QA Investigation Results

Pennsylvania Department of Health
AVEANNA HEALTHCARE
Health Inspection Results
AVEANNA HEALTHCARE
Health Inspection Results For:


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Initial Comments:



Based on the findings of an unannounced onsite home health care agency state re-licensure survey completed December 11, 2018, Aveanna Healthcare, was found to not be in compliance with the requirements of 28 Pa. Code, Part IV, Health facilities, Subpart G. Chapter 601.







Plan of Correction:




601.31(b) REQUIREMENT
PLAN OF TREATMENT

Name - Component - 00
601.31(b) Plan of Treatment. The
plan of treatment developed in
consultation with the agency staff
covers all pertinent diagnoses,
including:
(i) mental status,
(ii) types of services and equipment
required,
(iii) frequency of visits,
(iv) prognosis,
(v) rehabilitation potential,
(vi) functional limitations,
(vii) activities permitted,
(viii) nutritional requirements,
(ix) medications and treatments,
(x) any safety measures to protect
against injury,
(xi) instructions for timely
discharge or referral, and
(xii) any other appropriate items.
(Examples: Laboratory procedures and
any contra-indications or
precautions to be observed).

If a physician refers a patient under
a plan of treatment which cannot be
completed until after an evaluation
visit, the physician is consulted to
approve additions or modifications to
the original plan.

Orders for therapy services include
the specific procedures and modalities
to be used and the amount, frequency,
and duration.
The therapist and other agency
personnel participate in developing
the plan of treatment.

Observations:


Based on reviews of medical records (MR), plans of care and interview with agency personnel (EMP), it was determined that the agency failed to ensure that the plans of care were followed for two (2) of seven (7) clinical records reviewed. (MR#2, MR# 3)

Findings include:

Review of Medical records and Plans of Care conducted on 12/7/18 between 09:00 AM-2:30 PM revealed the following:

Medical record (MR) #2; Start of care (SOC) 8/13/2018: Plan of Care: MEDICATIONS: "Oxygen reason: 2-4 LPM PRN (as needed) respiratory distress/desaturation. nasal..." RESPIRATORY: "SN (skilled nurse) will spot check O2 sats PRN. If O2 sats below 92 % begin O2 therapy per order..." 21. ORDERS: "Sn to complete a comprehensive assessment as allowed by scope of practice every shift and PRN to include temperature, HR (heart rate), Resp. q shift and change of status. notified MD and/or Nursing supervisor for HR below 50 or above 185; resp below 12 or above 30: Temp below 95 or above 102...." Medical record review revealed no documentation that a pulse ox check was completed for the entire period reviewed 10/12/18-12/7/18, No vital signs documented on 11/27/18, and no respiratory rate documented on 12/5/18.

Medical record (MR) #3; Start of care (SOC) 4/27/2015: Certification Period: 10/8/2018-12/6/2018: Plan of Care: RESPIRATORY: "SN to have emergency equipment ready at all times...." "SN/PCG to suction trach PRN for increased secretions with #10 FR suction catheter to a depth of 9-11 cm..." Medical record review revealed no documentation that suctioning was completed or not needed and no documentation that the emergency go bag was checked on 10/21/18.


An interview with the Agency Administrator/DON conducted on 12/7/2018 at approximately 2:40 PM confirmed the above findings.









Plan of Correction:

All clinical supervisors and the quality assurance nurse were re-educated on reviewing caregiver clinical visit notes prior to and during home visits to ensure accurate documentation is completed in accordance with all plan of treatment/physician's orders. A sign in sheet and documentation of this education has been completed and place onto each staff members personnel file.
An e-mail blast was sent out to all care-givers re-educating them on the importance of following the physician's orders i.e. vital signs: pulse, heart rate, respiratory rate. This e-mail blast also included documentation that when suctioning is completed on a patient that it is clearly documented in the clinical visit notes and includes color, consistency, thickness, odor etc. Re-education that the emergency go back is checked at the beginning and end of each shift.
An annual training blitz is scheduled 1/28/19 to 2/2/2019, caregivers will be re-educated on documentation standards and expectation to follow plans of care and physician's orders. In addition, the Quality Assurance nurse will conduct weekly audits consisting of 10% of client records related to field staff (RN, LPN, HHA) documentation. The audit tool includes review of: vital sign parameters, feeding orders, comprehensive assessment, reporting change in condition, treatments provided and client response to treatments. Any caregiver, whose documentation is found not to be in compliance will be re-educated, coached and counseled by the clinical team to improve performance.



601.31(d) REQUIREMENT
CONFORMANCE WITH PHYSICIAN'S ORDERS

Name - Component - 00
601.31(d) Conformance With
Physician's Orders. All prescription
and nonprescription (over-the-counter)
drugs, devices, medications and
treatments, shall be administered by
agency staff in accordance with the
written orders of the physician.
Prescription drugs and devices shall
be prescribed by a licensed physician.
Only licensed pharmacists shall
dispense drugs and devices. Licensed
physicians may dispense drugs and
devices to the patients who are in
their care. The licensed nurse or
other individual, who is authorized by
appropriate statutes and the State
Boards in the Bureau of Professional
and Occupational Affairs, shall
immediately record and sign oral
orders and within 7 days obtain the
physician's counter-signature. Agency
staff shall check all medicines a
patient may be taking to identify
possible ineffective drug therapy or
adverse reactions, significant side
effects, drug allergies, and
contraindicated medication, and shall
promptly report any problems to the
physician.

Observations:


Based on reviews of medical records (MR), plans of care and interview with agency personnel (EMP), it was determined that the agency failed to ensure that the plans of care were followed for two (2) of seven (7) clinical records reviewed. (MR#2, MR# 3)

Review of Medical records and Plans of Care conducted on 12/7/18 between 09:00 AM-2:30 PM revealed the following:

Medical record (MR) #2; Start of care (SOC) 8/13/2018: Plan of Care: MEDICATIONS: "Oxygen reason: 2-4 LPM PRN respiratory distress/desaturation. nasal..." RESPIRATORY: "SN will spot check O2 sats PRN. If O2 sats below 92 % begin O2 therapy per order..." 21. ORDERS: "Sn to complete a comprehensive assessment as allowed by scope of practice every shift and PRN to include temp, HR, Resp. q shift and change of status. notified MD and/or Nursing supervisor for HR below 50 or above 185; resp below 12 or above 30: Temp below 95 or above 102...." Medical record review revealed no documentation that a pulse ox check was completed for the entire period reviewed 10/12/18-12/7/18, No vital signs documented on 11/27/18, and no respiratory rate documented on 12/5/18.

Medical record (MR) #3; Start of care (SOC) 4/27/2015: Certification Period: 10/8/2018-12/6/2018: Plan of Care: RESPIRATORY: "SN to have emergency equipment ready at all times...." "SN/PCG to suction trach PRN for increased secretions with #10 FR suction catheter to a depth of 9-11 cm..." Medical record review revealed no documentation that suctioning was completed or not needed and no documentation that the emergency go bag was checked on 10/21/18.

An interview with the Agency Administrator/DON conducted on 12/7/2018 at approximately 2:40PM confirmed the above findings.








Plan of Correction:

All clinical supervisors and the quality assurance nurse were re-educated on reviewing care giver clinical visit notes prior to and during home visits to ensure accurate documentation is completed in conformance with all physician's orders. A sign in sheet and documentation of this education has been completed and place onto each staff members personnel file.
An e-mail blast was sent out to all caregivers re-educating them on the importance of following the physician's orders i.e. vital signs: pulse, heart rate, respiratory rate. This e-mail blast also included documentation that when suctioning is completed on a patient that it is clearly documented in the clinical visit notes and includes color, consistency, thickness, odor etc. Re-education that the emergency go bag is checked at the beginning and end of each shift.
An annual training blitz is scheduled 1/28/19 to 2/2/2019, caregivers will be re-educated on documentation standards and expectation to follow plans of care and physician's orders. In addition, the Quality Assurance nurse will conduct weekly audits consisting of 10% of client records related to field staff (RN, LPN, HHA) documentation. The audit tool includes review of: vital sign parameters, feeding orders, comprehensive assessment, reporting change in condition, treatments provided and client response to treatments. Any caregivers, whose documentation is found not to be in compliance will be re-educated, coached and counseled by the clinical team to improve performance.



Initial Comments:



Based on the findings of an onsite unannounced home health care agency state re-licensure survey completed December 11, 2018, Aveanna Healthcare, was found to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 51, Subpart A.





Plan of Correction:




Initial Comments:



Based on the findings of an onsite unannounced home health care agency state re-licensure survey completed December 11, 2018, Aveanna Healthcare, was found to be in compliance with the requirements of 35 P.S. 448.809 (b).






Plan of Correction: