Centerwell Home Health

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on record review and interview the home health agency failed to ensure that 2 of 17 (#5, #14) patients received services as outlined in the plan of care. Review of Patient #14’s record revealed that she was admitted to the home health agency with a start of care date (SOC) of 11/28/2023. Review of the plan of care for the certification period of 3/27/2024 to 5/25/2024 revealed the following disciplines and frequencies: “SN EFFECTIVE 3/31/2024 1WK 8” “PT 1WK2, 2WK1, 1WK2, 2WK1, 1WK3” “OT 1WK9” “HHA EFFECTIVE 3/31/2024 1 WK 7” Review of the Client Scheduling Calendar Report” revealed that the home health aide (HHA) initiated services on 4/04/2024. Interview with the Director of Rehab Services on 4/23/24 at 11:53 AM the aide did not start services on 3/31/2024 as specified in the plan of care. Findings included: Review of Patient #5’s record revealed that she was admitted to the home health agency with a start of care date (SOC) of 12/19/23. Review of the plan of care for the certification period of 12/19/23 to 2/16/24 revealed the following disciplines and frequencies: “SN 1WK6” “PT 1WK1, 2WK2, 1WK2, 2WK1, 1WK2, 2WK1” “OT EFFECTIVE 12/24/2023 1WK5” “MSW EFFECTIVE 12/24/2023 1WK1”. Review of the Review of the Client Scheduling Calendar Report” revealed that the patient was scheduled for a MSW visit on 12/28/23. Review of the patients missed visits revealed that at the patients request the 12/28/23 MSW visit was cancelled. Review of Patient #5’s visit notes, communications and the “Client Scheduling Calendar Report” revealed that there was no documentation that the MSW visit was rescheduled and conducted at any other time and no documentation that would indicate that the patient had refused any additional MSW visits. Interview with the Director of Clinical Operations on 4/23/24 at 11:58 AM revealed that there should have been a physicians order to make any changes. She reported that there is no narrative present in the record. The Director of Clinical Operations reported that there should have at least been a coordination note. Review of the facility policy titled “Care Planning” with the most recent revised date of 09/2022 revealed the following: -“Care will be planned to ensure effective utilization of services and resources including the total number of visits/hours appropriate to the care required and ordered.” -“Patients will receive the number of visits/hours needed for effective management of the patient POC.””

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on staff interviews and record reviews, the agency failed to ensure supervisory visits are conducted every 14 days to assess the aide services provided for 1 (#14) patient out of 1 record reviewed receiving aide services. Findings included: Review of Patient #14’s record revealed that she was admitted to the home health agency with a start of care date (SOC) of 11/28/2023. Review of the plan of care for the certification period of 3/27/2024 to 5/25/2024 revealed the following disciplines and frequencies: “SN EFFECTIVE 3/31/2024 1WK 8” “PT 1WK2, 2WK1, 1WK2, 2WK1, 1WK3” “OT 1WK9” “HHA EFFECTIVE 3/31/2024 1 WK 7” Review of the Client Scheduling Calendar Report” revealed that the home health aide (HHA) conducted a visit on 4/04/2024. A registered nurse (RN) did not conduct a supervisory visit within 14 days of the initial HHA visit on 4/04/2024. Interview with the Director of Rehab Services on 4/23/24 at 11:53 AM revealed there should have been an HHA supervisory visit added to the registered nurse visit conducted on 4/17/2024. “ On 4/17/2024 when the RN did an LPN ( Licensed Practical Nurse) supervisory visit she should have completed one of the HHA too.” For a policy, the home health agency follows the interpretive guidelines for onsite supervisory visits every 14 days: (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days.”