Enhabit Home Health

“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 record review and interview the home health agency failed to follow accepted standards of practice to individualize the plan of care in 3 (P[patient] P1, P2 , P3,), out of 10 patients (P1 – P10) records reviewed. This failure to tailor the care plan to each patient may not address specific guidance for staff who are unfamiliar with the patients’ needs resulting in inappropriate interventions and patient dissatisfaction. The findings are: A. During a record review of the home health agency policy titled, “Clinical records” dated 06/23/2025, stated, “Promote documentation that is a true and accurate account of the patient’s status, and the care provided,” the policy also states, “The clinical record includes essential components…3.2.2.6. Patient centered outcomes and responsibilities.” B. Record review of P1’s chart showed the plan of care for nursing is generalized with the following statements: “Observe and assess respiratory system; may provide teaching/reinforcement, including some or all of these best practices.” There are no specific best practices listed to teach. “Observe and assess genitourinary system. Provide teaching on signs/symptoms” There are no signs or symptoms listed to teach. “Observe and assess gastrointestinal system. Provide teaching on signs and symptoms”. There are no signs or symptoms listed. When reviewing goals the following statement was under skilled nursing: “Patient will continue to make progress toward unmet nursing goals.” There is no list of interventions, essential steps, or a time frame to reach unmet goals C. During an interview with S(staff)2 (clinical), 08/05/2025 at 02:15PM, she was shown this care plan for P1 and agreed that it was not individualized. D. Record review of P2’s chart it was observed that P2 had a diagnosis of cellulitis (a bacterial skin infection). Under the plan of care for skilled nurse the following is stated: “Skilled nurse to observe and assess skin integrity and hygiene. Skilled nurse may provide teaching/reinforcement on some or all of these best practices.” There are no specific best practices listed to teach. Under skilled nursing goals the following is stated: “Patient will continue to make progress towards unmet nursing goals.” There is no list of interventions, essential steps, or a time frame to reach unmet goals. Plan of care does not include wound assessment, measurements, progression, or patient education. E. During an interview with S2 (clinical) on 08/05/2025 at 02:45PM, she confirmed that P2 does have a wound and S2 was unable to find any documentation in the plan of care that addressed the care of the wound, assessment, measurements, progression, or patient education. F. During record review of P3 it was noted that the plan of care was not individualized. Under plan of care for skilled nurse the following was documented: “Skilled nurse to provide instruction regarding pain control, including pharmacological and nonpharmacological methods.” There are no specific pharmacological or nonpharmacological interventions or methods listed. “Skilled nurse to educate on best practices to mitigate risk of impaired nutrition.” There are no best practices listed, or specific interventions listed. “Skilled nurse to educate on best practices to mitigate fall risk.” There are no best practices or specific interventions listed to mitigate fall risk.”

“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 record review and observations during patient visits, the home health agency failed to follow accepted standards of practice to prevent the transmission of infection in 2 (P [patient] P4, P10) out of 2 patients (P4, P10) observed during home visits. This failure could result in the transmission of disease-causing bacteria resulting in an infection in the patient. The findings are: A. Record review of the home health agency policy titled, “Medical equipment management”- E04, (the policy number) revised 10/25/2024 stated, “All healthcare workers in the field will use an alcohol or sanitizing wipe (with excess fluid squeezed from the wipe) on their mobile devices in between visits.” B. During an observation of a home visit on 08/06/2025 at 10:30AM, S (Staff)4, (clinical) entered the home of P (patient)10 with a cross-body bag containing a tablet. S4 took the tablet out of the bag and did not sanitize it before using it. During the visit she entered information several times on the tablet. At the visit conclusion, S4 handed the tablet to the patient for a signature and then returned the tablet to her shoulder bag without sanitizing the device. C. During an observation of a home visit 08/06/2025 at 12:00PM, S (Staff)5 (clinical), entered the home of P4 with a travel bag containing supplies. S5 removed a tablet, did not sanitize it, and used it to document visit events and take images of a wound. S5 handed the tablet to P4 for a signature at the visit conclusion and then returned the tablet to her travel bag without sanitizing the device.”