Easy Care Health Care

“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 clinical home visit observations, a review of agency policies, and an interview with the administrator, the agency failed to follow its policy pertaining to infection control for two (2) of two (2) clinical home visits conducted, (CR#1 and 2.) Findings include: A review of agency policy titled “Exposure Control Plan: OSHA Regulations” was conducted on 2/10/25 at approximately 5:00 PM. Policy states, “Nurse, Home Health Aide and Other Staff Bags: 1. Nurses, home health aides and other staff bags which contain equipment, e.g., a thermometer, stethoscope, blood pressure cuff, etc., and are brought into the home are classified as clean on the inside. The outside of the bag, because it is exposed to all environments, is considered “soiled”. Methods of Disinfection: 6. Stethoscopes and blood pressure cuffs will be cleaned with Agency approved disinfectant after each use by the employee who has possession of the equipment. Nurse Bag Technique: 2. Upon entering the home, place the bag on a clean surface; paper towels or plastic bag may be used to create a clean area if indicated. Open the bag near the area, if possible, near the water supply... Remove all items which will be needed for the visit. Place items on one of the paper towels. Close the bag and give the patient care... Clean any visible soiled items which will be returned the bag...” On-site clinical home visits were conducted on 2/10/25 from approximately 1:15 PM to 1:40 PM. CR #1, arrived at the home at 1:15 PM. The nurse (PF#1) placed the clinical bag on the patient’s bed with no barrier beneath the bag. The nurse removed a blood pressure (BP) cuff and obtained patients’ blood pressure. The nurse returned BP cuff to the bag without sanitizing the item. The nurse then removed pulse oximeter, and obtained patients oxygen and heart rate, then returned this item to the bag without sanitizing. The nurse removed the stethoscope from the bag to listen to the patients’ lungs, then returned the item without sanitizing the item to the bag. The observation revealed that there was no separation between clean equipment and equipment that was used and required sanitization. CR #2, arrived at the home at 1:30 PM. The nurse (PF#1) placed the clinical bag on the patient’s bed with no barrier beneath the bag. The nurse removed a blood pressure (BP) cuff and obtained patients’ blood pressure. The nurse returned BP cuff to the bag without sanitizing the item. The nurse then removed pulse oximeter, and obtained patients oxygen and heart rate, then returned this item to the bag without sanitizing. The nurse removed the stethoscope from the bag to listen to the patients’ lungs, then returned the item without sanitizing the item to the bag. The observation revealed that there was no separation between clean equipment and equipment that was used and required sanitization. An interview conducted with the administrator conducted on February 10, 2025, at approximately 2:00 pm confirmed the above findings.”

“A qualified HH aide successfully completed: CFR(s): 484.80(a)(1)(i-iv) A qualified home health aide is a person who has successfully completed: (i) A training and competency evaluation program as specified in paragraphs (b) and (c) respectively of this section; or (ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or (iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of §483.151 through §483.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or (iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section. This Element is not met as evidenced by: Based on a review of agency policy, personnel files (PF), and an interview with the administrator, the agency failed to follow its policy to ensure that the home health aides had evidence of completing a minimum of 75 hours of classroom instruction prior to or during the first 3 months of employment for two (2) of two (2) home health aides reviewed, (PF #2 and 3). Findings Include: A review of agency policy titled “Home Health Aide (HHA) Services and Training Program” conducted on February 10, 2025, at approximately 12:30 PM states, “Policy: All Home Health Aides employed or contracted by the Agency will satisfactorily complete a home health aide training program and competency evaluation program prior to performing patient care...Procedure: 3. Home health aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while providing service to an individual under the direct supervision of a registered nurse (RN), or a licensed practical nurse (LPN) who is under the supervision of the RN. Classroom and practical training must total at least seventy-five (75) hours...” A review of PF’s conducted on February 10, 2025, from approximately 11:20 AM to 11:35 AM revealed the following: PF #2, Date of Hire: 8/23/23 (added HHA position on 1/14/25, did not contain any documentation the employee completed a training program with a minimum of seventy-five (75) hours of training. PF #3, Date of Hire: 8/19/24, did not contain any documentation the employee completed a training program with a minimum of seventy-five (75) hours of training. An interview with the administrator conducted on February 10, 2025, at approximately 2:00 PM confirmed that the above findings.”

“Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This Element is not met as evidenced by: Based on review of agency policy, the Center for Disease Control Tuberculosis Guidelines; personnel files (PF), and an interview with administrator, the agency failed to follow its policies to provide documentation of the following: initial competency evaluation for two (2) of four (2) PFs reviewed, (PF #1 and 4); annual competency evaluations for two (2) of four (4) PFs reviewed, (PF #1 and 4); tuberculosis (TB) testing at hire for two (2) of four (4) PFs reviewed, (PF #1 and 4); annual performance evaluations for two (2) of four (4) PFs reviewed, (PF #1 and 4). Findings Included: In May 2019, the CDC updated its recommendations for TB testing of health care personnel. The CDC guidelines state that all Health Care Workers (HCW) should: 1: receive baseline tuberculosis screening upon hire by using: a two-step tuberculin skin test (TST), a single blood assay for tuberculosis (TB), or a negative chest x-ray to test for infection with tuberculosis. 2. Completion of a tuberculosis symptom questionnaire. And 3. Completion of a tuberculosis risk assessment. After baseline testing for infection with tuberculosis, HCWs should receive TB education annually. HCWs with a baseline positive test for tuberculosis infections should receive one chest radiograph result to exclude tuberculosis disease. CDC Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care settings, 2005. Morbidity and Mortality World Report 2005;(5-16-19) A review of agency policy titled “Staff Competency Program” conducted on February 11, 2025, at approximately 2:35 PM states, “Policy: Easy Care Health Care will provide for initial and ongoing competency assessments for all patient care staff by qualified individuals...Procedure: 1. Patient care staff will be competency assessed at defined intervals: For each new employee (including contract employees) during orientation...Competency evaluations are performed at time of hire prior to providing care independently and annually...” A review of agency policy titled “Occupational Exposure to Tuberculosis (TB)/Prevention of Transmission of TB Plan” conducted on February 11, 2025, at approximately 2:40 PM states, “Easy Care Health Care will comply with the current OSHA Enforcement Policy and Procedure for Occupational Exposure to Tuberculosis as well as Centers for Disease Control guidelines...Procedure: 14. Employees will be screened for TB when: During the pre-employment physical, employees who have potential for exposure to tuberculosis, including those with a history of BCG vaccination, will have baseline PPD skin testing performed...” A review of agency policy titled, “Performance Appraisals/Evaluations” conducted on February 13, 2025, at approximately 10:00 AM states, “All employees will have a performance appraisal/evaluation based upon their job description no less frequently than annually...” A review of PF’s conducted on February 10, 2025, from approximately 11:20 AM to 11:40 AM revealed the following: PF #1, Date of Hire: 2/1/23, did not contain any documentation of: an initial competency; an annual competency for 2024 and 2025; and contained negative tuberculosis skin testing dated 5/13/24 and 5/25/24. PF #4, Date of Hire: 10/23/23, did not contain any documentation of: an initial competency; an annual competency for 2024; and tuberculosis testing at hire. An interview with the administrator on February 10, 2025, at approximately 2:00 PM confirmed the above findings.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on a review of agency policies, clinical records (CR), and interview with the administrator, it was determined that the agency failed to follow its policy regarding completion and submission of discharge summaries for two (2) of two (2) discharged CRs, (CR #3 and 5). Findings include: A review of agency policy titled “Discharge Summary” conducted on February 10, 2025, at approximately 12:15 PM states, “Policy: A Discharge Summary will be completed for all patients discharged from the Agency...Procedure: 1. A Discharge Summary form will be completed by the Skilled Nurse, Medical Social Worker and/or Therapist 2. A Discharge Summary will be sent within five (5) business days of patient discharge to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient. 3. The original Discharge Summary from each service will be filed in the medical record...” A review of CRs conducted on February 10, 2025, from approximately 10:00 AM to 11:00 AM revealed the following: CR #3, Start of Care: 7/22/24. Discharge Date: 8/2/24. Certification period reviewed: 7/22/24 through 9/21/24. File did not contain any documentation of a completed discharge summary and there is no documentation that the physician was notified of discharge. CR #5, Start of Care: 8/14/24. Discharge Date: 9/5/24. Certification period reviewed: 8/14/24 through 10/13/24. File did not contain any documentation of a completed discharge summary and there is no documentation that the physician was notified of discharge. An interview with the administrator conducted on February 10, 2025, at approximately 2:00 PM confirmed the above findings.”