Hillcrest Home Care

“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 the provision of care, and staff interview, the agency failed to ensure 1 of 7 staff (Staff I), observed during the provision of care for 1 of 7 patients (Patient 6), performed proper hand hygiene and bag technique, according to the agency’s policies and procedures. The total sample size was 17. The census was 377 (279 in the Bellevue office and 98 in the Lincoln branch). Findings are: A. Review of the agency’s policy and procedure titled 4.3 Bag Technique, effective date 3/1/24, revealed the home care bag was not to be placed on the floor unless it is a wheeled bag. B. Review of the agency’s policy and procedure titled 4.0 Infection Prevention, effective date 3/1/24, revealed hand hygiene was to be performed: 1.Before performing an aseptic task. 2. When moving from a contaminated body site to a clean body site, during client care. 3. Before application of and after removal of personal protective equipment. C. Review of Patient 6’s Home Health Certification and Plan of Care (POC) for the certification period 9/20/24 through 11/17/24, included orders for Skilled Nursing, to change the suprapubic catheter (a tube inserted into the bladder from an incision in the lower abdomen, to drain urine) every 2 weeks and as needed for leaking. D. The observation of the provision of care to Patient 6 on 10/30/24 at 1:00 PM, revealed Staff I failed to: 1. Place the nursing bag on a surface off the floor. 2. Sanitize hands prior to applying gloves, to set up catheter equipment. 3. Sanitize hands after removing the suprapubic catheter from the patient’s bladder, and prior to applying sterile gloves, to insert a new suprapubic catheter into the bladder. E. During an interview on 10/31/24 at 2:00 PM, the Administrator confirmed Staff I failed to follow the agency’s policies and procedures for bag technique and hand hygiene, during the provision of care for Patient 6.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure the patient’s medication orders on the Plan of Care and the medication profile (a real-time document used by the agency that lists the patient’s medications), were accurate, for 6 of 17 patient records reviewed (Patient 1, 4, 7, 9, 17, and 18). The total sample size was 17. The census was 377 (279 in the Bellevue office and 98 in the Lincoln branch). Findings are: A. Review of the agency’s policy and procedure titled 6.3 Medication Reconciliation And Administration, revised date 10/18/22, revealed: 1.On admission and during the comprehensive assessment, the professional team member was to reconcile all medications, including over-the counter medications. 2. The clinician was to report any identified problems to the client’s physician within one day of an identified discrepancy. 3. The nurse/therapist was to record all medications the client was taking on the Plan of Care and the Medication Profile. B. Review of Patient 1’s clinical record revealed: 1.The Order Summary Report from Fallbrook Assisted Living and Memory Care to the agency, dated 9/10/24, included orders for: a. Antacid Chew (medication that relieves indigestion and heartburn) 750 mg (milligrams), 2 tablets, orally, after every evening meal. b. Clotrimazole Cream (medication used to treat fungal skin infection) 1%, apply topically between left great toe and 2nd toe, two times daily, as needed for skin breakdown. c. Dorzol/Timol Solution (medication used to treat increased eye pressure) 22.3-6.8, instill 1 drop in each eye, two times daily. d. Warfarin (medication used to treat or prevent blood clots) 1mg, 1 tablet, orally, on Mondays. e. Warfarin 3mg, 1 tablet, orally, on Tuesdays, Thursdays, Fridays, and Saturdays. 2. The Patient’s Home Health Certification and Plan of Care (POC) for the certification period 9/11/24 through 11/9/24, and the medication profile, revealed: a. Calcium Carbonate Antacid (same as Antacid Chew), 750mg, 2 tablets, every night at bedtime. b. Clotrimazole Cream 1%, apply topically to feet and in between toes, daily, as needed for fungal infection. c. Dorzolamide HCL – Timolol Mal 2-0.5% (same as Dorzol/Timol Solution), instill 1 drop in each eye, daily. d. Warfarin 4mg, orally, 1 tablet, four times weekly, on Mondays, Wednesdays, Fridays, and Saturdays. 3. There was no documentation in the clinical record of medication reconciliation of Calcium Carbonate Antacid, Clotrimazole Cream, Dorzolamide HCL, and Warfarin, with the physician. C. Review of Patient 4’s clinical record revealed: 1. The Order Summary Report from Hillcrest Health & Rehab to the agency, dated 10/1/24, included orders: a. Tramadol (a medication used to treat pain) 50 mg, orally, 1 tablet, every 6 hours, as needed for pain. b. Cholecalciferol (a Vitamin D supplement) 25 mcg (microgram), 1 tablet, orally, every morning. c. Lidocaine External Patch (a medication to treat pain) 4%, apply topically to lower back, every 24 hours, as needed for pain. 2.The POC for the certification period 10/4/24 through 12/2/24, and the medication profile, revealed: a. Cholecalciferol 50 mcg, 1 capsule, orally, every morning. b. Tramadol and Lidocaine External Patch were not included. 3. There was no documentation in the clinical record of medication reconciliation of Cholecalciferol, Tramadol, and Lidocaine External Patch, with the physician. D. Review of Patient 7’s clinical record revealed: 1.The Medication Review Report from Hillcrest Millard to the agency, dated 10/1/24, included orders, and the POC for the certification period 10/5/24 through 12/3/24, and the medication profile, failed to include: a. Albuterol Sulfate (a medication used to treat difficult breathing), 2 puffs, inhale, every 6 hours, as needed for shortness of breath/wheezing. b. Allopurinol (a medication used to treat joint pain and inflammation) 100 mg, 1 tablet, orally, one time daily. c. Antacid tablet 500 mg, 2 tablets, orally, every 4 hours, as needed, for heartburn/indigestion. d. Atorvastatin Calcium (a medication used to treat high cholesterol) 40 mg, orally, 1 tablet at bedtime. e. Bisacodyl Laxative Suppository (a medication to treat constipation) 10 mg, 1 suppository inserted rectally, every 48 hours, as needed for constipation. f. Fleets Enema (a treatment used to treat constipation) 1 application inserted rectally, every 24 hours, as needed for constipation. g. Glucagon Emergency Injection Kit (used to treat low blood sugar) 1 millimeter, injected intramuscularly, as needed for low blood sugars. h. Ibuprofen (a medication used to treat pain) 200 mg, orally, 1 tablet, every 6 hours, as needed for pain. i. Insulin Aspart (a medication used to treat diabetes) 100 units/ml (a measurement of medication) inject subcutaneously (beneath the skin) three times daily with meals, per sliding scale (number of units of insulin injected based on blood sugar reading). j. Insulin Glargine (a medication used to treat diabetes) 100 units/ml, 35 units, injected subcutaneously, every day at bedtime. k. Jardiance (a medication used to treat diabetes) 10 mg, orally, 1 tablet, one time daily. l. Metformin (a medication used to treat diabetes) 1000 mg, orally 1 tablet, two times daily. m. Naloxone (a medication used to treat opioid overdose) 0.4 mg/ml (milliliter), inject 1 ml intramuscularly every 2 minutes as needed, for opioid overdose. n. Polyethylene Glycol (a medication used to treat constipation) 17 grams, orally, two times daily. o. Senna Plus (a medication used to treat constipation) 8.6-50 mg, orally, 2 tablets two times daily, as needed for constipation. p. Spironolactone (a medication used to treat high blood pressure) 25 mg, orally, ½ tablet, one time daily. q. Thiamine (a vitamin B1 supplement) 100 mg, orally, 1 tablet, every morning. 2. There was no documentation in the clinical record of medication reconciliation, with the physician. E. Review of Patient 9’s clinical record revealed: 1.The referral orders and the After Visit Summary from Nebraska Medicine Neurology Clinic, dated 8/29/24, to the agency, included: a. Pyridium (a medication used to relieve irritation in the urinary tract) 95 mg, 1 tablet, orally, three times daily, as needed for pain. b. CatecholaCalm (an herbal supplement to improve mood), dosage and frequency not listed. This was a patient reported medication. c. NeuroCalm (a supplement to improve mood), dosage and frequency not listed. This was a patient reported medication. 2. The POC for the certification period 9/5/24 through 11/3/24, and the medication profile, failed to include Pyridium, CatecholaCalm and NeuroCalm. 3. There was no documentation in the clinical record of medication reconciliation of Pyridium, CatecholaCalm, and NeuroCalm, to the physician. F. Review of Patient 17’s clinical record revealed: 1.The referral orders and Medication Review Report from Pemberly Place Senior Living, dated 5/20/24, to the agency, included orders for Aspirin low dose (a medication used to prevent heart attack and stroke) 81 mg, orally, 1 tablet, on Mondays, Wednesdays, and Fridays. 2. The POC for the certification period 5/22/24 through 7/20/24, and the medication profile, revealed, Aspirin 81 mg, orally, 1 tablet, as needed, on Mondays, Wednesdays, and Fridays. 3. There was no documentation in the clinical record of medication reconciliation, with the physician. G. Review of Patient 18’s clinical record revealed: 1.The Order Summary Report from Hillcrest Heath and Rehab, dated 10/21/24, to the agency, included orders: a. Alendronate Sodium (a medication to help keep bones strong) 70 mg, 1 tablet, orally, every Friday. b. Metformin HCL (a medication to treat diabetes) 500 mg, orally, 1 tablet, two times daily. c. Senna Plus (a medication to treat constipation) 8.6-50 mg, orally, 2 tablets, two times daily, as needed for constipation, was discontinued. 2. The POC for the certification period 10/24/24 through 12/22/24, and the medication profile, revealed: a. Alendronate Sodium 70 mg, orally, 1 tablet, daily. b. Sennosides-Docusate Sodium (same as Senna Plus) 8.6-50 mg. Dosage and frequency were not included. c. Metformin was not included. 3. There was no documentation in the clinical record of medication reconciliation, with the physician. H. During an interview on 10/31/24 at 2:00 PM, the Administrator confirmed, the agency failed to follow the agencies policy and procedure to ensure the patient’s medication orders on the Plan of Care and the medication profile, were accurate, for 6 of 17 patient records (Patient 1, 4, 7, 9, 17, and 18).”