Where the Heart Is 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 policy review, observation and interview, the agency failed to ensure measures to prevent the spread of infectious agents were followed by 1 of 7 (Licensed Practical Nurse (LPN) #1 staff observed providing direct patient care in the home setting. The findings included: Medical record review for Patient #5 revealed a Start of Care (SOC) date of 01/08/2025, with diagnoses which included hydrocephalus and bronchopulmonary dysplasia. Observations on 7/13/2026 at 7:00 AM revealed LPN (Licensed Practical Nurse) #1 administering medications into Patient #5’s gastrostomy feeding tube. LPN #1 performed hand hygiene and donned gloves. LPN #1 filled syringes with medications from a medicine cup. Between each medication, LPN #1 washed the medicine cup in the sink while wearing the same gloves. LPN#1 primed the gastrostomy tubing with water. LPN #1 removed gloves, did not perform hand hygiene, removed a bottle from a bag and took a drink. Without performing hand hygiene, LPN #1 donned gloves and connected the tubing to patient #5’s gastrostomy tube. LPN #1 proceeded to administer medication through the gastrostomy tube. LPN #1 rinsed the syringes in the sink while wearing the same gloves, and then proceeded to fill the syringes with medication. LPN #1 removed gloves and answered the phone. LPN #1 donned a pair of gloves without performing any type of hand hygiene. LPN #1 opened the tube feeding bag packaging and the tube feeding was added to the bag. The tube feeding bag was then placed on the pump. LPN #1 donned gloves and did not perform hand hygiene. LPN #1 administered medication and hooked the tube feeding up to Patient #5’s gastrostomy tube. LPN #1 removed her gloves and cleaned up her workspace without performing hand hygiene. LPN #1 removed a bottle from a bag and took a drink, without performing hand hygiene. LPN #1 placed a spacer on an inhaler, did not perform hand hygiene, donned gloves and administered the inhaler to the patient.”

“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 policy review, medical record review, observation and interview, the agency failed to ensure medications were accurately documented in the medical record for 2 of 7 (Patient #1 and #2) sampled patients observed during home visits. The findings included: 1. Review of the agency policy dated January 2026, “MEDICATION ADMINISTRATION” revealed, “...The clinician assesses the medication regime for duplications and discontinued medications…The clinician routinely reassesses medication regime…to ensure the ordered medication regime is followed…A medication profile, completed for each client at the time of admission, will be updated as indicated and reviewed at least every 60 days...” 2. Medical record review for Patient #1 revealed a Start of Care (SOC) date of 03/18/2026, with diagnoses which included hemiplegia and hemiparesis following CVA affecting right dominant side and weakness. Observations in Patient #1’s home on 07/13/2026 at 11:00 AM, revealed the following medications were not included on the Patient’s medication profile: a. Furosemide (diuretic) 20mg (milligrams) by mouth daily. Medication was filled on 01/24/2026. b. Linzess 145mcg (micrograms) by mouth daily for constipation. c. Trelegy 200mcg.6025mcg/25mcg I puff inhaled daily for COPD (chronic obstructive pulmonary disease). Observations in Patient #1’s home on 07/13/2026 at 11:00 AM, revealed the following medications were included on the Patient’s medication profile but not found in the home: a. fexofenadine (antihistamine) 180mg by mouth daily. b. mometasone furoate(corticosteroid) 0.1% external daily. c. Breo Ellipta (for COPD) 100-25mcg/inhalation puff by mouth daily. d. albuterol sulfate(bronchodilator) 108 mcg 2 puffs by mouth PRN(as needed). 3. Medical record review for Patient #2 revealed a Start of Care (SOC) date of 01/05/2026, with diagnoses which included hemiparesis affecting right side as late effect of CVA (cerebrovascular accident) [stroke] and vascular dementia. Observations in Patient #2’s home on 07/13/2026 at 12:05 PM, revealed the following medications were not included on the Patient’s medication profile: a. furosemide 40mg by mouth in the morning. b. amiodarone 200mg by mouth daily for heart arrhythmia. Medication was filled on 06/08/2026. c. Albuterol (2.5/3 ml (milliliter) 1 vial nebulized PRN (as needed). Observations in Patient #2’s home on 07/13/2026 at 12:05 PM, revealed the following medications were included on the Patient’s medication profile but not found in the home: a. doxycycline monohydrate (antibiotic) 100 mg by mouth daily. b. levofloxacin (antibiotic) 500 mg by mouth daily. c. rosuvastatin calcium (cholesterol medication) 10mg by mouth daily. Observations in Patient #2’s home on 07/13/2026 at 12:05 PM, revealed the following medications dosages did not match what was listed on the medication profile: a. Amlodipine (blood pressure medication) 10mg by mouth daily. b. Duloxetine (antidepressant) 60mg by mouth in the morning. During an interview on 07/13/2026 at 12:44 PM, the OT (Occupational Therapist) stated medications should be checked more often, and she forgets to check medications when a nurse is not ordered to see the patient. During a phone interview on 07/13/2026 at 1:42 PM, patient #2’s daughter stated her mother no longer took doxycycline monohydrate (antibiotic) 100mg (milligrams) by mouth daily, rosuvastatin calcium (cholesterol medication) 10 mg by mouth daily, or levofloxacin (antibiotic) 500 mg by mouth daily. She stated her mother currently took duloxetine hydrochloride 60 mg by mouth daily, amlodipine 10mg by mouth daily, furosemide 40 mg by mouth daily as needed, and amiodarone 200 mg by mouth daily. During an interview on 07/13/2026 at 3:34 PM, the DON (Director of Nursing) stated the medications should be reviewed at each home visit. If there is only Physical Therapy and Occupational Therapy ordered for the patient, those disciplines should be reviewing medications at every visit and reporting any concerns to the office for follow up.”