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 017035 (X3) Date Survey Completed 03/17/2022
Name of Provider or Supplier Infirmary Home Health Agency, Inc. Street Address, City, State 851 E I-65 Service Rd S, Suite 1000, Mobile, 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 Medical Records (MR), Agency Policy and Procedure and interviews, it was determined the agency failed to ensure the relevant physician was notified of Wound VAC (Vacuum-assisted closure) treatments not being provided in home.



This deficient practice affected 1 of 5 MR with wounds including MR # 8 and had the potential to negatively affect all patients admitted to this agency.



Findings include:



Agency Policy: The Role of the Physician



Policy Number: 5.011



Date revised: 11/1/21



Purpose: ...To describe the process of notifying the physician of these roles and responsibilities.




Procedure:




...2...a. The agency's responsibilities to the physician:




...ii. provides the physician with accurate, complete, up to date information on the patient.



...notifies the physician of significant changes.


1. MR # 8 was admitted to the agency on 2/19/22 with diagnoses of Encounter for Orthopedic Aftercare following Surgical Amputation, Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene and End Stage Renal Disease.




Review of the Home Health Certification and Plan of Care (POC) dated 2/19/22 to 4/19/22 revealed documentation of "Skilled Nurse (SN) to assess wound VAC dressing. No wound care/wound VAC orders at this time. Patient to follow up with (physician identified)...on 2/22/22..."



Review of the Client Coordination Note Reports revealed documentation of SN unsuccessful attempted visits on Friday 2/25/22 (week of 2/20/22 to 2/26/22), Friday 3/4/22 (week of 2/27/22 to 3/5/22) and Saturday 3/12/22 (week of 3/6/22 to 3/12/22).




Further review of the Client Coordination Note Reports revealed the SN missed visit notifications for 2/25/22, 3/4//22 and 3/12/22 were sent to the patient's primary care physician for the agency.




Review of the MR revealed no documentation the physician identified in the patient's POC following the wound VAC therapy was notified of the SN missed visits on 2/25/22, 3/4/22 and 3/12/22.



An interview was conducted on 3/16/22 at 3:59 PM with EI # 7, Patient Care Manager, who confirmed there was no documentation the physician identified in the patient's POC who was following the wound VAC therapy was notified of the SN missed visits on 2/25/22, 3/4/22 and 3/12/22.