Genesis Home Health Services

“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 observation, interview, and policy review, the facility failed to ensure that two of three staff followed disinfectant wipe directions when cleaning equipment after use on two of two patients during home visits (Patient (P) 2 and P1) from two of three home visits observed. This failure had the potential to affect two of two patients. Findings include: Review of the undated facility document titled, “Infection Control-Standard Precautions” states, “Hand Hygiene will be performed when moving from a contaminated body site to a clean body site during patient care. Gloves are to be changed between task and procedures on the same patient.” Review of facility document titled, “Hand Hygiene,” revised November 2024, revealed that staff were to use alcohol-based hand rub product to palm of one hand and rub hands together until hands are dry when moving from a contaminated body site to a clean body site. During home visit observations of P2 and interview on 04/09/25 beginning at 11:00 AM located in P2’s home, Certified Nursing Assistant (CNA) 1 removed vital sign monitoring equipment from CNA1’s work bag and placed the equipment on a clean barrier. CNA1 checked P2’s pulse, blood pressure, oxygen level, and temperature placing the equipment back on the same barrier. CNA1 donned (put on) gloves, then undressed P2, and assisted P2 to the shower where CNA1 washed and rinsed P2’s body, cleansing the perianal area last and potentially contaminating the gloves. Without changing the potentially contaminated gloves, CNA1 towel dried P2, rubbed baby oil and lotion on P2’s trunk and limbs, and dressed P2. CNA1 did not change gloves and perform hand hygiene when moving from a potentially contaminated body site to a clean body site. When the surveyor mentioned that CNA did not change gloves after completing P2’s shower, CNA1 replied, “Oh, I missed that. It went right over my head.”” When asked if gloves should have been changed after showering P2, CNA1 verified that the gloves should have been changed but were not changed. Near the end of the visit CNA1 doffed the potentially contaminated gloves, performed hand hygiene, and donned gloves before removing a “Chlorox” wipe container from CNA1’s bag. CNA1 cleaned the thermometer, blood pressure cuff, stethoscope, pulse oximeter, used to take vital signs, wiping each piece of equipment for less than one minute each before placing the equipment back into the bag. The “Chlorox” wipe container instructions indicated “To clean and disinfect allow surface to remain wet 4 minutes.” CNA1 did not keep the used equipment wet for four minutes before placing each piece into the clean bag. When the surveyor pointed out the instructions on the “Chlorox” wipes, CNA1 stated, “I did not keep the equipment wet for 4 minutes.” During home visit observations for P1 and interview on 04/08/25 beginning at 2:00 PM located in P1’s home, Registered Nurse (RN) 1 removed vital sign monitoring equipment from RN1’s bag placing the equipment on a barrier. After checking P1’s pulse, oxygen level, blood pressure, and temperature, RN1 placed the used equipment back on the barrier. RN1 used disinfectant wipes labeled, “CVS [consumer value store] Disinfectant Wipes” to clean each piece of vital sign monitoring equipment, wiping each piece for about one minute. The wipes container’s instructions state to “Allow surface to remain wet for 4 minutes.” After the visit was completed, RN1 verified he/she did not keep the equipment wet for four minutes. During a meeting with the Chief of Clinical Operations (CCO) and the Administrator on 04/09/25, at approximately 4:15 PM, the above issues were discussed. The CCO confirmed that the Home Health Agency (HHA) did not furnish disinfectant wipes to staff to use on home visits but rather staff purchased their own wipes. CCO added that it was the expectation that CNA1 should have changed gloves and disinfected hands after showering P2.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on record review and staff interview, the facility failed to ensure an initial patient assessment was completed within 48 hours of referral for one of seven sampled patients (Patient (P) 1) reviewed for assessments. This failure resulted in the potential to affect one of one patient. Findings include: Review of P1’s “Initial Admission OASIS [Outcome and Assessment Information Set] Assessment” located in the electronic medical record (EMR) “Referral” tab indicated that P1 had a referral for home health services on 08/30/24. Review of the “OASIS” tab indicated that the initial assessment was completed on 09/04/24. During an interview with the Chief of Clinical Operations (CCO) on 04/10/25 at 3:40 PM, the CCO stated, “Yes we found we had problems with that (delay in completing initial assessments) and are working on a PIP (Performance Improvement Plan) for that. I think we are improving now.””

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on record review and staff interview, the facility failed to ensure supervisory visits were conducted every fourteen days for one of four sampled patients (Patient (P) 2) who received Home Health aide services out of a total of seven patients sampled. This failure had the potential to affect one of one patient. Findings include: Review of P2’s electronic medical record (EMR) “Notes” tab indicated that supervisory visits were conducted 02/12/25, 02/26/25, and 03/13/25. The supervisory visit between 02/26/25 and 03/13/25 was fifteen days. During an interview with the Chief of Clinical Operations (CCO) and the Director of Clinical Services (DCS) on 04/10/25 at 3:40 PM., the DCS stated that the supervisory visit on 03/13/25 was one day late.”