First Choice Home Health Services, LLC

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on staff (EMP) interview and document review, it was determined the agency failed to ensure each patient received services as written in the plan of care in one (1) of eleven (11) medical records (MR) reviewed in the survey sample. MR1. Findings: MR1 was admitted to home health services following a knee replacement on June 11, 2025. MR1’s plan of care contained physician orders for physical therapy to evaluate the patient. MR1 contained documentation that the physical therapist’s first attempt to contact the patient was on June 16, 2025, and a visit was not made due to a scheduling conflict. The physical therapist did not attempt another visit until June 24, 2025, (thirteen days after MR1’s start of care) and a visit was not made again due to a scheduling conflict. The patient was discharged from the agency on June 25, 2025, without a physical therapist ever evaluating the patient. An interview was conducted with EMP1 on September 4, 2025, at approximately 11:00 AM, who indicated MR1, and the physical therapist initially had a scheduling conflict, but later MR1 requested outpatient therapy instead of home health therapy. EMP1 confirmed no physical therapy visit was ever made to MR1 despite the physician’s order for a physical therapy evaluation. The agency’s policy, “Plan of Care - CMS 485 and Physician/Practitioners Orders” (last revised February 2025) was reviewed and reads in part, “...Each patient must receive the home health services that are written in an individualized plan of care...””

“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 staff (EMP) interview, medical record review (MR), observation, and document review, it was determined the agency failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. Specifically, agency staff failed to clean and disinfect a pulse oximeter according to the manufacturer’s instructions for use (IFU) in two (2) of four (4) home visits conducted (MR7 and MR11); failed to perform hand hygiene at appropriate times during wound care in one (1) of two (2) wound care observations observed (EMP7); failed to maintain supplies in a manner that prevented contamination in one (1) of two (2) wound care observations observed (EMP7); failed to properly dispose of soiled dressings in one (1) of two (2) wound care observations (EMP9); and failed to ensure each staff member had required competencies related to wound care techniques to include infection control precautions in one (1) of two (2) nursing staff observed providing wound care (EMP7). Findings: A home visit was conducted with EMP7 and MR11 on September 03, 2025, at 3:00 PM. EMP7 was observed wiping a shared pulse oximeter after use with bleach wipes. EMP7 removed a dressing from MR11’s right foot. Without changing gloves or performing hand hygiene, EMP7 went to the patient’s closet to retrieve additional supplies. EMP7 retrieved a bin of clean supplies, touched multiple clean packages of dressing supplies with soiled gloves, and removed gauze pads from the bin. EMP7 then continued to perform wound care to MR11’s foot wound without performing hand hygiene or changing gloves. The surveyor requested wound care competencies for EMP7 on September 4, 2025. EMP1 indicated on September 4, 2025, at approximately 12:00 PM that the agency was unable to locate any documented competencies for wound care for EMP7. EMP1 indicated EMP7 should have competencies but believes they have been misplaced. A home visit was conducted with EMP9 and MR7 on September 4, 2025, at 4:00 PM. EMP9 wiped the pulse oximeter with bleach wipes for several seconds before and after use on MR7. EMP9 performed wound care to MR7’s lower back wound and disposed of soiled dressings in a red bag labeled as a biohazard. EMP9 then disposed of the red biohazard bag in MR7’s household trash. An interview was conducted with EMP2 on September 4, 2025, at approximately 12:30 PM. EMP2 indicated that soiled dressings should be placed in bags and then in the patient’s household trash. EMP2 confirmed that red biohazard bags should not be placed in household trash. EMP2 indicated that agency staff have bleach wipes to clean and disinfect all equipment. EMP2 confirmed pulse oximeters, blood pressure cuffs, stethoscopes, and thermometers are shared between patients and should be cleaned with bleach wipes after each patient use. An interview was conducted with EMP8 on September 4, 2025, at 10:30 AM. EMP8 indicated that supplies such as pulse oximeter and thermometer were shared between patients and cleaned with bleach after each patient use. EMP8 indicated that red biohazard bags are not typically used and should not be placed in the patient’s household trash. An interview was conducted with EMP6 at 10:59 on September 4, 2025. EMP6 confirmed shared supplies are cleaned with agency provided bleach wipes between patient use. EMP6 indicated that it is not necessary to use biohazard bags for wound dressing unless saturated with body fluids, and these bags are not placed in household trash. The IFU for the Medline Soft-Touch Finger Pulse Oximeter was provided by the agency for surveyor review. The document reads in part, “...Cleaning the fingertip pulse oximeter. Please use medical alcohol to clean the silicone that touches the finger inside of the oximeter with a soft cloth dampened with 70% isopropyl alcohol...Disinfecting. The applied parts touching the patient’s body are required to be disinfected once after each use. The recommended disinfectants include ethanol 70%, isopropanol 70%, glutaraldehyde-type 2% liquid disinfectants...” The IFU does not indicate that bleach is an appropriate disinfectant for the device. The agency’s policy, “Exposure Control Plan: OSHA Regulations” (last revised February 2025) was reviewed and reads in part, “...Disposal of Infectious Waste...Materials without the risk of puncturing, e.g. gauze dressings, catheters, tubing, gloves, etc., will be placed in leak-proof plastic bags, then securely fastened and disposed of in the patient’s household trash...Employees will receive education and training during orientation and at least annually...hand hygiene...procedures requiring special techniques - dressing changes, wound or decubitus care...” The agency’s policy, “Hand Hygiene Policy and Compliance Program” (last revised February 2025) was reviewed and reads in part, “...Indications for staff performing hand hygiene are:...After contact with contaminated materials; before re-entering nursing bag or patient’s clean supplies...after contact with blood, body fluids, mucous membranes, non-intact skin, and wound dressings; after contact with inanimate objects or medical equipment close to patient...” The agency’s policy, “Staff Competency Program” (last revised February 2024) was reviewed and reads in part, “...Patient care staff will be competency assessed at defined intervals: For each new employee (including contract employees) during orientation, at least every three years for all patient care staff...THe competency evaluation checklist will be completed and retained in the employee’s record....””