Chi Health at Home - Omaha

“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 record review, policy and procedure review, the observation of the provision of cares, and staff interview, 3 of 7 agency staff (Staff D, H, and I) failed to use proper hand hygiene, glove use, bag technique, and/or reusable equipment care during the provision of cares to 3 of 7 patients (Patient 1, 5, and 7) respectively. The total sample size was 17. The census was 318. A. Review of the agency policy and procedure titled, 33.900, Hand Hygiene, revised 8/10/22, revealed: 1. Staff are to perform hand hygiene using soap and water or alcohol based hand rub when entering and leaving the patient’s home, before and after direct patient contact, when hands are visibly soiled, before entering/re-entering the clinician’s bag, before handling patient’s clean supplies, after contact with non-intact skin and wound dressings, when moving from contaminated body site to clean body site, between task procedures on the same patient to prevent cross-contamination of different body sites, and after removing gloves. 2. The use of gloves does not eliminate the need to perform hand hygiene. Gloves should be worn whenever there is anticipated contact with blood, body fluids, secretions, excretions, contaminated items, contact with mucous membranes, and non-intact skin. Gloves are to be changed between tasks and procedures on the same patient and when visibly soiled. B. Review of the agency policy and procedure titled, 33.83, Bag Technique, revised 5/7/24, revealed staff are to: 1. Perform hand hygiene prior to entering/re-entering the clinician’s bag, before and after patient and/or equipment contact. 2. Remove necessary items for the visit and keep bag closed during the visit. 3. Reusable equipment (for example- stethoscope, blood pressure cuffs, tablets, thermometers) was to be cleaned with alcohol or cleansing agent, or disinfectant wipe after use and prior to returning items to the clinician’s bag. 4. This policy does not include steps to ensure equipment was cleaned between contaminated tasks and clean tasks such as cleaning scissors used for cutting soiled dressing and prior to cutting clean/sterile dressing. C. Review of the agency policy and procedure titled, Focus on Care, Home Care and Hospice, Wound Cleansing and Dressing, no date indicated, revealed staff are to: 1. Consider wounds with separate dressing as a separate wound and must be for independently. 2. Perform hand hygiene and glove changes between the care of each individual wound. 3. This policy does not include steps to ensure equipment is cleaned between contaminated tasks and clean tasks such as cleaning scissors used for cutting soiled dressing and prior to cutting clean/sterile dressing on the same patient. D. Review of clinical records revealed: 1. Patient 1’s Home Health Certification and Plan of Care for the certification period of 12/17/24 through 2/14/25 included orders for Skilled Nurse (SN) 2 times a week for 9 weeks and 3 as needed (PRN) visits for central venous catheter (a thin tube inserted in a vein near the heart and is used for administering medications, fluids, blood products, or drawing blood samples), lab draws, and wound care to wounds on the left and right lower extremities. 2. Patient 5’s Home Health Certification and Plan of Care for the certification period of 1/17/25 through 3/17/25 included orders for SN 1 time a week for 5 weeks, then 3 times a week for 1 week, and then 1 time a week for 3 weeks for evaluate and assess any condition that presents itself and will impact the plan of care. 3. Patient 7’s Home Health Certification and Plan of Care for the certification period of 1/8/25 through 3/8/25 included orders for Occupational Therapy (OT) 1 time a week for 2 weeks, then 1 time every 2 weeks for 6 weeks to assess, evaluate, and train the patient in functional activities. E. Observation of wound care provided to Patient 1, on 2/4/25 at 2:30 PM, revealed Staff D failed to: 1. Sanitize hands after cleansing the patients right foot wound and prior to prepping and applying clean dressing to the same wound. 2. Sanitize hands and change gloves after cleansing a wound on the patient’s right foot and prior to providing wound care to the left foot ulcer. 3. Sanitize the scissors between use to cut soiled dressing from wounds and prior to cutting clean dressing on 2 occasions during wound cares. F. Observation of the provision of nursing assessment to Patient 5, on 2/5/25 at 3:00 PM, revealed Staff H failed to: 1. Remove gloves and sanitize hands after contact skin with patient and prior to entering the clinician’s bag to obtain [gender] phone. 2. Sanitize phone after use as a flashlight during the patient assessment and prior to returning the phone back to the clinician’s bag. 3. Sanitize the tablet (electronic device used for documentation) after use by the patient and prior to returning the tablet to the clinician’s bag. G. Observation of the provision of assessment to Patient 7, on 2/11/25 at 11:00 AM, revealed Staff I failed to sanitize the electronic tablet after use by the patient and prior to leaving the patient’s home. H. During an interview on 2/13/25 at 9:00 AM, the Administrator, the Market Director of Operations, and the Manager of Clinical Services confirmed Staff D, H, and I, failed to use proper hand hygiene, glove use, bag technique, and/or reusable equipment care during the provision of cares to Patient 1, 5, and 7 respectively.”

“5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the home health agency failed to complete a comprehensive assessment of the patient’s physical therapy (PT) and/or occupational therapy (OT) needs no later than 5 days of the start of care (SOC) for 6 of 14 patients (Pt- 1, 3, 9, 10, 13, and 16) whose plan of care included orders for physical therapy (PT) and/or occupational therapy (OT) services. The total sample size was 17, the census was 318. A. Review of the agency policy and procedure titled, 33.43, Comprehensive Patient Assessment, last reviewed 4/15/2022, revealed: 1. A comprehensive assessment was to be completed in a timely manner, consistent with the patient’s immediate needs, but no later than five calendar days after the start of care (SOC). 2. The assessment was to include other needed information that could impact the level of services required to meet the patient and family needs. B. Review of Patient 1’s clinical record revealed: 1. Home Health Certification and Plan of Care (POC) for the certification period 12/17/24 through 2/14/25, included orders for Occupational Therapy (OT) to evaluate and treat. 2. The SOC was 12/17/24. 3. An OT evaluation visit was completed on 12/23/24 (6 calendar days after the SOC). 4. There was no documentation in the clinical record that the patient or the physician requested a delay in the OT comprehensive assessment beyond 5 calendar days after the SOC. C. Review of Patient 3’s clinical record revealed: 1. Home Health Certification and Plan of Care for the certification period 12/19/24 through 2/16/25, included orders for Occupational Therapy (OT) to evaluate and treat. 2. The SOC was 12/19/24. 3. An OT evaluation visit was completed on 12/26/24 (7 calendar days after the SOC). 4. There was no documentation in the clinical record that the patient or the physician requested a delay in the OT comprehensive assessment beyond 5 calendar days after the SOC. D. Review of Patient 9’s clinical record revealed: 1. Home Health Certification and Plan of Care for the certification period 12/10/24 through 2/7/25, included orders for Occupational Therapy (OT) to evaluate and treat. 2. The SOC was 12/10/24. 3. An OT evaluation visit was completed on 12/17/24 (7 calendar days after the SOC). 4. There was no documentation in the clinical record that the patient or the physician requested a delay in the OT comprehensive assessment beyond 5 calendar days after the SOC. E. Review of Patient 10’s clinical record revealed: 1. Home Health Certification and Plan of Care for the certification period 12/18/24 through 2/15/25, included orders for Occupational Therapy (OT) to evaluate and treat. 2. The SOC was 12/18/24. 3. An OT evaluation visit was completed on 12/27/24 (9 calendar days after the SOC). 4. There was no documentation in the clinical record that the patient or the physician requested a delay in the OT comprehensive assessment beyond 5 calendar days after the SOC. F. Review of Patient 13’s clinical record revealed: 1. Home Health Certification and Plan of Care for the certification period 9/24/24 through 11/22/24, included orders for Occupational Therapy (OT) to evaluate and treat. 2. The SOC was 9/24/24. 3. An OT evaluation visit was completed on 9/30/24 (6 calendar days after the SOC). 4. There was no documentation in the clinical record that the patient or the physician requested a delay in the OT comprehensive assessment beyond 5 calendar days after the SOC. G. Review of Patient 16’s clinical record revealed: 1. Home Health Certification and Plan of Care for the certification period 12/27/24 through 2/24/25, included orders for Physical Therapy (PT) to evaluate and treat. 2. The SOC was 12/27/24. 3. An PT evaluation visit was completed on 1/3/25 (7 calendar days after the SOC). 4. There was no documentation in the clinical record that the patient or the physician requested a delay in the PT comprehensive assessment beyond 5 calendar days after the SOC. H. During an interview on 2/13/25 at 9:00 AM, the Administrator, Market Director of Operations, and the Manager of Clinical Services confirmed the comprehensive assessment of the patient’s physical therapy (PT) and/or occupational therapy (OT) needs were not completed within 5 days of the SOC for Pt- 1, 3, 9, 10, 13, and 16.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure treatments and services were completed as ordered on the plan of care (POC) for 2 of 17 clinical records reviewed (Pt 2 and Pt 7). The census was 318. A. Review of the agency policy and procedure titled, 33.24, Plan of Care and Physician and Allowed Practitioner Orders, last revised 3/5/24, revealed: 1. All care and services provided are according to current physician or allowed practitioners orders. 2. Clinicians are responsible for alerting the physician and if indicated, the allowed practitioner, to any changes in patient care or condition that suggest a need to alter the POC. B. Review of Patient 2’s clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 10/26/24 through 12/24/24 Skilled Nurse (SN) 1 time a week for 1 week, then 2 times a week for 2 weeks, then 2 times every 3 weeks, then 2 times a week for 1 week, then 3 times a week for 2 weeks, then 1 times a week for 1 week, and 3 as needed (PRN) visits for wound care using a negative pressure wound therapy device (NPWT) (a device that utilized negative pressure through dressings and tubing to treat a wound). The physician order instructs the nurse to count and document the number of sponges removed from the wound. 2. The Home Health Certification and Plan of Care for the certification period of 12/25/24 through 2/22/25 included orders for SN 1 times a week for 1 week then 2 times a week for 2 weeks, then 3 times a week for 8 weeks, and 3 PRN visits for wound care using a negative pressure wound therapy device (NPWT) (a device that utilized negative pressure through dressings and tubing to treat a wound). The physician order instructs the nurse to count and document the number of sponges removed from the wound. 3. SN Visit Note Report revealed the SN completed NPWT dressing change with visits on 12/9/24, 12/11/24, 12/13/24, 12/16/24, 12/18/24, 12/20/24, 12/26/24, 12/30/24, 1/2/25, 1/10/25, 1/13/25, 1/15/25, 1/17/25, 1/21/25, 1/23/25, 1/27/25, 1/29/25, 1/31/25, 2/3/25, and 2/5/25. The SN did not document the number of sponges removed from the wound during the NPWT dressing changes. C. Review of Patient 7’s clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 1/8/25 through 3/8/25 included orders for SN 1 time a week for 9 weeks and 3 PRN visits to observe and assess respiratory system and to identify changes and to intervene to minimize complications. 2. A Visit Note Report dated 1/29/25 revealed the SN identified and documented the following: a temperature of 100.3, a cough, to be weak and lethargic, had recent pulmonary tests done on 1/27/25, and the patient reported [gender] felt like [gender] had the flu. 3. There was no documentation in the clinical record that the physician was notified by the patient or the SN of the change to allow the physician to potentially provide new interventions for the patient. D. During an interview on 2/13/25 at 9:00 AM, the Administrator, the Market Director of Operations, and the Manager of Clinical Services confirmed, the SN providing cares failed to follow orders as written on the physician approved plan of care for Pt 2 and Pt 7.”