VNA & Hospice of Cooley Dickinson

“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 observation, policy review, and interview, the agency failed to ensure infection control guidelines were maintained during an observation of a wound dressing change for 1 patient (#7), out of a total of 7 patient home visits. Findings include: Review of the Centers for Disease Control and Prevention (CDC) Core Infection and Control Practices for Safe Healthcare Delivery in All Settings, dated 4/12/24, indicated the following: -Clean and reprocess (disinfect or sterilize) reusable medical equipment prior to use on another patient or when soiled. Patient #7 was admitted to the agency in February 2026 with a diagnosis of Type 2 Diabetes Mellitus (DM-a chronic condition characterized by high blood sugar and insulin resistance) with foot ulcer (an open sore). Review of the physician ordered Home Health Plan of Care for certification period 4/9/26 through 6/7/2026 indicated the following: -Wound care to left plantar section (bottom surface) of foot, remove dressing, wash with normal saline, apply Triad (brand name) wound cream to open area followed by dry clean dressing, gauze, and secure with tape. During a home visit on 4/24/26 at 10:00 A.M., the surveyor observed Registered Nurse (RN) place wound dressing supplies, including bandage scissors, on a barrier pad prior to beginning a dressing change to Patient #7 left foot. She cleansed her hands and donned (put on) gloves. She took the bandage scissors into her gloves hands and cut across the gauze on Patient #7 left foot to loosen it off and removed the dressing. She doffed (removed ) her gloves, cleansed her hands, donned new gloves and completed the dressing change. While putting away the extra dressing supplies into a cardboard box, she included the scissors. She did not cleanse the scissors prior to or after the dressing change. During an interview on 4/24/26 at 10:30 A.M., the RN said she did not cleanse the scissors prior to and after use during the wound dressing change, as required”

“Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This Standard is not met as evidenced by: Based on record review, policy review, and interview, the agency failed to ensure clinical documentation was complete and appropriately authenticated and dated in accordance with currently accepted standards of practice for 7 patients (#2, #3, #6, #7, #9, #13 and #14), out of a total sample of 17 patients. Findings include: Review of the agency policy entitled, Documentation, dated 6/23/25, included the following: -All documentation in the patient medical record must be completed in a thorough, timely manner for safe hand off to the next provided of care. -All documentation must be completed according to the following guidelines: *Routine Visit, encounter to be closed in 1 calendar day. *Start of Care (SOC) OASIS Assessment (a group of standard data elements developed to enable systemic comparative measurements of home health care patient outcomes) encounter to be closed within 2 calendar days of SOC date. 1. Patient #2 was admitted to the agency in March 2026 with a diagnosis of displaced bimalleolar fracture of right lower leg (inner and outer bones of the ankle are broken). Review of the physician ordered Home Health Plan of Care (POC) for certification period 3/3/26 through 5/1/26 indicated the following: -Occupational Therapy (OT) visits: 1 visit every week for 1 week from 3/5/26 through 3/7/26. Review of the clinical record contained the following: *3/31/26 OT Cancelled visit, note was signed on 4/17/26. 2. Patient #3 was admitted to the agency in March 2026 with a diagnosis of hemiplegia (paralysis causing partial or total loss of movement on one side of the body) and hemiparesis (partial weakness or reduced motor control affecting one side of the body) following cerebral infarction (a stroke) affecting right dominant side. Review of the physician ordered Home Health POC for certification period 3/25/26 through 5/23/26 indicated the following: -Home Health Aide (HHA) visits: 2 visits every week for 8 weeks from 3/29/26 through 5/23/26. Review of the clinical record contained the following: *4/14/26 HHA visit, note was signed on 4/16/26. 3. Patient #6 was admitted to the agency in March 2026 with a diagnosis of displaced supracondylar fracture of lower end of left femur (a break in the thigh bone just above the knee joint). Review of the clinical record contained OASIS SOC Visit, dated 3/12/26, that was signed on 3/15/26. 4. Patient #7 was admitted to the agency in February 2026 with a diagnosis of Type 2 Diabetes Mellitus (DM-a chronic condition characterized by high blood sugar and insulin resistance) with foot ulcer (an open sore). Review of the physician ordered Home Health POC for certification period 2/8/26 through 4/8/2026 indicated the following: -Skilled Nurse (SN) visits: 2 visits every week for 4 weeks from 2/8/26 to 3/7/26, 1 visit every week for 5 weeks from 3/8/26 to 4/8/26, and 3 visits as needed. -OT visits: 2 visits every week for 1 week from 2/10/26 to 2/14/26, 1 visit every week for 1 week from 2/15/26 to 2/21/26, and 2 visits every week for 2 weeks from 2/22/26 to 3/7/26. -Speech Language Pathology (SLP) visits: 1 visit every 2 weeks for 2 weeks from 2/8/26 to 2/21/26. Review of the clinical record contained the following: *2/26/216 SN visit, note was signed on 3/1/26. *3/2/26 Licensed Practical Nurse (LPN) visit, note was signed on 3/4/26. *3/5/25 OT Therapy Functional Assessment (TFA) visit, note was signed on 3/10/26. *4/5/26 SLP visit, note was signed on 4/10/26. 5. Patient #9 was admitted to the agency with a diagnosis of malignant neoplasm (abnormal growth) of the hypopharynx (lowest part of the throat). Review of the physician ordered Home Health POC for certification period 3/13/26 through 5/11/26 indicated the following: -SN visits: effective 3/15/26, 2 visits every week for 6 weeks from 3/15/26 to 4/25/26, and 3 visits as needed. Review of the clinical record contained the following: *4/13/26 SN Cancelled visit, note was signed on 4/22/26. 6. Patient #13 was admitted to the agency in November 2025 with a diagnosis of osteoporosis with fracture of right femur. Review of the physician ordered Home Health POC for certification period 1/2/26 through 3/2/26 indicated the following: -SN visits: 1 visit every week for 9 weeks from 1/2/26 to 2/28/26. Review of the clinical record indicated the following: *1/2/26 SN visit, note was signed on 1/5/26. *1/9/26 SN visit, note was signed on 1/12/26. *1/16/26 SN Cancelled Visit, note was signed on 1/21/26. 7. Patient #14 was admitted to the agency in January 2026 with a diagnosis of multiple right rib fractures. Review of the physician ordered Home Health POC for certification period 3/10/26 through 5/8/26 indicated the following: -Physical Therapy (PT) visits: 1 visit every week for 3 weeks from 3/10/26 to 3/28/26. Review of the clinical record indicated the following: *3/26/26 PT visit, note was signed on 3/29/26. During an interview on 4/28/26 at 3:30 P.M., after reviewing the visit notes for Patients #2, #3, #6, #7, #9, #13 and #14, the Administrative Director said the notes were signed late and not within the required timeframe.”

“Nursing services supervised by RN CFR(s): 484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k). This Element is not met as evidenced by: Based on record review, policy review, and interview, the agency failed to ensure a registered nurse (RN) provided supervision of the care provided by a licensed practical nurse (LPN) every 30 days for 4 patients (#3, #4, #7 and #8), out of a total sample of 17 patient records reviewed. Findings include: Review of the agency policy entitled, Supervision, dated 11/10/25, included the following: -LPN Supervision: The Agency identifies an RN to supervise the care provided by an LPN. The RN monitors and evaluates the LPN performance in the provision of services, provision of treatments, patient education, communication with the RN, and data collection regarding the patient’s status and health needs as delegated by the RN. Only the RN may perform comprehensive assessment, evaluation, care plan modifications, and discharge assessment. The RN will see the patient every 30 days to perform this supervision. 1. Patient #3 was admitted to the agency in March 2026 with a diagnosis of hemiplegia (paralysis causing partial or total loss of movement on one side of the body) and hemiparesis (partial weakness or reduced motor control affecting one side of the body) following cerebral infarction (a stroke) affecting right dominant side. Review of the physician ordered Home Health Plan of Care (POC) for certification period 3/25/26 through 5/23/26 indicated the following: *Skilled Nurse (SN) visits: 2 visits every week for 1 week from 3/25/26 to 3/28/26, 1 visit every week for 8 weeks from 3/29/26 to 5/23/26, and 3 visits as needed. Review of the clinical record indicated LPN visits were provided on 3/27/26, 4/8/26, 4/10/26, 4/14/26, 4/16/26, and 4/21/26. Further review of the clinical record did not contain any documentation that LPN supervisory visits were completed by an RN, as required. 2. Patient #4 was admitted to the agency in March 2026 with a diagnosis of myocardial infarction (heart attack). Review of the physician ordered Home Health POC for certification period 3/17/26 through 5/15/26 indicated the following: *SN visits: 2 visits every week for 1 week from 3/17/2 to 3/21/236, 1 visit every week for 8 weeks from 3/22/26 to 5/15/26, and 3 visits as needed. Review of the clinical record indicated LPN visits were provided on 3/20/26, 4/14/26 and 4/23/26. Further review of the clinical record did not contain any documentation that LPN supervisory visits were completed by an RN, as required. 3. Patient #7 was admitted to the agency in February 2026 with a diagnosis of Type 2 Diabetes Mellitus (DM-a chronic condition characterized by high blood sugar and insulin resistance) with foot ulcer (an open sore). Review of the physician ordered Home Health POC for certification period 2/8/26 through 4/8/26 indicated the following: *SN visits: 2 visits every week for 4 weeks from 2/8/26 to 3/7/26, and 1 visit every week for 5 weeks from 3/8/26 to 4/8/26. Review of the physician ordered Home Health POC for certification period 4/9/26 through 6/7/26 indicated the following: *SN visits: 1 time a week for 1 week from 4/9/26 to 4/11/26, 3 visits every week for 8 weeks from 4/12/26 to 6/6/26, and 3 visits as needed. Review of the clinical record indicated LPN visits were provided on 3/2/26, 3/8/26, 3/24/26, 4/15/26, 4/17/26, and 4/20/26. Further review of the clinical record did not contain any documentation that LPN supervisory visits were completed by an RN, as required. 4. Patient #8 was admitted to the agency in March 2026 with a diagnosis of surgical aftercare following surgery on the circulatory (cardiovascular) system. Review of the physician ordered Home Health POC for certification period 3/23/26 through 5/21/26 indicated the following: *SN visits: 2 visits every week for 4 weeks from 3/23/26 to 4/18/26, 1 visit every week for 5 weeks from 4/19/26 through 5/21/26, and 3 visits as needed. Review of the clinical record indicated LPN visits were provided on 3/31/26, 4/2/26, 4/9/26, 4/14/26, 4/16/26, and 4/22/26. Further review of the clinical record did not contain any documentation that LPN supervisory visits were completed by an RN, as required. During an interview on 4/28/26 at 3:30 P.M., the Administrative Director said there was no documentation in the clinical records for Patients #3, #4, #7 and #8 to indicate that LPN supervisory visits had been completed every 30 days, as required.”