Klarus Home Care, LLC

“Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This Element is not met as evidenced by: Based on observation, record review, and interview the facility failed to educate patient on wound care in accordance with the plan of care for 1 (P[patient]6) out of 7 (P6, P7, P10, P13, P14, P16 and P17) patients observed for wound care. This deficient practice could lead to infection or worsening of wound. The findings are: A. Record review of facility’s procedure manual, dated 09/2022, provided the following information regarding wound vac (negative pressure wound therapy; type of dressing to help wounds heal) therapy: “Negative-pressure wound therapy encourages healing of acute and chronic wounds by applying continuous or intermittent subatmospheric [less than/lower than the atmosphere] pressure to the surface of a wound using a well-sealed dressing. Doing so removes excess wound fluids that can cause maceration [skin that has been exposed to moisture for too long] and delay in healing, reduces edema [fluid collection] and bacterial colonization [bacteria is introduced to wound], and stimulate the formation of healthy granulation tissue [new tissue and vessels] ...” Under “Special Considerations” it is stated “. . . Never leave the dressing in place without suction. If the machine malfunctions, replace the dressing with a wet-to-damp dressing until the machine is repaired or replaced. Leaving the dressing in place without suction puts the patient at high risk for infection.” B. Record review of P6’s plan of care dated 02/14/2024 – 04/13/2024 under, “Order of discipline and Treatments” stated, “Skilled nurse to cleanse wound to right groin surgical wound with wound cleanser or normal saline, apply skin prep [liquid that forms a protective barrier] to peri skin [skin around the wound]. Fill entire cavity of wound and tunnel at 12 o clock with black foam. Apply tubing and cover with transparent drape. Apply negative pressure device at 125 mmHg [millimeter of mercury] continuously. SN [skilled nursing] to change dressing every [Monday, Wednesday, and Friday] as needed for wound vac complications. May use the following protocol as an alternative dressing as needed for vac malfunction: wet to dry dressing [dressing that involves filling wound with soaked gauze and then removing when dry].” Under, “Goals/Rehabilitation Potential/Discharge Plans” stated, “Patient/Caregiver will verbalize/demonstrate ability to perform wound care.” C. During an observation on 03/06/2024, at 11:15 AM, Staff (S)2, RN (Registered Nurse) entered P6’s home for a visit, patient was on couch and patient’s wound vac was not attached to patient’s wound as ordered. Patient reported that the machine kept beeping that there was a clog in the line. S2 educated P6 to call agency or nurse directly if there were issues with the wound dressings or machine. During wound care it was observed that the wound vac dressing was intact over the wound, the black foam was expanded in the wound bed. S2 did not assess how long the patient had been off the wound vac machine. S2 did not provide education to the patient on changing the wound dressing, doing a wet to dry dressing or provide education on how leaving the dressing on without suction could lead to infection. D. During an interview with P6 on 03/06/2024, at 2:50 PM, P6 confirmed that they were not educated on performing their wound care independently if there were complications with the dressings.”