A Caring Heart Nursing Services LLC

“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, record review, and interview, the agency failed to ensure infection control guidelines were maintained before the use of a glucometer (a portable device used to measure the amount of glucose (sugar) in the blood) and failed to perform hand hygiene after the use of a glucometer during a home visit observation for 1 patient (#5), out of a total of 3 visits. Findings include: Review of the agency policy entitled, Infection Control, reviewed 3/2025, included the following: *Agency employees will employ infection control practices in the delivery of care to Agency patients to prevent the spread of infection within its home care patient caseload to the highest degree possible. *Cleaning Patient Care Equipment-cleaning is an act of removing visible organic residue (ex. blood/tissue) from patient care equipment and preparing it for safe handling and/or further decontamination. Review of the CDC’s Clinical Safety: Hand Hygiene for Healthcare Workers, dated 2/27/24, indicated the following: *Wear gloves when needed for Standard Precautions (when you anticipate that you will come in contact with blood or other infectious materials, mucous membranes, non-intact skin, potentially contaminated skin, or contaminated equipment). *When to change gloves and clean hands: *If gloves become soiled with blood or body fluids after a task. *If moving from work on a soiled body site to a clean body site on the same patient or if a clinical indication for hand hygiene occurs. *If they look dirty or have blood or body fluids on them after completing a task. Patient #5 was admitted to the agency in February 2023 with a diagnosis of Diabetes Mellitus (a chronic disease characterized by high blood sugar resulting from the body’s inability to produce or properly use insulin) with diabetic neuropathy (nerve damage caused by long-term, high blood sugar). Review of the physician ordered Home Health Certification and Plan of Care, dated 1/31/26 through 3/31/26, included the following: -Skilled Nurse Visits (SNVs): 2 SNVs times 1 week, 14 SNVs weekly times 8 weeks, 6 SNVs times 1 week and 3 SNVs, as needed (PRN), for acute health change. -Patient/caregiver independent with self-administered medications: No -Blood sugar checks twice daily before breakfast and dinner. -Humalog Mix 75/25 (a pre-mixed, intermediate and rapid-acting insulin) 100 units per milliliter (ml) subcutaneously (the fatty tissue layer between the skin and muscle), inject 15 units subcutaneously daily before breakfast. If sugar is less than 100 milligrams per deciliter (mg/dl-a unit of measurement commonly used to measure the concentration of glucose in the blood), hold insulin. If sugar is greater than 400 mg/dl, call Summit Eldercare (a program that helps seniors live at home). During a home visit on 3/11/26 at 7:10 A.M., the surveyor observed Nurse #1 cleanse his hands with an alcohol-based hand gel, don (put on) gloves, remove a glucometer from a plastic bag that was laying on the counter. Nurse #1 cleansed the patient’s finger with an alcohol wipe and obtained the blood sample. He obtained the results, cleansed the glucometer with a cleansing wipe, and put it back into the plastic bag. He then removed the Humalog Mix 75/25 KwikPen (a pre-filled, disposable pen containing the insulin) from the patient’s refrigerator, attached a needle to the pen, administered the insulin, as ordered, disposed the needle in a sharps container, and put the pen back into the refrigerator. During this observation, Nurse #1 did not cleanse the glucometer prior to using it. He did not doff (remove) his gloves after he obtained the finger stick blood sample, cleaned the glucometer and put the glucometer away before Nurse #1 obtained the insulin, prepared the KwikPen (touching the objects in the environment) and administered the insulin. During an interview on 3/11/26 at 7:18 A.M., Nurse #1 said he did not cleanse the glucometer prior to use, as required. He further said he did not doff his gloves, perform hand hygiene and don new gloves after he obtained the blood sample prior to administering the insulin, as required.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on record review, policy review, and interview, the agency failed to ensure a completed discharge summary was sent to the primary care practitioner or other health care professional responsible for providing care and services to the patient after discharge from the agency within 5 business days of the patient’s discharge for 1 patient (#1), out of a total sample of 7 patients. Findings include: Review of the agency policy entitled, Transfer and Discharge, dated 3/2025, indicated the following: *A discharge summary will be completed for all discharged patients. A copy will be provided to the primary physician with 7 calendar days, and the receiving facility if the patient is transferred to another agency or facility within 2 calendar days. Patient #1 was admitted to the agency in June 2025 with a diagnosis of cellulitis (a bacterial skin infection) of left lower limb. Review of the clinical record indicated the patient was discharged from the agency on 8/27/25. Further review of the clinical record did not contain any documentation to indicate a discharge summary was sent to the physician responsible for providing care to the patient after discharge. During an interview on 3/10/26 at 2:38 P.M., after reviewing the clinical record, the Administrator said there was no documentation to indicate that the discharge summary was provided to the physician, as required.”