ALLIED SERVICES HOME HEALTH
Health Inspection Results For:
There are 8 surveys for this facility. Please select a date to view the survey results.
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Initial Comments:
Based on the findings of an onsite, unannounced Medicare recertification survey conducted March 28, 2022 through March 31, 2022, Allied Services Home Health was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies-Emergency Preparedness.
Plan of Correction:
Initial Comments:
Based on the findings of an onsite, unannounced Medicare recertification survey conducted March 28, 2022 through March 31, 2022, Allied Services Home Health was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.
Plan of Correction:
484.75(b)(1) ELEMENT
Interdisciplinary assessment of the patient
Name - Component - 00
Ongoing interdisciplinary assessment of the patient;
Observations:
Based on review of agency policies/procedures, clinical records, and CMS (Centers for Medicare/Medicaid Services) wound assessment guidelines, observation and based on interview with the administrator, the agency failed to ensure the progress toward wound healing goals were assessed by the registered nurse for two (2) of five (5) active patients for whom wound assessment orders and goals were included on the "Home Health Certification and Plan of Care". (Patients #9 and #14)
Findings include:
On March 31, 2022 at approximately 3:00 PM, review of the agency policy titled "Nursing Services Policy" revealed the following:
II. Statement of Policy...Skilled nursing services are provided to patients in their homes or in other appropriate settings, with the frequency and pattern of visiting based on patient/family needs and patient service priorities. Nursing services include:
-An assessment of physical, nursing...needs of patient...
-Promotion of continuity of care through...ongoing evaluation of the patient...response to nursing care...
III. Procedure...Skilled professional nursing...carries out the following functions:
-2. Regularly re-evaluates the patient's condition...
On March 31, 2022 at approximately 3:01 PM, review of the agency wound assessment procedure revealed the following:
2. Basic wound assessment for all wounds includes...
d. Dimensions:
1. Length, width and depth
2. Presence of tunneling or undermining...
5. Wounds and patients change; therefore, wounds need to be reassessed regularly...
a. In-home care, professional reassessment of most wounds is indicated at least once a week...
On March 31, 2022 at approximately 3:55 PM, review of the CMS (Centers for Medicare/Medicaid Services) website () revealed the following:
Medicare coverage for wound care on a continuing basis, for a given wound, in a given patient, is contingent upon evidence documented in the patient's medical record that the wound is improving in response to the wound care being provided. Evidence of improvement may include measurable changes in the following...
Wound dimensions (surface measurements, depth)
Granulation tissue
Necrotic tissue/slough
Tunneling or undermining.
Patient #9: On March 30, 2022 at approximately 2:34 PM, review of the clinical record revealed the start of care date was 02/02/2022, the primary diagnosis is cellulitis of the right lower limb, that skilled nursing (SN) is to obtain wound measurements weekly and that SN goals included the following as documented on the "Home Care Certification and Plan of Care" for the initial certification period of 02/02/2022 through 04/02/2022: The open wounds of the BLE (legs) will heal.
During home visit conducted on 03/30/2022 at approximately 9:00 AM, observation of the patient's BLE revealed open areas were present on the left lower leg (LLE), the left ankle and the right lower leg (RLE). The registered nurse (employee #10) obtained wound measurements and provided wound care to the BLE wounds.
Review of skilled nursing visit note report documentation dated 03/13/2022 revealed the wound depth of right leg (RLE) wounds (#1, #2, #5), the left ankle (#4) and the left leg (LLE) wound (#6) was 0.1 cm.
There was no documentation in the clinical record which provided evidence that the registered nurse (RN) measured the depth of wounds #1, #2, #4, #5 and #6 when the RN (employee #10) measured the length and width of the aforementioned wounds on 03/21/2022.
Patient #14: On March 31, 2022 at approximately 12:14 PM, review of the clinical record revealed the start of care date was 11/10/2021, the primary diagnosis is other complications of procedures, that skilled nursing (SN) is to obtain wound measurements weekly and that SN goals included the following as documented on the "Home Care Certification and Plan of Care" for the recertification period of 03/10/2022 through 05/08/2022: The patient will have no complications of the right posterior (back of) thigh wounds.
Review of skilled nursing visit note documentation dated 03/07/2022 revealed the right posterior thigh wound measured 2.8 cm (length) by 1.0 cm (width) by 1.1 cm (depth).
Review of the skilled nursing visit note dated 03/14/2022 revealed the licensed practical nurse (employee #16) documented that wound tunneling (extension of the wound into underlying tissue) was now present at the 12 o'clock position of the right posterior thigh wound.
Review of skilled nursing visit note documentation revealed the RN (employee #17) provided wound care to the right posterior thigh wound on 03/16/2022 and 03/18/2022. There was no documentation in the clinical record which provided evidence that the RN (employee #17) measured the length, width, depth and tunneling depth of the right posterior thigh wound on 03/16/2022 nor 03/18/2022.
During interview conducted on March 31, 2022 at approximately 3:05 PM, the administrator confirmed that there was no documentation in the clinical record which provided evidence that the above referenced wounds were measured on the aforementioned dates for the above identified patients.
Plan of Correction:Allied Services Home Health will correct this deficiency by:
The agency will provide education to all nursing staff regarding completing and documenting a wound assessment. Education will include instruction on the documentation of weekly wound dimensions and progress towards wound healing goals. The agency will utilize VNAA Clinical Procedure Manual Volume 20: Skin and Wound Care- Assessment- Wound- Section: 25.02 as a reference for education.
Allied Services Home Health will prevent the reoccurrence of this deficiency by ongoing chart audits to assess proper documentation of professional reassessment of wounds to include dimensions and progress towards wound healing goals.
Agency will implement a chart audit tool to assess compliance of documentation. After targeted chart audits achieve sustained compliance the audits will be integrated into agency quarterly chart review. Results of compliance will be monitored and reported quarterly at agency quality meetings.
Plan will be implemented by May 7, 2022
Who is responsible for implementation: Administrator
Initial Comments:
Based on the findings of an unannounced, onsite state re-licensure survey conducted March 28, 2022 through March 31, 2022, Allied Services Home Health was found not to be in compliance with the following requirements of 28 PA Code, Part IV, Health Facilities, Subpart G. Chapter 601.
Plan of Correction:
601.32(b) REQUIREMENT
DUTIES OF THE REGISTERED NURSE
Name - Component - 00
601.32(b) Duties of the Registered
Nurse. The registered nurse:
(i) makes the initial evaluation
visit,
(ii) regularly reevaluates the
patient's nursing needs,
(iii) initiates the plan of treatment
and necessary revisions,
(iv) provides those services
requiring substantial specialized
nursing skill,
(v) initiates appropriate
preventive and rehabilitative nursing
procedures,
(vi) prepares clinical and progress
notes,
(vii) coordinates services, and
(viii) informs the physician and other
personnel of changes in the patient's
condition and needs, counsels the
patient and family in meeting nursing
and related needs, participates in
inservice programs, and supervises and
teaches other nursing personnel.
Observations:
Based on review of agency policies/procedures, clinical records, and CMS (Centers for Medicare/Medicaid Services) wound assessment guidelines, observation and based on interview with the administrator, the agency failed to ensure the progress toward wound healing goals were assessed by the registered nurse for two (2) of five (5) active patients for whom wound assessment orders and goals were included on the "Home Health Certification and Plan of Care". (Patients #9 and #14)
Findings include:
On March 31, 2022 at approximately 3:00 PM, review of the agency policy titled "Nursing Services Policy" revealed the following:
II. Statement of Policy...Skilled nursing services are provided to patients in their homes or in other appropriate settings, with the frequency and pattern of visiting based on patient/family needs and patient service priorities. Nursing services include:
-An assessment of physical, nursing...needs of patient...
-Promotion of continuity of care through...ongoing evaluation of the patient...response to nursing care...
III. Procedure...Skilled professional nursing...carries out the following functions:
-2. Regularly re-evaluates the patient's condition...
On March 31, 2022 at approximately 3:01 PM, review of the agency wound assessment procedure revealed the following:
2. Basic wound assessment for all wounds includes...
d. Dimensions:
1. Length, width and depth
2. Presence of tunneling or undermining...
5. Wounds and patients change; therefore, wounds need to be reassessed regularly...
a. In-home care, professional reassessment of most wounds is indicated at least once a week...
On March 31, 2022 at approximately 3:55 PM, review of the CMS (Centers for Medicare/Medicaid Services) website () revealed the following:
Medicare coverage for wound care on a continuing basis, for a given wound, in a given patient, is contingent upon evidence documented in the patient's medical record that the wound is improving in response to the wound care being provided. Evidence of improvement may include measurable changes in the following...
Wound dimensions (surface measurements, depth)
Granulation tissue
Necrotic tissue/slough
Tunneling or undermining.
Patient #9: On March 30, 2022 at approximately 2:34 PM, review of the clinical record revealed the start of care date was 02/02/2022, the primary diagnosis is cellulitis of the right lower limb, that skilled nursing (SN) is to obtain wound measurements weekly and that SN goals included the following as documented on the "Home Care Certification and Plan of Care" for the initial certification period of 02/02/2022 through 04/02/2022: The open wounds of the BLE (legs) will heal.
During home visit conducted on 03/30/2022 at approximately 9:00 AM, observation of the patient's BLE revealed open areas were present on the left lower leg (LLE), the left ankle and the right lower leg (RLE). The registered nurse (employee #10) obtained wound measurements and provided wound care to the BLE wounds.
Review of skilled nursing visit note report documentation dated 03/13/2022 revealed the wound depth of right leg (RLE) wounds (#1, #2, #5), the left ankle (#4) and the left leg (LLE) wound (#6) was 0.1 cm.
There was no documentation in the clinical record which provided evidence that the registered nurse (RN) measured the depth of wounds #1, #2, #4, #5 and #6 when the RN (employee #10) measured the length and width of the aforementioned wounds on 03/21/2022.
Patient #14: On March 31, 2022 at approximately 12:14 PM, review of the clinical record revealed the start of care date was 11/10/2021, the primary diagnosis is other complications of procedures, that skilled nursing (SN) is to obtain wound measurements weekly and that SN goals included the following as documented on the "Home Care Certification and Plan of Care" for the recertification period of 03/10/2022 through 05/08/2022: The patient will have no complications of the right posterior (back of) thigh wounds.
Review of skilled nursing visit note documentation dated 03/07/2022 revealed the right posterior thigh wound measured 2.8 cm (length) by 1.0 cm (width) by 1.1 cm (depth).
Review of the skilled nursing visit note dated 03/14/2022 revealed the licensed practical nurse (employee #16) documented that wound tunneling (extension of the wound into underlying tissue) was now present at the 12 o'clock position of the right posterior thigh wound.
Review of skilled nursing visit note documentation revealed the RN (employee #17) provided wound care to the right posterior thigh wound on 03/16/2022 and 03/18/2022. There was no documentation in the clinical record which provided evidence that the RN (employee #17) measured the length, width, depth and tunneling depth of the right posterior thigh wound on 03/16/2022 nor 03/18/2022.
During interview conducted on March 31, 2022 at approximately 3:05 PM, the administrator confirmed that there was no documentation in the clinical record which provided evidence that the above referenced wounds were measured on the aforementioned dates for the above identified patients.
Plan of Correction:Allied Services Home Health will correct this deficiency by:
The agency will provide education to all nursing staff regarding completing and documenting a wound assessment. Education will include instruction on the documentation of weekly wound dimensions and progress towards wound healing goals. The agency will utilize VNAA Clinical Procedure Manual Volume 20: Skin and Wound Care- Assessment- Wound- Section: 25.02 as a reference for education.
Allied Services Home Health will prevent the reoccurrence of this deficiency by ongoing chart audits to assess proper documentation of professional reassessment of wounds to include dimensions and progress towards wound healing goals.
Agency will implement a chart audit tool to assess compliance of documentation. After targeted chart audits achieve sustained compliance the audits will be integrated into agency quarterly chart review. Results of compliance will be monitored and reported quarterly at agency quality meetings.
Plan will be implemented by May 7, 2022
Who is responsible for implementation: Administrator
Initial Comments:
Based on the findings of an onsite, unannounced state re-licensure survey conducted March 28, 2022 through March 31, 2022, Allied Services Home Health was found to be in compliance with the requirements of 28 Pa. Code, 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 March 28, 2022 through March 31, 2022, Allied Services Home Health was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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