Every finding on record at Adoration Home Health Martin

An Emergency Preparedness Survey was conducted along with a recertification survey beginning 7/22/24. The facility was found to be in compliance with the regulations reviewed related to Emergency Preparedness.

A recertification survey was conducted beginning 7/22/24 and concluded on 7/24/24. An exit conference was held on 7/24/24 with survey findings provided.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on policy review, record review and interview, the facility failed to ensure wound care orders and laboratory orders were followed per plan of care (POC) for 2 of 12 (Patient #2 and #8) active patients reviewed. The findings included: 1.Review of the facility's "PLAN OF CARE AND PHYSICIAN ORDERS" policy (revised 1/12/2024) revealed, "...Each patient must receive the home health services that are written in the individualized plan of care...In the event of a change in patient condition or needs that suggest outcomes are not being achieved and/or that the patient's plan of care should be altered, the agency will promptly alert both the responsible physician or allowed practitioner and the physician/allowed practitioner associated with the relevant aspect of care.. Review of the facility's "WOUND CARE" policy (revised 7/26/2022) revealed, "...All wound care will be performed in accordance with physician orders...All wound assessments, wound care, and teaching will be documented in the clinical record..." 2.Medical record review for Patient #2 revealed a Start of Care (SOC) date of 4/26/24 with diagnoses that included Type 2 Diabetes Mellitus (DM) with foot ulcer. Review of the 6/25/24 through 8/23/24 POC revealed wound care orders that documented, "Remove all dressing material excluding the yellow Xeroform [fine mesh gauze used on exudating wounds] layer. Cleanse the skin around the top and side of the foot with wound spray or Hibiclens [antibacterial/antimicrobial skin cleanser] and pat dry. When applying a new dressing to the right foot, ensure that lots of cushion is used. To achieve this, layer unfolded sterile 4"x4"s on top of one another until a large bolster/fluff is created. Insure [ensure] that the bolster/fluff covers the entire wound. Please insure [ensure] that there is plenty of cushion covering the entire plantar surface!!! Then start with 2 rolls of Kerlix (or similar roll gauze) and secure in place with one roll of Kling [rolled gauze]. Apply a clean stockinet and the patient's post-op shoe" Review of Skilled Nurse (SN) visit notes beginning 6/28/24 through 7/22/24 revealed LPN #1 documented, "wound care provided per MD [medical doctor] orders" on the 6/28, 7/1, 7/5, 7/8, 7/15, 7/19 and 7/22/24 SN visit notes. There was no documentation of the actual wound care provided on those visit dates. In an interview on 7/24/24 at 10:55 AM, the facility's Administrator stated the wound care documentation "...should be specific...how else do you know they're following the right orders..." 3.Medical record review for Patient #8 revealed a SOC date of 6/7/24 with diagnoses that included infection of amputation stump and cellulitis of left lower limb. Review of the 6/7/24 through 8/5/24 POC revealed orders that documented, "Skilled Nurse to obtain CBC [complete blood count], BMP [basic metabolic profile], ESR [erythrocyte sedimentation rate], and CRD [component resolved diagnosis] labs via PICC [peripherally inserted central catheter] line every Monday". Review of Patient #8's SN visit notes beginning 6/7/24 revealed week of 7/7/24, the SN visit and ordered lab work was performed on Tuesday, 7/9/24. There was no documentation why the SN visit and ordered lab work was not performed on Monday, 7/8/24, as ordered. Further review of Patient #8's POC revealed a 7/12/24 supplemental physician order that documented, "...collect wound culture week of 7/15..." Review of week of 7/14/24 SN visit notes revealed no documentation a wound culture was collected as ordered. 4.In an interview on 7/24/24 at 10:00 AM, the facility's Administrator verified there was no documentation the SN collected a wound culture the week of 7/15/24 and stated, "...they should have had an order to cancel the wound culture since it was done at the physician's office..."

An Emergency Preparedness survey was conducted along with a recertification survey beginning 6/14/2021. This facility was found to be in compliance with the regulations reviewed related to Emergency Preparedness.

A recertification survey was initiated on 6/14/20201 at the facility's home office. An entrance conference was held with the Administrator. The survey was completed on 6/17/2021 and an exit conference was held with the following staff: Administrator, Patient Care Manager, Branch office Clinical Managers, Vice President of Operations, Director of Quality and Private Duty Clinical Supervisor.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on policy review, medical record review and interview, the facility failed to ensure the plan of care (POC) was followed for wound care and weights for three of twelve (Patients #9, 10 and 11) active patients reviewed. The findings included: 1. Review of the facility's "Physician Orders" policy revealed, "...Skilled nursing and other home health services will be in accordance with a Plan of Care based on the patient's diagnosis and assessment of immediate and long-range needs and resources...Care and services provided will be provided according to physician orders. Orders are current and updated..." 2. Medical record review for Patient #9 revealed a POC dated 4/29/2021-6/27/2021 with diagnoses that included Cutaneous abscess of perineum, Pressure Ulcer of Sacral Region (Stage 3) and Chronic diastolic heart failure. Skilled Nursing (SN) was ordered for one visit weekly for eight weeks beginning the week of 5/3/2021. Patient #9's POC documented SN was to monitor the patient's weight. Review of SN notes beginning 5/7/2021 through 6/9/2021 revealed no documentation that the patient's weight was monitored. Patient #9's POC documented the following wound care to be provided by SN for the pannus (a condition in which a layer of vascular fibrous tissue extends over the surface of an organ or other specialized anatomical structure) excoriation wound: Cleanse with sterile saline or wound cleanser and dry, apply Santyl (debrieding ointment), aquacel ag (wound dressing integrated with silver), abd pad (non-adherent dressing) and tape. Review of SN notes beginning 5/7/2021 through 6/9/2021 revealed no documentation that Santyl ointment was applied to the pannus wound as ordered. Patient #9's POC documented the following wound care to be provided by SN for the suprapubic scattered excoriation and candidiasis (yeast) wound every visit: Cleanse with wound cleanser or sterile saline, dry, apply aquacel, ABD pad and secure with tape. Review of a 5/21/2021 SN note revealed the wound was cleansed, but no further treatment performed. Review of a 5/28/2021 SN note revealed the wound was cleansed, then barrier cream was applied. The facility failed to ensure the POC related to wound care was followed for Patient #9. 3. Medical record review for Patient #10 revealed a POC dated 4/18/2021-6/16/2021 with diagnoses that included Pressure ulcer of left buttock (Stage 2), Pressure ulcer of right buttock (Stage 2), Myopathy, and unspecified Heart Failure. SN was ordered for one visit weekly for eight weeks beginning week of 4/19/2021. Patient #10's POC documented the SN was to notify the MD of any weight gain or loss of 2 pounds in 24 hours or 5 pounds in 7 days. Review of SN notes beginning 4/22/2021 through 6/16/2021 revealed no documentation of Patient #10's weights. The facility failed to ensure the POC related to monitoring of Patient #10's weights was followed. 4. Medical record review for Patient #11 revealed a POC dated 5/21/2021-7/19/2021 with diagnoses that included Chronic Venous Hypertension with ulcer and inflammation of right lower extremity, Atherosclerotic native arteries of right leg with ulceration of ankle. SN was ordered for two visits weekly for eight weeks beginning week of 5/24/2021. Patient #11's POC documented the following wound care to be provided by the SN to the right leg and right foot every visit: Add foam protectors to heels to prevent breakdown. Review of a SN note dated 5/25/2021 revealed no documentation that the SN applied foam protectors to Patient #11's heels as ordered per the POC. 5. In an interview on 6/17/2021 at 12:15 PM, the Administrator verified the POC was not followed for weight monitoring and wound care for Patients #9, 10 and 11.