Every finding on record at Pediatria Health Care, LLC

Based on the findings of an unannounced, onsite Medicare recertification survey conducted on September 14 through September 16, 2022, Aveanna Healthcare was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced, onsite Medicare recertification survey conducted September 14 through September 16, 2022, Aveanna Healthcare was found not to be in compliance with the following requirement of 42 CFR, Part 484, Subparts B & C, Conditions of Participation: Home Health Agencies.

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 the review of agency policies/procedures and clinical records, and based on interview with the administrator, the agency failed to ensure gastric (feeding) tube interventions were completed as per physician order for two (2) of two (2) patients for whom physician orders for gastric tube (GT) flushes and maintenance were included on the "Home Health Certification and Plan of Care". (Patients #4 and #7) Findings include: On September 16, 2022 at approximately 4:30 PM, review of the agency policy titled "Physician Orders" revealed the following: Overview...Care and services will be provided in accordance with physician's (or other authorized practitioner's) orders, as required by law and regulations. Patient #4: Between September 15, 2022 at approximately 10:59 AM and September 16, 2022 at approximately 7:26 AM, review of the clinical record revealed the patient is 13 years old, the start of care date was 07/22/2022, the primary diagnoses is encounter for aftercare of gastrostomy (GT insertion) and that skilled nursing (SN) is to flush the GT with 120 milliliters (ml) of water after GT feedings as documented on the "Home Health Certification and Plan of Care" for the initial certification period of 07/22/2022 through 09/19/2022. Review of physician orders revealed an antibiotic was prescribed for treatment of a urinary tract infection on 07/28/2022. Review of SN flow sheet documentation revealed licensed practical nursing staff (Employees #4, #5 or #6) flushed the GT with 100 ml of water or less, instead of the prescribed 120 ml of water, after completion of the GT feeding or the LPN's failed to document the volume of water utilized to flush the GT after completion of the feedings during 17 of 71 SN shifts completed between 07/24/2022 and 09/15/2022. Patient #7: On September 16, 2022 at approximately 1:17 PM, review of the clinical record revealed the patient is 10 years old, the start of care date was 02/18/2019, the primary diagnosis is cerebral palsy and that SN is to administer/complete the following as documented on the "Home Health Certification and Plan of Care" for the recertification period of 08/01/2022 through 09/29/2022: GT Flush: 80 ml 3 times a day; and GT position: 2.0 centimeters (cm). Review of SN flow sheet documentation revealed licensed practical nursing staff (Employee #12) flushed the GT with 60 ml, instead of the prescribed 80 ml, of water during 33 of 33 SN shifts completed by the LPN between 08/01/2022 and 09/15/2022. Review of SN flow sheet documentation revealed licensed practical nursing staff (Employees #12 and #13) documented that the GT was maintained at 2.5 cm, instead of the prescribed 2.0 cm, during 68 of 69 SN shifts completed between 08/01/2022 and 09/15/2022. During interview conducted on September 16, 2022 at approximately 4:35 PM, the administrator confirmed GT flushes and positioning were not administered/maintained as per physician orders for the above identified patients.