Every finding on record at Kah Development 12, LLC

An onsite unannounced complaint investigation was conducted 7/11/22. The allegation related to quality of care was substantiated. The allegation related to patient rights was unsubstantiated. Standard level deficiencies to the Medicare CoP were identified.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on agency policy review, clinical record review and staff interviews the agency failed to include the weight bearing status on the Plan of Care [POC] for 1 of 1 patients with weight bearing limitations [#1]. The findings included: The policy, Care Planning [revised 1/2022], was provided by the agency director on 7/11/22 at approximately 3:30 pm. The policy stated, “…The individualized POC [plan of care] is comprised of the Home Health Certification and Plan of Care form and all subsequent orders received during the patient’s 60-day episode of care and must include... functional limitation, activities permitted…" Patient # 1 had a Start of Care date of 4/29/21 and an admitting diagnosis of Dysphagia [difficulty in swallowing] following Other Cerebrovascular Disease. The patient was hospitalized from 6/6/21-6/14/21 after a fall at home resulting in a fracture of the left femur. A review of the resumption of care orders from ______ [physician’s name] dated 6/14/22 revealed the patient was to be TTWB [toe touch weight bearing] LLE [left lower extremity]. The recertification Plan of Care [POC] for 6/28/21 to 8/26/21 included a diagnosis of fracture Unspecified Part of Neck of left femur. The POC also revealed orders for Skilled nursing 2 times a week for 1 week, 1 time a week for 8 weeks, 1 PRN [as needed] for signs of infection, changes in skin integrity, wound changes, cardiopulmonary complications, falls, med changes; Physical therapy 1 time a week for 5 weeks; Occupational therapy 1 time a week for 2 weeks, 1 time a week every 2 weeks for 2 weeks, 1 time a week for 1 week, 1 time a week every 2 weeks for 2 weeks. Further review of the POC revealed the order for TTWB for LLE been omitted from the Recertification POC. During an interview with the branch manager, she confirmed the weight bearing limitation should have been included on the POC.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on agency policy review, job description review, clinical record review and staff interviews the LPN [licensed practical nurse] failed to communicate the presence of a new wound to the RN [registered nurse] for 1 of 3 patients with wounds [#1]. The findings included: The policy, Coordination of Care [revised 6/2021], was provided by the agency director on 7/11/22 at approximately 4 pm. The policy stated, “Interdisciplinary personnel, internal and external to the Company, must maintain close communication to ensure the patient receives coordinated complimentary care that meets their needs and supports the objectives identified in the Plan of Care… Communication with other team members may be face-to-face, via phone, and/or electronically and may include but is not limited to… All communication will be documented in the patient’s clinical record…" A LPN [licensed practical nurse] job description [revised date 9/2020] was provided by the agency director on 7/11/22 at approximately 4 pm. The job description stated, “…Under the direction of the RN, assists in providing nursing services and identifying the patient’s physical, psycho-social and environmental needs as evidenced by observation, documentation, clinical record, case reference, team report and evaluation…” Patient # 1 had a Start of Care date of 4/29/21 a review of the Plan of Care [POC] for the certification period 6/28/21 to 8/26/21 revealed a diagnosis of Fracture of Unspecified Park of Neck of left Femur. The POC also included orders for Skilled nursing 2 times a week for 1 week, 1 time a week for 8 weeks, 1 PRN [as needed] for signs of infection, changes in skin integrity, wound changes, cardiopulmonary complications, fall and med [medication] changes and “Nursing assessment to be performed by RN [registered nurse]; LPN [licensed practical nurse] to observe and report changes to the RN.” A review of the clinical record revealed LPN # 2 made a routine visit on 6/28/21. During the visit the LPN documented the presence of a “a wound that wife stated was present from the hospital”. The visit note report dated 6/28/21 by LPN # 2 revealed the wound was noted to be a stage 2 [has broken through the top layer of skin] pressure injury located on the coccyx [triangular arrangement of bone that makes up the bottom portion of the spine]. There is no evidence the LPN notified the RN of the skin break down for her to assess the area. LPN # 2 was not available for an interview. An interview was conducted with the RN # 3 on 7/11/22 at approximately 4:30 pm. During the interview RN # 3 confirmed there is no evidence the LPN notified the RN.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on clinical record review and staff interviews the agency failed to provide proper caregiver education on wound care for 1 of 3 patients with a wound [#1]. The findings included: Patient # 1 had a Start of Care date of 4/29/21 a review of the Plan of Care [POC] for the certification period 6/28/21 to 8/26/21 revealed a diagnosis of Fracture of Unspecified Part of Neck of Left Femur. The POC also included orders for skilled nursing 2 times a week for 1 week, 1 time a week for 8 weeks, 1 PRN [as needed] for signs of infection, changes in skin integrity, wound changes, cardiopulmonary complications, fall and med [medication] changes. A review of the clinical record revealed LPN # 2 made a routine visit on 6/28/21. During the visit the LPN documented the presence of a “a wound that wife stated was present from the hospital.” LPN # 2 obtained a supplemental order for wound care on 6/28/21. The wound care order was for, “SN or CG [caregiver] to clean coccyx [triangular arrangement of bone that makes up the bottom portion of the spine] area with wound cleanser, 4x4’s and pat dry. Apply Calcium Alginate [dressing], cover with foam dressing. Change 2 times per week. Wife or caregiver to be trained and may change when SN not visiting.” LPN # 2 made a second routine visit on 7/1/21 and documented the following information “…Education done, and caregiver was able to do treatment as taught.” A review of the coordination notes revealed a note entered by RN # 4 on 6/30/21. The note stated, “…Caregiver states she received wound supplies in the mail, but she is unsure of how to change the dressing…States the dressing placed on the coccyx on Monday [6/28/21] is still in place…” There is no evidence related to the RN making a visit after the LPN identified the wound to do proper education with the caregiver on dressing changes. The RN did not make a visit until 7/6/21. The LPN was not available for interview. An interview was conducted with RN # 3 on 7/11/22 at approximately 4:30 pm. During the interview the RN confirmed the LPN could not “educate” the caregiver on dressing changes and no RN visit was made until 7/6/21 for assessment/education to the caregiver on wound care.