Every finding on record at Banner Home Care Colorado

A recertification survey was completed on 1/6/22. One deficiency was cited

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on interview, and record review the agency failed to ensure services and treatments were provided in conformance with physician orders for wound care for 1 of 4 patients reviewed who were ordered to receive wound care (Patient #9). Findings include: AGENCY POLICY According to the agency policy titled "Skin Integrity - Prevention and Early intervention for skin breakdown" dated 7/23/21. "Wound measurements and assessments are to be completed by the RN (Registered Nurse), wound specialist, trained LPN (Licensed Practical Nurse), wound designee, or provider on admission or wound discovery, and weekly." 1. The clinical record for Patient #9 was reviewed on 1/4/22. The plan of care for the certification period dated 10/27/21 to 12/25/21, revealed a start of care date of 8/28/21; diagnoses included dehiscence of amputation stump, type 1 diabetes mellitus with diabetic nephropathy, and type 1 diabetes mellitus with diabetic polyneuropathy. Plan of care orders included skilled nursing (SN) visits once a week for one week, twice a week for five weeks, and once a week for one week, with two as needed visits, for education and performing wound care on the right below knee amputation (BKA) wound site, perform fall risk assessment, and provide assessment of pain. a) The agency failed to ensure care and services were provided in conformance with the physician ordered wound care for Patient #9, specifically weekly wound measurements. Review of Patient #9's clinical record revealed a plan of care dated 10/27/21, orders for wound care were as follows; cleanse with wound cleanser, apply calcium alginate, cover with absorbent dressing, using clean/aseptic technique, change dressing three times a week and PRN. On 11/8/21 new physician orders regarding wound care read as follows; SN to remove old dressing, cleanse with wound cleanser, fill wound with AMD (antimicrobial foam dressing), cover with alginate ag, cover with gauze and secure with tape three times a week with patient changing the outer dressing as needed. Review of Patient #9's clinical record from 10/27/21 to 12/25/21 revealed the SN was to take weekly wound measurements. Further review of the record revealed separate wound measurement visit note reports dated 11/2/21, 11/8/21, 11/18/21, 11/29/21, 12/14/21 and 12/20/21, that stated wound measurements were due, and RN #4 had documented she had obtained the wound measurements on all of these dates. However, visit notes from the dates 11/2/21, 11/8/21, 11/18/21, 11/29/21, 12/14/21, and 12/20/21 revealed no wound measurements. Further review of the record revealed that on the days that RN #4 documented she had obtained the wound measurements the SN visit notes showed that wound measurements were not taken. Review of all SN visit note reports from the certification period 10/27/21 to 12/25/21, a period of eight weeks, revealed that wound measurements were only documented once on 11/24/21. The agency failed to document wound measurements on a weekly basis for seven out of eight weeks of the certification period. During interview on 1/5/22 at 1:56 p.m., RN #4 stated that she had taken the wound measurements and recorded them in a "planner". She went on to state that she had not then taken the measurements and recorded them in the agency's electronic medical record (EMR) system and that she now understood how that was a problem.