Enhabit Home Health Bluffton

“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 policy review, the Home Health Agency (HHA) failed to ensure standard precautions for infection control were observed for 3 of 4 home visits observed. (Patients #4, #5, and #6). Observation visit on 06/04/2024 between 10 AM and 11 AM for Patient #5 showed Physical Therapy (PT) #1 having patient sign electronic tablet but failed to sanitize the tablet before leaving patient’s home. During an interview on 06/05/2024 at 10:49 AM, DOO stated the tablet should have been sanitized. Observation visit on 06/04/2024 between 11 AM and 11:58 AM for Patient #6 showed PT #2 removing electronic device used to time patient during the assessment from uniform pocket and replacing the device into the uniform pocket with ungloved, un-sanitized hand. Patient singed electronic tablet, PT #2 placed the electronic tablet under left arm, then sanitized the tablet. During an interview on 06/04/2024 at 11:58 AM, PT #2 agreed with this surveyor about sanitizing equipment. Findings: On 06/04/24 from 9:18 AM to 10:00 AM a home visit was made to Patient #4 to observe a nursing visit by Licensed Practical Nurse (LPN) #1. While providing care, LPN #1 was observed to re-enter the nursing bag without performing hand hygiene. Also, LPN #1 did not disinfect the electronic tablet she/he used during the visit. In an interview with LPN #1 at 10:00 AM, she/he confirmed the findings. In an interview with the Branch Director (BD) on 06/05/24 at 10:00 AM, he/she confirmed the findings and stated the staff’s electronic tablets are supposed to be disinfected right after the vital signs equipment used during the visit is disinfected and before leaving the patient’s home.”

“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 interview and record review, the Home Health Agency (HHA) staff failed to keep an updated, accurate medication list for 1 of 4 patient home visits observations (Patient #6). Findings include: Review of Patient #6’s medical record on 6/04/2024 at 4:02 PM revealed discrepancies between the HHA medication list and the facility Medication Administration Record (MAR) and duplications on the HHA listing. HHA medication lists Vitamin B Complex one tablet by mouth daily and B Complex-Vitamin B one tablet by mouth daily. This is a duplication. HHA medication lists Lyrica 75 mg 1 capsule by mouth two times daily and Pregabalin 75 mg one capsule by mouth twice a day. This is also a duplication. HHA medication lists Nystatin 100,000 unit/Gram topical ointment four times daily to mouth sore. MAR reports Nystatin 100,000 unit/GM topical ointment three times a day to groin for rash. MAR reports Ferosul 325 mg one tablet by mouth daily and this medication is not on the HHA list. HHA medication lists Culturelle 15 billion cell sprinkle one capsule by mouth daily and Digestive Advantage Probiotic Gummy 250 million cell chewable one tablet by mouth daily of which both are not documented in the MAR. During an interview on 6/05/2024 at 11:05 AM, the DOO (Director of Operations) stated that “The medication lists should be accurate”.”

“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 record review and interview, the Home Health Agency (HHA) failed to ensure the plans of care included all pertinent patient information for two of ten records reviewed, Patients #5 and #8. Findings: Review of Patient #8’s record on 06/04/24 at 12:00 PM revealed Patient #8 was admitted to the Home Health Agency on 04/19/24. Review of the initial nursing assessment on 04/19/24, as well as all other nursing visit notes (04/22/24, 04/25/24, 04/30/24, 05/05/24, 05/06/24, 05/07/24, 05/10/24, and 05/13/24) revealed the primary skilled nursing services provided each visit was wound care, including a wound vac (negative pressure device to decrease drainage) to Patient #8’s sacral area (some nursing notes indicated the wound was at the sacrum and other nursing notes indicated the wound was at the rectum). The plan of care dated 04/19/24 to 06/17/24 indicated, “...SKILLED NURSE TO CLEANSE WOUND TO SACRUM WITH WOUND CLEANSER. PREPARE PERI-WOUND AREA WITH SURE PREP. FILL ENTIRE CAVITY WITH BLACK FOAM. APPLY TUBING AND COVER WITH TRANSPARENT DRAPE. APPLY NEGATIVE PRESSURE DEVICE AT 125 MM/HG CONTINUOUS. CHANGE DRESSING MONDAY AND THURSDAY BY SN (Skilled Nurse)...” The first diagnosis on the plan of care was Malignant Neoplasm of Colon, Unspecified, and the second diagnosis was Encounter for Attention to Ileostomy (an opening in the abdomen at the location of the ileus for stool elimination). There were no diagnoses in the plan of care for a sacral wound. In an interview with the Branch Director (BD) and the Director of Operations (DO) on 06/05/24 at 10:30 AM, the BD confirmed wound care to Patient #8’s sacrum was the primary reason the SN was visiting Patient #8 and the BD confirmed there were no diagnoses for the sacral wound in Patient #8’s plan of care. The DO reviewed Patient #8’s record and printed the Operative Note dated 02/05/24. Concurrent review the Operative Note revealed Patient #8 had surgery to remove a rectal mass which required surgical incision near the sacrum. Review of Patient #5’s medical record on 06/04/2024 at 2:01 PM showed Physical Therapist (PT) #2 failed to provide a full assessment for mental status. The admission paperwork documents “none” under mental status. During an interview on 06/05/2024 at 10:49 AM, DOO stated that mental status was incorrectly documented and verified the finding.”

“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 interview and record review, the Home Health Agency (HHA) staff failed to follow physician orders for wound care and weights for 2 out of 10 patients. (Patient #3 and Patient #6). Findings include: Review of Patient #3’s medical record on 6/04/2024 at 4:02 PM showed wound care orders for right malleolus “Cleanse with wound cleanser apply Aquacel AG cover with foam dressing using clean/aseptic technique”. Registered Nurse (RN) note dated 3/29/2024 documents “SN (Skilled Nurse) cleaned wound with wound cleanser. Patted dry. Applied Aquacel AG. Covered with foam dressing. Secured with kerlix and Tubigrip”. SN note dated 3/06/2024 documents “SN cleansed wound with wound cleanser. Applied Aquacel. Covered with Sorbion Absorbant Dressing. Secured with Kerlix.” During an interview on 6/05/2024 at 10:44 AM, the Director of Operations (DOO) stated that wound care orders were not followed and verified the findings. Review of Patient #6’s medical record on 6/04/2024 at 4:02 PM showed physician orders for licensed professional to report weights less than 135 pounds and greater than 145 pounds. Occupational Therapy (OT) visit dated 5/20/2024 revealed no documentation of a weight for the patient. Physical Therapy Assistant (PTA) visit dated 5/24/2024 revealed no documentation of a weight for the patient. During an interview on 6/05/2024 at 10:50 AM,the DOO stated that, Weights should have been recorded at each visit” and verified the findings.”