Moore Home Health Care Inc.

“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 record review and interview the agency failed to ensure infection prevention practices were adhered to while providing services to patients, in 1 of 3 home visits observed. (Registered Nurse (RN 1) Findings include: 1. A review of an agency policy titled ‘HANDWASHING/HAND HYGIENE D-330’ stated,”… 3. Indication for hand washing and hand antisepsis … f. after removing gloves … g. After touching objects that are potentially contaminated …” 2. On 04/02/2025 at 10:50 AM during a home visit, RN 1 was observed providing wound care to Patient #3. RN washed hands appropriately, then returned to patient area, donned gloves, then cleansed the wound with normal saline soaked 4x4 gauze then doffed their gloves. The nurse then took a pair of pre-packaged gloves out the nursing bag, set them on the barrier, unfolded the packaging and donned the new gloves. Hand hygiene was not performed after gloves had been doffed, but before new gloves had been applied. After the new dressing was applied, gloves were doffed, hand hygiene was not performed, and new gloves were donned. During the visit the nurse indicated their hand sanitizer was normally kept on top of their nursing bag, but not today. 3. On 04/02/2025 at 12:00 PM after the visit, RN 1 was queried as to what should be done after gloves are removed, but before new gloves are put on, the nurse indicated they should have used hand sanitizer. On 04/06/2025 at 4:40 PM, when queried as to the infection control breaches by RN 1 during wound care for Patient #3, the Clinical Director indicated she expected hands to be sanitized between glove changes. 410 IAC 17-12-1(m)”

“Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient’s status, and must include, at a minimum, the following information: (1) The patient’s current health, psychosocial, functional, and cognitive status; This Element is not met as evidenced by: Based on record review and interview the agency failed to ensure comprehensive assessments accurately reflected patients’ health status for 3 of 7 active clinical records reviewed. (Patients #3, #4, and #5) Findings include: 4. A review of the clinical record for Patient #4 evidenced a document titled ‘OASIS Assessment’ with a start of care date of 02/05/2025 for the certification period of 02/05/2025 to 04/05/2025, completed by RN 1 on 02/05/2025 indicated Integumentary Assessment there were no pressure ulcer or injury, a right shoulder surgical area with no other wounds documented. The clinical summary indicated Patient #4 had a “total reverse of right shoulder” in January, had a dressing on the right shoulder “no orders for” and “a pressure ulcer on the outer heel on the right foot” which indicated Patient #4 stated, “I had surgery on the right shoulder in January and my right heel … injury by heel protectors”; RN 1 indicated there were no orders for either, care coordination was with the ordering physician, and Patient #4, the caregiver, and the physician was in agreement with the plan of care. The OASIS assessment failed to evidence an accurate integumentary status without description or measurements of wounds; and failed to evidence a cardiovascular and gastrointestinal assessment was completed. 5. A review of the clinical record for Patient #5 evidenced a document titled OASIS Assessment’ with a start of care date of 12/24/2024 for the recertification period of 02/22/2025 to 04/22/2025, completed by RN 1 on 02/17/2025 indicated the Integumentary status had fair skin turgor, condition was moist, dry/rash/itchy, temperature was marked warm, and it was noted Patient #5 had “blister”. Integumentary Comments were left blank. Cardiovascular Status and Gastrointestinal Status were blank. The clinical summary indicated Patient #5 had blisters on his right foot draining a small amount of serosanguinous drainage. DME supplies cotton tips, underpads, tape, incontinent briefs, cotton tipped applicators 4 x 4’s, kerlix, and saline. Further review of the clinical record for Patient #5 evidenced a document titled ‘Home Health Plan of Care and Certification’ signed and dated by RN 1 on 02/17/2025 indicated the following DME supplies: Underpads, incontinent briefs, 4 x4’s abdominal pads, cotton tipped application, kerlix size 4, saline tape, hospital bed and walker. The OASIS assessment failed to evidence an accurate integumentary status without wound measurements and location of blister and failed to evidence a cardiovascular and gastrointestinal assessment was completed and failed to list all DME supplies required for patient care. 6. On 04/03/2024 at 11:18 AM, RN 1 indicated during initial assessments, they do complete head to toe assessments, document location and measurements of wounds. On 04/02/2025 at 3:49 PM, the Clinical Director indicated their expectations were that complete head to toe assessments were performed during assessments and during each skilled nursing visit, along with measurements and location of wounds, and would expect to have all DME supplies listed in the comprehensive assessment. 410 IAC 17-14-1(a)(1)(B) 1. A review of undated agency policy titled ‘COMPREHENSIVE CLIENT ASSESSMENT C-145’ stated, “… a. The Comprehensive Assessment must accurately reflect the client’s status, and must include at a minimum, the following information: The client’s current health … status … e. The client’s medical nursing … needs…” 2. A review of the clinical record for Patient #3 evidenced a document titled ‘OASIS (Outcome and Assessment Information Set, a standardized assessment tool used in home health care to collect data on patients’ health status, functional abilities, and service needs) Assessment’ with a start of care of 11/08/2024 and a recertification period of 03/08/2025 to 05/06/2025 contained diagnoses which included but were not limited to: cellulitis (common bacterial infection of the skin and underlying tissues characterized by redness, swelling, pain, and warmth, typically entering through a break in the skin) of the left lower leg and lymphedema (chronic condition caused by a buildup of lymph fluid in the body’s soft tissues, leading to swelling, often in the arms or legs, can be managed but not cured) and was completed 03/06/2025 by RN 1. The assessment failed to evidence the patient’s lung sounds had been assessed. The integumentary section indicated the patient had fair skin turgor, with a box titled, ‘dry/rash/itchy’ also checked. ‘Skin Problems’ indicated, “Other: blisters right leg”, the integumentary comments section was left blank, and the document failed to evidence measurements of the site. The reassessment summary stated, “… multiple blisters noted and weeping …”, indicated ordered wound care had been provided, and also stated, “… moderate amount of yellowish drainage noted from weeping blisters …” but failed to evidence the site, or measurements for the area the care had been provided to. 3. On 04/02/2025 at 3:52 PM, when queried as to missing comprehensive assessment items in patients clinical records, the Clinical Director indicated understanding the documentation should be complete and added she had instructed staff to utilize the comment sections and write findings in the summary as well, to indicate that items had been addressed.”

“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 record review and interview the agency failed to include all durable medical equipment (DME) in use in 1of 5 clinical records (Patient #2) and failed to evidence complete treatment/wound orders/medication order in 2 of 3 wound care patients (Patients #3 and #5). Findings include: 5. A review of the clinical record for Patient #3 evidenced a document titled ‘HOME HEALTH CERTIFICATION AND PLAN OF CARE’ for the recertification period of 03/08/2025 to 05/06/2025, signed and dated by the clinical manager on 03/06/2025. Skilled nursing was ordered to provide wound care to the right lower leg 2 times weekly. The medication list included but was not limited to: “… Gentamycin Sulfate (topical) (a medication applied to the skin for treating skin infections caused by certain bacteria) external ointment 0.1 % - 3 x week to be applied to during wound change - tropically[sic] - new …” The Plan of Care failed to evidence the location the medication was to be applied to. 6. On 04/03/2025 at 3:12 PM, when queried as to the gentamycin medication listed on Patient #3’s Plan of Care being written for three times per week and failing to evidence what site or location the medication was to be applied to, the Clinical Director indicated the frequency was an error and the medication was only for twice weekly, and “yes” a location should be included in the medication order, but had been included in the wound care order. 410 IAC 17-13-1(a)(1)(D)(i-xiii) 1. A review of an undated policy titled ‘PLAN OF CARE C-580’ stated, “SPECIAL INSTRUCTIONS … 2. The Plan of Care shall be completed in full to include: e. Need for presence of home medical equipment … m. Medications, treatments …” 2. A review of the clinical record for Patient #2 evidenced a document titled ‘OASIS (Outcome and Assessment Information Set is a standardized data collection tool used by home health agencies to collect and report assessment data) Assessment’ for the recertification period of 04/01/2025 to 05/30/2025, completed by RN 1 on 03/27/2025, indicated Renal/Genitourinary status, Patient #2 was incontinent with urine and bowel and DME required were under pads, briefs, and wipes. Further review of the clinical record for Patient #2 evidenced a document titled ‘Home Health Plan of Care and Certification’ signed and dated by RN 1 on 03/27/2025 evidenced DME supplies as hospital bed, side rails, piston syringes, wheelchair, pressure reducing mattress, heel protectors, thermometer, and non-sterile gloves. The Plan of Care failed to evidence DME: under pads, briefs, and wipes. 3. A review of the clinical record for Patient #5 evidenced an ‘OASIS Assessment” for the recertification period of 02/22/2025 to 04/22/2025 dated 02/17/2025 by RN 1 which indicated Patient #5 was to have Triamcinolone (a synthetic glucocorticoid [a type of corticosteroid] used to treat various inflammatory conditions, including skin disorders, asthma, and allergic rhinitis, by reducing inflammation and suppressing the immune system) 0.1 ointment 454 gm to apply twice a day beginning 01/14/2025. Further review of the clinical record for Patient #5 evidenced a document titled ‘Home Health Plan of Care and Certification’ signed and dated by RN 1 on 02/17/2025 indicated wound care was to cleanse blister to right top of foot with normal saline, apply Silvadene cream, and cover with a dry dressing. The Plan of Care failed to evidence an updated order for wound care to the right lower extremity and where Triamcinolone 0.1 ointment was to be applied. 4. On 04/01/2025 at 10:20 AM, the Clinical Director indicated new medications need to be written down, MD notified, added to the medication profile, and were to update the Plan of Care. On 04/03/2025 at 11:18, RN 1 indicated they were to write a verbal order when receiving orders for patients, and add the order to the Plan of Care.”

“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 and interview, the agency failed to ensure all orders were recorded on the Plan of Care in 1 of 3 clinical records reviewed with ordered wound care. (Patient #5) Findings include: 1. A review of a policy titled ‘PHYSICIAN/ALLOWED NON_PHYSICIAN PRACTITIONER (NPP) ORDERS C-635’ stated, “… SPECIAL INSTRUCTIONS 1. When the nurse … receives a verbal order from the NPP, he/she shall write the order as given and then read the order back … heard it correctly and interpreted the order correctly … The order must include the date, specific order, be signed with the full name and title of the person receiving the order … 6. Documentation must be placed in the record …” 2. A review of the clinical record for Patient #5 evidenced an ‘OASIS (Outcome and Assessment Information Set is a standardized data collection tool used by home health agencies to collect and report assessment data) Assessment” for the recertification period of 02/22/2025 to 04/22/2025 dated 02/17/2025 by RN 1 which indicated Patient #5 was to have Triamcinolone (a synthetic glucocorticoid [a type of corticosteroid] used to treat various inflammatory conditions, including skin disorders, asthma, and allergic rhinitis, by reducing inflammation and suppressing the immune system) 0.1 ointment 454 gm to applied twice a day beginning 01/14/2025 to the right lower extremity. Further review of the clinical record for Patient #5 evidenced a document titled ‘Home Health Certification and Plan of Care’ dated 02/17/2025 and signed by the Clinical Director. Patient #5 was to receive skilled nursing visits 1 hour two (2) times a week to assess and evaluate draining blister to right foot and to provided wound care and dressing changed. Procedure was to cleanse the blister to right top of foot with normal saline, apply Silvadene cream, and cover with dry dressing. The clinical record failed to evidence a verbal order was written and included on the Plan of Care to discontinue Silvadene Cream and initiate Triamcinolone 0.1 ointment 454 gm. 3. On 04/01/2025 at 10:20 AM, the Clinical Director indicated new medications need to be written down, the attending physician notified, added to the medication profile, and the Plan of Care be updated. On 04/03/2025 at 11:18 AM, RN 1 indicated they were to write a verbal order when receiving orders for patients, and add the order to the Plan of Care further indicated Patient #5 had the order for Triamcinolone for the right lower extremity since January and had forgotten to write the verbal order.”