| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017027 | (X3) Date Survey Completed 09/26/2018 |
| Name of Provider or Supplier Hga Homecare, Llc | Street Address, City, State 2050 Beltline Rd Sw, Decatur, 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) 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 and interview with the staff it was determined the agency failed to ensure the physician was notified of changes in the patient's condition in 4 of 17 sampled records affecting home visit (HV) # 1 and # 4, MR # 1 and # 4 and had the potential to affect all patients served by the agency. Findings include: 1. HV # 1 was admitted to the agency 8/18/18 with diagnoses including Dizziness and Giddiness, Other Pancytopenia, Atherosclerotic Heart Disease, Old Myocardial Infarction, Personal History of Nicotine Dependency and History of Falling. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 8/18/18 to 10/16/18 included orders for the licensed professional to report vital signs falling outside parameters for temp (temperature) > 101, pulse 125, resp (respirations) (greater than) 26, systolic BP (blood pressure) 165, diastolic BP 90, pain > 6, O2 SAT(oxygen saturation) 350..." Review of the Visit Note Report dated 5/9/18 revealed the random FBS was "373" and the 5/9/18 narrative documentation revealed the "Patient has an open lesion to right foot in the area of an amputated right great toe" and the patient was "instructed on wet to dry dressing to right great toe." There was no documentation the physician was notified of FBS outside of ordered parameters or of the open lesion to the area of the right great toe. Review of the Visit Note Report dated 5/16/18 revealed the measurements of wound # 6 documented as "Length x (by) Width x Depth (CM) (centimeters) 4.5 x 0.5 x 0" and wound # 7 as "3 x 2 x 1." Review of the Visit Note Report dated 5/23/18 revealed wound # 6 measurements were documented as "5.5 x 0.1 x 0" and wound # 7 as "7 x 10 x 0.2." Further review of the Visit Note Report dated 5/23/18 revealed no documentation the physician was notified wound # 6 had increased length of 1 cm and wound # 7 had an increased length of 1.5 cm, an increased width of 9.9 cm and an increased depth of 0.1 cm. Review of the Vital Signs Report dated 6/13/18 revealed documentation the random FBS as "396." There was no documentation the physician was notified of FBS outside of ordered parameters. An interview was conducted on 9/26/18 at 10:35 AM with EI # 1, who confirmed the previous findings. 4. MR # 4 was admitted to the agency on 3/9/18 with diagnoses including Type 2 Diabetes Mellitus with Foot Ulcer and Non-Pressure Chronic Ulcer of Right Heel and Midfoot with Unspecified Severity. Review of the Physician Order form dated 3/21/18 revealed order for wound # 2 Right Foot, "Caregiver to cleanse Right Foot Ulcer with Vashe (brand of wound cleanser) and gauze, pat dry with gauze, apply Medihoney (wound treatment) to wound bed. Cover with gauze and rolled gauze. Secure with tape. Change daily..." Review of the Visit Note Report dated 3/23/18 revealed documentation the necrotic tissue amount to wound # 2 was "None". Review of the Visit Note Report dated 3/27/18 revealed documentation the necrotic tissue amount to wound # 2 was "50-<(less than)75%". There was no documentation the physician was notified wound # 2 had developed necrotic tissue. An interview was conducted on 9/26/18 at 11:34 AM with EI # 1, who confirmed the above finding. |