Every finding on record at Gem City Home Care, LLC

Substantial Allegation Survey Substantial Allegation 71341 An onsite entrance was conducted on 09/12/22 with the Executive Director of Operations, and an exit conference was completed on 09/13/22 with the Executive Director of Operations, Director of Clinical Operations, and Area Vice President of Clinical Operations. The following deficiency is based upon substantial allegation 71341 completed on 09/13/22. Gem City Home Care LLC 367785, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to coordinate care delivery to meet the patient's needs for one of four patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The patient census was 782. Findings include: Review of the medical record for Patient #1 was completed on 09/13/22. The certification period reviewed was dated 06/14/22 to 08/12/22. The patient was admitted to the agency on 04/15/22 with a primary diagnosis of urinary tract infection. Other diagnoses included essential hypertension and quadriplegia. Physician orders were for skilled nursing two times a week for one week, one time a week for one week, one time every two weeks, one time every four weeks, and then one time a week for one week. The patient was to receive physical therapy one time a week for four weeks and two times a week for four weeks. The patient was to be seen by occupational therapy one time a week for one week and three times every four weeks. The patient was to received home health aide services two times a week for one week, one time a week for one week, once every three weeks, and three times a week for four weeks. A late entry communication note dated 09/13/22 revealed on 07/09/22 the Licensed Practical Nurse (LPN) notified the Registered Nurse (RN) of a wound to the patient's back side. The RN notified the physician's office for a wound care evaluation on 07/09/22. On 07/13/22 an order was received from the physician for a certified wound nurse to assess wounds and provide recommendations. There was no documentation of a wound consult in the patient's record. Further review of the patient's record revealed she was transferred to the hospital on 07/20/22. An interview with Staff G, who provided care to the patient on 07/09/22, was completed on 09/13/22 at 2:45 PM. Staff G stated the patient had bandages on the left and right thigh, both buttocks and coccyx areas. The bandages were worn by the patient as a barrier to prevent skin breakdown, and the patient allowed the nurse one time, on the 06/24/22 visit, to remove the dressings. No open areas were identified at that time according to Staff G. Staff G recalled identifying skin breakdown on the 07/09/22 visit, and described as what looked like shearing on the patient's left thigh while attempting to provide catheter care. The patient allowed the nurse to remove the dressing barrier that was on the left thigh, but no other bandages were allowed by the patient to be removed. Staff G notified the RN once the skin breakdown was identified. A call was going to be made to set up an evaluation by a wound care nurse. An interview with Staff B and Staff C on 09/13/22 at 4:00 PM revealed Patient #1's doctor was contacted for a wound consult on 07/09/22, which was a Saturday. The agency received an order for a wound consult on 07/13/22. The interview revealed the wound care nurse was on paid time off leave at the time he/she was contacted to do a wound care evaluation. The patient went into the hospital on 07/20/22, and was never seen for a wound care evaluation while at this agency. When asked what the agency's back up plan was when a patient needed a wound evaluation and the wound care nurse was unavailable at the time, the response was the agency would notify the patient's doctor. An interview with Staff A, Staff B, and Staff C during the exit on 09/13/22 at 5:20 PM confirmed the agency failed to provide a wound care evaluation to Patient #1 while under the agency's care before the patient was admitted to the hospital. This deficiency substantiates Substantial Allegation 71341.