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 03/27/2025
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)
G0572 Plan of care
CFR(s): 484.60(a)(1)

Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan.


This STANDARD is not met as evidenced by:
Based on review of agency policy and procedure, medical records (MR), and staff interviews it was determined the agency failed to follow Plan of Care (POC) ordered visit frequency.  

This deficient practice did affect two of 17 MRs reviewed including Home visit (HV) # 7, MR # 6, and had the potential to negatively affect all patients served by the agency. 

Findings include: 

Agency Policy: POC

Policy Number: 2.1.007

Revised Date: 9/1/24

Purpose: To assure an appropriate POC is developed and revised in a timely manner for each patient. To ensure that physician/authorized practitioner's orders are followed. 

Policy: Each patient has an individualized POC developed...that integrates comprehensive assessment findings to address patient problems, needs, and goals, as well as to address specific services being provided. 

Procedure: 

...2. The POC includes: 

...b. Types, frequency, and duration of services required...

i. Patient specific interventions...measurable outcomes and goals identified by the agency and patient. 

 


2. MR # 6 was admitted on 2/11/25 with diagnoses including Type 2 Diabetes Mellitus with Hyperglycemia, Hypertensive Heart and Chronic Kidney Disease, and Chronic Diastolic (Congestive) Heart Failure.

Review of the Home Health Certification and Plan of Care dated 2/11/25 revealed physicians orders for Skilled Nurse (SN) one visit per week for one week, two visits per week for one week, then one visit per week for seven weeks and Physical Therapist (PT) one visit for one week, then two visits per week for eight weeks.

Review of the SN and PT Visit Notes for the week 2/23/25 to 3/1/25 revealed no SN visits were completed and one of two PT visits were completed.

There was no documentation the physician was notified of the missed visits and no documentation the agency attempted to reschedule the visits. 

An interview was conducted on 3/27/25 at 12:15 PM with EI # 9, Registered Nurse, who confirmed the agency failed to ensure the physician's orders for visit frequency were followed.

 

1. HV # 7 was admitted to the agency on 2/6/25 with diagnoses including Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease and Hypertensive Heart and Chronic Kidney Disease without Heart Failure, with Stage 1 through Stage 4 Chronic Kidney Disease. 

Review of the Physician Order dated 3/11/25 revealed an order for HHA (home health aide) once a week for four weeks. 

Review of the missed visit notification dated 3/13/25 (Thursday) revealed a missed HHA visit due to the patient having a physician appointment. 

Review of the HHA visit notes dated 3/11/25 to 3/15/25 revealed no documentation of a HHA visit or an attempt to reschedule the missed HHA visit. 

An interview was conducted on 3/27/25 at 12:57 PM with Employee Identifier (EI) # 2, Clinical Director, who confirmed there was no documentation of a HHA visit or an attempt to reschedule the missed HHA visit.