Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 017027 (X3) Date Survey Completed 09/26/2018
Name of Provider or Supplier Hga Homecare, Llc Street Address, City, State 2050 Beltline Rd Sw, Decatur, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
G0682 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 review of agency policies, Centers for Disease Control (CDC) Guidelines, observations and interviews, it was determined the agency staff failed to follow their policies and CDC guidelines for hand hygiene, bedbath and equipment cleaning in 2 of 7 home visits (HV) completed. This affected HV's # 4 and # 7 and had the potential to negatively affect all patients admitted to this agency.



Findings include:



Policy: Hand Hygiene - CDC (Centers for Disease Control) Guidelines

Last Updated: November 5, 2015



1. Rational For Hand Hygiene:



Potential risks of transmission of microorganisms to patients.



Potential risks of health-care workers colonization or infection caused by organisms acquired from the patient.



Contact with the patient's intact skin (e.g., taking pulse or blood pressure, performing physical examinations, lifting the patient in bed).



Contact with environmental surfaces in the immediate vicinity of patients.



After glove removal.



2.. Recommendations:



Indications For handwashing and hand antisepsis:



A. When hands are visibly dirty or contaminated.



C. Decontaminate hands before having direct contact with patients.



F. Decontaminate hands after contact with patient's intact skin (e.g., taking pulse or blood pressure, performing physical examinations, lifting the patient in bed).



H. Decontaminate hands if moving from a contaminated - body site to a clean - body site during patient care.



I. Decontaminate hands after contact with inanimate objects ( including medical equipment) in the immediate vicinity of the patient.



J. Decontaminate hands after removing gloves.



****



Policy: Clinical Skills Bathing: Bed Bath

Date: August 2018



"Complete or Partial Bed Bath



16. Provide pernieal care. Perform perineal care during the daily bath...For a male patient, cleanse around the penis...For a female patient, cleanse the outer and inner labia. Cleanse, rinse, and dry the area throughly..."



1. HV # 4 was admitted to the agency on 8/26/18 with diagnoses of Cellulitis of Right Lower Limb, Type II Diabetes Mellitus with Diabetic Chronic Kidney Disease.



A home visit was conducted on 9/24/18 at 2:27 PM with Employee Identifier (EI) # 5, Registered Nurse, to observe PICC (Peripherally Inserted Central Catheter) care.



After EI # 5 collected the ordered labs, labeled and placed tubes in the bio hazard bag, EI # 5 removed gloves and sanitized hands.



EI # 5 changed the port on the PICC line, removed gloves and sanitized hands then documented on the computer tablet. After completing the documentation, EI # 5 donned gloves without first completing hand hygiene.



During the PICC dressing change, EI # 5 removed supplies from the barrier causing the hand sanitizer bottle to fall on the floor. EI # 5 removed glove, used a different bottle of hand sanitizer to sanitize hands, then retrieved the hand sanitizer bottle from the floor and placed the sanitizer on the barrier with the PICC dressing supplies.



After the PICC dressing change was complete, EI # 5 used the bottle of hand sanitizer which was on the floor to sanitize hands. EI # 5 did not clean the bottle or lid prior to placing on barrier and before using to sanitize hands.



An interview was conducted on 9/24/18 at 3:30 PM with EI # 1 who confirmed the above mentioned findings.



2. HV # 7 was admitted to the agency on 9/22/18 with diagnoses including Pressure Ulcer of Sacral Region, Unspecified Stage.



A HV was conducted on 9/26/18 at 8:36 AM with EI # 7, Home Health Aide (HHA) for the observation of a bed bath.



After taking HV # 7's blood pressure and temperature, EI # 7 removed a personal cell phone from his/her uniform pocket and touched the cell phone screen for several minutes.



EI # 7 checked HV # 7's pulse rate using the cell phone to time the pulse. EI # 7 failed to clean cell phone or perform hand hygiene after touching contaminated equipment.



EI # 7 placed cell phone on a barrier with the used blood pressure cuff, stethoscope, and thermometer.



EI # 7 cleaned blood pressure cuff, stethoscope, and thermometer with wipe and replaced equipment in the nursing bag.



EI # 7 then obtained the cell phone from barrier and placed in uniform right pocket. EI # 7 failed to clean cell phone prior to placement in uniform pocket.



EI # 7 obtained bath supplies and bathed the patient's arms, chest, legs, and left side of back.



EI # 7 then removed patient's diaper, washed the pubic area and inguinal groin areas and turned patient to the left side.



EI # 7 washed the right buttock and outer labia, then turned HV # 7 onto his/her back and assisted the patient with placement of a new diaper.



EI # 7 failed to clean inner labia and left buttock during the bed bath.



An interview was conducted on 9/26/18 at 10:30 AM with EI # 1, who confirmed staff failed to clean all equipment used during the visit and follow the agency bed bath procedure.