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 017009 (X3) Date Survey Completed 04/26/2018
Name of Provider or Supplier Eh Health Home Health Of Birmingham, Llc Street Address, City, State 1 Chase Corporate Drive, Suite 210 A, Hoover, 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)
G0570 Care planning, coordination, quality of care
CFR(s): 484.60

Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice.


This CONDITION is not met as evidenced by:
This condition level deficiency was cited based on review of medical records, agency policies and procedures, and interviews with staff, it was determined the agency failed to ensure:



1. Failed to follow wound care orders written by the physician.



2. Failed to notify and inform the physician of changes in patient's condition and care.



3. Failed to educate/ instruct and observe the patient and/ or family/ caregiver regarding the care of patient related to wound care, Percutaneous Endoscopic Gastrostomy (PEG) and Peripherally Inserted Central Cathe ter (PICC).



4. Perform onsite supervisory visit to patient's home evey 14 days regarding home health aide services and care.



Findings include:



Refer to G 578, G 590, G 610 and G808.