Every finding on record at Caresouth HHA Holdings of Winchester, LLC

An Emergency Preparedness survey was conducted from 5/3/2022 to 5/5/2022 at Enhabit Home Health. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

A Recertification survey was conducted on 5/3/2022 to 5/5/2022 at Enhabit Home Health. Deficiencies were cited under CFR 484, Requirements for Homecare Organizations Providing Home Health Care.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on medical record review and interview, the agency failed to obtain weights for 2 patients #8 and #17 of 7 patients who were ordered weights. The findings include: Medical record review revealed Patient #8 was admitted to the agency on 4/19/2022 with diagnoses including Type 2 Diabetes Mellitus with Foot Ulcer and Chronic Obstructive Pulmonary Disease. Medical record review of the Home Health Certification and Plan of Care dated 4/19/2022 to 6/17/2022 revealed a physician's order for "...Clinician to weigh patient each visit and notify physician for weight gain > (greater) than 2 lbs (pounds) in 24 hours and/or > 5 lbs in 1 week..." Medical record review of the skilled nurse's notes between 4/19/2022 and 5/3/2022 (3 visits) revealed the patient's weight was not obtained. Interview with the administrator on 5/4/2022 at 3:00 PM confirmed the patient's weight was not obtained as ordered by the physician. Medical record review revealed Patient #17 was admitted to the agency on 2/15/2022 with diagnoses including Aftercare Following Joint Replacement Surgery and Hypertension. Medical record review of the Home Health Certification and Plan of Care dated 2/15/2022 to 4/15/2022 revealed a physician's order for "...Clinician to weigh patient each visit and notify physician for weight gain > 2 lbs in 24 hours and/or > 5 lbs in 1 week..." Medical record review of the physical therapy notes dated 2/21/2022 and 3/14/2022 revealed no weight was obtained for the patient. Interview with the administrator on 5/3/2022 at 3:10 PM confirmed weights were not obtained with every visit as ordered by the physician.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to obtain frequency for wound care orders for 1 patient (#9) of 4 patients with wound care. The findings include: Medical record review revealed Patient #9 was admitted to the agency on 4/4/2022 with Chronic Kidney Disease and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care dated 4/4/2022 to 6/2/2022 revealed a physician's order for "...skilled nurse to perform/teach wound care to right heel. Cleanse with NS (normal saline). Pack with packing wrap with Kerlix (rolled dressing). Secure with Coban (dressing)..." Further review revealed the wound care frequency was not obtained from the physician. Interview with the administrator on 5/4/2022 at 3:30 PM confirmed the agency failed to obtain wound care frequency orders from the physician.

Plan of care revisions must be communicated CFR(s): 484.60(c)(3) Revisions to the plan of care must be communicated as follows: This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to communicate to the physician a revision to the plan of care as ordered by the physician for 1 patient (#14) of 17 patients reviewed. The findings include: Medical record review revealed Patient #14 was admitted to the agency on 9/3/2021 with diagnoses including Partial Traumatic Amputation of Left Great Toe and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care dated 9/3/2021 revealed a physician's order for skilled nurse visit at 1 time a week for 1 week. Medical record review of a coordination note dated 9/3/2021 revealed the patient refused the skilled nurse evaluation visit. Further review revealed the physician was not notified the patient refused skilled nurse services. Interview with the administrator on 5/4/2022 at 3:15 PM confirmed the physician was not notified of the patient's refusal of skilled nursing services.

Development and evaluation of plan of care CFR(s): 484.75(b)(2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s); This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to assess glucose monitoring for 1 patient (#6) of 5 patients with glucose monitoring. The findings include: Medical record review revealed Patient #6 was admitted to the agency on 4/6/2022 with diagnoses including Type 2 Diabetes Mellitus and Chronic Kidney Disease. Medical record review of the Home Health Certification and Plan of Care dated 4/6/2022 to 6/4/2022 revealed the physician established parameters for random and fasting blood sugars. Medical record review of the skilled nurse's notes between from 4/6/2022 to 4/27/2022 (4 visits) revealed the skilled nurse failed to monitor blood sugar readings provided by the patient. Further review revealed the skilled nurse failed to obtain any glucose readings from the patient. Interview with the branch manager on 5/4/2022 at 3:00 PM confirmed the skilled nurse failed to evaluate the random and fasting blood sugar parameters ordered by the physician.