Every finding on record at Americans Home Health Care, Inc

An unannounced on-site Medicare authorized complaint investigation was conducted for intake #99740 by the Michigan Department of Licensing and Regulatory Affairs on 8/2/23 at: Americans Home Health Care 2575 North McLeod Drive, Suite C Saginaw, MI 48604 The agency has no branch sites. Clinical records reviewed for this survey included 2 records without home visits. The following determination was made during the investigation: #99740 - Allegation: unsubstantiated with citations. At the conclusion of the survey, Americans Home Health Care was not in compliance with standard level deficiencies for the Conditions of Participation for Home Health Agencies at: 42 CFR Part 484.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the registered nurse completed ongoing assessments of the patient's wounds for 1 of 2 (P-1) records reviewed, resulting in the potential for a poor patient outcome. Findings include: P-1: This patient was admitted to home care on 3/23/23 with diagnoses of a Stage 4 (open skin extending to muscle, tendon, or bone) sacral pressure ulcer and unstageable pressure ulcers on the right and left buttocks. During record review on 8/2/23, it was noted that the sacral pressure ulcer had a wound vac to assist with healing. The 3/23/23 plan of care ordered the nurse to provide 3 visits each week for 4 weeks to provide wound care and wound vac changes. The nurse was instructed to leave both hip (right/left buttocks) eschar (scab) wounds open to air to let the sores heal underneath on their own and do not attempt to cause eschar to come off faster. The nurse was also instructed to assess the patient's skin regularly for breakdown and assess wound/ulcer during each visit for improvement. The 3/23/23 start of care assessment by the registered nurse (Staff-B) documents the sacral pressure ulcer dimensions at (all dimensions in centimeters, length x width x depth) 12 x 8 x 2 with 2 cm undermining in all quadrants; right ischium pressure ulcer at 10 x 8 with black eschar; and left ischium pressure ulcer at 10 x 8 with black eschar. Staff-B then documented that 13 additional visits were provided between 3/24/23 and 4/19/23. During this 4-week time frame, there was no mention of the condition or status of the right and left ischial pressure ulcers. During an interview with Staff-B on 8/2/23 at 1:40 p.m., Staff-B acknowledged he did not document wound assessments or measurements for the ischial pressure ulcers because the wounds had not changed. Staff-E (director of clinical services) added that wounds are to be measured weekly. Staff-F (quality assurance) provided documentation of the agency's "Wound Assessment and Documentation" (copyright 2000, pages 49-50) practices which instructs staff to document wound measurements at least weekly, including the length, depth, and width of the wound in centimeters along with inflammation, color, odor, and estimate of drainage. Staff-B failed to follow agency practices and ensure assessments and documentation of wounds at least weekly.

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 record review and interview, the agency failed to ensure the clinical record contained documentation of wound treatments and response to interventions for 1 of 2 (P-1) records reviewed, resulting in a lack of information for the physician and all agency staff caring for this patient: Findings include: P-1: This patient was admitted to home care on 3/23/23 with diagnoses of a Stage 4 (open skin extending to muscle, tendon, or bone) sacral pressure ulcer and unstageable pressure ulcers on the right and left buttocks. During record review on 8/2/23, it was noted that the 3/23/23 plan of care ordered the nurse to provide 3 visits each week for 4 weeks to provide wound care. The nurse was instructed to leave both hip (right/left buttocks) eschar (scab) wounds open to air to let the sores heal underneath on their own and do not attempt to cause eschar to come off faster. The nurse was also instructed to assess the patient's skin regularly for breakdown and assess wound/ulcer during each visit for improvement. The 3/23/23 start of care assessment by the registered nurse (Staff-B) documents the sacral pressure ulcer dimensions at (all dimensions in centimeters, length x width x depth) 12 x 8 x 2 with 2 cm undermining in all quadrants; right ischium pressure ulcer at 10 x 8 with black eschar; and left ischium pressure ulcer at 10 x 8 with black eschar. Staff-B then documented that 13 additional visits were provided between 3/24/23 and 4/19/23. During this 4-week time frame, there was no mention of the condition or status of the right and left ischial pressure ulcers. During an interview with Staff-B on 8/2/23 at 1:40 p.m., Staff-B acknowledged he did not document wound assessments or measurements for the ischial pressure ulcers because the wounds had not changed. Staff-E (director of clinical services) added that wounds are to be measured weekly. Staff-F (quality assurance) provided documentation of the agency's "Wound Assessment and Documentation" (copyright 2000, pages 49-50) practices which instructs staff to document wound measurements at least weekly, including the length, depth, and width of the wound in centimeters along with inflammation, color, odor, and estimate of drainage. Staff-B failed to follow agency practices and ensure the clinical record contained documentation of wound treatments/interventions and responses to those interventions.