| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017024 | (X3) Date Survey Completed 12/29/2021 |
| 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) |
| G0462 | Before discharge for cause HHA must: CFR(s): 484.50(d)(5) The HHA determines, under a policy set by the HHA for the purpose of addressing discharge for cause that meets the requirements of paragraphs (d)(5)(i) through (d)(5)(iii) of this section, that the patient's (or other persons in the patient's home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the HHA to operate effectively is seriously impaired. The HHA must do the following before it discharges a patient for cause: This ELEMENT is not met as evidenced by: Based on review of agency policy and procedure, Medical Record (MR), and interviews with staff, it was determined the agency staff failed to follow facility policy and procedure when discharging for cause. This affected 1 of 1 MR's review with Intravenous (IV) administration and wound care who was discharged for cause. This affected MR # 1 and had the potential to affect all patients who are admitted to this home health agency.Findings include:Agency Policy: Patient Discharge/TransferPolicy Number: 2.1.004Revised date: 11/1/21 Purpose: To ensure continuity of care when a patient is discharged... Policy: 1. Any of the following reasons may be criteria for patient discharge or transfer: …e. Agency determines a discharge for cause is appropriate because patient's (or other persons in the patient's home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or ability of the agency to operate effectively is seriously impaired... Procedure: ...7. In the event a discharge for cause (i.e. disruptive, abusive, or uncooperative behavior interfering with delivery of care) is being considered, the agency will: a. Advise patient, legal representative...responsible for care after discharge of possible discharge. The clinical record will reflect identification of the problems encountered, assessment of the situation...a plan to resolve issues and results of the plan implementation. In situations when staff are threatened or endangered, the agency can take immediate actions without taking measures to resolve the issue... 1. MR # 1 was admitted to the agency on 7/31/21, recertified for continued care from 9/29/21 to 11/27/21, with diagnoses including Pressure Ulcer of Sacral Region, Stage 4 and Encounter for Orthopedic Aftercare Following Surgical Amputation. Review of the MR revealed documentation the patient was receiving daily nursing visits from 10/17/21 through discharge date of 10/24/21 for daily IV antibiotic administration and wound care twice weekly. Further review of the MR revealed no documentation the patient and caregiver were notified of a possible upcoming discharge or a discharge for cause was being considered by the agency. Review of the Skilled Nurse (SN) Visit Note Report (VNR) dated 10/24/21 revealed documentation of "...upon arrival to home, patient immediately requests for RN (Registered Nurse) to go to the store and purchase cigarettes for her/him, with refusal patient began verbally abusing this nurse. Patient informed due to multiple episodes of cursing, verbal abuse and outbursts with nurse, medical and medication non-compliance and no available caregiver that patient would be discharged this date. Patient verbalized understanding. Patient refused vital sign assessment and further intervention education and requested nurse to leave residence and went to her/his room. Attempted to make contact with patients (parent identified) that lives out of town with no success..." Further review of the SN VNR dated 10/24/21 revealed documentation of "...Indicate other community service involved or needed: DHR...Is there an unstable caregiver or potential for an unstable caregiving situation? No...Indicate type of environmental safety barriers present in the home:...None..." Review of the Care Management sections revealed the patient did not require assistance with ADL's, medical procedures/treatments, assistance for supervision and safety and the patient did require assistance for medication administration which was documented as "...non-agency caregiver(s) currently provide assistance." Further review of the SN VNR dated 10/24/21 revealed no documentation of how the patient was verbally abusing the nurse and no documentation the agency staff felt threatened or endangered based on the nurse offering further assessment and intervention and the patient asking the nurse to leave while the patient went to her/his room. The patient's primary nurse was unavailable for interview due to sickness. An interview was conducted on Employee Identifier (EI) # 2, RN, on 12/29/21 at 9:10 AM, who performed a nursing visit 3 days prior to discharge of the patient. EI # 2 verbalized the agency was going to see the patient daily because the patient's primary nurse said there was some worry about the patient's cognitive ability to administer the IV antibiotics. EI # 2 stated, "She/He did try to get me to leave and go get her/him cigarettes. I do remember that. I told her/him no..." EI # 2 was asked what the patient's response was to the nurse refusing to obtain cigarettes for the patient. EI # 2 stated, "She said okay that was fine. I will get a friend to get them." EI # 2 was asked if the patient displayed any outburst, agitation or cursing during the visit. EI # 3 stated, "nothing of that nature." EI # 2 was asked is she/he was aware of any safety issues/concerns related to the patient and/or caregiver situation. EI # 2 stated, "She/He was safe with ADL's (Activities of Daily Living), there wasn't any acute mental issues. I think she/he had some occasional forgetfulness and that's what we were coming for, as reminders. There wasn't any significant altered mental status." An interview was conducted on 12/29/21 at 9:34 AM with EI # 3, RN, who performed a nursing visit 7 days prior to discharge of the patient. EI # 3 who verbalized PI # 1 "...acted okay. She/he was kind of forgetful, like when the medication was infusing, she/he would try to get up. I would say, 'hey, don't forget you have medicine infusing' and she/he would say oh ya I forgot and sit down but then she/he would do it again later..." EI # 3 was asked if the patient displayed any outburst, agitation or cursing during the visit. EI # 3 stated, "no, not with me." EI # 3 verbalized "I remember in her/his visit notes there was someone we could talk to, a cousin or aunt, someone since the mother/father lives so far away." An interview was conducted on 12/29/21 at 10:04 AM with EI # 4, Licensed Practical Nurse, who performed 2 visits within 2 weeks prior to the patient's discharge. EI # 4 verbalized the patient was a "...little unsteady" and verbalized at one of EI # 4's visit the patient fell. EI # 4 verbalized the patient was trying to feed the dogs and fell. EI # 4 verbalized the caregiver was notified and told EI # 4 she/he was on the way. EI # 4 was asked the patient displayed any outburst, agitation or cursing during the visit. EI # 4 stated, "no, just one time the (caregiver) was there and told her/him I was there and (MR # 1 identified) said just tell her/him I'm sick. I said (MR # 1 identified), I can hear you. She/He did a little cussing then but nothing out of the normal. She/He just didn't want to be seen that day. That's all." EI # 4 was asked if the cursing was directed at the staff member. EI # 4 state, "no, not at all." EI # 4 was asked if she/he recalled noticing any noncompliance from the patient. EI # 4 state, "no...she/he was always complaint when I was there." An interview was conducted on 12/29/21 at 11:05 AM with EI # 5, Occupational Therapist, who had been seeing the patient weekly until 10/20/21 when the patient was discharged for goals met. EI # 5 stated, "...she/he was very nice to me but a little wild..." EI # 5 explained the patient "there was always a giant bottle of alcohol there. She/He partied. She/He smoked but would say don't tell my (mother/father). You couldn't really tell if she/he was doing the things or not because she/he would say one time she/he did all of that and the next time would say she/he didn't. EI # 5 was asked about the bottle of alcohol and if the agency would discharge for the alcohol. EI # verbalized "it was one bottle, it was huge. As far as I could tell it was the same bottle...I wouldn't think so unless it was seriously interfering with the Plan of Care." EI # 5 was asked if the patient displayed any outburst, agitation or cursing during the visit. EI # 5 stated, "not while I was there. I mean she/he cursed when she/he talked but nothing like an outburst while I was there." EI # 5 was asked if the patient cussing was ever direct at the staff member or if the patient would become verbally abusive. EI # 5 stated, "no, with me she/he was always polite, she/he just cusses when she/he talks. It's just her/his language." EI # 5 was asked if the patient was noncompliant in anyway. EI # 5 stated, "I felt she/he wasn't doing exercises. She/He would say she/he was doing them and then also at time say...I'm not doing them. I think medication was a problem, she/he had a big set up but still think they were an issue." EI # 5 was asked about the patient's "set up". EI # 5 state, "they had a dining room table with medications in baggies with the times on them. We would come in the afternoon and she/he would just be woke up and hadn’t took her/his medications. She/He would go in there and take some. There was some confusion if she/he was taking the morning or afternoon, since she just woke up but I don't remember if I just was thinking that (talking about the agency confusion on which medication the patient was taking) or if we talked about it...I don't know that I would have gone and looked at what was taken or not taken..."EI # 5 was asked his/her if the patient was able to live alone. EI # 5 stated, "I don't know. I felt she was borderline, she was having...services before and felt it would be helpful for them to come back. I don't think she/he needed anyone there full time but someone checking on her/him." EI # 5 was asked about the caregiver's involvement with the patient. EI # 5 stated, "sometimes they were fighting, and she would be (MR # 1 identified) is going to do what (MR # 1 identified) is going to do but most of the time she was involved." In an interview on 12/29/21 at 1:42 PM with EI # 1, Executive Director and EI # 7, Performance Improvement Coordinator, verified there was no documentation of what verbal abuse occurred at the visit. EI # 1 and EI # 7 were asked was the patient's documented behavior to the extent that the delivery of care to the patient or the ability of the agency to operate effectively seriously impaired? EI # 1 stated, "I think it was just the nurse herself." EI # 7 stated, "if a patient started a verbal abuse towards me, I would not stay in the home but in addition to that I believe the nurse felt the patient needed more of a caregiver..." The surveyor asked if the agency administration had been contacted prior to the discharge about the patient's discharge. EI # 1 verbalized the nurse had not called prior to discharging the patient and EI # 1 was notified after the discharge had taken place. EI # 1 was asked per the agency policy/procedure if the agency administration were supposed to be notified prior to a discharge for cause. EI # 1 stated, "yes". |