Every finding on record at Caresouth HHA Holdings of Washington, LLC

At the time of the survey, Encompass Health Home Health in Atlanta , GA. was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a recertification survey conducted on April 15, 2021. A Focus Infection Control Survey was completed at the time of the survey. No deficiencies were cited.

At the time of the survey, Encompass Health Home Health in Atlanta Ga. was in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of a partial extended recertification survey conducted on April 15, 2021. The following deficiencies were cited:

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency failed to ensure the patients' individualized plan of care included all of the required elements to address the patients' needs for 2 of 10 (#5 and #4) sampled patients. Findings were: 1. Review of the plan of care/treatment for Patient #5 with a certification period of 2/10/21 to 4/10/21 revealed an incomplete Foley catheter order which reads as follows: Skilled nurse for insertion of Foley catheter maintenance with catheter # 16 French 5 to 10 cc Balloon. Change every 4 weeks and as needed for dislodgement or stoppage. The order was not complete as it did not specify what type and the amount of fluid to instill into the balloon. The agency failed to obtain a complete and accurate order for the care and maintenance of the catheter. During an interview on 4/14/21 at 12:00 p.m., the Director acknowledged the agency failed to ensure the plan of care has accurate and complete foley catheter order for the care and maintenance of the catheter. Furthermore, the plan of care revealed the patient has pertinent diagnosis of Diabetes and patient is on Novolog U-100 Insulin Aspart 100 Unit/ML Subcutaneously (SQ) as per sliding scale. However, the plan of care lacks the type and the amount of Insulin to be administered and the sliding scale parameters. Additionally, review of the clinical record revealed that patient receives Promote protein shake 0.06 gram-1 Kcal/ml via percutaneous endoscopic gastrostomy (PEG) tube. However, the plan of care lacks orders for PEG tube care/management. During an interview on 4/15/21 at 12 p.m., with patient 's caregiver, it was revealed that patient is on the following sliding scale: Novolog U-100 51-179 = 0 units, 180-250= 4 units, 251-300= 6 units 301-400= 8 units, 401-500= 10 units, call physician for blood glucose over 500. The caregiver verbalized that patient's Diabetes, and PEG tube care is managed by the caregiver. The caregiver reported that the caregiver takes care of the PEG tube site and administers Promote protein shake via PEG tube. The caregiver stated that the insertion site is clean and free of infection. The plan of care lacks specific interventions to monitor the patient's foley catheter, diabetic status and PEG tube care management. The plan of care also lacks blood glucose assessment /sliding scale parameters to monitor for diabetic complications. The agency failed to ensure that plan of care includes blood glucose parameters and a monitoring frequency to adequately manage patient's diabetes. During an interview on 4/15/21 at 9:00a.m., with RN AA, it was reported that the caregiver provides diabetic care and PEG tube care for the patient. The RN AA stated due to Covid pandemic, the caregiver is very protective of the patient and provides all needed care for the patient. During an interview on 4/15/21 at 11:00 a.m., the Administrator and the Director confirmed the plan of care lacked complete Foley catheter order, lacked diabetic management with sliding scale parameters and interventions/orders for PEG tube care/management. 2. Review of the plan of care for patient #4 with a recertification period of 3/5/21 to 5/3/21 required the skilled nurse (SN) to perform blood glucose check for signs and symptoms of hypo/hyperglycemia during home visits. The SN is required to assess the blood glucose and report a pattern (three or more) of blood glucose levels greater than 230 MG/DL or less than 60 MG/DL. SN may administer four ounces of fruit juice or one tablespoon of sugar if the blood sugar analysis is between 60-80 MG/DL and recheck blood sugar in fifteen to twenty minutes . If subsequent blood sugar is greater than 80 MG/DL, administer Insulin, otherwise notify physician. However, the order lacks the amount and the type of insulin to be administered if the blood sugar is greater than 80 MG/DL. The agency failed to obtain complete order for patient's diabetic regimen. During an interview on 4/14/21 at 3:00 p. m., the Director verbalized that the plan of care lacks complete Insulin order to administer if and when blood glucose is greater than 80 MG/DL. During an interview on 4/15/21 at 11:00 a.m., the Administrator and the Director confirmed that the plan of care lacked diabetic management/assessments and interventions for the patient.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined that the agency staff failed to ensure treatments were administered only as ordered by the physician for 1 of 10 (#5) sampled patients. Findings were: 1. Review of skilled nurse (SN) visit note dated 3/11/21 for patient #5 with a certification period of 2/10/21 to 4/10/21 revealed the SN performed foley catheter change as follows: utilizing clean technique, perineal area cleansed, SN placed 16 French catheter, inserted with 10 cc bulb inflated with 12 cc of water and secured catheter. Additionally, the SN visit note dated 4/14/21, revealed the SN performed foley catheter change as follows: A new foley catheter inserted using aseptic technique bulb inflated with 10 ml sterile saline, catheter secured it right inner thigh . However, the plan of care/treatment revealed an incomplete Foley catheter order which reads as follows: Skilled nurse for insertion of Foley catheter maintenance with catheter # 16 French 5 to 10 cc Balloon. Change every 4 weeks and as needed for dislodgement or stoppage. The order was not complete as it did not specify the type and the amount of fluid to instill into the balloon. The clinical record lacked an order for this intervention. The agency failed to ensure this procedure was administered only as ordered by a physician. During an interview on 4/15/21 at 11:00 a.m., the Administrator and the Director acknowledged the catheterization was performed without a physician's order.

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 that the agency staff failed to provide treatment as required by the plan of care for 1 of 10 (#9) sampled patients. Findings were: 1. Review of the plan of care for patient #9 with a certification period of 3/24/21 to 5/22/21 reveals that patient has a diagnosis of Type 2 Diabetes mellitus without complications. The plan of care requires the physical therapist (PT) and occupational therapist (OT) to report fasting blood sugar less than 70 MG/DL or greater than 250 MG/DL. The PT visit notes dated 3/24, 3/29, 4/1, 4/5, and 4/7/21, lacked evidence of blood sugar assessments. The OT visit notes dated 3/25, 4/6, and 4/8 /21 also lacked evidence of blood sugar assessments. The PT and OT failed to follow the plan of care for blood sugar assessments. During a home visit on 4/13/21 at 12:45 p.m., patient stated that patient checks the blood sugar daily and patient does not have high blood sugar. During an interview on 4/14/21 at 3:00 p.m., the Director and the administrator confirmed the clinical record lacked evidence of blood sugar assessments on the above referenced dates and acknowledged the PT and OT were not following the plan of care for diabetic assessment.