| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017024 | (X3) Date Survey Completed 11/21/2024 |
| 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) |
| G0574 | Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on review of agency policy and procedure, medical records (MR), and staff interviews it was determined the agency staff failed to include patient specific interventions for the administration of ordered Cyanocobalamin (Vitamin B-12) injections in the Plan of Care (POC). This deficient practice did affect MR # 2, one of one MR with monthly B 12 injections, and had the potential to effect all patients requiring monthly injections served by the agency. Findings include: Agency Policy: POC Policy Number: 2.1.007 Revised Date: 9/1/24 Purpose: To assure an appropriate POC is developed and revised in a timely manner for each patient... Policy: Each patient has an individualized POC developed... Procedure: ...2. The POC includes: ...i. Patient specific interventions... 1. MR # 2 was admitted to the agency on 10/23/24 with diagnoses including Encounter for Adjustment and Management of VAD (Vascular Access Device) and Problems Related to Health Literacy. Review of the Home Health Certification (HHC) and POC dated 10/23/24 to 12/21/24 revealed an order for a skilled nurse (SN) frequency once a week for nine weeks and Cyanocobalamin 1000 micrograms/milliliter (ml) 1 ml injection monthly. Further review revealed no documentation of an intervention to administer the Cyanocobalamin monthly. Review of five of five SN visits from 10/23/24 to 11/20/24 revealed no documentation the Cyanocobalamin injection was administered, when the patient last received the Cyanocobalamin injection, or who provided the Cyanocobalamin injection. An interview was conducted on 11/21/24 at 8:47 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed there was no intervention on the patients POC for the administration of the Cyanocobalamin and there was no documentation the patient had received the injection in the five weeks. |