| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017037 | (X3) Date Survey Completed 11/21/2019 |
| 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 review of medical records (MR), agency policies and procedures, and interviews with agency staff, it was determined the agency failed to ensure: 1. The physician was promptly notified of blood clots in foley bag, edema to genital area after removal of a foley prior to attempt to reinsert a new foley catheter. 2. The physician was promptly notified of the patients pain above established parameters. 3. The physician was promptly notified of a significant increase in wound size. This deficient practice affecting 3 of 17 records reviewed including MR # 5, Home Visit (HV) # 6, MR # 7, and had the potential to negatively affect all patients served by the home health agency. Findings Include: Policy: Coordination Of Care, From Admit Through Discharge Policy Number: 2.1.017 Revised Date: 8/1/19 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: Identifying patient needs through assessment and communication with other health care providers ... ...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 or 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 4/8/19 and discharged on 5/8/19. Admitting diagnoses included Chronic Obstructive Pulmonary Disease (COPD) with Acute Exacerbation, Acute Diastolic Congestive Heart Failure (CHF), and Chronic Atrial Fibrillation. Review of the Client Coordination Note dated 4/11/19 revealed the agency received a phone call from the patient's wife stating "no urine draining in catheter bag since 0400 (4:00 AM) and he is hurting really bad ..." Review of the Visit Note Report from the PRN visit made by the SN on 4/11/19, documentation revealed " ...Blood clots in new urine bag ..." There was no documentation the physician was notified of the patient not having urinary output, patient's increased pain and blood clots in the Foley drainage bag. Review of the Visit Note Report from the PRN visit made by the SN on 5/4/19 at 2:05 PM revealed "...Thick yellow grayish urine in foley bag ...SN call ambulance to have patient sent to ER ..." Further review of the Visit Note Report of a PRN visit made by the SN on 5/4/19 at 3:24 PM revealed " ...urine in tube cloudy and strong odor noted ...attempted to insert new foley catheter. Foley would not advance into the bladder. Strong resistance met and was not going to force the foley. Advised patient and wife to go to ER (emergency room) for treatment." There was no documentation the physician was notified of the patient's discolored and foul-smelling urine in foley drainage bag and the SN's inability to insert a new foley prior to the SN notifying the ambulance for transport to the ER. An interview was conducted on 11/21/19 at 2:02 PM with Employee Identifier (EI) # 2, Performance Improvement Coordinator, who confirmed the above findings. 2. HV # 6 was admitted to the agency on 10/15/19 with diagnosis including Gout, Atherosclerotic Heart Disease, Chronic Kidney Disease, Congestive Heart Failure, and Pressure Ulcer of Sacral Region. Review of the Home Health Certification and Plan of Care (POC) dated 10/15/19 to 12/13/19 revealed the physician ordered "when vital signs are obtained by licensed professional to report vital signs falling outside the following established parameters:...Pain greater than 6". Review of Occupational Therapy (OT) Visit Note Report dated 11/4/19 revealed the OT documented the patient pain scale of 7. There was no documentation the physician was notified of HV # 6's pain scale of 7. An interview was conducted on 11/21/19 at 11:10 AM with EI # 1, Executive Director who confirmed the above findings. 3. MR # 7 was admitted to the agency on 2/4/18 and recertified for home care 10/17/19 to 12/15/19 with diagnoses including Pressure Ulcer of Sacral Region, Chronic Kidney Disease, and Congestive Heart Failure. Review of the SN Visit Note Report dated 11/1/19 revealed wound # 1 coccyx stage IV pressure ulcer measurements Length 7 cm (centimeters) x Width 11 cm x Depth 3 cm. Review of SN Visit Note Report dated 11/4/19 revealed wound # 1 coccyx stage IV pressure ulcer measurements Length 10 cm x Width 6 cm x Depth 3 cm. There was no documentation the physician was notified of the increased wound length by 3 cm. An interview was conducted on 11/21/19 at 10:50 AM with EI # 2, Performance Improvement Coordinator who confirmed the above findings. |