| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017037 | (X3) Date Survey Completed 05/11/2023 |
| 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) or allowed practitioner(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 policy and procedure, hospital report and staff interviews, it was determined the agency failed to ensure the physician was promptly notified of changes in the patient's condition or needs. This deficient practice affected six of 17 MR's reviewed, including MR # 8, Home Visit (HV) # 5, MR # 3, MR # 10, HV # 3, MR # 9 and MR # 7, and had the potential to negatively affect all patients admitted to this agency. Findings include: Agency Policy: Coordination of Care, from Admit Through Discharge Policy number: 2.1.017 Revised: 04/01/23 ...Policy: The agency provides care and services within an integrated continuum of care system... Identifying patient needs through assessment and communication with other health care providers... Procedure: ...4. Coordination of care with physician:... a. When changes occur in the patient's condition or response to treatment... b. When changes occur in caregiver support or the environment that affect patient treatment. ...e. When there is a need to change the patient's plan of care. 6. MR # 9 was admitted to the agency on 7/29/22 with diagnoses including Hypertensive Heart Disease without Heart Failure, Paroxysmal Atrial Fibrillation and Type 2 Diabetes Mellitus without Complications. Review of the HHC and POC dated 7/29/22 to 9/26/22 revealed an order for Physical Therapy (PT) to instruct patient on management of Diabetes. Review of the Physical Therapy (PT) Visit Note dated 7/29/22 revealed the patient does not have a glucometer and believes he/she is not a Diabetic. Further review of the PT Visit Note dated 7/29/22 revealed the patient's home "...is cluttered and unsanitary with dog urine/feces on floor..." and the patient's spouse was having difficulty caring for the patient. There was no documentation the physician was notified of the patient not having a glucometer in the home, home condition and difficulty of caregiver in caring for patient. Review of the PT Visit Note dated 8/2/22 revealed the patient was found laying on the sofa in his/her own urine and feces and reported he/she had been that way for a week. The fire department was called to assist in transferring the patient to a hospital bed. Further review of the PT Visit Note dated 8/2/22 revealed the home had a strong odor due to multiple small dogs were in the home with animal feces and urine throughout the house. The PT felt it was unsafe to breathe the air in the home and the caregiver was unable to provide adequate care for the patient. There was no documentation the physician was notified of the patient condition, the caregiver being unable to provide adequate care for the patient and the home condition. Review of the PT Visit Note dated 8/4/22 revealed the patient was found in the same unsanitary conditions as the visit on 8/2/22 with the bed saturated and the PT felt the home was unsanitary and is not suitable for habitation. There was no documentation the physician was notified of the patient condition and the home condition. An interview was conducted on 5/11/23 at 9:50 AM with EI # 1 who confirmed the PT failed to notify the physician of the patients condition and home environment. 7. MR # 7 was admitted to the agency on 12/19/22 with diagnoses including Hypertensive Heart and Chronic Kidney Disease with Heart Failure and Stage 1 Through Stage 4 Chronic Kidney Disease, or Unspecified Chronic Kidney Disease, Unspecified Systolic (Congestive Heart Failure) and Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease. Review of the HHC and POC dated 12/19/22 to 2/16/23 revealed an order for the licensed professional to report a blood sugar below 60 mg/dL (milligrams per decilitre) or above 250 mg/dl. Review of the PT visit note dated 12/28/22 revealed a blood sugar of 316 mg/dL. There was no documentation the PT notified the physician of the blood sugar. Review of the PT visit note dated 1/6/23 revealed a blood sugar of 341 mg/dL, the patient's weight had increased by 14 pounds since the start of care on 12/19/22, 18 days, and the patient verbalized he/she had been noncompliant with fluid pills administration and monitoring blood glucose. There was no documentation the PT notified the physician of the blood sugar, weight gain and patient noncompliance. Review of the PT visit note dated 1/11/23 revealed a morning blood sugar of 426 mg/dL, a noon blood sugar of 406 mg/dL and the patient was noncompliant with diabetic medication administration. There was no documentation the PT notified the physician of the blood sugars and the patient noncompliance. Review of the PT visit note dated 1/17/23 revealed a blood sugar of HI during the visit and the patient was not complaint with monitoring blood sugar and administration of medications. There was no documentation the PT notified the physician of the blood sugar and the patient noncompliance. Review of the PT visit note dated 1/18/23 revealed no documentation of a blood sugar and assessment of patient compliance with diabetic management and medication administration. Review of the hospitalization report dated 1/23/23 revealed the patient was hospitalized with a blood sugar of 821 mg/dL. An interview was conducted on 5/11/23 at 10:57 AM with EI # 1 who confirmed there was no documentation the PT notified the physician of the patient's blood sugars, weight gain and noncompliance. 5. HV # 3 was admitted to the agency on 4/6/23 with admitting diagnoses of Encounter for Surgical Aftercare Following Surgery on the Digestive System and Essential (Primary) Hypertension. Review of the HHC and POC dated 4/6/23 revealed the SN was to visit one time a week for one week, then two times a week for one week, and one time a week for two weeks. The SN to perform/instruct/ reinforce patient and caregiver procedure of wound care to wound # 1 anterior-abdominal right lower quadrant - surgical incision daily and as needed for soiled or dislodged dressings. Cleanse with soap and water and gauze. Rinse well and pat dry with gauze. Cover with bordered gauze using clean technique... Review of the RN (Registered Nurse) Add On Evaluation dated 4/7/23 revealed wound # 1 measured 1 cm in length x 0.1 cm in width x 0 cm in depth. Review of the SN visit note dated 4/11/23 revealed wound # 1 measurements as 0.1cm in length x 6.2 cm in width x 0 cm in depth. Review of the 4/11/23 SN visit note revealed no documentation the physician was notified of the increase of the width of wound # 1 from 0.1 cm to 6.2 cm. An interview was conducted on 5/11/23 at 10:23 AM with EI # 1 who confirmed the documentation of the wound was incorrect and the nurse did not document the physician was notified. 3. MR # 3 was admitted on 4/18/23 with admitting diagnoses including Chronic Obstructive Pulmonary Disease and Acute and Chronic Respiratory Failure with Hypoxia. Review of the HHC and POC dated 4/18/23 revealed orders for SN visits two times a week for one week then one time a week for six weeks. Physical Therapy (PT) one time a week for one week then two times a week for four weeks. Occupational Therapy (OT) effective 4/23/23 one time a week for one week. Further review of the HHC and POC dated 4/18/23 revealed Licensed Professional to report vital signs outside of the following parameters: Pain greater than six out of ten. Review of the PT visit note dated 4/20/23 revealed the patient reported pain eight out of ten. There is no documentation the physician was notified of pain outside the parameters. Review of the OT visit note dated 5/2/23 revealed the patient reported pain eight out of ten. There is no documentation the physician was notified of pain outside of parameters. An interview was conducted on 5/11/23 at 1042 with EI # 1, who confirmed there was no documentation physician was notified of pain outside of parameters. 4. MR # 10 was admitted to the agency on 3/8/23 with admitting diagnoses including Cellulitis of Left Upper Limb and Type Two Diabetes Mellitus with Diabetic Polyneuropathy. Review of the HHC and POC dated 3/8/23 revealed Occupational Therapy (OT) visits one time a week for one week effective 3/12/23. Further review of the HHC and POC dated 4/18/23 revealed Licensed Professional to report vital signs outside of the following parameters: Pain greater than six out of ten. Review of the OT visit note dated 3/17/23 revealed the patient reported pain of seven out of ten. There is no documentation the physician was notified of pain outside of parameters. An interview was conducted on 5/11/23 at 9:57 AM with EI # 1, who confirmed there was no documentation physician was notified of pain outside of parameters. 1. MR # 8 was admitted on 6/16/22 and recertified for home care from 10/14/22 to 12/12/22 with diagnoses including Non Pressure Chronic Ulcer of Left Lower Leg, Essential (Primary) Hypertension, and Paroxysmal Atrial Fibrillation. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 10/14/22 revealed orders for SN (Skilled Nurse) one visit per week for eight weeks. Review of the SN Visit Note dated 11/23/22 revealed the SN documented the presence of wound # 6, Stage II pressure ulcer to the distal lateral left posterior distal calf, onset date 11/23/22. The wound measurements were 0.6 cm (centimeters) length x 0.3 cm width x 0.1 cm depth with scant serosanguous exudate. Further review of the SN Visit Note dated 11/23/22 revealed no documentation the physician was notified of the new pressure ulcer. An interview was conducted on 5/11/23 at 10:00 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed there was no documentation the physician was notified of the new wound. 2. HV # 5 was admitted on 4/20/23 with diagnoses including Hypertensive Heart Disease, Heart Failure, and Post Procedure Hematoma of the Skin. Review of the HHC and POC dated 4/20/23 revealed orders for SN one visit a week for one week then two visits a week for three weeks. Review of the Physician Order dated 4/24/23 revealed orders for the SN to perform/instruct/reinforce patient/caregiver procedure of wound care to wound # 1 left subclavian surgical incision. Review of the SN Visit Note dated 4/27/23 revealed the SN documented wound # 1 measurements were 1 cm length, 2 cm width, and 0.2 cm depth. Review of the SN Visit Note dated 5/2/23 revealed the SN documented wound # 1 wound measurements were 5.8 cm length x 0.1 cm width x 0 cm depth. There was no documentation the physician was notified of the increase in wound size. Review of the SN Visit Note dated 5/4/23 revealed the SN documented wound # 1 wound measurements were 3.7 cm length x 0.1 cm width x 0 cm depth. An interview was conducted on 5/11/23 at 10:30 AM with EI # 1 who confirmed there was no documentation the physician was notified of the increase in wound size. |