Best Home Care Corporation

“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, clinical record review and interview, the DON failed to follow and complied with accepted professional standards and principles in 1 out of 3 Sample Patients (SP) with home visits done. SP#8 Findings include: The surveyor conducted clinical record reviews from 12/12/23 to 12/14/23 for SP#2 and SP#8. The Plan of Care for SP#2 certification period 11/19/23 to 01/17/24 reads “Safety Measure: Instructed on proper handling of biohazard waste. Standard Precautions/Infection Control”. The Plan of Care for SP#8 certification period 10/23/23 to 12/21/23 reads “Safety Measure: Instructed on proper handling of biohazard waste. Standard Precautions/Infection Control”. The surveyor observed during a home visit of SP#8 on 12/13/23 at 9:24 am the DON (director of nursing) placed nursing bag directly on dining table without using a barrier protector. At 9:27am the DON with gloves donned, removed old lancet from the lancing device, the safety cover of the lancing device fell on the floor. The DON picked up the safety cover of the lancing device from the floor and proceeded to place a new lancet in the lancing device and the safety cover (the same safety cover that fell on the floor and was not cleansed). The DON then used SP#8 left index finger, pressed the safety cover against the patient’s skin, then pressed the button to discharge the lancet to make a puncture that produces a drop of blood to test using the glucometer device for blood sugar level result. At 9:29am the DON with same pair of gloves entered the SP#8 refrigerator to obtain the insulin medications. At 9:31 the DON provided Levemir 28 units using a pen tip needle to left arm. At 9:31am the DON with the same dirty gloves entered the nursing bag and obtained a notebook. DON flipped pages on notebook to obtain scale notation for the administration of Novolog 10 units using a pen tip needle to right arm. At 9:32 am the DON using the outer cover of the needle tips, recapped the used needles in the air. The DON failed to use the scoop method on a counter surface to prevent a needle stick. At 9:34am the DON entered the nursing bag with dirty gloves to obtain laser thermometer. At 9:38am the DON removed gloves and sanitized hands. The surveyor observed a home visit conducted at SP#2 on 12/14/23 at 9:53am. The DON placed nursing bag on wheelchair with no barrier. The DON donned gloves and used BP (Blood pressure) cuffing to obtain reading. The BP cuff and stethoscope were not cleaned before applying to patient. At 9:55 am the DON put away BP cuff and stethoscope without cleansing. At 9:57am the DON obtained the wound care supplies from the bag kept in the patient’s room. AT 9:58 am the DON removed gloves, sanitized hands and donned new pair of gloves. At 10:00am the DON used saline spray to cleanse the wound on lower sacral area, using 4X4. The DON placed the dirty 4X4 on the chuck to the right side and obtained from the left side a clean 4X4 gauze to pat dry the wound and the surrounding skin. The DON without changing gloves, obtained {Medication name} tube and squeezed out a small amount on cotton tip applicator, applied the medication to the wound. The wound started to bleed at a small point. The gloves worn by DON were contaminated and the left glove visible with blood stain. AT10:01am the DON with same pair of dirty gloves entered the supply bag to obtain tape and scissors. The DON cut (2) moderate size tape to place over the self-adhesive bandage and secure in place. At 10:05 am the DON grabbed the soiled gauze with right hand, and with left hand grabbed the spray bottle and medication tube, picked up all items together and were touching each other, then the DON placed the spray bottle and medication inside the supply bag (without cleansing) and proceeded to dispose of the dirty gauze using the donned gloves to encase and throw away in garbage bin. The DON sanitized hands. At 10:06 am the DON prepared the glucometer, donned a new pair of gloves and performed fingerstick.”

“HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient’s plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient’s condition; and (vi) Honoring patient rights. This Element is not met as evidenced by: Based on record review and interview, the provider failed to document in the home health aide supervision the following elements: maintaining an open communication process with the patient, representative (if any), caregivers, and family: reporting changes in the patients’ condition; in 2 out of 8 sampled patients (SP). SP#2 and SP#4 Findings include: Review of the clinical record was conducted on 12/12/23-12/14/23 for SP#2 and SP#4. SP#2 contained documentation titled “Supervisory Visit” for dates 10/24/23, 11/7/23 and 12/5/23. SP#4 contained documentation titled “Supervisory Visit” for dates 9/8/23, 10/6/23 and 12/1/23. All supervisory visits omitted documentation of home health aides being supervised for maintaining an open communication process with the patient, representative (if any), caregivers, and family; and reporting changes in the patient’s condition. Interview conducted with the Director of Nursing 12/14/23 at 1:15pm. The Director of Nursing acknowledged findings made by the surveyors, that the agency failed to document all the required items listed above.”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on observation and interview, the home health agency administrator/director of nursing failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases for 1 out of 3 SP (Sampled Patients) with home visits made. SP#2 Findings include: Clinical record review was conducted from 12/12/23 to 12/14/23 for SP#2. The Plan of Care for SP#2 certification period 11/19/23 to 01/17/24 reads “Safety Measure: Instructed on proper handling of biohazard waste. Standard Precautions/Infection Control”. A home visit was conducted at SP#2 on 12/14/23 at 9:53am. The DON placed nursing bag on wheelchair with no barrier. The DON donned gloves and used BP (Blood pressure) cuffing to obtain reading. The BP cuff and stethoscope were not cleaned before applying to patient. At 9:55 am the DON put away BP cuff and stethoscope without cleansing. At 9:57am the DON obtained the wound care supplies from the bag kept in the patient’s room. AT 9:58 am the DON removed gloves, sanitized hands and donned new pair of gloves. At 10:00am the DON used saline spray to cleanse the wound on lower sacral area, using 4X4. The DON placed the dirty 4X4 on the chuck to the right side and obtained from the left side a clean 4X4 gauze to pat dry the wound and the surrounding skin. The DON without changing gloves, obtained {Medication name} tube and squeezed out a small amount on cotton tip applicator, applied the medication to the wound. The wound started to bleed at a small point. The gloves worn by DON were contaminated and the left glove visible with blood stain. AT10:01am the DON with same pair of dirty gloves entered the supply bag to obtain tape and scissors. The DON cut (2) moderate size tape to place over the self-adhesive bandage and secure in place. At 10:05 am the DON grabbed the soiled gauze with right hand, and with left hand grabbed the spray bottle and medication tube, picked up all items together and were touching each other, then the DON placed the spray bottle and medication inside the supply bag (without cleansing) and proceeded to dispose of the dirty gauze using the donned gloves to encase and throw away in garbage bin. The DON sanitized hands. At 10:06 am the DON prepared the glucometer, donned a new pair of gloves and performed fingerstick.”

“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 provider was unable to demonstrate a completed discharge summary for 2 out of 8 sampled Patients (SP), SP#6 and SP#7. The surveyor conducted closed record reviews of SP#6 and SP#7 on 12/12/23-12/14/23. The clinical record for SP#6 contained a discharge summary from the agency with a discharge date 07/15/23: and SP#7 contained a discharge summary from the agency with a discharge date of 06/10/23. The discharge summaries for SP#6 and SP#7 omitted information such as notations reason for admission to home health; type of services being provided and frequency of visits; Laboratory data; Medications the patient is on at time of discharge; Patient’s discharge condition, Patient outcomes in meeting the goals in the plan of care; and Patient and family post-discharge instructions. The surveyor conducted an Interview with the Director of Nursing (DON) on 12/14/23 at 1:15pm, the DON acknowledged that the summaries for SP#6 and SP#7 were incomplete, missing the required notifications as previously mentioned.”