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)
G0714 Patient and caregiver education
CFR(s): 484.75(b)(5)

Patient and caregiver education;


This ELEMENT is not met as evidenced by:
Based on Medical Record (MR), Agency Policy and Procedure, and interviews, it was determined the agency failed to ensure the patients and/or caregivers (pt/cg) received education and training appropriate for care.



This deficient practice affected 2 of 5 records reviewed with wounds including MR # 4 and HV (Home Visit) # 7, and 1 of 2 records reviewed with a PICC (Peripherally Inserted Central Catheter) line including HV # 1 had the potential to negatively affect all patients admitted to this agency.



Agency Policy: Patient Education



Policy Number: 3.001



Date Revised: 11/1/17



Purpose: To describe pt/cg interactions designed to promote and maximize patient health and safety.



Policy: The agency plans, supports, and coordinates pt/cg education designed to promote optimal pt health and safety. Patients receive oral and/or written information for this purpose on an ongoing basis while being cared for by the agency.




Procedure:




...3. The pt/cg receive ongoing information specific to the identified needs...including:




b. Pt/cg Plan Of Care responsibilities.




...7. Using the progress/visit note, the clinician documents the level of pt/cg comprehension, pt/cg return demonstration of skill(s) taught...


3. HV # 1 was admitted to the agency on 2/8/22 with diagnoses including Arthritis due to Other Bacteria, Vertebrae and Essential (Primary) Hypertension.




Review of the HHC and POC dated 2/8/22 revealed a Skilled Nurse (SN) frequency of 1WK9 (one time per week for 9 weeks) and orders to instruct pt/cg on administering the following medication Nafcillin 2 GM (Grams) IV (Intravenous) every 4 hours. Pt/cg to flush IV site with 10 ml (Milliliters) of Normal Saline before infusion and 10ml of normal saline and Heparin units/ml 3-5 ml after infusion. Instruct pt/cg regarding infusion procedure, care and use of infusion equipment and signs and symptoms of complications of IV therapy.




Review of the VNR by the SN dated 2/8/22, 2/12/22, 2/15/22, 2/22/22, 3/1/222, and 3/8/22 revealed no documentation of pt/cg return demonstration of accessing of the PICC line, flushing the line and administering Nafcillin via PICC line.




An interview conducted on 3/17/22 at 8:30 AM with EI # 1, Executive Director confirmed there was no documentation of a return demonstration of accessing of the PICC line, flushing the line and administering Nafcillin via PICC line per agency policy.







2. HV # 7 was admitted to the agency on 2/7/22 with admitting diagnoses of Abscess of The Breast and Nipple and Necrotizing Fasciitis.




Review of the Certification and Plan of Care dated 2/7/22 revealed the following wound care orders:




SN to perform/instruct/reinforce patient/caregiver procedure of wound care to RT (Right) breast. Cleanse with Dakins solution, apply silver Alginate, cover with dry gauze, secure with tape using clean technique... change daily. Instruct patient/caregiver signs/symptoms of wound infection and proper disposal of dressings.




Review of the RN (Registered Nurse) OASIS dated 2/7/22 revealed no documentation of the specific education for wound care and no documentation of a return demonstration by the caregiver.




Review of the SN visit notes dated 2/16/22, 2/21/22 and 2/23/22 revealed no documentation of a return demonstration by the caregiver or the patient for the wound care.




Review of the physician order dated 3/4/22 revealed an order for wound care as follows:




Right breast: May shower using liquid antibacterial soap or cleanse with normal saline, rinse well and pat dry, Cover with Silver Alginate. Change dressing daily and as needed. Cover and secure with ABD (Abdominal) pad or absorptive pad equivalent, may use incontinence pad as substitute. Secure in place with Medipore tape or may or may not use sports bra to hold dressing in place ensuring elastic band does not rub against wound.




Review of the SN notes dated 3/9/22 revealed no documentation of the new wound care nor was there documentation of a return demonstration for the new wound care.




An interview was conducted on 3/17/22 at 9:35 AM with EI # 6, Performance Improvement Coordinator, who confirmed there was no documentation of a return demonstration or of specific teaching.

1. MR # 4 was admitted to the agency on 1/14/22 with diagnoses including Aftercare following Joint Replacement surgery, Essential (Primary) Hypertension, and Dependence on Supplemental Oxygen.




Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 1/14/22 to 3/14/22 revealed documentation of a Physical Therapy (PT) frequency of 1wk1, 3wk1,1wk1 (once a week for 1 week, three times a week for 1 week) and a physician's order for "PT to provide/instruct/reinforce to pt/cg wound care to Right Knee Surgical wound daily. Cleanse with Antimicrobial Soap. Cover with Island Dressing.




Review of the PT Visit Note Reports (VNR) revealed no documentation the PT provided education to the pt/cg on how to provide wound care and obtained a return demonstration of the wound care to ensure competency.




An interview was conducted on 3/16/22 at 3:51 PM with Employee Identifier (EI) # 7, Patient Care Manager (PCM), who confirmed there was no documentation wound care education was provided to the pt/cg and a return demonstration was obtained.