Cvh Home Health Services

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Condition of participation: Care planning, coordination of services, and quality of care. Based on interview and record review, for one of three sampled patients (Patient 1), the agency failed to ensure that the physician-ordered wound care treatment was completed as indicated in the plan of care when the agency did not provide necessary wound care supplies. This failure had resulted in worsening infection and delayed wound healing and hospitalization for Patient 1. The cumulative severity and intensity of these deficiencies resulted in failure of the Agency to meet 484.60, Care Planning, Coordination of Services, and Quality of Care for Patient 1. Cross reference G580 During a review of Patient 1’s “Home Health Certification and Plan of Care (HHCPOC)” for certification period 4/2/26 to 5/31/26, the HHCPOC indicated Patient 1 was admitted for home health services on 4/2/26 with diagnoses that included cellulitis (potentially serious bacterial skin infection that affects the deeper layers of your skin and underlying tissues) of the lower extremity, laceration on the right lower leg and an unspecified open wound on the left elbow. During a concurrent interview and record review on 6/29/26 at 1:16 p.m. with President & Chief Operating Officer (P&COO), Patient 1’s “Plan of Care (POC)” and “Start of Care (SOC)” assessment dated 4/2/26, were reviewed. P&COO stated Patient 1 had two traumatic wounds (a sudden physical injury that damages the skin and underlying tissues), one on the right lower extremity (leg, RLE) and the other wound on the right elbow. P&COO stated treatments for both wounds were started but there was an issue related to supply availability. The SOC indicated wound care supplies provided by the hospital were sufficient for only one time dressing change. P&COO stated, typically, hospitals would discharge patients with a three-day supply of wound care items, but this protocol was not followed for Patient 1. P&COO also stated for other patients, wound supplies are generally ordered in advance based on instructions included in the referral. The SOC indicated “Registered Nurse [RN) 1 was able to use minimal supplies (some 4x4 gauze, two abdominal pads and two gauze rolls) to remove old dressing and assess wound bed (the base or exposed interior surface of an open wound)… Wound bed was covered with dry gauze, abdominal pad and gauze roll to secure. Advised that we would request to have supplies expedited as soon as possible.” During a review of Patient 1’s POC dated 4/2/26, the POC indicated the following wound treatment orders: “traumatic wound on the RLE, cleanse with soap and water or wound cleanser, skin prep (liquid barrier films or adhesive enhancers applied to the healthy skin surrounding an injury before bandaging ) to peri wound (around the wound) skin, apply TheraHoney (a sterile, medical-grade wound care dressing made from 100% Manuka honey) gel to wound bed and Xeroform (type of non-adherent wound dressing), abdominal pad (ABD- a thick, highly absorbent medical dressing used to treat heavily draining wounds, surgical incisions, or trauma sites), and Kerlix (medical-grade, 100% cotton gauze bandage used to dress, pack, and protect wounds). Traumatic wound on elbow, cleanse with soap and water or wound cleanser, skin prep to peri wound skin, TheraHoney gel to wound bed, cover with Mepilex (soft silicone foam wound dressings designed to absorb drainage and maintain a moist healing environment while minimizing pain and skin trauma during changes)”. During a telephone interview on 6/30/26 at 3:41 p.m. with Registered Nurse (RN) 1, RN 1 stated she completed the SOC visit on 4/2/26 and found Patient 1 had wound supplies sufficient for only one dressing change. RN 1 stated available supplies with Patient 1 included one ABD pad and one piece of HydroFera Blue (foam wound dressing with antibacterial properties against infection). RN 1 stated using additional wound care materials from her vehicle that included gauze, wound cleanser, and Kerlix, leaving the remaining roll of Kerlix with Patient 1 to ensure dressing coverage if the primary dressing became dislodged or for use on the next visit. RN 1 also stated for Patient 1’s elbow wound, RN 1 applied one Mepilex dressing from her personal vehicle supply, noting that TheraHoney, required per physician’s order, was not available. RN 1 stated, Patient 1’s wound on the RLE appeared shallow but very wet. During a telephone interview on 7/1/26 at 10:17 a.m. with RN 2, RN 2 stated she conducted a home visit on 4/3/26, after the originally assigned clinician had cancelled the scheduled visit. RN 2 stated she completed Patient 1’s wound dressing care during this visit. RN 2 stated Patient 1’s RLE wound was “huge”, fresh in appearance, and had oozing drainage. RN 2 stated the previous dressing was wet when removed, and Patient 1’s family member, who was present during the visit, reported she had to change the dressing the day prior because it had also become saturated. RN 2 stated she cleaned the RLE wound with Vashe (wound cleanser), applied Hydrofera Blue, covered it with an abdominal pad, and then secured the dressing with Kerlix. RN 2 stated that the only supply available in Patient 1’s room was the Hydrofera Blue. The ABD pad, Vashe, and Kerlix were supplies taken from her vehicle. RN 2 stated that the physician’s order required TheraHoney gel for the RLE wound but stated she used the supplies available to her at the time. RN 2 stated Patient 1’s right elbow wound was “not that bad” compared to the RLE. RN 2 stated she used normal saline and gauze from her vehicle, applied Aquacel (wound dressing that absorbs wound drainage and transforms into a soft, cohesive gel), and covered the dressing with a Mepilex also taken from her trunk supply. RN 2 again stated that TheraHoney gel and Xeroform ordered for the right lower extremity wound were not available in the home, and she used “whatever was there”. During a telephone interview on 7/2/26 at 8:53 a.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated completing a home visit for Patient 1 on 4/4/26. LVN 1 stated cleaning Patient 1’s RLE wound with Vashe, applied Hydrofera Blue, covered it with an ABD pad and Mepilex, then wrapped it with Kerlix. LVN 1 stated the Hydrofera Blue was from Patient 1’s supply from the hospital; other supplies were from LVN 1’s car’s trunk. During an interview on 6/29/26 at 2:37 p.m., with P&COO, P&COO stated the wound supplies were delivered on 4/6/26. During a concurrent follow-up telephone interview and record review on 7/2/26 at 3:46 p.m. with RN 1, RN 1 stated that although she documented using Hydrofera Blue during the SOC visit on 4/2/26, there was no new wound treatment order to use Hydrofera Blue. RN 1 stated only using HydroFera Blue because it was the only supply that was available, but the wound care order using TheraHoney gel remained the same, unless a clinician who followed her had made a change in the order. During a follow-up telephone interview on 7/2/26 at 3:56 p.m. with RN 2, RN 2 stated the ordered wound care treatment was TheraHoney and not Hydrofera Blue, but RN 2 said she used whatever dressing was available to avoid leaving the wound uncovered. RN 2 confirmed there was no order for Hydrofera Blue but used it since it was the only option. During further review of Patient 1’s “Addendum: Plan of Treatment (APT)” dated 4/2/26, the APT indicated the following: “Interim Wound Care Orders: Traumatic Wound of RLE (lateral to mid shin): Cleanse with soap and water or wound cleanser, pat dry with 4x4 gauze. Apply skin prep to peri-wound skin. Apply TheraHoney gel then Xeroform to wound bed. Cover with abdominal pad then Kerlix. Change 2-3 times a week and as needed if soiled or dislodged, until supplies arrive. Traumatic Wound of Elbow: Cleanse with soap and water or wound cleanser, pat dry with 4x4 gauze. Apply skin prep to peri-wound then TheraHoney gel to wound bed, cover with Mepilex, Change 2-3 times a week and as needed if soiled or dislodged, until supplies arrive…” During a review of the “Patient Communication (PC)” dated 4/6/26, the PC indicated Patient 1 was transported to the Emergency Room by Family Member (FM) 1 because the dressing was coming off. During a review of the “Emergency Department (ED) Provider Notes” dated 4/6/26, the “ED Provider Notes” indicated Patient 1 was scheduled for home health wound care after the prior hospital discharge on 3/30/26, but there were no wound care supplies available. After not being seen at a wound clinic due to no appointment, Patient 1 went to the ED for wound care and evaluation. Patient 1’s RLE showed full-thickness tissue loss (wound extends completely through the epidermis and dermis into the subcutaneous fat layer or deeper, exposing muscle, tendon, or bone) with mixed red and yellow tissue, non-viable skin flap (damaged tissue) was trimmed, peri-wound skin had mild redness and tenderness, edema (swelling) was present. At the ED, physicians considered intravenous antibiotics for worsening cellulitis of the RLE. The wound nurse indicated the RLE wound had gotten worse than the prior week. During a review of Patient 1’s SOC dated 4/2/26, the SOC indicated Patient 1’s RLE wound measured 9 cm (centimeter- is a metric unit of length equal to one hundred of a meter) x 7 cm x 0.1 cm with moderate amount of serosanguineous (a thin, watery wound discharge with a pale pink or light red hue) drainage; the right elbow wound measured 0.5 cm x 5 cm x 0.1 cm with slight amount of sanguineous (characterized by a bright red color and a syrup-like consistency) drainage. During a review of Patient 1’s “Clinical Notes (CN)” dated 4/6/26, the “CN” indicated Patient 1’s RLE measured 14 cm x 6.5 cm x 0.1 cm, with 26-50 percent (%) slough (soft, moist, dead tissue found in wound beds) and 26-50% non-granular tissue (any non-viable or exposed anatomical tissue in a wound bed that is not the red, bumpy, and vascular tissue needed for healing); the right elbow wound measured 2 cm x 3cm x 0.1 cm, with 51-75% non-granular tissue and 0-25% slough. During a review of the “Referral Info (RI)” dated 4/9/26, the “RI” indicated Patient 1 was discharged from the hospital on 4/9/26. During a review of the agency’s policy and procedure (P&P) titled “General Wound Care” last reviewed 1/31/26, the P&P indicated, wound care procedures include verifying physician’s orders, measuring and assessing the wounds, and applying dressings as ordered.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on interview and record review, for one of three sampled patients (Patient 1), the agency failed to ensure that the physician-ordered wound care treatment was completed as indicated in the plan of care when the agency did not provide necessary wound care supplies. This failure had resulted in worsening infection, delayed wound healing and three-day hospitalization for Patient 1. During a review of Patient 1’s “Home Health Certification and Plan of Care (HHCPOC)” for certification period 4/2/26 to 5/31/26, the HHCPOC indicated Patient 1 was admitted for home health services on 4/2/26 with diagnoses that included cellulitis (potentially serious bacterial skin infection that affects the deeper layers of your skin and underlying tissues) of the lower extremity, laceration (tears or rips on or inside your body) on the right lower leg and an unspecified open wound on the left elbow. During a concurrent interview and record review on 6/29/26 at 1:16 p.m., with President & Chief Operating Officer (P&COO), Patient 1’s “Plan of Care (POC)” and “Start of Care (SOC)” assessment dated 4/2/26, were reviewed. P&COO stated, Patient 1 was admitted on 4/2/26 with two traumatic wounds (a sudden physical injury that damages the skin and underlying tissues), one on the right lower extremity (leg, RLE) and the other wound on the right elbow. P&COO stated treatments for both wounds were started on 4/2/26 but there was an issue related to supply availability. The SOC indicated wound care supplies provided by the hospital were sufficient for only one time dressing change. P&COO stated, typically, hospitals would discharge patients with a three-day supply of wound care items, but this protocol was not followed for Patient 1. P&COO also stated for other patients, wound supplies are generally ordered in advance based on instructions included in the referral. The SOC indicated “Registered Nurse (RN)1 was able to use minimal supplies (some 4x4 gauze, two abdominal pads and two gauze rolls) to remove old dressing and assess wound bed (the base or exposed interior surface of an open wound) … Wound bed was covered with dry gauze, abdominal pad and gauze roll to secure. Advised that we would request to have supplies expedited as soon as possible.” During a review of Patient 1’s POC dated 4/2/26, the POC indicated the following wound treatment orders: “Traumatic wound on the RLE, cleanse with soap and water or wound cleanser, skin prep (liquid barrier films or adhesive enhancers applied to the healthy skin surrounding an injury before bandaging ) to peri wound (around the wound) skin, apply TheraHoney (a sterile, medical-grade wound care dressing made from 100% Manuka honey) gel to wound bed and Xeroform (type of non-adherent wound dressing), abdominal pad (ABD- a thick, highly absorbent medical dressing used to treat heavily draining wounds, surgical incisions, or trauma sites), and Kerlix (medical-grade, 100% cotton gauze bandage used to dress, pack, and protect wounds). Traumatic wound on elbow, cleanse with soap and water or wound cleanser, skin prep to peri wound skin, TheraHoney gel to wound bed, cover with Mepilex (soft silicone foam wound dressings designed to absorb drainage and maintain a moist healing environment while minimizing pain and skin trauma during changes)”. During an interview on 6/29/26 at 2:37 p.m., with P&COO, P&COO stated the wound supplies were delivered on 4/6/26. During a telephone interview on 6/30/26 at 3:41 p.m., with Registered Nurse RN 1, RN 1 stated she completed the SOC visit on 4/2/26 and found Patient 1 had wound supplies sufficient for only one dressing change. RN 1 stated available supplies with Patient 1 included one ABD pad and one piece of HydroFera Blue (foam wound dressing with antibacterial properties against infection). RN 1 stated using additional wound care materials from her vehicle that included gauze, wound cleanser, and Kerlix, leaving the remaining roll of Kerlix with Patient 1 to ensure dressing coverage if the primary dressing became dislodged or for use on the next visit. RN 1 also stated for Patient 1’s elbow wound, RN 1 applied one Mepilex dressing from her personal vehicle supply, noting that TheraHoney, required per physician’s order, was not available. RN 1 stated, Patient 1’s wound on the RLE appeared shallow but very wet. During a telephone interview on 7/1/26 at 10:17 a.m. with RN 2, RN 2 stated, conducted a home visit for Patient 1 on 4/3/26, after the originally assigned clinician had cancelled the scheduled visit. RN 2 stated she completed Patient 1’s wound dressing care during this visit. RN 2 stated Patient 1’s RLE wound was “huge”, fresh in appearance, and had oozing drainage. RN 2 stated the previous dressing was wet when removed, and Patient 1’s family member, who was present during the visit, reported she had to change the dressing the day prior because it had also become saturated. RN 2 stated she cleaned the RLE wound with Vashe (wound cleanser), applied Hydrofera Blue, covered it with an abdominal pad, and then secured the dressing with Kerlix. RN 2 stated that the only supply available in Patient 1’s room was the Hydrofera Blue. The ABD pad, Vashe, and Kerlix were supplies taken from her vehicle. RN 2 stated that the physician’s order required TheraHoney gel for the RLE wound and not Hydrofera Blue, but RN 2 used the supplies available to her at the time. RN 2 stated Patient 1’s right elbow wound was not as bad (no oozing drainage) compared to the RLE. RN 2 stated she used normal saline and gauze from her vehicle, applied Aquacel (wound dressing that absorbs wound drainage and transforms into a soft, cohesive gel) and covered the dressing with a Mepilex also taken from her trunk supply. RN 2 again stated that TheraHoney gel and Xeroform that were ordered for the right lower extremity wound were not available in the home, and she used Aquacel which was not the physician-ordered treatment. RN 2 stated she used “Whatever was there.” During a telephone interview on 7/2/26 at 8:53 a.m., with Licensed Vocational Nurse (LVN) 1, LVN 1 stated completing a home visit for Patient 1 on 4/4/26. LVN 1 stated cleaning Patient 1’s RLE wound with Vashe, applied Hydrofera Blue, covered it with an ABD pad and Mepilex, then wrapped it with Kerlix. LVN 1 stated the Hydrofera Blue was from Patient 1’s supply from the hospital; other supplies were from LVN 1’s car’s trunk. During a concurrent follow-up telephone interview and record review on 7/2/26 at 3:46 p.m., with RN 1, RN 1 stated that although she documented using Hydrofera Blue during the SOC visit on 4/2/26, there was no new wound treatment order to use Hydrofera Blue. RN 1 stated only using HydroFera Blue because it was the only supply that was available, but the wound care order using TheraHoney gel remained the same, unless a clinician who followed her had made a change in the order. During a follow-up telephone interview on 7/2/26 at 3:56 p.m., with RN 2, RN 2 stated the ordered wound care treatment was TheraHoney and not Hydrofera Blue, but RN 2 said she used whatever dressing was available to avoid leaving the wound uncovered. RN 2 confirmed there was no order for Hydrofera Blue but used it since it was the only option. During further review of Patient 1’s “Addendum: Plan of Treatment (APT)” dated 4/2/26, the APT indicated the following: “Interim Wound Care Orders: Traumatic Wound of RLE (lateral to mid shin): Cleanse with soap and water or wound cleanser, pat dry with 4x4 gauze. Apply skin prep to peri-wound skin. Apply TheraHoney gel then Xeroform to wound bed. Cover with abdominal pad then Kerlix. Change 2-3 times a week and as needed if soiled or dislodged, until supplies arrive. Traumatic Wound of Elbow: Cleanse with soap and water or wound cleanser, pat dry with 4x4 gauze. Apply skin prep to peri-wound then TheraHoney gel to wound bed, cover with Mepilex, Change 2-3 times a week and as needed if soiled or dislodged, until supplies arrive…” During a review of the “Patient Communication (PC)” dated 4/6/26, the PC indicated Patient 1 was transported to the Emergency Room on 4/6/26 by Family Member (FM) 1 because the dressing on Patient 1’s RLE wound was coming off. During a review of the “Emergency Department (ED) Provider Notes” dated 4/6/26, the “ED Provider Notes” indicated Patient 1 was scheduled for home health wound care after the prior hospital discharge on 3/30/26, but there were no wound care supplies available. After not being seen at a wound clinic due to no appointment, Patient 1 went to the ED for wound care and evaluation. Patient 1’s RLE showed full-thickness tissue loss (wound extends completely through the epidermis and dermis into the subcutaneous fat layer or deeper, exposing muscle, tendon, or bone) with mixed red and yellow tissue, non-viable skin flap (damaged tissue) was trimmed, peri-wound skin had mild redness and tenderness, edema (swelling) was present. At the ED, physicians considered intravenous antibiotics for worsening cellulitis of the RLE. The wound nurse indicated the RLE wound had gotten worse than the prior week. During a review of Patient 1’s SOC dated 4/2/26, the SOC indicated Patient 1’s RLE wound measured 9 cm (centimeter- is a metric unit of length equal to one hundred of a meter) x 7 cm x 0.1 cm with moderate amount of serosanguineous (a thin, watery wound discharge with a pale pink or light red hue) drainage; the right elbow wound measured 0.5 cm x 5 cm x 0.1 cm with slight amount of sanguineous (characterized by a bright red color and a syrup-like consistency) drainage. During a review of Patient 1’s “Clinical Notes (CN)” dated 4/6/26, the “CN” indicated Patient 1’s RLE‘s wound measured 14 cm x 6.5 cm x 0.1 cm, with 26-50 percent (%) slough (soft, moist, dead tissue found in wound beds) and 26-50% non-granular tissue (any non-viable or exposed anatomical tissue in a wound bed that is not the red, bumpy, and vascular tissue needed for healing); the right elbow wound measured 2 cm x 3cm x 0.1 cm, with 51-75% non-granular tissue and 0-25% slough. During a review of the “Referral Info (RI)” dated 4/9/26, the “RI” indicated Patient 1 was discharged from the hospital on 4/9/26. During a review of the agency’s policy and procedure (P&P) titled “General Wound Care” last reviewed 1/31/26, the P&P indicated, wound care procedures include verifying physician’s orders, measuring and assessing the wounds, and applying dressings as ordered.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on interview and record review, for one of three sampled patients (Patient 1), the agency failed to ensure skilled nursing visit records were accurate when the actual wound care provided differed from what was documented in the clinical records. This failure had the potential to result in inaccurate information for proper wound management During a review of Patient 1’s “Home Health Certification and Plan of Care (HHCPOC)” for certification period 4/2/26 to 5/31/26, the HHCPOC indicated Patient 1 was admitted for home health services on 4/2/26, with diagnoses that included cellulitis of the lower extremity, laceration on the right lower leg and an unspecified open wound on the left elbow. The HHPOC indicated wound care orders that included: for the right lower extremity (RLE) traumatic wound (a sudden physical injury that damages the skin and underlying tissues ), cleanse with soap and water or wound cleanser, skin prep (liquid barrier films or adhesive enhancers applied to the healthy skin surrounding an injury before bandaging ) to peri (around) wound skin, TheraHoney gel (a sterile, medical-grade wound care dressing made from 100% Manuka honey) to wound bed and xeroform, abdominal pad (ABD, a thick, highly absorbent medical dressing used to treat heavily draining wounds, surgical incisions, or trauma sites) and Kerlix (medical-grade, 100% cotton gauze bandage used to dress, pack, and protect wounds). Wound treatment order for right elbow traumatic wound, cleanse with soap and water or wound cleanser, skin prep to peri-wound skin, TheraHoney gel to wound bed, cover with Mepilex (soft silicone foam wound dressings designed to absorb drainage and maintain a moist healing environment while minimizing pain and skin trauma during changes). During a telephone interview on 6/30/26 at 3:41 p.m. with Registered Nurse (RN) 1, RN 1 stated she completed the SOC visit on 4/2/26 and found Patient 1 had wound supplies for only one dressing change. RN 1 stated available supplies included ABD pad and one piece of HydroFera Blue (foam wound dressing with antibacterial properties against infection). During a telephone interview on 7/1/26 at 10:17 a.m. with RN 2, RN 2 stated she conducted a home visit on 4/3/26. RN 2 stated Patient 1’s RLE wound was “huge”, fresh in appearance, and had oozing drainage. RN 2 stated that the physician’s order required TheraHoney gel for the RLE wound but stated she used Hydrofera Blue which was the only available supply to her at the time During an interview on 6/29/26 at 2:37 p.m. with P&COO, P&COO stated the wound supplies were delivered on 4/6/26. During a concurrent telephone interview and record review on 7/2/26 at 8:53 a.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated completing a home visit for Patient 1 on 4/4/26. LVN 1 stated he treated Patient 1’s RLE wound with Vashe, applied Hydrofera Blue that was available in Patient 1’s room, covered it with an ABD pad and Mepilex, then wrapped it with Kerlix. Review of the “Routine Visit Notes (RVS)” dated 4/4/26 signed and dated by LVN 1, the “RVS” indicated LVN 1 cleaned the RLE wound with soap and water or wound cleanser, skin prep to peri-wound skin, TheraHoney gel to wound bed and xeroform, abdominal pad and Kerlix. LVN 1 acknowledged the treatment he provided differed from what was documented in the “RVS” notes. During a review of the agency’s policy and procedure (P&P) titled “General Wound Care” last reviewed 1/31/26, the P&P indicated wound care procedures include verifying physician’s orders, measuring and assessing the wounds, applying dressings as ordered, and document the type of wound care performed.”