Every finding on record at Catholic Home Health Services of Broward, Inc

During the Recertification survey commenced on 11/09/2021 and concluded on 11/12/2021 at Catholic Home Health Services of Broward, Inc., Home Health Agency provider, Emergency Preparedness was reviewed. Catholic Home Health Services of Broward, Inc. is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was commenced on 11/09/2021 and concluded on 11/12/2021 at Catholic Home Health Services of Broward, Inc., Home Health Agency provider. The provider was not in compliance with 42 CFR, Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved 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 follow up timely with the relevant physician for new orders after a clinical change and in-office physician visit for further assessment for 1 of 17 sampled patients (Patient #5). The findings included: Review of the record reveals Patient #5 began receiving care and services, from the Home Health Agency on 07/02/21 for a Skilled Nurse to drain fluid from a "PleurX" catheter (type of tube inserted in the pleural space outside the lung). Review of daily "Skilled Nurse Visit Notes," between 07/03/21 and 07/15/21 reveals between 75 ml. (milliliters) and 150 ml. of fluid were drained daily from the patient's PleurX catheter. Review of a physician's order on 07/15/21 reveals Skilled Nurse visits for PleurX drainage were changed to every other day effective, 07/16/21. A “LPN (Licensed Practical Nurse) High Tech Visit” note on 07/16/21 documents 100 ml. of fluid was removed through the patient's PleurX catheter. A “LPN High Tech Visit” by LPN "A" on 07/18/21 documents 650 ml. of fluid was drained from the patient's PleurX catheter and that a Registered Nurse was "conferenced," regarding the amount of fluid removed, but there was no evidence of documentation that the physician was notified. A “Patient Communication” note by the DON (Director of Nursing), dated 07/12/21 documents all team members on the patient's case were aware of Patient #5's physician appointments scheduled on 7/20/21 and 07/30/21. Continued review reveals that after 100 ml. of fluid drainage was documented by LPN "A" on 07/20/21, further "Skilled Nurse Visit Notes" document continued increased PleurX drainage with 700 ml. of fluid removed on 07/22/21, 550 ml. of fluid removed on 07/24/21, 700 ml. of fluid removed on 07/26/21 and 550 ml . of fluid removed on 07/28/21. A Pulmonology (Lung) Physician's) "Appointment Note," dated 07/20/21, with fax date 08/23/21, documents Patient #5's caregiver notified the Pulmonologist of increased PleurX drainage and to "continue daily drainage" until it is less than 100 (ml), after which it could be drained every other day. Review of Patient #5's "Skilled Nurse Visit Notes" reveal the patient continued to be seen every other day and not daily, until new physician's orders were received on 08/25/21 changing the visit frequency to every 3 days. During telephonic interview on 11/12/21 at 11:32 AM, LPN "A" stated he notified a Registered Nurse and the Pulmonologist of the increased PleurX drainage on 07/18/21; the Pulmonologist stated he would see Patient #5 in 2 days and assess the patient; LPN "A" confirmed that he did not check for further physician's orders or outcome of that appointment but LPN "A" stated if there was a change in care, the physician "would definitely notify" the Home Health Agency; LPN "A" further stated it is the Clinical Manager's role to follow up with physicians he did not alert either the Clinical Manager or Director of Nursing of the increase in the patient's PleurX drainage. During interview with the DON and Administrator on 11/12/21 at 12:08 PM, the Director of Nursing stated he was following Patient #5's case closely but he and the Clinical Manager were never advised of the increase in drainage; the Administrator stated the LPN, who was seeing the patient with a change in condition and aware of the upcoming appointment, should have been communicating with the DON asking for follow through and not just telling the "Field" Registered Nurse.

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency's failed to ensure communication of changes between members of the patient's interdisciplinary team to enable appropriate follow up with physicians and to carry out new physician's orders for 1 of 17 sampled (Patient #5). The findings included: Review of the record reveals Patient #5 began receiving care and services, from the Home Health Agency on 07/02/21 for a Skilled Nurse to drain fluid from a "PleurX" catheter (name of type of tube inserted in the pleural space outside the lung). Review of daily "Skilled Nurse Visit Notes," between 07/03/21 and 07/15/21 reveals between 75 ml. (milliliters) and 150 ml. of fluid were drained daily from the patient's PleurX catheter. Review of a physician's order on 07/15/21 reveals Skilled Nurse visits for PleurX drainage were changed to every other day effective, 07/16/21. A “LPN (Licensed Practical Nurse) High Tech Visit” by LPN "A" on 07/18/21 documents 650 ml. of fluid was drained from the patient's PleurX catheter and that a Registered Nurse was "conferenced," regarding the amount of fluid removed, but there was no evidence of documentation that the physician was notified. After 100 ml of fluid drainage was documented by LPN "A" on 07/20/21, further "Skilled Nurse Visit Notes" document continued increased PleurX drainage with 700 ml. of fluid removed on 07/22/21, 550 ml. of fluid removed on 07/24/21, 700 ml. of fluid removed on 07/26/21 and 550 ml. of fluid removed on 07/28/21. During a telephonic interview on 11/12/21 at 11:32 AM, LPN "A" stated he notified a Registered Nurse and the Pulmonologist (Lung Physician) of the increased PleurX drainage on 07/18/21; the Pulmonologist stated he would see Patient #5 in 2 days; stated it is the Clinical Manager's role to follow up with physicians; stated that he did not alert either the Clinical Manager or Director of Nursing of the increase in the patient's PleurX drainage. During an interview with the DON and Administrator on 11/12/21 at 12:08 PM, the Director of Nursing stated that he was following Patient #5's case closely but he and the Clinical Manager were not aware of the increase in Patient #5's PleurX drainage until during survey, as they were never advised of this by the Registered Nurse or LPN; that if he had known he would have been concerned and followed up with the physician and the Administrator stated LPN "A" should have been communicating with them for follow through, rather than only telling one "Field RN."

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record review, review of the Home Health Agency's Policy and Procedure and interview, the Home Health Agency failed to ensure clinical notes included complete wound assessments for 2 of 4 sampled patients, Patients #1 and #17 and accurate assessments of PleurX (chest tube) drainage for 1 of 1 sampled patients reviewed for a PleurX drainage Patient #5 (Patient #1, #17 and #5). The findings included: 1) Review of the record reveals Patient #1 began receiving care and services from the Home Health Agency on 10/12/21 with physician's orders for wound care 3 times weekly. Patient #1's "Start Of Care Assessment," by a Registered Nurse, dated 10/12/21 documents a left ... (area) wound that measures 4.5 x 1.8 x 1.5 cm (centimeters) with moderate serous (watery) drainage, a white wound bed with 90% slough (dead tissue) and 10% pink/red, wound edges not attached and that the surrounding tissue was reddened and fragile. Review of the Home Health Certification and Plan Of Care for 10/12/21 to 12/10/21 reveals no evidence of documentation of how often or by whom wound assessments should be completed. Review of Patient #1's record reveals no evidence of documentation of Registered Nurse visits after the Start Of Care on 10/12/21 up to and including the date of review on 11/12/21. An "LPN (Licensed Practical Nurse) Skilled Nursing Visit Note," dated 10/18/21 documents the left ... (area) wound bed as pink, moderate serous drainage with no odor, surrounding redness and "RN (Registered Nurse) performed wound measurement weekly." An "LPN Skilled Nursing Visit Note," dated 10/20/21 documents the left ... (area) wound was 3.6 x 1.4 x 1.0 cm, wound bed 60% pink/red, 40% slough, redness to surrounding tissue, and had moderate serous drainage with no odor. An "LPN Skilled Nursing Visit Note," dated 10/27/21 documents the left ... (area) wound was 3.6 x 1.4 x 1.0 cm, wound bed pink, moderate serous drainage with no odor and "RN performed wound measurement weekly." An "LPN Skilled Nursing Visit" dated 10/31/21 documents the left ischial wound bed was pink with attached wound edges, had moderate serous drainage with no odor. An "LPN Skilled Nursing Visit Note," dated 11/03/21 documents the left ... (area) wound had moderate serous drainage with no odor and "RN performed wound measurement weekly." An "LPN Skilled Nursing Visit Note," dated 11/05/21 documents the left ... (area) wound bed as white, 20% pink/red, with moderate serous drainage with no odor, no measurements and "RN performed wound measurement weekly." An "LPN Skilled Nursing Visit" note dated 11/08/21 documents the left ... (area) wound bed was white, had moderate serous drainage with no odor, and "RN performed wound measurement weekly." An "LPN Skilled Nursing Visit Note," dated 11/10/21 documents the left ... (area) wound bed was pink, had moderate serous drainage with no odor, and "RN performed wound measurement weekly." Review of the record revealed no evidence of further descriptions of wound appearance or wound measurements, by either Skilled Nursing staff or Physician/Wound Clinic notes, as of 11/10/21. Review of the Home Health Agency's "Policy and Procedure" titled, "Admission" documents, "Complete wound care assessments are conducted by registered nurse-type-drainage-measurement-consistency-treatment and patient's response. This is done at SOC (Start of Care), weekly and as I dictated during the episode. If patient is seen by wound healing center this complete assessment will be accepted in lieu of the nurses weekly assessment and incorporated in the patients medical record. If patient is not seen in the wound healing center or weekly by a physician, then the registered will conduct a full assessment at least every two weeks." During an interview on 11/12/21 at 12:44 PM, the DON (Director of Nursing) confirmed the Home Health Agency's Policy and Procedure for a Registered Nurse to assess and measure wounds every 2 weeks. 2) Review of the record reveals Patient #17 began receiving care and services from the Home Health Agency on 10/04/21 with physician's orders for wound care to the right ... (limb) every other day until 10/18/21, then twice weekly thereafter. Further review reveals Patient #17's "Start Of Care Assessment" by a Registered Nurse (RN) dated 10/04/21 documents a right ... (limb) wound that measured 4.5 x 5.5 x 0 cm. (centimeters) and a right ... (limb) surgical wound that measured 10.5 cm. long. Review of Patient #17's Home Health Certification and Plan Of Care for 10/04/21 to 12/02/21 reveals no evidence of documentation of how often or by whom wound assessments should be completed. Review of the "Skilled Nurse Visit Notes" reveals wound measurements by a RN for the right ... (limb) wound on 10/14/21. Continued review reveals LPNs (Licensed Practical Nurses) made subsequent visits and documented wound care, there was no evidence or documentation of RN visits or wound measurements to the right ... (limb) wound as of record review on 11/12/21, and no evidence of documentation of wound assessments by a clinic or physician. 3) Review of the record reveals Patient #5 began receiving care and services from the Home Health Agency on 07/02/21 with orders to drain a PleurX catheter (tube to drain fluid from the pleural space around lungs) daily. Review of the Home Health Certification and Plan Of Care for 07/02/21 to 08/30/21 reveals evidence of documentation for the Skilled Nurse to assess/perform/teach care of the PleurX catheter, to drain fluid from the PleurX catheter site daily and report findings to the physician as needed and does not specify elements of the assessment and documentation, such as color and appearance of the drainage fluid. Review of the Home Health Certifications and Plans Of Care for 08/31/21 to 10/29/21 and 10/30/21 to 12/28/21 reveals evidence of documentation to monitor/assess catheter drainage with each visit but also do not specify elements of the assessment and documentation, such as to record the color and appearance of drainage fluid. Review of the Home Health Agency's "PleurX Drainage and Dressing Procedure," undated and provided by the Administrative Assistant on 11/10/21, documents to record the amount of drainage in the record and under "Reportable Conditions- any change in color or appearance of the drainage fluid." Review of Patient #5's "Skilled Nurse Visit Notes" documents amounts of fluid drained but no color or description of the drainage fluid for 28 of 31 reviewed nursing notes by LPN "A" and 1 of 1 "Skilled Nursing Visit Note by LPN "B; for LPN "A" dated 07/03/21, 07/04/21, 07/08/21, 07/09/21, 07/10/21, 07/11/21, 07/12/21, 07/16/21, 07/18/21, 07/20/21, 07/24/21, 07/26/21, 07/28/21, 09/04/21, 09/07/21, 09/20/21, 09/23/21, 09/26/21, 10/02/21, 10/05/21, 10/08/21, 10/14/21, 10/17/21, 10/20/21, 10/23/21, 11/04/21, 11/07/21 and 11/12/21 by LPN "A" and a "Skilled Nurse Visit Note," dated 10/11/21 by LPN "B." On 07/14/21 and 07/15/21, LPN "A" documented "brick red" drainage from the PleurX catheter and on 11/10/21 LPN "A" documented blood clots in the drainage catheter, but no descriptions of the fluid on any other days the LPN visited Patient #5. Review of the amounts of drainage documented on different pages of the same "Skilled Nurse Visit Notes" reveals evidence that documents on 09/10/21, 450 ml. (milliliters) drained per Page 1 but 400 ml. per Page 6; on 09/23/21, 250 ml. per Page 4 with 200 ml. documented on Page 6. During interview on 11/12/21 at 12:08 PM, the Administrator stated nurses should document the color and consistency of PleurX drainage as well as amount and report changes from baseline to the physician.