Apicon Home Health Agency Inc.

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on record review and interview, the Agency failed to encode and electronically transmit each completed OASIS assessment to the CMS system within 30 days of completing the assessment of the patient for 28 of 736 assessments processed for the time-period reviewed of 04/06/2024 to 04/06/2025. This failure resulted in quality data used to continuously improve the effectiveness of home healthcare and improve patient care failing to be reported to CMS in the required time frame. Findings included: Review of the HHA Error Summary Report for the time period of 04/06/2024 to 04/06/2024 identified Error #-3330. The description for Error #-3300 read in part, “Record Submitted Late: The submission date was more than 30 days after M0090 (item M0090 specifies the date the actual assessment was completed) on this new record.” The documentation further identified the number of assessments with this error was 28 assessments and the percentage of assessments with this error was 3.80% of assessments completed by the Agency. In an interview completed with the Administrator on 04/09/2025 at 2:03 PM, the surveyor showed Administrator the “Home Health Error Summary” report which indicated that 28 OASIS assessments were late by the agency. The Surveyor asked the Administrator why assessments were submitted late to OASIS. Administrator reported the she is the person who is responsible for submitting assessments to OASIS and she usually submits assessments at least twice a month to ensure the submission is within the 30 day deadline. The Administrator normally clicks a button labelled “mark as exported” so that she knows they are complete, but on one incident she did not click that button, causing for some of the assessments to be delayed. When asked how this impacted client care, the Administrator responded that she does not believe that it does, all clients still received the services that were ordered per their treatment plan. Review of the Agency’s policy titled “Timelines,” dated 10/25/2024, revealed that “(All completed and encoded OASIS data) will be transmitted using electronic communications software […] within 30 days of the M0090 date.””

“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, record review, and interview, the Agency failed to enforce written policies to address infection control and prevent the spread of infectious and communicable disease for 3 of 7 clients (Client #2, 3 and 4). This failure placed clients at risk of acquiring infections and diseases. Findings included: Review of policy titled “Bag Technique,” dated 05/01/24, revealed “in the patient/client home, a barrier (such as newspaper, paper towel, small trash bag, etc.) is to be placed under the bag. Bags should never be placed on the floor.” The policy then read “when the visit is completed, reusable equipment is cleaned using alcohol, disinfectant wipe, and/or soap and water on a cleaned surface […], and clean equipment and supplies are returned to the bag.” On 04/08/2025 at 11:00 AM, Surveyor A observed LVN A place newspaper barrier between her equipment bag and the floor prior to placing equipment bag on the floor. LVN A used her stethoscope, blood pressure cuff, and pulse oximeter on Client 2 and returned the items to the equipment to the bag without disinfecting the equipment. On 04/08/2025 at 12:30 PM, Surveyor A observed LVN A use her blood pressure cuff and pulse oximeter on Client 4 and then she returned the items to the equipment bag without disinfecting them. On 04/08/2025 at 2:05 PM, Surveyor B entered the home of Client 3 for a home visit. LVN B had already entered the home of Client 3 prior to Surveyor B’s arrival. Surveyor B observed that LVN B’s equipment bag was placed on a barrier on the floor. Surveyor B observed that LVN B removed stethoscope and blood pressure cuff from bag. LVN B listened to Client 3 and then took Client 3’s blood pressure. After taking blood pressure, LVN B left stethoscope on his neck, and blood pressure cuff was placed on Client 3’s bed. LVN B removed thermometer from bag and took Client 3’s temperature. After taking temperature, LVN B placed thermometer on Client B’s bedside table. In an interview with LVN A on 04/09/2025 at 11:00 AM, Surveyor A asked about the agency’s bag policy and infection control. LVN A reported that she was instructed during orientation that they should not place equipment on a patient’s couch or coffee table, and that if she needed to place it on the floor then she had to use a barrier. Surveyor described HHA policy which indicated that the bag should never be placed on the floor. LVN A reported that she did not know that. Surveyor A asked how often LVN A sanitizes items such as the pulse oximeter, stethoscope, or blood pressure cuff. LVN A responded that she should sanitize items after using them on a patient with alcohol wipes or sanitizer and prior to placing them back into the equipment bag. Surveyor A asked LVN A why she did not disinfect the pulse oximeter, stethoscope or blood pressure cuff prior to returning the items to the bag and after patient use during the home visits with Client 2 and Client 4. LVN A reported that she did not have alcohol wipes and that the sanitizer she was carrying could not be used on the equipment she was using. Surveyor A asked LVN A how this impacted patient care. LVN A responded that it is important to clean equipment in between patient use to ensure there is not cross-contamination between patient. In an interview with LVN B on 04/09/2025 at 11:21 AM, Surveyor B asked LVN B what the HHA’s policy was regarding bag technique. LVN B stated it was to set the bag down on a barrier, and wash hands and then you can pull everything out, and place on another barrier. He stated you should not reach back into bag until your hands have been sanitized. Surveyor asked LVN B if he was familiar with the surfaces the bag was allowed to be placed on. LVN B said he was not sure what the policy said but most likely it should be a table or chair. Surveyor told LVN B the policy states to not put the bag on the floor, even with a barrier. LVN B said that “makes sense” but that we were limited on space in the patient’s bedroom. He stated that generally if he has another place to put the bag, he will use that over the floor. Surveyor asked LVN B how having the bag on the floor could impact patient care. LVN B said, “Yeah, it’s a sanitary thing - all boils down to it being clean and keeping patients safe.” In an interview with the Administrator/SN on 04/09/2025 at 2:03PM Surveyor A asked about the agency bag technique and described the observations made during the home visits with Client 2 and Client 4, where LVN A placed her equipment bag on the floor of the home with Client 2 and did not sanitize equipment after patient use and prior to returning it to her equipment bag. The Administrator/SN reported that the barrier and bag for Client 2 should have been placed on the table, chair, or bed. The Administrator/SN reported that she tells them to always use a barrier and acceptable surface include chair, bed, or table, but not on the floor. The Administrator/SN reported that items should be cleaned after patient use prior to putting them back into the bag. Surveyor B described the home where she also observed LVN B him place the equipment bag on the floor. The Administrator/SN responded that that should not have occurred and another surface should have been used. Surveyor A asked how this could impact patient care. The Administrator/SN responded that it could contribute to transmitting a infection from one patient to another.”