Every finding on record at Innovative Senior Care Home Health Alabama, LLC

Based on the on-site recertification survey conducted on 7/20/23, Alabama Homecare of Oneonta was found to be in substantial compliance with the standards for Emergency Preparedness.

A recertification survey was conducted on 7/18/2023 to 7/20/2023 at Alabama Homecare of Oneonta. Standard level deficiencies were cited and will require a plan of correction.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on Medical Record (MR) review, agency policy and procedure and interviews it was determined the agency's staff members failed to ensure an initial assessment visit and admission was completed within 48 hours from the referral date. This affected three of ten MR's reviewed including Home Visit (HV) # 2, MR # 3, HV # 4 and had the potential to negatively affect all patients admitted to the agency. Findings include: Agency Policy: Admission Process Policy Number: 2.1.001 Revised: 01/01/21 Purpose: To determine the eligibility of patients for agency services and to provide a description of the admission process. Policy: Patients admitted to home care services must be under the care of a physician... Procedure: ...3. The qualified clinician scheduled to make the visit: ...b. admission/initial visits are made within 48 hours from referral... 3. HV # 4 was admitted to the agency on 6/19/23 with diagnoses including Type 2 Diabetes with Foot Ulcer and Non-Pressure Chronic Ulcer of Right Foot. Review of the Oasis Admission dated 6/19/23 revealed the nurse documented no specific SOC/ROC (Start of Care/Resumption of Care) date ordered by the physician. Further review of the Oasis Admission dated 6/19/23 revealed the nurse documented the date of referral was 6/16/23. An interview was conducted on 7/20/23 at 9:45 AM with EI # 1, who confirmed the agency failed to ensure the start of care was within 48 hours of the referral. EI # 1 stated the start of care should have been 6/18/23. 1. HV # 2 was admitted to the agency on 6/12/23 with diagnoses including Chronic Obstructive Pulmonary Disease with (Acute) Exacerbation and Acute and Chronic Respiratory Failure with Hypoxia. Review of HV # 2's MR revealed a discharge summary from Brookwood Baptist Medical Center with a discharge date of 6/2/23, and a physician's order dated 6/7/23 for Home Health evaluation. Further review of the OASIS (The Outcome and Assessment Information Set) Admission dated 6/12/23 revealed date of referral 6/9/23 and inpatient discharge dated 6/9/23. An interview was conducted on 7/20/23 at 10:05 AM with Employee Identifier (EI) # 1, Executive Director. EI # 1 reported an updated referral was dated 6/11/23. The surveyor requested the updated referral documentation, none was provided. 2. MR # 3 was admitted to the agency on 6/12/23 with diagnoses including Malignant Neoplasm of Pancreas, Unspecified and Dehydration. Review of the OASIS Admission dated 6/12/23 revealed the physician's ordered start of care date 6/5/23. An interview was conducted on 7/20/23 at 9:52 AM with EI # 1, who confirmed the patient evaluation was not completed within the 48 hour timeframe per agency policy.

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on review of Medical Records (MR), agency policy and procedure, and interviews, it was determined the agency failed to ensure Occupational Therapy evaluation was completed within five days of ordered start of care. This deficient practice affected one of four patients with Occupational Therapy ordered including MR # 1 and had the potential to affect all patients admitted to this agency. Findings include: Agency policy: Patient Assessment, Initial and Reassessment Policy number: 2.1.002 Revised: 3/1/22 ...Procedure: ... c. Physical Therapist, Speech Therapist, Occupational Therapist (OT) ... This initial discipline specific evaluation(s) will occur within 5 days from the referral ... 1. MR # 1 was admitted to the agency on 5/2/23 and recertified from 7/1/23 to 8/29/23 with diagnosis including Encounter for Orthopedic Aftercare Following Surgical Amputation and Type I Diabetes Mellitus with Diabetic Chronic Kidney Disease. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 7/1/23 revealed orders for OT effective 7/2/23 one week one. Review of the Narrative note dated 7/7/23 revealed the OT documented, "spoke with patient to reschedule OT eval (evaluation), states (he/she) has dialysis MWF (Monday, Wednesday, Friday) today and requested OT try again next week". Further review of the MR revealed no documentation the OT evaluation was completed or attempted again. An interview was conducted on 7/20/23 at 10:00 AM with Employee Identifier # 1, Executive Director, who confirmed there was no documentation an OT visit was completed or attempted again.

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 review of Medical Records (MR), agency policy, and interviews it was determined the agency failed to ensure care was coordinated for Meals on Wheels as requested per patient. This affected one of one records reviewed of patients who requested Meals on Wheels assistance, including MR # 1, and had the potential to affect all patients requesting this assistance. Findings include: Agency Policy: Coordination of Care, From Admit Through Discharge Policy Number: 2.1.017 Revised: 8/1/19 ... Policy: The agency provides care and services within an integrated continuum of care system. This is accomplished by: a. identifying patient needs through assessment and communication with other health care providers... b. coordinating patient care among various disciplines to ensure that services are continuous and coordinated... 1. MR # 1 was admitted to the agency on 5/2/23 and recertified for home care from 7/1/23 to 8/29/23 with diagnoses including Encounter for Orthopedic Aftercare Following Surgical Amputation and Type I Diabetes Mellitus with Diabetic Chronic Kidney Disease. Review of the RN (Registered Nurse) ROC/Recert (Return of Care/Recertification) dated 6/26/23 revealed the nurse documented the patient expressed interest in Meals on Wheels. Review of the SN (Skilled Nurse) visit notes from 6/26/23 to 7/17/23 revealed no documentation of follow up on the patient's request. An interview was conducted on 7/20/23 at 10:00 AM with Employee Identifier # 1, Executive Director, who confirmed the agency failed to coordinate care and follow up with the patient's request for Meals on Wheels.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observations, agency policy and procedure, and interview with staff it was determined the agency failed to ensure the staff followed hand hygiene guidelines. This affected one of four Home Visits (HV) including HV # 4 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revised: 5/1/19 ...Procedure: 1. Staff performs hand hygiene by handwashing with soap and water or using an alcohol based hand sanitizer: ...c. after contact with blood, body fluids or excretions, ... wound dressings... f. before and after removal of personal protective equipment (PPE)... 1. HV # 4 was admitted to the agency on 6/19/23 with diagnoses including Type 2 Diabetes Mellitus with Foot Ulcer and Non-Pressure Chronic Ulcer to Right Foot. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 6/19/23 revealed orders for Skilled Nurse (SN) two times a week for one week, three times a week for four weeks, then one time a week for one week. SN to cleanse (wound) with wound cleanser, pat dry with gauze, pack with Iodoform and cover with gauze and secure with tape. A HV was conducted on 7/18/23 at 8:15 AM to observe wound care provided by Employee Identifier (EI) # 5, Registered Nurse (RN). EI # 5 applied gloves, obtained the Blood Pressure (BP), wiped the BP cuff with sanitizing wipes, then removed the gloves and applied new gloves. EI # 5 failed to perform hand hygiene after removing gloves. EI # 5 then palpated the patient pulse, removed the gloves and applied new gloves. EI # 5 failed to perform hand hygiene after removing gloves. EI # 5 removed dressing from right foot, removed the gloves, applied new gloves. EI # 5 failed to perform hand hygiene after removing gloves. EI # 5 cleansed the wound with wound cleanser and gauze, removed the gloves, applied new gloves. EI # 5 failed to perform hand hygiene after removing gloves. EI # 5 packed the wound with Iodoform, removed the gloves, applied new gloves. EI # 5 failed to perform hand hygiene after removing gloves. An interview was conducted on 7/20/23 at 9:45 AM with EI # 1, Executive Director, who confirmed hand hygiene was not performed after each glove removal per agency policy.