Hometown Homecare

“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 policy review, home visit observation, and interview, the home health provider failed to follow accepted standards of practice, in hand hygiene, to prevent the transmission of infections in, one of three home visit observations conducted (Record/Patient #3). This deficient practice has the potential to affect all the patients served by the home health provider. Findings included: Review of the home health provider’s undated policy titled, “Hand Washing - Hand Hygiene,” showed in part, in the event that you are putting gloves on, do hand washing hygiene before applying gloves and after removing them. Do this each time you need to change gloves for any care provided. RECORD/PATIENT #3: Observation on 04/21/2025 at 11:40 AM, showed registered nurse (RN) A: - Completed a full body assessment of the patient; - Failed to perform hand hygiene and applied gloves; - Touched the big toe and assessed it for drainage; - Removed gloves and obtained a band aid dressing to place on the big toe; - Applied new gloves on his/her hands without performing hand hygiene; - Performed hand hygiene and set up supplies for a dressing change to the patient’s peripherally inserted central catheter (PICC line, inserted into a peripheral vein and ending in a large vessel above the heart); - Removed his/her exam gloves and applied sterile gloves to perform PICC line dressing change (RN-A failed to perform hand hygiene); - Removed his/her sterile gloves and applied another pair of gloves to withdraw blood from the PICC line tubing (RN-A failed to perform hand hygiene); - Completed the blood draw, removed his/her gloves and performed hand hygiene; and - RN-A failed to perform hand hygiene per the provider’s policy. During an interview immediately following the home visit, RN-A acknowledged that he/she should have performed hand hygiene each time that he/she changed his/her gloves. During an interview on 04/22/2025 at 3:35 PM, the administrator stated that RN-A should have performed hand hygiene before and after each glove application.”

“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 policy review, record review, home visit observation, and interview, the home health provider failed to maintain an accurate, updated medication profile in one of three home visit observations conducted (Record/Patient #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Medication Policy,” regarding medication reconciliation showed, in part, upon admission, recertification, resumption of care, discharge and after physician appointments (or medication changes) there will be a complete medication assessment and evaluation with notification of the physician of any discrepancies that are discovered, as well as a drug to drug interaction completed after each new medication is added to patient’s medication list. Teaching sheets will be provided and reviewed with patient and/or family as needed for those medications. The patient’s in home medication list is to be evaluated at the above intervals as well and updated in clinical software to be accurate. RECORD/PATIENT #2: Review of the clinical record showed the patient was readmitted to home health services on 04/04/2025 after a hospital stay. The patient’s primary diagnosis was adenocarcinoma of the prostate (cancer in a gland of the male reproductive system). The patient lived at home with a family caregiver. Observation and interview on 04/21/2025 at 4:15 PM, showed the following discrepancies between the patient’s home medications and the provider’s medication profile: - The provider’s medication profile showed the patient took Alka-Seltzer Plus Cold by mouth two tablets every four hours as needed for cold symptoms. The patient stated that he/she had not taken this medication since 02/27/2025; - The provider’s medication profile showed the patient took ciprofloxacin (antibiotic) by mouth 500 milligrams (mg) one tablet every 12 hours, to be started three days prior to Foley catheter (brand, a sterile tube placed in the bladder to drain urine) removal. The patient stated that he/she had not taken this medication for quite some time, that his/her Foley was removed; - The provider’s medication profile showed the patient took CVS (brand) Senna Plus (used for constipation) 8.6-50 mg two tablets as needed at bedtime. The patient stated that he/she “didn’t take”; - The provider’s medication profile showed the patient took Eliquis (used to prevent blood thickening) 5 mg one tablet twice a day. The patient’s medication bottle label showed one tablet daily, and the patient stated that was how he/she took this medication; - The provider’s medication profile showed the patient took epinephrine injection solution (for allergic reaction) auto injector 0.3 mg/0.3 milliliter (ml). The patient stated “never use, if you take it, you have to go to the hospital”; - The provider’s medication profile showed the patient took Klor-Con 10 (potassium supplement) extended release 10 millequivalent (mEq) one tablet daily. The patient’s hospital medication list showed Klor-Con 20 mEq (two tablets) daily - The provider’s medication profile showed Nucala (treatment for asthma) subcutaneous (inject under the skin) prefilled syringe 100 mg/ml - 1 ml every month. The patient stated he/she did not “have any of this”; - The provider’s medication profile showed the patient took quetiapine fumarate (used to treat depressive disorder and sometimes used for sleep) one tablet every AM, and two tablets in the evening. The patient stated that he/she only took this medication in the evening; and - The patient’s medication profile failed to show hydrochlorothiazide (HCTZ - used to treat fluid retention and to lower blood pressure) two tablets daily. The medication was listed on the hospital’s medication discharge list. The hospital’s medication list failed to show the dosage amount. The patient stated “no longer take this medication”. During an interview on 04/22/2025 at 3:35 PM, the home health administrator stated that the medication lists were not reconciled and that he/she would expect staff to follow the policy.”