Every finding on record at Promed Home Health Care LLC

Purpose: Recertification survey with follow-up Entrance Date: 1/3/2022 at 12:50 p.m. with the Administrator Census: Licensed and Certified - 35 patients Exit Date: 1/6/2022 at 4:10 p.m. with the Administrator, Alternate Administrator/Director of Nursing, Quality Manager, and the Office Manager. The agency was given the opportunity to provide additional information during the survey. The preliminary findings were discussed. Written instructions were given for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies and the time frame that the agency would receive the Statement of Deficiencies. The agency was in compliance with 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies.

Purpose: Recertification survey with follow-up Entrance Date: 1/3/2022 at 12:50 p.m. with the Administrator Census: Licensed and Certified - 35 patients Exit Date: 1/6/2022 at 4:10 p.m. with the Administrator, Alternate Administrator/Director of Nursing, Quality Manager, and the Office Manager. The agency was given the opportunity to provide additional information during the survey. The preliminary findings were discussed. Written instructions were given for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies and the time frame that the agency would receive the Statement of Deficiencies. The agency was in compliance with 42 CFR Part 484, Conditions of Participation for Home Health Agencies.

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 record review and interview, the agency failed to individualize the Plan of Care in 1 (#1) of 1 patient that received intravenous medications, laboratory testing, and wound care. The agency failed to include wound care, laboratory testing, all intravenous medications, and peripherally inserted central line catheter care in the Plan of Care. The failure resulted in the wound care provided was not consistent and omission of Creatine Phosphokinase being obtained every week. Findings Include: The patient records were electronic medical records. Patient #1: Review of Patient #1's clinical record revealed a Plan of Care dated 10/23/2021 to 12/21/2021. The Plan of Care indicated that Patient #1 started on the agency's services on 10/23/2021. The Plan of Care listed Sepsis, Osteomyelitis, Pressure Ulcer of Sacral Region Stage IV, and Pneumonia as diagnoses. The Plan of Care listed the following medications: Daptomycin (antibiotic) 500 milligrams intravenous every 24 hours. Ceftriaxone (antibiotic) 2 grams intravenous every 24 hours. Heparin (an anticoagulant used to keep intravenous catheters open and flowing freely) 100 units/milliliter, 5 milliliters, intravenous after intravenous antibiotics. The Plan of Care contained an order for skilled nursing services with one skilled nurse visit the first week, then skilled nurse visits 3 times each week until the end of the episode. The clinical record contained a physician order dated 10/22/2021 from Physician X. The order read in part; "... Daptomycin 500 mg (milligram) IV (intravenous) q (every) 24h (24 hours), Ceftriaxone 2 grams IV (intravenous) q24h (24 hours), DL PICC (double-lumen peripherally inserted central catheter): flush lumen with 5-10 milliliters of NS (Normal Saline - this was not included in the Plan of Care) before and after infusion followed by 3-5 milliliter of Heparin 100 units/milliliter as a last flush. Flush unused lumen once daily. Change dressing every 7 days (not included in Plan of Care). Labs weekly: Complete Blood Count, Complete Metabolic Panel, and Creatine Phosphokinase (not included in the Plan of Care." The clinical record contained a physician order from Physician Z dated 10/20/2021. The order read in part; “…Services needed – Home infusion, IV abx (intravenous antibiotics), and wound care (not included in the Plan of Care)…” Laboratory Licensed Vocational Nurse D documented that laboratory testing was conducted on 11/8/2021, 11/15/2021, 11/26/2021, 11/29/2021, and, 12/6/2021. Licensed Vocational Nurse D did not obtain a Creatine Phosphokinase on these dates. The Creatine Phosphokinase was drawn only on 11/1/2021 and 11/22/2021. Wound A Start of Care comprehensive assessment was conducted on 10/23/2021 by Registered Nurse E. Registered Nurse E documented; "WC (wound care) Narrative: Wound Vac (vacuum) order to sacrum: Cleanse with NS (Normal Saline), pat dry, apply black foam to wound bed, apply and secure wound vac. Frequency to be 3 x (times) week, Monday, Wednesday, and Friday until resolved. Alternate dressing if needed: Cleanse wound with NS, pat dry, apply wet to dry dressing, cover with 4x4 or foam dressing and secure with tape." Registered Nurse E documented notification to the physician and receipt of a verbal order for the Plan of Care. Registered Nurse E (2), Registered Nurse F (2), and Licensed Vocational Nurse D (19), conducted 23 skilled nurse visits from 10/25/2021 through 12/20/2021 and provided wound care to Patient #1's sacral Stage IV Decubitus Ulcer. The wound care provided by the skilled nurses was as follows: Wound cleaned with Normal Saline, foam applied, to wound vacuum per physician order. Licensed Vocational Nurse D provided visits on 10/27/2021 and 10/29/2021 and provided wound care as follows: Cleaned wound with Normal Saline, applied Calcium Alginate, covered with foam and secured with tape. (documented in the Start of Care comprehensive assessment, a wet to dry dressing was to be utilized when alternate dressing was needed.) A home visit was conducted on 1/5/2021 at approximately 10:00 a.m. to Patient #1. Licensed Vocational Nurse D was present during the visit. Licensed Vocational Nurse D provided wound care to Patient #1's sacral wound. The wound was cleaned with Normal Saline, packed with black foam, and attached to a wound vacuum with the suction set at 125. Patient #1 was not receiving intravenous antibiotics and did not have a peripherally inserted central catheter. Patient #1 informed the surveyor that the intravenous medications had been “stopped months ago.” Licensed Vocational Nurse D stated that the wound was improving. Registered Nurse F conducted a Recertification Comprehensive assessment on 12/20/2021. Registered Nurse F's documented in the comprehensive assessment, “IV therapy, No.” Patient #1's clinical record contained a Plan of Care dated 12/22/2021 to 2/19/2022. The Plan of Care listed Daptomycin 500 milligrams every 24 hours intravenous, Ceftriaxone 2 grams every 24 hours intravenous, and Heparin 100 units/milliliter, 5 milliliters, intravenous after antibiotics as medications. The Plan of Care contained an order for the skilled nurse to perform wound care 3 times each week to the sacral pressure ulcer but did not specify the wound care to be performed. During an interview on 1/6/2022 at approximately 10:00 a.m., with the Administrator, Director of Nursing, and the Quality Manager, the surveyor discussed and asked questions regarding Patient #1's Plans of Care. The Quality Manager informed the surveyor that the physician may have pulled the peripherally inserted central catheter. The Supervising Nurse informed the surveyor that the agency had a new documentation system and that items were not crossing over to the Plans of Care. The Director of Nursing informed the surveyor that the nurse did not take the intravenous medications off the Plan of Care dated 12/22/2021 to 2/19/2022. The agency had a policy titled "Plan of Care," labeled PC.8 and dated 1/13/2018. The policy read in part; "Purpose To ensure that care provided is appropriately planned in a timely manner to meet the patient's/client's specific needs and problems...Procedure...III. Each patient/client must receive an individualized written plan of care...The individualized plan of care must specify the care and services necessary to meet the patient/client specific needs...A. The individualized plan of care must include the following: 1...10. All medications and treatments...14. Patient/client-specific interventions...VII. A revised plan of care must reflect current information from the patient's/client's updated comprehensive assessment..."