QA Investigation Results

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


There are  29 surveys for this facility. Please select a date to view the survey results.

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Initial Comments:


An onsite unannounced follow-up and state relicensure survey conducted on January 7 and 8, 2019 found that Aveanna Healthcare (formally Care Unlimited, Inc.) had not corrected the following deficiencies cited under PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart G. Chapter 601, Home Health Care Agencies. The deficiencies were cited as a result of a home health relicensure survey completed on June 18, 2018.








Plan of Correction:




601.31(a) REQUIREMENT
PATIENT ACCEPTANCE

Name - Component - 00
601.31(a) Patient Acceptance.
Patients are accepted for treatment on
the basis of a reasonable expectation
that the patient's medical, nursing
and social needs can be met adequately
by the agency in the patient's place
of residence. Care follows a written
plan of treatment established and
periodically reviewed by a physician
and care continues under the general
supervision of a physician.

Observations:


Based on review of agency policy, clinical records (CR) and interview with staff (EMP), the agency failed to ensure the licensed practical nurse provided services in accordance with the written plans of treatment for two (2) of eleven (11) clinical records reviewed (CR 5, CR 8).

Findings included:

Review on 1/7/19 at approximately 11:00 a.m., of job description, Licensed Practical Nurse/Licensed Vocational Nurse-Field read "...Responsibilities and Job Requirements...Provides nursing care under the supervision of a Registered Nurse and according to the plan of care derived from the physician's orders...Documents all activities, assessments..."

Review on 1/7/19 at approximately 2:05 p.m., of policy, Physician Orders read "...Care and services will be provided in accordance with physician's...orders, as required by law and regulation..."

CR 5, reviewed on 1/8/19 at approximately 10:30 a.m., revealed start of care 10/8/18 for episode of care dated 12/7/18 through 2/4/19, with primary diagnosis of type 1 (insulin dependent) diabetes mellitus. Patient had insulin pump with an Omnipod system that was programmed by the physician to deliver an ordered amount of insulin continuously. Client changes omnipod independently every 3 days. Physician ordered plan of care directed nursing services to monitor client obtaining BG (blood glucose) before meals, snacks/physical activity; monitor client entering total carbs per each meal into pump; monitor amount of insulin delivered via preprogrammed pump. Procedures included to check urine for Ketones if blood glucose was found to be greater than 250 mg/dl (measurement of milligrams per deciliter) and if ketones positive, give 8-10 ounces of water, repeat blood glucose measurement and retest urine ketones in one hour. If blood glucose measurement was below 80 mg/dl to administer quick acting glucose product and recheck blood glucose in 15 minutes. Notify physician if any significant changes in clinical status.
Skilled nurse visit dated 12/26/18 revealed, LPN (EMP 14) recorded at 1:16 p.m., glucose check of "346" without evidence for obtaining a urine ketone measurement. Evidence not found for repeat blood glucose level performed. LPN recorded note at 1:20 p.m., "...encouraged fluids...remains in stable condition and will continue to monitor...2:46 p.m., "...remains stable..." Skilled nurse visit dated 12/28/18, LPN recorded at 9:06 a.m., blood glucose level of "300...will monitor closely. Resting in bed..." Evidence for a urine test for ketones was not found. More than one hour later, the next entry read at 11:16 a.m., "awakening to eat breakfast and do bg [blood glucose] and insulin..." with reading as "212" and recorded that patient calculated carbohydrate consumed and entered into ominpod and administered insulin by way of insulin pump located on left upper arm.
During interview on 1/8/19 at approximately 4:00 p.m., EMP 11 (Administrator) stated, to have contacted EMP 14 who acknowledged to have not followed the plan of care. EMP 11 stated to have contacted physician and awaiting a return phone call. EMP 11 stated the agency provided services to client when not in school which was four days in the month of December.

CR 8, reviewed on 1/8/19 at approximately 12:45 p.m., revealed start of care 8/15/18 for episode of care dated 12/13/18 through 2/10/19, with primary diagnosis of type 2 (adult onset) diabetes mellitus. The physician ordered plan of treatment directed skilled nursing to assess vital signs every shift (Blood pressure, pulse, respirations and temperature) and to check blood glucose once daily in the a.m. and as needed for signs or symptoms of hyper/hypoglycemia. Notify physician for readings less than 60 or greater than 300.
Skilled nurse visits by LPN (EMP 13) failed to record the following: 12/28/18 failed to record vital signs. 12/30/18 failed to record blood pressure or respirations. LPN recorded pulse of 56 and patient "not feeling well" with coordination with physician and supervising nurse with patient taken to emergency room accompanied by LPN. No change in orders occurred during evaluation and patient returned home the same day. 1/4/19 failed to record blood pressure, pulse, or respirations.
During interview on 1/8/19 at approximately 4:00 p.m., EMP 11 reviewed clinical record and confirmed finding. "it appears the electronic system failed to pull over the data...will need to contact IT [technician]..."










Plan of Correction:

Clinical Director will re-educate Clinical Supervisors on reviewing the plan of care with the LPN in the home during home visits at clinical meeting.
Due Date 1/25/19

Clinical Supervisors will QA 10% of their individual census case load notes per week for 2 weeks. During this QA period the clinical supervisors will reeducate any non-compliant staff (not following the plan of care) beginning 1/28/19.
Completion due date is: 2/11/19.

Ongoing Clinical Supervisors and the Clinical Director or Designee will QA 10% of active census each week and will re-educate any non-compliant staff (not following the plan of care). A disciplinary process is in place that will be followed for non-compliant staff.



601.32(a) REQUIREMENT
SUPERVISION

Name - Component - 00
601.32(a) Supervision. The home
health agency provides skilled nursing
service by or under the supervision of
a registered nurse and in accordance
with the plan of treatment.

Observations:


Based on review of agency policy, clinical records (CR) and interview with staff (EMP), the agency failed to ensure skilled nursing services were provided in accordance with the written plans of treatment for two (2) of eleven (11) clinical records reviewed (CR 5, CR 8).

Findings included:

Review on 1/7/19 at approximately 11:00 a.m., of job description, Licensed Practical Nurse/Licensed Vocational Nurse-Field read "...Responsibilities and Job Requirements...Provides nursing care under the supervision of a Registered Nurse and according to the plan of care derived from the physician's orders...Documents all activities, assessments..."

Review on 1/7/19 at approximately 2:05 p.m., of policy, Physician Orders read "...Care and services will be provided in accordance with physician's...orders, as required by law and regulation..."

CR 5, reviewed on 1/8/19 at approximately 10:30 a.m., revealed start of care 10/8/18 for episode of care dated 12/7/18 through 2/4/19, with primary diagnosis of type 1 (insulin dependent) diabetes mellitus. Patient had insulin pump with an Omnipod system that was programmed by the physician to deliver an ordered amount of insulin continuously. Client changes omnipod independently every 3 days. Physician ordered plan of care directed nursing services to monitor client obtaining BG (blood glucose) before meals, snacks/physical activity; monitor client entering total carbs per each meal into pump; monitor amount of insulin delivered via preprogrammed pump. Procedures included to check urine for Ketones if blood glucose was found to be greater than 250 mg/dl (measurement of milligrams per deciliter) and if ketones positive, give 8-10 ounces of water, repeat blood glucose measurement and retest urine ketones in one hour. If blood glucose measurement was below 80 mg/dl to administer quick acting glucose product and recheck blood glucose in 15 minutes. Notify physician if any significant changes in clinical status.
Skilled nurse visit dated 12/26/18 revealed, LPN (EMP 14) recorded at 1:16 p.m., glucose check of "346" without evidence for obtaining a urine ketone measurement. Evidence not found for repeat blood glucose level performed. LPN recorded note at 1:20 p.m., "...encouraged fluids...remains in stable condition and will continue to monitor...2:46 p.m., "...remains stable..." Skilled nurse visit dated 12/28/18, LPN recorded at 9:06 a.m., blood glucose level of "300...will monitor closely. Resting in bed..." Evidence for a urine test for ketones was not found. More than one hour later, the next entry read at 11:16 a.m., "awakening to eat breakfast and do bg [blood glucose] and insulin..." with reading as "212" and recorded that patient calculated carbohydrate consumed and entered into ominpod and administered insulin by way of insulin pump located on left upper arm.
During interview on 1/8/19 at approximately 4:00 p.m., EMP 11 (Administrator) stated, to have contacted EMP 14 who acknowledged to have not followed the plan of care. EMP 11 stated to have contacted physician and awaiting a return phone call. EMP 11 stated the agency provided services to client when not in school which was four days in the month of December.

CR 8, reviewed on 1/8/19 at approximately 12:45 p.m., revealed start of care 8/15/18 for episode of care dated 12/13/18 through 2/10/19, with primary diagnosis of type 2 (adult onset) diabetes mellitus. The physician ordered plan of treatment directed skilled nursing to assess vital signs every shift (Blood pressure, pulse, respirations and temperature) and to check blood glucose once daily in the a.m. and as needed for signs or symptoms of hyper/hypoglycemia. Notify physician for readings less than 60 or greater than 300.
Skilled nurse visits by LPN (EMP 13) failed to record the following: 12/28/18 failed to record vital signs. 12/30/18 failed to record blood pressure or respirations. LPN recorded pulse of 56 and patient "not feeling well" with coordination with physician and supervising nurse with patient taken to emergency room accompanied by LPN. No change in orders occurred during evaluation and patient returned home the same day. 1/4/19 failed to record blood pressure, pulse, or respirations.
During interview on 1/8/19 at approximately 4:00 p.m., EMP 11 reviewed clinical record and confirmed finding. "it appears the electronic system failed to pull over the data...will need to contact IT [technician]..."








Plan of Correction:

Clinical Supervisors will be re-educated on the supervision guidelines and their job description.
Due Date: 1/30/19


Prior to each in home supervision, the Clinical Supervisor will review the nursing documentation of staff to be supervised to ensure staff is following the plan of care. Any noted deficits will be re-educated during the supervision. This will be documented on the Nursing Supervision form. Clinical Director will review 100% of nursing supervisions and proof of pre-documentation review completed for 3 weeks.
Due date: 2/11/19

Ongoing Clinical Supervisors and the Clinical Director or Designee will QA 10% of active census each week and will re-educate any non-compliant staff (not following the plan of care). A disciplinary process is in place that will be followed for non-compliant staff.



601.32(c) REQUIREMENT
DUTIES OF THE QUALIFIED LPN

Name - Component - 00
601.32(c) Duties of the Qualified
Licensed Practical Nurse. The
qualified licensed practical nurse:
(i) provides services in accordance
with agency policies,
(ii) prepares clinical and progress
notes,
(iii) assists the physician and/or
registered nurse in performing
specialized procedures,
(iv) prepares equipment and
materials for treatments observing
aseptic technique as required, and
(v) assists the patient in
learning appropriate self-care
techniques.

Observations:


Based on review of agency policy, clinical records (CR) and interview with staff (EMP), the agency failed to ensure the licensed practical nurse provided services in accordance with the written plans of treatment for two (2) of eleven (11) clinical records reviewed (CR 5, CR 8).

Findings included:

Review on 1/7/19 at approximately 11:00 a.m., of job description, Licensed Practical Nurse/Licensed Vocational Nurse-Field read "...Responsibilities and Job Requirements...Provides nursing care under the supervision of a Registered Nurse and according to the plan of care derived from the physician's orders...Documents all activities, assessments..."

Review on 1/7/19 at approximately 2:05 p.m., of policy, Physician Orders read "...Care and services will be provided in accordance with physician's...orders, as required by law and regulation..."

CR 5, reviewed on 1/8/19 at approximately 10:30 a.m., revealed start of care 10/8/18 for episode of care dated 12/7/18 through 2/4/19, with primary diagnosis of type 1 (insulin dependent) diabetes mellitus. Patient had insulin pump with an Omnipod system that was programmed by the physician to deliver an ordered amount of insulin continuously. Client changes omnipod independently every 3 days. Physician ordered plan of care directed nursing services to monitor client obtaining BG (blood glucose) before meals, snacks/physical activity; monitor client entering total carbs per each meal into pump; monitor amount of insulin delivered via preprogrammed pump. Procedures included to check urine for Ketones if blood glucose was found to be greater than 250 mg/dl (measurement of milligrams per deciliter) and if ketones positive, give 8-10 ounces of water, repeat blood glucose measurement and retest urine ketones in one hour. If blood glucose measurement was below 80 mg/dl to administer quick acting glucose product and recheck blood glucose in 15 minutes. Notify physician if any significant changes in clinical status.
Skilled nurse visit dated 12/26/18 revealed, LPN (EMP 14) recorded at 1:16 p.m., glucose check of "346" without evidence for obtaining a urine ketone measurement. Evidence not found for repeat blood glucose level performed. LPN recorded note at 1:20 p.m., "...encouraged fluids...remains in stable condition and will continue to monitor...2:46 p.m., "...remains stable..." Skilled nurse visit dated 12/28/18, LPN recorded at 9:06 a.m., blood glucose level of "300...will monitor closely. Resting in bed..." Evidence for a urine test for ketones was not found. More than one hour later, the next entry read at 11:16 a.m., "awakening to eat breakfast and do bg [blood glucose] and insulin..." with reading as "212" and recorded that patient calculated carbohydrate consumed and entered into ominpod and administered insulin by way of insulin pump located on left upper arm.
During interview on 1/8/19 at approximately 4:00 p.m., EMP 11 (Administrator) stated, to have contacted EMP 14 who acknowledged to have not followed the plan of care. EMP 11 stated to have contacted physician and awaiting a return phone call. EMP 11 stated the agency provided services to client when not in school which was four days in the month of December.

CR 8, reviewed on 1/8/19 at approximately 12:45 p.m., revealed start of care 8/15/18 for episode of care dated 12/13/18 through 2/10/19, with primary diagnosis of type 2 (adult onset) diabetes mellitus. The physician ordered plan of treatment directed skilled nursing to assess vital signs every shift (Blood pressure, pulse, respirations and temperature) and to check blood glucose once daily in the a.m. and as needed for signs or symptoms of hyper/hypoglycemia. Notify physician for readings less than 60 or greater than 300.
Skilled nurse visits by LPN (EMP 13) failed to record the following: 12/28/18 failed to record vital signs. 12/30/18 failed to record blood pressure or respirations. LPN recorded pulse of 56 and patient "not feeling well" with coordination with physician and supervising nurse with patient taken to emergency room accompanied by LPN. No change in orders occurred during evaluation and patient returned home the same day. 1/4/19 failed to record blood pressure, pulse, or respirations.
During interview on 1/8/19 at approximately 4:00 p.m., EMP 11 reviewed clinical record and confirmed finding. "it appears the electronic system failed to pull over the data...will need to contact IT [technician]..."

















Plan of Correction:

All active caregivers will be re-educated on following the plan of treatment via policy review memo. Memo will be mailed to each active LPN on the roster.
Due Date : 1/31/19

Prior to each in home supervision, the Clinical Supervisor will review the nursing documentation of staff to be supervised to ensure staff is following the plan of care. Any noted deficits will be re-educated during the supervision. This will be documented on the Nursing Supervision form. Clinical Director will review 100% of nursing supervisions and proof of pre-documentation review completed for 3 weeks.
Due date: 2/11/19

Ongoing Clinical Supervisors and the Clinical Director or Designee will QA 10% of active census each week and will re-educate any non-compliant staff (not following the plan of care). A disciplinary process is in place that will be followed for non-compliant staff.



Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted January 7 and 8, 2019, found that Aveanna Healthcare (formally Care Unlimited, Inc.) was in compliance with the requirements of Pa. Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart A., Chapter 51.






Plan of Correction:




Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on January 7 and 8, 2019, found that Aveanna Healthcare (formally Care Unlimited, Inc.) was found to be in compliance with the requirements of 35 P.S. 448.809 (b).








Plan of Correction: