Mesa View Home Care LLC

“Exercise of rights CFR(s): 484.50(b)(1)(2)(3) Standard: Exercise of rights. (1) If a patient has been adjudged to lack legal capacity to make health care decisions as established by state law by a court of proper jurisdiction, the rights of the patient may be exercised by the person appointed by the state court to act on the patient’s behalf. (2) If a state court has not adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient’s representative may exercise the patient’s rights. (3) If a patient has been adjudged to lack legal capacity to make health care decisions under state law by a court of proper jurisdiction, the patient may exercise his or her rights to the extent allowed by court order. This Standard is not met as evidenced by: Based on record review, interview, and policy review, the Home Health Agency (HHA) failed to ensure Advanced Directives were entered into the electronic medical record (EMR) for two of 17 patients (Patient (P) 3 and P5) reviewed in the sample. This failure had the potential to affect all patients receiving services from the HHA who may have had designated Advance Directives in place. Findings include: Review of the agency’s undated policy titled, “Rights, Responsibilities and Ethics Policy,” revealed “The Agency acknowledges and understands that a component of providing high quality medical and health care is to recognize that a patient has a right to refuse, to accept or request a withdrawal of certain medical procedures or treatment after receiving the information necessary to make informed decisions regarding Advance Directives.” 1. Review of P3’s “Home Health Certification and Plan of Care” found in P3’s EMR revealed P3 had diagnoses including chronic respiratory failure, heart disease, and retention of urine. Review of P3’s “Plan of Treatment,” dated 05/20/2025 and found in the EMR, revealed P3 had an Advance Directive (a Do Not Resuscitate (DNR)) in place. The record indicated the resident was the Responsible Party (RP). There was no evidence that the patient’s DNR designation had been obtained and placed in the patient’s record. 2. Review of P5’s “Home Health Certification and Plan of Care” found in P5’s EMR revealed P5 had diagnoses including right femur fracture and history of Gastrointestinal (GI) hemorrhage. Review of P5’s “Plan of Treatment,” dated 05/21/2025 and found in the EMR, revealed P5 had an Advance Directive (DNR) in place. The record indicated the resident was the RP. There was no evidence that the patient’s DNR designation had been obtained and placed in the patient’s record. During an interview on 06/13/2025 at 12:12 PM, the Director of Nursing (DON) confirmed P3 and P5’s Advance Directives had not been obtained or placed in the patients’ records. The DON stated the Advance Directives should have been placed in P3 and P5’s records after the agency became aware the patients had Advance Directives in place.”

“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, record review, interview, and policy review, the facility failed to 1. ensure that stored clean and sterile supplies for patient care were located in a clean area for one of the four restrooms observed and 2. ensure patient care equipment was disinfected correctly citing three out of seven home visits made. This deficient practice had the potential to cause cross contamination resulting in increased infections for all 180 patients receiving care by the home health agency. Findings include: 1. Review of the agency’s undated policy titled, “Storage of Patient Care Supplies,” indicated, “Only rooms that have been designated for storage room can be used for storage.” Observation on 06/11/2025 at 1:46 PM the first restroom next to the supply room at the Home Health Agency there were two wire racks containing four shelves of clean and sterile supplies mixed with cleaning supplies. The bottom of the racks was open to the floor and the supplies could have become contaminated when they were mopping and when the restroom was used. During an interview on 06/11/2025 at 1:45 PM, the Director of Nurses (DON) confirmed the above findings. 2. Review of the “Centers for Disease Control (CDC) Guidelines for Cleaning Equipment in a Home Health Setting,” dated 03/19/2024 and located at CDC.gov, indicated the kill time/wet time required for 70% alcohol to kill common pathogens was between 30 seconds and 2 minutes and indicated equipment cleaned with 70% alcohol (the percentage of alcohol in an alcohol prep pad) would have to remain submerged in the alcohol solution/the surface would have to remain completely wet) for that amount of time to be effective. a. Observation during P1’s homecare visit performed by Physical Therapist (PT) 2 on 06/12/2025 at 11:15 AM revealed PT2 was observed to obtain P1’s vital signs, including temperature, blood pressure, pulse, and oxygen saturation. After completing the vital signs, PT2 cleaned / sanitized the blood pressure cuff and the oxygen saturation / pulse monitor with an alcohol prep pad. The equipment was allowed to air dry after sanitization. PT2 did not clean / sanitize the thermometer used to obtain P2’s temperature. Although the thermometer was a forehead scanning thermometer and PT2 did not touch P1’s skin with the thermometer while taking his temperature, the thermometer was observed to be placed on the table next to P1 during the visit. During an interview on 06/12/2025 at 11:45 AM, PT2 usually used an alcohol prep pad to sanitize equipment after use in patients’ homes. PT2 had approved sanitizing wipes available, but did not often use them to clean equipment. b. Observation during P5’s homecare visit performed by PT3 on 06/13/2025 at 9:00 AM revealed PT3 was observed to obtain P5’s vital signs, including temperature, blood pressure, pulse, and oxygen saturation, during the visit. After completing the vital signs, PT3 cleaned / sanitized the blood pressure cuff, the thermometer, and the oxygen saturation / pulse monitor with an alcohol prep pad. The equipment was allowed to air dry after sanitization. During an interview on 06/13/2025 at 9:45 AM, PT3 usually used an alcohol prep pad to clean / sanitize medical equipment after it was used in a patient’s home. PT3 stated the agency provided approved sanitizing wipes, but PT3 rarely used them. c. Observation during P6’s homecare visit performed by Licensed Practical Nurse (LPN) 1 on 06/12/2025 at 10:30 AM revealed that LPN1 cleaned / sanitized reusable equipment, including the blood pressure cuff, stethoscope, oxygen saturation / pulse monitor, and thermometer, that was used to obtain P6’s vital signs, with an alcohol prep pad. The equipment was allowed to air dry after sanitization. During an interview on 06/12/2025 at 11:00 AM, LPN1 had approved sanitizing wipes available, but often did not use them to clean / sanitize equipment between each patient visit. During an interview on 06/13/2025 at 12:45 PM, the Director of Nursing (DON) had been thinking it was appropriate to use alcohol prep pads when cleaning and sanitizing medical equipment between patient use and so had instructed staff to use alcohol prep pads for cleaning / sanitization of equipment. The DON agreed that the alcohol prep pads were not effective for sanitizing medical equipment because the surface of any equipment sanitized with an alcohol prep pad did not stay wet long enough to ensure thorough sanitization of the equipment.”