Liberty Home Care, 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 agency policy, observation, and staff interviews, the agency failed to perform hand hygiene after contact with inanimate objects in the patient’s environment while performing wound care. (patient #12) Findings included: A policy, Hand Hygiene, home care (reviewed 09/15/2025) received on 09/16/2025 at 1:25 PM from the agency administrator stated, “Using an alcohol-based hand rub is appropriate for decontaminating the hands before direct contact with the patient; … and after contact with inanimate objects in the patient’s environment…” Patient #12 was admitted on 09/04/2025 with a diagnosis of laceration with a foreign body (wound). The plan of care for 09/04/2025-11/02/2025 included orders for skilled nurse (SN) visits 2 times a week for 1 week, 3 times a week for 2 weeks, 2 times a week for 6 weeks, with 4 PRN (as needed) and “SN to perform wound care to RLE [right lower extremity] skin tear. Cleanse wound with Normal saline, pat dry, apply polymem [wound dressing] to wound bed and overlap wound edges by ½” cover and secure with kerlix and tape, apply ace wrap from toes to just below knee for compression using clean technique every other day for 2 weeks starting 9/16/25. SN may teach patient/caregiver to perform wound care.” During a home visit conducted on 09/16/2025 at 9:25 AM RN (registered nurse) #5 performed hand hygiene and donned clean gloves, cleansed the wound, applied polymen dressing, wrapped the extremity with gauze, removed the trash, removed the gloves, removed the patient’s shoes and socks and applied the ace wrap. RN #5 failed to perform hand hygiene after removing the patient’s shoes and socks. During an interview conducted on 09/16/2025 at 1:15 PM RN #5 stated, “It’s not like I touched the bottom of her shoes… Yes” [would normally perform hand hygiene after touching the shoes]. During an interview conducted on 09/16/2025 at 1:19 PM the administrator stated, “I would expect that they clean their hands after touching anything before touching the patient.””

“Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This Standard is not met as evidenced by: Based on clinical record review and staff interviews, the agency failed to assess blood pressures for 1 of 4 discharged patients. (patient #4) Findings included: Patient #4 was admitted on 03/29/2024 with diagnoses of encounter for change or removal of surgical wound dressing, hypertension secondary to endocrine disorders (high blood pressure), and chronic combined systolic and diastolic heart failure (condition where heart doesn’t pump blood effectively). The plan of care for 03/29/2024-05/27/2024 include orders for skilled nurse visits 1 time a week for 1 week, 2 times a week for 2 weeks, 1 time a week for 2 weeks, 1 every other week for 5 weeks, 4 PRN (as needed), physical therapy (PT) 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 1 week, occupational therapy (OT) 1 time a week for 1 week, and “Notify Physician of vital sign parameters out of range: … Systolic BP [blood pressure]: Greater (>) Than 170 Less Than () Than 100 Less (<) Than 55.” Review of the clinical record revealed the following: During the registered nurse (RN) visits 08/01/2024, 09/09/2024, and 09/25/2024 RN #9 documented blood pressure reading assessments. During the PT visit on 09/10/2024 PT #10 documented a blood pressure reading assessment. During the OT visit on 08/02/2024 OT #11 documented a blood pressure reading assessment. During the physical therapy assistant (PTA) visits on 08/08/2024, 08/09/2024, 08/13/2024, 08/20/2024, 08/26/2024, 08/26/2024, PTA #12 documented blood pressure readings assessments. During 5 of 5 SN [skilled nurse] visits on licensed practical nurse (LPN) #3 documented, “SN unable to obtain BP due to inabitiy [SIC] to hear correctly.” During an interview conducted on 09/14/2025 at 2:15 PM LPN #3 stated, “The patient was a dialysis patient… I would try on the right leg…” An interview conducted on 09/15/2025 at 4:10 PM with the clinical manager revealed that the expectation would be for staff to discuss problems with blood pressure assessments.”

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on agency policy, clinical record review and staff interviews, the agency failed to notify the physician of a blood pressure that was not assessed for 1 of 4 discharged patients. (patient #4) Findings included: A policy, Coordination and Communication Activities (revised 03/2024), received on 09/15/2025 at 2:51 from the administrator stated, “Home Health staff will maintain on-going communication with all physicians involved in the plan of care… that addresses the following, at a minimum: … findings that are outside of established parameters…failure to follow the plan of care…” Patient #4 was admitted on 03/29/2024 with diagnoses of encounter for change or removal of surgical wound dressing, hypertension secondary to endocrine disorders (high blood pressure), and chronic combined systolic and diastolic heart failure (condition where heart doesn’t pump blood effectively). The plan of care for 03/29/2024-05/27/2024 included orders for skilled nurse visits 1 time a week for 1 week, 2 times a week for 2 weeks, 1 time a week for 2 weeks, 1 every other week for 5 weeks, 4 PRN (as needed), and “Notify Physician of vital sign parameters out of range: … Systolic BP [blood pressure]: Greater (>) Than 170 Less Than () Than 100 Less (<) Than 55.” Review of the clinical record revealed the following: During the SN [skilled nurse] visit on 08/06/2024 licensed practical nurse (LPN) #3 documented, “SN unable to obtain BP due to inabitiy [SIC] to hear correctly.” During the SN visit on 08/13/2025 (LPN) #3 documented, “SN unable to obtain BP due to inabitiy [SIC] to hear correctly.” During the SN visit on 08/21/2025 (LPN) #3 documented, “SN unable to obtain BP due to inabitiy [SIC] to hear correctly.” During the SN visit on 08/27/2025 (LPN) #3 documented, “SN unable to obtain BP due to inabitiy [SIC] to hear correctly.” During the SN visit on 09/13/2025 (LPN) #3 documented, “SN unable to obtain BP due to inabitiy [SIC] to hear correctly.” Further review revealed that there was no documentation that the physician was notified. During an interview conducted on 09/14/2025 at 2:15 PM LPN #3 stated, “The patient was a dialysis patient. I would try on the right leg… I did call the doctor. I do document communication with the RN [registered nurses] and doctors.” During an interview conducted on 09/16/2025 at 4:10 PM the clinical manager stated, “If it’s [failure to obtain blood pressure] 1 time only, they should notify the doctor. If it continues, they should get an order to discontinue the blood pressure.””

“Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This Element is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the agency failed to document the correct dose of oxygen for 1 of 4 patients with an order for supplemental oxygen. (patient #5) Findings included: A policy, Legal Aspects of Clinical Documentation (revised 01/2025) received on 09/15/2025 at 2:51 PM from the administrator stated, “Chart completely, concisely and accurately…” Patient #5 was admitted on 07/20/2025 with a diagnosis of chronic obstructive pulmonary disorder (lung disease that blocks airflow). The plan of care for 07/20/2025-09/17/2025 included orders for skilled nurse visits 2 times a week for 2 weeks, 1 time a week for 7 weeks, 3 PRN (as needed) and “OXYGEN 3L [3 liters] continuous nasal” Review of the clinical record revealed the following: On 08/22/2025 licensed practical nurse (LPN) #3 documented “Oxygen use, continuous LPM [liters per minute] 2 via nasal cannula.” On 08/28/2025 LPN #3 documented, “Oxygen use, continuous LPM 2 via nasal cannula.” On 09/03/2025 LPN #3 documented, “Oxygen use, continuous LPM 2 via nasal cannula.” On 09/09/2025 LPN #3 documented, “Oxygen use, continuous LPM 2 via nasal cannula.” During an interview conducted on 09/17/2025 at 8:39 AM LPN #3 stated, “That’s probably like a mistake, an error on my part, instead of putting 3, I put 2…” During an interview conducted on 09/17/2025 at 8:42 AM the administrator stated, “She should have double checked her documentation.””