Liberty Home Care V, 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, direct observation, and clinical interviews, the RN failed to follow correct bag technique for 1 of 1 patient who received wound care during a home visit [3]. The findings included: The policy, Bag Technique, home care [revised 5/19/25], was provided by the agency director on 9/9/25 at 8 am. The policy stated, “...Remove all needed equipment from the bag and place them on a clean, dry surface. Use a fluid-impermeable pad as a barrier...” Patient # 3 had a Start of Care date of 1/8/25 with an admitting diagnosis of pressure ulcer, sacral area [lower back, just above the buttocks] stage 4 [skin damage involving full-thickness tissue loss, exposing muscle, tendon or bone]. Review of the Plan of Care for the certification period 9/5/25-11/3/25 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 7 weeks and “Wound care to sacral/upper buttock wound-clean wound with soap and water, rinse and pat dry...apply to wound bed fibercol plus then cover with abdominal pads...” On 9/8/25 at approximately 12 noon a joint visit was made with RN # 1 to observe wound care. RN # 1 removed disposable gloves from the nursing bag along with other supplies for the dressing change and placed the items at the foot of the bed on the bed covers. The RN failed to use a barrier between the bed and the clean wound care supplies. During an interview with the agency director on 9/9/25 at approximately 10 am, the director confirmed the RN should have placed a barrier on the bed before placing the clean supplies/gloves on the bed.”

“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 agency policy, direct observation, clinical record review, interviews with staff and patients, the Plan of Care [POC] failed to include all current/correct medications the patient was taking for 2 of 3 home visits [#3 and 4]; and the POC failed to include all wound care orders for 1 of 1 patient receiving wound care during a home visit [#3]. The findings included: The policy, Care Planning: Initial Care Plan and Updates to the Plan of Care [03/24], was provided by the agency director on 9/9/25 at 8 am. The policy stated, “...The Plan of Care also included documentation of the following...All current prescriptions and over the counter medications...All patient care orders, including verbal orders must be recorded in the plan of care...” 1A. Patient # 3 had a Start of Care date of 1/8/25 with an admitting diagnosis of pressure ulcer, sacral area [lower back, just above the buttocks] stage 4 [skin damage involving full-thickness tissue loss, exposing muscle, tendon or bone]. Review of the Plan of Care [POC] for the certification period 9/5/25-11/3/25 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 7 weeks and “SN to perform medication review each skilled nursing visit and reconcile medications as indicated...” On 9/8/25 at approximately 12 noon a joint visit was made with RN # 1. During the visit a medication review was conducted using a medication profile provided by the agency. The following discrepancies were noted: The medication profile listed cranberry [supplement] 1000 mg. Take 2 tablets daily. During an interview with the patient he stated, “I don’t take that anymore.” The medication profile listed gabapentin [used for nerve pain] 800 mg. Take 1 capsule 3 times a day. During an interview with the patient he stated, “The doctor changed that to 900 mg 3 times a day several months ago.” During an interview with the agency director on 9/9/25 at 10 am, the director confirmed the POC did not include all current/correct medications. 1B. Patient # 3 had a Start of Care date of 1/8/25 with an admitting diagnosis of pressure ulcer, sacral area [lower back, just above the buttocks] stage 4 [skin damage involving full-thickness tissue loss, exposing muscle, tendon or bone]. Review of the Plan of Care [POC] for the certification period 9/5/25-11/3/25 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 7 weeks and “Wound care to sacral/upper buttock wound-clean wound with soap and water, rinse and pat dry...apply to wound bed fibercol plus then cover with abdominal pads...Change dressing 3 times per week and as needed if soiled and drainage. Caregiver to perform wound care when RN not present.” A joint visit was made with RN # 1 on 9/8/25 to observe wound care. After the wound care was completed, an interview was conducted with the patient. The patient reported the wound care is done 2 times a week by the RN. The patient went on to explain that his wife recently had surgery and couldn’t do the dressing change. During an interview with the agency director on 9/9/25 at 10 am, the director reported the frequency for the wound care was changed in April 2025 from 3 times a week to 2 times a week, and the RN had failed to write the order to change the frequency. A late order was noted on the chart dated 9/8/25 for 4/2025 to change the frequency of the wound care. The director confirmed the order was not included in the POC. 2. Patient # 4 had a Start of Care of 7/17/25 with an admitting diagnosis of hemiplegia [paralysis of half of body] following cerebral infarction [stroke] affecting left non-dominant side. Review of the Plan of Care [POC] for the certification period 7/17/25-9/14/25 revealed orders for PT [physical therapy] 1 time a week for 9 weeks. On 9/8/25 at approximately 2 pm a joint visit was made with PT # 2. During the visit a medication review was conducted using a medication profile provided by the agency. The following discrepancies were noted: The medication profile listed vitamin B 12 [supplement] 1000 mcg. Take 2 every day. During an interview with the patient he reported, “I don’t take those anymore.” The medication profile listed melatonin [sleep aid] 3 mg. Take 2 tablets each night. During the interview with the patient he stated, “I don’t take those anymore either.” During an interview with the agency director on 9/9/25 at 10 am, the director confirmed the POC did not include all current/correct medications.”