Ardent Home Health of Fresno

“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 control practices were followed to prevent the risk of cross contamination (the inadvertent transfer of harmful microorganisms or other contaminants from one substance or surface to another) for one of seven sampled patients (Patient 2) when Home Health Aide (HHA) 1 stored clean items in a bin designated for dirty items. This failure had the potential to expose patients to infection. Findings: During a concurrent observation and interview on 9/11/25 at 10:39 a.m. with HHA 1, a clear large bin labeled “dirty” was observed containing a smaller bin labelled “clean” inside. HHA 1 stated, she placed the clean bin inside the dirty bin to prevent it from moving while driving up the mountain. HHA 1 stated she cleaned the dirty bin and believed it was acceptable to place her clean items inside. HHA 1 stated “I would put my extra items in the dirty bin.” HHA 1 stated she stored scrubs and personal protective equipment (PPE) in the dirty bin. HHA 1 stated the dirty bin was intended for trash brought from patients’ homes. HHA 1 stated clean items could be stored in the dirty bin if it had been cleaned. HHA 1 stated she did not remember the last time she had a in service on trunk storage. HHA 1 stated trunk box was cleaned monthly. HHA 1 stated she did not remember the last time staff had checked her trunk box. During an interview on 9/11/25 at 1:40 p.m. with Registered Nurse (RN) 1, RN 1 stated HHA 1 should not store clean items in the dirty bin. RN 1 stated clean and dirty items must always be kept separate, and once clean items are placed in a dirty bin, they are considered contaminated. RN 1 stated storing clean items in the dirty bin could cause cross-contamination and placed patients at risk for infections. During an interview on 9/15/26 at 9:43 a.m. with the Director of Patient Care Services (DPCS), the DPCS stated she expected staff members to always practice infection control when providing patient care. The DCPS stated staff members were required to receive annual training on infection control. The DCPS stated clean and dirty items must be designated and should not have been mixed. The DCPS stated cleaning the dirty bin was not acceptable practice for storing clean items inside. The DCPS stated the dirty bin was designated solely for dirty items and should not contain clean supplies. The DCPS stated the best practice was to store clean items in clean areas and dirty items in dirty areas. The DCPS stated storing clean items in the dirty bin could have caused cross-contamination and resulted in staff bringing germs into the patient’s home. During a review of Patient 2’s “Home Health Certification” dated 9/5/2025 the “HHCPS” indicated, Patient 2 start of care date was 9/5/2025 with diagnosis of encounter for other orthopedic aftercare [follow-up care after orthopedic procedures or treatments, such as surgeries, casts, or braces]… HHA effective 09/07/2025 1WK4 [one time a week for four weeks]...” During a review of the agency job description (J/P) titled, “Job title/Position: Certified Home Health Aide” dated 5/2022, the “J/P” indicated, “The home health aide is a paraprofessional member of the home care team...performs various personal care services necessary to meet the patient’s need...Essential Job Function/Responsibilities...meeting safety needs of patients and using equipment safely and properly...adhering to the organization’s documentation and care procedures and standards of personal and professional conduct...” During a review of the agency’s policy and procedures (P&P) titled, “Risk Management: Infection Control and Safety Control: Stand Precaution Policy No. 6-004.1” dated 5/2025, the P&P indicated, “Any nondisposable equipment returned to organization stock will be transported in a designated dirty area in trunk...” During a review of the professional article titled, “CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, “dated 4/12/2024, retrieved from, https://www.cdc.gov/infection-control/hcp/core-practices/index.htm, the article indicated, “Adherence to infection prevention and control practices is essential to providing safe and high quality patient care across all settings where healthcare is delivered...The core practices in this document should be implemented in all settings where healthcare is delivered. These venues include both inpatient settings (e.g., acute, long-term care) and outpatient settings (e.g., clinics, urgent care, ambulatory surgical centers, imaging centers, dialysis centers, physical therapy and rehabilitation centers, alternative medicine clinics). In addition, these practices apply to healthcare delivered in settings other than traditional healthcare facilities, such as homes, assisted living communities, pharmacies, and health fairs. Healthcare personnel (HCP) referred to in this document include all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances, contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air... Reprocessing of Reusable Medical Equipment... Maintain separation between clean and soiled equipment to prevent cross-contamination...””

“Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This Standard is not met as evidenced by: Based on observations, interviews, and record reviews, the agency failed to ensure professional standards of practice were followed for three of seven sampled patients (Patient 1, Patient 2, and Patient 3) when clinicians did not evaluate the patient’s medication regimens by updating a current and accurate medication profile in the clinical record. This failure placed Patient 1, Patient 2, and Patient 3 at risk for medication errors, duplicate medications, and potential adverse outcomes related to their medications. Findings: During an interview on 9/9/25 at 3:52 p.m. with the Director of Patient Care Services (DPCS), the DCPS stated all clinicians should have been checking medication with each visit. During an observation and interview on 9/10/25 at 9:30 a.m. in Patient 1’s room, the Physical Therapy Assistance (PTA) did not review the medications profile list. During an observation on 9/10/25 at 10:10 a.m. in Patient 1’s room, Patient 1 medication bottles included glipizide [oral medication used to treat type 2 diabetes] 2.5 mg [milligram-unit of measurement]: take 1 tablet by mouth daily, pantoprazole [used to treat certain conditions in which there is too much acid in the stomach] 40 mg: take 1 tablet by mouth daily, atorvastatin [prescription medication used to lower cholesterol and reduce the risk of heart disease] 80 mg: take 1 tablet by mouth daily, clopidogrel [an antiplatelet medication used to prevent blood clots in people with a history of heart attack, stroke, or other cardiovascular issues] 75 mg: take 1 tablet by mouth daily, pramipexole [prescription medication used to treat Parkinson’s disease and restless legs syndrome] 0.25mg take 1 tablet by mouth daily and gabapentin [anticonvulsant medication used to treat seizures and nerve pain] 300 mg -take 1 capsule by mouth at bedtime. During an interview on 9/10/25 at 10:23 a.m. with the PTA, the PTA stated he reviewed the care plan (personalized, evolving documents that details an individual’s health and support needs, outlining specific services, goals, and outcomes in collaboration with the individual, family, and healthcare team) before seeing patients. The PTA stated he would have communicated with the Physical Therapist if there had been any issues with patient care. The PTA stated he asked Patient 1 about taking any new medications. The PTA stated Patient 1 denied any medications changes; therefore, he did not review the medication list. During an interview on 9/10/25 at 10:45 a.m. with Patient 1, Patient 1 stated he was taking six pills daily, three pills in the morning and three pills at night. Patient 1 stated he was no longer taking [Brand name drug] because it was too expensive and he could not afford it. Patient 1 stated the agency had not reviewed his medications with him. Patient 1 stated a nurse from the agency had previously asked about his medications, but he had not seen the nurse for some time. During an interview on 9/10/25 at 11:20 a.m. with the DPCS, the DPCS stated skilled nursing was ordered for medication management for one week, repeated over three weeks. The DPCS stated, Patient 1 had three nursing visits for medication management before the services were discontinued. The DPCS stated the PT and PTA should have updated the medication list after the nursing services were discontinued. The DPCS stated the PT was responsible for any updates to the care plan. The DPCS stated, “We don’t want patient to be taking medication they should not be taking, and we need to be aware of what medications the patient were taking in case of any medication interactions.” The DPCS stated, the clinicians should update the medication profile and ensure patients were taking the correct medications. The DPCS stated, updating the medication list and reviewing medications was important to ensure the patients received education on side effects of the medications. During an interview on 9/15/25 at 3:25 p.m. with the PT, the PT stated the PTA should have been updating or checking on patients’ medication. The PT stated clinicians should have asked patients if there were any new medications. The PT stated Patient 1 was living in a Residential Care Facility for the Elderly (RCFE-s a licensed, non-medical residential facility in California for people aged 60 and older who need assistance with daily activities but do not require 24-hour skilled nursing care), and he should have spoken to staff members and checked for any changes in medications. The PT stated Patient 1 had been taking [brand name medication] at the beginning of services, but stopped taking it at some point, and he was unsure when Patient 1 stopped taking his medication. The PT stated Patient 1 did not report changes in medications, and the medication should have been updated at each visit. The PT stated failing to check the medication list could have resulted in medication errors for Patient 1. During a review of Patient 1’s “Home Health Certification [physician’s or allowed practitioner’s (like a Nurse Practitioner or Physician Assistant) attestation that a Medicare beneficiary is eligible for home health services] and Plan of Care ((document outlining the specific medical, rehabilitative, and supportive care a patient will receive at home) (HHCPS))” dated 7/18/25, the “HHCPS” indicated, Patient 1 start of care date was 7/18/25 with diagnoses of type 2 diabetes mellitus, long term use of anticoagulants…[line] SN [skilled nursing] 1 wk3 [one times a week for 3 weeks], PT skilled nurse for monitoring and management of effectiveness of anticoagulant therapy regime and skilled teaching related to anticoagulant management, skilled nursing to intervene with effectiveness anticoagulant therapy…medications: atorvastatin 80mg tablet…[brand name drug] 5 mg tablet…fluticasone propionate [corticosteroid medication used to reduce inflammation caused by conditions such as allergies, asthma, and skin problems] 50 mcg [microgram-unit measurement] glipizide 5 mg…” There were a total of four medications listed. During an observation on 9/11/25 at 10:37 a.m. with Patient 2 in the living room, the following medications and supplements were observed: Hydrocortisone 5 mg: take 3 tablets daily (a medication used to reduce inflammation, suppress the immune system, and replace low levels of cortisol in the body) Hydromorphone 4mg: take 1 tablet every four hours as needed (pain medication) Cyclobenzaprine 10 mg: 1 tab by mouth daily (muscle relaxant) Gabapentin 300 mg: 1 cap three times a day, colchicine (anti-inflammatory medication) 0.6 mg; 1 tab by mouth daily, Potassium chloride 20 mEq [milliequivalents-a unit of chemical activity for electrolytes like sodium and potassium]: 2 tabs by mouth twice a day (medicine use as a salt substitute) Docusate sodium100 mg: 2 tabs by mouth twice a day (stool softener) Cetirizine 10 mg: 2 tablets by mouth daily (medication for allergies) Fluticasone salmeterol 50 mcg/ 250 mcg (combination medication to treat asthma) Hydrocodone/acetaminophen 10/ 325 mg: 1 tab every 6 hours as needed (combined pain medication to treat severe pain) Citalopram 10 mg: 1 tab by mouth daily (medication for depression) Tizanidine 2 mg; take 1 or 2 capsules at bedtime (muscle relaxant) Atenolol 2 mg; ½ tab by mouth daily (medication use to treat high blood pressure) Rosuvastatin 20 mg; 1 tablet daily (medication used to treat high fat level in the blood) Biotin 2500 mcg: 2 gummies daily (supplement) Collagen 120 mg; 2 gummies daily (supplement) Calcium 500 mg w/ Vit D 25 mg & Zinc 7 mg 2 gummies daily, (supplement) Multivitamin 2 tabs daily (supplement) Metformin 500 mg: 2 tab by mouth with evening meal (medication use to treat high sugar level) Amlodipine 2.5 mg; 1 tab by mouth daily, (medication used to treat high blood pressure) Vitamin C 1000 mg; 1 tab by mouth daily (supplement). During a concurrent observation and interview on 9/11/25 at 11:02 a.m. with Patient 2, a bottle of hydromorphone [opioid pain medication used to treat moderate to severe pain] 4 mg [milligram-unit of measurement] hydromorphone bottle was on the nightstand next to Patient 2. Patient 2 stated the agency had sent a nurse to admit her to service on 9/5/25. Patient 2 stated she had been taking hydromorphone 4 mg for pain at the time of admission and planned to finish the remaining hydromorphone before starting a new bottle of hydrocodone/acetaminophen. Patient 2 stated the nurse did not review her medications with her, did not look at her medication bottles, and did not assess what medications she was currently taking. During an interview on 9/15/25 at 9:28 a.m. with the RNCM, the RNCM stated they had begun reviewing Patient 2’s medication list, but Patient 2’s husband was going to pick up the medications from the pharmacy. The RNCM stated, “I think it [hydromorphone] was on the list, at the time of visit. The RNCM stated the nurse was scheduled to review the medication during the second visit. The RNCM stated nurses should have contacted the physician to update Patient 2’s current medications after the visits. The RNCM stated she did not remember seeing the bottle of hydromorphone. The RNCM stated she had been waiting for Patient 2’s husband to return before reviewing the medications, but he did not return. During an interview with on 9/15/25 at 11:05 with the Quality Assurance Registered Nurse (QARN), the QARN stated Patient 2 had been taking hydrocodone/acetaminophen 10/325mg at admission, and it should have been documented in Patient 2’s medication profile and but was not. The QARN stated it was important to document Patient 2’s medications to prevent duplicate therapy and adverse outcome. During a review of Patient 2’s “Home Health Certification” dated 9/5/2025 the “HHCPS” indicated, Patient 2 start of care date was 9/5/2025 with diagnosis of encounter for other orthopedic aftercare [follow-up care after orthopedic procedures or treatments, such as surgeries, casts, or braces]…medications: atenolol 25 mg tablet, baclofen [medication to treat muscle spasms] 10mg, citalopram 10mg, clonidine 0.1 mg tablet, colchicine 0.6 mg, gabapentin 300 mg, rosuvastatin 20mg tablet…” There was a total of seven medications on the medication profile listed. During an observation on 9/11/25 at 1:05 p.m. in Patient 3’s living room, three bottles of medication were observed on the table. During an interview on 9/11/25 at 1:41 p.m. with the RNCM, the RNCM stated nurses, and other licensed clinicians should have updated the medication profile with each visit. The RNCM stated staff should have checked the medications with each visit to prevent patients from taking duplicate medications. RNCM stated the nurse should check medication bottles and compared them to the medication profile list. The RNCM stated patients could have taken duplicate medications. The RNCM stated patients should have been educated about side effects of the medications. The RNCM stated patients could experience adverse outcomes when medications were changed or when they did not take medications as directed by the physician, and physicians needed to be aware of these changes. During an observation and interview on 9/11/25 at 2:02 p.m. with Patient 3, Patient 3 medications were reviewed. Three medication bottles were observed: Amlodipine 2.5 mg 1 tablet by mouth daily (for blood pressure control) Culturelle 10 billion cell capsules: 1 capsule daily (probiotic supplement) Metformin 500 mg tablet, take two by mouth daily. (for blood sugar control) Patient 3 stated he had been taking amlodipine 2.5 mg for two months for his blood pressure. Patient 3 stated he had originally been prescribed 2.5 milligrams of amlodipine but stopped taking it because it caused his blood sugar to rise. Patient 3 Stated his previous physician had retired, and his new physician prescribed amlodipine 5 milligrams, but he resumed his old 2.5 milligrams dose. Patient 3 stated the nurses did not look at the medication bottles and did not ask about any medication changes. During a review of Patient 3’s “Home Health Certification”, dated 8/25/25 the “HHCPS” indicated, Patient 3 start of care date was 8/25/25 with diagnoses of hypertension [high blood pressure], type 2 diabetes mellitus, laceration [ a tear or cut in the skin that causes bleeding] of foreign object, history of falls…medications: amlodipine 5 mg tablet, cefpodoxime 200 mg tablet, Culturelle 10 billion cell cap, metformin 500 mg tablet…” There was a total of four medications listed on the profile. During a review of the agency policy and procedures (P&P) titled, “Medication Profile” dated revised 5/2024, the P&P indicated, “To define the use of the medication profile in evaluating a patient’s medication regimen including over-the-counter (OTC) medications, nutrition supplements, herbal remedies, vitamins and minerals…Patient receiving medication administered by the organization will have a current, accurate medication profile in the clinical record, medication profiles will be updated for each change to reflect current medications, new and /;or discontinued medication…Upon admission to the organization, the admitting clinician will initiate a medication profile to document the current medication regimen, including name dose, strength, route, frequency, date and time of administration…” During a review of a professional article titled, “Medication Dispensing Errors and Prevention” dated 2/12/2024, retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519065/, the article indicated, “Medication errors rank as the most frequent and avoidable source of patient harm. They can manifest at various points in the healthcare process, ranging from prescribing to actual drug administration…Medication errors rank as the most frequent and avoidable source of patient harm. They can manifest at various points in the healthcare process, ranging from prescribing to actual drug administration…Medication errors rank as the most frequent and avoidable source of patient harm. They can manifest at various points in the healthcare process, ranging from prescribing to actual drug administration… Preventing medication errors requires an understanding of the causes and types of medication errors as well as when during the prescribing process mistakes can occur…System Failures…Inaccurate order transcription…Incomplete order checking…Poor interprofessional communication…Unavailable or inaccurate patient information…According to the World Health Organization’s publication titled “Medication Errors: Technical Series on Safer Primary Care,” the following factors have been associated with an increased risk of medication errors in the primary care setting…Lack of accuracy of patient records…Poor communication with secondary care providers…Types of Medication Errors: Prescribing, Omission, Wrong time, Unauthorized medication, Improper dose, Wrong dose prescription or wrong dose preparation, Administration errors such as incorrect route of administration, administering the drug to the wrong patient, extra dose, or wrong rate…””

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure the physician was notified for one of seven sampled patients (Patient 1) when Patient 1’s primary care physician (PCP) was not notified that Patient 1 had stopped taking Eliquis (medication used to prevent and treat blood clots [a mass of blood that forms when cells in the blood stick together]). This failure had the potential to result in Patient 1 developing a blood clot or stroke (a medical condition that occurs when blood flow to the brain is interrupted or reduced, leading to brain cell damage or death). Findings: During a review of Patient 1’s “Home Health Certification and Plan of Care” (HHCPC), dated 7/25/25, the HHCPC indicated Patient 1’s start of care with the agency was on 7/18/25. The HHCPC indicated Patient 1 was admitted to the agency with diagnoses which included hemiplegia (paralysis or weakness on one side of the body) following cerebral infarction (a condition where blood flow to the brain is interrupted, causing brain tissue to die), affecting the right side. The HHCPC indicated Patient 1 was to receive skilled nursing (specialized medical care provided by licensed healthcare professionals, such as nurses) visits once a week for three weeks, and physical therapy (PT – the treatment of disease, injury, or physical conditions by methods such as message, heat treatment, and exercise rather than by drugs or surgery) once a week beginning 8/3/25. The HHCPC indicated Patient 1 was taking Eliquis 5 mg (milligrams – unit of measurement). During an interview on 9/10/25 at 10:22 a.m. with Patient 1, Patient 1 stated he had not been taking Eliquis for three weeks. Patient 1 stated he took Eliquis to prevent blood clots due to his history of stroke. During an interview on 9/10/25 at 2:40 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated since Patient 1’s skilled nursing visits were discontinued after three weeks, the Physical Therapist (PT) should be reviewing Patient 1’s medications at every home visit and informing his physician of any changes. During an interview on 9/15/25 at 3:45 p.m. with the PT, the PT stated Patient 1 should be taking Eliquis, since it was listed on the HHCPC. The PT stated it was important for Patient 1 to take Eliquis because of his history of stroke. The PT stated he did not know Patient 1 was not taking his Eliquis. The PT stated he should have known Patient 1 was not taking his Eliquis and notified Patient 1’s PCP. The PT stated it was important to notify Patient 1’s PCP that he had stopped taking Eliquis because it could lead to a blood clot or stroke. During an interview on 9/16/25 at 1:30 p.m. with Medical Doctor (MD) 1, MD 1 stated she was the PCP for Patient 1, and she oversaw Patient 1’s care. The PCP stated she was not notified by agency staff that Patient 1 was not taking his Eliquis. During an interview on 9/16/25 at 2:44 p.m. with the Quality Assurance Registered Nurse (QARN), the QARN stated that all licensed disciplines, including the PT, should be verifying patient medications and communicating any changes with the physician. The QARN stated it was important for the PT to update Patient 1’s PCP that he was not taking Eliquis because it could cause a stroke. During a review of the agency’s policy and procedure (P&P) titled, “Monitoring Patient’s Response/ Reporting to Physician”, dated 5/2024, indicated, “Clinicians will establish and maintain ongoing communication with the physician … to ensure safe and appropriate care for the patient … During each home visit, the clinician will monitor the patient’s response to care against the established goals including, but not limited to: … Medications … The patient’s physician … will be contacted on the same day when any of the following occur: … Changes that have occurred regarding diagnosis, prognosis, or treatment (including … medications …).””

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on interview and record review, the agency failed to include documentation in the clinical record for one of seven sampled patients (Patient 1) when Patient 1’s clinical record did not include communication from agency staff to Patient 1’s referring physician regarding occupational therapy (OT - a healthcare profession that aims to improve individuals’ ability to perform daily activities) services not being offered by the agency. This failure resulted in Patient 1’s clinical record not including communication from agency staff to the referring physician and had the potential to affect Patient 1’s coordination of care. Findings: During a review of Patient 1’s “Home Health Certification and Plan of Care” (HHCPC), dated 7/25/25, the HHCPC indicated Patient 1’s start of care with the agency was on 7/18/25. The HHCPC indicated Patient 1 was admitted to the agency with diagnoses which included hemiplegia (paralysis or weakness on one side of the body) following cerebral infarction (a condition where blood flow to the brain is interrupted, causing brain tissue to die), affecting the right side. During an interview on 9/10/25 at 2:40 p.m. with the Director of Patient Care Services (DPCS), the DPCS stated Patient 1 was not provided with OT services because the agency did not have an OT. The DPCS stated it was communicated verbally to Patient 1’s referring physician that the agency did not provide OT services. The DPCS stated this communication was not clearly documented in patient 1’s medical record. The DPCS stated that it is important to clearly document communication regarding patient care in the clinical record to ensure coordination of care. During a concurrent interview and record review on 9/16/25 @ 1:47 p.m. with the Intake Coordinator (IC), Patient 1’s “Discharge Communication Order request by Physician”, dated 7/17/25, was reviewed. The IC stated she received a referral for Patient 1 on 7/17/25 with orders from the referring physician for “RN (Registered Nurse) Medication Management”, “Physical Therapy”, “Occupational Therapy”, and “Home Health Aide”. The IC stated she communicated verbally with staff from the referring facility that OT services were not offered by the agency, but she did not document the communications in Patient 1’s clinical record. The IC stated it’s important to document all communication regarding patient care in the clinical record so the physician and other agency staff are aware of what is going on with the patient. The IC stated it is important to document all communication regarding patient care to ensure coordination and continuity of care. During a review of the agency job description for “Clinical Director/ Director of Patient Care Services (Clinical Manager), dated 5/2022, the job description indicated, “Oversees the maintenance of patient clinical records … assures proper maintenance of clinical records in compliance with local, state and federal laws.” During a review of the facility’s policy and procedure titled, “Contents of Clinical Record”, dated 5/2024, indicated, “The clinical record will contain sufficient information to … facilitate continuity of care … The following information will be available in the clinical record for patients … relevant communication to the patient’s physician …””