Better Care Home Health and Hospice, Inc.

“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 staff interview, the agency failed to ensure that infection control guidelines were followed for one patient (#5) of 3 home visits conducted in a total sample of 7 records. Findings include: Review of the agency’s policy titled “OSHA Infection Control/Exposure Control Plan”, dated 12/18/2024, indicated the following: *Client infection control procedures shall include, but not limited to: -Wearing and changing gloves as necessary during the delivery of care. -Appropriate wound and skin care dressing techniques following sterile or aseptic dressing procedures. Review of the agency’s policy titled “Infection Prevention/Control”, dated 12/18/24, indicated the following: *Standard Precaution -Standard precaution apply to blood, all body fluids, secretions, excretions, non-intact skin, and mucus membranes. All are to be treated as a potential source of infection regardless of whether the client has a communicable disease. -Hands are washed if contaminated with blood or body fluids, immediately after gloves are removed. -Gloves are worn when touching blood, bloody fluids, secretions, excretions, non-intact skin, mucus membranes, or contaminated items. Patient #5 was admitted to the agency in 8/2024 with a primary diagnosis of Encounter for adjustment and management of vascular access devices. Review of the plan of care for certification period of 4/4/25-6/2/25, indicated skilled nurse visit for wound assessment and dressing change to the abdominal surgical site which included four open wounds (top midline, central midline, suprapubic midline, and right lower quadrant). The physician’s order for the treatment of the wounds included normal saline, pack open wounds with calcium alginate (a highly absorbent wound dressing) and cover with abdominal pads three times a week. On 5/28/25 at 9:30 A.M., a home visit was conducted with Registered Nurse (RN) #1 to perform wound assessment and dressing change to Patient #5. The surveyor observed RN #1 perform hand hygiene and put gloves on and set the dressing supplies (clean gauze, calcium alginate dressing, tape, and scissors) on the chair next to the patient. She removed the patient’s abdominal dressing, and she placed them on the chair next to the dressing supplies. RN #1 then removed the wound packing strips on all four open wounds that were visibly soiled, put it on the gauze and placed them on the chair next to the dressing supplies. Without changing her gloves, she obtained clean gauze and 10 milliliter (ml) of normal saline and squirted it into the surgical wounds and pat it dry with the gauze. RN #1 removed her gloves, performed hand hygiene and donned clean gloves. The surveyor observed RN #1 open and cut a sterile calcium alginate dressing to size to pack it to the open wounds. In the process of packing the top midline open wounds, the calcium alginate dressing fell out and touched the patient’s skin on the umbilical area making it contaminated. RN #1 then packed the top midline open wound with the same contaminated calcium alginate dressing. During an interview on 5/28/25 at 10:02 A.M., RN #1 said that she should have changed gloves and perform hand hygiene after removing the old dressing. She said that she usually has a trash bin next to her to throw away the old dressings and an extra pair of gloves to change. RN #1 said that she should have used a new calcium alginate dressing to pack the top midline open wound when it fell and got contaminated.”

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure the participant, be informed about, and consent or refuse care in advance of and during treatment, for Occupational Therapy to furnish the care and services, for one Patient (#6), out of a total sample of 7 patients. Findings include: Review of the agency’s policy entitled Plan of Care, dated 12/18/24, indicated the following: *The client, the therapist and other Better Care Home Health, Inc. personnel shall participate in developing the plan of care. The client shall be informed of any changes in the plan of care. Review of the agency’s policy entitled, Consent For Use and Disclosure of Protected Health Information, dated 12/18/24, indicated the following: *Purpose: To access information needed to effectively provide services and provide documentation needed for reimbursement. *If consent cannot be obtained prior to treatment due to communication barriers or emergency situations, it will be obtained as soon as possible. Reasons why it is not signed must be documented. Patient #6 was admitted to the agency in March 2025 with a diagnosis of non-pressure chronic skin ulcer (impaired skin), requiring skilled services. Review of a physician’s order dated 4/25/25, for a Physical Therapy (PT) and Occupational Therapy (OT) evaluation and treatment as indicated. Review of the clinical record indicated a PT evaluation was completed on 4/30/25 and an OT evaluation was completed on 5/1/25. Further review of the clinical record indicated a Consent for Assessment/Evaluation and Accepted for Treatment of PT services was obtained and signed by Patient #6 on 4/30/25, however there was no signed Consent for Assessment/Evaluation and Accepted for Treatment of OT services completed on 5/1/25 During an interview on 5/28/25 at 10:40 A.M., the Executive Director said the Occupational Therapist did not ensure Patient #6 had given consent to complete the evaluation and/or provide services as needed.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure that the physician ordered plan of care was followed relative to Occupational Therapy (OT) services for 1 patient (#6), out of a total sample of 7 patients. Findings include: Review of the agency’s policy entitled Plan of Care, dated 12/18/24, indicated the following: *Home care services are furnished under the supervision and direction of the client’s physician. *Orders for therapy services shall include the specific procedures and modalities to be used and the amount, frequency and duration. Patient #6 was admitted to the agency in March 2025 with a diagnosis of non-pressure chronic skin ulcer (impaired skin), requiring skilled care. Review of a physician order dated 4/30/25 for a Physical Therapy and OT evaluation and treatment as indicated. Review of the clinical record indicated the OT evaluation was completed on 5/1/25. Further review of the evaluation included treatment plan for OT services once a week for 8 weeks effective 5/1/25. The evaluation indicated the physician was notified of the plan of care update and agreed to the order. Further review of the clinical record indicated an OT visit was not provided for the week of 5/4/25 through 5/10/25, and no documentation to indicate why the visit was not provided as ordered. During an interview on 5/28/25 at 10:45 A.M. the Executive Director (ED) said the plan of care had not been followed as ordered, as OT services were not provided during the week noted above. She said she spoke with the Occupational Therapist who indicated she did not do a visit that week and had not documented why it was missed.”