Pruitthealth Home Health New Bern

“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 follow accepted standards of practice to prevent the transmission of infections and communicable diseases for 2 of 5 patients with home visits conducted. (Patients #9 & 11) Findings included: A policy, Infection Control Plan-Home Health (effective 04/01/2024) was received on 04/03/2024 from the agency director at 11:30 A.M. The policy stated, “Hand hygiene must be performed at least in the following instances: … Prior to donning sterile or non-sterile gloves… After removing gloves.” Patient #9 was admitted on 01/24/2024 with a diagnosis of DISPL (displaced) bimalleol (ankle) FX (fracture) L (left) lower leg. The plan of care for 03/24/2024-05/22/2024 included orders for occupational therapy (OT) 1 time a week for 6 weeks. A home visit was conducted with OT #2 on 04/02/2024 at approximately 9:30 A.M. OT #2 donned clean gloves, assessed patient #9’s skin, and removed the clean gloves. OT #2 failed to perform hand hygiene before donning the gloves and fail to perform hand hygiene after removing the gloves. An interview was conducted with OT #2 on 04/03/2024 at approximately 9:05 A.M. OT #2 stated, “I should have used hand sanitizer after I took my gloves off. I thought I used hand sanitizer before I put the gloves on, I may not have.” Patient # 11 was admitted on 01/26/2024 with a diagnosis of dehiscence (splitting open) of amputation stump. The plan of care for 03/26/2024-05/24/2024 included orders for skilled nurse visits 1 time a week for 1 week, 2 times a week for 8 weeks, and 2 PRN (as needed) A home visit was conducted on 04/03/2024 at approximately 1:00 PM with registered nurse (RN) #4. RN #4 donned clean gloves, measured patient #11’s wound, removed the gloves and donned a clean pair. RN #4 failed to perform hand hygiene after removing the soiled gloves before donning clean gloves. An interview was conducted on 04/03/2024 at approximately 10:30 A.M. RN #4 stated “You should always wash your hands in-between gloves.” An interview was conducted with the agency administrator on 04/03/2024 at approximately 9:12 A.M. The agency director stated, “They should be washing hands or using hand sanitizer before and after gloves.””

“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 direct observation, policy review, clinical record review, and staff interview, the agency failed to maintain accurate medication profiles for 2 of 7 home visits conducted. (Patient #9, Patient #12) Findings included: Patient #12 was admitted to the agency on 02/19/24 with diagnoses including Type 2 diabetes with diabetic chronic kidney disease, pulmonary hypertension (affects blood vessels in the lungs), and atrial fibrillation (irregular heart rhythm). Plan of Care from 02/19/24 to 04/18/24 revealed orders for skilled nursing two times per week for one week, one time per week for nine weeks, and 2 PRN (as needed). On 04/02/23, Employee #5, registered nurse, conducted a home visit, that was observed during survey. Employee #5 was observed performing a medication review during the home visit. Patient #12 stated that he was no longer taking losartan 12.5 milligrams (used for hypertension), meclizine 25 milligrams (used for nausea or motion sickness) was only being taken as needed and not scheduled as listed on the agency’s medication profile, and valacyclovir 500 milligrams (used to treat shingles) was being taken twice daily and not three times daily as listed on the agency’s medication profile. Additionally, Patient #12 stated that he was taking the following medications that were not listed as current medications on the agency’s medication profile: furosemide 40 milligrams daily (used to treat fluid retention), omeprazole 20 milligrams daily (used to treat acid in the stomach), and potassium chloride extended release 10 milliequivalents daily (used to treat and/or prevent low potassium). In an interview on 04/03/24 at 9:12 AM, Employee #1, agency director, stated that employees are told that they should be doing it (medication reconciliation) every visit. In an interview on 04/03/24 at 11:05 AM, Employee #5 stated, “I typically do it [medication reconciliation] every other visit…it should have been done two weeks ago.” A policy, Medication Management for Home Health (revised 07/21/2021) was received on 04/03/2024 at approximately 11:30 A.M. The policy stated, “The home health agency will maintain accurate documentation of all medications that the patient is currently taking.” 1. Patient #9 was admitted on 01/24/2024 with a diagnosis of DISPL (displaced) bimalleol (ankle) FX (fracture) L (left) lower leg. The plan of care (POC) for 03/24/2024-05/22/2024 included orders for occupational therapy (OT) 1 time a week for 6 weeks. A home visit was conducted with OT #2 on 04/02/2024 at approximately 9:30 A.M. OT #2 conducted a comprehensive medication review. The POC included Amlodipine (blood pressure medication) 2.5 mg 1 time daily. Patient #9’s care giver stated, “That was discontinued on 02/20/2024.” The POC included Remeron (appetite stimulant) 15 mg 1 time daily. Patient #9’s care giver stated, “Not [taken] since the end of January [2024].” The POC included ibuprofen (anti-inflammatory) 800mg as needed. Patient #9’s care giver stated, “Not [taken] since the end of January [2024].” An interview was conducted on 04/03/2024 at approximately 9:05 AM with OT #2. OT #2 stated, “I ask every visit if there has been any [medication] changes. [Physical Therapist name] had recently done a recert and found no changes. I do them [medication reviews] on evals [evaluations], reassessment recert [recertifications], and discharges.” An interview was conducted on 04/03/2024 at approximately 9:12 A.M. with the agency administrator. The agency administrator stated, “They [clinicians] are told that they need to reconcile the meds at every visit, that’s our policy.””

“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 agency policy, clinical record review, and staff interview the registered nurse failed to document the assessment or response to treatment of penile cellulitis (skin infection of the penis) for 1 of 1 clinical record reviewed with the diagnosis of penile cellulitis (Patient #13). Findings included: A policy titled “Skilled Nursing Services for Home Health”, and reviewed 11/21/22, was received from the agency administrator on 04/03/24 at 11:34 AM. This policy revealed, “Nursing visits are individually based on the need, but not necessarily limited, to…assess and reassess the patient’s condition and response to the treatment plan.” Patient #13 was admitted to the agency 02/27/24 with diagnoses including penile cellulitis (skin infection of the penis), bradycardia (heart rate lower than 60), and pressure ulcer of sacral region, stage 2 (wound with a superficial opening of skin). Plan of Care from 02/27/24 to 04/26/24 included orders for skilled nursing one time per week for nine weeks with two PRN (as needed) and “skilled nurse to assess/evaluate…conditions including penile cellulitis…” A hospital discharge note dated 02/26/24 revealed “…they [hospital staff] found that he [Patient #13] had a lot of cottage cheese type discharge from his penis and his entire penis is erythematous [red]…was noted patient also suffering from penile cellulitis…he will be discharged to complete an additional 4 days of oral Cipro [antibiotic] and oral fluconazole [antifungal]…” Employee #6, registered nurse, conducted skilled nursing visits for Patient #13 on 02/27/24, 03/08/24, 03/13/24, 03/20/24, 03/27/24, and 04/02/24. There was no documented evidence that the status of Patient #13’s penile cellulitis was assessed during those visits. In an interview on 04/03/24 at 10:11 AM, Employee #6 stated, “That [cellulitis of penis] is resolved…it’s been resolved for about 2 weeks. I guess I didn’t [assess the status of Patient #13’s penile cellulitis] because I don’t see it in his notes… I did a full assessment on him, but I really don’t think he had that [penile cellulitis] when he went in [to the hospital] … he had a pretty bad yeasty rash and wound [of the buttocks] … sometime after that, I had to call the doctor because he did have a yeasty area in the penile area, a rash or redness.” In an interview on 04/03/24 at 10:30 AM, Employee #7, clinical manager, stated, “We’re told to do a head-to-toe assessment and document as such.””