Saint Lukes Home Care

“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 ensure staff followed the bag technique procedure in one of three home visits (Record/Patient #1). This deficient practice has the potential to affect all the provider’s patients. Findings included: Review of the provider’s policy titled, “Bag Technique,” last reviewed 03/31/2021 showed, “Hand washing equipment should be kept on the outside pockets or dirty area of the bag. Wash hands before entering the bag and upon returning for any reason.” RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted on 02/16/2024 for a primary diagnosis of a pressure ulcer (wound) of the right lower leg. The patient resided alone in his/her own home. Observation on 06/24/2024 at 3:53 PM, during the patient’s home visit, showed the clinician: - Performed hand hygiene and donned nonsterile gloves; - Entered the clinical bag and retrieved the blood pressure cuff; - Placed the blood pressure cuff on the patient, and assisted the patient in signing the tablet; - Failed to remove their soiled gloves prior to re-entering the clinical bag to retrieve the pulse ox and thermometer; - Measured the patient’s temperature and pulse oximetry reading; - Failed to perform hand hygiene and continued to wear soiled nonsterile gloves; - Cleansed the blood pressure cuff, thermometer, and pulse oximeter using cleansing wipes; - Failed to perform hand hygiene and continued to wear soiled nonsterile gloves; and - Returned the ‘cleaned’ equipment into the clinical bag. During an interview on 06/25/2024 at 3:41 PM, the administrator stated they would expect the clinician to perform hand hygiene prior to re-entering the clinical bag.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on policy review, clinical record review, and interview, the home health provider failed to ensure the individualized plan of care contained the types of services, supplies, and equipment required to meet the needs of their patients in two of five records reviewed (Records/Patients #2 and #4). This deficient practice has the potential to affect the care for all of the provider’s patients. Findings included: Review of the provider’s policy titled, “Care Planning (Plan of Care),” last revised 12/17/2024, showed all orders or service and/or products will be incorporated into the plan of care. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted on 05/28/2024 with a diagnosis of atrial fibrillation (abnormal heart rhythm characterized by rapid and irregular heartbeat), and a new diagnosis of type 2 diabetes (a group of diseases that results in too much sugar in the blood) on 05/18/2024. Review of the start of care, comprehensive nursing assessment visit documentation, for the visit performed 05/28/2024, showed that the patient: - Had a non-removeable dressing on their right hip; - Was not performing blood sugar monitoring; and - Had diagnoses of right hip arthroplasty (a surgical procedure that improves joint function and pain by repairing or replacing a damaged joint) following a recent fall and atrial fibrillation. Review of the plan of care dated 05/28/2024, failed to show: - Information that the patient had undergone a right hip arthroplasty on or around 05/12/2024; and - Interventions to monitor or address the new diagnosis of type two diabetes. During an interview on 06/25/2024 at 3:46 PM, the administrator stated that they would expect the right hip arthroplasty and interventions to monitor a newly diagnosed diabetic to be included on the plan of care. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted on 05/26/2024 following a hospital stay for treatment of a urinary tract infection. The patient had a history of pressure injuries (wounds), chronic respiratory failure (a condition that occurs when the lungs cannot exchange oxygen and carbon dioxide properly, resulting in low oxygen levels or high carbon dioxide levels in the blood), and oxygen dependence. The patient resided in their own home with the assistance of their spouse. Review of the start of care, comprehensive nursing assessment visit documentation, for the visit performed on 05/26/2024, showed the patient: - Used a Purewick system (an external urine collection system to manage urinary incontinence) for management of urinary incontinence; and - Used oxygen at 4 (four) liters per minute. Review of the physical therapy evaluation visit documentation, for the visit performed on 05/30/2024, showed the patient: - Used a Luisa system (a home ventilator system); and - Someone in the home was a smoker. Review of the occupational therapy evaluation visit documentation, for the visit performed on 05/31/2024, showed the patient was using oxygen at 6 (six) liters per minute. Review of the plan of care, with start of care date 05/26/2024, failed to contain orders and interventions for: - The use of the Purewick or Luisa systems; - The reason for an oxygen range of 4 to 6 liters per minute; and - Safety measures associated with having a smoker in the home with concurrent oxygen therapy. During an interview on 06/25/2024 at 4:16 PM, the administrator stated that they would expect the plan of care to contain orders and interventions for: - The use of the Purewick or Luisa systems; - The reason for an oxygen range of 4 to 6 liters per minute; and - Safety measures associated with having a smoker in the home with concurrent oxygen therapy.”