Feliciana Home Health South

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on record review and interview the agency failed to ensure the patient received skilled nursing services for the frequency specified in the plan of care for 2 (Patient #6 and Patient #10) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for care and services per the plan of care. Findings: Patient #6 Review of Patient #6’s Home Health Certification and Plan of Care for certification period of 11/15/2023 to 01/13/2024 revealed, in part, Patient #6 was to receive skilled nursing services once a week for nine weeks. Review of Patient #6’s record revealed no documented evidence and the agency presented no documented evidence that the skilled nurse provided services the week of 12/03/2023 through 12/09/2023. In an interview on 12/20/2023 at 1:18 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no documented evidence, nor any explanation for the reason as to why the skilled nurse did not provide services the week of 12/03/2023 through 12/09/2023 to Patient #6. Patient #10 Review of Patient #10’s Home Health Certification and Plan of Care for certification period of 11/21/2023 to 01/19/2024 revealed, in part, Patient #10 was to receive skilled nursing services once a week for nine weeks. Review of Patient #10’s record revealed no documented evidence and the agency presented no documented evidence that the skilled nurse provided services the week of 12/03/2023 through 12/09/2023. In an interview on 12/20/2023 at 1:05 p.m., S1Administrator/DON stated the agency had no documented evidence, nor any explanation for the reason as to why the skilled nurse did not provide services the week of 12/03/2023 through 12/09/2023 to patient #10.”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure the skilled nurse removed her gloves and performed hand hygiene after cleaning the patient’s foot and prior to cleaning an open wound for 1 (Patient #18) of 1 (Patient #18) sampled patients observed for wound care. Findings: Review of Patient #18’s Home Health Certification and Plan of Care for certification period of 12/15/2023 to 02/12/2024 revealed, in part, the skilled nurse was to perform wound care to Patient #18’s right heel. Further review of Patient #18’s Home Health Certification and Plan of Care revealed the skilled nurse was to cleanse Patient #18’s right heel wound with normal saline, apply honey treatment using clean technique, and apply a wet to dry dressing. Observation on 12/20/2023 at 8:15 a.m. revealed after S2Licensed Practical Nurse (LPN) cleaned Patient #18’s periwound tissue (intact skin on the border of the wound) to his right heel wound, disposed of the gauze, and did not change her gloves and/or perform hand hygiene. Further observation revealed S2LPN then cleaned Patient #18’s entire right foot including between the toes, disposed of the gauze, did not remove her gloves and/or perform hand hygiene, and then proceeded to clean Patient #18’s right heel wound. In an interview on 12/20/2023 at 8:37 a.m., S2LPN stated she had not removed her gloves and performed hand hygiene after cleaning Patient #18’s foot and toes prior to cleaning Patient #18’s right heel wound, and should have. In an interview on 12/20/2023 at 11:20 a.m., S1Administrator/Director of Nursing stated S2LPN should have changed her gloves and performed hand hygiene between cleaning Patient #18’s foot and toes and then clean Patient #18’s right heel wound.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on record review and interview the agency failed to notify the patient’s physician: 1. For a patient who experienced a fall with pain (Patient #5); and 2. For a patient who had weight gain in excess of the parameters set by the physician (Patient #17). This deficient practice was identified for 2 (Patient #5 and Patient #17) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) reviewed for physician notification of change of condition. Findings: Patient #5 Review of Patient #5’s Client Coordination Note Report dated 11/09/2023 revealed, in part, upon skilled nurse’s arrival Patient #5 was on the floor on the side of the sofa. Review revealed Patient #5 had slid off the sofa and had a pain level of 8 (on a scale of 0 being no pain and 10 being the worse pain). Further review revealed no documented evidence and the agency presented no documented evidence Patient #5’s physician had been notified of the fall. In an interview on 12/20/2023 at 1:17 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no documented evidence that Patient #5’s physician had been notified of Patient #5’s fall. Patient #17 Review of Patient #17’s Home Health Certification and Plan of Care for certification period of 09/15/2023 to 11/13/2023 revealed a diagnosis of, in part, heart failure. Further review revealed the skilled nurse was to obtain a weight every visit and notify the physician of a weight gain or loss of 3-5 pounds within one day. Review revealed the skilled nurse was to instruct on the importance to obtain weights and to keep a weight log. Review of Patient #17’s record and Vital Signs report revealed the following weights, in part, 09/15/2023 a weight of 317 pounds; 09/18/2023 a weight of 320 pounds; 09/22/2023 a weight of 320 pounds; 09/25/2023 a weight of 317 pounds; and 10/04/2023 a weight of 321 pounds. There was no documented evidence and the agency presented no documented evidence that Patient #17 had obtained daily weights nor had documentation of daily weights. There was no documented evidence and the agency presented no documented evidence Patient #17’s physician had been notified of Patient #17’s three pound weight gain from 09/15/2023 to 09/18/2023 nor the four pound weight gain from 09/25/2023 to 10/04/2023. In an interview on 12/20/2023 at 1:27 p.m., S1Administrator/DON stated the agency had no documented evidence the nurse was ensuring Patient #17 was taking daily weights, nor did the agency have any documented evidence of the physician had been notified of the weight gains as mentioned above.”

“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 record review and interview the agency failed to coordinate care with a patient’s physician to ensure a urine specimen was collected for culture and sensitivity for 1 (Patient #14) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for coordination of care. Findings: Review of Patient #14’s Physician Order dated 01/17/2023 revealed the skilled nurse was to obtain a urine specimen for urinalysis and culture and sensitivity. Review of Patient #14’s record revealed the urine specimen was collected on 01/17/2023 with only the urinalysis requested. Review of Patient #14’s record revealed on 01/20/2023 Patient #14 was discharged from the agency. Review of faxed lab note dated 01/25/2023 revealed the urine culture testing was not performed due to the age of the urine specimen. Review of Patient #14’s record revealed no documented evidence and the agency presented no documented evidence of communicating with Patient #14’s physician to ensure Patient #14 received a urine culture and sensitivity and/or if further testing was needed. In an interview on 12/20/2023 at 1:22 p.m., S1Administrator/Director of Nursing stated the agency had no documented evidence of the coordination with Patient #14’s physician to ensure Patient #14’s physician was aware the urine culture was unable to be completed.”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on record review and interview the agency failed to ensure a registered nurse measured pressure ulcers weekly for 2 (Patient #9 and Patient #16) of 3 (Patient #9, Patient #15, and Patient #16) sampled patients with pressure ulcers reviewed. Findings: Review of the Wound Ostomy and Continence Nurses Society’s Guidelines revealed assessment and documentation of wound status, which includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes dimensions and depth; and presence, location and depth of any sinus tracts or undermining areas. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses Wound Care Management revealed, in part: the registered nurse may delegate to a Licensed Practical Nurse (LPN) wound care if the Registered Nurse (RN) had deemed the wound stable; and provides appropriate supervision. Patient #9 Review of Patient #9’s Home Health Certification and Plan of Care for certification period of 11/15/2023 to 01/13/2024 revealed Patient #9 was to receive skilled nursing services for assessment and care of his stage four pressure ulcer (open wound in which the bone and/or tendon is exposed) to the right buttock. Review of Patient #9’s record revealed no documented evidence and the agency presented no documented evidence the registered nurse had measured Patient #9’s right buttock stage four pressure ulcer the week of 12/03/2023 through 12/09/2023. In an interview on 12/20/2023 at 1:15 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no documented evidence the registered nurse had measured Patient #9’s right buttock stage four wound the week of 12/03/2023 through 12/09/2023. Patient #16 Review of Patient #16’s Home Health Certification and Plan of Care for certification period of 01/13/2023 to 03/13/2023 revealed Patient #16 was to receive skilled nursing services for assessment and care of his stage two pressure ulcer (open wound caused by pressure) to the left below the knee amputation site. Review of Patient #16’s record revealed no documented evidence and the agency presented no documented evidence the registered nurse had measured Patient #16’s left below the knee amputation site pressure ulcer for the weeks of, in part: 01/15/2023 through 01/21/2023; 01/22/2023 through 01/28/2023; and 01/29/2023 through 02/04/2023. In an interview on 12/20/2023 at 1:25 p.m., S1Administrator/DON stated the agency had no documented evidence the registered nurse had measured Patient #16’s left below the knee amputation site pressure ulcer for the above mentioned dates.”