Clarion Forest VNA 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 review of manufactures directions for use, observations (OBS) with home visits (HV), review of agency policy and procedure, and an interview with the Administrator, the agency failed to ensure that acceptable standards of practice for infection control/prevention were maintained for four (4) of six (6) OBS (HV #3, #4, #5 and #6). Findings include: A review of the home health agency’s (HHA) Policy and Procedure “Bag Technique ... Purpose: Prevent, reduce and control the spread of microorganisms... Bag Placement in the vehicle... The healthcare bag should be placed on a visibly clean, dry surface inside the vehicle... Bag Technique... Place the bag on a clean, dry surface with a water-resistant barrier placed between the bag and the surface... changed with every patient visit... Clean the equipment and supplies that had direct patient or environmental contact with agency approved disinfectant wipes and allow to dry...” Review of manufacturer’s directions for use for disinfectant wipes “Micro-Kill One Germicidal Alcohol Wipes: ... Disinfecting: To disinfect hard, non-porous surfaces use one or more wipes, as necessary, to thoroughly wet the surface to be treated. Treated surface must be visibly wet for one (1) minute to achieve complete disinfection of all pathogens... allow surfaces to air dry... Contact Time: Allow surface to remain wet for one (1) full minute... Storage and Disposal: Always store this product and all pesticides in the original container...” 4/11/2024 approximately 10:00 am to 10:30 am - HV#3: State surveyor observed employee placing equipment bag, that was lined with clear plastic trash bags, directly on the patient’s couch and placed the facility laptop without a barrier, directly on patient’s couch. EMP completed patient care, did not remove the clear plastic trash bags from equipment bag, did not disinfect laptop and exited the patient’s house with surveyor. Employee placed equipment bag, without removing clear plastic trash bags, directly on the employee’s vehicle’s backseat. Surveyor questioned employee regarding clear plastic trash bag removal... Employee stated, “I usually don’t take it off of the bag prior to leaving the house.” 4/11/2024 approximately 1:45pm to 2:30pm - HV#4: State surveyor observed employee performing disinfection of equipment with wipes that were removed from an unmarked, small clear plastic bag that was stored inside the equipment bag. Surveyor asked employee what the wipes were, and employee stated, “The Micro-Kill wipes but the container leaks if it tips over in my car, so I put new one’s in this bag every day.” 4/11/2024 approximately 12:00pm to 12:30pm - HV #5: State surveyor observed employee placing a single barrier onto a hard chair next to patient. The employee then removed “clean/unused” equipment directly from equipment bag, placing the equipment onto the barrier. The employee then used the “clean/unused” equipment to perform assessment on patient and returned the “dirty/used” equipment back onto the one and only barrier that the employee placed on the chair. Upon completion of assessment tasks with equipment, the employee proceeds to perform hand hygiene when assessment was complete and then immediately began to disinfect the “dirty/used” equipment with Micro-Kill One wipes. Immediately after wiping the “dirty/used” equipment the employee placed the disinfected, visibly wet equipment directly on the one and only “dirty/used” barrier that was in place on the chair. State surveyor asked employee if employee had more than one barrier in place to designate “clean” from “dirty” equipment and employee responds, “I do have more than one but did not put more than one out to separate “clean”/“disinfected” equipment from “dirty/used” barrier.” 4/11/2024 approximately 12:45pm to 1:15pm - HV #6: State surveyor observed employee remove laptop from inside the equipment bag and place the laptop directly on patient cushioned top chair without a barrier. An interview conducted with the Administrator on 4/12/2024 at approximately 1:00 PM confirmed the above findings.”

“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 review of clinical records (CR), observation of home visits (HV), review of agency policies, and interview with the administrator, it was determined that the agency failed to ensure the plan of treatment included complete orders for individualized plan of care required for two (2) of seventeen (17) CR reviewed (CR 13 and CR 14). Findings included: Review of agency policy on 4/10/2024 at approximately 1:30pm revealed: “...Content of Plan of Care ...PROCEDURE: The individualized plan of care will included the following: ...The frequency and duration of visits to be made...” Review of agency policy on 4/10/2024 at approximately 1:45pm revealed: “... Physician Orders ...Policy: ... Physician orders must specify the treatment to be provided, the discipline(s) to provide frequency of visits.”... Review of Clinical Records (CR) on 4/10/2024 at revealed: CR13, start of care (SOC) 3/16/2024, dates reviewed 3/15/2024-4/9/2024. Plan of Care (POC) included physician orders for “PT 1-2 x Week for 0 Weeks...” no duration ordered or documented. CR14, SOC 3/1/2024, dates reviewed 3/1/2024 to 4/9/2024. included physician order “...Order Changes: Revision of Plan of Care: Add Home Health Aide services to assist patient with bathing 1-2x/week...” no duration ordered or documented. Findings confirmed with administrator on April 10, 2024, at approximately 2:00pm. “I don’t know how these orders got past us. I will have them corrected.””