| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017037 | (X3) Date Survey Completed 10/10/2018 |
| Name of Provider or Supplier Alabama Homecare Of Montgomery, Llc | Street Address, City, State 400 South Union Street Suite 285, Montgomery, 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) 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 medical records (MR) review, agency policy and procedure, and staff interviews, it was determined staff failed to notify the physician for change in the patient's condition which included deterioration in wound status. This affected 3 of 6 records reviewed with wounds and did affect MR # 5, Home Visit (HV) # 1, MR # 2, and had the potential to negatively affect all patients served by the agency. Findings include: Policy: 2.1.017 Subject: Coordination of Care, From Admit Through Discharge Revised: 01/01/2018 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...coordinating patient care among various disciplines to ensure that services are continuous and coordinated from admission through discharge. 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 or response to treatment... 1. MR # 5 was admitted to the agency on 3/9/18 and recertified for continued care for the dates of 9/5/18 through 11/3/18 with diagnoses including Type 2 Diabetes Mellitus with Foot Ulcer. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 9/5/18 through 11/3/18 revealed a physician's order for skilled nurse (SN) to instruct/perform/reinforce wound care with negative pressure device to left diabetic ulcer... Review of the Visit Note Report dated 9/11/18 revealed documentation of wound # 3 Left Distal Dorsum Diabetic Ulcer exudate (drainage) as a moderate amount of serosanguineous exudate. Review of the Visit Note Report dated 9/14/18 revealed documentation of wound # 3 exudate as a moderate amount of purulent exudate. Review of the Visit Note Report dated 9/17/18 revealed documentation of wound # 3 exudate as a moderate amount of purulent exudate. Further review of the Visit Note Report dated 9/14/18 and 9/17/18 revealed no documentation the physician was notified of the change of the wound exudate. An interview was conducted on 10/10/18 at 1:22 PM with EI (Employee Identifier) # 1, Executive Director, who confirmed the previous findings. 2. HV # 1 was admitted to the agency on 8/27/18 with diagnoses including, Encounter for Orthopedic Aftercare Following Surgical Amputation. Review of the Physician Order dated 8/29/18 revealed the following physician's order: "SN (skilled nurse) to perform wound care with KCI (company that supplies the Negative Pressure Device) Negative Pressure Device to # 2 Right Transmetatarsal Surgical Amputation site..." Review of the Visit Note Report dated 9/10/18 revealed wound # 2 measurements as "11 x 6 x 0.1" (length x (by) width x depth) in cm (centimeters). Review of the Visit Note Report dated 9/12/18 revealed wound # 2 measurements as "13.5 x 7.5 x 0.2" in cm, which was an increase in length by 2.5 cm, width by 7.5 cm, and depth by 0.1 cm. Further review of the Visit Note Report dated 9/12/18 revealed no documentation the physician was notified of the increased length, width, or depth of wound # 2. Review of the Visit Note Report dated 9/26/18 revealed documentation of wound # 2 measured width as 7 cm. Review of the Visit Note Report dated 10/1/18 revealed documentation of wound # 2 measured width as 14 cm, which was an increase of 7 cm. Further review of the Visit Note Report dated 10/1/18 revealed no documentation the physician was notified of the increased width of wound # 2. An interview was conducted on 10/10/18 at 1:19 PM with EI # 1, who confirmed the previous findings. 3. MR # 2 was admitted to the agency on 7/25/18 with diagnoses including Type 2 Diabetes Mellitus with Diabetic Polyneuropathy and Non-Pressure Chronic Ulcer of Left Heel and Midfoot with Fat Layer Exposure. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 7/25/18 through 9/22/18 revealed a physician's order for "Skilled Nurse (SN) to Perform / Instruct / Reinforce patient/caregiver procedure of wound care to left foot..." Review of the Visit Note Report dated 7/25/18 revealed wound # 1 Lt (left)-Mid Plantar, Diabetic Ulcer length measurement as "7" cm. Review of the Visit Note Report dated 7/30/18 revealed wound # 1 length measurement as "7.5" cm, which was an increase in length by 0.5 cm. Further review of the Visit Note Report dated 7/30/18 revealed no documentation the physician was notified of the increased length of wound # 1. Further review of the Visit Note Report dated 7/30/18 revealed wound # 1 depth measurement as "0.2" cm. Review of the Visit Note Report dated 8/6/18 revealed wound # 1 depth measurement as "1" cm, which was an increase in depth by 0.8 cm. Further review of the Visit Note Report dated 8/6/18 revealed no documentation the physician was notified of the increased depth of wound # 1. Review of the Visit Note Report dated 8/20/18 revealed wound # 1 width measurement as "3" cm. Review of the Visit Note Report dated 8/27/18 revealed wound # 1 width measurement as "3.4" cm, which was an increase in width by 0.4 cm. Further review of the Visit Note Report dated 8/27/18 revealed no documentation the physician was notified of the increased width of wound # 1. An interview was conducted on 10/10/18 at 1:44 PM with EI # 1, who confirmed the previous findings. |