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 017025 (X3) Date Survey Completed 05/12/2022
Name of Provider or Supplier Saad Enterprises, Inc. Street Address, City, State 1515 University Blvd, South, Mobile, 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 agency policy and procedure, medical record (MR) reviews and staff interviews, it was determined the agency failed to ensure patients and/or caregivers were educated on:




1. Wound care to include teaching with return demonstration.




2. Diabetes care to include blood glucose testing and insulin injections.




This deficient practice affected 2 of 6 records reviewed with wounds and did affect Home Visit (HV) # 6, MR # 10, and 1 of 3 records reviewed with a diagnosis of diabetes and did affect MR # 8, and had the potential to affect all patients served by the agency.




Findings include:




Agency Policy:




Oasis (Outcome and Assessment Information Set) Based Admission and Resumption of Care Assessments




Policy Revised Date: 1/20




Procedure:




4.4, c. Patient/Caregiver will provide and get a return demonstration of ALL procedures specified to be performed in the POC (Plan of Care) between the specified Skilled Nurse (SN) Frequency and documented in the EMR (Electronic Medical Record).








3. MR # 8 was admitted to the facility on 4/12/22 with diagnoses including Unspecified Fracture Right Patella, Subsequent for Open Fracture Type 3A/B/C with Routine Healing, and Unspecified Fracture Lower End of Right Tibia, Subsequent for Closed Fracture with Routine Healing.




Review of the HHC and POC dated 4/12/22 to 6/10/22 revealed a SN frequency of 1 WK 9.




Further review of the HHC and POC revealed orders for the SN for instructions/ reinforcement of diabetic care to include: ...blood glucose testing... and administration of insulin.




Further review of the HHC and POC revealed the following orders:




Skilled nurse for administration of SQ (Subcutaneous) insulin PRN (as needed).




Skilled nurse for instructions/ reinforcement of administration of prescribed insulin injection.




Review of the RN (Registered Nurse) Oasis Admission, dated 4/12/22, revealed no documentation the nurse obtained a return demonstration for blood glucose testing or administration of insulin from the patient or caregiver.




Review of the following 2 weeks VNR's, dated 4/19/22 and 4/26/22, revealed no documentation of return demonstration for blood glucose testing or administration of insulin.




An interview was conducted on 5/12/22 at 11:15 AM with EI # 9, who confirmed staff failed to document a return demonstration for blood glucose testing or insulin administration.






























2. MR # 10 was admitted to the agency on 4/25/22 with diagnoses including Pyogenic Arthritis, Methicillin Susceptable Staphylococcus Aureus, and Essential (Primary) Hypertension.




Review of the HHC and POC dated 4/25/22 revealed orders including SN 2 x a week for 1 week then 1 x a week for 8 weeks and SN to perform/teach wound care to incision/suture site located on right shoulder.




Further review of the HHC and POC dated 4/25/22 revealed orders for wound care including "cleanse with SNS, pat dry, apply Mepilex AG Foam, Cover with gauze...Patient to perform daily in the absence of SNV..."




Review of the SN VNR dated 4/25/22, 4/27/22, and 4/2/22 revealed no documentation of patient or caregiver teaching or return demonstration of wound care.




Review of the SN VNR dated 5/11/22 revealed MR # 10 was re-admitted to the hospital on 5/3/22.




In an interview conducted on 5/12/22 at 11:22 AM, EI # 8, Supervisor, confirmed there was no documentation of patient or caregiver teaching or return demonstration in either of the 3 visit notes.







1. HV # 6 was admitted to the agency on 3/10/22 with diagnoses including Essential (Primary) Hypertension and Acute Embolism and Thrombosis of Unspecified Deep Veins of Unspecified Lower Extremity.




Review of the Home Health Certification (HHC) and POC) dated 3/10/22 to 5/8/22 revealed a SN frequency of 1WK9 (Once per Week for Nine Weeks).




Review of the SN Visit Note Report (VNR) dated 3/16/22 revealed, "New wound assessed to left calf. Wound care orders implemented and instructions given to check the wound daily for signs of infection."




Review of the Physician Order dated 3/23/22 revealed SN to perform/teach wound care to left lateral mid lower extremity; using clean technique, cleanse with wound cleanser/SNS (Sterile Normal Saline), pat dry, apply foam island dressing.




Review of the SN VNR's dated 3/23/22 and 3/29/22 revealed wound care provided..."change dressing 3 times a week, CG (Caregiver) to perform WC (Wound Care) between nurse visit." There was no documentation of caregiver teaching with return demonstration.




Review of the Physician Order dated 4/5/22 revealed SN to perform/teach wound care to left lateral mid lower extremity; using clean technique, cleanse with wound cleanser/SNS, pat dry, apply medihoney to wound bed, cover with foam island dressing.




Review of the SN VNR's dated 4/5/22, 4/14/22, 4/27/22 and 5/4/22 revealed an on-going wound to the left calf and no documentation the SN had taught wound care with a return demonstration by the patient and/or caregiver.




Review of the HHC and POC dated 5/9/22 to 7/7/22 revealed SN frequency of 1WK9 and orders for skilled nurse to perform/teach wound care to left lateral mid lower extremity trauma superficial injury using clean technique as follows: Cleanse with wound cleanser/SNS, pat dry, apply medihoney to wound bed, and cover with foam island dressing. Wound care to be completed each visit. Wound care to be performed daily in the absence of the SN.




A home visit was conducted on 5/11/22 to observe the SN provide wound care to the left calf. During the visit the caregiver reported to the SN that he/she had only changed the dressing to the left calf one time since the patient has had the wound. The patient reported to the nurse that he/she does not change the dressing and the only time the dressing is changed is when the SN visits one time per week.




An interview conducted on 5/12/22 at 12:50 PM with Employee Identifier (EI) # 9, Clinical Educator confirmed the SN did not provide patient/caregiver teaching of wound care with a return demonstration per policy.