Pointe Coupee Homebound Health

“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 observations, interviews and record review, the agency failed to ensure staff followed accepted standards of infection control practices for 1 (#3) of 4 (#1, #2, #3 and #4) patients observed during home visits. The agency staff failed to: 1. Practice proper hand hygiene while providing wound care for Patient #3; and 2. Properly disinfect reusable equipment during wound care for Patient #3. Findings: Review of the agency’s policy titled, “Hand Hygiene Policy”, with a revision date of July 2021, revealed the following, in part: Policy: Hand Hygiene will be done by all employees to reduce the transfer of microbes to patients and to prevent the growth of microorganisms on the nails, hands and forearms. 7. The agency will follow the Centers for Disease Control and prevention (CDC) guidelines for hand hygiene. CDC Hand Hygiene Guidelines... I. Indications for handwashing and hand antisepsis B. Before direct patient contact. After removing gloves. After contact with … non-intact skin and wound dressings. After contact with inanimate objects or medical equipment close to patient. Review of Patient #3’s Clinical Record revealed she began receiving services with the Home Health Agency on 02/22/2024 and had a current Certification Period of 12/18/2024 through 02/15/2025. Patient #3 had diagnoses, which included Type 2 Diabetes Mellitus with Foot Ulcer and Non-Pressure Chronic Ulcer of Left Heel and Midfoot with Necrosis of Bone. Review of Patient #3’s Plan of Care dated 12/18/2024 through 02/15/2025 revealed the following Physician Orders: Skilled Nurse once a week for one week and twice a week for eight weeks; and Wound #2 Diabetic Ulcer Left Plantar Heel - Cleanse wound with normal saline or wound cleanser using gauze. Skin protection or barrier ointment to periwound, moisturizing lotion to legs daily. Pack wound loosely and fill all dead space. Do not over pack wound. Use calcium alginate with silver dressing, hydroconductive wound dressing as secondary (only if needed for moderate to large amount of drainage), then cover with abdominal pad to arch and wrap with gauze roll. Secure with tape. Change three times a week and as needed. A home visit was conducted with Patient #3 on 01/15/2025 at 11:00 a.m. with S4RN present. Patient #3 was observed seated in a recliner chair with her legs elevated. A dressing was observed to Patient #3’s left foot with a barrier pad underneath. S4RN sanitized her hands and donned gloves. S4RN used scissors to cut the soiled dressing to the left foot and placed the scissors on the barrier pad. S4RN removed the soiled dressing, discarded into a bag, removed the soiled gloves, sanitized her hands and donned clean gloves. S4RN cleansed the wound and left foot with wound cleanser and gauze, removed her soiled gloves, and applied clean gloves without sanitizing her hands. S4RN picked up the soiled scissors off the barrier pad and without disinfecting them, opened a package and cut a piece of calcium alginate with silver dressing, placed the soiled scissors on the barrier pad, and packed the wound to the left foot with the calcium alginate with silver dressing and a cotton tipped applicator. Without changing her gloves or sanitizing her hands, S4RN applied barrier ointment to the periwound and left foot. S4RN then removed her soiled gloves, and without sanitizing her hands, applied clean gloves, and dressed the patient’s wound with an abdominal pad and gauze wrap. S4RN then removed her soiled gloves and sanitized her hands. An interview was conducted with S4RN on 01/15/2025 at 11:45 a.m. S4RN stated hand hygiene should have been performed prior to wound care, when going from dirty to clean, after removing soiled gloves and after wound care. S4RN stated any reusable equipment used during wound care should have been disinfected before and after each use. S4RN confirmed she did not perform hand hygiene when going from dirty to clean and in between changing gloves. S4RN confirmed she did not disinfect the scissors she used to remove Patient #3’s soiled wound dressing and prior to using them to cut the clean wound care supplies and should have. An interview was conducted with S2DON on 01/15/2025 at 2:00 p.m. S2DON was made aware of the above observation. S2DON verified the nurse should have performed hand hygiene when going from dirty to clean and in between changing gloves. S2DON confirmed reusable equipment used during wound care should have been disinfected prior to use, when going from dirty to clean and after use.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on observations, interviews, and record review, the agency failed to ensure each patients’ comprehensive assessment included a review of all medications the patients were currently using. The agency failed to ensure skilled nursing and therapy staff reconciled patients’ medications for 2 (#2 and #4) of 4 (#1, #2, #3, and #4) patients reviewed with home visits. Findings: Review of the agency’s policy titled, “Medication Reconciliation” with a revision date of February 2021, revealed the following, in part: Policy: The agency will reconcile patient’s medications at time of admission and on an ongoing basis in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy and non-compliance with drug therapy. Procedure: 2. Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each changed medication. The patient’s medication list in the home will also be updated. Patient #2 Review of the Clinical Record for Patient #2 revealed he began receiving services from the Home Health Agency on 12/12/2024 and had a current Certification Period of 12/12/2024 to 02/09/2025. Patient #2 had diagnoses, which included Staphylococcal Arthritis Right Knee, Balanitis, and Chronic Kidney Disease. Patient #2 was ordered to receive Skilled Nursing Visits once weekly for one week, twice weekly for one week, once weekly for two weeks for Certification Period of 12/12/2024 to 02/09/2025. Patient #2 was ordered to receive Physical Therapy Visits once weekly for one week, twice times weekly for six weeks. A home visit was conducted with Patient #2 on 01/14/2025 at 2:15 p.m. with S5PT and the patient’s spouse present in the home. Patient #2’s spouse stated she managed the patient’s medications. Patient #2’s medications were reviewed during the home visit with Patient #2’s spouse. The following discrepancies were identified when compared to the patient’s current medication profile provided by the home health agency: Ferrous Sulfate 325 mg delayed release tablet take one tablet by mouth daily was on the medication profile and the patient was taking every other day; Fluconazole 150 mg tablet take one tablet by mouth once a week Comments: once a week times two weeks with a start date of 12/19/2024 was on the medication profile and the patient was no longer taking; Senna 8.6 mg tablets take two tablets by mouth daily was on medication profile and not present in the home; and Dulcolax 5 mg tablet take one tablet by mouth as needed for constipation was present in the home and not on the medication profile. An interview was conducted with Patient #2’s spouse on 01/14/2025 at 2:30 p.m. She stated the nurses did not always review Patient #2’s medication bottles during their visits. She stated the Ferrous Sulfate was changed to every other day after his last physician appointment over a week ago. She stated the Fluconazole was completed a while ago. She stated after his last hospitalization he was ordered Senna, but she never picked it up and had Dulcolax to use if he was constipated. An interview was conducted with S5PT on 01/14/2025 at 2:45 p.m. S5PT reviewed the medication list and confirmed the medications the patient was taking and the home health medication list did not match and should have. An interview was conducted with S2DON on 01/15/2025 at 1:50 p.m. S2DON stated the nurses should reconcile medications every visit. S2DON was made aware of the medication discrepancies identified during Patient #2’s home visit on 01/14/2025. S2DON confirmed the medications the patient was taking and the home health medication list should match. Patient #4 Review of the Clinical Record for Patient #4 revealed she began receiving services from the Home Health Agency on 11/22/2024 and had a current Certification Period of 11/22/2024 to 01/20/2025. Patient #4 had diagnoses, which included Left Femoral Neck Fracture and Unspecified Fall. Patient #4 was ordered to receive Skilled Nursing Visits once weekly for one week, twice weekly for one week, once weekly for one week, and discharged on 12/03/2024 for Certification Period of 11/22/2024 to 01/20/2025. Patient #4 was ordered to receive Physical Therapy Visits once weekly for one week, three times weekly for three weeks, twice weekly for four weeks, and twice weekly for one week. A home visit was conducted with Patient #4 on 01/15/2025 at 8:00 a.m. with S6PTA present in the home at a local assisted living facility. Patient #4 and S6PTA verbalized the assisted living facility managed Patient #4’s medications. Patient #4’s medications were reviewed during the home visit with Patient #4’s assisted living nurse. The following discrepancies were identified when compared to the patient’s current medication profile provided by the home health agency: Pantoprazole 40 mg by mouth daily was on the medication profile and not present in the home; Celebrex 200 mg by mouth twice daily as needed for pain was on the medication profile and not present in the home; and Tylenol 325 mg take two tablets by mouth every six hours as needed for pain was on the medication profile and not present in the home. An interview was conducted with Patient #4’s assisted living nurse on 01/15/2025 at 8:20 a.m. She stated Patient #4’s Pantoprazole was discontinued on 12/30/2024 and Celebrex and Tylenol were discontinued on 12/10/2024. An interview was conducted with S6PTA on 01/15/2025 at 8:23 a.m. She stated Patient #4 was in an assisted living facility. S6PTA stated Patient #4 was currently only receiving therapy services from the home health agency. S6PTA explained the assisted living facility managed Patient #4’s medications and contacted the home health office of any changes. S6PTA stated therapy did not reconcile Patient #4’s medications during their visits since she was in an assisted living facility. An interview was conducted with S2DON on 01/15/2025 at 1:48 p.m. She stated medications should have been reconciled by nurses. She stated therapists are instructed to ask if there had been a change in medications and/or appointments. She stated the therapist then reported to the office, and the office followed up. She stated the home health agency should have been aware of the medications each patient was currently taking. She stated the therapists should have asked Patient #4’s assisted living facility nurse about any medication changes during their visit. She was made aware of the medication discrepancies identified during Patient #4’s home visit on 01/15/2025.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on record review and interviews, the agency failed to ensure the Physician was notified of a patient’s systolic blood pressure being outside of the established parameters per the Plan of Care for 1 (#3) of 10 (#1 – #10) patients reviewed for care and services provided per the Plan of Care. Findings: Review of Patient #3’s Clinical Record revealed she began receiving services with the Home Health Agency on 02/22/2024 and had a Certification Period of 10/19/2024 through 12/17/2024. Patient #3 had diagnoses, which included Type 2 Diabetes Mellitus with Foot Ulcer and Hypertensive Chronic Kidney Disease. Review of Patient #3’s Plan of Care dated 10/19/2024 through 12/17/2024 revealed the following Physician Orders: Skilled Nurse beginning 10/21/2024 twice a week for eight weeks, once a week for one week; Vital Parameters: systolic blood pressure less than or equal to 90 or greater than or equal to 160 mm/Hg. Review of Patient #3’s Skilled Nurses’ Visit Notes revealed the following, in part: 12/02/2024 – Blood pressure 164/82, Report given to primary nurse S4RN. Signed S3LPN. 12/09/2024 – Blood pressure 180/90, Report given to primary nurse S4RN. Signed S3LPN. 12/11/2024 – Blood pressure 164/82. Signed S4RN. Further review revealed no documented evidence Patient #3’s Physician was notified of her systolic blood pressure being outside of the established parameters per her Plan of Care. Review of Patient #3’s Communication Notes for Certification Period 10/19/2024 through 12/17/2024 revealed no notification to the Physician of Patient #3’s systolic blood pressure being outside of the established parameters per her plan of care. An interview was conducted with S4RN on 01/15/2025 at 11:45 a.m. S4RN stated the physician ordered Plan of Care for Patient #3 included vital sign parameters. S4RN reviewed the clinical record for Patient #3 and confirmed on 12/02/2024, 12/09/2024, and 12/11/2024 the patient’s systolic blood pressure was outside the ordered parameters. S4RN stated on 12/02/2024 and 12/09/2024, S3LPN reported to her she was notifying the physician of Patient #3’s blood pressure out of parameters. S4RN confirmed there was no documentation in the clinical record of S3LPN notifying Patient #3’s physician of her blood pressure outside of parameters. S4RN verified, during her skilled nurse visit on 12/11/2024, Patient #3’s blood pressure was outside of parameters. S4RN reviewed the clinical record and confirmed there was no documentation she notified the Physician of Patient #3’s blood pressure out of parameters, and should have. An interview was conducted with S2DON on 01/15/2024 at 2:00 p.m. S2DON reviewed Patient #3’s Plan of Care, Skilled Nurses’ Notes dated 12/02/2024, 12/09/2024, 12/11/2024 and Communication Notes for the Certification Period. S2DON confirmed the blood pressure readings obtained during the above mentioned skilled nurse visits were outside of the physician ordered parameters with no documented evidence Patient #3’s blood pressures had been communicated to the patient’s physician and should have been.”