West River Home 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 observation, policy review, and interview, the agency staff failed to ensure infection control guidelines were maintained during the home visit observation for 1 of 4 patients ( #10), out of a total sample of 4 patient home visits. Findings include: Review of the agency policy, titled Infection Control Plan, dated April 2017, included the following: *Personnel will be provided training on the basics of transmission of pathogens to patients and personnel, bloodborne diseases, the use of standard precautions, infectious waste management, and other infection control procedures when their work activities may result in an exposure to blood, other potentially infectious materials, or under circumstances in which differentiation between body fluid types is difficult or impossible. Review of the agency policy, titled Bag Technique, not dated, included the following: *Clean and disinfect the vital sign equipment (i.e., stethoscope, thermometer, pulse oximeter, sphygmomanometer [blood pressure cuff]) and electronic equipment used during patient care. On 4/1/26 at 11:30 A.M., the surveyor observed Licensed Practical Nurse (LPN) #1 provide care during a home visit to Patient #10. The LPN placed a clean protective barrier down on a foot stool and placed her home care bag on the barrier. She proceeded to take out all her medical equipment and place it on the clean protective barrier. As the LPN was talking to the patient her home care bag and equipment slid from the foot stool onto the floor, contaminating her medical equipment and bag. She then proceeded to place a new clean protective barrier on the foot stool and placed her bag on the clean barrier. LPN #1 failed to clean the outside of her bag with a disinfectant wipe before placing it on the clean barrier. She put on a clean pair of gloves and cleaned her equipment with a disinfectant wipe and place them back on the barrier. The LPN then removed her gloves, performed hand hygiene, and put on a clean pair of gloves and performed a patient assessment, which included temperature, oxygen saturation, heart rate, and blood pressure. The LPN then put all the medical equipment down on the clean protective barrier without disinfecting the equipment first, causing concern for the potential risk of cross contamination. The LPN removed her gloves, performed hand hygiene, and then put on a clean pair of gloves and proceeded to take the INR machine (portable handheld medical device that allows patients on blood thinners to measure their blood clotting time), and placed it directly on the couch next to the patient. The LPN used a lancet (small sterile needle used to prick the skin) to obtain blood from the patient and then placed the dirty lancet directly into the INR machine case causing concern for the potential risk of cross contamination. After checking the patient’s INR the LPN then placed the INR machine back in the case to wait for the INR result. She failed to disinfect the INR machine, causing concern for the potential risk of cross contamination. The LPN also failed to disinfect the outside of the INR case before placing the case back into her bag. She then removed her gloves, performed hand hygiene, and put on a new pair of gloves. The LPN proceeded to disinfect each piece of medical equipment. After disinfecting the medical equipment, she placed the clean equipment back on to the contaminated barrier, causing concern for the potential risk of cross contamination. During an interview on 4/1/26 at 12:30 P.M., with the Administrator and the Clinic Manager, the surveyor made them aware of the observations. The Administrator and the Clinic Manager both said the LPN had made errors with infection control and caused concern for the potential risk of cross contamination.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure physician orders were completed and recorded in the plan of care for 1 patient (#10) record, out of a total sample of 10 patients. Findings include: Review of the agency policy, titled Administration and Documentation of Medications, dated December 2018, indicated the following: *As part of the assessment process, a drug history will be taken and a comparison made between the physician’s (or other authorized independent practitioner’s) orders and the current medication the patient is taking. Any discrepancies or contradictions should be reported to the physician for resolution. *The Home Health nurse will provide instructions to the patient on a continuing basis. This instruction will include medication administration, route, how medication relates to disease process, contraindications, side effects, and adverse reactions. *Licensed nurses will administer medications ordered by the physician (or other authorized independent practitioner) that can be safely administered and monitored during a home visit. Review of the skilled nurses note, dated 3/26/26, indicated the patient’s INR (standardized blood test that measures how long it takes for the blood to clot) was 1.7. The note indicated that the patient was to receive 7.5mg of Coumadin (blood thinning medication) on 3/26/26 and 3/27/26 and then 5mg on 3/28/26, and 7.5mg on 3/29/26 and then to recheck the INR on 3/30/26. Review of the physician ordered Plan of Care (POC) for certification period 3/23/26 through 5/21/26 indicated the following: *Recheck INR on Monday 3/30/26 and call results to Coumadin Clinic-Start date 3/26/26. Further review of the physician ordered POC failed to include a physician order for a Coumadin dose. During an interview on 4/1/26 at 10:00 A.M., the Clinic Manager said that all physician orders for Coumadin dosing should be updated in the POC and written in the physician orders.”