| 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) |
| 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 review of medical records (MR), agency policy and procedure, Fundamentals of Nursing by Potter-Perry, and interview with agency staff, it was determined the agency failed to ensure the following: 1. The patient or caregiver was provided instruction on how to perform wound care. 2. The patient or caregiver performed a return demonstration to ensure competency for wound care. This affected 1 of 6 records reviewed with wounds including MR # 2. This had the potential to negatively affect all patients served by the agency. Findings include: Policy: 3.001 Subject: Patient Education Revised: 11/1/2017 "Purpose: To describe patient and/or caregiver interactions designed to promote and maximize patient health and safety Policy: The agency plans, supports, and coordinates patient and caregiver education designed to promote optimal patient 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 patient and caregiver receive ongoing information specific to the identified needs, at a level appropriate to their learning abilities, including: ...b. Patient/caregiver plan of care responsibilities... Fundamentals of Nursing by Potter-Perry 6th Edition Chapter 24 Client Education Page 473 Key Concepts-....A nurse evaluates a client's learning by observing performance of expected learning behaviors under desired conditions.... 1. 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. Using clean technique, cleanse with wound cleanser and pat dry. Apply Santyl to wound bed. Cover with Xeroform and ABD (abdominal) pad. Wrap with Kerlix. Secure with tape. Wound care to be performed daily... Caregiver to perform wound care in absence of SN..." Review of the Visit Note Report dated 7/25/18 revealed documentation of wound care at the visit was provided by the SN. Further review of the Visit Note Report dated 7/25/18 revealed the following documentation, "Patient lives alone but has a friend to come by to assist with wpund (wound) care. Verbalized good understanding of wound care and written step by step instructions left..." Further review of the Visit Note Report dated 7/25/18 revealed no documentation the "friend" that assists patient with the wound care was present at visit or that the "friend" was instructed and/or knowledgeable about the wound care to be performed. Review of the Visit Note Report(s) dated 7/27/18 and 7/30/18 revealed documentation of wound care was provided by the SN Further review of the Visit Note Report(s) dated 7/27/18 and 7/30/18 revealed no documentation the caregiver was provided instruction on wound care or that a return demonstration was obtained to ensure caregiver competency with wound care. Review of the Physician order dated 8/1/18 revealed order for "SN to Perform / Instruct / Reinforce patient/caregiver procedure of wound care to left foot: using clean technique, cleanse with wound cleanser and pat dry. Apply Prisma or equivalent to wound bed. Cover with Xeroform, dry gauze and ABD pad. Wrap with cotton and kerlix. Secure with paper tape. Wound care to be performed 3 times a week...Caregiver to perform wound care in absence of SN..." Review of the Visit Note Report dated 8/3/18 revealed documentation of wound care was provided by the SN. Further review of the Visit Note Report dated 8/3/18 revealed no documentation the caregiver was provided instruction on wound care or that a return demonstration was obtained to ensure caregiver competency with wound care. Review of the Physician Order dated 8/6/18 revealed order for "SN to provide negative pressure wound therapy to Left Foot wound...Cg (Caregiver) may apply normal saline wet to dry dressing if vac malfunctions..." Review of the Visit Note Report dated 8/6/18 revealed documentation of the following, "Patient educated on wet to dry dressing, patching leaks and changing canister, verbalized understanding." Further review of the Visit Note Report dated 8/6/18 revealed no documentation that the caregiver was provided instruction on the normal saline wet to dry wound dressing for vac malfunctions or that a return demonstration was obtained to ensure caregiver competency with normal saline wet to dry wound dressing. Review of the Visit Note Reports dated 8/8/18 through 9/11/18 revealed no documentation the caregiver was provided instruction on the normal saline wet to dry wound dressing for vac malfunctions or that a return demonstration was obtained to ensure caregiver competency with normal saline wet to dry wound dressing. An interview was conducted on 10/10/18 at 1:44 PM with Employee Identifier # 1, Executive Director, who confirmed the previous findings. |