Facility Evaluation Report

On 1/19/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with designee, Shenel Phang . LPA spoke with Administrator by phone regarding the report and findings.

On 12/14/23, LPA Mknelly, conducted a visit and issued a citation based on the information available at the facility at the time regarding an incident report received by the department on 12/12/23. The 12/12/23 incident report was regarding a hospital visit for R1 on 12/7/23. LPA conducted a records review regarding R1. Records found that R1 was admitted to this facility on 10/25/23. Discharge instructions from the referring hospital identified R1 as having wounds that require daily ongoing wound care. Between 10/25/23 and 12/7/23 R1 did not receive home heath wound care at the facility.

Following the 12/14/23 visit, LPA Mknelly collected the following additional records regarding R1’s wounds care history: referring hospital wound care and discharge status of wounds, area hospital records for 12/7/23- 12-9/23, and current home health records.

Referring hospital wound care records, received from the hospital by LPA on 1/11/24, showed that on 10/25/23, R1 was transferred to this facility with a stage IV Sacrococcygeal pressure injury, a Full thickness (non- pressure) injury to left thigh, contractures requiring continued physical therapy. Report continued...