Every finding on record at Centerwell Certified Healthcare Corp.

A Recertification survey was conducted at Centerwell Home Health on March 3, 2025, and concluded on March 5, 2025. At the time of the survey, the agency was in compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 infection control.

A Recertification survey was conducted at Centerwell Home Health on March 3, 2025, and concluded on March 5, 2025. At the time of the survey, the agency was not in compliance with Chapter 42 CFR Part 418, Rules and Requirements for Home Health and Hospice Agencies. The census was 307. The following deficiencies were cited:

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on the Centers for Medicare & Medicaid Services (CMS) Home Health Agency (HHA) Error Summary by agency report, review of the Home Health Policy Manual, and staff interview, it was determined that the agency failed to electronically transmit monthly Outcome and Assessment Information Set (OASIS) data collected to the CMS system every 30 days. Findings include: Review of the policy within the Home Health Policy Manuel titled “OASIS Data Collection,” last revised 09/28/2018, revealed the following: OASIS data items will be collected and transmitted within 30 calendar days of the completion of the OASIS assessment. Review of CMS report titled “HHA Error Summary by Agency,” with report period of 02/01/2024 - 02/01/2024 and run date of 2/17/2025, revealed the agency failed to transmit OASIS data to CMS system within 30 days. During an in-office interview on 3/3/2025 at 1:00 p.m., the Administrator revealed that she was aware that the 30-day OASIS submission timeframe requirements were not met during the time frame of 02/01/2024 - 02/01/2024. The Administrator reported that the agency has experienced an interruption of service with the companies OASIS file transfer solution department due to an incident originating at the companies finance department.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on review of the policy titled “03-11 Care Planning, " record reviews, and staff interviews, it was determined the agency failed to ensure that the individualized plan of care includes all treatments and interventions related to the patient’s diagnoses for four patients (P) (P#2, #7 #9, and P #10) of 17 sampled patients. Findings include: Review of the policy titled “03-11 Care Planning," last revised 09/2024, reveals the following: Policy Each patient must receive an individualized written Plan of Care (POC) including ongoing updates and/or additions related to patient findings. The Plan of Care • Will be developed in collaboration with the physician/allowed practitioner and Home Health Clinical Associate following the initial /comprehensive assessment and will contain integrated orders from all physicians or allowed practitioners involved in the POC to assure coordination of all services and interventions provided to the patient. • The individualized POC is developed for the patient 60-day episode of care and must include: • Patient -specific interventions and measurable goals. 1.Review of the Plan of Care (POC) for P#9, revealed that P#9 was admitted to the Home Health agency on 1/16/25, with a diagnosis of hypertensive heart disease with heart failure (heart muscle does not pump blood well into the heart) and type 2 diabetes (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel). Further review of the POC revealed that the agency failed to address interventions on the POC to monitor fluid retention, weight, or calf measurements with a diagnosis of heart failure and failed to address interventions for diabetic complications and identifying and reporting the signs and symptoms of hypoglycemia and hyperglycemia (refers to blood sugar levels that are too low or too high respectively). 2. Review of the Plan of Care (POC) for P#10, revealed that P#10 was admitted to the Home Health agency on 1/17/25, with a diagnosis of heart failure unspecified (heart muscle does not pump blood well into the heart) and type 2 diabetes with diabetic peripheral angiopathy (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel). Further review of the POC revealed that the agency failed to address interventions on the POC to monitor fluid retention, weight, or calf measurements with a diagnosis of heart failure and failed to address interventions for diabetic complications and identifying and reporting the signs and symptoms of hypoglycemia and hyperglycemia 3. Review of the Plan of Care (POC) for P#7, revealed that P#7 was admitted to the Home Health agency on 1/27/25, with a diagnosis sarcoidosis (condition that causes tiny collections of cells in any parts of the body), morbid (severe) obesity due to excess calories (overweight), and long-term use of steroids (medicine used for sarcoidosis). Review of medication profile dated 1/27/25 revealed that patient is currently on Prednisone (corticosteroid (cortisone-like medicine or steroid); works on the immune system to help relieve swelling, redness, itching, and allergic reactions) 50 milligrams daily for Sarcoidosis and Victoza 18Mmg/3ml injection daily for weight control. Review of initial assessment visit note dated 1/27/2025, the Physical Therapist (PT) documents the following: patient has steroid -induced hyperglycemia and obesity. Further review of the POC revealed that the agency failed to address interventions to monitor weight loss /gain, or calf measurements for obesity and failed to address interventions for diabetic complications caused by steroids and identifying and reporting signs and symptoms of hypoglycemia and hyperglycemia. 4. Record review reveals P#2 was admitted on 3/14/2024 with the diagnosis of secondary malignant neoplasm of pleura (refers to cancerous tumors affecting the pleura, which is the thin membrane lining the chest cavity and lungs) and co-morbidities that include type 2 diabetes, long term use of insulin and long term (current) use of oral hypoglycemic drugs. Review of “Home Health Certification and Plan of Care,” dated 3/14/2024, reveals P#9 was prescribed Januvia, insulin, and metformin, all anti-diabetic medications. Further review of the clinical record failed to reveal interventions related to diabetes management, including blood sugar monitoring and frequency. On 3/4/25 at approximately 1:30 p.m., an interview was conducted at the agency with the Executive Director (ED) and the Branch Director (BD), who confirmed the plan of care lacked specific interventions for heart failure and diabetic management for above mentioned patients.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on review of policy titled "Service Provided," record reviews and staff interviews, it was determined that the agency failed to provide services that are ordered by the physician in the plan of care. Specifically, the agency failed to perform blood sugar for two patients (P) (P#9 and P#10) of 17 sampled patients. Findings include: Review of the policy titled “02-18 Services Provided,” Policy Number 02-18, last revised 05/2024, reveals the following: Policy • Home Health services and products are provided directly and /or under arrangement in accordance with physician/allowed practitioner written orders and applicable federal and/or state-specific laws/regulations. 1. Review of the Plan of Care (POC) for P#10 revealed that P#10 was admitted to the Home Health agency on 1/17/25, with a diagnosis of type 2 diabetes (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel) with diabetic peripheral angiopathy (common complication of chronic diabetes). POC revealed an order to report to physician for blood sugar level less than 60 and blood sugar level above 250. Review of visit note dated 2/4/25 failed to reveal blood sugar levels. Review of visit note dated 2/17/25 failed to reveal blood sugar levels. 2. Review of the Plan of Care (POC) for P#9, revealed that P#9 was admitted to the Home Health agency on 1/16/25, with a diagnosis of type 2 diabetes. Review of medication list dated 1/16/25 revealed the following: Accu-Chek Guide me Glucose Meter: Test 4 times daily. Lantus (long-acting insulin that lowers blood sugar) 100 unit/ml (3ml) once daily at bedtime for diabetes. Humalog (fast acting insulin to lower glucose) KWI PEN 100 unit/ml; inject 10 units 3 times daily after meals. POC revealed an order to report to physician for blood sugar level less than 80 and blood sugar level above 300. Review of initial assessment visit note dated 1/16/25 failed to reveal blood sugar levels. Review of visit note dated 1/30/25 failed to reveal blood sugar levels. The agency failed to follow POC by performing, and documenting blood sugar as ordered by physician for P#9 and P#10. On 3/4/2025 at 2:32 p.m., an interview was conducted at the agency with Executive Director (ED) and Branch Director (BD) who confirmed that the agency failed to perform and document blood sugar as ordered by physician for P#9 and P#10.

A routine survey was conducted at Kindred At Home Home Health in Atlanta, GA on 3/10/22. At the time of the on-site survey, the agency was in compliance with 42 CFR Part 484.22, Emergency preparedness for Home Health Agencies. A Focused Covid 19 Infection Control Survey was also conducted at the time of the on-site visit. The agency census was 419 at the time of the on-site visit. No deficiencies were cited.

A routine survey was conducted at Kindred At Home Home Health in Atlanta, GA on 3/10/22. The on-site survey revealed that the agency was in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies. The census was 419 at the time of the on-site visit. The following deficiencies were cited:

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 home visit observation, clinical record review and staff interview, it was determined that the agency failed to ensure that patient medication profiles were updated to reflect current medications at the time of the comprehensive assessment for three of seven patients (P) during home visits conducted by the surveyor (P#2, P#3 and P#7). The findings include: 1. A home visit was conducted at 9:20 a.m. on 3/9/22, at the residence of Patient #2 with Registered Nurse (RN) #FF. P#2 was admitted to the home health agency on 12/29/21, with the diagnosis of encounter for change or removal of surgical wound dressing. The clinical record was reviewed for certification period 2/27/22 to 4/27/22. During the home visit, the surveyor compared P#2's current medication list in the agency's electronic medical record (EMR) to the medications present in P#2's home. P#2 had the following medication listed in the EMR but P#2 was no longer taking them. P#2 stated it had “been a while” since the medications had been a regular part of the medication regimen, but could not state a specific discontinuation date:a. Succinate ER, a mediation used to treat hypertension. While reviewing medications in the home with RN #FF, RN #FF verbalized understanding of the requirement to reconcile all medications in the home with medications listed in the agency EMR during every comprehensive visit. 2. A home visit was conducted at 1:00 p.m. on 3/9/22, at the residence of Patient #7 with RN #EE. P#7 was admitted to the home health agency on 1/1/22, with the diagnosis of unspecified sepsis. The clinical record was reviewed for certification period 3/2/22 to 4/30/22. During the home visit, the surveyor compared P#7’s current medication list in the agency’s EMR to the medications present in P#7’s home. P#7 had the following medications present in the home but not listed in the agency’s EMR:a. Lorazepam, a medication used to treat anxiety. b. Pregabalin, a medication used to treat neuropathic pain. c. Tramadol, a medication used to treat pain. d. Aspirin, a medication used to thin blood. e. Multivitamin, a nutritional supplement. While reviewing medications in the home with RN #EE, RN #EE verbalized understanding of the requirement to reconcile all medications in the home with medications listed in the agency ERM during every comprehensive visit. During an interview at the agency at 11:00 a.m. on 3/10/22, the Administrator was made aware that the medication profile was not updated to reflect current medications at the time of the comprehensive assessment for three of seven patients (P) during home visits conducted by the surveyor (P#2, P#3 and P#7). 3. A home visit was conducted at 1:30 p.m. on 3/8/22, at the residence of Patient #3 with Physical Therapist (PT) #BB. P#3 was admitted to the home health agency on 2/7/22, with the diagnosis of Bilateral primary Osteoarthritis of knee. The clinical record was reviewed for certification period 2/7/22 to 4/7/22. During the home visit, the surveyor compared P#3's current medication list in the agency’s Electronic medical record (EMR) to the medications present in P#3's home. P#3 had the following medication listed in the home but not in the EMR: KLOR-CON M20 tab x1 tab twice daily, 12-16-21, a dietary supplementWarfarin sodium 5 mg tab x1 tab daily, 2-4-22, a medication used to thin bloodTriple Magnesium Complex 400 mg x1 tab twice a day, a dietary supplementAlbuterol, a medication used to treat shortness of breathAdvair Diskus, a medication used to treat shortness of breathStool softener 100 mg x1 tab daily, a medication used to soften stoolTriamcinolone acetonide cream USP 0.1% (454) grams, apply to affected area twice a day, 12-16-2, used to treat skin irritation The following medication was listed incorrectly in the EMR: Aspirin, a medication used to thin blood, was discontinued based on P#3 caregiver interview but still listed in the agency’s EMR.Diclofenac 3% gel, a medication used to treat pain, was listed as 3% in the EMR but the home medication was 1%.Gabapentin, a medication used to treat neuropathic pain was listed in the EMR as taken once daily but the home medication instructed P#3 to take twice daily.Metoprolol Succinate, a medication used to treat hypertension was listed in the EMR as 12.5 mg (milligram) but the home medication instructed P#3 to take 25 mg.Torsemide, a medication used for fluid retention was listed in the EMR as 100 mg but the home medication instructed P#3 to take 50 mg. While reviewing medications in the home with PT#BB, PT#BB verbalized understanding of the requirement to reconcile all medications in the home with medications listed in the agency EMR during every comprehensive visit.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record review, observation and staff interview it was determined that the agency failed to ensure the plan of care contained all the treatments necessary to provide care to five of 17 sampled patients (P) (P#2, P#7, P#8, P#9 and P#10). Findings include: 1. Patient #2 was admitted to the home health agency on 12/29/21, with the diagnosis of encounter for change or removal of surgical wound dressing. P#2 also had the diagnoses of type 2 diabetes with foot ulcer, type 2 diabetes with diabetic peripheral angiopathy without gangrene, type 2 diabetes with diabetic chronic kidney disease and long-term use of oral hypoglycemic drugs. The clinical record was reviewed for the certification period 12/27/21 to 4/27/22. The clinical record revealed that P#2 was taking metformin, a medication to treat hyperglycemia. However, the clinical record did not contain physician’s orders for frequency of monitoring of hyperglycemia/hypoglycemia via monitoring finger stick blood sugar testing. 2. Patient #7 was admitted to the home health agency on 1/1/22, with the diagnosis of sepsis. Pt#7 also had the diagnoses of type acute systolic heart failure, hypertensive heart disease and non-ST elevation myocardial infarction. The clinical record was reviewed for the certification period 3/2/22 to 4/30/22. The clinical record revealed that P#7 had a physician’s order dated 3/2/22 stating “Skilled nurse to teach heart failure management such as definition, risk factors, and symptom monitoring. SN (skilled nurse) to report weight gain of 5lbs (pounds) in a week.”. However, the plan of care did not contain a physician’s order for frequency of weights to be obtained by the patient or the skilled nurse. Additionally, the clinical record contained the following physician’s order dated 2/11/22; “Oxygen per MD directions”. The physician’s order lacked a route for the oxygen to be administered to P#7 as well as flow rate needed to meet P#7’s needs. 3. Patient #8 was admitted to the home health agency on 1/28/22 with the diagnosis of emphysema. P#8 also had the diagnoses of unspecified heart failure and unspecified pulmonary hypertension. The clinical record was reviewed for certification period 1/28/22 to 3/28/22. P#8 had a physician’s order dated 1/28/22 stating “Skilled nurse to teach related to altered cardiovascular status including disease process, nutrition, medications, activities, personal/ environmental factors, and to report weight gain of 2-3 lbs (pounds)/day or 5lbs/ wk (week).” However, the plan of care did not contain a physician’s order for frequency of weights to be obtained by the patient or skilled nurse. The clinical record for P#8 also contained the following order dated 2/11/22: “Skilled nurse to perform wound care to right leg. Cleanse with saline. Pat dry. Apply skin protectant to periwound. Cover with hydrocolloid dressing”. The physician’s order lacked a frequency for the wound care to be provided to P#8 and lacked designation of who was responsible for the wound care. 4.Patient #9 was admitted to the home health agency on 9/8/2, with the diagnosis of encounter for change or removal of non-surgical wound dressing. P#9 also had the diagnosis of type 2 diabetes. The clinical record was reviewed for the certification period 2/19/22 to 4/19/22. The clinical record revealed that P#9 was taking Lispro insulin, a medication used to treat hyperglycemia. However, the clinical record did not contain physician’s orders for monitoring for frequency of monitoring of hyperglycemia/ hypoglycemia via monitoring finger stick blood sugar testing. The clinical record for P#9 also contained the following order dated 2/17/22: “SN (skilled nurse) to perform wound care via clean technique to skin surrounding colostomy stoma. Remove old and discard dressing. Cleanse surrounding skin, then prep under wafer, allow to air dry. Apply hydrofera blue then to wound bed. Then apply barrier seal with only 1/4” from stoma apply one piece ileostomy bag. Hold hand over bag 3-5 minutes. Secure with ostomy belt. Wound care to be done twice weekly by SN. Skilled nurse to observe/ assess.” The physician’s order lacked specification of product to clean the skin surrounding the colostomy stoma. 5. Patient #10 was admitted to the home health agency on 3/2/22 with the diagnosis of unspecified combined systolic and diastolic congestive heart failure. P#10 also had the diagnosis of unspecified atrial fibrillation. The clinical record was reviewed for the certification period 3/2/22 to 4/30/22. The clinical record revealed that P#10 had a physician’s order dated 3/2/22 stating “Skilled nurse to teach hypertension management such as definition, risk factors, and symptom monitoring. Weight parameters upper limit 182 pounds, lower limit 177 pounds” However, the plan of care did not contain a physician’s order for frequency of weight to be obtained by the patient or the skilled nurse. During interview at the agency at 11:00 a.m. on 3/10/22, the agency Administrator was made aware that agency failed to ensure the plan of care contained all the treatments necessary to provide care to five of 17 sampled patients (P) (P#2, P#7, P#8, P#9 and P#10).

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 observation and staff interview it was determined, the agency failed to follow basic home health standards of infection control in two of seven patients (P) home visits observed during the survey (P#5 and P#6). The findings include: A home visit was conducted at 9:00 a.m. on 3/9/22, at the residence of P#5 with Certified Occupational Therapist Assistant (COTA) #CC. P#5 was admitted to the home health agency on 11/22/21, with diagnosis of age-related osteoporosis with current pathological fracture to the right femur. The clinical record was reviewed for certification period 1/21/22 to 3/21/22. During the home visit, COTA #CC was noted to don gloves and sanitized the same gloves multiple times during the visit. COTA#CC was also noted to place gait belt used on P#5 back in the home health bag clean compartment without prior cleaning. During the home visit, COTA#CC verbalized understanding that the observed bag technique and hand sanitizing technique did not meet standard infection control techniques for home health. 2. A home visit was conducted at 10:23 a.m. on 3/9/22, at the residence of P#6 with Physical Therapist (PT) #DD. P#6 was admitted to the home health agency on 2/10/22, with diagnosis of Fractured right shoulder girdle, part unspecified subsequent for fracture with routine heal. The clinical record was reviewed for certification period 2/10/22 to 4/10/22. During the home visit, PT# DD was noted to don gloves and sanitized the same gloves multiple times during the visit. PT#DD was also noted to place gait belt used on P#6 back in the home health bag clean compartment without prior cleaning. During the home visit, PT#DD verbalized understanding that the observed bag technique and hand sanitizing technique did not meet standard infection control techniques for home health. During an interview at the agency at 11:00 a.m. on 3/10/22, the Administrator was made aware that agency staff failed to follow basic standards of infection control in two of seven (P) home visits observed during the survey (P#5 and P#6).