Above and Beyond Home Health

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on patient interview, agency staff interview, clinical record review and agency policy review, the agency failed to coordinate care delivery to meet the patient’s needs of 1 of 5 sampled patients (Patient #4). Failure to ensure staff ordered medical supplies placed agency patients at risk for inconsistent care/treatment. Findings include: According to the agency policy, titled Care Management and Plan of Care, dated 4/15/24, the case manager identifies and notifies appropriate agency management about patient changes including: patient care issues. The individualized plan of care specifies the care and services necessary to meet the needs of the patient identified in the comprehensive assessment and addresses the types of services, supplies, and equipment required. During an interview on 12/23/24 at 10:28 AM, with the Clinical Manager, reported nurses order their own supplies for patients through their tablet. If staff have problems ordering they can reach out to Clinical Manager or Staff C, Education RN (registered nurse), for assistance. Nurses are expected to order additional supplies for patients to ensure patients do not run out of supplies. Patient #4 had a start of care date of 9/18/24 and a discharge date of 11/20/24. Clinical record review revealed: 1.Plan of care, dated 9/18/24 to 11/16/24, included physician orders for skilled nursing services to provide wound care and colostomy management every Monday, Wednesday and Friday. 2. Start of Care comprehensive assessment, dated 9/18/24, included documentation Clinical Manager notified patient will need wound vac supplies, colostomy bags, barrier rings (for colostomy), skin prep and skin powder. During an interview on 12/16/24 at 5:02 PM, Patient #4, reported he/she had very few colostomy supplies, had to wait 10-12 days sometimes to get supplies, had to be out of supplies before he/she could get more supplies. Supplies were ordered for colostomy and patient never received the supplies and had to use cardboard one time because he/she didn’t have the needed colostomy supplies. Colostomy supplies that were received were not correct items or were not a large enough quantity to last the required time frame, would receive 10 colostomy bags but only 1 colostomy ring and had to sometimes change the colostomy ring 3 times a week. 3. Skilled nurse visit note, dated 10/2/24, included documentation patient concerned about ordering more ostomy bags and rings. Supplies ordered today: ostomy bags and rings. 4. Skilled nurse visit note, dated 10/11/24, included documentation supplies ordered today: texted Clinical Manager ostomy bag, barrier rings, skin prep, stoma powder, medipore 4 inch tape, gauze, 8 inch x 10 inch abdominal pads. 5. Skilled nurse visit note, dated 10/16/24, included documentation supplies ordered today: ostomy bags, barrier rings, adhesive remover wipes. 6. Skilled nurse visit note, dated 11/1/24, included documentation supplies ordered today: asked Clinical Manager to order the following: tape, saline, 12 rings (for ostomy), sterile swabs and smaller abdominal pads if available. 7. Skilled nurse visit note, dated 11/6/24, included documentation supplies ordered today: ostomy rings, sterile swabs, tape, saline and attempting to order the 2 piece ostomy bag. 8. Skilled nurse visit note, dated 11/8/24, included documentation supplies ordered today: waiting on shipment of: ostomy rings, sterile swabs, tape, saline, 2 different dressings and attempting to order the 2 piece ostomy bag. 9. Review of the undated Order History Detail Report for the durable medical supply company, included documentation supplies were ordered on the following visit dates: a. 10/10/24, items ordered: barrier strip elastic bravac shaped strip, 1 piece colostomy bag, barrier rings; b. 10/11/24, items ordered: abdominal pads 8 inches x 10 inches, gauze pads, 1 piece colostomy bag, medipore cloth tape, barrier ring extenders, adhesive remover wipe, barrier powder, barrier rings; c. 10/25/24, items ordered:1 piece colostomy bag, paper tape, barrier rings, saline, and packing strips; d. 11/1/24, items ordered: saline, cotton tipped applicator, barrier rings, gauze, cloth tape, adhesive dressing 4 inch x 4 inch, adhesive dressing 6 inch x 6 inch, and 2 piece colostomy bag. The skilled nurse failed to order supplies as documented on 9/18/24, 10/2/24, 10/16/24, 11/6/24 and 11/8/24. During an interview on 12/23/24 at 9:57 AM, Staff A, Administrator reported she was not aware Patient #4 was not receiving their medical supplies. The agency failed to provide the needed medical supplies for the patient care needs.”