Patient 16 stated she did not know the state toll free hotline telephone number. Patient 16 stated she would tell the nurse if she had a complaint. During a concurrent interview with RN A, RN A stated she did not go over the state toll free hotline telephone number with Patient 16 at the SOC visit. RN A stated she did not know it. During an interview, on 7/23/24 at 2:02 p.m., with the director of patient care services (DPCS), DPCS stated RN A should have told Patient 16 about the state toll free hotline telephone number at the SOC visit. During a subsequent interview, on 7/25/24 at 10:20 a.m., with the DPCS, DPCS stated Patient 16’s FM/DPOA should have been told about the state toll free hotline telephone number when the office called him and verbally reviewed with him the admission consents. During a telephone interview, on 7/25/24 at 10:30 a.m., with Patient 16’s FM/DPOA, FM/DPOA stated he received a call from the office and was told they would send over the consents for him to sign. FM/DPOA stated no one verbally reviewed with him the consents over the telephone. FM/DPOA stated he did not recall if he was informed of the state toll free hotline telephone number and it’s purpose for filing complaints. Review of the HHA’s policy and procedure titled, “Patient Bill of Rights and Responsibilities,” revised October 2017, indicated “the agency will provide verbal notice of patient’s rights and responsibilities” and …”to be advised of the telephone number and hours of operation of the state’s Home Health Agency hotline, that receives complaints or questions about local home care agencies.””

“Revisions communicated to patient and MDs CFR(s): 484.60(c)(3)(i) (i) Any revision to the plan of care due to a change in patient health status must be communicated to the patient, representative (if any), caregiver, and all physicians or allowed practitioner’s issuing orders for the HHA plan of care. This Element is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to ensure a change in the plan of care (POC, written document summarizing a patient’s health condition and current treatment for their care) was communicated to one of seven home visit patients (Patient 13) when the home health aide (HHA) did not inform Patient 13 and her family member (FM) she would not make a scheduled visit. This failure had the potential to compromise patient care and well-being. Review of Patient 13’s patient profile (written document of patient information) indicated Patient 13’s start of care (SOC) date was 6/25/24, and diagnoses included fracture (broken bone) of unspecified carpal bone (bone of the wrist that connect the distal aspects of the radial and ulnar bones of the forearm to the bases of the five metacarpal bones of the hand), left wrist (the joint between the human hand and the arm) with routine healing, unspecified fall (to drop suddenly from an erect position) and essential primary hypertension (high blood pressure that does not have a known secondary cause). Review of Patient 13’s POC, for the certification period, 6/25/24 through 8/23/24, indicated disciplines ordered were home health aide (HHA) services one time per week times one week, effective 6/25/24 through 6/29/24 and two times per week for three weeks, effective 6/30/24 through 7/20/24. POC also indicated occupational therapy (OT) services one time per week times one week, effective 6/25/24 through 6/29/24 and three times per week times one month, effective 7/1/24 through 7/31/24. During a concurrent observation and interview at a home visit, on 7/24/24, at 12:40 p.m., with Patient 13, her FM, and physical therapy assistant B (PTA B), Patient 13’s FM stated they expected home health aide C (HHA C) to visit yesterday. FM stated HHA C did not show up and she did not call to communicate she would not be coming. FM stated she called HHA C but she did not answer and she did not return the call. During a concurrent interview with PTA B on 7/24/24 at 12:45 p.m., PTA B stated there were no scheduled HHA visits this week because the occupational therapist (OT) was scheduled to make a visit to evaluate the patient. PTA B stated HHA C should have communicated with Patient 13 and her FM about the change in the schedule. During an interview on 7/25/24, at 10:15 a.m., with the director of patient care services (DPCS), DPCS stated HHA C should have communicated with Patient 13 and her FM ahead of time about the change in the schedule. Review of the home health agency’s policy and procedure titled, “Coordination of Patient Care,” revised October 2017, indicated, “Agency staff members regularly communicate to ensure that their efforts are coordinated effectively and ultimately support the objectives outlined in the plan of care...Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any) and caregiver(s), as appropriate, in the coordination of care activities...””