All County Home Health and Hospice

“Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA’s quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This Standard is not met as evidenced by: Based on observation, interview, and record review, the agency failed to enforce written policies to control infections including how to keep infections and communicable diseases from spreading for two of four clients (Client #’s 2 and 3) observed during care. LVN A failed to perform and maintain aseptic technique (used to prevent the spread of germs and cause infection) while doing wound care on Client #2’s right fifth toe. LVN A failed to perform and maintain aseptic technique while doing wound care on Client #3’s right leg. This deficient practice placed Client #2 and Client #3 at risk for infection, delay in healing, and the spread of infections. The findings include: Record review of the agency’s policy titled “Risk Management: Infection and Safety Control” with a revision date of July 2023, revealed in part ...”5…reusable equipment will be cleaned…and equipment and supplies will be returned to the bag.” Record review of Client #2’s clinical record revealed a Plan of Care (POC) with a Start of Care (SOC) date of 11/16/2024 for a certification period from 11/16/2024 through 01/14/2025 with a diagnosis of Encounter for Orthopedic Aftercare following Surgical Amputation (a procedure to remove a limb or other body part, such as a finger, toe, hand, foot, arm, or leg). Further review revealed a section titled “Safety Measures” included “Infection control, Standard Precautions.” (a set of infection control practices designed to prevent the transmission of infections) In addition, under the “Orders of Discipline and Treatments” Skilled nurse to perform/teach wound care…” Record review of LVN A’s personnel record revealed she was in serviced on infection control on 06/24/2024. Observation on 12/17/2024 at 11:30 a.m. during a home visit revealed LVN A provided wound care to Clientt #2. During the care, LVN A failed to change contaminated barrier before continuing with wound care to Client #2’s right fifth toe. The wound cleanser bottle had fallen to the floor and the patient picked up the bottle of wound cleanser and placed it on the barrier where LVN A had the patient’s clean wound care supplies. LVN A also cleansed her equipment (blood pressure cuff, stethoscope and pulse oximeter) following Client #2’s assessment and placed said equipment back on the contaminated barrier to air dry. LVN A failed to switch the contaminated barrier after removing patient’s soiled dressing before proceeding with wound care. Therefore, Client # 2’s freshly dressed wound to right fifth toe amputation was resting on soiled bandages. Record review of Client #3’s clinical record revealed a Plan of Care (POC) with a Start of Care (SOC) date of 12/03/2024 for a certification period from 12/03/2024 through 01/31/2025 with a diagnosis of Encounter for Orthopedic Aftercare following Surgical Amputation, Acquired Absence of Right leg below knee, Type 2 Diabetes Mellitus with Diabetic Neuropathy (a type of nerve damage that can occur with Diabetes). Further review of Client #3’s clinical record revealed a Physician’s Order dated 12/13/2024 with a section titled “Order Description” which included Skilled Nurse (SN) 2wk3 (two visits a week for three weeks) for dressing change to right below the knee…” Observation on 12/17/2024 at 1:09 p.m. during a home visit, LVN A failed to switch the contaminated barrier after removing patient’s soiled dressing before proceeding with wound care for Client #3. LVN A placed clean gauze for Client #3’s wound care for right leg below the knee amputation right next to soiled bandages on the same contaminated barrier. LVN A also cleansed her equipment (blood pressure cuff, stethoscope and pulse oximeter) following client #3’s assessment and placed said equipment back on the contaminated barrier to air dry. During an interview on 12/17/2024 at 4:58 p.m. with LVN A following wound care, she stated she was new to home health and acknowledged she needed to be more mindful of when to change her gloves and barriers for both Client #2 and Client #3 and acknowledged that she failed to do so. During an interview on 12/19/2024 at 11:40 a.m. with the acting Director of Clinical Services she stated, “nurses are trained on bag technique (a practice where healthcare professionals manage their medical supplies/bag during home visits to prevent cross-contamination and spread of infection while providing patient care)) and infection control. I’m going to be honest with you, the previous DON is gone for reason.” She further stated LVN A was new, and the issue would be addressed with further training.”