Pruitthealth Home Health-Florence

“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, interview and review of the Home Health Agency’s (HHA’s) policy, the HHA failed to ensure infection control practices were followed for one of one wound care procedures observed, Patient #5. The findings include: A home visit was made to Patient #5 on 5/29/24 at 9:23 AM with Registered Nurse (RN) #3. During observation of the nursing visit, RN #3 was providing wound care to Patient #5’s bilateral lower leg wounds with breaches in infection control observed. RN #3 used the temporal thermometer to take Patient #5’s temperature, then placed it down and without doing hand hygiene, entered the nursing bag multiple times to obtain a sublingual thermometer and thermometer covers. During wound care, with gloved hands, RN #3 used her/his right hand to use the spray bottle of wound cleanser to spray a piece of gauze and then clean the wound with the moistened gauze using both the right and left hands multiple times and then without removing the soiled gloves and performing hand hygiene, RN #3 applied a new clean dressing. RN #3 performed this process for both the right and left lower leg wounds. RN #3 also used a tape measure to measure Patient #5’s ankles and retracted the measuring tape back in without disinfecting the tape measure. During an interview on 5/29/24 at 11:00 AM, RN #3 confirmed re-entering the nursing bag without doing hand hygiene. During an interview on 5/30/24 at 11:35 AM, the Administrator confirmed staff are always supposed to perform hand hygiene before re-entering the nursing bag, remove soiled gloves and perform hand hygiene after removing the soiled dressing, and disinfect the tape measuring after using it and before retracting it.”

“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 observations, staff intervews and Home Health Agency (HHA) reconciled medication record review, the HHA failed to ensure staff updated the patient’s agency medication profile with the patient’s home medications for 5 of 6 home observations. (Patient #1, #2, #3, #4 and #5). Findings: A home visit was made with Registered Nurse (RN) #3 to Patient #5 on 05/29/24 at 9:23 AM. Medication discrepancies were revealed during medication reconciliation with the HHA “Medication List” dated 05/29/24 and the medications in the home Patient #5 was actually taking. Venlofaxin ER (extended release) 150 mg (milligrams) daily was in Patient #5’s medications but was not on the HHA “Medication List.” Patient #5’s caregiver (CG) stated, “She’s been on Venlofaxin for a long time.” Tolterodine 1 mg orally twice a day with a fill date of 5/17/24 was in the home and the CG confirmed Patient #5 was taking it. Tolterodine was not on the HHA “Medication List.” Certrizine 10 mg daily with a fill date of 2/27/24 was in the home and the CG confirmed Patient #5 was taking it. Certrizine was not on the HHA “Medication List.” In a concurrent interview, RN #3 confirmed the discrepancies. A home visit was made with Physical Therapist (PT) #1 to Patient #4 on 05/29/24 at 1:50 PM. Medication discrepancies were revealed during medication reconciliation with the HHA “Medication List” dated 05/29/24 and the medications in the home Patient #4 was actually taking. Patient #4 was taking Celecoxib 200 mg once daily. It had a fill date of 03/25/24. Celecoxib was not on the HHA Medication List. Patient #4 was taking Tadalafil 20 mg once daily with a fill date of 05/15/24. Tadalafil was not on the HHA Medication List. In a concurrent interview, PT #1 confirmed the discrepancies. Observations during Patient #2’s home visit on 05/29/2024 between 9:30 AM and 10:10 AM yielded inaccuracies in the home health agency’s medication profile for the patient when compared with medications in the home that Patient #2 reports actively taking. Patient #2 reports currently taking Amlodipine 10 mg (milligrams) by mouth daily. HHA profile does not list Amlodipine 10 mg daily. Interview on 5/29/2024 at 10:11 AM with Physical Therapy Assistant (PTA) #1. PTA #1 reported medications were missing and verified the finding. Observation during a home visit with Patient #1 on 05/29/2024 between 11:10 AM and 11:45 AM yielded inaccuracies between the HHA profile for the patient when compared with medications in the home. Patient #1 and the patient’s caregiver confirm Patient #1 is currently taking Hydrocodone. Hydrocodone 5mg-325 mg by mouth q 6 hours as needed for pain. This medication is not listed on HHA medication list. Interview on 05/29/2024 at 11:47 AM with Registered Nurse (RN) #1. RN #1 reported medications were missing and verified the finding. Observations during a home visit with Patient #3 on 05/29/2024 between 12:25 PM and 1:10 PM yielded inaccuracies between the HHA profile for the patient when compared with medications in the home. Patient #3 reports the Macrobid 100 mg capsule 2 times a day was discontinued. Interview on 05/29/2024 at 1:12 PM with RN #2. RN #2 reports Macrobid should have been removed from current medication list.”

“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 observation, interview and record review, the Home Health Agency (HHA) failed to ensure all diagnoses were included in the plan of care for one of six patient records reviewed, Patient #5. Findings: During a home visit to Patient #5 on 5/29/24 at 9:23 AM Registered Nurse (RN) #3 was observed providing wound care to Patient #5’s bilateral lower extremities. Patient #5’s caregiver stated Patient #5’s leg wounds were caused by calcium which collects in her/his legs and stones of calcium come up through the skin and cause wounds. The caregiver stated this started years ago when Patient #5 had heart surgery. Review of Patient #5’s record on 5/30/24 at 9:00 AM revealed Patient #5 was admitted to the HHA on 05/16/24 with a diagnosis of Chronic Venous Hypertension with Ulcer of Right and Left Lower Extremities. The list of diagnoses indicated Patient #5 had a heart valve replacement in 2019 with no diagnosis reflecting calcium accumulation in the legs with stones. During an interview on 5/30/24 at 11:20 AM, the Administrator when asked about the condition causing Patient #5’s wounds stated, “It’s Calcinosis Cutis.” The Administrator further stated he/she became aware of it when he/she provided wound care to Patient #5 and confirmed Calcinosis Cutis was the cause of Patient #5’s bilateral lower extremity wounds and the diagnosis was not included in Patient #5’s plan of care.”

“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 observation, interview and record review, the Home Health Agency (HHA) staff failed to follow physician orders regarding visit schedules and vital sign assessments for 4 out of 17 patient charts reviewed. (Patients #7, #10, #11 and #16). Findings include: Review of Patient #7’s medical record on 5/29/2024 at 12:22 PM showed physician orders for licensed professionals to notify physician for weights outside of parameters 208 pounds (lbs) to 218 lbs at skilled visits. Physical Therapist (PT) reassessment visit on 5/09/2024 revealed no documentation of Patient #7’s weights and/or vital signs. During an interview on 5/30/2024 at 10:41 AM, Regional Administrator #1 stated that he/she was unable to find documentation of vital signs or weight for that visit and verified the findings. Review of Patient #10’s medical record on 5/29/2024 at 9:20 AM showed physician orders dated 3/15/2024 for wound care orders stated, “Wound care to be done three times a week, once by Mobile Wound Care and twice by Home Health”. Chart documentation revealed Registered Nurse (RN) visits on 3/21/2024, 3/29/2024 and 4/04/2024 for one visit each week and not two per physician orders. During an interview on 5/30/2024 at 10:35 AM, Regional Administrator #1 stated that visits should have been increased to twice a week and verified the findings. Review of Patient #11’s medical record on 5/29/2024 at 9:45 AM showed physician orders for licensed professionals to report fasting blood glucose levels less than 75 and greater than 280. PT reassessment visit on 5/09/2024 revealed no documentation of glucose levels. During an interview on 5/30/2024 at 10:24 AM, Regional Administrator #1 stated that he/she was unable to find documentation of a glucose level for that visit and verified the findings. Review of Patient #16’s medical record on 5/29/2024 at 1:31 PM showed physician orders for Medical Social Worker (MSW) to evaluate patient for social and emotional needs. Record review on 3/15/2024 revealed the MSW made a phone call to Patient #16 to set up a visit with no answer by the patient. Further review of the chart revealed no documentation for any follow up by the MSW to contact the patient. During an interview on 5/30/2024 at 9:55 AM, Regional Administrator #1 stated that the MSW is part time which did not excuse the lack of followup and verified the finding.”