Every finding on record at Eh Home Health of Colorado LLC

A survey, prompted by #CO71903, was completed on 10/26/22. One deficiency was cited.

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 interview and record review, the agency failed to ensure services and treatments were administered by agency staff only as ordered by a physician for 1 of 2 active patient records reviewed who received skilled nursing services (Patient #1). Findings include: 1. The clinical record for Patient #1 was reviewed on 10/25/22. The plan of care (POC) for the certification period dated 7/4/22 to 9/1/22, revealed a start of care date of 7/4/22; diagnoses included diabetes with chronic foot wounds, insulin dependence and chronic kidney disease. POC orders included skilled nurse (SN) visits three times weekly for comprehensive assessment and diabetes management. POC orders also included the SN to provide wound care three times per week to the bilateral lower extremities and to cleanse the wounds with Dakins solutions, pat dry, apply Dakin's soaked gauze to the wounds, cover with a pad and wrap with rolled gauze using a clean/aseptic technique. a) The agency failed to ensure the skilled care services and wound care treatment administered at the start of care on 7/4/22, were provided only as ordered by the physician. Review of referral documents received by the agency on 7/1/22 revealed a referral for skilled services beginning 7/4/22, however, there were no physician orders for services and treatments contained within the referral documents. Continued review showed registered nurse (RN) #4 documented she had completed a start of care comprehensive assessment on 7/4/22 and had also documented “wound care to BLE [bilateral lower extremities]” within the same comprehensive assessment, however, the RN failed to document any detail of the wound care provided. Further record review revealed RN #4 had developed the POC dated 7/4/22 to 9/1/22 on 7/4/22 after she had completed the start of care comprehensive assessment. The POC also showed RN #4 had obtained verbal orders for the start of care on 7/7/22, three days after RN #4 had already initiated the start of care and administered the wound care treatment. Furthermore, the verbal order was countersigned by the branch director (RN #3). The POC was signed by the physician of record on 8/3/22. Record review failed to reveal any further documentation to show the agency had obtained orders to provide specific wound care treatment at the start of care on 7/4/22. During interview on 10/25/22 at 1:45 p.m., RN #4 stated she provided SN and wound care for Patient #1 from 3/2022 until she was admitted to an inpatient facility on 6/27/22. Patient #1 was subsequently discharged from the home health agency on 6/28/22 because the POC certification period had ended. The RN stated on 7/4/22 she initiated the start of care, completed a comprehensive assessment and provided wound care that included the cleansing of the wounds with Dakin's solution, applied Dakin's soaked gauze to the wounds, padded and then wrapped the wounds having utilized the same wound care orders that had been provided by the physician of record prior to the patient's discharge from the home health agency on 6/28/22. RN #4 stated she was aware the agency had not yet received orders to provide the wound care but was certain the physician of record would approve of the orders because Patient #1’s wound care orders had not changed in the months past in the previous admission. RN #4 stated she did not call Patient #1’s physician prior to the start of care because it was a holiday and did not believe the physician was available. RN #4 further stated she had contacted the physician the next day on 7/5/22 to obtain orders for the start of care and wound care treatment that she had administered on 7/4/22, however, the RN was unable to recall if she had documented the verbal order or communication with the provider. During interview on 11/26/22 at 11:20 a.m., the regional administrator acknowledged the agency did not obtain orders for the start of care or administration of services and treatments prior to the initiation of services on 7/4/22. The regional administrator also acknowledged she was unable to locate any documentation to verify RN #4 had communicated with the physician of record on 7/5/22 as RN #4 had indicated in her interview.