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 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)
G0716 Preparing clinical notes
CFR(s): 484.75(b)(6)

Preparing clinical notes;


This ELEMENT is not met as evidenced by:
Based on review of medical records (MR), policy and procedure, and interview, it was determined the agency failed to document wound care with NPWT (Negative Pressure Wound Therapy) per policy. This affected one of one patients receiving NPWT, and did affect MR # 3.




Findings Include:




Agency Policy: Negative Pressure Wound Therapy




Agency Policy number: 2.2.007




Revised date: 01/01/20




Purpose:




To promote wound healing and establish competency assessment guidelines when utilizing negative pressure wound therapy.




Policy:




Prior to the first independent visit for NPWT and annually thereafter, the clinician will:




Review the Negative Pressure Wound Therapy policy and procedure...




Procedure:




1. Obtain orders from physician for:




...g. type of foam/ sponge/ filler.




...4. The clinician will document the number of foam/ sponge pieces placed in the wound bed and the number of foam/ sponge/ filler pieces removed from the wound.














1. 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 Home Health Certification and Plan of Care dated 6/20/22 to 8/18/22 revealed a SN (Skilled Nurse) frequency of three times a week for eight weeks, then two times a week for one week, and the following order: "SN to cleanse wounds to left foot with wound cleanser, prepare periwound area with transparent drape. Fill entire cavities with foam. Cover with transparent drape and apply tubing. Apply negative pressure device at 125 mm/ Hg (millimeters of mercury) continuous..."




Review of the RN (Registered Nurse) OASIS (Observation and Assessment Information Set) Admission note dated 6/20/22 revealed the following documentation for Wound # 2: Lat (lateral) Ant (Anterior) edge of foot, lt (left), diab (diabetic) ulcer, Wound # 3: Lat lt ant edge of foot, left, and Wound # 1: Lt prox (proximal) plantar, lt: "Cleansed wound with wound cleanser, prepared periwound area with transparent drape, filled entire cavities with foam. Covered with transparent drape and applied tubing. Applied negative pressure device at 125 mm/ Hg continuous. Instructed patient/ caregiver on troubleshooting techniques and canister changes; Instructed on signs/ symptoms of wound infection. Patient tolerated well with minimal discomfort." There was no documentation of how many pieces of foam were placed in the wound cavities, per policy.




Review of the SN Visit Note dated 6/28/22 revealed the following documentation of wound care for Wound # 3: "Cleansed wound with wound cleanser, prepared periwound area with transparent drape, filled entire cavitiy 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. Patient tolerated well with minimal discomfort." There was no documentation of how many pieces of foam were removed from the wound, or how many pieces of foam were place in the wound, per policy.




An interview was conducted on 7/14/22 at 11:59 AM with Employee Identifier # 1, Executive Director, who confirmed staff failed to document NPWT dressing change per policy.