| 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) |
| G0466 | Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation; 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 make efforts to resolve problems presented by the patient's behavior and/or situation. 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: b. Attempt to resolve problems(s) presented by patient's behavior or other individual's behavior in home or situation. ...d. Ensure the issue of concern and efforts to resolve problems is documented in the MR. 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 Skilled Nurse (SN) Visit Note Report (VNR) dated 10/11/21 revealed the patient had fallen on 10/9/21, 10/11/21 and at the visit with the SN. The SN also documented the patient had just returned from a physician's appointment where the patient was found to be "severely impacted with stool" per caregiver. The SN also documented the patient's wound were found to have MRSA (Methicillin-Resistant Staphylococcus Aureus) and the patient had complained of nausea and vomiting. There was no documentation of how long the patient had been having the nausea and vomiting, how many occurrences of the vomiting the patient had, and the hydration status of the patient. Review of the SN VNR dated 10/12/21 revealed documentation of an Registered Nurse (RN) follow up due to patient fall and "...mother/father has a plan to have family keep medication oit (out) of home ane (and) come to administer multiple times daily as patient is not taking medications as ordered. She/He is becoming increasingly forgetful. Patient refuses to move in with mother/father althoigh (although) mother/father feels she/he is unsafe to live alone..." There was no documentation of how the patient was not taking the medication as ordered and the reason the parent felt the patient was unsafe to live alone. Review of the SN VNR dated 10/13/21 revealed documentation of "patient more alert and coherent today...called and spoke with...(IV infusion company identified)... was waiting to make sure patient would have help. Spoke with (agency Patient Care Manager identified)...stated we could cover assistance..." Review of the OT (Occupational Therapy) VNR dated 10/13/21 revealed documentation of "...required assistance to access pills from sandwich bag to take. Complains of some issues with swallowing pills and food the last week, requests SLP (Speech Therapist) evaluation." There was no documentation the caregiver was notified of the patient requiring assistance to access pills from sandwich bag and interventions/efforts by the agency to help resolve the required assistance to access pill in the sandwich bag(s). The was no documentation of the agency staff's interventions/efforts to resolve the issues found during the visit. Review of the physician order dated 10/13/21 revealed an order for a Speech Therapy (ST) evaluation due to "difficulty swallowing meds (medications) and food over the last week as well as increasing cognitive issues/confusion..." Review of the ST evaluation dated 10/20/21 revealed documentation the patient was alert and oriented with no abnormal neurologic, cognitive and behavioral problems identified. Further review of the ST evaluation dated 10/20/21 revealed documentation of "...complains of pills hanging in her/his throat when she/he swallows. Patient takes 8 to 10 pills at once. Educated patients on taking 1-2 at a time... no overt signs or symptoms of aspiration observed on soft solids and thin liquids...report no difficult (difficulty) with food...patients may benefit from GI (Gastrointestinal) consistency to rule out esophageal stricture..." Review of the SN VNR dated 10/22/21 revealed documentation of "patient reports fall...patient states (Neurologist Identified) changed her/his dosage of antiseizure medication, new medication not in home this date. This RN feels patient still isn't taking medications as ordered. She/He still has no one managing her/his medications as all medications are still in the home..." The nurse further documented the patient reported smoking and the caregiver verbalized the patient would be disowned if anymore cigarettes were bought, the patient attempts to call people to obtain cigarettes during the visit and "...patient asked this RN to go to the store to purchase...cigarettes. When RN refused...states she/he will ride...riding lawnmower to the store if that's what she/he has to do. Notified (MD office staff identified) of above and that patient would be discharged if when RN arrives tomorrow patient has cigarettes and tells RN she/he rode her/his lawn mower to town for them. Patient lives approx (approximately) 3-4 miles from closest store..." Further review of the SN VNR dated 10/22/21 revealed no documentation of when the antiseizure medication dosage was increased, attempts to find out what the medication dosage was increased too, an assessment of the medications to determine what medications the patient was or was not taking incorrectly, assessment of the reason the patient was taking the medication correctly, notification of the caregiver about nurses concern of the patient's medications being in the home and feeling the patient was not taking medications as ordered, the patient's fall and patient statement regarding riding the lawnmower to store for cigarettes with possibility of discharge if action occurred. The was no documentation of the agency staff's interventions/efforts to resolve the issues found during the visit. Review of the SN VNR dated 10/23/21 revealed documentation of "...patient requesting RN go and get her/him cigarettes at beginning and end of visit. Patient cursed at RN when...told...wound not. RN began infusion, assessed patient, returned to car for duration of infusion due to patient cursing at RN and returned to home to flush and disconnect. Patient states a friemd (friend) is going to pickup her/his new medications today..." There was no documentation the SN attempted to address the issue of cursing at the SN and asking agency staff to acquire cigarettes for them with the patient and/or caregiver to resolve the issue. Review of the SN VNR dated 10/24/21 revealed documentation of "...upon arrival to home, patient immediately requests for RN 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. In an interview on 12/29/21 at 1:42 PM with Employee Identifier (EI) # 1, Executive Director and EI # 7, Performance Improvement Coordinator. The surveyor asked about the 10/11/21 SN visit and if there was an assessment performed for the amount of vomiting and/or hydration status of the patient. EI # 1 verbalized there was no documentation of the assessment because the patient had just returned from the GI physician's office. The surveyor asked about the 10/22/21 visit and if the SN had documented the reason she felt the patient was not taking the medication correctly. EI # 1 verbalized it was based on the medication being in the home and what was documented on 10/12/21 SN visit. The surveyor asked if the patient and/or caregiver had been notified of the possible discharge action documented on 10/22/21 if the patient rode the lawn mower to the store to obtain cigarettes. EI # 1 verbalized there was no documentation and according the the facility policy the patient and/or caregiver should have been notified. The surveyor asked about the 10/24/21 SN visit EI # 1 verified there was no documentation of what verbal abuse occurred at the visit. The surveyor asked 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 suppose to be notified prior to a discharge for cause. EI # 1 stated, "yes". EI # 1 and EI # 7 verified there was no further documentation of the agency's efforts to resolve the issues found then what is documented above. |