Every finding on record at Care Unlimited Inc

Based on the findings of an onsite unannounced Medicare Recertification and State Licensure Survey conducted onsite 1/10/2023 through 1/13/2023 and offsite 1/24/2023 through 1/25/2023, Aveanna Healthcare was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an onsite unannounced Medicare Recertification and State Licensure survey conducted onsite 1/10/2023 through 1/13/2023 and offsite 1/24/2023 through 1/25/2023, Aveanna Healthcare was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of Agency Policy, clinical records (CR), and staff interview, the agency failed to follow Agency Policy and the Physician ordered Plan Of Care (POC) for one (1) of seven (7) clinical records reviewed (CR3). Findings included: Review of Agency Policy, specifically, (Wound Care Management) on 1/24/2023 at approximately 12:00 p.m. revealed "Wound Care Management... Policy 1. Wounds will be assessed every visit/shift... 2. Wound assessment and wound care can be completed by... Licensed Practical Nurses... 3. Wounds are to be measured weekly... 4. Wound measurement is to be completed using centimeters/metric system and includes measurement of length, width, depth, undermining and tunneling... 5. Wound care and dressing changes will be provided only as ordered by the physician... 6. Documentation... should be done at each visit or shift... 7. An initial detailed diagram or photograph of the wound(s) is best and is filed in the patient's medical record." Review of CR3 on 1/24/2023 from approximately 12:30 p.m. through 4:00 p.m. revealed Start of Care (SOC): 11/11/2022, certification period: 11/11/2022 to 1/09/2023. Plan of Care (POC) "Diagnosis Primary... Quadriplegia, C5 - C7 complete Start Effective Date: 11/11/2022... INTERVENTIONS FREQUENCIES RN/LPN will provide skilled nursing services 8-13 hours per day, 2-3 days per week (M, T, Th); 7-12 hours per day, 1-2 days per week (W, F); 5-9 hours per day, 1 day per week (Sat); 6-10 hours per day, 1 day per week (Sun) for 60 days. Daily hours may vary at pt's request, not to exceed 82 hours per week... Start Effective Date; 11/11/2022." WOUND SN to complete wound care to B/L heels every 3 days and PRN for drainage or soilage. Cleanse peri-wound with soap and water and irrigate wound with 30 mL of room temperature NS or sterile water, using a SALJET and holding at an angle 2-3 inches from the wound. Dry and apply skin prep to peri-wound. Using clean technique, apply Mepilex Ag to wound ben using a sterile cotton-tipped applicator. Cover wound with sterile gauze and secure with omniflex tape. (Start Effective Date: 11/11/2022 Met/Discontinued Date 11/21/2022.)... SN to monitor B/L heel pressure ulcers with each dressing change every 2 days and PRN for change in condition. Document wound measurements and characteristics (length, width, depth, tunneling, color, odor, drainage). Start Effective Date: 11/11/2022... 60 DAY SUMMARY... The patient has wounds to B/L heels, left heel has a stage 3 pressure wound, 2.2 cm x 1.8 cm x 0.25 cm, wound bed is pink and moist, granulation tissue with a scant amount of light-yellow slough present. Surrounding tissue slightly darker but intact. Right heel has a stage 2 pressure wound measuring 01.7 cm x 0.4 cm x 0.15 cm. The wound base is pink and moist with granulation tissue, no drainage observed." Skilled Nursing (SN) visits were performed routinely from 11/11/2022 through 1/09/2023. Following is a complete listing of wound documentation which appeared randomly during the aforementioned Certification Period: 11/11/2022 The initial plan of care included the aforementioned 60 DAY SUMMARY. 11/12/2022... NURSING NARRATIVE DOCUMENTATION... 10:00 AM... "Wound bandages remain dry and intact at this time." 11/14/2022... NURSING NARRATIVE DOCUMENTATION... 10:00 AM... "Wound care done on bilateral heels per orders." 11/16/2022... NURSING NARRATIVE DOCUMENTATION... 10:00 AM... "Wounds on bilateral heels dressing applied." 11/21/2022... NURSING NARRATIVE DOCUMENTATION... 10:00 AM... "At wound clinic for approximately 1.5 hrs. new dressings applied after being seen by MD." 11/29/2022... NURSING NARRATIVE DOCUMENTATION... 7:00 PM... "Wound found on right Upper thigh. Supervisor notified. pt has appointment with wound clinic on Monday will contact wound clinic in AM to inform them of area on Upper thigh per Supervisor orders." 11/29/2022... "WOUND ASSESSMENT... Wound #1... Location: Upper right thigh... Type: Pressure Ulcer... Stage: 1... Length: 5cm... Width: 2.5cm... Depth: 0.25cm... Surrounding Tissue: Normal for ethnic group... Wound Bed Tissue: Bloody... Drainage Type: Bloody... Amount: Small... Odor: None... Wound Care Provided: Yes." 12/01/2022... "WOUND ASSESSMENT... Wound #1... Location: Upper right rear thigh... Type: Pressure Ulcer... Stage: 1... Length: 4.25cm... Width: 2.0cm... Depth: 0.15cm... Surrounding Tissue: Normal for ethnic group... Wound Bed Tissue: Healthy... Drainage Type: Bloody... Amount: Scant... Odor: None... Wound Care Provided: Yes." 12/08/2022... "WOUND ASSESSMENT... Wound #1... Location: Left heel... Type: Pressure Ulcer... Stage: 1... Surrounding Tissue: Pale... Wound Care Provided: Yes... Wound #2... Location: Upper right rear thigh rear... Type: Pressure Ulcer... Stage: 1... Surrounding Tissue: Pale... Wound Bed Tissue: Bloody... Drainage Type: Bloody... Amount: Small... Odor: None... Wound Care Provided: Yes." 12/08/2022... NURSING NARRATIVE DOCUMENTATION... 10:00 AM... "Wound dressings changed per orders." 12/12/2022... NURSING NARRATIVE DOCUMENTATION... 8:30 AM... "Drove client to wound clinic." 12/14/2022... PHYSICIAN ORDERS... FREQUENCIES ***Addendum to the POC*** Start Effective Date: 12/12/2022... SN to complete wound care to right posterior thigh every 2 days and prn for drainage/soilage or displacement. Cleanse peri-wound area with soap and water and irrigate with 30mL of NSS. Dry and apply large Mepilex Flex border plain foam dressing. 12/19/2022... NURSING NARRATIVE DOCUMENTATION... 12:00 PM... "Wound on left foot and right buttocks intact clean and dry..." 1/03/2023... NURSING NARRATIVE DOCUMENTATION... 12:45 PM... "Wound care done per orders." An exit interview conducted via telephone, with agency Administrator (EMP#1), Agency Executive Director (EMP#2) Agency AVP Clinical Operations (EMP#3), Area Director of Operations (EMP#4), Operations Specialist (EMP#5) and Quality Assurance (EMP#6) on 1/25/2023 at approximately 1:00 p.m. confirmed the above findings.