Centerwell Home Health

“Before discharge for cause HHA must: CFR(s): 484.50(d)(5) The HHA determines, under a policy set by the HHA for the purpose of addressing discharge for cause that meets the requirements of paragraphs (d)(5)(i) through (d)(5)(iii) of this section, that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the HHA to operate effectively is seriously impaired. The HHA must do the following before it discharges a patient for cause: This Element is not met as evidenced by: Based on record review and interview, the agency failed to complete all requirements when discharging patients for cause. Specifically, for 1 of 3 sample discharged patients, the agency failed to provide contact information for other agencies or providers who may have been able to provide care (Patient #4); for 1 of 3 sample discharged patients the agency failed to notify the patient/patient representative of their intention to discharge the patient for cause (Patient #4); and for 2 of 3 sample discharged patients the agency failed to document, in the medical record, efforts made by the agency to address behaviors which placed agency staff at risk and led to the patients’ discharges for cause (Patient #3 and #4)​. Findings include: I. The agency failed to provide contact information for other agencies or providers who may have been able to provide care. The clinical record for Patient #4 was reviewed on 5/26/26. Plan of care orders for the certification period dated 2/8/26 to 4/8/26 revealed a start of care date of 2/8/26; diagnoses peripheral vascular disease with a lower leg ulceration. Plan of care orders included skilled nursing two times per week for wound care and occupational therapy one time per week to promote improved independence. Record review revealed the patient was discharged for cause on 4/17/26 due to safety concerns for agency staff. Further review of the record failed to reveal documentation of contact information, for other agencies who may have been able to provide care, was provided to Patient #4 or their representative. During an interview on 5/27/26 at 11:39 a.m., the administrator stated there was no documentation the agency provided contact information, for other agencies or providers capable of providing ongoing care, to the patient/patient representative. II. The agency failed to notify the patient/patient representative of their intention to discharge the patient for cause. The clinical record for Patient #4 was reviewed on 5/26/26. Plan of care orders for the certification period dated 2/8/26 to 4/8/26 revealed a start of care date of 2/8/26; diagnoses peripheral vascular disease with a lower leg ulceration. Plan of care orders included skilled nursing two times per week for wound care and occupational therapy one time per week to promote improved independence. Record review revealed the patient was discharged for cause on 4/17/26 due to safety concerns for agency staff. Further review of the record failed to reveal documentation, prior to discharge, the patient or their representative was notified of the agency’s intention to discharge Patient #4. During an interview on 5/27/26 at 11:39 a.m., the administrator stated she could not provide documentation advanced notice of the discharge had been given to the patient/patient representative. III. The agency failed to document, in the medical record, efforts made by the agency to address behaviors which placed agency staff at risk and led to patients’ discharges for cause. A. The clinical record for Patient #3 was reviewed on 5/26/26. Plan of care orders for the certification period dated 3/16/26 to 5/14/26 revealed a start of care date of 3/16/26; diagnoses included dementia and pressure ulcers to sacrum, right hip, and left hip. Plan of care orders included skilled nursing three times per week for wound care. Record review revealed a skilled nursing visit for wound care was attempted by a registered nurse on 3/25/26. The nursing note documented the nurse was unable to complete the wound care due to staff safety concerns when Patient #3’s representative, the spouse of the patient, was verbally abusive. Review revealed a communication note by the agency administrator, on 3/25/26, documented a phone call from the administrator to the patient’s spouse to notify her Patient #3 would be discharged due to the verbal abuse. Further review revealed the patient was discharged for cause on 3/25/26. No documentation of the agency’s efforts to address or resolve the behaviors or safety concerns prior to discharge was found in the medical record. During an interview on 5/27/26 at 10:53 a.m., the agency administrator stated the agency had notified Patient #3’s physician of the verbal abuse immediately. She stated the situation was discussed with the agency’s safety committee, who recommended discharging the patient. The administrator stated she did not feel the issues could be resolved and stated there was no documentation of attempts to resolve issues. B. The clinical record for Patient #4 was reviewed on 5/26/26. Plan of care orders for the certification period dated 2/8/26 to 4/8/26 revealed a start of care date of 2/8/26; diagnoses included peripheral vascular disease with a lower leg ulceration. Plan of care orders included skilled nursing two times per week for wound care and occupational therapy one time per week to promote improved independence. Record review revealed the patient was discharged for cause due to safety concerns for agency staff. Further review did not reveal documentation of agency efforts to resolve the safety concerns prior to discharge. During an interview on 5/27/26 at 11:39 a.m. the administrator stated she could not provide documentation of attempts to resolve issues with the patient/patient caregiver.”