Home Health Care Solutions 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 record review and interview the agency failed to implement a nationally recognized standard for transmission of communicable diseases as related to tuberculosis screening of employees of a home health agency. Findings include: 1. A review of a policy titled ‘Management of Infections/Exposure in Personnel IC 612’ stated, “ . . . “ 1. “ b. All patient care personnel will complete a screening questionnaire for pulmonary symptoms on an annual basis … 5. … The agency shall maintain records on appropriate personnel but is not limited to, a record of TB skin testing, any personal exposure incidents, medical evaluation and treatment as applicable …” 2. Review of personnel record PT 2 (Physical Therapist #2) evidenced most recent annual tuberculin risk assessment date 02-18-2021. 3. Review of personnel record LPN 1 (Licensed Practical Nurse #1) evidenced no annual tuberculin risk assessment in the record. 4. Interview with Administrator on 08-15-2024 at 1:50 PM, when queried about the process for tuberculin risk assessment requirements, the Administrator reported all staff get a baseline tuberculin skin test and annually complete a tuberculin risk screening assessment as per policy. When queried about what national standard was used for their agency on tuberculin skin test and screening, the Administrator said to go ask Human Resources, Administrator 2. 5. During an Interview with Admin 2 (administrative staff #2) on 08-15-2024 at 3:20 PM, when queried about what national standard is followed for tuberculin skin test and screening, Admin 2 stated agency staff from the facility usually do the tuberculin test and was not sure what was meant by national standard followed for tuberculin policy and that a national standard was not being used. 410 IAC 17-12-1(m)”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure physician wound orders were followed according to the plan of care for 1 of 1 active clinical record review with a home visit of a Skilled Nurse providing wound care. (Patient #11) Findings Include: 1. An undated policy titled “Wound Care, Policy Number: C 313” indicated but was not limited to, “ … Continued/Ongoing Treatment, 1. Nurse will provide wound care per physician orders …” 2. On 08-14-2024 at 11:45 AM, Licensed Practical Nurse (LPN) 1 was observed providing wound care for Patient #11 at their residence. A bottle labeled Simply Saline Wound Wash was used by LPN 1 to cleanse Patient #11’s wound on their right lower leg. 3. A review of Patient #11’s clinical record evidenced a Plan of Care (POC), Start of Care (SOC) date 07-17-2024, and an initial certification period from 07-17-2024 to 09-14-2024. The diagnoses listed in the POC included but were not limited to Type 2 Diabetes Mellitus (a disease where the body is unable to appropriately use sugar) with a skin ulcer (an open wound in the skin with potential to cause damage to tissue) and ulcer of the right lower leg with the fat layer exposed. The POC evidenced the patient had Skilled Nursing visits 2 times a week for wound care. The POC indicated the patient’s wound was cleansed with Vashe (a wound cleansing solution that assists in fighting infection). A review of Patient #11’s clinical record evidenced documents titled “Wound Care Worksheet” dated 08-12-2024 and 08-14-2024 and signed by LPN 1 evidenced the patient’s right lower leg wound was cleansed with Normal Saline. Patient #11’s clinical record failed to evidence orders for the clinician to substitute Normal Saline for Vashe to cleanse the patient’s wound. 4. On 08-15-2024 at 12:10 PM, an interview with LPN 1 evidenced they used Normal saline to cleanse Patient #11’s right lower leg wound on 08-14-2024. They indicated the patient had to buy Vashe, and if the supply was not in the home it could not be used. 5. During an interview with Registered Nurse (RN) 1 on 08-15-2024 at 12:35 PM, they indicated they admitted Patient #11 to the agency. RN 1 indicated LPN 1 communicated with them consistently and indicated the LPN was to inform the RN if a supply was not in the home. RN 1 confirmed they were not informed the LPN was using Normal Saline instead of the Vashe for Patient #11. On 08-15-2024 at 3:28 PM, LPN 1 called back and indicated they used the Vashe on Patient #11 until last Wednesday, 08-07-2024, and switched to Normal Saline on 08-12-2024. 6. During an interview with the Administrator on 08-15-2024 at 3:40 PM, they indicated the order for Normal Saline should have been sent on 08-12-2024 for Patient #11. They confirmed the clinical record failed to evidence an order for Normal Saline to be used as a substitute for Vashe for the patient’s wound care. 410 IAC 17-13-1(a)”

“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 agency failed to ensure transfer summaries were sent to the physician or health care entity providing care for 3 of 3 discharged records reviewed who transferred to an inpatient facility. (Patients #13, 14, and 15) Findings Include: 5. A review of Patient #14’s discharge clinical record evidenced a document titled “OASIS-E Transfer” dated and signed by Registered Nurse (RN) 2 on 06-26-2024. The document indicated the patient transferred from the agency on 06-26-2024 to the hospital, Entity 7. Patient #14’s discharge clinical record failed to evidence a discharge summary was sent to the patient’s physician, Person 9, on 06-26-24. The clinical record failed to evidence a transfer summary was sent to the hospital, Entity 7. 410 IAC 17-15-1(a)(7) 1. An undated policy titled “Transfer and Discharge Services, Policy Number: C334” indicated but was not limited to, “ … Documentation … When a patient is … transferred … to another organization, relevant information includes at least … A. Reason for transfer or discharge. B. Physical and psychosocial status at time of transfer or discharge. C. Summary of the care/services provided and progress toward achieving goals. D. Instruction and/or referral provided to the patient. E. A complete list of medications was provided to the patient … 4. A copy will be forwarded to the attending physician …” 2. A review of Patient #15’s discharge clinical record evidenced a document titled “OASIS-E Transfer” dated and signed by Registered Nurse (RN) 2 on 06-26-2024. The document indicated the patient discharged from the agency on 06-26-2024 and was transferred to the hospital, Entity 5. Patient #15’s discharge clinical record failed to evidence a transfer summary was sent to the patient’s physician, Person 6. 3. A review of Patient #13’s discharge clinical record evidenced a document titled “OASIS-E Transfer” dated and signed by Physical Therapist (PT) 3 on 07-18-2024. The document indicated the patient discharged from the agency on 07-18-2024 and was transferred to the hospital, Entity 7. Patient #13’s discharge clinical record failed to evidence a transfer summary was sent to the patient’s physician, Person 8. 4. During an interview with the Administrator on 08-15-2024 at 2:55 PM, when queried regarding a transfer summary for discharged Patients #13, #14, and #15, they indicated they had not heard of a transfer summary and only sent the physicians the medication profile. On 08-15-2024 at 4:05 PM, the Administrator explained “OASIS-E Transfer” documents were not sent to the physicians when a patient transferred, the physicians were faxed the medication lists.”