| 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) |
| G0590 | Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(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 review of the agency On-Call Log, medical records (MR), agency policy and procedure, and interviews, it was determined the agency failed to notify the physician for the following: 1. Blood glucose results outside of ordered parameters, including one critical blood glucose lab value. 2. New symptoms and Emergent Care received by the patient. 3. Increase in wound measurements. 4. Weight gain outside of ordered parameters. This affected an unsampled patient, and 4 of 12 active records reviewed, including Home Visit (HV) # 1, HV # 2, MR # 1, and MR # 3, and had the potential to affect all patients served by the agency. Findings include: Agency Policy: Coordination of Care, From Admit Through Discharge Policy Number: 2.1.017 Revision Date: 8/1/19 Purpose: To establish processes and criteria so that the coordination of patient care will be optimal from admit through discharge. Policy: The agency provides care and services within an integrated continuum of care system. This is accomplished by: - Identifying patient needs through assessment and communication with other health care providers. Procedure: ...4. Coordination of care with physician: At admission, throughout care, and at discharge, coordination of services is promoted through routine communication with the patient's physician. a. When changes occur in the patient's condition... d. When results of laboratory and other tests become available... 1. A review of the agency's On-Call Log was conducted on 7/13/22 at 3:45 PM which revealed an entry dated 6/28/22 for a call received from (unnamed) hospital lab to report a critical lab glucose of 26. The agency on-call entry documented the lab was, "registered into the system at (unnamed) hospital at 4:41 PM today." Further review of the entry revealed documentation that Employee Identifier (EI) # 10, RN (Registered Nurse) attempted to call the patient on 6/28/22 with no answer. The surveyor asked if any other follow-up was done to ensure the patient status? A copy of a Client Coordination Note Report dated 6/30/22 was provided by the agency to the surveyor which revealed EI # 11, LPN (Licensed Practical Nurse) made a phone call to the patient two days later. In an interview conducted 7/14/22 at 12:20 PM, EI # 1, Executive Director, stated the agency should have notified the physician of the critical lab value when received, and called the patient's emergency contact when unable to reach the patient by phone on 6/28/22, and did not. 2. HV # 1 was admitted to the agency on 6/16/22 with diagnoses including Fracture Superior Rim of Right Pelvis Subsequent for Fracture with Routine Healing and Hypertensive Chronic Kidney Disease with Stage Five Chronic Kidney Disease or End Stage Renal Disease. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 6/16/2022 to 8/14/2022 revealed SN visits once a week for nine weeks and ... Licensed Professional to report vital signs falling outside the following established parameters...FBS ( Fasting Blood Sugar ) less than 60 greater than 250, RBS ( Random Blood Sugar ) less than 70 greater than 300... Review of the SN visit note narrative dated 6/16/22 revealed RBS of 319. There was no documentation the physician was notified of RBS greater than 300. An interview was conducted on 7/14/22 with EI # 1 Executive Director, at 10:46 AM who confirmed there was no documentation the physician was notified of RBS of 319 which was outside the established parameters. 3. HV # 2 was admitted to the agency on 6/29/22 with diagnoses including Crohn's Disease, Unspecified, Without Complications, and Essential (Primary) Hypertension. Review of the HHC and POC dated 6/29/22 to 8/27/22 revealed an order for SN one time a week for nine weeks, PT (Physical Therapist) one time a week for one week. Review of the MR revealed a Client Coordination Note Report dated 7/6/22, note type: "Emergent Care Notification: ...nausea, vomiting, and abdominal pain... patient checked for UTI (Urinary Tract Infection) which was negative. Given IV (Intravenous) fluids and discharged home with 2 (two) prescriptions." There was no documentation the physician was notified of the patient's new symptoms and emergent care. An interview was conducted on 7/14/22 at 11:14 AM with EI # 1, who confirmed staff failed to notify the physician of the patient's new symptoms. 4. MR # 1 was admitted to the agency on 6/1/22 with diagnoses including Pressure Ulcer of Right Buttock, Stage Two, Hypertensive Heart and Chronic Kidney Disease with Heart Failure... Review of the HHC and POC dated 6/1/22 to 7/30/22 revealed an order for the SN to obtain weight every visit and notify RN/ MD (Medical Doctor) of weight gain or loss of five lbs (pounds) within seven days, and orders for wound care for wound # 12 Low buttock, right pressure ulcer, stage two. Review of the SN Visit Note dated 6/9/22 revealed the patient's wound # 12: Low buttock, right pressure ulcer, stage two, measured Length x (times) Width x Depth was 1 cm (centimeter) x 1 cm x 0.1 cm. Review of the SN Visit Note dated 6/14/22 revealed the SN documented wound # 12 measured 2 cm x 2 cm x 0 (zero) cm, which was an increase of one cm in length and one cm in width, and a decrease in depth of 0.1 cm. There was no documentation the SN notified the MD of the increase in wound size. Review of 3 SN Visit Notes dated 6/6/22, 6/9/22, and 6/14 revealed the patient weighed 252 lbs, 251 lbs, and 252 lbs respectively. Review of the SN Visit Note dated 6/23/22 revealed the SN documented the patient weighed 254 lbs. Review of the SN Visit Note dated 6/27/22 revealed the SN documented the patient weighed 249 lbs, which was a loss of five pounds in four days. There was no documentation the SN notified the MD of the patient's weight loss. An interview was conducted on 7/14/22 at 10:52 AM with EI # 1, who confirmed staff failed to notify the MD of changes in the patients wound size and weight loss. 5. 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. Orders for the SN included wound care to be performed Monday, Wednesday, and Friday, including application of Negative Pressure Wound Therapy. Review of the SN Visit Note dated 7/4/22 revealed the nurse documented wound # 2 lat (lateral) ant (anterior) edge of foot, lt (left) measured length x width x depth (cm) (centimeters): 2.5 x 4 x 0.5, an increase from 1.5 x 1.5 x 0.2 on 7/1/22, which was an increase of 1.0 cm in length, 2.5 cm in width, and 0.3 cm in depth. The nurse also documented the wound had Exudate type: Purulent; Exudate amount: Moderate; and Odor: Faint. There was no documentation the SN reported the changes in the wound to the physician. An interview was conducted on 7/14/22 at 11:59 AM with EI # 1, who confirmed staff failed to notify the physician of changes in the patient's wound. |