| 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) |
| G1022 | Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on medical record (MR) review, agency policy, and interview, it was determined the agency failed to ensure a discharge summary was sent to the health care provider who would be providing care after discharge. This affected one of five patients who were discharged from the agency including MR # 9 and had the potential to affect all patients discharged from this agency. Findings include: Agency Policy: Patient Discharge/Transfer Process Policy Number: 2.1.004 Revised: 10/1/23 Purpose: To ensure continuity of care when a patient is discharged, transferred, or referred... 21. A discharge summary including admission and discharge dates, reason for admission...patient's condition at time of discharge...is sent to the physician or other healthcare professional responsible for care after discharge from the agency within 5 (five) business days of patient's discharge... 1. MR # 9 was admitted on 4/24/24, recertified from 6/23/24 to 8/21/24, with diagnoses including Pressure Ulcer of Sacral Region, Stage Two, Pressure Ulcer of Left Buttock, Stage Two, and Type Two Diabetes Mellitus Without Complications. Review of the Physician Order dated 7/1/24 revealed orders to discharge patient from the agency per patient request due to moving out of the service area. Review of the Registered Nurse (RN) Discharge from Agency note dated 7/2/24 revealed the RN documented MR # 9 was no longer moving out of the service area due to cancer progression and was being discharged to hospice. There was no documentation the hospice agency or hospice physician was provided a Discharge Summary Report. An interview was conducted on 11/21/24 at 9:45 AM with Employee Identifier # 7, Clinical Director, who stated the Discharge Summary was sent to the Home Health physician and confirmed there was no documentation the Discharge Summary was sent to the receiving hospice agency or hospice physician. |