Every finding on record at Hallmark Homecare LP

Purpose of Visit: Recertification Entrance Conference Date: 9/27/22 at 8:15 a.m., with the Administrator and the Alternate Supervising Nurse/Branch Director Agency Census: Licensed and Certified (L&C) – 0 Licensed Home Health (LHH) – 0 Exit Conference Date: 9/29/22 at 11:20 a.m., with the Administrator and the Alternate Supervising Nurse The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. The agency was in substantial compliance with 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies.

Purpose of Visit: Recertification Entrance Conference Date: 9/27/22 at 8:15 a.m., with the Administrator and the Alternate Supervising Nurse/Branch Director Agency Census: Licensed and Certified (L&C) – 0 Licensed Home Health (LHH) – 0 Exit Conference Date: 9/29/22 at 11:20 a.m., with the Administrator and the Alternate Supervising Nurse The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. SOC – Start of Care POC – Plan of Care wk.- week prn – when needed PU – Pressure Ulcer NS – Normal Saline SN – Skilled Nurse LVN - Licensed Vocational Nurse

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 record reviews and interviews, the agency failed to enforce a written policy that detailed its patient care practices for planning patient care for one of five closed records (Patient #5), whose records were reviewed, in that there was no physician’s order to treat Patient #5’s Stage 3 (full thickness skin loss) sacral region (at the bottom of the spine). This deficient practice could place the patients at risk of receiving inadequate care and services when all treatments are not addressed in the POC. The findings included: 1. Review of Patient #5’s clinical record revealed a SOC on 5/15/22 with a POC certification from 5/15/22 through 7/13/22 with a diagnosis of Dilated Cardiomyopathy (when the heart is enlarged and does not pump blood very well throughout the body), PU of Sacral region, stage 3, and PU of the right buttock (bottom) stage 2 (partial thickness of skin loss). Further review revealed a SN frequency of three visits a week for one week (3 wk. 1), and two visits a week for eight weeks (2 wk. 8), and two prn. In addition, “Skilled Nurse to perform/teach wound care to pressure ulcer/pressure injury to buttock cleanse NS (a basis solution)/Wound cleaner, apply Medihoney (aides in healing) to open areas. Cover with foam dressing (protects and cushions the skin) using aseptic (without germs) technique.” Further review revealed no documented evidence of orders for treatment to the Stage 3 PU on the patient’s sacral region. 2. Review of “Wound Care Record” revealed Patient #5’s PU to the coccyx was identified as Wound #1 and PU to the right lower buttock was identified as Wound #2. Further review revealed the wounds were assessed and treated on 5/15/22, 5/17/22, and 5/20/22 and both were cleansed with NS, Medihoney was applied, and dressed with a foam dressing. The clinical record failed to reveal that (LVN B or RN A) called the physician to obtain specific wound care orders for Wound #1 prior to administering the care. 3. During an interview and concurrent review of Patient #5’s clinical record on 9/29/22 at 10:00 a.m. with the Administrator/Supervising Nurse, she stated that there were two wounds and the POC did not address treatment for the sacral wound, and it should have. She further stated that this was an oversight by RN A and LVN B. She added that this could impact client care and causing further wound deterioration when all treatments were not addressed specifically in the POC. 4. Review of the agency’ policy titled “Service Delivery Physician’s Role” (undated) revealed in part “…2.1 Plan of care is a written plan developed with the participation of professional staff and the patient, in consultation with and authorized by the physician that support the patient’s medical, nursing, and psychosocial needs in the home setting and services are the basis of care delivery. 2.1.1 The plan includes all pertinent diagnoses, mental status, types of services and equipment required, frequency and duration of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications, treatments safety measures…and other appropriate items…”