Blossom Ridge Home Health Agency

“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 staff interview and record review, the Home Health Agency (HHA) failed to ensure ordered therapy services were provided for one of 17 sampled patients (Patient 8) and failed to notify the physician of missed visits. This failure had the potential to result in unmet healthcare goals. Findings: During a review of Patient 8’s “Home Health Certification and Plan of Care” (POC), certification period 1/29/26 to 3/29/26, the POC indicated the start of care for Patient 8 was 1/29/26, with multiple diagnoses including congestive heart failure (CHF – a chronic manageable condition where the heart doesn’t pump blood as efficiently as it should, causing fluid buildup in the lungs and body.) During a review of Patient 8’s POC, certification period from 1/29/26 to 3/29/26, the Orders of Discipline and Treatments indicated, “Physical Therapy to evaluate/assess and develop Physical Therapy (PT) plan of care that will be approved by the physician prior to implementation…once a week for one week, then twice a week for three weeks, then once a week for three weeks…” During a review of Patient 8’s POC, certification period from 1/29/2026 to 3/29/2026, the Orders of Discipline and Treatments indicated, “Occupational therapy to evaluate/assess and develop occupational therapy plan that will be approved by the physician prior implementation… once a week for one week…” During a concurrent interview and record review on 3/19/26 at 11:30 a.m. with Operational Support (OS), the calendar for certification period 1/29/26 to 3/29/26 was reviewed. The calendar indicated there were two missed visits. One missed visit with Occupational therapy on 2/6/26 and one missed visit with Physical therapy 2/27/26. OS confirmed that these 2 visits were missed and the physician was not notified. During a review of the facility’s policy and procedure titled, “Coordination of care, from admit through Discharge,” revised 12/2025, indicated,” … Coordination of care with physician/authorized practitioner: at admission, throughout care, and at discharge, coordination of services is promoted through routine communication with the patient’s physician…c. when a missed visit occurs altering the Plan of care…””

“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 (HHA) failed to ensure that infection control procedures were followed during home visits for three of 17 sampled patients (Patient 2, Patient 3 and Patient 16) when: During a home visit with Patient 2, Licensed Nurse (LN) grabbed alcohol wipes from a clean multi-use package with dirty gloves, and not performing hand hygiene,During a home visit with Patient 3, Occupational Therapist (OT) touched the inside of the trash bag and continued cleaning vital signs equipment, without changing gloves and performing hand hygiene, and,During a home visit with Patient 16, Physical Therapist (PT) grabbed alcohol wipes from a clean multi-use package without performing hand hygiene.These failures had the potential to result in transmission and spread of infection. 3. During a review of Patient 16’s POC, for certification period 3/10/26 to 5/8/26, the POC indicated, Patient 16’s start of care was on 3/10/26 with diagnoses that included essential hypertension. POC indicated Patient 16 received physical therapy services. During an observation on a home visit on 3/18/26 at 10:10 a.m. in Patient 16’s home, Physical Therapist (PT) measured Patient 16’s ankle using a tape measure with bare hands, rolled down and reapplied the compression socks, and obtained Patient 16’s blood pressure using a cuff without glove use. PT did not perform hand hygiene between tasks and then proceeded to document on a tablet. At 10:36 a.m. PT removed a disinfectant wipe from a multi-use pack of wipes without performing hand hygiene after patient contact, used the wipe to disinfect the tape measure, and then, without hand hygiene, removed another wipe from the same pack to disinfect the blood pressure cuff. During a review of Patient 2’s “Home Health Certification and Plan of Care “(POC), for certification period 3/11/26 to 5/9/26, the POC indicated Patient 2 had a Start of Care (SOC) with the HHA on 3/11/26 with multiple diagnoses including aftercare following joint replacement surgery. During a concurrent observation and interview on 3/18/26 at 9:08 a.m. in Patient 2’s home with LN, LN was cleaning vital signs equipment and grabbed alcohol wipes out of a clean multi-use pack with dirty gloves. LN acknowledged the risk for contamination when she grabbed clean alcohol wipes from the multi-use pack without changing gloves. During an interview on 3/19/26 at 12:56 p.m. with Administrator (ADM), ADM acknowledged the risk for contamination when LN grabbed alcohol wipes out of the muti-use pack with dirty gloves. ADM stated the expectation was for gloves to be changed when grabbing wipes out of the multi-use pack or alcohol wipes were pulled out of multi-use pack with clean gloves before cleaning vital signs equipment. During a review of Patient 3’s POC, for certification period 3/7/26 to 5/5/26, the POC indicated Patient 3 had a SOC with the HHA on 1/6/26 with multiple diagnoses including fracture of the right lower leg. During a concurrent observation and interview on 3/18/26 at 10:15 a.m. in Patient 3’s home with OT, OT touched the inside of the trash bag while disposing of alcohol wipes in between sanitizing vital equipment and did not change gloves before wiping down the rest of the vital signs equipment. OT acknowledged the risk for contamination when he did not change gloves after touching the signs inside of the trash bag. During an interview on 3/19/26 at 12:56 p.m. with ADM, ADM acknowledged the risk for contamination when OT did not change gloves after touching the inside of the trash bag. ADM stated the expectation was for infection control procedures to be followed. During a review of the HHA’s policy and procedure (P&P) titled, “Infection Control Plan,” dated 5/15/99, the P&P indicated, “…ensure proper sanitation of medical equipment, devices, and supplies by being compliant with cleaning and…disinfection techniques…””

“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 (HHA) failed to accurately reconcile the medications in the home with the medication orders in the “Home Health Certification and Plan of Care” (POC) for two of 17 sampled patients (Patient 2 and Patient 3), when: Patient 2’s naproxen (nonsteroidal anti-inflammatory drug [NSAID] used to relieve mild to moderate pain, fever, and inflammation) dosage was incorrect on the medication list and, Patient 3 was taking a multivitamin that was not on the medication list.These failures had the potential for Patient 2 to receive incorrect dosage and Patient 3 to take supplements that interact with medications causing adverse effects. 1.During a review of Patient 2’s POC, for certification period 3/11/26 to 5/9/26, the POC indicated Patient 2 had a Start of Care (SOC) with the HHA on 3/11/26 with multiple diagnoses including aftercare following joint replacement surgery. During a review of Patient 2’s POC for certification period 3/11/26 to 5/9/26, the POC indicated medication orders including: naproxen 250 mg (milligram, unit of measure), 2 tablets daily. During a concurrent observation, interview, and record review on 3/18/26 at 9:08 a.m., with Licensed Nurse (LN), a medication reconciliation (the process of comparing a patient’s medication orders to all the medications that the patient has been taking) was done with Patient 2 in Patient 2’s home. There was a bottle of naproxen 220 mg in the home and Patient 2 stated he took naproxen 220 mg. Patient 2 confirmed he told the visiting nurse at SOC that he was taking naproxen 220 mg instead of naproxen 250 mg. LN confirmed the medication orders on POC should have reflected what was being administered in the home. During an interview on 3/19/26 at 1 p.m. with Patient Care Manager (PCM), PCM stated the expectation was for medication reconciliation to be done at SOC, when there are medication changes, and weekly. PCM acknowledged risk for incorrect dosage of medication to be administered when Patient 2’s POC did not accurately reflect the medication he was taking. 2.During a review of Patient 3’s POC, for certification period 3/7/26 to 5/5/26, the POC indicated Patient 3 had a SOC with the HHA on 1/6/26 with multiple diagnoses including fracture of the right lower leg. During a concurrent observation, interview, and record review on 3/18/26 at 10:15 a.m., with Occupational Therapist (OT), a medication reconciliation was done with Patient 3 in Patient 3’s home. There was a bottle of multivitamin (calcium citrate 500 mg., vitamin D3 20 mcg [microgram, unit of measure]., magnesium 80 mg., Zinc 10 mg) in the home. Patient 3 stated he took the multivitamin daily since being admitted to the HHA in January 2026. OT confirmed the medication orders on POC should have reflected what was being administered in the home. During an interview on 3/19/26 at 1 p.m. with PCM, PCM stated the expectation was for patient medications to be reconciled at SOC, weekly, and with medication changes. PCM acknowledged risk for medication interactions when Patient 3’s medication list was not updated weekly. During a review of the HHA’s policy and procedure (P&P) titled “Monitoring Medications,” dated 5/4/99, the P&P indicated, “…a drug regimen review will be performed on all patients in conjunction with all comprehensive assessments...additionally, all clinicians will participate in medication review and reconciliation throughout the episode…the discipline responsible for the drug regimen will…compare medication list…to actual medications patient is taking…review all medications including over the counter (OTC) medications…””

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to ensure coordination of care for one of 17 sampled patients (Patient 2), when Patient 2 was not provided a visit schedule which included frequency of visits by HHA personnel. This failure had the potential for Patient 2 to have missed HHA visits. During a review of Patient 2’s “Home Health Certification and Plan of Care “(POC), for certification period 3/11/26 to 5/9/26, the POC indicated Patient 2 had a Start of Care (SOC) with the HHA on 3/11/26 with multiple diagnoses including aftercare following joint replacement surgery. During a concurrent observation and interview on 3/18/26 at 9:08 a.m. in Patient 2’s home with Licensed Nurse (LN), a schedule of home health visits was not in the home. Patient 2 confirmed he did not receive a visit schedule that included visit dates and HHA disciplines. LN stated the expectation was for a visit schedule to be in the home to coordinate care. During an interview on 3/19/26 at 12:56 p.m. with Administrator (ADM), ADM acknowledged the risk of missed visits when Patient 2 was not provided with a schedule of HHA visits. During a review of the HHA’s policy and procedure (P&P) titled, “Coordination of Care, From Admit Through Discharge,” dated 5/1/99, the P&P indicated, “…written information obtained from plan of care will be provided to the patient…outlining…visit schedule including frequency of visits by agency staff…””

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on interview and record review the Home Health Agency (HHA) failed to ensure Home Health Aide supervision for one of 17 sampled patients (Patient 4) when the Home Health Aide was not supervised every 14 days. This failure had the risk for Patient 4 to receive inappropriate or low-quality care. During a review of Patient 4’s” Home Health Certification and Plan of Care” (POC), for certification period 7/29/25 to 9/26/25, the POC indicated Patient 4 had a Start of Care (SOC) with the HHA on 7/29/25 with multiple diagnoses including atrial fibrillation (an irregular and often very rapid heart rhythm). During a review of Patient 4’s POC for certification period 3/11/26 to 5/9/26, POC indicated a home health aide would visit Patient 4 once a week for three weeks. During a review of Patient 4’s medical record, there was no documentation indicating the home health aide was supervised during the certification period of 7/29/25 to 9/26/25. During an interview on 3/19/26 at 12:49 p.m. with Operations Support (OS), OS confirmed there were no documented supervised home health aide visits. OS stated the expectation was for home health aides to be supervised every 14 days. OS acknowledged risk for inappropriate services when the home health aide was not supervised. During a review of the HHA’s policy and procedure (P&P) titled, “Home Health Aide Supervision,” dated 5/1/99, the P&P indicated, “…the Registered Nurse and/or Qualified Therapist…will supervise the Home Health Aides according to State and Federal Conditions of Participation…California….at least every 14 days, with our without aide present…””