Every finding on record at Homecare Advantage Chc

An emergency preparedness survey was conducted at this agency. No deficient practice was identified related to emergency preparedness requirements.

A federal recertification survey was conducted for this agency. Deficient practice was identified.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, surveyor observation, and staff and patient interviews, it has been determined that the agency failed to ensure that all patient care orders, including verbal orders, are recorded in the plan of care for 1 of 1 patient reviewed requiring wound care, Patient ID #1. Findings are as follows: Record review for Patient ID #1 revealed s/he was admitted to the agency with a start of care date of 9/27/2023. S/he had a diagnosis including but not limited to a laceration without foreign body of the left lower leg. During a surveyor visit to the patient’s home on 7/22/2024 at 2:00 PM, Registered Nurse (RN), Staff A was observed providing wound care to the patient’s left lower leg, left knee, great toe, and the second toe to the patient's right foot. Review of the plan of care, dated 5/28/2024, revealed treatment orders for wounds to the left lower leg, right great toe, and the right second toe but lacked evidence of an order for a wound treatment to the left knee. During a surveyor interview with RN, Staff A following the home care visit he indicated that he had been providing wound care to the client’s left knee since the patient obtained the wound about 1 month ago. Staff A could not explain why the plan of care was not updated to reflect this treatment. During a surveyor interview with the Director of Nursing Services on 7/23/2024 at 3:50 PM, she acknowledged that the plan of care was not updated to include the left knee.

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 review and staff interview, it has been determined that the agency failed to ensure that treatments are administered as ordered by the physician for 1 of 1 patient who had a verbal order for wound care which was not transcribed to the patients plan of care resulting in a failure to provide treatments as ordered. Patient ID #1. Findings are as follows: Record review for Patient ID #1 revealed s/he was admitted to the agency with a start of care date of 9/27/2023. S/he had a diagnosis, including but not limited to a laceration without foreign body of the left lower leg. Review of a document titled, “Patient Care Order (Verbal Order)” revealed a wound treatment order, dated 6/17/2024, to cleanse the patient’s left knee with normal saline and pat dry, then apply Prisma AG (secondary wound dressing) followed by calcium alginate (absorbent dressing), next cover with a dry dressing three times per week. This order was not reflected in the patient's current plan of care which may have resulted in the failure of nursing staff to provide treatments. Review of the skilled nursing visit notes, from 6/17/2024 through 7/15/2024, lacked evidence that the left knee wound treatments were completed as verbally ordered by the physician on 6/17/2024: - 7/10/2024 - 7/8/2024 - 7/5/2024 - 7/3/2024 - 7/1/2024 - 6/24/2024 - 6/19/2024 - 6/17/2024 During a surveyor interview with the Director of Nursing Services on 7/23/2024 at 3:50 PM, she was unable to explain why the treatment to the patient's left knee was not indicated on the patients plan of care.

Social Worker CFR(s): 484.115(m) Standard: Social worker. A person who has a master's or doctoral degree from a school of social work accredited by the Council on Social Work Education, and has 1 year of social work experience in a health care setting. This STANDARD is not met as evidenced by: Based on record review and staff interview, it has been determined that the home care agency failed to ensure social work services are available to patients. Findings are as follows: Review of agency services that are listed in the admission packet indicate social work services are included in the services offered and provided by the agency. A list of active employees provided by the Executive Director did not identify a Social Worker on staff. During a surveyor interview with the Executive Director on 7/24/2024 at 3:30 PM, she acknowledged the agency did not have a social worker that is employed, contracted, or available to provide services, as required.

A Federal recertification survey was conducted at this agency. A Standard Level deficiency was identified.

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 surveyor observation, record review, and staff interviews, it was determined that the Home Health Agency (HHA) failed to provide treatments only as ordered by a physician or practitioner, for 2 of 10 patients reviewed for physician orders, ID"s #2 and #6. Findings are as follows: 1. Record review revealed that Patient ID #2 was admitted to the agency on 5/27/2021, for skilled nursing, physical therapy, and occupational therapy following a hospital stay. Primary diagnoses included malignant neoplasm of right renal pelvis, acquired absence of kidney, Type 2 diabetes mellitus with diabetic neuropathy, and emphysema. During the hospital stay, the patient developed an exacerbation of COPD (Chronic Obstructive Pulmonary Disorder). The patient was discharged to home with a physician's order for oxygen (O2) to be continually administered at 2 liters per minute via nasal cannula. A review of the 5/27/2021 Plan of Care for certification period 5/27/2021 to 7/25/2021, revealed a physician's order for "oxygen inhaled aerosol; Inhale 2 liters per minute intranasally Continuous Start Date 05/27/2021". Surveyor observation during a home visit on 7/8/2021 from 11:05 AM to 11:50 AM, revealed the resident receiving physical therapy. During the visit the patient was not using oxygen as ordered by the physician. The Physical Therapy (PT) narrative note for the 7/8/2021 visit states that the patient complained of slight shortness of breath (SOB) while walking 300 feet with a rolling walker and doing leg strengthening exercises. The PT (Staff A) did not inquire about the patient not utilizing the the O2. During an interview on 7/15/2021 at 4:15 PM with the Administrator she was unable to provide evidence that the oxygen was administered was administered per physicians order. 2. Record review revealed that Patient #6 was admitted to the agency on 10/24/2018 for skilled nursing services following a short-term stay at a nursing home. Diagnoses includes hypertensive heart disease, acute on chronic congestive heart failure, pneumonia, ischemic cardiomyopathy. Record review of a 6/25/2021 Skilled Nursing Visit Note states in part "Upon arrival patient sleeping in bed with O2 in place." Further review revealed a 6/30/2021 Skilled Nursing Note that states in part "Upon arrival patient sleeping in bed with the O2 on.- concentrator tank beeping with red light on. TC [telephone call] placed to Rohotex spoke with Ann unable to troubleshoot-will send tech out today. Patient reported feeling a little dizzy." Further record review failed to reveal evidence of a physician's order for the resident to use oxygen. During surveyor interview with the Administrator on 7/15/2021 at 4:15 PM she could not provide evidence of a physician's order for oxygen.