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 017024 (X3) Date Survey Completed 10/21/2021
Name of Provider or Supplier Southeast Alabama Homecare, Llc Street Address, City, State 3813 Ross Clark Circle, Suite 300, Dothan, 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)
G0798 Home health aide assignments and duties
CFR(s): 484.80(g)(1)

Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist).


This STANDARD is not met as evidenced by:
Based on review of agency policy and procedure, observation and staff interviews, it was determined the agency failed to ensure the plan of care developed for the Home Health Aide (HHA) was individualized to meet the needs of the patient. This deficient practice affected 1 of 7 medical records (MR) reviewed receiving Home Health Aides (HHA) services and did affect HV # 5 and had the potential to affect all patients receiving HHA services.

Findings include:

Agency Policy: Plan of Care (POC)

Revised Date: 1/1/21

Purpose:

To assure an appropriate POC is developed and revised in a timely manner for each patient. To ensure that physician's orders are followed.

Policy:

Each patient has an individualized POC developed in consultation with the patient...to address specific services being provided.

Procedure:

14. An aide POC will be developed by the Registered Nurse (RN) or other appropriate skilled professional...that is familiar with the patient if aide services have been ordered.


1. HV # 5 was admitted to the agency on 1/4/2019 with diagnosis including Neuromuscular Dysfunction of Bladder, Unspecified and Encounter for Attention to Cystostomy.

Review of the Home Health Certification and Plan of Care dated 8/21/21 to 10/19/21 revealed the patient is "chair bound with weakness, contracture to right hand and foot drop to right foot."

Review of the Aide Care Plan Report dated 8/21/21 included an (Activities of Daily Living) assignment of, "Stand-by assistance with ambulation every visit."

A HV was conducted on 10/19/21 at 11:10 AM to observe EI (Employee Identifier) # 8 provide care for HV # 5.

During the visit, the patient remained in a chair and the aide was observed providing a chair bath for the patient.

An interview conducted on 10/20/21 at 3:45 PM with EI # 5, Clinical Director confirmed, the patient is unable to stand and ambulate and the aide POC was not updated to meet the needs of the patient.