| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017037 | (X3) Date Survey Completed 05/11/2023 |
| Name of Provider or Supplier Alabama Homecare Of Montgomery, Llc | Street Address, City, State 400 South Union Street Suite 285, Montgomery, 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 observations, agency policy and procedure and interviews with the staff it was determined the staff failed to follow the agency policy for hand hygiene, complete bed bath and glove change. This deficient practice affected two of five Home Visits (HV), including HV # 7 and HV # 4 and had the potential to negatively affect all patients served by the agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revised Date: 5/1/19 Policy: Staff are required to perform hand hygiene prior to, at specified time points during, and following patient contact. Hand Hygiene will be performed using soap and water or an alcohol-based hand sanitizer. Procedure: 1. Staff performs hand hygiene by handwashing with soap and water or using an alcohol-based hand sanitizer: a. before direct contact with patients. ...d. if moving from a contaminated body site to a clean body site during patient care. e. after contact wit inanimate objects (including medical equipment...) in the immediate vicinity of the patient. f. before and after removal of personal protective equipment (PPE). g. at the conclusion of the visit after contact with a patient's intact skin, (e.g., when taking vital signs and lifting a patient.) 8. Other Aspects of Hand Hygiene: c. Change gloves during patient care if moving from a contaminated body site to a clean body site. Point of Care - Complete or Partial Bed Bath: ...16.Perform Hand hygiene and don gloves. ...27.Wash the patient's face... 28. Wash the patient's upper extremities and trunk. Change bath water when moving from one body part to the next... 29. Wash the patient's hands and nails... 30. Change the water and check the temperature of the bath water. Bathwater should be changed when moving from one body part to the next. 31. Wash the patient's abdomen... 32. Change the bathwater, being mindful of water temperature. 33. Wash the patient's lower extremities... 34. Change the bath water before perineal care... 35. Provide perineal care while the patient is in supine position... 36. Change the bath water after perineal care... 37. Remove gloves, perform hand hygiene, and don clean gloves. 38. Wash the patient's back. a. Assist patient to a prone or side-lying positing... b. ...wash, rinse and dry the patient's back from neck to the buttocks with long, firm strokes. c. Use a clean washcloth mitt for cleansing the buttocks and anus to prevent contamination of the bathwater. d. Cleanse the buttocks and anus...Cleanse, rinse and dry the area thoroughly... ...40. Remove gloves, perform hand hygiene, and don clean gloves. ...51. Discard or store supplies, remove PPE and perform hand hygiene... Agency Policy: Cleaning of Re-Useable Equipment. Policy Number: 8.006 Revised Date: 6/1/22 Policy: Equipment used for more than one patient is cleaned between each patient use. Definitions: 1. Low-Level disinfection - destroys most bacteria, fungi and some viruses...Examples include at least 70% isopropyl alcohol/ethyl alcohol... Procedure: 6. a. The hand-held computer device (i.e. tablet or Smartphone) should be wiped down with a low-level disinfectant at the beginning and end of each visit.... 2. HV # 4 was admitted to the agency on 4/12/23 with diagnoses including Multiple Sclerosis and Anemia, Unspecified. Review of Home Health Certification (HHC) and POC dated 4/12/23 to 6/10/23 revealed an Occupational Therapy (OT) frequency of once a week for one week, then twice weekly for three weeks, then once a week for one week. A HV was conducted on 5/9/23 at 2:10 PM with EI # 5, OT, to observe care. During the HV, EI # 5 failed to perform hand hygiene prior to donning gloves once and after removing gloves once. An interview was conducted on 5/9/23 at 3:44 PM with EI # 1, who confirmed the agency staff failed to follow the agency policy by not performing hand hygiene prior to donning gloves and after removing gloves. 1. HV # 7 was admitted to the agency on 4/27/23 with admitting diagnoses of Hemiplegia Following Cerebral Vascular Accident Right Dominant Side, and Aphasia Following Cerebral Infarction. An observation was conducted on 5/9/23 at 5:15 PM with Employee Identifier (EI) # 8, Home Health Aide (HHA), to observe care provided during a bed bath. EI # 8 sanitized hands, placed barrier on table and placed HHA bag on barrier. EI # 8 sanitized hands and donned clean gloves and removed equipment from the HHA bag. EI # 8 took HV # 7's vital signs (VS) and placed the equipment on the barrier. With the same gloves, EI # 8 cleaned the blood pressure cuff, stethoscope and the Oxygen saturation monitor and placed on clean side of barrier, removed gloves and sanitized hands and donned clean gloves. EI # 8 bathed and dried HV # 7's face and the upper body. EI # 8 then performed perineal care and bathed the patient's legs. The patient rolled on his/her right side and EI # 8 bathed the patient's back, buttocks and legs. Once complete HV # 7 asked if EI # 8 was going to wash his/her right side of back and legs. EI # 8 told the patient he/she did but the patient rolled on the left side and with the same gloves, water and wash cloths bathed the patient's right side. While on the left side the son applied a dressing to the coccyx area. EI # 8 used the same wash cloths, water and gloves for the entire bath. HV # 7 then asked EI # 8 if he/she was going to shave him/her. EI # 8 removed gloves and donned clean gloves and failed to sanitize hands prior to donning clean gloves and shaved the patient. EI # 8 removed gloves and did not sanitize hands and pulled an ink pen from the scrub pocket and documented in the patient's folder and replaced the pen back into the pocket. EI # 8 picked up the barriers from the table and placed in a bag and documented on the tablet. HV # 7 asked to have his/her hair combed. EI # 8 placed the HHA bag on the table without a barrier, donned clean gloves and did not sanitize hands prior to donning the gloves and combed the patient's hair. EI # 8 removed gloves, did not sanitize hands, placed the gloves in the trash bag and documented on tablet. Upon exiting the home EI # 8 used the hand sanitizer at the patient's front door. EI # 8 failed to clean the tablet prior to exiting the home. An interview was conduced on 5/9/23 at 4:00 PM with EI # 1, Executive Director, who confirmed the HHA failed to change the bath water during the bath, failed to sanitize hands when removing gloves, failed to use multiple wash cloths during the bath and failed to clean tablet prior to exiting the home. |