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 017016 (X3) Date Survey Completed 06/18/2025
Name of Provider or Supplier Southeast Alabama Homecare, Llc Street Address, City, State 804 Glover Avenue, Enterprise, 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)
G0706 Interdisciplinary assessment of the patient
CFR(s): 484.75(b)(1)

Ongoing interdisciplinary assessment of the patient;


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

1.Midline catheter exposed catheter length and arm circumference were measured per the physician order. 

2.Infusion access device site care was performed per the physician order. 

This deficient practice affected one of one MR reviewed with a infusion access device, including Home Visit (HV) # 2, and had the potential to negatively affect all patients served by the agency with a infusion access device. 

 


1.HV # 2 was admitted to the agency on 5/21/25 with diagnoses including Type 2 Diabetes Mellitus with Other Specified Complication, Acute Hematogenous Osteomyelitis, Right Ankle and Foot, and Non-pressure Chronic Ulcer of Other Part of Right Foot with Necrosis of Bone.

Review of the Home Health Certification and Plan of Care dated 5/21/25 to 7/19/25 revealed an order for Skilled Nurse (SN) twice weekly for eight weeks then once weekly for one week to perform site care to the infusion access device by cleansing the site with ChloraPrep, allow to dry, apply antimicrobial disc to insertion site, secure with stabilization device, cover with transparent dressing and measure midline catheter length exposed and arm circumference 5 centimeters above the insertion site with each weekly dressing change of the midline catheter.

Review of the SN Visit Note Reports (VNR) dated 5/27/25, 6/2/25, and 6/9/25 revealed site care to the midline catheter was performed. There was no documentation of the exposed catheter length or arm circumference. 

Further review of the SN VNR dated 6/9/25 revealed no documentation of what was used to cleanse the infusion access device site, no documentation of the application of the antimicrobial disc, and no documentation the stabilization device was placed. 

An interview was conducted on 6/18/25 at 9:20 AM with Employee Identifier # 2, Patient Care Manager, who confirmed the midline catheter exposed catheter length and arm circumference were not measured and the infusion access device site care was not performed per the physician order.