Pathwell Home Health

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on clinical record review, agency documentation, and staff interviews, for one of five patients reviewed (Patient #3) receiving wound care and for one of one patient reviewed (Patient #15) requiring pleural catheter draining, the agency licensed personnel failed to provide services in accordance with agency policies. The findings include: a. Patient #3 had a start of care date of 7/24/26 and diagnoses that included wound myiasis of the right foot, hypertensive heart and chronic kidney disease with heart failure, chronic obstructive pulmonary disease and congestive heart failure. The physician’s orders dated 7/24/26 included nursing services one to three times weekly for twice weekly wound care to the right foot and assessments including daily weight log at every visit. Additionally, a home health aide, physical therapy, occupational therapy and medical social worker referral were ordered. Review of Licensed Practical Nurse/LPN #1 nursing notes dated 8/03/26 and 8/03/26 failed to identify documentation of wound measurements. Interview and review of the clinical record with the Administrator on 8/12/26 at 12 PM identified weekly wound measurements should have been documented, and staff did not follow agency policies. Review of the agency Wound Care policy directed to document location, stage, size, exudate, wound bed tissue type, peri wound condition and signs and symptoms of infection. Wound measurements should be taken at least one time per week. b.Patient #15 had a start of care date of 3/02/26 and diagnoses that included malignant neoplasm of the right bronchus, malignant pleural effusion and chronic respiratory failure with hypoxia. The physician’s orders dated 3/02/26 included nursing services one to three times weekly for assessments and drainage of the left V (a small flexible tube placed in the chest to remove excess fluid buildup at home) one to three times a week, up to one thousand milliliters during each visit. Additionally, physical therapy and occupational therapy evaluations were ordered. Review of the nursing note dated 3/04/26 identified twenty-five (25) milliliters were drained from the left pleural catheter, but lacked documentation of the color and clarity of the drainage. Interview and review of the nursing note with the Administrator on 8/12/26 at 12:15 PM identified the nurse should have noted in the clinical recordthe color and clarity of the drainage and failed to follow agency policies Review of the agency policy for Pleural Catheter Care and Drainage directed to inspect the catheter insertion site to verify that it is clean, dry and intact. Post drainage, a new sterile dressing must be placed and thoroughly secured. Every procedure must record the volume, color and clarity of the fluid.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on review of clinical records, agency documentation, and staff interviews, for two of six patients reviewed (Patient’s #3 & #6), for weight monitoring and for two of four patient’s reviewed (Patient’s #3 & #15),for wound care and/or pleural catheter draining, the agency failed to ensure completion of comprehensive care plans to meet the patient’s needs and physician orders. The findings include: a. Patient #3 had a start of care date of 7/24/26 and diagnoses that included wound myiasis of the right foot, hypertensive heart and chronic kidney disease with heart failure, chronic obstructive pulmonary disease and congestive heart failure. The physician’s orders dated 7/24/26 included nursing services one to three times weekly, and twice weekly wound care to the right foot and assessments to include review of daily weight log, at every visit. Additionally, a home health aide, physical therapy, occupational therapy and medical social worker referral were ordered. Review of the physician order and nursing notes dated from 7/27/26 to 8/10/26 (5 nursing visits) failed to identify clinical documentation of the patients daily weight measurements. Interview and review of the clinical record with the Administrator on 8/12/26 at 11:15 AM indicated that the nurses should have documented the weights from the patient’s daily log at every visit, and did not follow the physician’s orders. Review of the physician’s orders further identified twice weekly wound care to the patient’s right foot. Interview and review of the wound treatment orders and clinical record with the Administrator on 8/12/26 at 11:25 AM identified a visit frequency for nursing services, as one to three times a week, which did not follow the twice weekly nursing visits for wound care per the physician order, and failed to ensure a comprehensive care plan was developed to meet the patient’s needs. b. Patient #6 had a start of care date of 7/10/26 and diagnoses that included type II diabetes mellitus, chronic kidney disease and congestive heart failure. The physician’s orders dated 7/10/26 included nursing services one to three times weekly for assessments of blood glucose and review of the patient’s daily weight log at every visit. Additionally, a physical therapy and occupational therapy evaluation were ordered. Review of the nursing notes from 7/10/26 to 8/04/26 (5 nursing visits) failed to identify clinical documentation of the patients daily weight measurements. Interview and review of the clinical record with the Administrator on 8/12/26 at 1:15 PM indicated that the nurses should have documented the weights from the patients daily log at every visit, and did not follow the physician’s orders. Review of agency policy for Care for Patients with CHF directed to perform a comprehensive cardiovascular assessment at every visit, including edema, lung sounds, and weight monitoring, vital signs and identified the weight must be recorded immediately in accordance with the clinical documentation policy. c. Patient #15 had a start of care date of 3/02/26 and diagnoses that included malignant neoplasm of the right bronchus, malignant pleura/ effusion and chronic respiratory failure with hypoxia. The physician’s orders dated 3/02/26 included nursing services one to three times weekly for assessments and drainage of the left pleural catheter (a small flexible tube placed in the chest to remove excess fluid buildup at home) up to one thousand milliliters during each visit. Additionally, physical therapy and occupational therapy evaluations were ordered. Review of the Inter-Agency physician referral report dated 2/26/26 identified nursing services to maintain and drain the left pleural catheter every Monday, Wednesday and Friday. Interview and review of the referral document, clinical documentation, and physician’s signed plan of care with the Administrator on 8/12/26 at 11:30 AM identified a frequency for nursing visits of one to three times a week for draining the pleural catheter, and did not follow the Inter-Agency referral request of three nursing visits per week for draining the pleural catheter, every Monday, Wednesday and Friday. The Administrator indicated the agency did not ensure a comprehensive care plan was created to meet the patient’s needs, and physician order.”

“Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This Element is not met as evidenced by: Based on review of the clinical record, review of agency documentation and staff interview, for one of one patient reviewed (Patient #15) , the agency failed to document patient/caregiver education regarding dressing care for a drainage device. The findings include: Patient #15 had a start of care date of 3/02/26 and diagnoses that included malignant neoplasm of the right bronchus, malignant pleural effusion and chronic respiratory failure with hypoxia. The physician’s orders dated 3/02/26 included nursing services one to three times weekly for assessments and drainage of the left V (a small flexible tube placed in the chest to remove excess fluid buildup at home) one to three times a week up to one thousand milliliters during each visit. Additionally, physical therapy and occupational therapy evaluations were ordered. Review of the nursing notes dated 3/04/26 and 3/06/26 did not identify documentation of patient education being provided to the patient and caregiver concerning the care of the pleural dressing (covering over the device) to patient’s chest wall.. Interview and review of the clinical nursing notes with the Administrator on 8/12/26 at 12:25 PM indicted the nurses should have documented patient and caregiver education regarding the pleural catheter device and the care of the dressing in accordance with agency policies. Review of the agency policy for Pleural Catheter Care and Drainage directed the clinicians must instruct the patient and caregiver to keep the dressing completely covered during showers and strictly avoid submersing the catheter site in water.”

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on review of the clinical record, review of agency policies and interview with agency personnel for one of seventeen patients (Patient #13) in the survey sample, the agency nurses failed to provide the services. The findings include: Patient #13 had a start of care date of 6/07/23 and diagnoses that included hypertensive heart and chronic kidney disease and type II diabetes mellitus. The physician’s orders dated 6/07/23 included nursing services once weekly for assessments. Interview and review of LPN #3’s documentation dated 6/28/23, 7/14/23 and 7/21/23 with the Administrator and SCS on 12/07/23 at 10:20 AM identified a weekly visit was attempted, but the patient didn’t answer the phone and/or did not answer the door, but agency nurse failed to notify the physician of an alteration in the plan of care. Review of agency policy for Plan of Care directed that each patient must receive home health services that are written in an individualized plan of care. If the agency misses a visit as required by the plan of care, the agency must notify the responsible physician of such missed service.”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on clinical record review, observation, review of agency policies and interview with agency personnel, for one of seven patients (Patient #5) visited during the survey, the agency nurse failed to maintain accepted infection control practice. The findings include: Patient #5 had a start of care date of 8/22/23 and diagnoses that included stage II pressure ulcers of the left buttock and left medial posterior lower leg and venous thrombosis. The physician’s orders for the certification period of 10/21/23 to 12/19/23 included nursing services three times a week for wound care to the left medial posterior lower leg by cleansing with normal saline followed by the application of Opticel, covering with an ABD pad and wrapping the left lower leg with Kerlix and general assessments. During a joint home visit with LPN #2 on 12/06/23 at 10:35 AM, the surveyor observed LPN #2 wash his/her hands with soap and water upon arrival, don gloves, remove the left lower leg dressing, discard the dressing in a bag, doff gloves, then reapply clean gloves to cleanse the wound without the benefit of sanitizing hands between glove changes. Subsequent to surveyor inquiry, LPN #2 indicated that the agency policy was to wash /sanitize hands at the end of the visit. Interview and review of LPN #2’s joint home visit with the Administrator and Supervisor of Clinical Services/SCS on 12/06/23 at 12:15 PM failed to indicate that LPN #2 followed the agency policies on hand hygiene between glove changes. The agency policy on Hand Hygiene directed the staff must perform hand hygiene using soap and water or an alcohol-based hand sanitizer before and after patient contact, after touching potentially contaminated surfaces and after removing gloves.”

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on clinical record review, review of agency policies and interview with the agency personnel, for two of five patients (Patient’s #1 and # 5) receiving wound care, the agency licensed personnel failed to follow agency policies. The finding includes: Patient # 1 had a start of care date of 7/13/23 with diagnoses that included Diabetic Mellitus with Right Foot Diabetic Ulcer, and Chronic Kidney disease with Peritoneal Dialysis. The physician’s orders for the certification period 11/10/23 through 1/8/2024 included nursing services 2 times (2) a week for wound care including weekly wound measurements, nursing assessments for diabetic management, diet, and peritoneal dialysis monitoring, education and fluid overload monitoring, and medication management. Review of the clinical documentation with the Supervisor of Clinical Services (SCS) on 12/6/23 at 12:15pm, identified in the clinical nursing notes, for 11/14/23, 11/17/23, 11/21/23, 11/29/23, and 12/5/23, the notation “ wound care provided as ordered”, but failed to identify within the clinical note, the wound care provided, the physical location of the wound and the wound bed characteristics, in accordance to the agency Wound Care policy. Patient #5 had a start of care date of 8/22/23 and diagnoses that included stage II pressure ulcers of the left buttock and left medial posterior lower leg and venous thrombosis. The physician’s orders for the certification period of 10/21/23 to 12/19/23 included nursing services three times a week for wound care to the left medial posterior lower leg by cleansing with normal saline followed by the application of Opticel, covering with an ABD pad and wrapping the left lower leg with Kerlix and general assessments. The patient’s left buttock wound was healed. Interview and review of LPN #2’s nursing notes dated 10/27/23, 11/03/23 and 11/17/23 with the Administrator on 12/06/23 at 1 PM identified that wound care was provided per physician’s orders but failed to identify the specific wound care provided and the physical characteristics of the wound according to agency policy. Review of agency Wound Care policy directed to assess and accurately document physical characteristics such as location, stage, size, tissue type, wound bed and peri wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, necrotic tissue, odor, presence/absence of granulation tissue and epithelialization.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on clinical record review, review of agency policies, observation and interview with agency personnel, for one of five patients (Patient #5) receiving wound care, and/or for one of seventeen patients (Patient #13) in the survey sample, the agency licensed personnel failed to ensure the care delivered was in accordance with the physician’s orders. The findings include. Patient #5 had a start of care date of 8/22/23 and diagnoses that included stage II pressure ulcers of the left buttock and left medial posterior lower leg and venous thrombosis. The physician’s orders for the certification period of 10/21/23 to 12/19/23 included nursing services three times a week for wound care to the left medial posterior lower leg by cleansing with normal saline followed by the application of Opticel, covering with an ABD pad and wrapping the left lower leg with Kerlix and general assessments. During a joint home visit with LPN #2 on 12/06/23 at 10:35 AM, the surveyor observed LPN #2 cleansing the left lower leg wound with a gallon of clear solution. Subsequent surveyor observation of the solution identified the solution was distilled water. LPN #2 indicated that the normal saline solution was unavailable in the home and was on reorder. Upon arrival to the next joint home visit with LPN #2, the surveyor inquired about the availability of additional supplies on hand in his/her bag or trunk and the LPN identified the s/he had normal saline in his/her bag showing the surveyor but failed to utilize it for Patient #5’s wound care instead of using distilled water. Interview and review of LPN #2’s joint home visit with the Administrator and SCS on 12/06/23 at 12:15 PM identified that the LPN failed to follow physician’s orders for wound care and should have accessed the normal saline in his/her bag. Interview and review of the clinical record with the SCS on 12/06/23 at 2PM identified that LPN #2 was unable to visit for wound care on 11/24/23 (the third visit of the week), no subsequent visit was attempted, and failed to follow the physician-certified plan of care for three times a week wound care. Patient #13 had a start of care date of 6/07/23 and diagnoses that included hypertensive heart and chronic kidney disease and type II diabetes mellitus. The physician’s orders dated 6/07/23 included nursing services once weekly for assessments. Interview and review of LPN #3’s documentation dated 6/28/23, 7/14/23 and 7/21/23 with the Administrator and SCS on 12/07/23 at 10:15 AM identified a visit was attempted but the patient didn’t answer the phone and/or did not answer the door, no subsequent visit was attempted and failed to follow the physician- certified plan of care for once weekly visits. Review of agency policy for Plan of Care directed that each patient must receive home health services that are written in an individualized plan of care.”