Traditions Health of Stigler

“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 and interview, the Skilled Nurse failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases for one (#2) of 3 (#1-#3) home visits. Patient #2 During a home observation visit on 11/08/23 at 10:45 AM, the SN failed to perform hand hygiene before entering bag, after contact with the patient, after removing gloves, placed bag on barrier on floor with one compartment remained open during visit and failed to allow dry time after disinfecting reusable equipment. A review of Agency policy # IC.15 titled, “Hand Hygiene” states, “...staff my use an alcohol-based rub...: 1. Prior to initial entry into supply bag 2. Before having direct contact with patient 5. After contact with inanimate object 8. After removing gloves”. Policy #IC60 titled, “Bag Protocol” states E.” ... Bags should never be placed on the floor. G After cleansing hands, the supplies and/or equipment needed fo the visit are removed from the bag. Hands are washed again if additional supplies are needed during the visit. Close bag before performing patient care. J. When the visit is completed, reusable equipment is cleaned....Ensure that all parts and surfaces are air dried thoroughly before returning... back to bag”. On 11/08/23 at 2:30 PM, the Branch Director stated the SN did not follow agency policies for hand hygiene, bag protocol and equipment cleaning.”

“Laboratory services/CLIA waivers CFR(s): 484.100(c)(1) Laboratory services. If the HHA engages in laboratory testing outside of the context of assisting an individual in self-administering a test with an appliance that has been cleared for that purpose by the Food and Drug Administration, the testing must be in compliance with all applicable requirements of part 493 of this chapter. The HHA may not substitute its equipment for a patient’s equipment when assisting with self-administered tests. This Standard is not met as evidenced by: Based on observation, record review and interview, the Agency failed to conduct waived testing quality controls and maintain waived testing quality controls records for blood glucose testing for one (#2) of ten (#1-#10) records reviewed. During a home observation visit on 11/08/23 at 10:45 AM, the SN performed a fingerstick blood glucose test with her glucometer as the Caregiver stated they do not test the patient’s blood glucose. A review of Agency policy #PC.70 titled, “Waived Testing Quality Controls”, states “Agency staff will conduct quality control on each Agency owned blood monitoring/testing device. The Agency will maintain records of the results according to the manufacturer’s recommendations for each specific brand of equipment”. On 11/08/23 at 2:00 PM, upon request to see the Agency’s waived testing quality control records, the Brach Director stated the Agency did not have a record of quality controls. Further review of the SN visit note for 11/08/23 failed to provide evidence the SN conducted a quality control test before performing the blood glucose test on Pt #2. On 11/08/23 at 2:30 PM, the Branch Director stated the Agency does not have a quality control record as required by policy and stated the SN did not follow the waived testing policy for testing with Pt #2.”

“5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care. This Element is not met as evidenced by: Based on record review and interview, the Physical Therapist failed to conduct an evaluation within 5 days of the SOC as part of the comprehensive assessment for one (#3) of four (#3, #8 - #10) records reviewed with orders for Physical Therapy evaluation. Patient #3 A review of the POC for Patient #3 for the initial certification period 10/11/23 to 12/09/23 revealed a primary diagnosis of Multiple Fractured Ribs. The referral orders and the POC included orders for “Physical Therapy to evaluate...”. Further review of Physical Therapy Notes revealed the Physical Therapy Evaluation was conducted on 10/17/23 (6 days after the Initial Start of Care Visit) and no documentation was evident as to the reason for delay. On 11/08/23 at 2:30 PM, the Administrator stated the Physical Therapist failed to conduct the evaluation within 5 days as required for 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 observation, record review and interview, the Skilled Nurse failed to conduct a review of all medications the patient was taking and maintain a current medication list for one (#2) of ten (#1 - #10) records reviewed. Patient #2 During a home observation visit on 11/08/23 at 10:45 AM, the SN failed to conduct a review of medications Pt#2 was currently taking. The Caregiver reviewed medications the patient was taking with this Surveyor and the medication list failed to include: Lutein 20 mg, 1 tablet every other day and Tylenol 500 mg as needed for pain which the Caregiver stated Pt#2 has taken for a while. The medication list included Omeprazole 20 mg, delayed release, 1 capsule every AM of which the Caregiver stated the patient takes every other day. Review of the Agency policy #PC.80 titled, “Medication List and Monitoring” states, “The agency staff will maintain a current, accurate list of prescription, over-the-counter and sample medications, herbals and home remedies taken by the patient/client. Professional clinical staff will update the medication list with any change in medication regimen”. A review of the POC for Patient #2 for re-certification period 11/1/23 to 12/30/23 revealed the last medication review was conducted 10/30/23 during the RN recertification visit. On 11/08/23 at 2:30 PM, the Branch Director stated the medications identified during the home observation visit were not listed on the agency’s medication list for Patient #2.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on record review and interview, the Agency failed to provide an individualized POC to include the correct supplies and equipment necessary to meet the patient’s assessed needs for three (#5, #8 and #10) of ten (#1- #10) records reviewed. Patient #8 A review of the POC for Patient #8 for re-certification periods 09/29/23 to 11/27/23 revealed a primary diagnosis of Type II Diabetes Mellitus. The POC included orders for “SN for instruction/ reinforcement of diabetic care to include, diet, skin care, blood glucose testing and diabetic foot care”. Further review of the POC failed to identify diabetic supplies or equipment as DME and Supplies. Patient #10 A review of the POC for Patient #10 for re-certification periods 09/14/23 to 11/12/23 revealed a primary diagnosis of Type II Diabetes Mellitus. The POC included orders for “SN for instruction/ reinforcement of diabetic care to include, diet, skin care, blood glucose testing and diabetic foot care”. Further review of the POC failed to identify diabetic supplies or equipment as DME and Supplies. Patient #5 A review of the POC for Patient #5 for re-certification periods 09/30/23 to 11/28/23 revealed a primary diagnosis of Infection of Cardiovascular Device. The POC included Oxygen Supplies as DME and Supplies. Further review of the record failed to provide evidence Pt#5 was currently using Oxygen. On 11/08/23 at 2:30 PM, the Branch Director stated Pt #5 was not currently using Oxygen and Oxygen should not be listed as DME for Pt #5. The Branch Director also stated the Agency failed to include patient specific diabetic supplies and equipment on the POC for Patients #8 and #10.”