Unique Health Care Solutions, LLC

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on record review, interview and policy review, the facility failed to complete skilled nurse visits per the plan of care. This affected one (Patient #3) of three sampled patients. The facility census was 426. Findings include: Record review revealed Patient # 2 had a start of care date of 10/27/23. Patient #2’s primary diagnosis was a below the knee amputation with a open wound above the stump. Skilled nursing was ordered for visits three times per week for dressing changes. Orders were received 1/29/24 for daily visits to complete dressing changes. Dressing changes were completed daily except for 02/07/24 or 2/09/24. During an interview on 02/22/24 at 3:00 PM, Staff C stated no missed visit notes were found for this patient for the dates 02/07/24 and 02/09/24. Review of the policy titled “Missed Visit Note”, dated 10/01/16, instructed staff to complete a Missed Visit Form as soon as they are aware a client’s visit will be missed. This staff member is responsible for notifying the appropriate persons to include their immediate supervisor, physician, case manager and/or family member as applicable.”

“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 policy review, the facility failed to ensure staff changed gloves during a wound treatment. This affected one (Patient #2) of three patients reviewed. The facility census was 426. Findings include: Record review revealed Patient # 2 had a start of care date of 10/27/23. Patient #2’s primary diagnosis was a below the knee amputation with a open wound above amputation. Skilled nursing was ordered for visits three times per week for dressing changes. Orders were received 1/29/24 for daily visits to complete dressing changes. Another order was received on 02/15/24 from the wound care center to cleanse the wound with Vashe (sodium chloride solution with preservative to inhibit growth of microorganisms) and to cleanse the perimeter of the wound area. Allow the Vashe soaked gauze to sit on wound for five minutes and then pat dry, apply Iodoflex (an iodine treated dressing), Adaptic non-adhering dressing, then Mepilex boarder. A physician order was received on 02/16/24 for an alternative dressing to be completed with medi-honey until the Iodoflex is available. A home visit was completed with Staff E on 2/21/24 at 2:20 PM to observe wound care. Staff E stated new orders were received after Patient #2 went to the wound care clinic to wash with Vashe, apply Iodoflex but since this was not available to use medi honey. Staff E looked through the patients supplies but no medi-honey was present in the home. Staff E washed their hands at prior to the dressing change and applied gloves. The ACE bandage was removed from the left stump then the dressing was cut off using scissors from the patient’s supply box. Measurements were completed of the wound. Staff E kept the same gloves on but applied a second glove over the right hand glove, washed the wound with Vashe on a two by two gauze pad, then used two more two by two gauze pads with Vashe solution, but didn’t soak the wound according to the physician order. Adaptic was then applied. The Mepilex foam dressing was cut with same scissors used to cut off the old dressing and were not cleaned in between. Kerlix was applied, taped in place, then an ACE bandage was applied. The scissors were placed back in the patient’s supply box without being cleaned. Staff E kept the same pair of gloves on for the entire procedure. Staff E was interviewed immediately following the dressing change, at 3:10 PM. Staff E stated they bring gloves to the house and there was no issue with glove supply. Staff E verified they did not remove the soiled gloves, but put another glove over their dominate hand when they cleansed the wound and did not soak the wound per order. Review of the policy titled “Wound Care”, dated 10/01/16, instructed to perform hand hygiene (refer to Universal Precautions policy), lay out your supplies on a clean work surface, remove the old dressing then change your gloves. Apply the new dressing, take off and discard the gloves, wipe down the equipment and wash your hands. The policy titled “Universal Precautions”, dated 10/01/16), instructed to wash hands with soap and water and gloves should be worn when coming in contact with blood or non-intact skin.”