Chi Health at Home - Lincoln

“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, observation of provision of cares, and staff interview, 3 of 7 staff (Staff G, H, and I) observed during the provision of cares to 3 of 7 patients (Patients 5, 6, and 7) respectively, failed to follow the agency’s infection control policies and procedures for proper bag technique, cleaning of equipment, barrier use, glove use, hand hygiene and/or wound care. The total sample size was 17. Census was 133. Findings are: A. Review of the agency policy and procedure titled, Bag Technique, revised 6/22/23, revealed: 1. Staff are to place the bag (a bag utilized to carry patient supplies and equipment) on a clean, hard, dry surface with a barrier underneath. 2. Hand hygiene was to be performed before entering or re-entering the bag, and before and after patient and equipment contact. 3. Equipment was to be cleaned, after patient care with a sanitizing or alcohol wipe, before placing back into the bag. B. Review of the agency policy and procedure titled, Hand Hygiene, revised 8/10/22 revealed: 1. Staff were to perform hand hygiene before entering/re-entering the bag, handling clean supplies including laptop/tablet, after removing gloves, when moving from a contaminated body site to a clean body site, and after contact with body secretion, non-intact skin, and wound dressings. 2. Gloves were to be changed between tasks and procedures. C. Review of the agency policy and procedure titled, Wound Cleansing and Dressing, from Focus On Care for Home Care and Hospice (an online procedure catalog utilized by the agency), no date indicated, revealed: 1. During wound care, of a patient with multiple wounds, staff were to treat each individual wound separately and perform proper hand hygiene and change gloves between the care of each wound. 2. Staff were to use a separate cleansing material for each wound. D. Review of the clinical records revealed: 1. Patient 5’s Home Health Certification and Plan of Care, for certification period 11/1/23 through 12/30/23, included orders for Skilled Nurse, 2 times per week for 2 weeks, then 1 time per week for 8 weeks, to perform/teach pressure ulcer care to bilateral heels using clean technique, irrigate with normal saline, cleanse with Betadine (a wound disinfectant), apply Collagenase (an ointment to help heal wounds) to wound bed, cover/secure with gauze wrap. Change dressing 2 times daily. Offload pressure to wound with soft boots. Wound care to be completed by clinician or caregiver. 2. Patient 6’s Home Health Certification and Plan of Care, for the certification period 8/7/23 through 10/5/23 and 10/6/23 through 12/4/23, included orders for Home Health Aide services 1 time per week to assist with personal cares, hygiene and activities of daily living. 3. Patient 7’s Home Health Certification and Plan of Care, for certification period of 8/21/23 through 10/19/23 and 10/20/23 through 12/18/23, included orders for Medical Social Worker to assist with community resources. E. The observation of wound care provided to Patient 5 on 11/8/23 at 8:25 AM, revealed Staff G failed to: 1. Sanitize hands prior to entering the supply bag. 2. Sanitize hands and change gloves after cleansing a wound on the patient’s left heel and prior to cleansing the wound on the patient’s right heel. 3. Use a clean gauze for the application of Betadine to the patient’s wound on the left heel when Staff G used a layer of discarded used gauze. 4. Sanitize hands and change gloves after cleansing the wounds on the left and right heels, and prior to applying treatment to those same wound areas. 5. Treat each wound location separately. F. The observation of providing a bed bath, grooming, and catheter care to Patient 6, on 11/8/23 at 10:15 AM, revealed Staff-H failed to remove gloves and sanitize hands after providing perineal care (cleaning the scrotum and anal area), and prior to applying offloading boots, obtaining a blanket from another room, touching cabinet and drawers, moving the patient’s bedside table, and cleaning bath supplies. G. Observation during a home visit to Patient 7, on 11/8/23 at 2:00 PM, revealed Staff I failed to: 1. Place a barrier under the supply bag, cell phone, and clipboard before placing these items directly on the patient’s bed. 2. Sanitize hands after touching items and bedding in the patient’s room and prior to entering the supply bag for the tablet (electronic documentation tool). 3. Cleanse the staff member’s cell phone and tablet after used by the patient and staff member, and prior to placing those items back in the supply bag. H. During staff interview on 11/8/23 at 3:30 PM, the Administrator and the Manager of Clinical Services confirmed Staff G, H, and I, did not perform hand hygiene, bag technique, equipment care, barrier use, and glove use during home visits with Patients 5, 6, 7, respectively, and did not follow the agency’s policy and procedure for Bag Technique, Hand Hygiene and Wound Cleansing and Dressing.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency staff failed to follow the policy and procedure for documenting medication changes on the medication profile (a real-time document used by the agency that lists patient medications including new and updated orders received between certification periods) for 2 of 17 patient records reviewed (Patient 14 and 15). The census was 133. Findings are: A. Review of the agency policy and procedure titled, Medication Administration and Management, revised 12/19/22, revealed when a medication order was received by the nurse, the change and/or update was to be documented on the patient’s medication profile. B. Review of Patient 14’s clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 3/27/23 through 5/25/23 included an order for Duloxetine (a medication for depression) 30 milligrams (mg) orally two times daily. 2. A physician order was received on 5/1/23 to clarify the Duloxetine dose. The new order was Duloxetine 30 mg orally one time daily. 3. The Client Medication Report (medication profile) printed on 11/7/23 continued to include the order for Duloxetine 30 mg orally two times daily. C. Review of Patient 15’s clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period 3/25/23 through 5/23/23 included Carvedilol (a medication for hypertension) 25 mg orally two times daily. 2. A Visit Note Report (documentation of skilled nurse visit) dated 3/30/23. The Skilled Nurse (SN) documented the patient was instructed to decrease their Carvedilol dose to 25 mg, ½ tablet two times daily. 3. The Client Medication Report printed on 11/7/23 continued to include Carvedilol 25 mg orally two times daily. 4. The Client Medication Report printed on11/7/23 did not include the new dose of Carvedilol 25 mg, ½ tablet two times daily. D. During staff interview on 11/14/23 at 1:30PM, the Administrator confirmed the Client Medication Report for Patient 14 and Patient 15 were not updated when medication changes were received, and confirmed staff did not follow the agency’s Medication Administration and Management policy and procedure.”