Centerwell Home Health

“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 observation, record review, and interview, the agency failed to ensure the Registered Nurse (RN) practiced standard precautions while providing wound care to 1 of 1 patients observed receiving wound care services by the agency. (Employee: RN 1) Findings Include: 1. A review of an agency policy, titled “Standard Precautions” revision date 08-2021, indicated but was not limited to, “ … All clinicians performing job-related responsibilities will observe Standard Precautions … Clinicians are to follow Centers for Disease Control and Prevention (CDC) recommendations … ” 2. Centers for Disease Control last updated January, 2021. When to Perform Hand Hygiene. Retrieved from cdc.gov/hand hygiene/providers/index.html indicated … “Use an Alcohol-Based Hand Sanitizer: Immediately before touching a patient. Before performing an aseptic task [e.g., placing an indwelling device] or handling invasive medical devices. Before moving from work on a soiled body site to a clean body site on the same patient. After touching a patient or the patient’s immediate environment. After contact with blood, body fluids or contaminated surfaces. Immediately after glove removal. Wash with Soap and Water: When hands are visibly soiled ... After known or suspected exposure to spores ... When using alcohol-based hand sanitizer: Put product on hands and rub hands together. Cover all surfaces until hands feel dry. This should take around 20 seconds ... The CDC Guideline for Hand Hygiene in Healthcare Settings recommends: When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product ... and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse your hands with water and use disposable towels to dry. Use towel to turn off the faucet ... Other entities have recommended that cleaning your hands with soap and water should take around 20 seconds. Either time is acceptable. The focus should be on cleaning your hands at the right time ... When and How to Wear Gloves: Wear gloves ... when ... contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur ... Change gloves and perform hand hygiene during patient care, if gloves become damaged, gloves become visibly soiled ... moving from work on a soiled body site to a clean body site on the same patient or in another … “ 3. During a home visit observation on 06-25-2024 at 11:25 AM, RN 1 was observed providing wound care for Patient #2. The RN removed the dressing from Patient #2’s right forearm, revealing a diameter, of approximately 50 cent piece size pink open area. The RN discarded the dressing and their gloves, in the trash bag, and donned new gloves without performing hand hygiene. RN 1 cleansed the right forearm wound with normal saline and gauze 4 x 4s. After taking pictures of the wounds, RN 1 placed an adaptive collagen dressing and gauze wrap on Patient #2’s right wound. RN 1 removed the old gauze wrap and the adhered dressing from Patient #2’s left forearm with saturated normal saline gauze and discarded the dressing and gloves into the trash bag. Patient #2’s left elbow to forearm contained a triangle-shaped skin tear under a moderate amount of sanguineous drainage; RN 1 cleansed the left forearm skin tear with saline and a 4 x 4 gauze, and applied a gauze dressing, a cut-to-size abdominal pad, gauze wrap, and secured with Meflix tape. RN 1 applied a Tubigrip sleeve to hold the dressing in place without performing hand hygiene and donning new gloves. During an interview on 06-25-2024 at 1:20 PM, when queried regarding the agency’s policy on wound care and when to perform hand hygiene and glove changes, RN 1 indicated the following: remove old dressing into the trash, remove gloves, hand hygiene, don new gloves, clean wound, dispose of dirty gauze and gloves, hand hygiene, and don new gloves. 4. During an interview on 06-26-2024 at 5:10 PM, the Clinical Manager and Administrator confirmed hand hygiene should be performed after the staff discard their gloves. They further confirmed after nurses remove the dressing or cleanse the wound, gloves should be discarded, hand hygiene should be completed, and new gloves should be applied. 410 IAC 17-12-1(m)”

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure they coordinated care delivery to meet the patient’s needs for 2 of 3 active patient records reviewed of patients receiving in-center dialysis treatment. (Patients: #9 and 10) Findings Include: 1. A review of a revised dated 01-2024, agency policy, titled “Coordination of Care-Case Conferences,” indicated but was not limited to, “ … All healthcare providers – whether internal or external to the Company - associated with direct patient care must maintain close communication to ensure each patient receives coordinated care that meets their needs … ” 2. During the Entrance conference on 06-24-2024 at 9:33 AM, when queried on how care was coordinated with other agencies, the Administrator and Clinical Manager indicated they reported off to other facilities with their shared patients. The Administrator further the case manager contacts other providers to coordinate care. When queried regarding documentation of the coordination of care with other agencies, the Administrator indicated documentation would be noted either on the plan of care, communication notes, or the clinician’s visit note. 3. A review of the clinical record for Patient #9 start of care date 05-08-2024, included a plan of care for the initial certification period 05-08-2024 to 07-07-2024. The plan of care failed to evidence coordination of care with Entity 1, the in-center dialysis treatment facility for Patient #9. A review of the agency documents titled “Client Coordination Notes” dated 05-08-2024 to 06-26-2024 failed to evidence coordination of care with Entity 1. During an interview on 06-26-2024 at 2:46 PM, Person 3, a family member of Patient #9’s confirmed Patient #9 received dialysis treatment at Entity 1. 4. During an interview on 06-26-2024 at 2:52 PM, Person 2, the dietician for Entity 1, confirmed Patient #9 received dialysis treatment at Entity 1. Person 2 indicated they would send Patient #9’s orders. A review of Entity1’s documents received 06-26-2024 at 3:15 PM, titled “Patient Summary Report,” contained orders for hemodialysis (a machine filters wastes, salts, and fluid from the blood when the kidneys are no longer healthy enough to) at Entity 1 every Tuesday, Thursday, and Saturday for Patient #9. During an interview on 06-26-2024 at 3:54 PM, the Clinical Manager confirmed they could not provide any documentation in Patient #9’s record of coordination of care with Entity 1. 4. A review of the clinical record for Patient #10, with a start of care of 05-10-2024, contained a plan of care for the certification period of 05-10-2024 to 07-08-2024. The record indicated Patient #10 attends in-center dialysis Monday, Wednesday, and Friday. In an interview on 06-26-24 at 1:30 PM the alternate administrator reported they did not know where Patient # 10 received dialysis. A review of the agency documents titled “Client Coordination Notes” dated 05-10-2024 to 06-26-2024 failed to evidence coordination of care with Entity 12. In an interview on 06-26-24 at 2:45 PM, Patient # 10’s family caregiver communicated Patient # 10’s dialysis treatments took place at Entity 12, an inpatient dialysis center.”

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure a written visit schedule, including home health agency staff visits, was provided to the patients in 3 of 7 home visits. (Patients: #1, 5 and 6 ) Findings Include: 4. During a home visit at the residence of Patient #6 on 06-26-2024 at 3:45 PM, he/she provided the binder received from the agency. The binder contained a calendar that was blank. When queried if there was schedule of visits provided by the agency in their residence, they reported they did not have one. The agency failed to provide a schedule with frequency of visits to the patient. 3. During a home visit at Patient #1’s residence on 06-25-2024 at 9:35 AM, Patient #1 provided the binder they received from the agency. The binder contained a blank whiteboard calendar. When queried about scheduled visits, the agency staff were to provide they indicated they did not have one. ST stated, “That is on us not to have had the calendar completed.” During an interview on 06-26-2024 at 5:05 PM, the Administrator and Clinical Manager confirmed it is the patient’s right to know the agency staff’s scheduled visit dates and times. A policy received from the administrator on 06-26-2024 at 4:50 PM titled, “03-09 Patient Rights/Notice of Privacy Practices” contained but was not limited to “ . . . Receive information relating to their care . . . be informed in advance about treatment including . . . be provided or the revisions of the care plan; frequency of visits; expected outcomes and goals . . . the patient or caregiver will be provided a copy of the POC . . . . During a home visit at the residence of Patient #5 on 06-25-2024 at 8:53 AM, he/she provided the binder received from the agency. The binder contained a calendar that was blank. When queried if there was schedule of visits provided by the agency in their residence, they reported they did not have one. The agency failed to provide a schedule with frequency of visits to the patient.”

“Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient or the patient’s caregiver were provided with a medication schedule/instructions, including medication name, dosage, and frequency in plain language in 2 of 7 home visit patients. (Patients # 5 and 6) Findings include: 3. During a home visit at the residence of Patient #6 on 06-26-2024 at 3:45 PM, he/she provided the binder received from the agency. When queried if there was a medication list in the residence, they reported they did not have one. The agency failed to provide a medication list with medication schedule or instructions to the patient. 1. A policy received from the administrator on 06-26-2024 at 4:50 PM titled, “03-11 Care Planning” contained but was not limited to “ Each patient must receive an individualized Plan of Care (POC) . . . the individualized POC must specify . . . Care and services to meet patient specific needs . . . Types of services . . . Frequency of visits to be made . . . All medications and treatments . . . The patient or caregiver will be provided a copy of the POC and/or other written instructions outlining: visit schedule, disciplines and frequency of visits, patient medication schedule/instructions . . . updated written information as the POC changes . . . .” 2. During a home visit at the residence of Patient #5 on 06-25-2024 at 8:53 AM, he/she provided the binder received from the agency. When queried if there was a medication list in the residence, they reported they did not have one. The agency failed to provide a medication list with medication schedule or instructions to the patient.”