| 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) |
| G0468 | Provide contact info other services CFR(s): 484.50(d)(5)(iii) (iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and 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 provide contact information for other agencies and/or services available to the patient and/or caregiver. 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: ...c. Provide patient and legal representative (if any) contact information for other agencies. ...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. 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..." Review of the SN VNR dated 10/24/21 and the MR revealed no documentation the patient and caregiver were provided contact information for other agencies and/or services available. 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 the patient and/or caregiver were provided contact information for other agencies and/or services available. |