Every finding on record at Centerwell Certified Healthcare Corp.

An Emergency Preparedness survey was conducted from 6/29/2021 to 7/1/2021 at Kindred at Home. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

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 agency policy review, medical record review and interview the agency failed to follow physician's orders for 2 patients (#10 and #12) of 13 patients reviewed. The findings include: Review of the Physician/Provider Orders policy revised on 9/28/2018 revealed “...The office will notify the physician/allowed practitioner if the patient refuses service or treatment ordered...If fewer visits are provided during the week than ordered, the physician/allowed practitioner will be notified with documentation in the EMR (electronic medical record) that the physician/allowed practitioner is aware of the missed visit...” Patient #10 was admitted to the agency on 4/5/2021 with diagnoses including Essential Hypertension and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care (485) dated 4/5/2021 to 6/3/2021 revealed an order for skilled nurse to report to the physician a complaint of pain greater than 7 (scale 0-10). Medical record review of a skilled nurse visit dated 4/7/2021 revealed the patient complained of abdominal pain of 10. Further review revealed no documentation the physician was notified of the increased pain. Interview with the Administrator on 6/30/2021 at 1:00 PM confirmed the physician's plan of care was not followed and the physician was not notified of the patient's increased pain. Patient #12 was admitted to the agency on 4/20/2021 with diagnoses including Cutaneous Abscess of Left Lower Limb and Toxic Effect of Spider Venom. Medical record review of the 485 dated 4/20/2021 to 6/18/2021 revealed a physician's order for the skilled nurse to assess/evaluate...wound to left thigh spider bite..." Further review revealed a physician's order for 3 skilled nurse visits for the week of 4/20/2021 to 4/24/2021. Medical record review of the skilled nurses notes for the time frame between 4/20/2021 to 4/24/2021 revealed only 2 visits were completed and not the 3 as ordered by the physician. Further review of the nurses notes on 4/26/2021, 4/30/2021 and 5/3/2021 revealed the patient refused to allow the skilled nurse to assess the spider bite wound. Further review revealed no documentation the physician was notified of the missed skilled nurse visit or of the skilled nurse's inability to evaluate and assess the wound. Interview with the Administrator on 6/30/2021 at 1:00 PM confirmed the physician's orders were not followed and the physician was not notified.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to obtain physician orders for PT/INRs (Prothrombin Time Test - measures blood coagulation) for 1 patient (#3) of 13 patients reviewed. The findings include: Patient #3 was admitted to the agency on 9/18/2020 with diagnoses including Paroxysmal Atrial Fibrillation and Heart Disease. Medical record review of the Home Health Certification and Plan of Care dated 5/16/2021 to 7/14/2021 revealed a physician's order to obtain a PT/INR using the PT/INR meter between 5/17/2021 and 5/22/2021. No additional orders for PT/INR were ordered. Medical record review of skilled nurse's notes dated 5/25/2021; 5/30/2021; 6/3/2021; 6/10/2021; and 6/28/2021 revealed a PT/INR was collected using the PT/INR meter. Further review revealed physician orders were not obtained to collect a PT/INR on those visits. Interview with the administrator on 6/30/2021 at 12:00 PM confirmed physician orders were not obtained for the skilled nurse to obtain PT/INRs.