Every finding on record at Centerwell Certified Healthcare Corp.

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the State of Nevada Department of Health and Human Services. An unannounced on-site Recertification Survey at the above-named Home Health Agency (HHA) from 06/06/22 to 06/09/22 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.22.

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the State of Nevada Department of Health and Human Services. An unannounced on-site Recertification Survey conducted at the above-named Home Health Agency (HHA) from 06/06/22 to 06/09/22 resulted in a finding of substantial compliance respective to the applicable Condition of Participation (CoP) under 42 CFR 484, Subparts A through C with the following standard-level deficiencies listed below.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review, staff interview, and review of the agency's policies and procedures, the agency failed to ensure services were provided as ordered by the provider for one of 17 patient records reviewed (Patient (P)15). Failure to provide ordered services could lead to negative outcomes for all 776 patients currently receiving care by this agency. Findings include: Review of P15’s electronic medical record (EMR) revealed a SOC date of 04/22/22 with a diagnosis of fractured pelvis. Review of the initial Plan of Care (POC), in the “Orders” section of the EMR, revealed a provider order for “Occupational Therapist to evaluate for OT [Occupational Therapy] services and develop plan of care for physician signature to include physical and psychosocial test results, establishment of a plan of treatment, rehabilitation goals, and evaluating the home environment for accessibility and safety and recommending modification.” Review of "Visits” in the EMR for the certification period of 04/22/22 through 06/20/22 revealed no OT evaluation was completed to date for P15 during the certification period. During an interview with the Quality Assurance Manager (QA) 06/09/22 at 2:45 PM, the EMR for P15 was reviewed. The QA confirmed the OT evaluation had not been completed for P15 and agreed the agency had not followed the provider’s plan of care. The most current policy for Plan of Care was requested at this time. Review of the agency policy titled, “Care Planning,” last revised 01/22, revealed, “Skilled professionals – Registered Nurse (RN), Physical Therapist (PT), Speech-Language Pathologist (SLP), Occupational Therapist (OT), Medical Social Worker (MSW) – must assume responsibility for but not be restricted to…Providing services ordered by the physician or allowed practitioner as indicated in the POC.”

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, staff interview, and review of agency policies and procedures, the agency failed to ensure the Skilled Nurse (SN) performed patient care, including wound care, with appropriate hand hygiene (washing hands with soap and water or alcohol-based hand rub/ABHR) after glove removal, failed to use clean gloves for wound care, and failed to disinfect equipment after use on a patient for two of seven observations of patient care (Patient (P) 7 and P10). Failure to maintain infection prevention techniques during patient care could lead to infections for all patients receiving services from this agency. Findings include: During a home visit to P7 on 06/07/22 from 9:30 AM to 10:00 AM, Registered Nurse (RN)1 was observed obtaining vital signs and conducting an assessment of P7’s right leg and foot using gloved hands and employing palpation (touching) of the leg and foot to assess circulation. Using the same gloves, RN1 then cleaned the equipment used to obtain vital signs, placed those items in his/her bag, removed the gloves and, without performing hand hygiene, used a tablet to electronically document the visit notes. During an interview with RN1 on 06/07/22 at 10:00 AM, the above observation was reviewed. RN1 agreed he/she should have changed gloves after having hands on P7’s skin and agreed he/she should have performed hand hygiene after glove removal. During a home visit to P10 on 06/08/22 from 11:50 AM to 12:40 PM, RN2 was observed performing wound care on P10’s left leg. After removing the old wrap and dressing from the wound, RN2 used the same gloves to cleanse the wound with sterile gauze pads and cleansing solution and apply lotion to P10’s leg. RN2 then removed his/her gloves and, without performing hand hygiene, donned new gloves and proceeded with the rest of the wound care, which included applying a new, sterile, dressing to the wound. After completing the wound care, RN2 disposed of the trash, removed his/her gloves, performed hand hygiene, then wiped the equipment used to obtain vital signs with a disinfectant wipe, but failed to wipe the stethoscope hanging on his/her neck. RN2 then left P10’s home. During an interview with RN2 on 06/08/22 at 12:40 PM, the above observations were reviewed. RN2 agreed he/she had failed to perform hand hygiene following glove removal and agreed he/she should have changed gloves after removal of the old dressing and prior to opening clean supplies. When asked about his/her failure to disinfect the stethoscope, RN2 stated, “I planned to wipe the stethoscope later.” During an interview with Branch Manager of Carson City (BMCC) on 06/08/22 at 2:40 PM, the above observations were reviewed. The BMCC agreed that all of the observations noted above were missed opportunities for appropriate hand hygiene and infection control practices expected by the agency. The BMCC agreed RN2 should have disinfected his/her stethoscope prior to leaving P10’s home. The most recent policy and procedure related to infection control procedures was requested. The BMCC also stated the agency relies on guidance from “Lippincott Procedures,” manual for educating and training nursing staff, and this was also requested by the surveyor. Review of the agency policy titled, “Engineering and Work Practice Controls,” last revised 04/22, revealed, “Hands will be washed with soap or approved sanitizer when donning/doffing gloves and prior to direct contact with patients or procedures. Hands and other skin surfaces will be washed immediately and thoroughly if contaminated with blood or other body fluids.” Review of “Lippincott Procedures – Hand Hygiene, Home Care,” last reviewed 08/20/21, revealed, “Using an alcohol-based hand rub is appropriate for decontaminating the hands before direct patient contact; before putting on gloves…after contact with a patient; when moving from a contaminated body site to a clean body site during patient care; after contact with body fluids, excretions, mucous membranes, nonintact skin, or wound dressings (if hands aren’t visibly soiled); after removing gloves; and after contact with inanimate objects in the patient’s environment.”