Every finding on record at Virginia Homecare, LLC

An unannounced Home Health Agency recertification survey was conducted on June 7-9, 2021 by two (2) Medical Facilities Inspectors from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Home Health Medicare/Medicaid recertification survey was conducted on June 7-9, 2021 by two (2) Medical Facilities Inspectors from the Virginia Department of Health, Office of Licensure and Certification. The agency reported 669 unduplicated admissions for the past twelve months and operates one branch location in addition to the parent office. Branch Location: 3800 Electric Road, Suite 202 Roanoke, VA 24018-4568 The survey was conducted at the parent office and an onsite visit was made to the branch office on June 7, 2021. In conjunction with the survey, thirteen (13) clinical records, two (2) personnel files, an admission packet, complaint log, emergency preparedness, CLIA (Clinical Laboratory Improvement Amendments) and the organization chart were reviewed. Five (5) home visits and staff interviews were conducted. The agency was found not to be in compliance with the federal requirements of 42 CFR 484, Conditions of Participation for Home Health Agencies. Deficiencies were identified and cited in this report.

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 a review of clinical records and staff interview it was determined the agency staff failed to ensure a plan of care contained specific location of a wound with wound care ordered by the physician for one (1) of three (3) patients in the survey sample whom had a wound (Clinical record: #2). The findings were: Thirteen (13) clinical records were reviewed in electronically in read only mode on June 7-8, 2021. The clinical record for Patient #2 was reviewed for the certification period of 3/11/2021 to 5/09/2021. The plan of care contained orders for skilled nursing as follows: skilled nursing to cleanse wound with normal saline, apply Prisma (type of dressing to provide a moist wound bed) in wound bed, cover with sterile gauze, wrap with gauze and ace bandage three times weekly using universal precautions and caregiver to perform wound care in skilled nurse absence. The location of the wound was not specified in the plan of care orders. In addition, new orders were written on 3/26/2021 to change the wound care orders. The order read skilled nurse to perform wound care as follows: skilled nurse to cleanse wound with dermal wound cleanser, apply wet to dry dressing with Dakin solution, cover with ABD pad, and secure with tape, wrap with compression wrap using universal precautions and caregiver to perform wound care in skilled nurse absence. The new order also failed to contain the location of the wound. An interview was conducted with the administrator on 6/9/2021 at 9:30 am. The administrator acknowledged the lack of identification of the wound on the plan of care and on the new orders. A review of the record revealed the wound was located on the patient's Left heel.