Premier Home Health Inc.

“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, staff interview and policy and procedure review, the agency failed to ensure infection prevention practices were performed during 1 of 3 client home visits (#6) while providing cares. The findings were: 1. Review of the Plan of Care (POC) certification period 1/16/25 to 3/16/25 for client #6 showed durable medical equipment (DME) and Supplies included wound care, 4 by 4 gauze, wound cleanser, foam dressing, and gloves. The rehabilitation potential was good. The orders and goals included “Wound Care to Left elbow traumatic partial thickness wound: Observation and Assessment Wound for Signs and Symptoms of infection and report to MD. The frequency was weekly and as needed. Clean wound with normal saline or non-cytotoxic wound cleanser. Dress with tegaderm or foam dressing as appropriate for drainage and depth...” The following concerns were identified: a. Observation on 2/5/25 at 11 AM with RN #1 showed the nurse providing wound care. She preformed hand hygiene, donned gloves, opened the dressing package, cleansed the wound. She continued on to dressing the wound without doffing gloves, hand hygiene, and donning clean gloves. b. Interview with the nurse on 2/5/25 at 12:05 PM confirmed she had failed to changes gloves between dirty and clean dressing change. c. Interview with the administrator on 2/6/25 at 10:15 AM revealed it was the agency’s expectation for staff to change gloves between dirty and clean wound care dressing change. 2. Review of policy/procedure “Universal Precautions for Patient and Caregivers/Fluid Precautions” faxed on 2/7/25 at 3:113 PM from agency showed “...Wash or sanitize hands before and after donning and doffing gloves. Apply clean gloves prior to applying fresh dressing...””

“Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This Element is not met as evidenced by: Based on medical record review, staff interview, and client and spouse interview, the agency failed to ensure physician orders integrated into the patient care for Occupational Therapy for 1 of 7 clients reviewed (#5). The findings were: Review of the medical record for client #5 showed the client’s start of care was dated 8/7/24. The client’s diagnoses included pressure ulcer of right ankle, unstageable, hereditary motor and sensory neuropathy, and chronic pain syndrome. Review of the plan of care (POC) dated 12/5/24 to 2/2/25 showed “Safety Measures: Fall Precaution/Transfer Safety, Keep Pathways Clear, and Proper use of Assistive Devices.” The Rehabilitation Potential showed good. The following concerns were identified: 1. Review of the 8/7/24 to 10/5/24 POC showed the “Physician Certification and Signature, I certify that this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy (PT) and/or speech therapy or continues to need occupational therapy (OT)...” dated 9/17/24. 2. Review of the physician orders dated 8/7/24 showed orders for PT and OT. Review of the client’s therapy notes failed to show OT notes. 3. Review of the physician orders dated 1/29/25 showed orders for PT and OT. Review of the client’s therapy notes failed to show OT notes. 4. Interview with the client and spouse on 2/4/25 at 1:30 PM revealed OT still had not come. They stated they were still waiting for OT; the physician ordered the service when they started with the agency and again recently. The client stated s/he needed help with transferring. 5. Interview with the administrator on 2/5/25 at 9:45 AM verified there were no notes of why there was no OT services, and why services were not provided.”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on observation, staff interview, professional standard review, and policy and procedure review, the agency failed to ensure supplies available for client use were not expired for 1 of 1 supply room. The findings were: 1.Observation of the supply room on 2/4/25 at 9:35 AM showed the following concerns: a. 6 Kendall silicone bordered lite dressing 6 by 6 inch expired 12/19/24. b. 10 Kendal silicone bordered lite foam dressing 4 by 4 inch expired 9/16/24. c. 130 Kendall silicone bordered lite foam dressing 2 by 5 inch expired 11/16/24. d. 84 Kendall silicone bordered lite foam dressing 1.6 by 2 inch expired 12/19/24. e. 1 Dover 100 percent silicone foley tray with coude’ tip expired 10/1/22. f. 48 BD 14 French intermittent catheter expired 10/31/24. g. Heparin lock flush solution 30 USP units per 3 milliliter 23 expired 11/2024, 4 expired 9/2024, and 16 expired 2/2024. 2. Interview with the administrator on 2/4/25 at 10:15 AM revealed the supplies were checked monthly for expirations, and they were for client use. She confirmed the identified supplies were out of date.”