Americare Nursing Services, P.L.L.C.

“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 record review, observation, and interview the agency failed to enforce its written policy addressing infection control including the prevention of the spread of infectious and communicable disease for 2 of 5 active Patients (Patient #1 and Patient #2) reviewed for infection control in that: LVN A {Licensed Vocational Nurse} failed to follow proper procedures while conducting a home visit with patient #1 and patient #2: 1.) missed opportunities to sanitize hands between glove changes. This deficient practice could place Patients at risk for increased wound infections, and further deterioration of the Patient’s wounds. The findings included: Record review of [Agency Name] Administrative Policy Manual titled “IC.10 Infection Control Program” with a revision date of 04/14/23, quoted in part…Purpose: “Policy: The agency and staff will follow accepted standards of practice…including standard precautions, to prevent the transmission of infections and communicable diseases…3. Other policies to be followed by staff to prevent, control, and improve infections include Hand Hygiene… V. Education…A. Employees… 1. Upon hire and annually thereafter, all Agency employees will be educated regarding the policies and procedures related to: … a. Infection control… c. Bloodborne/ Airborne/HIV Pathogen Program… e. Patient/client care procedures for preventing and/or controlling infections… f. Standard precautions…B. Patient/Clients and Caregivers…2. Education regarding precautions to protect immune-compromised patients/clients for employees, patients/clients and others in the home will include, but not limited to: … a. personal protective equipment (PPE)… b. Hand Hygiene…” Record review of [Agency Name] Administrative Policy Manual titled “IC.15 Hand Hygiene” with a revision date of 04/14/23, quoted in part… “Purpose…To ensure patient care staff practice proper hand hygiene techniques… Definitions… I. Alcohol-base hand rub- an alcohol-containing preparation…Such preparations usually contain 60%--95% ethanol or isopropanol… VIII. Hand hygiene… Policy…All Agency Staff providing care will observe proper hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendations… D. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Staff may use an alcohol-based hand rub for routine decontaminating hands in the clinical situations described below:4. After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings and used supplies (PPE) {Personal Protective Equipment} if hands are not visibly soiled … 5. Before moving from a contaminated-body site to a clean body site during patient care…. 6. After touching a patient/client or the patient’s/client’s immediate environment… 7. After contact with blood, body fluids, or contaminated surfaces…8. After removing gloves…” Record review of [Agency Name] Administrative Policy Manual titled “PC.10 Standards of Practice” with a revision date of 01/13/18, quoted in part, “Purpose: To provided patient care within acceptable standards of practice by Agency staff…Procedure… I. The Agency will have the state professional practice acts and all agency policies and procedures available for staff… II. The Agency will provide ongoing educational opportunities and updates for agency staff by means of verbal and/or written communication… III. Patient/client care staff will adhere to the respective state professional practice acts, and to agency policies and procedures during patient/client visits…” Review of Patient #1 “Home Health certification and plan of care” documented a 65-year-old female with primary diagnosis of pressure ulcer (localized damage to the skin and/or underlying tissue, typically over bony prominences, caused by prolonged pressure) of sacral region (the area at the base of the spine, specifically where the sacrum is located), pressure ulcer to left heel unstageable, pressure ulcer to right heel stage 2, and other diagnoses of Type 2 Diabetes mellitus(a chronic condition where the body does not use insulin effectively or does not produce enough insulin to regulate blood sugar levels), Encounter for fitting and adjusting of urinary device, Depression (persistent low mood, loss of interest or pleasure in activities). The form also documented a start of care as 05/02/25 and a “current episode” or certification period as 05/02/2025-06/30/2025 with skilled nurse visits for once a day for 60 days, and 3 as needed visits for wound complications, lose soiled dressing, skin breakdown, falls, injuries, pain >5/10, abnormal vitals, foley (a thin, flexible tube inserted into the bladder to drain urine, often used for extended periods) complications. Safety Measures: Standard precautions/Infection Control. Further review of “Home Health Certification and Plan of Care” Orders and treatment quoted in part… 13. Using aseptic technique and sterile supplies; skilled nurse to perform wound care to stage 2 pressure ulcer to right heel as follows: cleanse with normal saline (also known as 0.9% saline, is a sterile solution of sodium chloride (salt) dissolved in water. It is one of the most widely used intravenous (IV) solutions in healthcare settings) using gauze, pat dry with gauze, apply Silvadene (is an antibiotic. It works by killing the bacteria or preventing its growth. It is used to prevent and treat wound infections) cream with CTA (cotton tipped applicator), cover with gauze, and secure with tape. May wrap with kerlix (gauze made of prewashed, fluff-dried 100% woven gauze with unique crinkle-weave pattern for loft and bulk to cushion and protect wound areas) if needed. Dressing changes to be performed daily. Skilled nurse may discontinue wound care when wound has healed with Medical Doctor approval… 14. Using aseptic technique and sterile supplies; Skilled nurse to perform wound care to unstageable pressure ulcer to left heel as follows: cleanse with normal saline using gauze, pat dry with gauze, apply Santyl (an FDA (U.S. Food and Drug Administration)-approved prescription ointment primarily used to help remove dead tissue from wounds, specifically chronic skin ulcers and to promote healing.) with CTA (cotton tipped applicator, cover with gauze, and secure with tape. May wrap with kerlix (gauze made of prewashed, fluff-dried 100% woven gauze with unique crinkle-weave pattern for loft and bulk to cushion and protect wound areas) if needed. Dressing changes to be performed daily. Skilled nurse may discontinue wound care when wound has healed with Medical Doctor approval. Review of Patient #2 “Home Health certification and plan of care” documented a 50-year-old female with primary diagnosis of Infection following a procedure, organ and space surgical site. The form also documented a start of care as 05/02/25 and a “current episode” or certification period as 04/25/2025-06/23/2025 with skilled nurse visits for once a day for 60 days, and 3 as needed visits for wound complications, lose soiled dressing, skin breakdown, falls, injuries, pain >5/10, abnormal vitals. Safety Measures: Standard precautions/Infection Control. Further review of “Home Health Certification and Plan of Care” Orders and treatment quoted in part… 9. Using aseptic technique and sterile supplies; skilled nurse to perform wound care to lower abdomen: cleanse with normal saline using gauze, pat dry with gauze, pack with wet to dry gauze moistened with Normal Saline, cover with gauze, then cover with ABD pad (a medical device used to absorb fluids from wounds, particularly abdominal wounds, and to protect them), and secure with tape. Dressing changes to be performed daily. Skilled nurse may discontinue wound care when wound has healed with Medical Doctor approval… An observation was made of LVN A performing wound care to Left heel for Patient #1 on 05/29/25 at 08:00 a.m. Surveyor arrived at Patient #1’s home at 08:00 a.m. LVNA was observed to perform hand washing as per policy. Brief introductions were made, and consent for home visit was signed by Patient #1. LVN A and Surveyor proceeded into Patient #1’s living room. Patient #1 observed to be sitting comfortably in bed with legs elevated in footrest with a blue pad (moisture absorbent pad used for incontinent individuals). LVNA sanitized hands, donned (put on) new gloves, removed soiled dressing to Left heel and placed dirty dressing into trash bag. LVN A then removed dirty gloves and grabbed a new pair of clean gloves without sanitizing in between. LVN A then proceeded to apply Silvadene (an antibiotic ointment. It works by killing the bacteria or preventing its growth. It is used to prevent and treat wound infections) cream with CTA (cotton tipped applicator). LVN A proceeded to remove gloves, grabbed a new pair of clean gloves but failed to sanitize hands again. LVN A covered wound with gauze, wrapped foot with kerlix, removed gloves, grabbed new pair of clean gloves, again failed to sanitize hands between glove change, and secured kerlix with tape. An observation was made of LVN A performing wound care to lower abdomen for Patient #2 on 05/29/25 at 10:00 a.m. Surveyor arrived at Patient #2’s home at 10:00 a.m. LVNA was observed to perform hand washing as per policy. Brief introductions were made, and consent for home visit was signed by Patient #2. LVN A and Surveyor proceeded into Patient #2’s spare bedroom. Patient #2 observed to be lying supine (resting on one’s back with the face and body facing upward) comfortably in bed with legs extended with a blue pad (moisture absorbent pad used for incontinent individuals) placed under Patient #2’s lower back. LVN A sanitized hands, donned (puts on) new gloves, removed soiled dressing to Lower abdomen and placed dirty dressing and gloves into trash bag. LVN A was discarding gauze packaging in trash bag when surveyor observed nurse grab the trash bag with bare right hand, LVN A then sanitized hands prior to putting on new pair of clean gloves. LVN A removed soiled gauze and Abdominal pad (Abd pad) with care to not hurt Patient #2. Patient #2 had minimal pain/discomfort when this was removed. LVN A disposed of soiled gauze/Abd pad in trash bag, LVN A touched the trash bag with right hand, did not sanitize after doing so, then grabbed a pair of clean gloves and put them on to continue wound care. LVN A proceeded to cleanse wound with Normal Saline (NS) soaked gauze as per order. LVN A then took off gloves and put on a new pair of clean gloves without sanitizing between change. LVN A cleansed wound with another NS (Normal Saline)-soaked gauze and removed gloves. LVN A then grabbed a new pair of clean gloves and put them on without sanitizing between the change. LVN A then pat dried inside abdominal wound with gauze, disposed of gloves, did not sanitize hands again and put on new pair of clean gloves. LVN A packed wound as per order and disposed of gloves, touched trash bag again, did not sanitize hands prior to putting new pair of clean gloves. LVN A then grabbed scissors, sanitized scissors prior to cutting Abd pad that would go to pt’s abdominal wound, LVN A then disposed of gloves, put on new pair of clean gloves without sanitizing between change. LVN A covered abdominal wound with Abd pad and secured with tape. In an interview on 05/30/25 at 09:30 a.m., with LVN A, surveyor presented the above findings during home visits for Patient #1 and Patient #2 which included the following: 1.) missed opportunity for sanitizing hands after left glove change, and 2.) Touching contaminated surface and not sanitize after. LVN A agreed to these infection control findings concerning the transmission of diseases. LVN A confirmed employees are to use infection control precautions at every home visit. LVN A further confirmed LVN A was trained upon hire and yearly for standard and infection control precautions by the agency. Surveyor asked LVN A why infection control policy was not followed during wound care “I’m not sure, the only thing I can think of I put sanitizer away from, well there is really. I’m not sure why I failed to do that at the time, I was nervous, everyone is scared of State”. Surveyor asked LVN A what negative outcome could happen to a wound if proper infection control technique is not utilized, LVN A answered, “The patient can become septic (a serious, life-threatening condition that occurs when the body’s response to an infection damages its own tissues and organs), the patient can be hospitalized, it could become a severe infection.” Further interview with Alt Adm/DON on 05/15/25 at 11:00 a.m., the surveyor presented the findings of infection control for home visits with Patient #1 and Patient #2. Alt Adm/DON confirmed the agency provided trainings to their nurses for standard and infection control precautions upon hire and annually. Alt Adm/DON confirmed the agency’s infection control policy should be used at every home visit and agreed that the findings were an infection control issue concerning transmission of diseases. Surveyor asked considering the Patient’s age, diagnosis, comorbidities (medical conditions that you have in addition to a primary diagnosis. You may have one or more comorbidities. Morbidity is a medical term that refers to the state of having a specific disease or condition. So, adding “co” in front of this word means two or more conditions occur together) and wounds how can these infection control findings concerning transmission of disease affect the agency Patients. Alt Adm/DON stated, “well a lot of these patients have a lot of conditions and if you go in there and introduce infection that could send these patients into sepsis (a serious, life-threatening condition that occurs when the body’s response to an infection damages its own tissues and organs) and hospitalizations and what not.” The agency did not dispute the surveyor’s findings. The agency was afforded the opportunity to provide additional information. No additional information was presented to this surveyor upon exit on 06/02/25.”