Total Nursing Services, Inc.

“Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA’s quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This Standard is not met as evidenced by: Based on record review, interview and direct observation the agency failed to provide infection control on 1 out of 3 Sampled Patients (SP) during home visits. SP #4. Findings Include: A home visit of Sample Patient (SP) #4 was conducted on 05/07/2025 with Administrator and field nurse//LPN Staff K. At 12:18pm the surveyor observed staff K removed used gloves and dispose of them in garbage and put on new gloves without sanitizing hands. Staff K proceeded to cleanse the wound with Normal Saline Solution, he then reached into the container that had clean supplies and took a bottle of betadine solution and poured that over the patient’s wound, then he reached into the container and grabbed wrapped sterile 4X4 gauze pads in individual packages and grabbed 2 and opened them and then dabbed the wound to wipe off extra betadine solution. He then reached into the supply box and took out a package of sterile Q-Tips, opened up the end of that package and then took them out and put betadine on the tips and dabbed that on top of the wound. He then reached again into the box of supplies, grabbed a wrapped package of Kerlix gauze opened it up and wrapped the wound and then went into the supply box and got tape to wrap the Kerlix with, all this time using his soiled dirty gloves to reach into the box and remove supplies and place them on the wound. At the same time staff K was cleansing the wound with Normal Saline Solution some had spilled onto the floor and when he was cleaning up, he didn’t notice the liquid on the floor and the administrator had to advise him of such and then the administrator got paper towels to wipe up the liquid on the floor to prevent the patient from slipping and falling. Interview with the administrator on the ride back to the office 05/07/2025 at 12:50pm from the SP #4 home she confirmed she saw all the things happen during the wound care that was written about above. She expressed that Staff K was a physician in his own country but here in the United States has been an LPN for at least 10 years, and possibly he wasn’t used to having nurses question the way he is providing care. She also expressed sometimes the staff get “sloppy” in the way they perform wound care.”

“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 record review, direct observation and interview the agencies staff failed to follow the orders written in 1 out of 3 Sampled Patients (SP). SP #4. Findings Include: Home visit was performed on Sample Patient (SP) #4 05/07/2025 between 12:05pm and 12:40pm. Record review of SP#4 Plan of Care orders include every visit for the skilled nurse to perform vital signs. This includes Complete head to toe assessment, Temperature, Pulse, Respiratory Rate and Heart Rate. The surveyor observed staff K take the patients’ blood pressure and temperature. No other vital signs were obtained during this visit. Head to toe assessment were not performed either. Staff K went from taking temperature and blood pressure to the wound care but did no other assessment. Interview with the Administrator on the car ride home from the home visit at 12:45pm, she agreed that only part of the vital signs was conducted, and no head-to-toe assessment was done either.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on record review and interview, the home health agency is unable to demonstrate a completed termination summary, including the type of services being provided, frequency of services, lab data (as applicable) and medication list at the time of discharge for 2 out of 5 Sampled Patients (SP). SP #1 and SP #2. Findings Include: Closed record reviews of Sample Patients (SP) #1 and #2 were conducted on 05/05/2025 to 05/08/2025. The clinical record for SP #1 contained a discharge summary from the agency with a discharge date of 04/12/2025; and SP #2 contained a discharge summary from the agency with a discharge date of 04/04/2025. The discharge summaries of SP #1 and SP #2 omitted information such as type of services being received, frequency of services, Lab data (as applicable) and medications at the time of discharge. Interview conducted on 05/08/2025 between 11:45am and 12:15pm with the Administrator and 2 office staff, they acknowledge the summaries for SP #1 and SP #2 were incomplete, missing the required notations as previously mentioned.”