Home Health Specialty Services, Inc.

“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 review of the agency Emergency Preparedness Plan, the agency failed to identify the scheduling and completion of a review of the agency Emergency Preparedness risk assessment and response plan, and failed to identify the participation in an annual testing exercise, including the inclusion of a full scale exercise every 2 years, during the calendar years 2022 and 2023. Review of the the agency Emergency Preparedness Plan with the Administrator on 7/24/24 at 11:00am, failed to identify the scheduling and completion of an agency specific and/or participation in a municipal sponsored tabletop exercise that included a group discussion using a narrative , clinically relevant emergency scenarios, and problem statements with resolutions, along with documentation of tabletop exercises summary.”

“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 an onsite observations, interview with agency personnel, and review of agency policy, for one (1) of five (5) patients (Patient #4), receiving skilled nursing services, the agency personnel failed to utilize accepted infection control practice techniques during a nursing visit. The findings include. Patient # 4 had a start of care date to the home care agency on 4/7/23, with diagnoses that included Diabetes Mellitus -Type II, Hypertension, Dysphagia, Epilepsy, Traumatic Brain Injury (TBI), with forgetfulness. Review of the physician orders for certification period dated 5/31/24 through 7/29/24 identified skilled nursing visits daily (7 days a week) for eight weeks, and 2 times for 1 week, for daily medication administration, general health evaluation, reinforcement of diabetic education, blood glucose monitoring, weekly medication pre-pour for evening medication self administration by patient, and diet compliance education. During a joint onsite home nursing visit with Registered Nurse (RN #1) on 7/23/24 at 8:15am, medication administration, weekly evening medication pre-pour, and a nursing health evaluation visit, the surveyor observed RN #1 perform a blood pressure evaluation utilizing a blood pressure cuff and stethoscope from her agency nursing bag, but failed to identify RN #1 cleaned/disinfected the equipment at the completion of the patient evaluation before replacing it in her agency nursing bag. Interview with the agency Supervisor of Clinical Services (SCS) and the agency Administrator (Admin.) on 7/24/24 at 11:00am, identified all direct care staff complete onboard and annual training that includes education and updates on the agency infection control practices, and proper nursing bag technique, but failed to identify that RN #1 followed the agency policy on Nursing Bag technique. Review of the agency policy for Nursing Bag Technique, identified all agency visiting home health providers will utilize proper nursing bag technique. All visiting home health providers that have utilized reusable equipment, including a blood pressure cuff, and stethoscope etc., must be cleaned with 70% isopropyl alcohol before returning to the bag.”

“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 review, review of agency documentation, review of agency policy, and interview with agency personnel, for one (1) of five (5) patients (Patient #4), receiving daily medication administration and weekly medication pre pour from the agency, the agency personnel failed to monitor, evaluate and supervise the Registered Nurse staff, in the delivery of skilled nursing services. The findings include. Patient # 4 had a start of care date to the home care agency on 4/7/23, with diagnoses that included Diabetes Mellitus -Type II, Hypertension, Dysphagia, Epilepsy, Traumatic Brain Injury (TBI), with Forgetfulness. Review of the physician orders for certification period dated 5/31/24 through 7/29/24 identified skilled nursing visits daily (7 days a week) for eight weeks and 2 times for 1 week, for daily medication administration, general health evaluation, reinforcement of diabetic education, and blood glucose monitoring, weekly medication pre-pour for evening medication self-administration by patient, and diabetic diet compliance. During a joint home nursing visit with Registered Nurse (RN#1) on 7/23/24 at 8:15am, for medication administration, medication pre-pour, and a nursing health evaluation. The surveyor observed LPN #1 perform a blood pressure evaluation, removing and utilizing a blood pressure cuff and stethoscope from her agency nursing bag, but failed to identify RN #1 cleaned/disinfected the equipment at the completion of the evaluation for patient, before replacing it in her agency nursing bag. During the same joint onsite visit with RN #1 on 7/23/24, the surveyor observed the nurse prepare the morning oral medications, including an injectable medication syringe of Insulin Glargine (Lantus Solostar) 100units/ml (per milliliter) 20 units for administration, without the use of a paper and/or electronic medication administration record (MAR). While RN #1 was preparing Patient #1’s, she turned to this surveyor and said, “ I have memorized all his meds, I’ve done them for so long”. Interview with the agency Supervisor of Clinical Services (SCS) and the Administrator (Admin.) on 7/24/24 at 11:00am, identified all direct care staff complete onboarding and annual training that includes education and updates on the agency infection control practices, including proper nursing bag technique, and medication profile reconciliation, medication administration and medication pre-pour techniques, along with the corresponding policy reviews. The SCS identified that all staff are expected to clean/disinfect any equipment at the completion of a task, before being stored in the nursing bag. The SCS further identified that all care providers are supplied with computer tablets, for use during each home visits. Medication profile reconciliation, new medication order verification and review of the patient’s medication administration record (MAR) are to be completed at every nursing visit, per agency policy, but failed to identify the monitoring and evaluation of the RN’s performance in the provision of services, treatments and care, and adherence to the agency policies. Review of the agency policy for Nursing Bag Technique, identified all agency visiting home health providers will utilize proper nursing bag technique. All visiting home health providers that have utilized reusable equipment, including a blood pressure cuff, and stethoscope etc., must be cleaned with 70% isopropyl alcohol before returning to the bag. Review of the agency policy on medication administration identified that medication will be administered only per the order of a physician, and the medication profile must be reconciled at each visit.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on clinical record review, review of agency documentation, observation, review of agency policy and interviews with agency personnel, for one (1) of five (5) patients (Patient #4), the agency failed to ensure that care delivered was in accordance to the physician ordered plan of care, in accordance to the agency policy. The findings include. Patient # 4 had a start of care date to the home care agency on 4/7/23, with diagnoses that included Diabetes Mellitus -Type II, Hypertension, Dysphagia, Epilepsy, Traumatic Brain Injury (TBI), with forgetfulness. Review of the physician orders for certification period dated 5/31/24 through 7/29/24 identified skilled nursing visits daily ( 7 days a week) for eight weeks and 2 times for 1 week, for daily medication administration, general health evaluation, reinforcement of diabetic education, and blood glucose monitoring, weekly medication pre-pour for evening medication self administration by patient, and diet compliance, During a joint onsite home nursing visit with Registered Nurse (RN #1) on 7/23/24 at 8:15am, for medication administration, medication pre-pour, and a nursing health evaluation. The surveyor observed RN #1 perform a medication administration and weekly pre pour of the patient’s evening self administered medications, but failed to identify RN #1 reconciled the patient’s medications, or utilized a written or computerized medication list for the morning medication administration, and for the evening medication pre pour. Interview with agency Supervisor of Clinical Services (SCS) and the Administrator (Admin.) on 7/24/24 at 11:00am, identified all direct care staff complete onboard and annual training that includes education and updates on the agency policy for medication administration and medication pre pours. The SCS further identified that all care providers are supplied with computer tablets, for use during each home visits for medication reconciliation, order verification and review of the patient’s medication administration record (MAR) during a medication administration and medication pre-pour, per agency policy, but failed to identify the monitoring and evaluation of the RN’s performance in the provision of services, treatments and care, and adherence to the agency policies. Review of the agency policy on Medication Administration identified that medication will be administered only per the order of a physician, and the medication profile must be reconciled at each visit.”