Every finding on record at Gunnison Valley Health Senior Care Center

A recertification survey was completed on 10/12/22. One deficiency was cited.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure a registered nurse (RN) or other appropriate skilled professional familiar with the patient, the patient's plan of care and the written patient care instructions made an onsite visit to the patient's home no less frequently than every 14 days to conduct certified nurse aide (CNA) supervision for 2 of 2 patients receiving skilled care and CNA services (Patient #1 and Patient #2). Findings include: AGENCY POLICY According to agency policy titled, Responsibilities/Supervision of Care and Services, dated 3/5/2019 (in pertinent parts): "Home health aide supervisory visits are conducted onsite at least every two weeks by registered nurses. At the discretion of the RN, supervisory visits can be made in conjunction with the home health aide or in their absence. A direct observation supervisory visit will be made at least monthly for those acute Medicare patients receiving skilled nursing, therapy, and aide services." 1. The clinical record for Patient #2 was reviewed on 10/11/22. The Plans of Care for the certification periods dated 7/18/22 to 9/15/22 and 9/16/22 to 11/14/22 revealed a start of care date of 5/19/22; diagnoses included; displaced comminuted fracture of shaft of right arm humerus, hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease. Plan of care orders included skilled nursing (SN) services, once a week for nine weeks for medication management, set up and teaching, skilled assessments and disease process education and CNA services twice a week for eight weeks to assist with showers, home exercise program, dressing, skin care, shaving, nail care, and safety monitoring, specifically fall prevention. a) The RN failed to conduct onsite visits to supervise the CNA no less frequently than every 14 days as required. Review of the clinical record for the time period dated 7/17/22 to 10/11/22, revealed Patient #2 received CNA services twice weekly. Further review of the clinical record revealed Patient #2 had supervisory visits on 7/19/22, 8/9/22, 8/30/22, 9/6/22, 9/14/22 and 10/4/22. The record revealed that supervisory visits were not done on a consistent basis. There were 21 days between visits done on 7/9/22 to 8/9/22; 20 days between supervisory visits done on 8/9/22 and 8/30/22 and 19 days between supervisory visits done on 9/14/22 and 10/4/22. During an interview on 10/11/22 at 2:56 p.m., RN #2 stated she was not sure why the supervisory visits were not completed every 14 days. RN #5 was not available for an interview as she was no longer an employee of the agency. 2. The clinical record for Patient #1 was reviewed on 10/11/22. The Plans of Care for the certification periods dated 7/26/22 to 9/23/22 and 9/24/22 to 11/22/22 revealed a start of care dated of 9/29/21; diagnoses included other emphysema, acute and chronic respiratory failure with hypoxia, pulmonary hypertension due to lung diseases and hypoxia, permanent atrial fibrillation, chronic pain syndrome, and hypertensive heart disease with heart failure. Plan of care orders included SN services, once a week for nine weeks for medication management, set up and teaching, skilled assessments and disease process education and CNA services once a week for nine weeks to provide showers, assistance with transfers, nail care, skin care and safety monitoring. a) The RN failed to conduct onsite visits to supervise the CNA no less frequently than every 14 days as required. Review of the clinical record for the time period dated 7/27/22 to 10/11/22, revealed Patient #1 received CNA services weekly. Further review of the clinical record revealed Patient #1 had supervisory visits on 7/27/22, 8/10/22, 8/24/22, 9/21/22 and 10/5/22. The record revealed that there were 27 days between the supervisory visits on 8/24/22 and 9/21/22. During an interview on 10/11/22 at 2:56 p.m., RN #2 stated that supervisory visits were done every 14 days. She could not answer why the supervisory visit was missed in September. 3. During an interview on 10/12/22 at 10:42 a.m., the administrator stated that they did supervisory visits every 14 days and she could not answer why the supervisory visits were missed.