Every finding on record at Island Health Care, Inc.

At the time of the survey, Island Health Care in Savannah, Ga. was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a standard recertification survey conducted on September 30, 2021. A Focus Infection Control Survey was completed at the time of the survey. No deficiencies were cited.

At the time of the Recertification survey, Island Health Care in Savannah, Georgia was in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of the survey conducted on September 30, 2021. A Focus Infection Control Survey was completed at the time of the survey. Current census 236. The follow deficiencies were cited.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews it was determined the agency failed to follow the ordered plans of care for suprapubic catheter care/maintenance and care of the peripherally inserted central catheter (PICC) as ordered for three of 17 patients (P) (P#3, #11, and #12) who required these services. Findings were: 1. Review of the plan of care for P#3 with a certification period of 7/31/21 to 9/28/21 required to skilled nurse (SN) to insert/change 16 French suprapubic catheter monthly and as needed for leakage/dislodgement. Inflate with 10ml balloon with solution to secure. The SN visited the patient on 8/27/21 and changed the catheter using a 16 French/ 15 ml balloon. During a home visit observation on 9/28/21 this surveyor observed the SN perform a suprapubic catheter change using a 16 French / 30ml balloon. The SN failed to follow the order plan of care for catheter care and maintenance as required. During an interview on 9/30/21 at 11:00 a.m., the Vice President of Talent Management and Operations and the Vice President of Performance Excellence did acknowledge the SN failed to follow the ordered plan of care for suprapubic catheter care. 2. Review of the plan of care for P#11 with a certification period of 9/7/21 to 11/05/21 required the SN to measure the arm circumference 5cm above PICC insertion site and external PICC length at admission and each dressing change. The SN visited the patient on 9/17 and documented the PICC dressing change was completed however, the SN failed to measure the arm circumference at each dressing change as ordered. Additionally, the plan of care required the SN to obtain blood specimen for complete blood count (CBC), creatine phosphokinase (CPK), and basic metabolic panel (BMP) every Tuesday via venipuncture or PICC line. The SN visited the patient the week of 9/6/21, however the SN obtained the labs on 9/10/21 (Thursday) instead of 9/7/21 (Tuesday) as ordered. The SN failed to obtain labs on the specific day ordered by the physician. During an interview on 9/30/21 at 11:00 a.m., the Vice President of Talent Management and Operations and the Vice President of Performance Excellence did not provide evidence that the arm circumference was measured at each visit as ordered. It was also acknowledged that the SN failed to obtain labs on 9/7/21 (Tuesday) per the physician's order. 3. Review of the plan of care for P#12 with a certification period of 9/1/21 to 10/30/21 required the SN to measure the arm circumference 5cm above PICC insertion site and external PICC length at admission and each dressing change. The SN visited the patient on 9/9 and 9/17/21 and documented the PICC dressing change was completed however, the SN failed to measure the arm circumference at each dressing change as ordered. During an interview on 9/30/21 at 11:00 a.m., the Vice President of Talent Management and Operations and the Vice President of Performance Excellence did not provide evidence that the arm circumference was measured at each visit as ordered.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined that the personnel furnishing services failed to maintain liaison to ensure their efforts were coordinated effectively and timely to support the objectives outlined in the plan of care for 1 of 17 patients (P) (P#16). Findings were: 1. Review of the plan of care for P#16 with a certification period of 4/6/21 to 6/4/21 (closed record) required the SN to visit the patient one time a week for one week then two times a week for eight weeks for wound care management and education. The clinical record indicated the SN visited the patient on 4/23/21 and provided wound care. The clinical record revealed an authorized missed visit on 4/27/21. The SN visited the patient on 4/30/21 and documented wound care was provided and SN services will continue. However, the SN did not visit the patient after 4/30/21. The record did contain SN missed visit notifications for 5/4, 5/7, 5/11, 5/13, 5/18, and 5/21/21. The missed visit notifications indicated the patient was going to the wound care center to have wound care provided. However, the clinical record lacked any orders for the patient to be seen at the wound care center or for the SN to discontinue wound care. The SN failed to communicate and coordinate care with the care team and physician to effectively coordinate the patient’s care and treatment for wound assessment and management. During an interview on 9/30/21 at 11:00 a.m., the Vice President of Talent Management and Operations and the Vice President of Performance Excellence did not provide evidence that the SN coordinated care with the care team and physician for the assessment and care of the patient's wound. On 9/30/21 the Vice President of Talent Management did present this surveyor a physician's order for the SN to discontinue wound care as the patient would be seen by the wound care center for wound care. However, this physician's order was not written until 9/30/21. The patient had been discharged from services on 5/25/21.

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 clinical record reviews and staff interviews, it was determined that the agency failed to ensure aide supervisory visits were conducted at least every 2 weeks for 1 of 2 (#6) sampled patients (P) that were receiving home health aide services. Findings were: 1. Review of the plan of care for P#6 with a certification period of 8/25/21 to 10/23/21 required the home health aide to visit the patient 1 time per week for 5 weeks however, the clinical record lacked documentation of aide supervisory visits for the month of September. The agency failed to perform home health aide supervisory visits no less frequently than every 2 weeks as required. During an interview on 9/30/21 at 11:00 a.m., the Vice President of Talent Management and Operations and the Vice President of Performance Excellence did not provide evidence of home health aide supervisory visits performed every 2 weeks during the month of September.