Day Kimball Homecare

“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 surveyor observations, review of clinical records, agency documentation and staff interviews for one of seven patients (Patient #3), receiving skilled nursing or therapy services during a home visit, the agency licensed personnel failed to utilize accepted infection control practice techniques during the nursing visit. The findings include. Patient #3 had a start of care date of 12/29/25 and diagnoses that included hypertensive heart and chronic kidney disease with heart failure and sick sinus syndrome. The physician orders dated 12/29/25 included nursing services weekly for assessments. During a joint home nursing visit with Registered Nurse/RN #1 on 1/12/26 at 1:25 PM, the surveyor observed RN #1 remove the electronic thermometer from her bag, drop the thermometer on the patients rug and proceeded to check his/her temperature moving the thermometer across the forehead without the benefit of sanitizing after the thermometer was picked up from the carpet. After the thermometer was used, the RN sanitized using an alcohol wipe. A subsequent interview with the RN indicated that she sanitized the thermometer after checking the patient’s temperature and indicated that she should have sanitized it after it dropped on the rug. Interview and review of the home visit on 1/12/26 at 2 PM with the Administrator identified that RN #1 should have sanitized the thermometer after it fell on the carpet and failed to follow the agency policy for Infection Control. Review of the agency policy for cleaning and disinfection of non-critical equipment, electronic thermometers, directed these items should be cleaned with a disinfectant when visibly soiled and on a regular basis, as needed and after each patient use.”

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on clinical record reviews, reviews of agency documentation and staff interviews, for one of four patients (Patient #4) who required wound care, the agency licensed personnel failed to ensure weekly wound measurements were conducted in accordance with the agency policy. The findings include: Patient #4 had a start of care date of 11/07/25 and diagnoses that included type II diabetes mellitus, heart failure, right ankle and foot wound and left above knee amputation. The physician orders for the certification periods of 11/07/25 to 3/06/26 included nursing services three times a week for assessments, blood glucose monitoring and wound care to the right outer ankle wound and between right first and second toes. Additionally, physical therapy and occupational therapy services were provided. Review of the clinical record from 12/02/25 to 1/12/26 identified the presence of a right outer ankle wound measuring 6.5 centimeters/cm x 4 cm x 0 cm and a right second toe surgical wound measuring 2 cm x 1.5 cm x 0.5 cm, but failed to identify weekly wound measurements of the right second toe the weeks of 12/07/25 and 12/28/25 and the right outer ankle the week of 12/28/25. Interview and review of the clinical record with the Administrator and SCS on 1/14/26 at 1:10 PM failed to identify weekly wound measurements in accordance with agency policies. The agency policy for Wound Care Guidelines directed at least every week, the wound assessment and documentation will include measurement of length, width, depth and undermining and tunneling if present.”

“Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This Element is not met as evidenced by: Based on reviews of agency documentation and staff interview, for two of seventeen patients (Patient #4 & 11) in the survey sample, the agency failed to update the comprehensive assessment within the last five days of every sixty-day period. The findings include: Patient #4 had a start of care date of 11/07/25 and diagnoses that included type II diabetes mellitus, heart failure, right ankle and foot wound and left above knee amputation. The physician orders for the recertification period of 1/06/25 to 3/06/26 included nursing services three times a week for assessments, blood glucose monitoring and wound care to the right outer ankle wound and between right first and second toes. Additionally, physical therapy and occupational therapy services were provided. Review of the clinical record identified a Registered Nurse/RN nursing visit on 1/02/26 (four days prior to the recertification period) but lacked evidence that the recertification assessment was completed at that time and the subsequent RN visit on 1/07/26 (one day after the recertification period) was identified as the recertification visit. Interview and review of the clinical record with the Administrator on 1/14/26 at 12 PM indicated that there should have been a nursing visit scheduled for 1/05/26 but it had not been put on the schedule and failed to identify the updating of the comprehensive assessment within the last five days of the sixty-day period (prior to 1/06/26). Patient #11 had a start of care date of 1/03/25 and diagnoses that included malignant neoplasm of the right lung with metastasis to the liver and kidney, chronic obstructive pulmonary disease and type II diabetes mellitus. The physician orders for the recertification period of 11/01/25 to 12/28/25 and 12/29/25 to 2/26/26 included nursing services two times a week for assessments. Review of the clinical record identified a Licensed Practical Nurse/LPN nursing visit on 12/26/25 (two days prior to the recertification period) but lacked evidence that the recertification assessment was completed by an RN, with a subsequent RN visit completed on 12/29/25 (one day past the certification expiration date and the same day of the next start of the recertification period) was identified as the recertification visit. Interview and review of the clinical record with the Administrator on 1/14/26 at 10 AM failed to identify an update to the comprehensive assessment within the last five days of the sixty-day period (prior to 12/29/25). Review of agency policy for Outcome and Assessment Information Set/OASIS directed all assessments will be completed within the framework of applicable law and regulation and the plan of care will be reviewed at least every sixty days.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on a review of agency documentation and staff interviews, for two of four patients (Patient’s #3 & 4) requiring weight monitoring for a diagnosis of congestive heart failure, the agency nurses failed to ensure the plan of care addressed the patient’s individual needs. The findings include: Patient #3 had a start of care date of 12/29/25 and diagnoses that included hypertensive heart and chronic kidney disease with heart failure and sick sinus syndrome. The physician orders dated 12/29/25 included nursing services weekly for assessments. Review of the physician’s-certified care plan lacked documentation of the need for weight monitoring and parameters for reporting abnormal findings to the physician. Interview and review of the plan of care dated 12/29/25 with the Administrator on 1/14/26 at 10:30 AM failed to identify communication with the physician for the frequency of weight monitoring and parameters for reporting abnormal findings to the physician. Patient #4 had a start of care date of 11/07/25 and diagnoses that included type II diabetes mellitus, heart failure, right ankle and foot wound and left above knee amputation. The physician orders for the certification period of 1/06/26 to 3/06/26 included nursing services three times a week for assessments, blood glucose monitoring and wound care to the right outer ankle wound and between right first and second toes. Additionally, physical therapy and occupational therapy services were provided. Review of the physician’s-certified care plan lacked documentation of the need for weight monitoring and parameters for reporting abnormal findings to the physician. Interview and review of the physical therapy 60-day summary and plan of care dated 1/06/26 with the Administrator on 1/14/26 at 10:35 AM identified that the patient’s right leg wounds were improved and the patient has been cleared by the specialist to resume some weight-bearing on the right leg but failed to identify communication with the physician for the frequency of weight monitoring and parameters for reporting abnormal findings to the physician. Review of the agency policy for Admission Documentation, Comprehensive Assessment directed the individualized plan of care must include pertinent diagnoses, physical findings and functional status.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on a review agency documentation and staff interviews, for one of patients (Patient #6) in the survey sample who received wound care, the agency professionals provided wound care without a physician’s order. The findings include: Patient #6 had a start of care date of 08/27/2023 with diagnoses that included type II diabetes, congestive heart failure, stage two (2) pressure ulceration to the right buttocks and a cardiovascular accident. The physician’s orders for the certification period of 12/14/2025 to 02/11/2026 included nursing services one-time (1) per week for eight (8) weeks for assessments and management of the suprapubic urinary catheter tube. Additionally, Patient #6 received home health aide services twice (2) per week for assistance with activities of daily living. Review of a clinical nursing note dated 12/30/2025, identified Patient #6 was evaluated for a right ear lesion, a biopsy was obtained, and the results were pending. The Dermatologist gave the Patient an anti-biotic ointment, but no additional wound care instructions were provided. The nurse identified the right ear biopsy site as draining moderate amount, anti-biotic ointment was applied, followed by Prisma (a biodegradable wound dressing) and a band aid to the wound bed. Interview and review of Patient #6’s clinical record with the Administrator on 01/14/2026 at 11:30 AM, failed to identify the agency’s nurse obtained an order to provide wound care to the Patient’s right ear. Review of the agency’s Nursing Service policy identified the Registered Nurse (RN) was responsible for the coordination of services with the provider and all clinical services would be implemented in accordance with a plan of care established by a physician’s written orders.”

“Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This Element is not met as evidenced by: Based on a review of agency documentation and staff interviews, for one of four (Patient #10) requiring weight monitoring for a diagnosis of congestive heart failure in the survey sample, the agency nurses failed to perform necessary assessments. The findings include: Patient #10 had a start of care date of 11/24/2025 with diagnoses that included congestive heart failure, myocardial infarction and depression. The physician’s orders for the certification periods of 11/24/2025 to 01/22/2026 included nursing services two times per week for one week and one time per week for three weeks for medication pre-pouring and weekly assessments including weight monitoring. Review of the clinical record from 11/24/2025 to 01/11/2026 (seven weeks) failed to identify evidence of weight monitoring results. Interview and review of the clinical record on 01/14/2026 at 11:15 AM with the Administrator indicated that the nurses should have assessed and documented weights and failed to follow the care plan.”