Centerwell 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 policy review, clinical record review, and interview, the home health provider failed to maintain professional standards according to their provider policy when wound measurements were not performed/documented weekly in the clinical record in two of two applicable records (Records/Patients #1 and #4). This deficient practice has the potential to affect all wound care patients served by the provider. RECORD/PATIENT #4: Review of the plan of care POC dated 09/18/2024 to 11/16/2024, showed in part: - Patient admitted to home health provider 09/18/2024; - Diagnoses included but not limited to type II diabetes mellitus with foot ulcer (open sore or wound), non-pressure chronic ulcer of left heel and midfoot with severity, and encounter for surgical aftercare following surgery on the circulatory system (surgical procedure that involves the heart, or the blood vessels that carry blood to and from the heart); and - SN to perform wound care to left medial big toe and change dressing every Monday, Wednesday and Friday. Review of the SN visit note report dated 09/18/2024 showed left (LT) - proximal (prox) (nearer to the center (trunk of the body) or to the point of attachment to the body) plantar (part of the foot contacting the ground), LT, diabetic ulcer surgical wound measured 7 x 4.5 x 0.3. Review of the SN visit note reports dated 09/23/2024, 09/25/2024, 09/27/2024, 09/30/2024 and 10/04/2024 failed to show documentation of wound measurements. Review of the SN visit note report dated 10/07/2024 showed LT – prox plantar, LT, diabetic ulcer surgical wound measured 4.3 x 4.4 x 2.8. During an interview on 11/06/2024 at 11:05 AM, the clinical manager A stated no wound measurements were done for the weeks of 09/22/2024 and 09/29/2024 and he/she would expect them to be done weekly. Findings included: Review of the provider’s policy titled “03-51 Wounds: Assessment/Care/Clinical Oversight,” with the most recent annual review date of “08/2024” showed in part, at least once weekly the wound will be measured: length x width x depth (length by width by depth) in centimeters. RECORD/PATIENT #1: Review of the plan of care (POC) dated 08/22/2024 to 10/20/2024, showed in part: - Diagnoses included but not limited to: disruption of external operation (surgical wound) (also known as wound dehiscence or separation- when a surgical wound reopens) and cutaneous abscess of abdominal wall (localized infection in the fatty tissue just under the skin); and - SN (skilled nurse) to perform/teach wound care to abdominal surgical wound. Review of the SN visit note report dated 10/05/2024 showed mid suprapubic (area of the abdomen located below the navel and above the pubic bone) surgical wound measured 0.4 x 0.4 x 0.2. Review of the SN visit note report dated 10/14/2024 showed mid suprapubic (area of the abdomen located below the navel and above the pubic bone) surgical wound measured 0.2 x 0.2 x 0.3. Review of the SN visit note reports the week of 10/06/2024 to 10/12/2024 dated 10/07/2024, 10/09/2024 and 10/11/2024 failed to show documentation of wound measurements. During an interview on 11/06/2024 at 10:20 AM, the administrator stated wound measurements are done weekly and confirmed there were no wound measurements documented the week of 10/06/2024 to 10/12/2024.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on policy review, clinical record review, and interview, the provider failed to ensure the initial assessment was completed within 48 (forty-eight) hours of the referral in one of five full records reviewed (Record/Patient #5). This deficient practice has the potential to affect the immediate needs of all the provider’s patients. Findings included: Review of the provider’s policy titled, “03-05 Patient Assessments,” with the most recent annual review date of “08/2024”, showed in part, initial assessments must be completed on or before start of care and within 48 (forty-eight) hours from the date of referral or facility discharge (whichever is later) unless otherwise ordered by the physician or allowed practitioner. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 09/18/2024 with a primary diagnosis of radiculopathy, thoracic/lumbar region (the pinching of nerves at the root of the middle and lower back). Review of a faxed referral cover sheet to the home health provider showed: - It was dated 09/13/2024 from the referring physician; and - “Please call if can’t accept”. Review of the SOC OASIS (Start of Care Outcome and Assessment Information Set; a standardized data collection tool) dated 09/16/2024 (three days (72 hours) following referral) showed: - Item M0104- Date of referral 09/16/2024; and - Item M0102- Date of physician-ordered SOC marked N/A, no specific SOC date. Further review of the clinical record failed to show a specific physician ordered start of care or any communication regarding the late start of care. During an interview on 11/06/2024 at 11:00 AM, clinical manager B stated that: - This was a new nurse; - He/she should have contacted the physician for a new verbal start of care date; and - He/she incorrectly completed the OASIS item M0102.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on policy review, clinical record review, home visit observation, and interview, the home health provider failed to ensure a complete and accurate medication list was maintained in, one of three home visit observations (Record/Patient #3). This deficient practice has the potential to affect the provider’s ability to ensure safe and effective use of medications for all patient’s served by the provider. Findings included: Review of the provider’s policy titled, 03-41 “Medication Review and Documentation,” revision date October 2024, showed in part: - During each patient visit, the home health agency (provider) will review all medications the patient is taking - both prescription and over the counter (OTC) - to include all routes of administration; - Medication review will be performed by a clinical associate each visit to ensure medications are current, accurate and documented on the medication profile within the patient’s medical record; - OTC drugs and herbal compounds - will also be included as part of the patient medication assessment and documented within the patient’s medical record; - When conducting medication review, clinical associates must complete the following actions with the patient/caregiver and/or staff regardless of the patient’s place of residence; * Examine and discuss with the patient/caregiver; * Medication bottles; * Prescriptions; * Current medication lists provided by the patient; and - Medication review includes all prescription medications, OTC medications and supplements/herbals administered by all routes. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 09/21/2024 with a primary diagnosis of chronic obstructive pulmonary disease (COPD; a group of lung diseases that block airflow and make it difficult to breathe) with acute exacerbation (recent onset worsening of a disease or an increase in its symptoms) and hypertensive heart and chronic kidney disease with heart failure and stage 1-4 chronic kidney disease, or unspecified chronic kidney disease. Observation and interview on 11/05/2024 at 12:00 PM, during the patient’s home visit, showed the following discrepancies: - The medication profile showed the patient took albuterol (opens airways to make breathing easier) sulfate HFA 90 micrograms (mcg) / actuation aerosol inhaler two puffs four times daily for shortness of air. The patient stated he/she used it as needed and hadn’t used since his/her flare up on 09/10/2024; and - The patient’s medication bottles showed probiotic 10 billion cell capsule for GI (gastrointestinal) health. The patient stated he/she took one capsule two times daily and had been taking for about one month since he/she was dismissed from the hospital. The medication was not on the patient’s medication profile. Per interview conducted during the observation, LPN (licensed practical nurse)-C stated that he/she would notify the physician and get the discrepancies clarified. During an interview on 11/06/2024 starting at 10:30 AM, the administrator stated that he/she expected medications to be reviewed every visit and with every discipline to conduct a medication reconciliation.”