Eden Home Health

Due to the manner and degree of the deficient practices, the agency failed to meet the Condition of participation: Patient Rights for Home Health Agencies.

The agency failed to ensure staff followed standards of practice for infection control for 1 (#6) of 3 sampled patients.

The agency failed to investigate multiple complaint allegations against staff member G, for being rough and inappropriate with patients.

The agency failed to document complaint allegations and the corresponding complaint resolutions of staff member G being rough and inappropriate with patients for 3 (#s 8, 9, and 10) patients of 4 sampled patients.

The agency failed to protect patients from further potential harm, after the first complaint was made to the agency, for staff member G being rough and inappropriate with patients, and during further complaint allegations by patients for 3 (#s 8, 9, and 10) of 4 sampled patients.

The agency failed to develop, establish, and maintain a comprehensive emergency preparedness (EP) program.

The agency failed to maintain an effective and ongoing QAPI program.

The agency failed to ensure it established an effective and ongoing infection control program.

The agency failed to develop, establish, and maintain a comprehensive emergency preparedness (EP) program which identified all-hazard approach strategies for addressing the agency's vulnerability during emergency events.

The agency failed to develop and maintain an EP training and testing program that was based on the agency's Emergency Preparedness plan.

The agency failed to conduct a full-scale community-based (or a full-scale facility based) exercise, with a second exercise which included a table-top exercise, annually.

The agency failed to maintain a quality improvement program which conducted surveillance, investigation, identification, prevention and control of infectious and communicable diseases as part of their QAPI program.

The agency failed to ensure it established an infection control program which covered all six of the identified standard precautions which included the appropriate use of PPE, minimizing potential exposures, and the reprocessing of reusable medical equipment between each patient.

The agency failed to maintain an infection control program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases.

The agency failed to ensure oxygen was included in the medication list on the POC for 2 (#s 2 and 5); and failed to ensure the antibiotic, Bactrim, was in the medication list on the POC for 1 (#5) of 7 sampled patients.

The agency failed to complete an OASIS discharge assessment within 48 hours of a patient's discharge for 1 (#2) of 7 sampled patients.

Agency staff failed to ensure home health aide services were provided at the frequency ordered by the physician to 1 (#6) of 7 sampled patients.

The agency failed to ensure it evaluated and tracked the improvement of selected quality improvement indicators to ensure improvements were sustained.

The agency failed to ensure the RN completed and documented an onsite, supervisory visits, of the LPN for 1 (#3) of 7 sampled patients.

Agency staff failed to ensure the HHA had successfully completed a training and competency evaluation program specific to the agency and patient needs.

Agency staff failed to ensure expired patient care supplies were not available for use on all patients utilizing agency supplies.

The agency failed to provide a discharge summary of care to the ordering provider at the time of discharge from services for 1 (#2) of 7 sampled patients.