Valley Care Home Health Services, Inc.

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on interview and record review, the agency failed to ensure that the Certified Home Health Aide (CHHA) was following the “Home Health Aide Care Plan” prepared by the Registered Nurse (RN), for two of 17 sampled patients (Patients 11 and 12). This failure had the potential to cause the patient harm due to lack of care. Findings: 1. On June 13, 2024, Patient 11’s face sheet was reviewed. Patient 11 was admitted to the home health agency on March 27, 2024, with a primary diagnosis of non-pressure chronic ulcer (wound caused by poor circulation). The certification period reviewed was May 26, 2024, through July 24, 2024. The “Home Health Certification and Plan of Care,” dated May 27, 2024, indicated Certified Home Health Aide (CHHA) visits 2wk8 (2 times a week for 8 weeks) to assist with bathing and personal care. A review of the “Aide Visit Record,” dated May 28 and 31, 2024, June 4, 7, and 11, 2024, indicated the CHHA was documenting Patient 11 was assisted with ambulation, assisted with bed mobility, and change bed linen. The “Home Health Certification and Plan of Care,” dated May 27, 2024, completed by the Registered Nurse (RN) did not indicate specific instructions as to how Patient 11 would be assisted with ambulation (able to walk about and not bedridden), assist with bed mobility (one bed position to another) or to change bed linens. 2. On June 13, 2024, Patient 12’s face sheet was reviewed. Patient 12 was admitted to the home health agency on January 5, 2024, with a primary diagnosis of non-pressure chronic ulcer. The certification period reviewed was May 4, 2024, through July 2, 2024. The “Home Health Certification and Plan of Care,” dated May 6, 2024, indicated CHHA visits 2wk8 (2 times a week for 8 weeks) to assist with bathing and personal care. A review of the “Aide Visit Record” dated May 10, 14, 17, 21, 24, 28, and 31, 2024, June 4, and 7, 2024, indicated the CHHA was documenting Patient 12 was assisted with ambulation, and with bed mobility. The “Home Health Aide Care Plan,” completed by the RN showed no documented evidence of specific instructions as to how Patient 12 was to be assisted with ambulation. On June 14, 2024, at 10:40 a.m., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the “Home Health Aide Care Plan,” and the “Aide Visit Record,” for Patient’s 11 and 12 did not coincide. A review of the policy and procedure titled, “Home Health Aide: Assignment,” date of review January 6, 2017, indicated. “…the initial assessment for need of home health aide services shall be determined by the authorized nurse/therapist. The assignment of tasks will be identified in the home health aide care plan/Assignment Sheet...””

“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 observation, interview, and record review the home health agency failed to ensure the clinical record contained an accurate comprehensive medication profile for two (2) of 17 sampled patients, (patients 2 and 5) when the mediation profile did not accurately reflect the medications patients 2 and 5 were taking in the home. This agency’s failure had the potential to put the patients at risk for medication errors, adverse drug reactions, and ineffective drug therapy Findings: 1. On June 11, 2024, Patient 2’s face sheet was reviewed. Patient 2 was admitted to the home health agency on May 8, 2024, with a primary diagnosis of type 2 diabetes mellitus (DM - abnormal blood sugar). The certification period reviewed was May 8, 2024, through July 6, 2024. Registered Nurse (RN) 1 verified from Patient 2’s physician the medication list and the following medications were already discontinued and were still listed on the medication profile: a. Glimepiride (medication used to treat DM) 1 milligram (unit of measurement), 1 tablet, orally, daily; b. Oxycodone Acetaminophen (narcotic medication used to treat moderate to severe pain) 10-325 mg, I tablet, orally, every 4 hours as needed; c. Metoprolol Succinate ER (Extended Release - medication used to treat high blood pressure) 25 mg, 1 tablet, orally, daily; and d. Lidocaine (medication used to relieve nerve pain) 4% topical patch, external daily. The following medication should have been given routinely: a. Methocarbamol (medication to treat muscle spasm and pain) 500 mg, 1 tablet, oral, every 8 hours as needed. The following medication was missing from the medication profile: a. Mirtazapine (medication used to treat depression) 15 mg, 1 tablet, orally, daily. b. Cranberry (supplement) 650 mg, 1 capsule, orally, daily. 2. On June 11, 2024, Patient 5’s face sheet was reviewed. Patient 5 was admitted to the home health agency on May 8, 2024, with a primary diagnosis of idiopathic scoliosis (spine to develop an abnormal curve). The certification period reviewed was May 8, 2024, through July 6, 2024. On June 11, 2024, at 9 a.m., during a home visit conducted with Licensed Vocational Nurse (LVN) 1, cephalexin (antibiotic used to treat infections) 250 mg, 1 tablet, oral, 3 x daily (three times daily) was observed from Patient 5’s medications. Patient 5’s record was concurrently reviewed and . On June 11, 2024, at 9 a.m. a concurrent interview and record review was conducted with Licensed Vocational Nurse (LVN 1). LVN 1 stated cephalexin was not in the patient’s medication profile as Patient 5 had not been taking it. LVN 1 stated all medications should be reviewed at least once a week. On June 14, 2024, at 10:40 a.m. an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated all of the patient’s medications should be reconciled at time of admission and on a weekly basis. A review of the policy and procedure titled, “Medication Reconciliation,” dated December 22, 2023, indicated, “…a licensed skilled nurse will conduct a weekly medication list review…””

“Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure personnel files for contract staff were complete when required documents were missing in the employee files. This failure had the potential to place patients at risk for harm or abuse. Findings: On June 13, 2024, during a review of the agency’s employee files the following were found missing: 1.Three Certified Nursing Assistants (CNAs 2, 3, and 4) and one Occupational Therapist (OT) 1 were missing background checks; 2. The Registered Dietician (RD) was missing a cardiopulmonary resuscitation (CPR) certification and physical health examination. On June 13, 2024, at 4 p.m., during an interview with the Human Resources Manager (HRM), the HRM confirmed the personnel files were missing background checks. HRM further stated background checks weren’t being done until 2017. On June 14, 2024 at 10:10 a.m., during an interview with the HRM, the HRM stated he was unable to obtain missing documents for the deficient employee files from the contracted agency. The HRM further stated the RD’s CPR certification and physical health exam were unavailable. On June 13, 2024, at 4:22 p.m., during an interview with the Administrator, the Administrator stated all employees should have a background check at the time of hire. During a review of the agency’s policy and procedure titled, “Employee Recruitment Process,” reviewed December 12, 2022, indicated”…Background check will be completed during the hiring process. Background checks may include criminal records, credit reports, identity verification, driving records, and reference checks…hire a reputable and reliable background check provider...””

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure expired medication and medical supplies were not readily available for use. In addition, the medication refrigerator did not have a thermometer and monitoring log to ensure the proper refrigerator storage temperatures were maintained. This agency failure increased the potential for patients to receive expired medical supplies to be used for patients. On June 10, 2024, beginning at 3:20 p.m., an inspection the medical supply room was conducted and the following were observed: 1. Several expired medical supplies were found stored beyond their expiration dates and readily available for use, as follows: a. Two boxes (containing 10 pcs) and five loose pieces of Hydrocolloid (brand name) Calcium Alginate 4” x 4.75” dressing (four inches by 4 3/4 inches, a type of wound care dressing) with expiration dates of December 15, 2023, and November 12, 2023, respectively; b. Seven 0.9 mg (milligram- unit of measurement) packet of Bacitracin ointment (antibiotic ointment) with expiration dates of May 2023; c. One box (containing 25 pieces) and 13 loose pieces of lemon-glycerin swabsticks (type of swabsticks used for oral care) with expiration dates of May 2022; d. One Surescan Safety II Needle (a type of intravenous [IV- into the vein] needle) with an expiration date of October 30, 2023; e. One WHIN Safe Safety Huber Needle Set (a type of IV needle) with an expiration date of October 31, 2021; and f. One box of ReliOn PRIME blood glucose test strips (test strips used for checking blood sugar levels) with an expiration date of December 13, 2021. On June 10, 2024, beginning at 4:20 p.m. a concurrent observation and interview was conducted with the Administrator (ADM) and Director of Patient Care Services (DPCS). The ADM and DPCS confirmed the medical supplies were expired and should have already been discarded. A review of the agency’s policy and procedure titled, “Expired Medical Supplies,” reviewed December 20, 2023, indicated, “…It is the agency’s policy t keep track of the expiration dates of the medical supplies stored in the office…To eliminate the risk of the Agency staff utilizing expired medical supplies in rendering care to their patients…For non-liquid medical supplies that have expired, these will be disposed of in the trash as long as they do not contain any medications or needles/sharps…” 2. Inside a small refrigerator was one vial of Aplisol tuberculin PPD (purified protein derivative – a skin test reagent used to diagnose silent tuberculosis) with an open date of “4/4/2024.” In addition, the refrigerator did not have a thermometer, nor was there a temperature log to indicate proper refrigerator storage temperatures were maintained. On June 10, 2024, beginning at 4:20 p.m., a concurrent observation and interview was conducted with the Administrator (ADM) and Director of Patient Care Services (DPCS). The ADM confirmed the date of “4/4/24” on the Aplisol vial, as well as the absence of a thermometer or temperature log for the refrigerator. The DPCS stated the Aplisol vial was good for 30 days from the time it was opened. The DPCS stated the Aplisol should have been discarded after 30 days. The ADM stated the refrigerator was used to store medications needing refrigeration once they were delivered to the agency. The medications would be stored for as little as two to three hours, until the nurses were able to pick them up to bring with them on the way to their scheduled home visits with their patients. The ADM and DPCS both stated there should have been a thermometer and temperature monitoring log to ensure the proper refrigerator storage temperature was maintained for medication safety. A review of the agency’s policy and procedure titled, “Medication Labels,” reviewed December 15, 2023, indicated, “...Multidose vials are to be discarded 28 days after first use unless the manufacturer specifies otherwise...’ A review of the agency’s policy and procedure titled, “Medical Supplies Storage and Management of Tuberculin Purified Protein Derivative,” reviewed January 12, 2023, indicated, “…Purpose: To promote consistency and competency in performing the tuberculin skin test (TST). To support safety and accuracy of the tuberculin test (TST) through the proper storage and handling of tuberculin purified protein derivative (PPD)…Store tuberculin at 35 degrees to 46 degrees F (Farenheit- a unit of measurement) (2 degrees to 8 degrees C [Celsius- a unit of measurement]) and protect it from light (keep in original packaging). Monitor refrigerator temperature using a digital thermometer Tuberculin that has been exposed to freezing temperatures (32 degrees F or lower) or has been stored above 46 degrees F should be discarded…” A review of the agency’s policy and procedure titled, “Medication Storage,” reviewed December 20, 2023, indicated, “…The agency will store medication properly and safely…If the agency stores medications onsite in office, medications will be stored properly and safely…Medications will be stored under proper conditions to ensure stability, including…Storing at proper temperatures, using appropriate thermometers and keeping temperature records…the storage area will be periodically inspected to make sure that the medications are stored properly…””