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 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)
G0580 Only as ordered by a physician
CFR(s): 484.60(b)(1)

Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner.


This ELEMENT is not met as evidenced by:
Based on review of Medical Records (MR), agency policy, and staff interview the agency staff failed to.


a. Flush a peripherally inserted central catheter (PICC) with only ordered medication.


b. Document what was used to clean PICC site.


c. Document if stat lock and biopatch were placed on a PICC site.


d. Follow physician orders for wound care.


This deficient practice did affect three of 17 MRs reviewed, including MR # 2, MR # 1, and Home Visit (HV) # 7, and had the potential to affect all patients served by the agency.


Findings include:


Agency Policy: Wound Assessment, Documentation, and Photography


Policy Number: 2.2.001


Revised: 9/1/24


...4. Redress the wound using appropriate wound care dressing procedures following physician's orders...





3. HV # 7 was admitted on 10/12/24 with diagnoses including Laceration Without Foreign Body, Right Lower Leg and Long Term (Current) Use of Non-Steroidal Non-Inflammatory.


Review of the HHC and POC dated 10/12/24 revealed physician's orders for SN one visit per week for one week, two visits per week for eight weeks, then one visit per week for one week for wound care per home health SN two times a week.


Review of the Physician Order dated 11/14/24 revealed orders for wound care to the surgical incision to the right lateral distal pretibial area, cleanse with wound cleanser, pat dry, apply Santyl to wound bed, apply Alginate dressing, and cover with foam dressing two times a week.


Review of the SN visit dated 11/16/24 revealed the SN documented the surgical wound to the right lateral distal pretibial area was cleansed with wound cleanser, patted dry, Alginate dressing was applied to the wound bed, and covered with gauze.


There was no documentation Santyl was applied to the wound bed and no documentation a foam dressing was applied.


An interview was conducted on 11/21/24 at 9:16 AM with EI # 7, Clinical Manager, who confirmed the agency failed to ensure the physician orders for wound care were followed.




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 Plan of Care (POC) dated 10/23/24 to 12/21/24 revealed an order for a skilled nurse (SN) frequency once a week for nine weeks to:


a. Perform site care to PICC line by cleaning site with chloroprep or alcohol and betadine, allow to dry, may apply biopatch (a hydrophilic polyurethane absorptive foam with chlorhexidine gluconate) and stat lock (stabilization device) then cover with a sterile tegaderm (transparent dressing) once a week.


b. Perform lab draw from the PICC line by flushing with 10 milliliters (ml) of Normal Saline prior and post blood draw.


c. Flush PICC line with 10 ml of Normal Saline at every dressing change.


Further review of the HHC and POC dated 10/23/24 to 12/21/24 revealed no documentation of an order for the administration of Heparin.


Review of the SN visits dated 10/30/24, 11/6/24, and 11/13/24 revealed a blood draw from the PICC and PICC site care was performed with Normal Saline 10 ml and Heparin 5 ml administered after the blood draw and during the dressing change. There was no documentation if chloroprep or alcohol and betadine was used to clean the PICC site and if a biopatch and stat lock were placed on the site.


Review of the SN visit date 11/20/24 revealed PICC site care was performed with Normal Saline 10 ml and Heparin 3 ml administered.


An interview was conducted on 11/21/24 at 8:47 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed the agency staff failed to follow physician orders for flushing a peripherally inserted central catheter (PICC) with only ordered medication, document what was used to clean PICC site, document if stat lock and biopatch were placed on a PICC site.


2. MR # 1 was admitted to the agency on 8/26/24 with diagnoses including Essential (Primary) Hypertension and Infection and Inflammatory Reaction due to Indwelling Urethral Catheter, Subsequent Encounter.


Review of the Physician order dated 8/30/24 revealed an order for the insertion of a indwelling catheter and to change the indwelling catheter every month.


Review of the SN visit dated 10/2/24 revealed the indwelling catheter was changed.


Review of the MR from 10/2/24 to 11/19/24 revealed no documentation of an indwelling catheter change per the physician order.


An interview was conducted on 11/21/24 at 8:33 AM with EI # 1 who confirmed there was no documentation of an indwelling catheter change since 10/2/24.