Heritage Home Care - Las Cruces Inc.

“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, interview and observation the agency failed to ensure supplies were not expired in the supply closet. This deficient practice could lead to an increased risk for infection as the quality of the supplies cannot be guaranteed past the expiration date. The findings are: A. Record review of agency policy titled, “Supply Procurement Storage and Inventory Controls-Home Health” dated 02/08/2022 under, “Purpose” stated, “To maintain a usable inventory of supplies to meet the needs of the Home Health agency client census.” Under bullet 5 it stated, “Supplies should be rotated and used by age of the product, with the oldest supplies used first.” B. During an observation of the agency’s supply room on 07/24/2024 at 10:00 am there were expired supplies found to include packing strip iodoform strips (medication-soaked strips used to pack a wound) unopened bottled with expiration date of 09/2023, Duoderm 4x4 CGF Border (specialized dressing) with an expiration date 01/01/2024. C. During an interview with S(staff) 1, non-clinical, it was confirmed that these supplies were expired.”

“Supervise skilled professional assistants CFR(s): 484.75(c) Standard: Supervision of skilled professional assistants. This Standard is not met as evidenced by: Based on record review, interview, and observations the facility failed to provide supervision for the Physical Therapy Aide (PTA) by the Physical Therapist (PT) for 1 (P(patient) 9 out of 10 (P1-P10) patients reviewed. This deficient practice could lead to unsafe care for all patients receiving physical therapy services with the agency. The findings are: A. Record review of the agency’s policy titled, “Therapy Service, Home Health and Therapy [and] Rehab-Enterprise” dated 02/22/2024 under “Purpose” stated, “To ensure that Home Health patient is served by professional employees and is receiving quality rehabilitation services.” Under “Procedures” stated, “. . . 4. Therapists may utilize and supervise therapy assistants such as PTA’s [physical therapy assistants] or Certified OTA’s (COTA) [Certified Occupational Therapy Assistant] as outlined by federal and state requirements. 5. The qualified therapist will: . . . Assist with the development and revision of the POC [plan of care], including specific procedures including the amount, frequency and duration of each - Prepare and submit clinical progress notes - Advise and consult with the family and agency staff. . . - Collaborate with the team in case conferences for coordination of care - Set up specific instructions for therapy assistants based on treatment prescribed in the POC [plan of care], patient evaluation, and acceptable standards of professional practice. - Document therapy assistant information in the EMR: delegation of duties, communication between team members, and the existence of supervision. . .” B. During observation on 07/24/2024 at 2:00 PM, S (Staff)7, PTA (physical therapy assistant), asked P9 if the therapist came to see the patient, P9 stated, “Yes, he did.” S7 then asked where the exercise plan and the band were that he left, P9 stated, “He didn’t leave anything”. The PTA stated, “Ok, well then let’s do some exercises.” There was no evidence during this observation that the PTA was left with specific instructions based on the POC. C. During an interview on 07/24/2024 at 2:30 PM with S7 when asked if the therapist will leave a plan and a band for the exercises she stated, “Yes, the PT will usually leave a program and band for the exercise plan”. D. During an interview on 07/24/2024 at 3:45 PM with S4, PT (Physical Therapist), he confirmed that there was not a program or band left at P9’s home and he did not have any conversation with S7 about the plan of care for P7. E. During an interview on 07/24/2024 at 4:28 PM with S1, non-clinical, it was explained that the therapist will go evaluate the patient, create the care plan and communicate with the aide regarding the patient’s needs.”

“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, interview, and observation the agency failed to update the plan of care to include a verbal wound care order for 1(P(patient) 4 out of 10 (P1-P10) patients reviewed. This deficient practice could lead to inappropriate treatment of patients in need of wound care. The findings are: A. Record review of agency policy titled, “Care Planning and Care Coordination, Home Health, and Therapy -Enterprise” dated 05/02/2024, stated under number 6, “The POC [Plan of Care] must be reviewed and revised by the provider and the team as frequently as the patient’s condition requires, but no less frequently than once every 60 days, beginning with the Start of Care (SOC).” B. Record review of P4’s Plan of Care revealed an order dated 06/03/2024 for skilled nursing wound care for a surgical wound, under “Interventions” it stated, “Surgical Wound Care [three times a week] to midline abd [abdomen]: cleanse with NS [normal saline], spray flonase OTC [medication used to decrease inflammation] spray to rash below wound, cover with ABD pad [thick padded dressing]. Apply HFB transfer [type of specialized dressing] to wound bed, ABD pad, gauze, soft cloth surgical tape.” C. During an observation on 07/24/2024 at 11:00 am of P4’s wound care, S(staff)5 clinical, removed a dressing from the midline abdomen that had a Mepilex dressing (padded cover dressing tan in color) and a piece of foam from the wound. S5 then cleaned the wound with NS and applied a piece of foam and covered the foam with a padded cover dressing. D. During an interview with S5 on 07/24/2024 at 11:45AM with S5 it was asked why that dressing orders were not followed. S5 explained that the dressing order was changed by the wound care clinic and they had not yet supplied the agency with a new written order. E. During an interview on 07/24/2024 at 3:40 PM with S1, non-clinical, it was asked if there should have been a verbal order placed in P4’s chart if the nurse knew the order was changed. S1 stated, “Yes, there should have been a written verbal order and placed on the plan of care.””