Every finding on record at Sanford Home Care Home Health

A recertification survey conducted on March 28-30, 2022 found Sanford Home Care in compliance with the requirements of 42 CFR § 484.102, Home Health Agency (HHA) Emergency Preparedness.

For the standard Medicare/Medicaid recertification survey started on 03/28/22 and completed on 03/30/22, the sampled included 6 records reviewed with no home visits and 4 records reviewed with home visits.

Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This ELEMENT is not met as evidenced by: Based on record review, facility policy review, and staff interview, the Home Health Agency (HHA) failed to ensure integration of orders from all providers for 1 of 2 sampled patients (Patient #4) with a current pressure ulcer. Failure to integrate orders from the wound clinic into the patient's current plan of care may result in inconsistent care delivery and a delay in treatment. Findings include: Review of the facility policy titled "Provider Orders and Notification" occurred on 03/30/22. This policy, revised 03/08/22, stated, ". . . When the provider has made a change in an order, an interim/supplemental order shall be written, including the date it was received . . ." Review of Patient #4's medical record occurred on all days of survey. Diagnoses included a Stage 3 right heel pressure ulcer. A wound care clinic note, dated 02/01/22, stated, ". . . Recommendations: Continue to change the dressing every Monday, Wednesday, and Friday. Cleanse using Dakins [sic] [a solution used to prevent skin infection] moistened gauze. . . ." Review of home visit notes, dated February 3, 10, and 24, identified normal saline or wound cleanser used to clean the wound. A physician's certification and plan of care, dated 03/01/22, failed to include the updated order for Dakin's solution. A second wound care clinic note, dated 03/15/22, stated, ". . . Recommendations: Continue to change the dressings every Monday, Wednesday, and Friday. Cleanse using Dakins [sic] moistened gauze. . . ." Review of home visit notes, dated March 4, 10, 24, and 29, identified normal saline or wound cleanser used to clean the wound. The home visit note, dated 03/17/22, identified Dakin's solution used to clean the wound and stated, ". . . Educated wife, [name], on using Dakins [sic] solution to cleanse the wound now per [wound care provider] new orders. . . ." During an interview on the afternoon of 03/30/22, a supervisory nurse (#2) stated home care staff should follow up with a patient's appointments and send an interim order to the provider so the new order can be included on the plan of care.

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 observation, record review, review of facility policy, and staff interview, the Home Health Agency (HHA) failed to provide care as indicated in the plan of care for 1 of 1 sampled patient (Patient #4) observed during wound care. Failure to provide wound care as ordered may result in delayed healing of the pressure ulcer. Findings include: Review of the facility policy titled "Plan of Care" occurred on 03/30/22. This policy, revised 08/03/21, stated, ". . . With each visit the RN [registered nurse] follows the plan, assesses the need for change and documents accordingly. . . ." Review of Patient #4's medical record occurred on all days of survey. Diagnoses included a Stage 3 right heel pressure ulcer. The current care plan stated, ". . . Wound care orders . . . Cleanse using Dakins [sic] [a solution used to prevent skin infection] moistened gauze. . . ." Observation on 03/29/22 at 11:00 a.m. showed a nurse (#1) performed a dressing change on Patient #4's heel. The nurse used saline solution to cleanse the wound, instead of Dakin's solution as ordered. On the afternoon of 03/30/22, a supervisory nurse (#2) identified the staff nurse (#1) should have used Dakin's solution.