Stat Home Health Innovative

“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, observation, and interview, the agency failed to ensure staff followed accepted standards of practice to prevent the transmission of infections and communicable diseases for 1 (#3) of 3 (#1, #2, and #3) patients observed during home visits conducted with agency staff. The skilled nurse failed to wear gloves while performing a finger stick to check Patient #3’s blood glucose level. Findings: On 04/16/2025, a review of the agency’s policy titled Standard Precautions last revised in February 2024 revealed in part…All healthcare workers will routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated. Gloves will be worn before touching blood and body fluids, mucous membranes or non-intact skin of all patients; for handling items or surfaces soiled with blood or body fluids; and for performing venipuncture and other vascular access procedures. Patient #3 Review of the medical record for the certification period of 03/23/2025 to 05/21/2025 revealed Patient #3 had diagnoses that included in part…Type 2 Diabetes Mellitus, Human Immunodeficiency Virus, and Hypertensive Chronic Kidney Disease. SN visits were ordered as follows: 2wk1 (2 visits per week for 1 week), 1wk8 (1 visit per week for 8 weeks). Review of Patient #3’s Physician’s orders/Plan of Care revealed in part…Skilled nurse may perform capillary blood sugar analysis every skilled nurse visit if patient/caregiver unable/unwilling and if patient has a glucometer and strips in the home. During a home visit on 04/14/2025 at 11:10 a.m., S2 LPN was observed performing a finger stick to Patient #3 to check her blood glucose level without wearing gloves. S2 LPN was observed at this time sticking the patient’s finger with a lancet, holding the patient’s finger with blood on it to the strip, and then putting an alcohol wipe on the fingertip while barehanded. In an interview on 04/14/2025 at 11:55 a.m., S2 LPN confirmed she did not wear gloves while checking Patient #3’s blood glucose level, but should have. In an interview on 04/14/2025 at 1:10 p.m., S1 Administrator acknowledged S2 LPN checked Patient #3’s blood glucose by finger stick without wearing gloves. S1 Administrator confirmed S2 LPN should have worn gloves.”

“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 observation, interview and record review, the agency failed to ensure a Patient’s medication regimen was reviewed and updated for accuracy for 2 (#2 and #3) of 3 (#1, #2, and #3) patient home visits requiring medication monitoring. The agency census was 3. Findings: Review of the agency’s policy entitled Medication Reconciliation, revised October 2017, revealed, in part…the Agency will reconcile the patient’s medications at the time of admission and on an ongoing basis. The medication list/profile will be updated with each new or changed medication. Patient #2 Review of the clinical record for Patient #2 revealed a Start of Care date of 02/19/2025. Patient #2’s diagnoses included, in part… Idiopathic Aseptic Necrosis of Pelvis, Right Hip Replacement, Congestive Heart Failure, Stage 4 Chronic Kidney Disease, Transient Ischemic Attack, and Dementia. Review of the current medications for Patient #2 revealed Oxycodone 5mg one tablet by mouth three times daily (TID) initiated on 09/11/2024. Further review revealed Levofloxacin 750mg ½ tablet by mouth daily initiated on 03/19/2025. Review of the physician’s orders for Patient #2 revealed an order dated 03/19/2025 which included Levofloxacin 750mg ½ tablet daily x 14days, and Oxycodone was ordered as needed, not routine. Interview with S1 Administrator on 04/15/2025 at 11:05 a.m. revealed Patient #2 had completed the Levofloxacin. S1 Administrator confirmed the Levofloxacin should have been removed from Patient #2’s current medication record after 14 days, but had not been. S1 Administrator confirmed Patient #2’s medication record should have been updated on 03/19/2025 to change Oxycodone to as needed, but had not been. Observation/home visit with Patient #2 on 04/16/2025 at 8:30 a.m. revealed S4 RN reviewed Patient #2’s current medications. Upon review, Patient #2’s current medication record revealed Levofloxacin 750mg ½ tablet by mouth daily. S4 RN stated Patient #2 had completed the Levofloxacin. S4 RN confirmed the Levofloxacin should have been removed from the current medication record after 14 days, when it was completed, but had not been. S4 RN stated Oxycodone 5mg was ordered “three times a day”. S4 RN was advised review of Patient #2’s physician’s orders had revealed an order dated 03/19/2025 for Oxycodone to be provided as needed, not routinely. S4 RN confirmed Patient #2’s current medication record should have been updated to change Oxycodone 5mg to one tablet by mouth TID as needed, but had not. Patient #3 Review of the clinical record for the certification period of 03/23/2025 to 05/21/2025 revealed Patient #3 had diagnoses that included in part…Type 2 Diabetes Mellitus, Human Immunodeficiency Virus, and Hypertensive Chronic Kidney Disease. SN visits were ordered as follows: 2wk1 (2 visits per week for 1 week), 1wk8 (1 visit per week for 8 weeks). Observation during the home visit on 04/14/2025 at 11:00 a.m., S2 LPN was reviewing Patient #3’s current medications. Upon review of the medications, it was determined Patient #3 was currently prescribed Ferrous Sulfate 325mg by mouth daily on Monday, Wednesday, and Fridays, Clonidine 0.1mg by mouth every 8 hours as needed, and Levetiracetam 1500mg by mouth two times daily. Review of the patient’s medication record with S2 LPN at that time revealed the medication record did not include Ferrous Sulfate 325mg or Clonidine 0.1mg. Further review revealed the medication record incorrectly listed the Levetiracetam dose as 500mg by mouth two times daily. S2 LPN confirmed the Levetiracetam dose was incorrect on the medication record and the Ferrous Sulfate 325mg and Clonidine 0.1mg were not listed on the medication record, but should have been.”