Every finding on record at Steele County Phns

On 8/28/23 through 8/30/23, a survey for compliance with CMS Appendix Z Emergency Preparedness Requirements, was conducted during a recertification survey. The facility is in full compliance with the Appendix Z Emergency Preparedness Requirements.

On 8/28/23 through 8/30/23, a recertification survey was conducted. This resulted in a partial extended survey at Steele County PHNS. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Healthy Agency's inability to ensure provision of quality of care. Unduplicated census previous 12 months: 30. Total home visits conducted: 3. No branches. List Hours of Operation: 8:00 a.m. through 5:00 p.m. List total number of records reviewed: 7.

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 observation, interview and document review, the agency failed to ensure the plan of care (POC) included information related to the type of wound care supplies for 1 of 3 patients (P3) reviewed with home visits. Findings include: P3's POC for the certification period 7/29/23 to 9/26/23, identified diagnosis of chronic ulcer to the left ankle. The POC identified P3 received skilled nurse visits two to three times weekly for treatment of bilateral lower extremity wounds, general assessment, and teaching. Under the durable medical equipment (DME) and Supplies section, no wound care supplies were listed. Under the Medications section, no wound care medications or treatments were listed. P3’s Care Plan Visit Assessments dated 8/16/23 through 8/28/23, lacked a description of wound care orders and supplies needed. During an observation and interview on 8/28/23 at 4:00 p.m., registered nurse (RN)-A completed P3's wound care with the following supplies: Kerracel AG (antibacterial gel dressing), Bactroban (topical antibiotic medication), Kerramax (high absorption wound dressing), gauze, edema flow stocking and compression wraps. RN-A stated she referred to a provider document dated 8/15/23, in P3's wound basket instead of the POC, for wound care supplies needed. During an interview on 8/30/23 at 12:00 p.m. RN-B reviewed P3's POC and agreed no wound care supplies or equipment were listed. During an interview on 8/30/23 at 2:00 p.m. the administrator stated she would expect the POC to include relevant orders, supplies and treatments. The agency policy Comprehensive Assessment dated 3/18/22, identified the RN would complete, review, and edit the comprehensive assessment in PhDOC software (agency’s electronic medical record) and develop the patient’s POC based on that assessment. The policy lacked a process for including wound care supplies and equipment in the POC.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on observation, interview and document review, the agency failed to update the plan of care (POC) to reflect new provider orders for wound care treatment for 1 of 3 patients (P3) reviewed with home visits. P3's POC for the certification period 7/29/23 to 9/26/23, identified a diagnosis of chronic ulcer to the left ankle. The POC indicated P3 received skilled nurse visits two to three times weekly for treatment of bilateral lower extremity wounds, general assessment, and teaching. The POC and medication list lacked orders for wound care treatments. During an observation and interview on 8/28/23, at 4:00 p.m. registered nurse (RN)-A referred to a document from P3’s wound care basket dated 8/15/23, which identified the following provider orders: -change wound care to Kerracel AG (antibacterial gel dressing) with a thin layer of Bactroban (topical antibiotic medication) -apply to wounds, cover with Kerramax (high absorption wound dressing). Wrap with gauze to secure. Apply edema flow stocking and compression wrap -return to using Medi-honey and previous wound care orders when current supplies are done. RN-A completed the wound care in accordance with the above orders. RN-A stated the wound care instructions and supplies from P3’s 8/15/23, visit were not included in P3’s POC and should have been. RN-A agreed it could be difficult for a different nurse to find the orders if they were not maintained in the POC. During an interview on 8/30/23 at 12:00 p.m. RN-B stated new orders would typically be kept with a patient’s wound care supplies and not added to the POC. During an interview on 8/30/23 at 2:00 p.m. the administrator stated she would expect the POC to include current orders. The agency policy Medication Management dated 6/23/17, identified all medications administered or set-up by licensed nurse required an order from the primary care provider which would be included in the POC. If the agency was made aware of any prescribed, over the counter, or supplemental medications not included in the POC, it must be documented in the client records.