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)
G0590 Promptly alert relevant physician of changes
CFR(s): 484.60(c)(1)

The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered.


This ELEMENT is not met as evidenced by:
Based on medical record (MR) review, agency policy, and interviews it was determined the agency failed to ensure the provider was notified of significant changes in the patient condition.


This deficient practice affected two of 17 MR reviewed including MR # 5 and MR # 2 and had the potential to affect all patients admitted to this agency.


Findings include:


Agency Policy: Coordination of Care, From Admit Through Discharge


Policy Number: 2.1.017


Revised Date: 4/1/23


Purpose: To establish processes and criteria so that the coordination of patient care will be optimal from admit through discharge...


4. Coordination of care with physician:


...coordination of services is promoted through routine communication with the patient's physician:


a. When changes occur in the patient's condition or response to treatment...


In the event that a physician cannot be reached to communicate the status of a patient the following will occur:


Medical Director and/or Supervisor will be contacted for assistance with contacting physician...





2. 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 HHC and POC dated 10/23/24 to 12/21/24 revealed an order for a SN frequency once a week for nine weeks to perform peripherally inserted central catheter (PICC) site care.


Review of the SN visit dated 10/23/24 revealed the PICC line was sutured with an exposed PICC catheter length was 0.0 centimeters (cm).


Review of the SN visit dated 10/30/24 revealed the PICC line was sutured with an exposed PICC catheter length of 2.0 cm. There was no documentation the physician was notified of the increased PICC exposed catheter length of 2.0 cm.


An interview was conducted on 11/21/24 at 8:47 AM with EI # 1, Executive Director, who confirmed there was no documentation the physician was notified of the increased PICC exposed catheter length of 2.0 cm.

1. MR # 5 was admitted on 10/3/24 with diagnoses including Type Two Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, and Long-Term Use of Insulin.


Review of the Home Health Certification and Plan of Care (HHC and POC) dated 10/3/24 revealed orders for the staff to report vital signs falling outside of established parameters including pain greater than six.


Review of the Skilled Nurse (SN) visit dated 11/9/24 revealed the LPN documented MR # 5 complained of a new pain to the back and left hip at a level of 9/10. There was no documentation of the cause of the pain.


Review of the HHC and POC dated 10/3/24 revealed no physician's orders for interventions or medications to relieve pain.


Further review of the SN visit dated 11/9/24 revealed the SN documented the Nurse Practitioner's office was closed and would notify on Monday.


There was no documentation the Physician, Nurse Practitioner, Medical Director, or Supervisor were notified of the new onset of pain and inability to contact the provider on 11/9/24 or on the following Monday, 11/11/24.


An interview was conducted on 11/21/24 at 9:32 AM with Employee Identifier (EI) # 7, Clinical Manager, who confirmed the agency failed to ensure the staff notified the provider of the pain level outside of the established parameters.