Select Care Home Health, Inc.

“Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This Element is not met as evidenced by: Based on observation, record review and interview, the agency failed to provide patient education for 1 of 7 patients (#6) whose records were reviewed in that: RN A did not instruct Patient #6 and /or caregiver on signs and symptoms of UTI / disease process / Infection Control as ordered on the POC. This failure could place the patients at risk of receiving inadequate care concerning diagnoses, treatments and procedures which could place the patients at risk of negative outcomes. The Findings Included: Record review of active Patient #6’s electronic clinical record (ECR) included a form titled “Home Health Certification and Plan of Care” (POC) for the period of 10/09/24-12/07/24 that revealed a SOC date of 06/17/23 with the following diagnoses: hypertensive chronic kidney disease stage 5(a severe stage of kidney disease that occurs when the kidneys are severely damaged and have stopped filtering waste from the blood), type 2 diabetes mellitus w diabetic chronic kidney disease (a type of kidney disease caused by diabetes), anemia in chronic kidney disease (a common complication in chronic kidney disease (CKD), and is associated with a reduced quality of life, and an increased morbidity and mortality), dependence on renal dialysis (a treatment that removes waste and excess fluids from the blood when the kidneys are no longer able to perform this function), flaccid neuropathic bladder (lack of bladder control because of a nerve problem such as a stroke, spinal cord injury, or tumor), retention of urine (a condition that occurs when a person is unable to completely empty their bladder), hydronephrosis encounter for attention to cystostomy (a surgical procedure that creates an opening in the bladder to drain urine). Review of the POC showed the skilled nurse (SN) visit frequency of once a week for nine weeks. The Orders for treatment included the SN to assess genitourinary status, identify any signs and symptoms of impaired genitourinary function. SN to instruct patient on disease process, including who to contact if signs and symptoms persist or worsen as well as dietary, hydration measures and medication management where indicated. Medical Necessity: Patient requires skilled intervention and teaching for intermittent urinary catheterization due to Neurogenic bladder/ retention of urine. Record review of a ECR titled Home Health End-of-Episode Summary dated 10/06/24 revealed: Reason for Admission to Home Health/Continued Services: Patient requires skilled intervention and teaching for intermittent urinary catheterization due to Neurogenic bladder/ retention of urine. Nursing: SN to assess genitourinary status, identify any signs and symptoms of impaired genitourinary function. SN to instruct patient on disease process, including who to contact if signs and symptoms persist or worsen as well as dietary, hydration measures and medication management where indicated. Patient has been assessed to be at high risk for infection as evidenced by history of sepsis and frequent UTI. SN to instruct on infection control precautions such as hand hygiene, personal protection equipment (PPE), waste disposal, environmental sanitation and signs and symptoms of infection to report. SN to instruct patient/caregiver regarding self-management and prevention of Urinary Tract Infection. SN to assess for signs and symptoms of genitourinary infection and instruct patient/caregiver regarding care of the genitourinary system including care of cystostomy, appropriate equipment use, appropriate perineal hygiene, dietary and fluid needs. Patient #6’s ECR revealed in part... Two SN visit notes signed by RN A, dated 10/29/24 and 11/05/24. Review of the SN visit notes failed to contain documentation that RN A instructed Patient #6 and/or caregiver on the self-management and prevention of Urinary Tract Infection (occurs when bacteria get into your urine and travels up to your bladder). During the home visit on 11/13/24 surveyor observed Patient # 6 sitting on a sofa chair, feet on the floor with her walker device (a device that gives support to maintain balance or stability while walking) positioned in front of her on the floor. The walker device had a urine drainage bag hanging on a bar located on the upper left side of the walker with a long plastic tube stretched over a left sided hand grip. The plastic tubing was positioned above the level of patient # 6’s bladder while she was sitting on the sofa chair (placing the urine drainage bag and tubing above the bladder level would cause the urine not to drain properly, which could backflow into the bladder and cause an infection). RN A was observed checking Patient #6’s vital signs while she was sitting on the sofa. RN A failed to educate the patient on the required position of the urinary catheter tubing, the disease process of Urinary Tract Infection or infection control preventions. During the home visit interview on 11/13/24 at 10:15 am Patient #6 stated she got her cystostomy procedure (a surgical procedure that creates an opening in the bladder to drain urine) about a year ago because she had a severe UTI that developed into sepsis (a life-threatening condition that occurs when the body’s immune system overreacts to an infection, damaging organs, and tissues). Patient # 6 stated she was told the cystostomy would be something she had to deal with for the rest of her life. Patient # 6 stated it made her sad, but she had to try and deal with it. The surveyor asked Patient # 6 if she received any training and education regarding her urine drainage bag and tubing position. Patient # 6 stated, “it might have been done at my doctor’s office.” Interview on 11/13/24 at 10:28 am with RN A, when asked why she did not provide any education with patient #6, RN A stated she forgot to provide teaching and education when she saw the plastic tubing connected to the urine drainage bag positioned above the level of Patient # 6’s bladder during the scheduled home visit with the surveyor. RN A stated she was responsible for following the POC to educate on infection control prevention because Patient # 6 had a history of UTI that developed into sepsis. RN A stated the risk of not providing teaching and education on keeping the urine bag lower than the bladder would cause the urine not to drain properly, which could backflow into the bladder and cause Patient # 6 to get an infection. RN A left the home without moving the urinary drainage bag from the walker or provide education to patient #6 on infection control precautions. During an interview on 11/13/24 at 1:28 pm with the DON, the surveyor showed the DON a picture of the position of the plastic tubing connected to the urine drainage bag hanging on Patient #6’s walker. The DON stated, “oh my that’s bad because I can see the evidence, the urine drainage bag tubing should never be placed in a position above the bladder.” The DON stated the SN was responsible for following the POC and providing teaching and education on every visit to the patient /or caregiver to prevent infection caused by the placement of the urine drainage bag and tubing. The DON stated the risk of not following agency policy is that Patient # 6 could have backflow from urine that could cause an infection. During further interview, the surveyor asks how the DON ensure that the order was implemented and executed as written. The DON stated the agency follows 60-day protocol of evaluation and updates as needed. During an interview on 11/15/24 at 12:22pm the Adm stated he was informed about the home visit observation with the surveyor and RN A regarding the urine drainage bag and tubing. The Adm stated all staff had to follow agency policies regarding patient care. Review of the Agency’s policy and procedure manual revealed a policy titled “Patient Care Site and Patient safety Education”, it was numbered PF.5 and had a revision date of 04/01/08. It read in part: “Purpose: To ensure the identification of patient/caregiver education needs and the provision of appropriate educational information. Policy: Agency will provide the needed education in response to specific identified needs in the following areas: infection control, 6. The home environment will be re-evaluated for safety issues/hazards on an ongoing basis ...” Review of the Agency’s policy and procedure manual revealed a policy titled “Plan of Care”, it was numbered PC.8 and had a revision date of 01/13/18. It read in part: “Purpose: To ensure that care provided is appropriately planned in a timely manner to meet the patients/client’s specific needs and problems. Policy: The agency will use data/information gathered during patient/client assessments in the care planning process which involves the identification of patient/client goals, actions or interventions that will resolve or alleviate the patients/client’s problems and/or needs. III. The individualized plan of care must also specify the patient/client and caregiver education and training.”