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 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)
G0710 Provide services in the plan of care
CFR(s): 484.75(b)(3)

Providing services that are ordered by the physician as indicated in the plan of care;


This ELEMENT is not met as evidenced by:
Based on review medical records (MR) and interviews, it was determined the agency staff failed to follow the physician's plan of care which included:



1. Oxygen saturation monitoring as ordered.



2. Completion of nurse visit as ordered.



This affected 3 of 17 MR's reviewed, including MR # 10, # 4 and Home Visit (HV) # 1 and had the potential to negatively affect all patients admitted to this agency.



Findings include:



1. MR # 10 was admitted to the agency 9/7/18 with diagnoses including Hemiplegia Following Cerebral Infarct Affecting Left Nondominant Side and History of Falling.



Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 9/7/18 to 11/5/18 revealed orders for the skill nurse to obtain O2 SAT (oxygen saturation) on room air via pulse oximeter every SNV (skill nurse visit).



Review of the 9/7/18 Registered Nurse (RN) Admission visit note report failed to contain documentation the O2 SAT monitoring was completed on admission as ordered in the POC.



Review of the 9/12/18 RN Visit failed to reveal documentation the nurse completed O2 SAT monitoring as ordered in the POC.



During an interview conducted on 9/26/18 at 11:30 AM, Employee Identifier (EI) # 2, Clinical Director confirmed the findings above.



2. HV # 1 was admitted to the agency 8/18/18 with diagnoses including Dizziness and Giddiness, Other Pancytopenia, Personal History of Nicotine Dependency and History of Falling.



Review of the HHC and POC dated 8/18/18 to 10/16/18 contained orders for the skill nurse to obtain O2 SAT on room air via oximeter on admission and with decline in respiratory status.



Review of the 8/18/18 RN Admission visit note report failed to contain documentation the O2 SAT monitoring was completed as ordered in the POC.



In an interview on 9/26/18 at 9:35 AM, EI # 3, Performance Improvement Coordinator confirmed the aforementioned finding.



3. 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 dated 3/19/18 revealed order for "SN (skilled nurse) to make visit 3/20/18 to assess wound and instruct on changed wound care..."



Review of all the Visit Note Report(s) dated 3/20/18 revealed no documentation a SN visit was made on 3/20/18 as ordered.



An interview was conducted on 9/26/18 at 11:34 AM with EI # 1, Executive Director, who confirmed a SN visit was not made on 3/20/18 as ordered by the physician.