Interim Healthcare Services of NE Pa, 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 agency policies and procedures, clinical records and personnel files, tuberculosis (TB) screening guidance from the Centers for Disease Control (CDC), and based on interview with the Director of Healthcare Services (DHCS)-Employee #9), Quality Coordinator (QC-Employee #18) and the Alternate Administrator (Employee #17), the agency failed to ensure a TB risk assessment form was completed upon hire for eight (8) of eight (8) employees hired after April 23, 2021. (Employees #1, #5, #7, #10, #11, #12, #13 and #14) Finding include: On April 26, 2024 at approximately 3:45 PM, review of the agency policy titled “Tuberculosis (TB) Prevention and Surveillance” revealed the following under “Purpose”: To establish TB prevention, surveillance and early detection for employees at risk for occupational exposure to TB... On April 26, 2024 at approximately 4:01 PM, review of the CDC webpage (https://www.cdc.gov/tb/topic/infectioncontrol/healthcarepersonnel-faq.htm) titled “Frequently Asked Questions” revealed the following under “Which health care personnel should be screened for TB?”: CDC and the National TB Controllers Association (NTCA) recommend that all U.S. health care personnel be screened for TB upon hire (i.e., pre-placement). Pre-placement screening should include a TB risk assessment, a TB symptom screen, and a TB test. These recommendations should be used for people who work or volunteer in health care settings, including... home-based health care...settings... On April 26, 2024 at approximately 12:04 PM, review of the agency employee TB screening form revealed the bottom portion of the TB screening form included a TB risk (symptom) screen and an area to document TB skin testing. There was no documentation which provided evidence the employee TB screening form included a TB risk assessment. Patient #1 (Branch Office): On April 24, 2024 at approximately 1:00 PM, review of the clinical record revealed a registered nurse (RN-Employee #1) and an occupational therapist (OT-Employee #12) provided patient care in April 2024. Patient #2 (Branch Office): On April 24, 2024 at approximately 1:30 PM, review of the clinical record revealed a physical therapist (PT-Employee #2) and a home health aide (HHA-Employee #14) provided patient care in April 2024. Patient #6: On April 26, 2024 at approximately 10:12 AM, review of the clinical record revealed a HHA (Employee #5) provided patient care in April 2024. Patient #8: On April 26, 2024 at approximately 10:51 AM, review of the clinical record revealed PT (Employee #7) provided patient care in April 2024. Patient #14 (Discharge): On April 26, 2024 at approximately 1:38 PM, review of the clinical record revealed a licensed practical nurse (LPN-Employee #13) provided patient care in January 2024. Between April 19, 2023 at approximately 2:07 PM and April 20, 2023 at approximately 10:01 AM, review of personnel file documentation revealed the following: Employee #1: The date of hire of the RN was 09/26/2023. Employee #5: The date of hire of the HHA was 06/12/2023. Employee #7: The date of hire of the PT was 06/13/2023. Employee #10: The date of hire of the RN/Clinical Manager was 07/31/2023. Employee #11: The date of hire of the RN/Clinical Manager was 08/30/2021. Employee #12: The date of hire of the OT was 09/07/2023. Employee #13: The date of hire of the LPN was 08/10/2023. Employee #14: The date of hire of the HHA was 09/06/2023. There was no documentation in the above referenced personnel files which provided evidence a TB risk assessment form was completed upon hire. During interview conducted on April 26, 2024 at approximately 4:05 PM, the DHCS, QC and Alternate Administrator confirmed there was no documentation in the above referenced personnel files which provided evidence that the above identified employees completed a TB risk assessment upon hire.”

“Treatments and therapy services CFR(s): 484.60(e)(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services. This Element is not met as evidenced by: Based on review of agency policies/procedures, documentation and clinical records and observation, and based on interview with the Director of Healthcare Services (DHCS-Employee #9), Quality Coordinator (QC-Employee #18) and Alternate Administrator (Employee #17), the agency failed to ensure written instructions regarding the type of treatments to be performed by skilled nursing (SN) were provided to two (2) of two (2) patients for whom wound care orders were included on the “Home Health Certification and Plan of Care” and for whom the admission folder/booklet was available for review. (Patients #4 and #5) Finding include: On April 26, 2024 at approximately 3:47 PM, review of the agency policy titled “Implementing the Plan of Care/Service Plan” revealed the following under “Policy”: Interim Healthcare...provides...resources to achieve the care/services goals or outcomes. Patient #4: On April 25, 2024 at approximately 2:40 PM, review of the clinical record revealed SN is to provide the following wound treatment to the right and left lower extremities (legs) as documented on the “Home Health Certification and Plan of Care” for the initial certification period of April 12 through June 10, 2024: Cleanse/irrigate with normal saline solution (NSS), apply calcium alginate (wound treatment) to wound bed, moisturizer to peri-wound (area surrounding the wound), cover with ABD (thick wound dressing) and kerlix (gauze wrap) three (3) times a week and as needed. SN to perform wound care until patient/caregiver independent. During home visit conducted on April 25, 2024 at approximately 8:30 AM, the SN (Employee #3) provided wound care to the right and left leg wounds. During the home visit, review of the patient admission booklet/folder and the agency message/whiteboard revealed there was no documentation which provided evidence instructions regarding the above referenced wound care had been provided to the patient in writing. Patient #5: On April 25, 2024 at approximately 3:02 PM, review of the clinical record revealed SN is to provide the following wound treatment to the coccyx (tailbone) wound as documented on the “Home Health Certification and Plan of Care” for the initial certification period of March 19 through May 17, 2024: Cleanse/irrigate with NSS or soap and water, apply Desitin (moisture barrier cream) and apply Allevyn (self-adhesive wound dressing) every 3 days and as needed for soiling and dislodgement. During home visit conducted on April 25, 2024 at approximately 9:20 AM, the SN (Employee #4) provided wound care to the coccyx wound. During the home visit, review of the patient admission booklet/folder revealed there was no documentation which provided evidence instructions regarding the above referenced wound care had been provided to the patient in writing. During interview on April 26, 2024 at approximately 4:05 PM the DHCS, QC and the Alternate Administrator confirmed written instructions for the above referenced wound care had not been provided to the above identified patients. (Deficiency previously cited during April 2021 Medicare recertification survey.)”

“Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This Element is not met as evidenced by: Based on the review of an agency procedure manual and clinical records, and based on interview with Director of Healthcare Services (DHCS-Employee #9), the Quality Coordinator (QC-Employee #18) and the Alternate Administrator (Employee #17), the agency failed to ensure peripherally inserted central catheter (intravenous inserted into a vein in the upper arm) assessment was completed per agency policy and procedure for two (2) of two (2) patients. (Patients #11 and #12) Findings include: On April 26, 2024 at approximately 3:34 PM, review of agency procedure included in the Elsevier manual revealed the following under Chapter 29 “Intravenous and Vascular Access Therapy”: Page 892: Insertion sites require regular inspection for early...signs and symptoms of IV related complications...measurements of external catheter length provides comparison...arm measurement... Page 896 (PICC removal): Inspect catheter for intactness especially along the tip and that length is appropriate for device... Patient #11 (Discharge): On April 26, 2024 at approximately at approximately 12:09 PM revealed skilled nursing (SN) was to maintain and provide care to the PICC line as documented on the “Home Health Certification and Plan of Care” for the initial certification period of March 27 through May 25, 2024. Review of the start of care (SOC) SN visit note dated 03/27/2024 revealed a PICC line was present in the right upper extremity (arm) and that a registered nurse (RN-Employee #15) changed the PICC line dressing. There was no documentation on the SOC SN visit note which provided evidence the RN assessed right upper arm circumference nor the external length of the PICC line. Review of the SN visit note dated 04/03/2024 revealed the RN (Employee #16) discontinued (removed) the PICC line. There was no documentation on the SN visit note which provided evidence the RN assessed the PICC length after removal. Patient #12: On April 26, 2024 at approximately at approximately 12:48 PM revealed SN was to maintain and provide care to the PICC line as documented on the “Home Health Certification and Plan of Care” for the initial certification period of March 30 through May 28, 2024. Review of the SOC SN visit note dated 03/30/2024 revealed a PICC line was present in the left upper extremity. There was no documentation on the SOC SN visit note which provided evidence the RN (Employee #15) assessed left upper arm circumference. During interview conducted on April 26, 2024 at approximately 4:05 PM, the DHCS, QC and the Alternate Administrator confirmed there was no documentation in the clinical records which provided evidence that PICC line assessment was performed as per agency procedures for the above referenced patients.”

“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 review of agency policies/procedures, documentation and clinical records and observation, and based on interview with the Director of Healthcare Services (DHCS-Employee #9), Quality Coordinator (QC-Employee $18) and the Alternate Administrator (Employee #17), the agency failed to ensure a registered nurse (RN) performed an onsite supervision of the home health aide (HHA) every 14 days for two (2) of four (4) patients for whom HHA services were provided for more than 14 days. (Patients #3 and #13) Finding include: On April 26, 2024 at approximately 3:48 PM, review of the agency policy titled “Supervision of Employees Who Provides Patient/Client Care/Services” revealed the following under “Policy”: Employee supervisory visits are conducted in accordance with applicable law, regulation...by designated, qualified supervisors. Patient #3 (Branch Office): On April 24, 2024 at approximately 2:18 PM, review of the clinical record revealed a registered nurse (RN) developed/established the HHA plan of care (POC) on 03/25/2024. Review of HHA visit note documentation revealed HHA services were provided one (1) to two (2) times a week during the weeks beginning on 03/25, 04/01 and 04/15/2024. Review of skilled nursing (SN) visit note documentation revealed SN services were provided two (2) times a week between 03/25/2024 and 04/19/2024 and that a RN performed a HHA supervisory visit on 03/28/2024. There was no documentation in the clinical record which provided evidence an RN performed on onsite visit to supervise HHA services after 03/28/2024. Patient #13: On April 26, 2024 at approximately 1:26 PM, review of the clinical record revealed a registered nurse (RN) developed/established the HHA POC on 04/02/2024. Review of HHA visit note documentation revealed HHA services were provided one (1) to two (2) times a week between 04/02/2024 and 04/23/2024. Review of skilled nursing (SN) visit note documentation revealed SN services were provided one (1) to two (2) times a week between 04/01/2024 and 04/16/2024. There was no documentation in the clinical record which provided evidence a RN performed on onsite visit to supervise HHA services on 04/16/2024. During interview on April 26, 2024 at approximately 4:05 PM the DHCS, QC and the Alternate Administrator confirmed there was no documentation in the clinical record which provided evidence a RN performed an onsite visit to supervise the HHA every 14 days for the above identified patients.”