Every finding on record at Greater Denver Home Health Care Inc

A recertification survey was completed on 8/8/24. 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 drugs, services and treatments were administered by agency staff only as ordered by a physician for 4 of 5 active patients records reviewed (Patients #1, #2, #3 and #4). Findings include: 1. The clinical record for Patient #4 was reviewed on 8/8/24. The plan of care (POC) for the certification period dated 6/21/24 to 8/19/24 , revealed a start of care date of 2/27/23. Diagnoses included hemiplegia unspecified affecting the left dominant side, essential hypertension, schizophrenia and malignant neoplasm of the prostate. POC orders included skilled nursing (SN) visits three times per week for eight weeks and twice a week for one week to perform physical assessments and wound care; certified nursing assistant (CNA) visits 18 times per week for one week, 21 times a week for seven weeks and 15 times per week for one week to provide assistance with activities of daily living (ADL's). a) The agency failed to receive orders, verbal or written, before starting care for Patient #4. Review of the clinical record for Patient #4 revealed the physician of the patient reviewed and signed the POC on 7/8/24. Review of the SN visit notes revealed Patient #4 received the following wound care on 6/21/24, 6/24/24, 6/26/24, 6/28/24, 7/3/24 and 7/5/24; cleanse wound with normal saline or soap and water, apply skin prep to the peri wound, apply collagen to wound bed, cover with silver foam, secure dressing with medipore tape. Review of the CNA visit notes revealed Patient #4 received the following services seven times a week between 6/21/24 and 7/8/24; bathing, mouth care, dressing, hand/foot hygiene, lotion, mobility, meal preparation, meal setup, bed linens, making the bed, cleaning the bedroom, laundry and shopping. Further review of the clinical record revealed there was no documentation of a verbal order from the physician of Patient #4 to receive orders to provide services between 6/21/24 and 7/8/24 when the POC was signed by the physician. During an interview on 8/8/24 at 1:00 p.m., the director of nursing (DON) stated the agency would send a document to the physician 10 days prior to the recertification of the patients to receive orders to continue care. The DON agreed the document the agency sent to the physician did not include frequency orders. The DON went on to state the agency would call the physician but would not document the phone call, the agency had no documented verbal orders to continue care. The DON agreed since the POC for Patient #4 was not signed until 7/8/24, and the agency had performed care for Patient #4 without physician orders. Patient #4 received care from the agency for 16 days before the agency had received physician orders to continue care. 2. Similar findings were found for Patients #1, #2 and 3.