Every finding on record at Lhcg Xl, LLC

A Recertification survey was conducted at Georgia Home Health on January 27, 2025, and concluded on January 29, 2025. At the time of the survey, the agency was in compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 infection control.

A Recertification survey was conducted at Georgia Home Health on January 27, 2025, and concluded on January 29, 2025. At the time of the survey, the agency was not in compliance with Chapter 42 CFR Part 418, Rules and Requirements for Home Health and Hospice Agencies. The census was 179. The following deficiencies were cited.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on review of policy “OASIS DATA CAPTURE, TRANSMISSION, VERIFICATION, DISPLAY AND REPORTS,” review of the Centers for Medicaid and Medicare Services (CMS) report, and staff interview, it was determined that the agency failed to submit to CMS system a completed Outcome and Assessment Information Set (OASIS) within thirty days of completing the assessments. Failure to submit OASIS within 30 days has the potential to cause delay in care and affect quality of care for all patients with late OASIS submission. Findings include: Review of the policy titled “OASIS Data Capture, Transmission, Verification, Display and Reports,” last revised 03/01/21, revealed the following: 2. a. At least monthly, Agency will electronically transmit accurate, completed, encoded and locked OASIS data to the state agency. All OASIS assessments completed must be transmitted within thirty (30) days of M0090 date. Review of CMS report ran on 1/13/25 for period 01/01/2024 to 12/31/2024 titled “HHA Error Summary by Agency,” revealed the agency failed to transmit OASIS data to the State Agency within 30 days. On 1/29/2024 at 10:00 a.m., during an in-office interview, the Executive Director (ED) confirmed awareness of the 30-day OASIS submission time frame requirements not met during the time frame of 01/01/2024 to 12/31/2024.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on observation, clinical record review, staff interviews, and review of policy “Wound Assessment, Documentation, and Photography,” it was determined the agency failed to ensure the care and services were provided in conformance with the patients' plan of care and treatment as ordered by physician for two patients (P) (P#11 and P#14) of seven sampled patients. Review of the clinical record for P#11 revealed the patient was admitted to hospice on 1/14/25 with an admitting diagnosis of non-pressure chronic ulcer other part of left lower leg. Review of the plan of care required the skilled nurse (SN) to visit the patient 1 time a week and obtain weights every visit and notify physician of weight gain or loss of seven pounds within seven days. Instruct patient/caregiver on importance of obtaining weight and keeping a weight log. The SN visited on 1/28/25 however, the SN failed to obtain a weight as required. Additionally, the plan of care required the SN to perform wound care to the left tibia (shinbone) weekly until healed as follows: cleanse with wound cleanser, pat dry, apply opticell (a wound dressing used to heal wounds) or equivalent to wound bed, moisturize legs with ointment. Apply ABD (thick absorbent padding) pad as overlay. Secure with kerlix (gauze bandage) and coban (self adherent wrap to secure bandages). During a home visit observation on 1/28/25 at approximately 10:30 a.m., with RN BB, this surveyor observed RN BB perform wound care to the right lower extremity. Once completed, RN BB began to perform wound care to the left leg. RN BB did confirm P#11 had bilateral wounds to lower extremities requiring wound care. However, the plan of care did not contain wound orders for the right lower extremity. The agency failed to obtain orders for wound care to the right lower extremity. During an interview on 1/29/25 at approximately 11:00 am., the Executive Director confirmed that the plan of care lacked physician orders for wound care to the right lower extremity. It was also confirmed that the SN failed to perform weekly weights on 1/28/25 as required. The Findings include: Review of policy titled: “Wound Assessment, Documentation, and Photography. Policy Number 2.2.001, page 2 of 3. Revised 09/01/24”. Procedure: number 2. Perform wound care according to LHC adopted clinical skills guidelines and physician orders. Review of the plan of care (POC), for P#14 with a certification period of 1/23/2025 to 3/23/2025 revealed the patient had pertinent diagnoses of pressure ulcer of sacral region stage 2. The physician’s order revealed a skilled nurse (SN), to perform wound care to right buttock stage two, twice a week, and as needed if soil. Cleanse the buttock wound with soap and water, apply hydrogel and cover with ABD pad and secure with tape, using clean technique. On 1/28/2025 at 11:00 a.m., observed Licensed Practical Nurse (LPN) AA perform wound care to P#14, sacral area. LPN AA cleaned the wound with soap and water, pat dry, then covered the sacral wound with abdominal pad (ABD) and secured the pad with tape. On 1/28/2025 at 11:56 a.m., an interview was conducted with LPN AA at the Livingroom in patient’s apartment. LPN AA said that P#14 was admitted on 1/23/2025 (five days ago), and they ordered for hydrogel, but it was not delivered, and she thought she had it in her car but unfortunately it had finished. LPN AA said that she would notify the physician that the hydrogel was not available when she visited the patient. After the interview, LPN AA went back to P#14 and told him that the hydrogel was not available. On 1/28/2025 at 12:15 p.m., an interview was conducted with the Administrator on phone. She acknowledged the LPN AA failed to apply hydrogel to P#14 sacral wound as ordered because the medicine was not available during SN visit.

At the time of the survey, Georgia Home Health in Atlanta , GA was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a recertification survey conducted on January 28, 2022. A Focus Infection control survey was completed at the time of the survey. Current census 186. No deficiencies cited.

At the time of the survey, Georgia Home Health in Atlanta , GA was in compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of a recertification survey conducted on January 28, 2022. A Focus Infection control survey was completed at the time of the survey. Current census 186. Following deficiencies cited:

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 clinical record reviews and staff interviews, it was determined that the agency staff failed to conduct an initial assessment within 48 hours of referral or on the physician ordered start of care date for nine of seventeen ( #1, #2, #4, #7, #10,# #13, #14, #15,and #17) sampled patients (P). Findings include: Review of the plan of care/treatment for P# 1 (closed record) with a certification period of 11/22/20 to 1/20/21 revealed the agency staff received a home health referral for services on 11/18/20. However, the patient did not receive services until 11/22/20. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay.Review of the plan of care/treatment for P# 2 (closed record) with a recertification period of 9/23/21 to 11/21/21 revealed the agency staff received a home health referral for services on 7/22/21. However, the patient did not receive services until 7/25/21. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay.Review of the plan of care/treatment for patient # 4 (closed record) with a certification period of 10/13/20 to 12/11/20 revealed the agency staff received a home health referral for services on 10/7/20. However, the patient did not receive services until 10/13/20. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay.Review of the plan of care/treatment for patient # 7 with a certification period of 12/22/21 to 2/19/22 revealed the agency staff received a home health referral for services on 12/7/21. However, the patient did not receive services until 12/22/21. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay.Review of the plan of care/treatment for patient # 10 with a certification period of 12/30/21 to 2/27/22 revealed the agency staff received a home health referral for services on 12/22/21. However, the patient did not receive services until 12/30/21. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay.Review of the plan of care/treatment for patient # 13 with a recertification period of 1/2/22 to 3/2/22 revealed the agency staff received a home health referral for services on 5/3/21. However, the patient did not receive services until 5/7/21. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay. Review of the plan of care/treatment for patient # 14 with a recertification period of 12/21/21 to 2/18/22 revealed the agency staff received a home health referral for services on 10/14/21. However, the patient did not receive services until 10/22/21. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay.Review of the plan of care/treatment for patient # 15 with a certification period of 12/28/21 to 2/25/22 revealed the agency staff received a home health referral for services on 12/20/21. However, the patient did not receive services until 12/28/21. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay. Review of the plan of care/treatment for patient # 17 with a certification period of 1/14/22 to 3/14/22 revealed the agency staff received a home health referral for services on 1/5/22. However, the patient did not receive services until 1/14/22. The clinical record lacked justification for the delay of start of care and documentation that the physician was notified and authorized the start of care later than 48 hours from the referral, resulting in an unauthorized start of care delay. During an interview on 1/28/22 at 12:00 p.m., the Administrator and the clinical manager did not provide any additional information regarding the lack of documentation or if the physician was notified of the start of care delay.

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 clinical record reviews and staff interviews, it was determined the agency staff failed to include orders to cover all pertinent diagnoses and ensure the patients' needs were addressed to include disease specific interventions/treatments were included on the plans of care for three of seventeen (#5,#6,and #13) sampled patients (P). Findings include: Review of clinical record for P #6 revealed the patient was admitted on 9/10/20 with diagnosis of encounter for fitting and adjustment of urinary device. Review of the plan of care required a skilled nurse( SN) to change the indwelling Foley catheter 18 French with 10 cubic centimeter (cc) balloon monthly and as needed for dislodgment or blockage. However, the Foley catheter order lacks the type and the amount of solution to inflate the balloon. The agency failed to ensure the plan of care was complete and consistent to include the specific steps and supplies used to change the Foley catheter monthly and on as needed basis. Review of clinical record for P #13 revealed the patient was admitted on 5/7/21 with diagnosis of encounter for attention to cystostomy and neuromuscular dysfunction of bladder. Review of the plan of care required a skilled nurse( SN) to change suprapubic Foley catheter 22 French with 10 cubic centimeter (cc) balloon every two weeks and as needed for dislodgment or blockage. However, the Foley catheter order lacks the type and the amount of solution to inflate the balloon. The agency failed to ensure the plan of care was complete and consistent to include the specific steps and supplies used to change the Foley catheter monthly and on as needed basis. Furthermore, the plan of care revealed the patient has pertinent diagnosis of Type 2 diabetes mellitus. The plan of care instructs the skilled nurse (SN) to teach the patient on blood glucose testing and notify the doctor if the blood sugar is below 60 or above 250. However, the plan of care does not contain a blood glucose monitoring frequency which would instruct the patient in how often to check blood glucose levels and prompt the staff to notify the physician for early intervention and treatment of a diabetic exacerbation. The agency failed to ensure the plan of care was complete and comprehensive for the care and monitoring of the patient's diabetic status.Review of clinical record for P #5(closed record) revealed the patient was admitted on 10/17/20 with diagnosis of Type 2 diabetes mellitus with hypoglycemia. The plan of care instructs the skilled nurse (SN) to teach the patient on blood glucose testing and notify the doctor if the blood sugar is below 60 or above 250. However, the plan of care does not contain a blood glucose monitoring frequency which would instruct the patient in how often to check blood glucose levels and prompt the staff to notify the physician for early intervention and treatment of a diabetic exacerbation. The agency failed to ensure the plan of care was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 1/28/22 at 12:00 p.m., the Administrator and clinical manager acknowledged the plan of care lacked blood glucose monitoring frequency to ensure the patient was monitoring blood glucose levels for complications and the plan of care did not include clear instructions for the care of the patient’s Foley catheter.

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 clinical record reviews and staff interviews, it was determined that the agency staff failed to ensure treatments were administered only as ordered by the physician for one of seventeen (#13) sampled patients (P). Findings include : 1.Review of clinical record for P #13 revealed the patient was admitted on 5/7/21 with diagnosis of encounter for attention to cystostomy and neuromuscular dysfunction of bladder. Review of the plan of care required a skilled nurse( SN) to change suprapubic Foley catheter 22 French with 10 cubic centimeter (cc) balloon every two weeks and as needed for dislodgment or blockage. The SN visited the patient on 1/13 and 1/26/22 and documented Foley catheter changed with 20 French with10cc balloon catheter , balloon inflated with 15 cc sterile water. However, the clinical record lacked an order for 20 French Foley catheter and the type and amount of solution to inflate the balloon, The agency failed to ensure this procedure was administered only as ordered by a physician. During an interview on 1/28/22 at 12:00 p.m., the Administrator and the clinical manager acknowledged the catheter irrigation was performed without a physician's order.

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 ensure the care and services were provided in conformance with the patients' plans of care/treatment as ordered by physicians for two of seventeen ( #5, and #8) sampled patients (P). Findings include : 1. Review of the plan of care/treatment for patient #8 with a recertification period of 11/25/21 to 1/23/22 with a diagnosis of hypertensive heart disease with heart failure required the skilled nurse (SN) to observe/assess and report weight gain of 2-2.5 pounds in one day or 7 pounds in a week. The SN visited the patient on 1/4 and 1/11/22 however, the weight was not assessed. The agency failed to ensure the plan of care/treatment for monitoring weights was assessed as ordered. 2. Review of the plan of care/treatment for patient #5 (closed record) with a certification period of 10/17/20 to 12/15/20 with a diagnosis Type 2 diabetes mellitus required the SN to report blood sugar less than 60 or above 250 . The SN visited the patient on 10/26/20 and 11/9/20 however, the blood sugar was not assessed. The agency failed to ensure the plan of care/treatment for monitoring blood sugar was assessed as ordered. During an interview on 1/28/22 at 12:00 p.m., the Administrator and the clinical manager acknowledged the SN failed to monitor blood sugar and weights as ordered.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency failed to ensure the clinical records contained clear, complete, and accurate documentation for three of seventeen (#6, #11, and #12) patients (P) who were current hospice beneficiaries. The findings include: Review of clinical record for P #6 revealed the patient was admitted on 9/10/20 with diagnosis of encounter for fitting and adjustment of urinary device. Review of the plan of care required a skilled nurse( SN) to change the indwelling Foley catheter 18 French with 10 cubic centimeter (cc) balloon monthly and as needed for dislodgment or blockage. The SN visited the patient on 11/19/21 and documented Foley catheter changed with 18 Fr 10cc. The SN failed to document the specific steps and supplies used to change the Foley catheter and the amount and type of solution used to inflate the balloon. The SN failed to completely document Foley catheter insertion procedure as required. Clinical notes must include clear, accurate, and contain complete documentation of any and all services provided. Review of the plan of care for patient #11 with a recertification period of 10/2/21 to 11/30/21 revealed the patient has a diagnosis of pressure ulcer to left heel and required the skilled nurse (SN) to perform wound care as follows: Cleanse left heel and great toe with wound cleanser , pat dry, paint with betadine . Cover with dry gauze secure with tape using clean technique, wound care to be done two times weekly. The SN visited the patient on 1/8 and 1/13/22 and documented the wound care was provided as per order. However, the SN failed to document the specific steps and supplies used to complete the wound care as required, the SN did not specify the steps taken or products used during the procedure. The SN failed to completely document wound care procedure as required. Clinical notes must include clear, accurate, and contain complete documentation of any and all services provided.Review of the plan of care for patient #12 with a recertification period of 1/5/22 to 3/5/22 revealed the patient has diagnosis of open wound to right lower leg and required the skilled nurse (SN) to perform wound care as follows: Cleanse right lower leg with wound cleanser pat dry, apply calcium alginate . Cover with dry gauze secure with tape using clean technique. Perform wound care twice weekly. The SN visited the patient on 1/10 and 1/13/22 and documented the wound care was provided. However, the SN failed to document the specific steps and supplies used to complete the wound care as required, the SN did not specify the steps taken or products used during the procedure. The SN failed to completely document wound care procedure as required. Clinical notes must include clear, accurate, and contain complete documentation of any and all services provided. During an interview on 1/28/22, at 12:00 p.m., the Administrator and the Clinical Manager confirmed the SN failed to document the specific steps and supplies used to complete the wound care and Foley catheter care as required.