Statement of Deficiencies

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)

G0714

Patient and caregiver education
CFR(s): 484.75(b)(5)

Patient and caregiver education;

This ELEMENT is not met as evidenced by:
Based on review of the agency policy and procedure, Medical Record (MR), and staff interviews the agency staff failed to provide patient education and/or document the patient or caregiver was able to provide a return demonstration to ensure competency of the following plan of care responsibilities:

a. Wound Care.

b. Diabetic education.

This did affect four of 17 MR's reviewed including MR # 6, MR # 2, MR # 5, and Home Visit (HV) # 5, and had the potential to affect all patients served by the agency.

Finding include:

Agency Policy: Patient Education

Policy Number: 3.001

Revised Date: 11/1/17

Purpose: To describe patient and/or caregiver interactions designed to promote and maximize patient health and safety.

Policy: The agency plans, supports, and coordinates patient and caregiver education designed to promote optimal patient health and safety. Patients receive oral and/or written information for this purpose on an ongoing basis while being cared for by the agency.

Procedure:

...3. The patient and caregiver receive ongoing information specific to the identified needs...including:

...b. Patient/caregiver plan of care responsibilities.

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

Review of the HHC and POC dated 10/3/24 revealed physician's orders including:

a. SN one visit per week for nine weeks.

b. Provide instructions on Diabetes Type Two including disease process, signs and symptoms, and causes of disease process.

c. Instruct on American Diabetes Association (ADA) diet.

d. Instruct on prescribed medications to treat diabetes.

e. Instruct on diabetic foot care.

f. Teach patient/caregiver on administration of insulin including proper preparation of medication, rotation of injection sites, and sharps disposal.

Review of the HHC and POC, Clinal Summary revealed the provider documented MR # 5 was referred to home care for education on diabetic medication. The primary focus of care is education of diabetes and diabetic medications which cannot be performed by patient/caregiver due to documented lack of knowledge and or skill...

Review of the SN visit dated 10/3/24 revealed the SN documented MR # 5 had not been taking insulin correctly and blood sugar had been out of parameters. MR # 5 needed further education on diabetes and medication management.

There was no documentation MR # 5 received diabetic teaching on the initial visit.

Review of the SN visit dated 10/8/24 revealed MR # 5 was instructed on skin breakdown, pain medication, and use of equipment including shower chair, Hoyer lift, grab bars, and removal of safety barriers.

There was no documentation MR # 5 received diabetic teaching.

There were no SN visits completed for the week of 10/12/24 due to patient refusal.

Review of the next SN visit dated 10/26/24 revealed the SN provided instructions for use of prescribed medications for diabetes and side effects.

Review of the SN visits dated 11/2/24 and 11/9/24 revealed no documentation MR # 5 was provided instructions for ADA diet, administration of insulin, preparation of medications, rotation of injection sites, or sharps disposal.

An interview was conducted on 11/21/24 at 9:32 AM with EI # 7, Clinical Director, who confirmed diabetic education was not provided per the POC.

4. HV # 5 was admitted on 10/22/24 with diagnoses including Type Two Diabetes Mellitus, Hypertensive Heart and Chronic Kidney Disease, and Heart Failure.

Review of the HHC and POC dated 10/22/24 revealed physician's orders for SN one visit per week for nine weeks. SN to instruct on diabetes to include disease process, signs and symptoms of exacerbation, complications, and management.

Review of the RN Oasis Admission dated 10/22/24 revealed the RN documented HV # 5 was being admitted for education on diabetes, physical therapy, occupational therapy, and speech therapy evaluation.

There was no documentation diabetic education was provided on admission.

Review of the SN visits dated 10/29/24 and 11/8/24 revealed diabetic education was not provided until 11/8/24.

An interview was conducted on 11/21/24 at 9:19 AM with EI # 7, who confirmed the diabetic education should have begun on admission.

1. MR # 6 was admitted to the agency on 1/25/24, recertified for continued care from 7/23/24 to 9/20/24, with diagnoses including Pressure Ulcer of Left Buttock, Stage 2, Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene, and Type 2 Diabetes Mellitus with Diabetic Polyneuropathy.

Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 7/23/24 to 9/20/24 revealed orders for a skilled nurse (SN) frequency of twice a week for one week then three times a week to perform/instruct the patient/caregiver on the following wound care:

Clean the left heel diabetic ulcer, left lower buttock pressure ulcer stage I, and left perineum with soap and water, pat dry with gauze, apply triple antibiotic ointment and xeroform, and cover with a bordered silicone foam dressing.

Clean the right leg (no documentation of the wound type), left proximal pretibial venous status ulcer, left distal pretibial venous status ulcer, and the mid pretibial venous status ulcer with soap and water, pat dry with gauze, apply triple antibiotic ointment and xeroform, cover with an abdominal pad and secure with tape.

Review of seven of seven SN visits dated 7/26/24 to 8/9/24 revealed no documentation the patient or caregiver was provided education on wound care or provided a return demonstration of the wound care for the patient's wound.

Review of the SN visit dated 8/9/24 revealed the SN did not provide wound care during the visit due to the caregiver had completed the care to all the patient’s wounds.

An interview was conducted on 11/21/24 at 8:55 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed there was no documentation the patient and/or caregiver was provided education on wound care and/or provided a return demonstration of the wound care.

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 physician order dated 11/8/24 revealed an order for a SN to perform/instruct on wound care to the left foot including cleansing the wound with antimicrobial wound cleanser, pat dry with gauze, apply a nonadherent calcium alginate with silver to the wound bed, cover with gauze, and secure with tape every other day and the patient/caregiver to perform in SN absence.

Review of the SN visits dated 11/13/24, first SN visit after the 11/8/24 order, and 11/20/24 revealed no documentation the SN provided the wound care to the left foot, the patient/caregiver was provided education of the wound care to the left foot and/or provided a return demonstration of the wound care to the left foot.

An interview was conducted on 11/21/24 at 8:47 AM with EI # 1 who verbalized prior to the 11/8/24 physician order, the patient had a graft, so no wound care was ordered for the left foot. EI # 1 confirmed 11/13/24 was the first SN visit following the 11/8/24 order and there was no documentation the SN performed the wound care, provided education on the wound care to the patient/caregiver, or obtained a return demonstration of the wound care to the left foot.