Every finding on record at Centerwell Certified Healthcare Corp

A Medicare Emergency Preparedness survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 2/11/25 through 2/14/25 at: CenterWell Home Health 5406 Gateway Centre Drive suite B Flint, MI 48507 The agency had no other locations at the time of survey. For this survey 5 home visits with record reviews, 4 active records without a home visit, and 4 discharged records were reviewed. At the conclusion of the survey the agency was found to be in compliance with the conditions of participation at: 42 CFR Part 484.22, Emergency Preparedness.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 2/11/25 through 2/14/25 at: CenterWell Home Health 5406 Gateway Centre Drive suite B Flint, MI 48507 The agency had no other locations at the time of survey. For this survey 5 home visits with record reviews, 4 active records without a home visit and 4 discharged records were reviewed. At the conclusion of the survey the agency was found to be out of compliance with the conditions of participation for home health agencies at: 42 CFR Part 484.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to inform patients and caregivers of the correct state toll free home health hot line phone number, resulting in a lack of information to voice concerns or questions regarding CenterWell Home Health. Findings include: On 2/13/25, the agency's booklet titled, "My home health resources booklet" was reviewed. Page 4 of the booklet states to report a complaint about CenterWell Home Health to call the State Home Health Hotline Number 800-979-4662. This is not the home health hotline number for the State of Michigan. The correct hotline phone number for Michigan is 1-800-882-6006. The finding was reviewed with and acknowledged by the Administrator (Adm) on 2/13/25 at 8:45 a.m. at the time of discovery.

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 record review and interview, the Plan of Care failed to include objectively measurable goals to determine the patient's progress towards attaining the goals in 4 of 13 (P-1, P-2, P-3, P-4, P-5, P-6, P-7, P-8) medical records reviewed, resulting in the inability to determine the patient's progress towards obtaining the goals. Findings included: P-5: The Start of Care (SOC) was dated 12/19/2024. The Plan of Care (POC) for the certification period 12/29/2024 to 2/16/2025 identified diagnoses of Open Wound of Right Forearm, Hypertension, Myocardial Infarction, Urinary Incontinence, Obesity, Right Artificial Knee and Hip Joint. This patient was receiving Skilled Nursing (SN) services 1xweekx1 week, 2xweekx3 weeks,1xweekx2 weeks, and 1 visit every 2xweekx2.During a review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "A Plan of Care will be established that meets the patient's nursing needs and countersigned by Physician; Changes in skin integrity will be identified promptly and interventions initiated to minimize risks, Changes in Pain status/management are identified promptly and reported to physician." These goals are not objectively measurable to determine the patient's progress towards achieving the goals. P-6: The Start of Care was dated 3/1/2024. The Plan of Care for the certification period 3/1/2024 to 4/29/2024 identified diagnoses of Urinary Tract Infection, Hypertensive Heart Disease with Heart Failure, Paroxysmal Atrial Fibrillation, Anemia, Rheumatoid Arthritis, Spinal Stenosis, Osteoporosis w/o fracture, Systemic Lupus erythematosus, Hydronephrosis, Hyperlipidemia, Dependence on Wheelchair. This patient was receiving (Skilled Nursing (SN) services 1xweekx1 and 2xweekx1; Physical Therapy (PT) services 1xweekx1; and Occupational Therapy (OT) services 1xweekx1week. Upon review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "A Plan of Care will be established that meets the patient's nursing needs and countersigned by physician; Genitourinary Exacerbations are identified promptly and interventions initiated to minimize risks; Patient adheres to medication regimen; PRN visits will be performed timely as indicated." These goals are not objectively measurable to determine the patient's progress towards achieving the goals. P-7: The Start of Care was dated 4/8/2024. The Plan of Care for the certification period 4/8/2024 to 6/6/2024 identified diagnoses of Cutaneous Abscess of Left Axilla, Hypertension, Depression, Anxiety Disorder, Stimulant use, and Alcohol Use. This patient was receiving Skilled Nursing (SN) services 3xweekx2weeks and 2xweekx2weeks. Upon review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals, nor were they specific to the patient's identified needs. Examples included: "A Plan of Care will be established that meets the patient's nursing needs and countersigned by physician"; "PRN visits will be performed timely as indicated"; Cardiovascular Exacerbations are identified promptly and interventions initiated to minimize risks. These goals are not objectively measurable nor are they specific to the patient's identified needs. P-8: The Start of Care was dated 8/8/2024. The Plan of Care for the certification period 8/8/2024 to 10/6/2024 identified diagnoses of "Age-related Osteoporosis of the Left and Right Humorous and Forearm; Hypertensive Chronic Kidney Disease stage 3; Chronic Obstructive Pulmonary Disease (COPD); Hypothyroidism; Abdominal Aortic Aneurysm without Rupture; and Osteoarthritis. The patient was receiving Skilled Nursing services 1xweekx4 weeks; Physical Therapy Services 1xweekx5 weeks; Occupational Therapy services 1xweekx4 weeks; and Home Health Aide services 1xweekx1week and 2xweekx2weeks. Upon review of the record, it was noted the goals on the Plan of Care were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "Cardiovascular exacerbations are identified promptly and interventions initiated to minimize risks; Changes in skin integrity will be identified promptly and interventions initiated to minimize risks; PRN visits will be performed timely as indicated; Patient will receive assistance with personal care and hygiene and other activities of daily living as needed". These goals are not objectively measurable to determine the patient's progress towards achieving the goals. These findings were reviewed with and acknowledged by the Administrator (ADM) on 2/14/2025 at 1:45 p.m. P-1: The Start of Care (SOC) was dated 11/7/2024. The Plan of Care (POC) for the certification period 1/6/2024 to 3/6/2025 identified diagnoses of chronic kidney disease (CKD), congestive heart failure (CHF), and Hypertension. This patient was receiving Skilled Nursing (SN), Physical Therapy (PT), and Occupational Therapy (OT) services. During a review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "Patient/caregiver verbalizes/demonstrates heart failure management as evidenced by improved cardiovascular status and no unplanned hospitalizations by 3/6/2025; Changes in skin integrity will be identified promptly and interventions initiated to minimize risks." These goals are not objectively measurable to determine the patient's progress towards achieving the goals. P-2: The SOC was dated 1/14/2025. The POC for the certification period 1/14/2025 to 3/14/2025 identified diagnoses of venous insufficiency, diabetes mellitus, and Hypertension. This patient was receiving SN, PT, OT, and home health aide (HHA) services. During a review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "A Plan of Care will be established that meets the patient's nursing needs and countersigned by physician; Patient/caregiver verbalizes/demonstrates hypertension management as evidenced by improved blood pressure readings and no unplanned hospitalizations by 3/14/2025." These goals are not objectively measurable to determine the patient's progress towards achieving the goals. P-3: The SOC was dated 1/22/2025. The POC for the certification period 1/22/2025 to 3/22/2025 identified diagnoses of rib fractures, diabetes mellitus, and atrial fibrillation. This patient was receiving SN, PT, OT, and home HHA services. During a review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "Patient/caregiver verbalizes/demonstrates atrial fibrillation management as evidenced by improved heart rhythm/rate and no unplanned hospitalizations by 3/22/2025; Patient/caregiver verbalizes/demonstrates hypertension management as evidenced by improved blood pressure readings and no unplanned hospitalizations by 3/22/2025." These goals are not objectively measurable to determine the patient's progress towards achieving the goals. P-4: The SOC was dated 1/23/2025. The POC for the certification period 1/23/2025 to 3/23/2025 identified diagnoses of rib fractures, diabetes mellitus, and atrial fibrillation. This patient was receiving SN, PT, OT, and home HHA services. During a review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards attaining the goals. Examples included: "Patient/caregiver verbalizes/demonstrates depression management including but not limited to medication adherence as evidenced by decreased symptoms and improvement of mood by 3/23/2025; Patient/caregiver verbalizes/demonstrates hypertension management as evidenced by improved blood pressure readings and no unplanned hospitalizations by 3/23/2025." These goals are not objectively measurable to determine the patient's progress towards achieving the goals. During an interview on 2/4/2025 at 10:30 a.m., the administrator (Adm) and the clinical manager (CM) acknowledged the above findings.

On 2/14/22 through 2/16/22, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Kindred At Home. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 2/14/22 through 2/16/22 at: Kindred At Home 4458 Oakbridge Drive, Suite B Flint, MI 48532 This agency has no branch sites. Records reviewed: 5 records with home visits; 8 records without home visits; for a total of 13 records reviewed. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the Conditions of Participation for Home Health Agencies at: 42 CFR Part 484.

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 document review and interview, the Agency failed to ensure a registered nurse conducted a timely and comprehensive review of the patient's medications for any potential adverse effects such as: side effects, drug interactions, and duplicate drug therapy for 4 of 13 (MR# 1, 4, 11, 13) records reviewed. This deficient practice results in the potential for unrecognized adverse effects due to medications that could negatively affect these four patients. Findings include: MR#11: This patient had a start of care (SOC) date of 12/13/21 with diagnoses which included chronic obstructive pulmonary disease, pneumonia, and congestive heart failure. On 2/15/2021, review of the initial comprehensive assessment conducted by skilled nursing (SN), noted the following documentation under section M2001 (medication review) on 12/13/2021: "No issues found during review." Further review of the "Client Medication Report" noted the first entry for medication review occurred on 2/9/2022. In addition, no severe drug interactions or duplicative therapies were noted within the drug review documentation. However, when the patient's 23 medications (dated 12/13/2021) were entered "Drugs.com" (online drug interaction checker) the following was revealed: 21 major and 6 duplicative drug therapies. There was no documented evidence that the Agency notified the physician concerning the above findings as stipulated by Agency policy referenced below. These findings were reviewed with the Administrator (Adm #1) and Clinical Manager (CM#1) during an interview on 2/16/22 at 10:54 a.m. Adm #1 acknowledged the findings and confirmed the software utilized by the Agency (First Databank) had not identified the major drug interactions or duplicative drug therapies and the documented date for the medication review was not timely. MR#13: The SOC date for this patient was 12/23/21 with diagnoses which included hypertensive heart disease with heart failure, diabetes-type 2, and dementia. On 2/15/2021, review of the initial comprehensive assessment conducted by SN, noted the following documentation under section M2001 on 12/13/2021: "No issues found during review." Further, no severe drug interactions or duplicative therapies were noted within the drug review documentation. However, when the patient's 12 medications (dated 12/23/2021) were entered "Drugs.com" the following was revealed: 3 major and 2 duplicative drug therapies. There was no documented evidence that the Agency notified the physician concerning the above findings. These findings were reviewed with the Adm #1 and CM#1 during an interview on 2/16/22 at 11:17 a.m. Adm #1 acknowledged the findings and confirmed the software utilized by the Agency had not identified the major drug interactions or duplicative drug therapies. Policy: "Review of Patient Medications" 03-05 (updated 06/2021) stated, "All medications will be evaluated for adverse events, duplication of medication therapy, contraindications, and other medication effects... with reports to the PCP (primary care provider) as appropriate." MR#1: This 91-year-old patient was admitted to home care on 12/04/21 with diagnoses of polyosteoarthritis, chronic kidney disease, and insulin dependent diabetes mellites. The comprehensive assessment was conducted by the physical therapist. Record review on 2/14/22, indicates the patient's medical record contains a "Client Medication Report" that lists the patient's medications and a medication review acknowledgement statement signed by the physical therapist on 12/5/21. There was no documented evidence that the patient's medications had been reviewed by a registered nurse (RN). During an interview on 2/14/22 at 1:20 p.m., the Administrator looked over the findings and confirmed that the medications were not reviewed by an RN. MR#4: This 87-year-old patient was admitted to home care on 1/7/22 with diagnoses of a recent left femur fracture and left hip joint replacement. The comprehensive assessment was conducted by the physical therapist on 1/7/22. The registered nurse/clinical manager (CM#1) documented a review of the medications on 1/18/22, which is 11 days after the start of care. Record review on 2/15/22 indicates the patient's medications include Torsemide and Furosemide which are both classified as loop diuretics to treat fluid retention. There was no documentation to indicate CM#1 recognized the duplicate drug therapy and informed the physician. The findings were reviewed with the Administrator and CM#1 during an interview on 2/16/22 at 12:05 p.m. The Administrator acknowledged the findings and confirmed the software utilized by the agency had not identified the duplicate drug therapy.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the aide care plan included pertinent patient safety measures to alert the aide to known safety issues for 6 of 8 (MR# 1, 2, 6, 10, 11, 12) records reviewed with aide services, from a total sample of 13 records reviewed, resulting in the potential for unmet safety needs for these patients. Findings include: MR#1: This 91-year-old patient was admitted to home care on 12/04/21 with diagnoses of polyosteoarthritis, chronic kidney disease, and insulin dependent diabetes mellites. The 12/04/21 plan of care included anticoagulant (bleeding) and diabetic safety measures for this patient. The aide was ordered to provide twice weekly visits to assist the patient with bathing and other personal hygiene tasks. The aide care plan developed by the registered nurse failed to include anticoagulant and diabetic safety measures for this patient. MR#2: This 67-year-old patient was admitted to home care on 10/10/21 with diagnoses of pancreatic cancer with development of secondary cancer to the liver and lungs. The 10/10/21 plan of care included diabetic and fall safety measures for this patient. The aide was ordered to provide weekly visits to assist the patient with bathing and other personal hygiene tasks. The aide care plan developed by the registered nurse failed to include diabetic and fall safety measures for this patient. MR#6: This 88-year-old patient was admitted to home care on 1/24/22with diagnoses of congestive heart failure, atrial fibrillation, and recent Covid-19 pneumonia. The 1/24/22 plan of care included anticoagulant safety measures for this patient. The aide was ordered to provide weekly visits to assist the patient with bathing and other personal hygiene tasks. The aide care plan developed by the registered nurse failed to include anticoagulant safety measures for this patient. The above findings were reviewed with and acknowledged by the Administrator and the Clinical Manager (CM#1) during an interview on 2/16/22 at 12:05 p.m. MR#10: This patient had a start of care (SOC) date of 12/7/21, with diagnoses which included left arm fracture, hypertension, and sciatica (radiating back pain). The 12/7/21 plan of care/485 included anticoagulant and Covid-19 precautions for this patient. The aide was ordered to provide twice weekly visits times three weeks to assist the patient with bathing and other personal hygiene tasks. The aide care plan developed for this patient by the registered nurse failed to include anticoagulant and Covid-19 precautions. MR#11: The SOC date for this patient was 12/13/21 with diagnoses which included chronic obstructive pulmonary disease, pneumonia, and congestive heart failure. The 12/13/21 plan of care/485 included anticoagulant and Covid-19 precautions for this patient. The aide was ordered to provide weekly visits times five weeks to assist the patient with bathing and other personal hygiene tasks. The aide care plan developed by the registered nurse failed to include anticoagulant and Covid-19 precautions for this patient. MR#12: This patient was admitted on 11/3/21 with diagnoses which included dislocated left shoulder, heart failure, and diabetes-type 2. The 11/3/21 plan of care/485 included diabetic and Covid-19 precautions for this patient. The aide was ordered to provide twice weekly visits times three weeks to assist the patient with bathing and other personal hygiene tasks. The aide care plan developed by the registered nurse for this patient failed to include diabetic and Covid-19 precautions. The above findings were reviewed with and acknowledged by the Administrator and Clinical Manager during an interview on 2/16/22 at 11:04 a.m.