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)
G0610 Patients receive education and training
CFR(s): 484.60(d)(5)

Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge.


This ELEMENT is not met as evidenced by:
Based on review of medical records (MR), agency policy and procedures, and interview with agency staff, it was determined the agency failed to ensure:



a) Education was provided to the patient/caregiver for wound care.



b) The patient or caregiver performed a return demonstration to ensure competency.



c) Instruction was given to family or caregiver regarding PEG (Percutaneous Endoscopic Gastrostomy) care and feeding including checking for residual.



This affected 5 of 5 wound care records reviewed including MR # 1, # 2, # 3, # 4, and # 5 and had the potential to negative affect all patients served by the home health agency.



Findings include:



Policy: Patient and Caregiver Education

Policy Bo. HH 5-104



Purpose

To provide guidelines for identifying and providing educational resources required to achieve learning objectives for patients and family/ caregivers.



Procedure:



2. Educational methods will be based on the patient's and family/ caregiver's ability to comprehend information and individual learning styles and may include, but not limited to, any of the following methods of instruction:

A. Verbal demonstration

B. Written demonstration

Demonstration and return demonstration

...

******

Skin Care- Wound Cleansing

Section: 7.26



After Care:



2. Instruct patient/ caregiver in the care of the wound including:

a. Reporting any changes in pain, drainage. temperature or other signs and symptoms of infection.

b. Techniques to change or reinforce dressings.

c. Diet to promote healing.

d. Medications/ disease processes that may be impending healing.

e. Activities permitted.





1. MR # 1 was admitted to home health on 9/9/17 with the diagnoses including Abnormal Microbiologic Findings in Specimen from Respiratory Organ/ Thorax, Methicillin Resistant Staphylococcus Infection Causing Disease Elsewhere Classified and Pressure Ulcer Sacral Region, Stage IV.



Review of the HHC and POC (Home Health Certification and Plan of Care) dated 9/9/17 to 1/7/18 revealed the order to: When applicable, teach caregiver to perform wound care.



Review of the SN visits on 4/24/18 dated 9/30/17, 10/4/17, 10/6/17, 10/10/17 and 10/12/17, 11/11/17, 11/15/17, 11/20/17 and 12/1/17 revealed no documentation the caregiver was taught how to perform wound care.



In an interview with Employee Identifier (EI) # 1, Branch Manager (BM) conducted 4/26/18 at 8:30 AM, EI # 1 confirmed the staff failed to follow agency's policies and procedures.



2. MR # 2 was admitted to home health on 9/30/17 with the diagnoses including Sepsis, Unspecified Organism, Pressure Ulcer on Left Heel, Stage II, Pressure Ulcer on Right Heel, Stage II and Pressure Ulcer on Other Site, Stage 2.



Review of the HHC and POC dated 9/30/17 to 11/28/17 revealed documentation on wound care orders as follows: When applicable teach caregiver to perform wound care.



Review of the SN visit notes on 4/24/18 dated 10/5/17, 10/6/17, 10/10/17, 10/14/17 and 10/17/17 revealed no documentation the patient or caregiver was instructed on wound care and/ or observed for return demonstration.



In an interview conducted on 4/26/18 at 9:30 AM with EI # 1 who confirmed the aforementioned findings.



3. MR # 3 was admitted to home health on 11/6/17 with the diagnoses including Pressure Ulcer Of Sacral Region, Stage IV and Myelodysplastic Syndrome, Unspecified.



Review of the HHC and POC dated 111/6/17 to 1/4/18 revealed the order to: When applicable, teach caregiver to perform wound care.



Review of the SN visit notes on 4/24/18 dated 11/6/17, 11/7/17, 11/14/17 revealed no documentation the patient and/ or the caregiver was instructed on wound care or return demonstration observed.



An interview was conducted on 4/26/18 at 8:45 AM with EI # 1 who confirmed the above mentioned findings.



4. MR # 4 was admitted to home health on 12/4/17 with the diagnoses including Pressure Ulcer of Right Buttock, Stage III and Hypertensive Chronic Kidney Disease, Stage I - IV.



Review of the HHC dated 12/4/17 to 2/1/18 revealed the order to: When applicable, teach caregiver to perform wound care. SN to teach in administration of PEG to include care of equipment and preparation of feeding. Administer 240 cc of Jevity 1.5 bolus TID. Flush PEG with 60 cc of water prior to and following feedings. Check for residual prior to administration of enteral formula or medications. If residual is greater than (>) 60 ml (milliliters) return gastric aspirate to stomach via PEG tube then recheck in one hour, if aspirate remains > 60 ml, return aspirate to stomach via PEG tube and notify the physician.



Review of the SN visit notes 4/25/18 dated 12/6/17, 12/12/17, 12/13/17, 12/15/17, 12/18/17, 12/20/17, 12/22/17, 12/24/17, 12/27/17, 12/28/17, 1/1/18, 1/13/18, 1/8/18, 1/10/18, 1/15/18 and 1/17/18 revealed no documentation the patient and or caregiver was instructed on how to administer tube feeding including checking for residual.



5. MR # 5 was admitted to home health on 11/17/17 with the diagnoses including Pressure Ulcer Left Hip, Stage III and Pressure Ulcer of Sacral Region, Stage II.



Review of the SN visit notes 4/25/18 dated 11/17/17, 11/20/17, 11/22/17, 11/27/17, 11/29/17, 12/3/17, 12/5/17, 12/11/17, 12/14/17, 12/18/17, 12/120/17, 12/27/17, 12/29/17 and 1/5/18 revealed no documentation the patient and/ or the caregiver was instructed on wound care or observed perform return demonstration.



In an interview conducted on 4/26/18 at 9:15 AM with EI # 1 who confirmed the above mentioned findings.