Tanner Home Health Services

“Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This Element is not met as evidenced by: Based on staff interview, and review of group of professional personnel (GOPP) meeting minutes, it was determined that the administrator failed to organize and direct the agency’s ongoing functions to include participation of a community representative in the GOPP meetings and to ensure the GOPP met quarterly to advise the agency on professional issues as required. Findings include: On 3/4/2024 at 2:00 p.m., the surveyor requested the last three quarters of the agency’s Group of Professional Personnel (GOPP) meeting minutes and participants attendance sheet. The Administrator provided the GOPP meeting minutes dated 8/17/2023. Review of the GOPP meeting minutes, and the attendance sheet dated 8/17/2023 revealed that a member from the community who is neither an employee nor an owner failed to participate in the meeting. The agency failed to ensure the GOPP meetings were held quarterly to advise the agency on professional issues as required and ensure a member of the community actively participated in the GOPP meeting as required. On 3/6/2024 at 10:00 a.m., an office interview was conducted with the Administrator. The Administrator verbalized that the agency did not have an appropriate representation to include at least one community representative at the GOPP meeting held on 8/17/2023. The Administrator also verbalized that GOPP had only conducted one meeting for the past one year, and not quarterly.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on record reviews, staff interviews, and policy review, it was determined the agency failed to ensure documentation of the patient’s response to wound care treatment and progress toward desired outcomes. In addition, the agency failed to ensure wound measurements were documented weekly for two patients (P) (P#1 and P#8) of two patients reviewed for altered skin conditions. Findings include: Review of the document titled, “Wound Care and Dressing Change,” dated 10/1/14, indicated weekly measurements of full thickness wounds (through the epidermis and dermis) are to be performed by SN and documentation of a description of the wound bed and surrounding tissue, amount of drainage and any sign or symptom of infection. 1. Review of the plan of care revealed P#1 was admitted to home health on 4/1/2023, with a diagnosis of encounter for change or removal of surgical dressing (wound care to surgical wound). Review of the plan of care required the skilled nurse to visit the patient three times a week for wound care. Wound care is as follows: cleanse wound with wound cleanser, blot dry. Pack dehisced (separation of wound edges) portion with aquacel AG ribbon (three places), apply abdominal pad and Medipore tape (highly breathable, perforated nonwoven soft cloth tape). The skilled nurse (SN) visited the patient the weeks of 2/4/24 and 2/12/24 however, the clinical record failed to reveal documentation to indicate the wound was measured weekly and the progress or lack of progress of the wound status. 2. Review of the plan of care revealed P# 8 was readmitted to home health on 2/8/24. P#8 has a wound to the mid chest and sacrum. The plan of care required the nurse perform wound care to right buttock: cleanse with wound cleanser, skin prep and barrier cream to periwound area. Apply Triamcinolone .1% to rash area. Apply collagen to wound bed, then Aquacel AG, cover with foam adhesive, Medipore tape as needed to be changed 3 times per week. The plan of care required the nurse to perform wound care to chest: cleanse with wound cleanser, skin prep to periwound area. Apply Aquacel AG rope to wound bed. Cover with foam adhesive. Apply Medipore as needed. To be changed 3 times per week. Review of skilled nurse (SN) visit notes dated 2/19/24 and 2/23/24, failed to reveal wound measurements and progress or lack of progress of wound status. On 3/5/2024 at 12:50 p.m., an office interview was conducted with Registered Nurse (RN) Supervisor. The RN Supervisor revealed that the SN visit notes lack measurements and progress of the abdominal wound. She also verbalized that the expectation of the SN is to measure the wound every week and the SN did not measure the wound as required. On 3/5/2024 at 1:00 p.m., an office interview was conducted with RN Supervisor. The RN Supervisor revealed that the SN visit notes lack measurements and progress of the chest and sacral wounds. She also verbalized that the expectation of the SN is to measure the wounds every week and the SN did not measure the wounds as required.”