Every finding on record at A1 Nursing Solution LLC

Substantial Allegation Survey Substantial Allegation 103352 An entrance conference was conducted on 01/18/24 at 10:02 AM with Administrator. An exit conference was conducted on 01/18/24 at 4:08 PM with administrative staff. The following deficiencies are based upon substantial allegation 103352 completed on 01/18/24. A1 Nursing Solution LLC 369237, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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 policy review, record review, and staff interview, the agency failed to ensure patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the agency, as appropriate, regarding the care and services identified in the plan of care for one of one patient reviewed with wound care (Patient #3). The total sample was three patients. The census was 94. Findings include: Review of the undated agency policy titled, “Wound Care,” revealed education with the patient and/or caregiver regarding wound healing will be ongoing and documented in the patient’s record. Review of Patient #3's medical record physician ordered plan of care dated 11/22/23 revealed orders for the nurse to instruct Patient #3, or caregiver, to change the negative pressure wound therapy (wound vac canister) when three-quarters full, but no more than every seven days, and instruct Patient #3 on application of a wet to dry dressing as needed for wound vac failure. Review of the skilled nursing visit sheets from 11/22/23 to 11/29/23 (four visits) revealed no patient or caregiver instructions on wound healing, when the canister should be changed or instructions on application of a wet to dry dressing as needed for wound vac failure. Interview on 01/18/24 at 2:20 PM with Staff A confirmed there was no documentation education on wound healing and when the canister should be changed was not provided per order or policy. Staff A also confirmed the lack of patient education on application of a wet to dry dressing as needed for wound vac failure per order. This deficiency represents non-compliance investigated under Substantial Allegation 103352.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on policy review, record review, and staff interview, the agency failed to ensure clinical notes were prepared for one of one patient reviewed with wounds (Patient #3). The total sample was three patients. The census was 94. Findings include: Review of the undated agency policy titled, “Wound Care,” revealed if a wound is noted during an assessment document the amount of drainage in the patient record. Review of Patient #3's medical record revealed the skilled nurse visit sheets from 11/22/23 to 12/01/23 (five wound vac dressing changes) lacked documentation of the amount of drainage from the wound vac. The only documentation was that the wound dressing was changed, and the wound vac was applied. Interview on 01/18/24 at 2:20 PM with Staff A confirmed the wound drainage was not documented per policy. This deficiency represents non-compliance investigated under Substantial Allegation 103352.