MUSC Health at Home, By Bayada- Charleston

“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, document review, and interview, the HHA failed to follow acceptable standards of practice when cleaning and disinfecting equipment in the home environment for 1 of 7 home visits observed. The findings included: On 09/09/2025 at 9: 43 AM, a home visit was conducted. Registered Nurse (RN) #1 was observed during the home visit providing care to Patient #4 (P4). RN #1 placed his/her nursing bag directly onto a cluttered coffee table, and then moved the bag to a nearby, uncleaned, counter-top, without a barrier. RN #1 placed a barrier onto the coffee table. RN #1 removed equipment (blood pressure cuff, pulse oximeter, scissors, thermometer, and stethoscope) from the nursing bag and placed the equipment onto the barrier on coffee table. RN #1 used the equipment and placed the used equipment onto the same barrier on coffee table. RN #1 cleaned the equipment and placed the cleaned equipment back onto the same soiled barrier (on the coffee table) to dry. RN #1 picked up the electronic tablet and handed it to P4. P4 gave it back. RN #1 placed the uncleaned electronic tablet on top of the cleaned equipment. RN #1 picked up the electronic tablet from on top of the cleaned equipment, placed the tablet under his/her arm, and placed equipment into the nursing bag. RN #1 exited the patient’s home with the bag on his/her arm and uncleaned tablet under his/her arm. RN #1 sanitized his/her hands outside on the front porch. On 09/09/2025 at 10:28 AM, an interview was conducted with RN #1. RN #1 stated, to their knowledge, if it’s a hard surface, a barrier is not needed for the bag unless it’s a soft or fabric surface like a couch or chair. RN #1 verified that he/she did not sanitize the tablet before placing it on top of the already sanitized equipment. On 09/10/2025, a review of policy, “0-1314 Bag Technique,”revealed that the bag carried into the home should be placed on a “clean, dry, hard surface.” A disposable barrier should be placed “between the bag and a dry, hard, surface.” The policy stated cleaned items are to be placed on a clean barrier to dry. On 09/11/2025 at 8:51 AM, an interview was conducted with the Agency Director (DIR). DIR stated that a hard surface is the ideal place to set the bag down. DIR attests that a barrier was still required, or if the bag was placed directly on the hard surface, the bag would need to be wiped down. DIR stated that 3 barriers are used; 1 used for bag placement, 1 for used equipment, and the 3rd for cleaned equipment to dry.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on agency policy review, record review, and interview, the agency failed to conduct an initial assessment visit within 48 hours after receiving a referral to provide services for 1 (Patient #1) of 17 sampled patients. This failure had the potential for the patient to not receive needed assessments and home care services that could have negatively impacted Patient #1’s health. Findings included: An agency policy titled, “0-672-Admission Criteria & Procedure-Medicare Certified Offices,” revised on 01/01/2025, revealed, “The initial assessment must be completed within: a. 48 hours of referral; b. 48 hours of the client’s return home; or c. on the physician-ordered SOC (start of care) date.” Record review of Patient #1’s “Home Health Certification and Plan of Care,” dated 08/29/2025, revealed the agency admitted Patient #1 on 08/29/2025. According to the Home Health Certification and Plan of Care, the patient had a medical history that included a diagnosis of unilateral primary osteoarthritis of the left hip (a degenerative joint condition affecting only the left hip, where the cartilage in the joint gradually breaks down leading to pain, stiffness, and reduced mobility). Patient #1’s “Home Health Certification and Plan of Care,” dated 08/29/2025, included a physician order for the agency to provide physical therapy services to Patient #1. Patient #1’s untitled referral document dated 08/21/2025 revealed the agency received the referral to admit Patient #1 on 08/21/2025. Patient #1’s clinical record did not reveal documentation regarding the reason for the delay in admitting Patient #1, and the agency did not provide additional documentation related to Patient #1’s delayed admission. During an interview conducted on 09/10/2025 at 2:35 PM, the Home Health Director (HHD) stated the agency expectation was the agency would admit all patients within 48 hours of receiving a referral to provide services unless the referring physician ordered a specific admission date or the patient requested a delay in the visit. The HHD stated the agency received a referral on 08/21/2025 to provide services to Patient #1, and their centralized intake department erroneously entered 08/29/2025 as the patient’s planned admission. The HHD stated the error caused the delay in the agency admitting the patient. The HHD acknowledged the agency did not follow its policy.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on agency policy, record review, and interview, the agency failed to provide services as ordered by a physician for 1 (Patient #8) of 17 sampled patients. This failure resulted in Patient #8 not receiving wound care as ordered by a physician. Findings included: An agency policy titled, “0-3230 Wound Care-Assessment & Treatment,” revised 09/2021, revealed clinicians were to “Verify physician’s orders which should include: ... d. Specific medications/treatment to be applied.” Record review of Patient #8’s “Home Health Certification and Plan of Care,” dated 08/01/2025, revealed the agency admitted Patient #8 on 08/01/2025. According to the Home Health Certification and Plan of Care, the patient had a medical history that included diagnoses of unspecified open wound on the right lower leg and type 2 diabetes mellites without complications (a chronic condition characterized by insulin resistance and elevated blood sugar levels, but without the adverse effects typically associated with the disease). Patient #8’s “Home Health Certification and Plan of Care,” dated 08/01/2025, revealed the patient’s physician ordered the agency to perform wound care for Patient #8’s right lower leg by cleansing the wound with a wound cleanser, applying Bacitracin (an antibiotic cream) to the wound bed (the open area or base of a wound), and covering and securing the treatment with foam (absorbent, non-adherent dressings made from polyurethane foam). Patient #8’s “Order Number: 12863863,” dated 08/21/2025, revealed Patient #8’s physician changed Patient #8’s lower leg wound care on 08/21/2025 and ordered the agency to cleanse the patient’s wound with soap and water, pat dry with clean gauze, apply Santyl (an ointment used to remove dead tissue from chronic skin ulcers and severe burns), than apply Hydrofera Blue wrap (a foam dressing that provides broad-spectrum antibacterial protection, manages drainage, and promotes a moist, non-toxic healing environment), with two layers of Co-flex (a cohesive flexible bandage that adheres to itself, not to the skin). Patient #8’s “Visit Note Report,” dated 08/22/2025, 08/25/2025, and 08/27/2025, revealed the agency staff did not provide Patient #8’s wound care as ordered by the patient’s physician on 08/21/2025 when they cleansed Patient #8’s lower leg wound with wound cleanser, applied xeroform, and covered the wound with foam on 08/22/2025, 08/25/2025, and 08/27/2025. During a concurrent record review and interview conducted on 09/10/2025 at 2:45 PM, the Home Health Director (HHD) stated the agency expected all clinicians to review a patient’s plan of care before providing service to the patient to ensure patients received service based on the most current physician orders. The HHD further stated the agency did not provide the correct wound care for Patient #8 on 08/22/2025, 08/25/2025, and 08/27/2025, and acknowledged the agency staff did not follow the agency’s policy.”