Every finding on record at Amedisys Georgia LLC

An unannounced complaint survey was conducted at Central Home Health Amedisys, in Douglasville, Georgia, on December 15, 2022. The agency was in substantial compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 infection control for Hospice.

An unannounced complaint survey was conducted at Central Home Health Amedisys, in Douglasville, Georgia, began on December 13, 2022, and concluded on December 15, 2022. The complaints 71714, 71946, and 93897, were Substantiated with deficiencies; but complaint 71815 was Unsubstantiated with no deficiencies. The agency was in compliance with Chapter 111-8-37 Rules and Requirements for Home Health and Hospice Agencies. The census was 1357. The following deficiencies were cited.

Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This ELEMENT is not met as evidenced by: Based on clinical record review, family, and staff interviews, it was revealed that the agency failed to document the complaints made by patient’s family related to having no Silvadene (silver gel) available as ordered by physician, to perform the left knee wound care for one (P#1) of three (3) sampled patients. Finding included: Review of physician’s order dated 8/28/22, revealed that skilled nurse to perform and teach patient and caregiver, wound care to traumatic wound to the patient left knee; irrigate and cleanse with normal saline, pat dry, then apply silver gel over exposed tendon; may apply skin barrier to peri-wound as needed to prevent maceration and protect peri-wound; cover with silver foam, secure with bordered gauze; change dressing three times weekly and as needed for soilage or displacement. On 12/13/22 at 3:06 p.m., an interview was conducted with the Clinical Manager (CM), of the Stockbridge branch, who stated the patient’s daughter called about wound dressing change and about wound supplies, but “I did not enter it into the complaint log. The nurse was waiting on the order from doctor for supplies for wound care, because we ran out of supplies.” The CM also stated that their protocol was after two days, the nurses would inform the CM if they were unable to contact the doctor, and then “I will try to contact the doctor, but this time (9/22/22), we had ordered the supplies for this patient.”

Patient's needs CFR(s): 484.55(c)(4) The patient's medical, nursing, rehabilitative, social, and discharge planning needs; This ELEMENT is not met as evidenced by: Based on clinical record review, family, and staff interviews, it was revealed that the agency failed to meet patient’s needs by not making Silvadene (sliver gel) available as ordered by physician, to perform left knee wound care for one (P#1) of three (3) sampled patients. Findings Included: Review of P#1’s clinical chart revealed that patient’s daughter had concern with incorrect wound care order for her father’s left knee. The physician’s order was to apply silver gel to the left knee; but the nurses have instead been using alginate to the left knee. During an interview with P#1’s daughter on 12/14/22 at 12:35 p.m., she stated that she asked (RN) BB, that the wound care order used for her father’s left knee was incorrect; and that she had been complaining since 8/28/22, but no one corrected it. P#1’s daughter stated that the nurses continued to use alginate and told her that silver gel was not available. During an interview with (RN) BB, on 12/14/22 at 1:57 p.m., she confirmed that the silver gel was not available when she visited P#1 on 9/22/22. (RN) BB also said that she used alginate for the left knee wound but called the Clinical Manager (CM) to order silver gel.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on clinical record review, family and staff interviews, it was revealed that the agency failed to follow Patient (P) plan of care (POC) to remove Medline intervenous catheter (IV), and also failed to perform left knee wound care with Silvadene (silver gel) as ordered by physician, for one (P#1) of three (3) sampled patients. Findings included: 1. Review of the Skilled Nurse (SN) assessment, physician’s order, and Plan of Care (POC) dated 8/28/22, revealed that P#1 had Medline intervenous order to administer Ceftriaxone (Rocephin) one gram solution every twelve hours, and to infuse over thirty minutes treatment for antibiotic, then discontinue on 8/31/22. On 12/13/22, at 3:00 p.m., review of client coordination note report written by Registered Nurse (RN) BB, dated 9/3/22, and skilled nurse’s note report after patient’s home visit, revealed that P#1’s daughter asked (RN) BB, to remove the IV. RN BB replied to P#1’s family that she could not remove the IV because there was no physician’s order to remove the IV. (RN) BB, did not remove the IV as ordered by physician. On 12/13/22 at 3:36 p.m., an interview was conducted with (RN) AA, who confirmed that she obtained the order from physician on 8/28/22, to remove the IV on 8/31/22, upon the completion of antibiotic. On 12/14/22 at 12:28 p.m., an interview was conducted with P#1’s daughter, who stated that she asked (RN) BB, to remove P#1’s IV on 8/31/22, when RN BB, visited her father, but RN BB, replied that she could not remove the IV because she did not have doctor’s order to remove the IV; so RN BB, left without removing the IV. On 12/14/22 at 1:49 p.m., an interview was conducted with (RN) BB, who confirmed that she was not aware of the physician’s order to remove IV on 8/31/22, because she did not synch her tablet computer. 2. Review of P#1 plan of care and physician’s order dated 8/28/22, required the skilled nurse to perform and teach patient and caregiver, wound care to traumatic wound to patient’s left knee; order revealed irrigate and cleanse left knee wound with normal saline, pat dry, then apply sliver gel over exposed tendon; may apply skin barrier to peri-wound as needed, to prevent maceration and protect peri-wound; cover with silver foam secure with bordered gauze; change dressing three times weekly and as needed for soilage or displacement. The skilled nurses’ notes from 8/28/22 to 9/22/22, revealed that the nurses have been using wrong treatment on P#1’s left knee. The skilled nurses’ notes revealed that they were using alginate, not silver gel. During an interview with P#1’s daughter on 12/14/22 at 12:35 p.m., she stated that she asked (RN) BB, that the wound care order used for her father’s left knee was incorrect, adding that she had been complaining since 8/28/22, and no one corrected it. P#1’s daughter said that the nurses kept using alginate and told her that silver gel was not available. During an interview with (RN) BB, on 12/14/22 at 1:57 p.m., she confirmed that the silver gel was not available when she visited P#1 on 9/22/22. (RN) BB also said she used alginate for the left knee wound, and that she called the Clinical Manager (CM) to order silver gel.

At the time of the survey, Central Home Health, an Amedisys Company, in Douglasville, Georgia was in compliance with 42 CFR Part 484, Requirement for Home Health, because of an onsite complaint investigation conducted on July 20, 2022, for complaint numbers #62184, #61631, and #62966. The complaint #61631 was substantiated, and deficiencies were cited related to the complaint. The agency census was 1462 at the time of the onsite visit. The following deficiencies were cited:

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency's skilled professional staff failed to provide services as ordered by the physician in the plans of care for one of three (#1) sampled patients. Findings include : Review of the plan of care for patient #1 with a certification period of 12/13/21 to 2/10/22 revealed pertinent diagnosis of Kidney transplant and disruption of internal operation (surgical) wound. The skilled nurse (SN) was required to provide wound care as follows: Apply Smith and Nephew wound Vac to surgical incision located to right lower quadrant of abdomen at 120 MMHG continuously. Change wound vac dressing 3 times weekly. Cleanse wound with normal saline or wound cleanser, apply /fill open wound with black foam , cover with Tegaderm and wound Vac drape dressing, In the event of malfunction of the device (wound Vac ) and maintaining a seal or discomfort or dislodgement of the dressing , SN may cleanse the wound with wound cleanser or normal saline, apply normal saline soaked gauze dressing, cover with gauze and tape to secure the dressing until the visit can be made to reapply the wound Vac device. Review of the SN visit note (admission assessment note) dated 12/13/21 revealed that SN made the visit and apply wound vac as ordered on the plan of care. Review of the Coordination note dated 12/14/21 titled "late note documentation " revealed that the wound Vac was malfunctioning and unable to fix the problem and the SN to follow up with the patient on 12/14/21. However, the clinical record lacked evidence of further SN visit notes on the week of 12/13/21. Review of the coordination note dated 12/15/21 revealed that patient called the agency to inquire about the SN visit. Review of the coordination note revealed that clinical manager verbalized to the patient that agency had reached out to the physician office to change the wound Vac system to another vendor (KCI) due to the agency nurses not being trained on this wound Vac (Smith and Nephew). Review of the verbal order dated 12/20/21 revealed wound care as follows: Cleanse wound with normal saline, pat dry, cover wound bed with dampen saline gauze, cover with ABD pad, and secure with tape. Dressing to be changed three times a week. This is a temporary wound care until nurses for Amedisys home health learn how to apply wound Vac. However, there were no evidence of coordination note to reflect the clinical manager notified the physician of not providing the wound care three times a week for the week of 12/13/21and further SN missed visits on the week of 1/9/22, 1/16/22 and 1/23/22, resulting in unauthorized missed visits. the SN did not provide wound care three times a week as ordered on the plan of care. The agency's skilled professional staff failed to provide services as ordered by the physician in the plans of care. During an interview on 7/20//22 at 1:00 p.m., the AVP acknowledged the SN did not follow the frequency for wound care as ordered in the plans of care for P#1.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined that the personnel furnishing services failed to maintain liaison to ensure their efforts were coordinated effectively and timely to support the objectives outlined in the plan of care for one of three (#1) sampled patients. Findings include: Review of the plan of care for patient #1 with a certification period of 12/13/21 to 2/10/22 revealed pertinent diagnosis of Kidney transplant and disruption of internal operation (surgical) wound. The skilled nurse (SN) was required to provide wound care as follows: Apply Smith and Nephew wound Vac to surgical incision located to right lower quadrant of abdomen at 120 MMHG continuously. Change wound Vac dressing 3 times weekly. Cleanse wound with normal saline or wound cleanser, apply /fill open wound with black foam , cover with Tegaderm and wound Vac drape dressing, In the event of malfunction of the device (wound Vac ) and maintaining a seal or discomfort or dislodgement of the dressing , SN may cleanse the wound with wound cleanser or normal saline, apply normal saline soaked gauze dressing, cover with gauze and tape to secure the dressing until the visit can be made to reapply the wound Vac device. Review of the SN visit note (admission assessment note) dated 12/13/21 revealed that SN made the visit and apply wound Vac as ordered on the plan of care. Review of the Coordination note dated 12/14/21 titled "late note documentation " revealed that the wound Vac was malfunctioning and unable to fix the problem and the SN to follow up with the patient on 12/14/21. However, the clinical record lacked evidence of further SN visit notes on the week of 12/13/21. Review of the coordination note dated 12/15/21 revealed that patient called the agency to inquire about the SN visit and requesting a nurse visit to change the wound Vac dressing to the wound. Further review of the coordination note dated 12/15/21 revealed that clinical manager verbalized to the patient that agency had reached out to the physician office to change the wound Vac system to another vendor (KCI) due to the agency nurses not being trained on this wound Vac (Smith and Nephew). However, the clinical record lacked documentation of communication or coordination efforts made with care team members and physician to discuss the concerns of not having trained staff to provide wound care to the patient as ordered on the plan of care. Furthermore, there were no documentation or coordination note to reflect the clinical manager notified the physician of not providing the wound care three times a week for the week of 12/13/21and further SN missed visits on the week of 1/9/22, 1/16/22 and 1/23/22, resulting in unauthorized missed visits. The agency failed to communicate with the physician and team to effectively coordinate the patient's care for identifying the patient's needs and services. During an interview on 7/20//22 at 1:00 p.m., Area Vice President (AVP) provided no evidence of coordination with the physician and/or agency team members regarding patient's wound Vac issues and patient specific needs. The AVP also verbalized that the agency nurses were not trained on wound Vac at the time of accepting the patient with wound vac therapy and all nurses were provided in-service on wound vac therapy since then.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency failed to ensure that clinical records contained clear, complete, and accurate documentation and orders in the record for one of three (#1) sampled patients. Findings include: Review of the plan of care for patient #1 with a certification period of 12/13/21 to 2/10/22 revealed pertinent diagnosis of Kidney transplant and disruption of internal operation (surgical) wound. The plan of care revealed a verbal order dated 12/20/21 as follows: wound care to surgical incision to right lower quadrant of abdomen; Cleanse wound with normal saline, pat dry, cover wound bed with dampen saline gauze, cover with ABD pad, and secure with tape. Dressing to be changed 3 times a week. SN to change 1 time a week and caregiver to change 2 times a week. This is a temporary wound care until nurses for Amedisys home health learn how to apply wound Vac. The verbal order also reads as SN effective date: 12/19/21 , 2 times a week for 2 weeks and 1 time a week for 6 weeks and 2 visits as needed (PRN) related to wound. The order is not clear as to how often should the nurse provide wound care to the patient. Furthermore, the verbal order dated 1/5/22 reads as follows: increase SN visit to 3 times a week to change wound Vac dressing to abdominal surgical wound. However, the order also reads SN effective 1/2/22 the week of 1/3/22, SN to visit patient 2 times a week for 1 week and 1 time week for 5 weeks and 2 as needed (PRN) visit for wound related concerns. it is not clear how often should SN visit the patient to provide wound care to the patient. The SN failed to obtain clear and precise and complete physician orders to treat patient's wound. During an interview on 7/20/22 at 1:00 p.m., the AVP verbalized that the orders are read differently than it is written and acknowledged that agency failed to ensure the clinical record contained clear and complete documentation regarding the wound care orders for the patient.