Angels Care Progressive Home Health

“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 care, and staff interview, 1 of 5 staff (Staff E) observed during the provision of cares to 1 of 5 patients, (Patient 3), failed to follow the agency’s policy and procedure for proper hand hygiene and bag technique. The total sample size was 13. The census was 200. Findings are: A. Review of the agency’s policy and procedure titled Infection Control, Policy Number CC.015, revised August 2022, revealed all employees are to be educated regarding policies and procedures related to infection control program and standard precautions, including hand hygiene, upon hire and annually. The policy did not include when hand hygiene should be performed. B. Review of the agency’s Hand Hygiene procedure, from Medbridge Clinical Procedure Manual, revealed steps to perform hand hygiene by using soap and water or hand sanitizer. The procedure did not include when hand hygiene should be performed. C. Review of agency’s Bag Technique procedure, from Medbridge Clinical Procedure Manual, revealed: 1. The bag is to be placed on a nonpermeable barrier. 2. Equipment needed for the appointment is to be placed on a clean section of the barrier. After use, equipment is to be placed on the dirty side of the barrier. 3. Hands are to be sanitized and clean gloves are to be put on prior to cleaning the equipment with alcohol wipe. Cleaned equipment is to be placed on the clean section of the barrier. 4. Gloves are to be removed, hands are to be sanitized prior to placing clean equipment back into bag. D. A Case Conference Education, on proper bag technique and review of employee handwashing competency checklist, was conducted with the agency staff by the Director of Nursing on 12/7/23. This education included keeping the supply bag off of the floor. Staff E was not included in this education. E. Review of Patient 3’s Home Health Certification and Plan of Care (POC) for the certification period 3/29/24 through 5/27/24, included orders for Physical Therapy (PT) 2 times weekly for 4 weeks, to provide therapeutic exercises, establish a home exercise program, gait training, stretching/flexibility, safety training, and balance. F. During the observation of the provision of care to Patient 3, on 5/23/24 at 2:30 PM, Staff E failed to: 1. Sanitize hands when entering the home. 2. Place the supply bag on a barrier. 3. Keep the supply bag off of the floor. 4. Sanitize hands prior to entering the supply bag to get equipment used during visit. 5. Place equipment needed on a clean section of the barrier. 6. Placed equipment used during the visit on a dirty section of the barrier. 7. Sanitize hands prior to cleaning equipment and prior to placing equipment back into the supply bag. 8. Perform proper hand hygiene prior to leaving the home. G. During an interview on 5/30/24 at 12:30 PM, the Administrator and the Director of Nursing (DON) confirmed that Staff E failed to follow the agency’s policy and procedures for hand hygiene and bag technique during the provision of cares to Patient 3.”

“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 that medication orders were included, accurate, and updated on the patient’s medication profile (a real-time document used by the agency that lists the patient’s medications, including new and updated orders) and on the physician’s approved plan of care, on admission and when there was a change in orders, for 3 of 13 records reviewed (Patients 1, 9 and 11). The census was 200. Findings are: A. Review of the agency’s policy and procedure titled Medication Profile/ Drug Regimen Review, Policy Number CC.020, revised February 2022, revealed: 1. On admission, the admitting nurse was to initiate a medication profile to document the current medication regimen of the patient. 2. The drug regimen review was to include all of the patient’s prescription and over-the-counter medications. 3. During the drug regimen review, any discrepancies in medications, including medications in the home that were different than what was on the medication listing that was received at the time of the referral, was to be reported to the provider to obtain resolution. Documentation was to be included in the medical record. 4. Medication reviews were to occur during each comprehensive assessment, or as any new medications were added during the episode of care, but at least every 60 days. 5. The medication profile was to be current and updated as changes occur with the patient’s medication regimen. 6. Review of medication changes were to be documented in the visit note and communicated with the clinical supervisor or any other clinicians involved in the patient’s care. B. Review of Patient 1’s clinical record revealed: 1. The Home Health Certification and Plan of Care (POC) for the certification periods of 3/12/24 through 5/10/24 and 5/11/24 through 7/9/24, included orders for Santyl (an ointment used to remove damaged tissue from wounds) 250 units/gram, apply a nickel thick layer topically to wound bed once daily with each dressing change. The POC did not specify which wound to apply the Santyl ointment. 2. The patient’s medication profile, printed on 5/22/24, included Santyl 250 units/gram, apply a nickel thick layer topically to the wound bed once daily with each dressing change. The orders did not specify which wound to apply the Santyl ointment. 3. New orders, dated 3/20/24, from Mary Lanning Healthcare Wound Center, revealed: a. Apply Aquacel AG (A dressing impregnated with silver, that adsorbs wound fluid), cover with a border foam dressing and apply a dry gauze or ABD (a thick gauze dressing that absorbs fluids from wounds), and secure with tape, to left medial buttock wound. Change dressing daily and as needed of soiled. b. Wound Vac (A vacuum-assisted sealed wound care system, with an electronically controlled pump and a foam dressing that drains fluid from a wound), to right hip wound, to be changed 3 times weekly. 4. The agency failed follow up with the provider to get orders to discontinue Santyl after 3/20/24, and discontinue on the medication profile. C. Review of Patient 9’s record revealed: 1. The Transition Orders and Information for the Continuation of Patient Care from the discharging facility, Mary Lanning Healthcare, to the agency, dated 5/3/24, included orders for the patient to start: a. Quetiapine (a medication to help regulate mood, behavior and thoughts), 25 milligrams (mg), by mouth, at bedtime as needed for agitation or insomnia, b. Furosemide (a medication to treat fluid retention) 20 mg by mouth every morning. c. Vitamin D3 (a vitamin supplement that helps prevent bone weakness), 125 micrograms (mcg), by mouth, 3 times a week, on Monday, Wednesday, and Friday mornings. 2. The POC for the Certification period of 5/4/24 through 7/2/24, and the patient’s medication profile, printed on 5/22/24, revealed: a. Quetiapine 25 mg by mouth at bedtime as needed for agitation or insomnia was not on the POC or the medication profile. b. The POC and the medication profile listed furosemide as 40 mg instead of 20 mg by mouth daily. c. The POC and the medication profile listed Vitamin D3 125 mcg as 1 tablet by mouth, 3 times daily instead of 3 times weekly on Monday, Wednesday and Fridays. D. Review of Patient 11’s record, revealed: 1. The discharge orders from Mary Lanning Healthcare transfer information to the agency, dated 1/1/24, included orders to start: a. Bacitracin Zinc Ointment (an antibiotic ointment to help prevent wound infection), topically to left leg wound daily. b. Pantoprazole (a medication to treat gastric reflux), 40 mg by mouth daily with breakfast. c. Povidone-iodine (an antiseptic used for skin disinfection) 10 % (percent) swabs, topically to 5th toe, daily. d. Sucralfate (an antacid used to treat and prevent intestinal ulcers) suspension, 10 milliliters (1,000 mg total) by mouth 4 times daily before meals and at bedtime. e. Aquaphor ointment (used to soothe skin irritation) 41% topically, daily to lower legs. 2. The POC for the Certification period of 1/2/24 through 3/1/24 and 3/2/24 through 4/30/24, and the patient’s medication profile, printed on 5/22/24, revealed: a. New orders from Mary Lanning Healthcare transfer summary to the agency, dated 1/1/24, for bacitracin zinc ointment, pantoprazole, povidone-iodine, sucralfate suspension, and Aquaphor ointment, were not listed on the medication profile or the POC. b. Amlodipine (a medication used to treat high blood pressure) 5 mg, by mouth, daily, was listed on the medication profile and the POC, but was not included on orders from Mary Lanning Healthcare transfer summary to the agency. c. Furosemide 40 mg, by mouth, 2 times daily, was listed on the medication profile and the POC, but was not included on orders from Mary Lanning Healthcare transfer summary to the agency. d. Lisinopril (A medication used to treat high blood pressure and heart failure) 40 mg, by mouth, daily, was listed on the medication profile and the POC but was not included on orders from Mary Lanning Healthcare transfer summary to the agency. e. Prednisone (a medication used to treat inflammation) 10 mg, by mouth, 2 times daily, was listed on the medication profile and the POC but was not included on orders from Mary Lanning Healthcare transfer summary to the agency. 3. The agency failed to communicate with the provider, and document in the medical record, regarding discrepancies in medications in the home that were different than what was on the medication listing that was received from Mary Lanning Healthcare, to obtain resolution. E. During an interview on 5/30/24, at 12:30 PM, the Administrator and the Director of Nursing confirmed the agency failed to follow the agency’s policy and procedure to ensure medication orders were included, accurate, and updated on the medication profile and on the POC when there was a change in orders, and failed to communicate with the provider, and document in the medical record, when medication discrepancies were noted for Patients 1, 9, and 11.”