Good Samaritan Society - Home Care

“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 plans of care included a list of durable medical equipment (DME), including non-routine DME, used to meet patient needs, for 1 of 4 patients (P3) reviewed during home visits. Findings include: P3’s plan of care (POC) for certification period 12/12/25 through 2/9/26, included chronic obstructive pulmonary disease (COPD), type 2 diabetes, acute on chronic systolic congestive heart failure. Skilled nurse orders to preform management and evaluation to observe and assess underlying conditions, complications and the effects of the non-skilled plan of care based on the registered nurse assessment to promote the patient’s recover and medical safety. The list of DME and orders section did not include oxygen or oxygen equipment. During a home visit on 1/21/26 at 10:30 a.m., registered nurse case worker (RNCW)-A HH, assessed P3’s seated vital signs and respiratory status which were baseline, except for the standing blood pressure which was low at 81/58, (normal blood pressure is less than 120/80). RNCW-A then completed medication set up. P3’s bedroom was observed to have an oxygen concentrator and steel portable oxygen cylinder, which were not being used. The steel portable oxygen cylinder was free standing and in an upright position. P3 stated he has not used the oxygen but kept it on hand for emergencies. On P3’s bedroom floor approximately 8 feet away from the oxygen, there was a propane heater set up but not running. P3 stated it was used over a week ago when his furnace went out. He stated he wouldn’t have used the oxygen with the propane but wasn’t sure about storage of the green tank. RNCW-A stated the oxygen was not a current order and would need to talk to the nursing manger. During an interview on 1/22/26 at 10:45 a.m., the nursing manager (NM) stated all DME should be included on the POC. The NM stated she knew P3 had oxygen on-hand, but not used currently, and should probably get an order to keep it if the patient wanted and so nursing could continue to educate on safety. The NM stated oxygen teaching was on a previous POC and was not sure why it was discontinued. A policy on oxygen use and DME was requested and not provided. The American Lung Association Oxygen Therapy: Using Oxygen Safely dated 1/28/26, identified to keep sources of heat and flame at least five feet away from where your oxygen unit is being used or stored. The section titled Oxygen Therapy: Getting Started with Oxygen in Metal Tanks dated 1/28/26, identified single tanks not in carriers or in use should be kept lying flat so they do not fall over.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on observation, interview, and document review, the agency failed to ensure wound care was administered to patients only as ordered by the physician, for 1 of 1 patient (P2), reviewed for wound care. Findings include: P2’s plan of care (POC) orders dated 1/14/26, identified a certification period of 12/10/25 through 2/7/26. P2’s diagnoses included pressure ulcer of sacral region and right buttock stage 4 (wound that extends through skin and underlying tissues exposing muscle, tendon, or bone), pressure ulcer of left buttock unstageable (wound that cannot be accurately assessed due to the presence of necrotic tissue), unspecified open wound right hip, pressure ulcer of other site stage 2 (partial thickness skin loss, presenting as shallow open wound), paraplegia (condition that causes partial or complete paralysis of the lower half of the body) and dementia. Skilled nurse orders to observe and assess integumentary status to identify changes and intervene to minimize complications, provide skilled teaching related to altered skin integrity including pathophysiology, nutrition, and medication regimen. Skilled nurses were to report significant changes in status to physician for early intervention. P2’s wound care orders dated 1/14/26, included in the POC identified wound care for the right hip, sacral, right and left ischial wounds: remove old dressing, cleanse with Vashe (prescription-only product that cleans, irrigates, moistens and debrides acute and chronic wounds) and gauze. Apply new Vashe moistened gauze, 4x4 gauze, Optilock (a non-adherent, super absorbent dressing), ABD pad (padded highly absorbent dressing), and tape. Change twice daily. During a home visit on 1/21/26 at 8:30 a.m., registered nurse case worker (RNCW)-A removed the left ischial wound dressing which was packed with gauze. Family member (FM)-A was also present to help with positioning. After about an arm’s length of gauze packing was removed from the wound, tunneling could be seen with moderate amount of reddish-brown drainage. RNCW-A cleaned the wound with gauze and Vashe. FM-A and RNCW-A had a conversation and decided to pack the wound with dry gauze instead of wet gauze as ordered. RNCW-A proceeded to pack the wound with about an arm’s length of dry gauze, covered with Optilock, ABD pad and tape. RNCW-A stated they had packed the wounds dry in the past when the wounds were too wet with drainage, and they should probably have an order for the dry dressing as needed. FM-A and RNCW-A stated the wounds were chronic and progress on wound healing fluctuated over the years. During an interview on 1/22/26 at 10:45 a.m., the nursing manager (NM) stated wound care should be provided according to current orders. A policy for wound care was requested and not provided.”