| 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) |
| G0610 | Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on review of medical records (MR) and interview with staff it was determined the agency failed to ensure instruction and teaching was provided to the patient/caregiver as ordered in the Plan of Care. This deficient practice affected 1 of 17 MRs reviewed including MR # 4, and had the potential to affect all patients served by this agency. Findings include: 1. MR # 4 was admitted to the agency 4/25/19 with diagnoses including Pilonidal Cyst With Abscess, Essential Hypertension, Type 2 Diabetes Mellitus With Diabetic Neuropathy Unspecified, and Hyperparathyroidism Unspecified. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 4/25/19 revealed orders for the skilled nurse (SN) to instruct: a. On diabetes to include disease process, signs and symptoms of exacerbation, complications and management. b. New and changed medication, those with assessed knowledge deficit, high risk medications and any applicable drug interactions. c. Patient/caregiver in measures to improve home safety and reduce fall risk. Review of the SN admission visit dated 4/25/19 revealed the patient and caregiver had knowledge base deficits of: technical procedures; pathophysiology of disease; signs and symptoms to report; home safety/emergency procedures; and medications. Further review of the SN note dated 4/25/19 revealed the patient was at risk for falling and "instructed on fall prevention". There was no documentation what patient-specific instructions were provided. Review of the Client Coordination Note dated 4/29/19 revealed the note type as "clinically significant medication issue". The form instructed to "briefly describe the medication issue and follow up" and this section was blank. There was no documentation in the MR what the medication issue was and what follow up was completed. Review of the SN visit notes dated 4/30/19 and 5/3/19 revealed no documentation of instructions provided regarding diabetes management including blood sugar testing, signs and symptoms of exacerbation, and complications. There was no documentation of instructions on high risk medications for diabetes - Januvia, Metformin, and Novolog insulin. Review of the MR revealed MR # 4 was admitted to the hospital on 5/6/19 for diabetes out of control/hyperglycemia. Review of the discharge summary dated 5/8/19 revealed medication changes to include Novolog insulin sliding scale before meals max (maximum) 10 units per day and Tresiba Flexpen 22 units once daily. Review of the SN Resumption of Care visit note dated 5/9/19 revealed the patient's random blood sugar was 248. The narrative note documentation revealed the visit was for wound care and additional teaching on medications, and new medication changed noted. There was no documentation the SN instructed on the Novolog and Tresiba insulin. Review of the physician's order dated 5/23/19 revealed the SN to visit for post fall follow up. Review of the SN visit note dated 5/23/19 revealed the patient fell at the physician's office. There was no documentation the SN provided instructions for fall prevention and safety. An interview conducted on 11/21/19 at 1:40 PM with Employee Identifier (EI) # 1, Executive Director, confirmed the above findings. |