DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
741526 A. BUILDING __________
B. WING ______________ 		09/24/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
HARBOR HOSPICE OF EAST HOUSTON LP 9802 FM 1960 BYPASS STE 110, HUMBLE, TX, 77338
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0733      
31109 Based on record review and interview the agency failed to maintain an infection control program that protects patients, staff and others by preventing and controlling infections and communicable disease for 1 of 1 employee (#52) whose was positive for Coronavirus Disease 2019 (COVID -19), in that: The agency failed to report the positive case to the local health department after it was known of Employee #52 positive result. This failure could place the agency's employee and active clients at risk for exposure and contracting and spreading the infectious disease COVID-19 which could lead to serious illness and/or death. Findings included: Record review of Intake #230543 revealed complaint intake notes revealed that Employee #52 tested positive for COVID-19 on 7/25/2020. Record review of the agency's policy manual revealed a policy titled "Infection Prevention and Control". The Purpose of the policy revealed in part: "To properly identify, manage and report personnel exposures to infection". The policy read in parts; Harbor Hospice will identify and report personnel exposures to bloodborne pathogens and infections on a routine basis through consistent enforcement of its procedures. Further record review of the agency's policy did not include the requirement for reporting Employee Infections. - as required by Chapter 81 Communicable Diseases a Health and Safety Code requirement in Texas. The agency's policy reveal the agency will report the infection occurrence to the appropriate regulatory agency cases or suspected cases of illness considered to be public health emergencies, outbreaks and exotic diseases such as COVID-19. Record review of Health and Safety Code - Chapter 81 Communicable Diseases revealed the following: "(e) The following persons shall report to the local health authority or the department a suspected case of a reportable disease and all information known concerning the person who has or is suspected of having the disease if a report is not made as required by Subsections (a)-(d): ....... (4) an administrator of a home health agency;" Record review of Employee #52's personnel record revealed a Positive COVID-19 test result dated 7/25/2020 at 3:27 p. m. Record review of the agency's Infection Control log failed to reveal the agency reported Employee #52 positive COVID-19 case to the local health department. Interview on 9/23/2020 at 3:44 p. m., with Alternate Administrator/Alternate Director of Nursing; when asked if the agency has COVID-19 positive cases since the pandemic outbreak. She stated; "Yes, a Certified Nurse Aide (CNA), Employee #52 was tested positive on 7/25/2020, but the agency did not know that she was having symptoms and that she tested positive for COVID- 19 until 7/30/2020 when the agency became aware through the client's call to the agency. What happened was that, on 7/30/2020, I got a call from Human Resources (HR) that, Employee #52 tested positive for COVID-19. When the HR asked Employee #52 to send her the result, she sent it and the result showed back on 7/25/2020 when she had tested positive. The only reason besides HR letting me know that Employee #52 tested positive was Client #5 called this office to let us know that Employee #52 had contacted her that she is COVID-19 positive. The problem was that Employee #52 continued to see clients without letting the office or her immediate supervisor know that she had tested positive. When we knew about this, she was terminated from this agency, because she did not follow protocol. She had received and signed all the training on COVID signs and symptom to experience and to report to her immediate supervisor. She knew all those, she tested positive and did not let me or the office know. The clients were the people that was telling us that our staff was positive for COVID. Surveyor asked if the Employee #52's COVID-19 positive result was reported to the Local Health Department. She stated; yes, we did report it, but I do not have documentation to show it. Anytime we have positive COVID-19 test, it must be reported to Local Health Department. Our prior Administrator #54 must have reported it. Interview on 9/24/2020 at 1:00 p. m., with the agency's prior Administrator #54. Surveyor asked, when you were with this agency, did the agency has any positive case for COVID-19. She stated; "No, not to my knowledge, but later, when I quit from the agency, I was told that one Employee #52, was tested positive for COVID-19. Further interview with Alternate Administrator/Alternate Director of Nursing on 9/24/2020 at 1:05 p. m., when asked what the agency's process for reporting COVID-19 positive cases to the Local Health Department. She stated; "I know that we are supposed to report it to the Local Health Department. I did not report it myself. When asked why the agency did not report the positive COVID-19 result of Employee #52 to the Local Health Department. She stated; "I was in the assumption that, someone in the agency might have reported it, now I know that it was not reported". The agency did not provide additional information by the time of exit on 09/24/2020 at 2:40 p.m.