| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017027 | (X3) Date Survey Completed 07/14/2022 |
| 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) |
| G0578 | Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on review of medical records (MR), policy and procedure, and interviews, it was determined the agency failed to ensure staff followed physician orders for performing wound care. This affected two of six active records reviewed with patients with wounds, which included MR # 1, and MR # 3, and had the potential to affect all patients with wounds, served by the agency. Findings include: Agency Policy: Plan of Care Policy number: 2.1.007 Revised Date: 12/01/21 Purpose: ...To ensure that physician... orders are followed. Policy: Each patient has an individualized Plan of Care (POC) developed in consultation with the patient, physician... and staff that integrates comprehensive assessment findings to address patient problems, needs, and goals... Procedure: ...2. The POC includes: ...f. Medications and treatments. ...n. All patient care orders. ...7. Medications, treatments, and interventions are provided by qualified agency staff as ordered by the physician... 1. MR # 1 was admitted to the agency on 6/1/22 with diagnoses including Pressure Ulcer of Right Buttock, Stage 2 (two), and Hypertensive Heart and Chronic Kidney Disease with Heart Failure... Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 6/1/22 tp 7/30/22 revealed a SN (Skilled Nurse) frequency of one time a week for one week, two times a week for one week, and one time a week for seven weeks. Review of the MR revealed a new physician's order dated 6/8/22 with the following wound care: "# 12 low buttock rt (right) PU (Pressure Ulcer) II (Stage two)- Apply Mepilex border twice weekly and as needed. Goal: Wound to show signs of healing within seven to 10 days." Review of the SN Visit note dated 6/9/22 revealed the nurse documented the following wound care to wound # 12: "Cleansed with wound cleanser and gauze, patted dry with gauze, applied barrier cream to periwound. Covered with foam dressing using clean technique..." The new order did not include instructions to clean the wound with wound cleanser, or apply barrier cream to periwound. Review of the SN Visit Note dated 6/23/22 revealed the SN documented the following wound care to wound # 12: "Applied Mepilex border. Cleansed with wound cleanser and gauze, patted dry with gauze, applied barrier cream to periwound. Covered with foam dressing using clean technique..." The order did not include instructions to clean the wound with wound cleanser, or apply barrier cream to periwound. Review of the MR revealed the following new wound care order dated 6/30/22: "# 12 Low buttock rt PU II - Apply Medihoney to wound bed then cover with Mepilex border twice weekly and as needed. Goal: Wound to show signs of healing within seven - 10 days." Review of the SN Visit Note dated 7/5/22 revealed the SN documented the following wound care to wound # 12: "Applied Mepilex border. Cleansed with wound cleanser and gauze, patted dry with gauze, applied barrier cream to periwound. Covered with foam dressing using clean technique..." The SN failed to apply Medihoney to wound bed as ordered. Review of the SN Visit Note dated 7/11/22 revealed the SN documented the following wound care to wound # 12: Cleansed with wound cleanser and gauze, patted dry with gauze, applied barrier cream to periwound. Covered with foam dressing using clean technique..." The SN failed to apply Medihoney to wound bed as ordered. An interview was conducted on 7/14/22 at 10:52 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed staff failed to perform wound care as ordered. 2. MR # 3 was admitted to the agency on 6/20/22 with diagnoses including Type 2 Diabetes Mellitus with Other Specified Complications, and Other Acute Osteomyelitis, Left Ankle and Foot. Review of the HHC and POC dated 6/20/22 to 8/18/22 revealed a SN frequency of three times a week for eight weeks, then two times a week for one week. Review of the MR revealed the following new wound care order dated 6/28/22, "Skilled nurse to cleanse wound # 3 left lateral foot with wound cleanser. Prepare periwound area with transparent drape. Fill entire cavity with foam. Cover with transparent drape and apply tubing. Apply negative pressure device at 125 mm/Hg (millimeters of Mercury) continuous. Wrap with rolled gauze and elastic bandage. Dressing to be changed every Mon (Monday), Wed (Wednesday), Fri (Friday). Skilled Nurse to cleanse wound # 2 left lateral foot and wound # 1 left proximal foot with wound cleaneser (cleanser). Pat dry with gauze. Apply wet to dry dressing and abd (abdominal) pad. Wrap with rolled gauze." Review of the SN Visit Note dated 7/4/22 revealed the nurse documented the following care for wound # 2: "Cleansed with wound cleanser and gauze. Patted dry with gauze. Prepared periwound area with transparent drape. Filled entire cavity with foam. Covered with transparent drape and applied tubing. Applied negative pressure device at 125 mm/Hg continuous. Tolerated well with no complaints." The SN failed to perform the correct wound care to wound # 2, as ordered. Further review of the SN Visit Note dated 7/4/22 revealed the nurse documented the following care for wound # 3: "Cleansed wound with wound cleanser. Prepared periwound area with transparent drape. Filled entire cavity with foam. Covered with transparent drape and applied tubing. Applied negative pressure device at 125 mm/Hg continuous. Wrapped with rolled gauze and elastic bandage. Cleansed with wound cleanser and gauze. Patted dry with gauze. Applied wet to dry dressing and abd pad. Wrapped with rolled gauze. Secured with ace wrap. Tolerated well." The surveyor was unable to determine if the wound care performed on wound # 3 was performed as ordered. An interview was conducted on 7/14/22 at 11:59 AM with EI # 1, who confirmed staff failed to perform wound care as ordered. |