Every finding on record at Centerwell Certified Healthcare Corp

. On 10/23/2023 at 10:00 AM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 10/26/2023 at 10:30 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. .

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 Clinical Record review and staff interviews, it was determined the Skilled Nurse (SN) failed to include Oxygen (O2) during the review of the patients medications in 1 (#8) of 17 (#1 - #17) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for patients on census receiving O2 therapy by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. A review of medical record #8 revealed the following: A. Document titled, "Home Health Care Certification and Plan of Care" (POC) dated 9/13/253 to 11/11/23, listed a diagnosis of "Dependence on supplemental oxygen". Review of a document titled "Visit Note Report dated 09/01/2021" showed the SN assessment and documentation of "O2 use PRN [as needed] at night." Review of a document titled "Client Medication Report" dated 09/13/2023 did not list O2 on the medication list. B. During an interview on 10/26/23 at 9:00 A.M., Agency staff member #1 verified 02 was not on the Client Medication Report and there was no evidence the 02 was included during the review of Patient #8 medications.

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 Clinical Record review and staff interview, it was determined the Physical Therapist (PT) did not follow the Attending Physician orders to evaluate Patients ordered in the Plan of Care in 1 (#8) of 17 (#1 - #17) Clinical Records reviewed. This deficient practice had the potential to prevent the Physician and PT from evaluating the improvement or decline of musculoskeletal function and prevented the Physician from determining the needed care which could result in decline in the Patient's functional ability. A review of clinical record #8 revealed the following: A. Review of a document titled "Home Health Certification and Plan of Care (POC)" dated 9/13/23 to 11/11/23, showed orders for Physical Therapy 1 time per week times 1 week to "evaluate to determine condition, physical therapy plans and rehabilitation potiontial." There was no evidenence the Physical Therapist completed an evaluation during the episode of care. B. During an interview on 10/26/23 at 9:00 A.M., Agency staff member #1 verified Patient #8 never received a Physical Therapist evaluation or any visits by a Physical Therapist.

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 observations during home visits, the Agency failed to provide patients with a written copy of the medication schedule and instructions in 2 ( #3,and #4) of 7 (#1 - #7) home visits performed. This failed practice had the potential to affect all patients on census in that patients and families maybe unaware of the name, dosage, frequency, purpose, and specific instructions related to ordered medications. This failed practice may result in result in medication errors, noncompliance with drug therapy, and unreported side effects which could result in adverse events and hospitalizations. 1. During a home visit with Patient #3 on 10/24/23 at 8:36 A.M. revealed the following: A. A visual inspection of Patient #3 home folder (a folder provided by the Agency containing items to be left in the home for patient instructions and education) was completed by the Surveyor and there was no evidence of a medication list found in the contents of the folder. 2. During a home visit with Patient #4 on 10/25/23 at 2:35 P.M. revealed the following: B. A visual inspection of Patient #4 home folder was completed by the Surveyor and there was no evidence of a medication list found in the contents of the folder.

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 observations during home visits, Centers for Disease Control (CDC) guidelines, and Agency staff interviews, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 2 (#5, #7) of 7 home visits observed (#1-#7). This failed practice had the potential to place the patient at risk for a wound infection and hospitalization. The deficient practice identified, if continued, potentially placed all patients with wounds and wound care at risk of adverse outcomes and hospitalization. 1. During a home visit for Patient #5 on 10/25/23 at 12:15 P.M., the Surveyor observed the Skilled Nurse (SN) Performing wound care to the left lateral foot. A. The SN sanitized hands and donned gloves. A drape was placed and all wound care and dressing materials to be used were placed on the drape. SN then proceeded to remove Patient #5 soiled dressing and discarded the soiled dressing into the household trash. B. The SN removed gloves and sanitized hands. SN proceeded to don clean gloves, picked up a cotton tipped applicator from the dressing field and began measuring patient #5 wounds. SN placed the paper package (this has a ruler for measuring on it), on the patient’s bare foot where wounds were located. The SN then proceeded to picked up the computer tablet and began taking pictures of patient #5 wounds. When SN completed photo taking, and without resanitizing hands and changing gloves, the SN proceeded to apply and secure the clean wound dressing. 2. A review of CDC guidelines shows " Standard precautions are based on the principle that all blood, body fluids, secretions, excretions, may contain transmissible infectious agents. The following are six (6) standard precautions, identified by the Center for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Committee (HICPAC), which apply during any episode of patient care: 1. Hand Hygiene; 2. Environmental Cleaning and Disinfection; 3. Injection and Medication Safety; 4. Appropriate Use of Personal Protective Equipment; 5. Minimizing Potential Exposures; and 6. Reprocessing of reusable medical equipment between each patient and when soiled. Hand Hygiene should be performed at a minimum: • Before contact with a patient; • Before performing an aseptic task (e.g., insertion of IV, preparing an injection, performing wound care); • After contact with the patient or objects in the immediate vicinity of the patient; • After contact with blood, body fluids or contaminated surfaces; • Moving from a contaminated body site to a clean body site during patient care; and • After removal of personal protective equipment (PPE)." 3 3. During a home visit for Patient #7 on 10/25/23 at 2:35 P.M., the Surveyor observed the Skilled Nurse (SN) Performing wound care to the right dorsal foot & sacral area. A, The SN measured the wounds to the right foot without sanitizing hands or donning gloves. The SN then proceeded to pick up the computer tablet to photgraph the wound to the right foot without sanitizing hands, doning golves nor cleaning the tablet. B. The Surveyor observed the SN providing wound care to the sacral area for Patient #7. The Patient had excrement on the sacral area. The SN sanitized hand and donned clean golves and began attempting to clean the excrement off the skin with clean dressing gauze and saline. The SN then went back and forth to the saline & gauze on the wound dressing field several times without changing gloves. The SN then proceded to dispose of the soiled brief and the gauze used to clean the area in the Patient's household trash without containing items in a plastic bag or other container which could cause a potential Infection Control risk. The SN continued to clean the excrement from the Patient's sacral area and proceeded to place the clean dressing to the area without sanitizing hands and doning clean gloves.