Residential Home Health of Kansas

“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 interview, record review, and facility policy review, the agency failed to follow the infection prevention process related to bag technique (an infection prevention procedure used to limit transmission of germs from one patient to another when an agency bag that contains multi-use equipment was carried into multiple patients’ homes) for 1 (Patient #2) of 7 patients reviewed. This failure had the potential to spread germs or infectious disease among the agency’s patients. Findings include: Review of an agency policy titled, “Bag Technique,” reviewed in 12/2023, revealed, “1. The bag will be placed on a clean surface (i.e., a surface that can be easily disinfected) in the car and on a barrier in the home.” Review of Patient #2’s “Home Health Certification and Plan of Care,” dated 07/25/2024, revealed the start of care date was 08/09/2022 and a certification period of 07/29/2024 to 09/26/2024. According to the Home Health Certification and Plan of Care, Patient #2 had a medical history that included diagnoses of third degree burn of the left foot (a severe burn that damages all three layers of skin) and squamous cell carcinoma of the right lower limb. During an observation on 08/06/2024 at 9:30 AM in Patient #2’s bedroom, Staff E, Registered Nurse, (RN), placed a plastic barrier on Patient #2’s bedroom floor, placed her agency bag on top of the barrier and provided nursing services to the patient. Upon completion of the nursing services, Staff E removed the barrier from under her agency bag, rolled it up within a trash bag and placed her agency bag back on the bedroom floor without a barrier under the bag. Staff E then placed the laptop computer on Patient #2’s bed with no barrier between the laptop and the patient’s bedcover. Staff E then gathered her belongings and left the patient’s home. During an interview on 08/06/2024 at 1:00 PM, Staff B, Occupational Therapist, (OT), stated the agency expectation was staff would keep computers and agency bags on a clean surface while in a patient’s home and neither the bag nor the computer should be placed directly onto a surface in a patient’s home. During an interview on 08/06/2024 at 3:00 PM, Staff C, Registered Nurse, (RN), stated the agency expectation was an agency bag had to be placed on a barrier and should never be placed on the floor of a patient’s home. Staff C stated the staff laptop computer should be kept on a barrier or kept under the clinician’s arm while in a patient’s home but should never be placed directly on a surface in a patient’s home. During an interview on 08/07/2024 at 11:55 AM, Staff D, Clinical Director, (CD), stated the agency policy for bag technique was agency bags should not touch the ground or be set down on a surface in a patient’s home. The CD said there should be a barrier between the agency bag and the surface in the patient’s home, and laptop computers should be either kept in a staff member’s lap or placed atop a barrier on a surface in a patient’s home. The CD stated the agency was not meeting expectations when Staff E, RN placed her agency bag on Patient #2’s bedroom floor and her laptop directly atop Patient #2’s bedcover.”

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on interview, record review, and facility policy review, the agency failed to include all medications a patient was taking in the patient’s medication profile during the admission visit for 1 (Patient #3) of 7 patients reviewed and failed to assess for any medication changes for 1 (Patient #2) of 7 patients reviewed. These failures had the potential for Patient #3 to not receive staff education, services, and the benefit of oxygen therapy and for agency staff to be unable to identify potential side effects or drug interactions for Patient #2. Findings include: 1. Review of an agency policy titled, “Medication Profile,” revised in 05/2023, showed, “1. Upon admission to the organization, the admitting clinician will initiate a medication profile to document the current medication regimen, including name, dose, strength, route, frequency, and reason.” Review of an agency undated policy titled, “Oxygen Therapy,” revealed, “2. Oxygen is classified by the FDA [Food and Drug Administration] as a drug requiring a prescription by a health care provider for home use. The delivery device, dose, route of administration and duration must be prescribed.” Review of Patient #3’s, “Home Health Certification and Plan of Care [POC],” dated 07/17/2024, revealed the start of care date was 07/18/2024 and a certification period of 07/18/2024 to 09/15/2024. According to the Home Health Certification and Plan of Care, Patient #3 had a medical history that included diagnoses of interstitial pulmonary disease (a group of chronic lung diseases that cause inflammation and scarring that impacts a person’s ability to breathe and get oxygen into the body), chronic obstructive pulmonary disease (COPD), (a disease characterized by persistent respiratory symptoms like progressive breathlessness and cough), pulmonary fibrosis (a disease in which the lungs become scarred and damaged causing difficulty in breathing) and a dependence on supplemental oxygen. The Home Health Certification and Plan of Care also showed a physician order for the home health nurse to instruct the patient and caregiver on the type of oxygen supply system, breathing device, oxygen safety, and cleaning of oxygen supplies. The medication section of the Home Health Certification and Plan of Care did not show Patient #3 was receiving oxygen. During an observation on 08/06/2024 at 1:00 PM in Patient #3’s living room, Staff B, Occupational Therapist, (OT), #1 administered oxygen to Patient #3 via a nasal cannula. Staff B asked Patient #3 what the oxygen setting should be, and the patient responded they did not know. Staff B stated the setting was 3 liters/minute (l/m) per the patient’s referral paperwork. During an interview on 08/08/2024 at 3:00 PM, Staff C, Registered Nurse, (RN), stated the agency expectation was that during a patient’s admission visit, clinicians reviewed all medications the patient was currently taking, documented the medications in the clinical software, and reconciled the medications. Staff C confirmed completion of Patient #3’s admission to the agency, reviewed Patient #3’s referral orders to the agency prior to the visit, noted an order for oxygen use at 3 l/m, and oxygen administration equipment were present in Patient #3’s home at the time of the admission visit. Staff C further stated the agency expectation was for oxygen orders to be listed under respiratory treatment in the clinician notes and in the patient’s POC. Staff C confirmed there was no information for the amount of oxygen documented in Patient #3’s POC. During a concurrent interview and record review on 08/07/2024 at 2:45 PM, the Regional Clinical Director of Operations (RCD) stated the agency expectation was a patient’s oxygen order should be documented in the patient’s medication profile in the patient’s POC, and should include the dose, route, type of mask or cannula, what company supplied the oxygen, when the patient should use the oxygen, and if the doctor identified any metrics or parameters for use of the oxygen by the patient. The RCD confirmed the agency staff did not include Patient #3’s oxygen order in the patient’s POC and the agency did not meet expectations. 2. Review of an agency policy titled, “Medication Profile,” revised in 05/2023, showed, “Patients will have a current, accurate medication profile in the clinical record.” Review of Patient #2’s, “Home Health Certification and Plan of Care,” dated 07/25/2024, showed the start of care date was 08/09/2022 and a certification period of 07/29/2024 to 09/26/2024. According to the Home Health Certification and Plan of Care, Patient #2 had a medical history that included diagnoses of third degree burn of the left foot (a severe burn that damages all three layers of skin) and squamous cell carcinoma of the right lower limb. The Home Health Certification and Plan of Care also showed an order for nursing staff to conduct a comprehensive assessment of Patient #2’s medication management at every visit. During an observation on 08/06/2024 at 9:30 AM, in Patient #2’s bedroom, Staff E, Registered Nurse, (RN), did not assess if there were any changes to Patient #2’s medications. During an interview on 08/06/2024 at 9:50 AM, Staff E confirmed Staff E did not assess or ask Patient #2 if there were any changes to the patient’s medication regimen. During an interview on 08/07/2024 at 11:45 AM, Staff D, Clinical Director, (CD), stated the agency expectation was nurses should ask patients at every nursing visit if there were any medication changes, and if a nurse did not ask a patient about medication changes during a nursing visit the agency was not meeting expectations.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on interview, record review, and policy review, the agency failed to conduct an initial assessment visit within 48 hours after receiving a referral to provide services for 1 (Patient #7) of 7 patients. This failure had the potential for the patient to not receive needed assessments and home care services and could have negatively impacted Patient #7’s health. Findings include: An agency policy titled, “Admission Criteria and Process,” revised in 06/2022, revealed, “3. A. The initial assessment visit must be performed either within 48 hours of the referral, within 48 hours of the patient’s return home, or on the start of care date ordered by the physician (or other authorized licensed independent practitioner).” Review of Patient #7’s, “Home Health Certification and Plan of Care,” dated 01/11/2024, showed the start of care date was 01/11/2024 and a certification period of 01/11/2024 to 03/10/2024. According to the Home Health Certification and Plan of Care, Patient #7 had a medical history that included a pressure ulcer on the sacral region, stage 2 (a wound caused by friction or pressure on the skin) and hypertensive chronic kidney disease (a medical condition referring to damage to the kidney due to chronic high blood pressure.) Review of an untitled document, dated 12/29/2023, showed Patient #7’s physician referred Patient #7 to the agency on 12/29/2023, and requested the agency admit the patient for wound care services. During an interview on 08/08/2024 at 10:45 AM, Staff F, Regional Clinical Director of Operations, (RCD), stated the agency received a referral on 01/02/2024 to provide services to Patient #7 and confirmed the agency did not admit Patient #7 until 01/11/2024. The RCD stated the expectation was a patient would be admitted within 48 hours of the agency’s receipt of a referral and approval for services and acknowledged the agency was not meeting expectation. The RCD s there were confirmed communication issues regarding the delay in admission for Patient #7 but was unable to provide any documentation to explain the delay. The agency did not provide additional documentation or rationale for Patient #7’s delayed admission to the agency.”