Anchor Home Health Services, LLC

“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 review of the Home Health Agency (HHA)’s Policy, observation and interview, the HHA’s staff failed to follow infection control standards for 2 of 7 sampled patients; “Bag Technique” was not utilized during the home visit observation for Patient #1 and Infection prevention standards were not followed during wound care for Patient #4 (Patient #1 and #4). The findings included: 1) Review of the HHA’s Policy titled, “Nurse, Home Health Aide and other Staff Bags” not dated, documents, “Nursing Bag Technique … 2. Upon entering the home, place the bag on a clean surface; paper towels, newspaper or plastic bag may be used to create a clean area if indicated. … Remove all items which will be needed for the visit. Place items on one of the paper towels.” Review of the guideline, “Home Care Infection Prevention and Control Program; Patient Care Practices; Wound care” documents, “Procedure: B. Use aseptic technique to perform wound care.” Aseptic is defined as the absence of microorganisms, or commonly known as clean technique.” Observation, on 04/30/24 beginning at 3:30 PM, during a home visit to Patient #1 reveals Staff B, Physical Therapy Assistant (PTA), entered the patient’s home, and placed their “backpack,” used to carry equipment needed at all home visits, directly onto the patient’s entry table in the foyer; Staff B did not place any type of “barrier” under the “backpack;” after hand hygiene, Staff B, obtained a zipped bag with a Blood Pressure cuff and an Oxygen Saturation monitor from their backpack, and laid them directly on the patient’s entry table, with no type of “barrier;” after using the equipment, Staff B continued to utilize the patient’s entry table for their used equipment, cleaned their Blood Pressure cuff and Oxygen Monitor, but did not clean their zipped bag that housed their Blood Pressure cuff; then Staff B placed the zipped bag back into their backpack. 2) Observation and interview, on 05/01/24 beginning at 12:40 PM, during a home visit, Patient #4 confirmed they had had two new nephrostomy tubes (urinary drainage tubes inserted into the kidneys), placed by the physician the previous day; observation after hand hygiene, Staff A, Registered Nurse (RN), gathered and set up their supplies to complete wound care for both nephrostomy tubes; Staff A provided care to both sites simultaneously, removing the dressings of each, soaking each with a wound cleanser, and cleaning each wound, without glove changes or hand hygiene between the two tubes; after cleaning the two wounds, Staff A failed to change gloves and do hand hygiene, before obtaining the new clean dressing to place over the patient’s new wounds. On 05/01/24 at approximately 1:15 PM, during an interview after the home visit observation, upon discussion of the wound care, Staff A, agreed she should have completed the care for one tube followed by complete care of the other, or changed gloves between wounds, in order to prevent possible infections should one of the wounds get infected; Staff A agreed she should change gloves after cleaning a wound.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on record review, interview and observation, the Home Health Agency (HHA) failed to ensure that there were physician’s orders for wound care for 1 of 2 sampled patients observed to have wound care provided (Patient #4). The findings included: Review of the record reveals Patient #4 was admitted to the HHA’s services on 09/11/23. Review of the current Plan of Care, for the certification period of 03/09/24 through 05/07/24 documents the Skilled Nurse was to provide “external nephrostomy (urinary drainage tubes inserted into the kidneys) tube” care. Further review reveals this Plan of Care lacked any specific physician’s orders for the wound care treatment. On 05/01/24 beginning at 12:40 PM, during an interview and home visit to Patient #4, the patient confirmed they had two new nephrostomy tubes inserted the previous day by their physician. Observation, on 05/01/24 beginning at 12:40 PM, reveals Staff A, Registered Nurse (RN), applied Vashe Wound Solution, a wound cleanser, onto gauze dressings, and soaked the insertion sites of each tube for two minutes; Staff A then placed a new gauze onto the inner side of a clear adherent dressing, and applied this to each nephrostomy site. During an interview after the home visit on 05/01/24 at approximately 1:15 PM, Staff A, explained that the private caregiver had been taught how to do the daily nephrostomy flush, but the HHA’s Skilled Nurses provided once weekly dressing changes, assessment of the nephrostomy sites, and flushed the tubes. Continued review of the patient’s electronic medical record lacked any specific physician’s orders for care to the nephrostomy sites. During a side-by-side review of the record and interview on 05/02/24 in the afternoon, the Director of Nursing (DON) agreed with the lack of physician’s wound care orders for Patient #4.”

“Treatments and therapy services CFR(s): 484.60(e)(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services. This Element is not met as evidenced by: Based on observation, interview, and record review, the Home Health Agency (HHA) failed to ensure 2 of 12 sampled active patients were provided written instructions outlining any treatments, including therapy, to be provided by the HHA (Patient #1 and Patient #5). The findings included: 1) Observation, on 04/30/24 beginning at 3:30 PM, during a home visit to Patient #1, reveals Staff B, Physical Therapy Assistant (PTA), provided Physical Therapy. Review of the HHA’s folder belonging to Patient #1 lacked any written instructions for the patient, related to the Physical Therapy treatments being provided by the HHA. 2) Observation, on 05/01/24 beginning at 2:45 PM, during a home visit to Patient #5, Staff C, Registered Nurse (RN), provided an injection. Review of the HHA’s folder belonging to Patient #5 lacked any written instructions related to the treatments being provided by the HHA. During an interview on 05/01/24 at approximately 3:30 PM, Staff C, confirmed she completed the Start of Care assessments for patients at the HHA, along with routine home visits to continue the care; when asked what written information was provided to the HHA’s patients, Staff C, explained the patient receives the HHA’s booklet of general information along with a copy of their medication list; when asked if the patients received any written information as to what treatments and or therapy was being provided by the HHA, Staff C stated they did not; when asked if the patients received a copy of their Plan of Care, Staff C stated they did not. During an interview on 05/02/24 at 10:45 AM, Director of Nursing (DON) was asked if patients received any written instructions outlining the treatments and or therapy to be provided, and the DON stated that they did not.”

“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 record review and interview, the Home Health Agency (HHA) failed to ensure all interventions and services for 2 of 7 sampled patients observed during home visits, were documented in the clinical record; as evidenced by Skilled Nursing staff who failed to document the specific nephrostomy tube (urinary drainage tubes inserted into the kidneys) care provided to Patient #4, failed to document the coordination of care related to the voiced concerns of the family of Patient #4, and failed to document the specific dose, route, and site of injection for Patient #5 (Patient #4 and Patient #5). The findings included: 1) Review of the record reveals Patient #4 was admitted to the HHA’s services on 09/11/23. Review of the current Plan of Care, for the certification period of 03/09/24 through 05/07/24 documents the Skilled Nurse was to provide “external nephrostomy (urinary drainage tubes inserted into the kidneys) tube” care. Further review reveals this Plan of Care lacked any specific physician’s orders for the wound care treatment. On 05/01/24 beginning at 12:40 PM, during an interview and home visit to Patient #4, the patient confirmed they had two new nephrostomy tubes inserted the previous day by their physician. Observation, on 05/01/24 beginning at 12:40 PM, reveals Staff A, Registered Nurse (RN), applied Vashe Wound Solution, a wound cleanser, onto gauze dressings, and soaked the insertion sites of each tube for two minutes; Staff A then placed a new gauze onto the inner side of a clear adherent dressing, and applied this to each nephrostomy site. Review of the “Skilled Nurse Visit Notes,” for this certification period, lacked documentation as to what care was provided to the nephrostomy tubes at each visit. During a side-by-side record review and interview, after the home visit observation on 05/01/24 at approximately 1:15 PM, Staff A, who had been one of the primary nurses for Patient #4, agreed with the lack of documentation. Review of the “Skilled Nurse Visit Notes” with Staff A reveals “dressing change as ordered” and Staff A agreed there were no specific dressing change orders. Review of the “Inter-Office Communication Report,” from the electronic medical record for Patient #4 reveals an entry dated 03/118/24 at 9:52 AM that documented, “... (Relative) called and stated, “port (entry) on neph (nephrostomy) tube not closing properly. SN (Skilled Nurse) to assess.” Review reveals the patient’s record lacked any documented Skilled Nurse follow-up or assessment. During a side-by-side record review and interview on 05/01/24 at approximately 1:15 PM, when asked about the entry related to the ... (Relative)’s voiced concerns, Staff A, explained the (HHA’s) office staff informed her of the ... (Relative’s) concern, and she spoke with the ... (Relative) via telephone at the time of the voiced concern; Staff A stated they discussed a home visit to assess the nephrostomy tubes, but the ... (Relative) decided to take ... (Patient #4) to the hospital, as they were near-by and were familiar with the staff there; when asked if Staff A documented the resolution to the voiced concerns in the patient’s record, Staff A was unable to locate any documentation. 2) Review of the record reveals Patient #5 was admitted to the HHA’s services on 06/24/21. Review of the current Plan of Care for the certification period of 04/09/24 through 06/07/24 reveals Skilled Nursing services for interventions to include the administration of weekly Ozempic (a medication for diabetes) injections. Observation, during a home visit to Patient #5, on 05/01/24 beginning at 2:45 PM reveals Staff C, RN, provided 0.5 milligrams of Ozempic via injection to the patient’s right arm. Review of the “Skilled Nursing Visit Notes,” for the current certification reveals they all documented the intervention to “administer Ozempic weekly” and the provision of “injection given per physician’s orders.” During a side-by-side review of the record and interview on 05/01/24 at 3:15 PM, Staff C agreed with the incomplete documentation for the injections, with the failure to include the dose, route and location of the injection given to Patient #5.”