Top Care Home Health

“HHA Comprehensive Assessment in Disaster CFR(s): 484.102(b)(1) §484.102(b)(1) Condition for Participation: [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (1) The plans for the HHA’s patients during a natural or man-made disaster. Individual plans for each patient must be included as part of the comprehensive patient assessment, which must be conducted according to the provisions at §484.55. This Standard is not met as evidenced by: Based on interviews and record review, the agency failed to complete the Individual Patient Emergency Preparedness Plan (IPEPP- is a written guide for unexpected events), per the agency’s policy and procedure, for 2 of 7 sampled patients (Patients 6 and 7) . This failure risks interruption of essential services during an emergency like natural disasters, power outages, or other events affecting patient care. Findings: 1. Per the Home Health Certification and Plan of Care (POC), dated 5/28/26 through 7/26/26, Patient 5 was admitted to the agency on 5/28/26 with diagnoses that included cervical disc degeneration (a condition where the discs between the neck bones gradually break down, leading to possible neck pain and stiffness). A review of Patient 5’s clinical record was conducted. Per the undated IPEPP, under the questions Shelter Location, Registered for Special Needs Shelter, Registered for At Risk Registry, and the Acuity Level, were blank. 2. Per the Home Health Certification and Plan of Care (POC), dated 5/23/26 through 7/21/26, Patient 6 was admitted to the agency on 5/23/26 with diagnoses that included heart disease. A review of Patient 6’s clinical record was conducted. Per the IPEPP, dated 5/23/26, the questions Shelter Location, Registered for Special Needs Shelter, Registered for At Risk Registry, and the Acuity Level were blank. On 6/3/26 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that on admission, the clinician will assess the patient’s level of need and will categorize the patient. Level 1 stable patients, who do not need urgent care, Level 2, who moderately need help, and Level 3, who are the unstable patients who need help right away from the agency in case of emergency. The DPCS stated that Patients 6 and 7’s IPEPP were not completed. The DPCS further stated it was important for the IPEPP to be accurate and completed to avoid confusion amongst the staff, and to identify the patients who need the most immediate care. Per the agency’s policy and procedure, dated 11/24, titled Emergency Management Plan, “…the patient will be placed in one of three categories for triaging patient care in the event the emergency management plan (operations) is implemented…The agency maintains a hard-copy of a current patient list including contact information and categories identified for each patient in the event there is a power failure…””

“EP Training and Testing CFR(s): 484.102(d) §403.748(d), §416.54(d), §418.113(d), §441.184(d), §460.84(d), §482.15(d), §483.73(d), §483.475(d), §484.102(d), §485.68(d), §485.542(d), §485.625(d), §485.727(d), §485.920(d), §486.360(d), §491.12(d), §494.62(d). *[For RNCHIs at §403.748, ASCs at §416.54, Hospice at §418.113, PRTFs at §441.184, PACE at §460.84, Hospitals at §482.15, HHAs at §484.102, CORFs at §485.68, REHs at §485.542, CAHs at §486.625, “Organizations” under 485.727, CMHCs at §485.920, OPOs at §486.360, and RHC/FHQs at §491.12:] (d) Training and testing. The [facility] must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least every 2 years. *[For LTC facilities at §483.73(d):] (d) Training and testing. The LTC facility must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually. *[For ICF/IIDs at §483.475(d):] Training and testing. The ICF/IID must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least every 2 years. The ICF/IID must meet the requirements for evacuation drills and training at §483.470(i). *[For ESRD Facilities at §494.62(d):] Training, testing, and orientation. The dialysis facility must develop and maintain an emergency preparedness training, testing and patient orientation program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training, testing and orientation program must be evaluated and updated at every 2 years. This Standard is not met as evidenced by: Based on interview and record review, the agency failed to participate in community wide emergency preparedness drills. This failure had the potential to cause the agency to be unprepared to care for patients during a natural disaster. During an interview on 6/4/26 at 9:35 A.M. with the Director of Patient Care Services (DPCS), the DPCS stated “…we did not participate in a community drill, last year we had in-services and before that we just reviewed the policy…” The DPCS continued “…by not participating we do not know how to coordinate with the other agencies in San Diego…” During a review of the agency’s Emergency Preparedness records, there was no evidence of participation in a community wide drill for the prior three years. During a review of the agency’s policy and procedure titled Emergency Management Plan Policy No. 6-037 revised November 2024, indicated “…Testing…2. The agency participates in a full-scale exercise that is community based…every two (2) years.””

“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 agency failed to ensure infection prevention was followed for 1 of 2 home visits conducted. This failure had the potential to expose other patients to the germs. Findings: Per the Home Health Certification and Plan of Care (POC), dated 5/23/26 through 7/21/26, Patient 6 was admitted to the agency on 5/23/26 with diagnoses that included heart disease. On 6/3/26 at 10 A.M., during the home visit, Physical Therapy (PT) 1 was observed with the blood pressure (BP) machine, thermometer, and alcohol swabs in the sealable plastic bag. PT 1 placed the BP machine on an empty chair without a protective barrier. After failing to get a reading, PT 1 placed the uncleaned BP machine on the upper left section of the clean barrier. PT 1 said, “I’m sanitizing the BP machine,” and placed the BP machine inside the sealable plastic bag. Upon further observation, there was no used alcohol swab noted on the barrier. After contact with Patient 6’s skin, PT 1 said she needed to check Patient 6’s temperature. PT 1 reached into the sealable bag without cleaning her hands. PT 1 took Patient 6’s thermometer, sanitized the equipment, but then placed the thermometer on the dirty area where the hand sanitizer and the BP machine were placed. PT 1 then placed the thermometer inside the sealable plastic bag. After the exercises, PT 1 was seen holding both the sealable plastic bag and the dirty barrier. An interview was conducted with PT 1. PT 1 stated she put the used alcohol swab in her pocket after sanitizing the BP machine because there was no trash can around. PT 1 also said that she realized that she should not have placed the dirty BP machine on the barrier, but it was already too late, and she contaminated the clean area. PT 1 further stated she had contaminated that clean side and should not have placed the cleaned thermometer on the dirty side, to prevent cross-contamination. PT 1 stated that she was holding the used barrier because there was no trash can around, and she did not want to go inside Patient 6’s house to dispose of it. PT 1 stated she will dispose of the used barrier in her car, but she could not find a plastic bag to secure the used barrier. PT 1 placed the used barrier in the passenger side floor of her vehicle. PT 1 stated that she did not follow the infection control guidelines. On 6/3/26 at 1:45 P.M., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that PT 1 called her, and they had discussed actions that PT 1 had taken during the home visits. The DPCS stated PT 1 did not follow the infection control guidelines to prevent cross-contamination. Per the agency’s policy and procedure, dated 11/25, titled Bag Technique, “...Prior to administering care, alcohol-based hand rub or soap, and paper towels will be removed, and hands will be washed. These supplies will be left at the sink for hand washing at the end of the visit. Hand washing will always be completed before operating the bag...The clean area contains unused or cleaned supplies/equipment, and the dirty area is designated for contaminated materials…protective barrier for bag placement in the patient’s home, they will be discarded.””

“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 interview and record review, the agency failed to complete the Start of Care (SOC) visit within 48 hours of the referral date for 1 of 7 sampled patients (Patients 7). As a result, the Home Health Agency (HHA) did not provide care and services in a timely manner for Patients 7. Per the Home Health Certification and Plan of Care (POC), dated 5/12/26 through 7/10/26, Patient 7 was admitted to the agency on 5/12/26 with diagnoses that included diabetes mellitus (abnormal blood sugar level). A review of Patient 7’s clinical record was conducted. Per the Clinic document, dated 5/7/26, Patient 7 was referred to this Home Health Agency on 5/7/26. The HHA did not start the care until 5/12/26, which indicated five days of delay in SOC. On 6/3/26 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that Patient 7’s was delayed and should not have been. The DPCS further stated the agency should conduct the SOC within 48 hours of the referral to ensure the patient’s needs were addressed. Per the agency’s policy and procedure, dated 11/24, titled Intake Process, “…The initial assessment visit will be performed either 48 hours of the referral, or within 48 hours of a patient’s return home…””

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure the referral order for 1 of 7 sampled patients (Patient 6) was followed when the physician ordered a Certified Home Health Aide (CHHA). As a result, Patient 6 did not receive the necessary care and services. Findings: Per the Home Health Certification and Plan of Care (POC), dated 5/23/26 through 7/21/26, Patient 6 was admitted to the agency on 5/23/26 with diagnoses that included heart disease. A review of Patient 6’s clinical record was conducted. Per the Referral Discharge Order, dated 5/18/26, Patient 6 was to be discharged on 5/22/26 with Home Health Physical Therapy, Occupational Therapy, Registered Nurse, and Home Health Aide services. Further review of Patient 6’s clinical record indicated that Patient 6 had not been seen by the CHHA. Skilled Nurse (SN) 1 was not available for an interview. On 6/3/26 at 1:45 P.M., an interview and joint record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that SN 1 missed the physician’s order for CHHA service. The DPCS stated it was important to follow the physician’s order to ensure continuity of care. Per the agency’s policy and procedure, dated 11/24, titled Intake Process, “…If service can not be provided, intake personnel will give the caller the names of other agencies that can provide the required services…” Per the agency’s policy and procedure, dated 11/24, titled Care/Service Coordination, “…To ensure the coordination of services for each patient and to minimize the potential for missed, conflicting, or duplicated services…each patient will be assigned a Case Manager upon admission…””

“Required items in clinical record CFR(s): 484.110(a)(1) The patient’s current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This Element is not met as evidenced by: Based on interviews and record review, the agency failed to ensure a patient’s clinical record was accurate for 1 of 7 sampled patients (Patient 4) when Patient 4’s Individual Patient Emergency Preparedness Plan Assessment (IPEPPA- is a written guide for unexpected events), had conflicting information with the Comprehensive Assessment (a thorough evaluation of a patient’s needs to create a personalized care plan that ensures safe and effective care). This failure could lead to confusion among staff and potentially affect the care and services provided to Patient 4 during an emergency. Findings: Per the Home Health Certification and Plan of Care (POC), dated 5/15/26 through 7/13/26, Patient 4 was admitted to the agency on 5/15/26 with diagnoses that included abnormal gait (walking) and mobility (movement). A review of Patient 4’s clinical record was conducted. Per the undated IPEPPA, Patient 4 requires Level 2 help in case of emergency. However, the Comprehensive Assessment dated 5/15/26 indicated that Patient 4 was placed on Level 3. On 6/3/26 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that on admission, the clinician will assess the patient’s level of need and will categorize the patient. Level 1 stable patients, who do not need urgent care, Level 2, who moderately need help, and Level 3, who are the unstable patients who need help right away from the agency in case of emergency. The DPCS further stated that Patient 4’s emergency plan had a discrepancy. The DPCS stated it’s important that the emergency assessments were accurate to avoid confusion amongst the staff who need the most immediate care, and were treated first. Per the agency’s policy and procedure, dated 11/24, titled Contents of Clinical Record, “…The clinical records will contain sufficient information to identify the patient, describe the patient’s problems and needs, justify care, accurately document care provided and results in detail…” Per the agency’s policy and procedure, dated 11/24, titled Emergency Management Plan, “…the patient will be placed in one of three categories for triaging patient care in the event the emergency management plan (operations) is implemented…””