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)
G0798 Home health aide assignments and duties
CFR(s): 484.80(g)(1)

Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist).


This STANDARD is not met as evidenced by:
Based on review of agency policy, medical record (MR) review and interview with staff it was determined the agency failed to ensure the Registered Nurse (RN) developed and maintained an individualized Home Health Aide (HHA) assignment to meet the needs of each patient.






This deficient practice affected 1 of 4 MR’s reviewed with HHA services and did affect MR # 11 and had the potential to negatively affect all patients receiving HHA services.






Findings include:






Agency Policy: Plan of Care/Description of Services/Health Care Finance Administration (HCFA) 485 and 487




Date Revised: 1/19




Purpose:




Section 1 Purpose/Objective




1.1 To provide… coordinated and comprehensive format that addresses patient/client physical… needs.




1.2 To establish and maintain a measurable and quantifiable method of evaluating the care process.




Agency Policy: Section 2 Policy









2.1 On admission and recertification a Plan of Care (POC) shall be developed under the direction of the attending physician.




2.3 The POC will be individualized…




2.4 The POC will be updated and revised as needed.




1. MR # 11 was admitted to the agency on 4/7/2020 and recertified on 4/7/22 with diagnoses including Type 2 Diabetes Mellitus Without Complications and Unspecified Osteoarthritis, Unspecified Site.








Review of the Home Health Certification and Plan of Care dated 4/7/22 to 6/5/22 revealed the HHA was to visit once a week for eight weeks and provide HHA services for assistance with personal care and ADL's (Activities of Daily Living) secondary to functional limitation which prevent self-care.






Review of the physician’s order dated 11/24/2021 states, “skilled nurse (SN) to remove patient’s Foley catheter on Wednesday, December 1, 2021.”




Review of Aide Care Plan Report dated 4/7/2022 revealed routine catheter care at every visit and empty urinary drainage bag per patient request.




Review of the Aide Visit Note Reports dated 4/8/22, 4/13/22, 4/20/22 and 5/5/22 revealed the HHA documented catheter care and emptied urinary drainage bag each visit.




Review of the SN Visit Note Reports dated 4/13/22, 4/20/22, 4/27/22, and 5/9/22 revealed genitourinary system, "bladder incontinent". There were no indications the patient had a Foley catheter.






An Interview conducted on 5/12/22 at 11:30 AM with Employee Identifier (EI) # 8, Nurse Supervisor, confirmed the SN failed to update the aide care plan after removal of the Foley catheter.