Rock Springs Young at Heart

“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, staff interview, and cleaning product review, the agency failed to ensure the correct cleaning product was used to ensure clean equipment. The findings were: Observation on 8/13/24 at 9:15 AM showed Certified Nursing Assistant (CNA) #1 was finishing his/her home visit. The CNA opened a circular container labeled Purell and wiped his/her blood pressure cuff, thermometer, pulse ox, and stethoscope down observing the wet time. Further, observation showed the Purell product was a hand sanitizer not meant for disinfecting equipment. Interview at that time with the CNA revealed that the container was what the agency provided him/her to clean the equipment and that was all s/he had with him/her. Interview with the Director of Nursing on 8/14/24 at 12 PM revealed it was the agency fault for the CNA having the wrong product to clean with. Further, she stated she did not look at the container when she issued it to the CNA.”

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on medical record review and staff interview, the agency failed to provide all services outlined in the plan of care for 1 of 7 patients (#2). The findings were: Review of the medical record for patient #2 showed the skilled nurse was to provide services 5 times a week for 9 weeks. The services included medication management and home safety. Review of the patient’s diagnosis showed diabetes mellitus type 2, multiple sclerosis, deep vein thrombosis, dementia, and macular degeneration. The patient lived by his/her self. The following concerns were identified: Observation on 8/13/24 at 11 AM showed the registered nurse (RN) restocked the medication minder, assessed the patient, and injected insulin. Interview at that time with the RN revealed the RN comes 5 times a week and injects the patients insulin for him/her. Review of the home visits showed the agency failed to provide services on 7/3/24, then had 7/4/24 and 7/5/24 off for the holiday. Review of the “Missed Visit Note/Order” form showed the physician had not signed the consent for the missed visit. Review of the agency “Holiday 2024” showed 7/4/24 was a paid Holiday off. 7/5/24 showed it was an unpaid day. Review of the letter to patients and families showed “The home health employees will be off to spend time with their families on ...July 4th.””

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on medical record review and staff interview, the agency failed to revise the plan of care to reflect the correct information related to advance directives for 1 of 7 patients (#2). The findings were: Review of the 5/8/24 to 7/6/24 Plan of Care (POC) for patient #2 showed the advance directive of Full Code. Review of the 2/6/24 WyoPOLST (Providers Orders for Life Sustaining Treatment) showed Do Not Attempt Resuscitation (DNR). Interview with the Director of Nursing on 8/14/24 at 12 PM revealed it is the expectation for staff to follow the POC. Further, she confirmed the change in the advance directives was missed.”