Every finding on record at Centerwell Certified Healthcare Corp.

An emergency preparedness survey was conducted at Kindred at Home from 3/29/21 to 3/30/21 as part of a recertification survey conducted during the same survey period. The agency was found to be in compliance with the Emergency Preparedness Conditions of Participation.

A recertification survey was conducted at Kindred at Home from 3/29/21 to 3/30/21. The agency provides skilled nursing, social work, physical therapy and occupational therapy services to Greenbrier, Nicholas and Webster counties. The agency had four hundred (400) unduplicated admissions for the past twelve (12) months. Eleven (11) clinical records were reviewed. Four (4) home visits were made. Five (5) standard level deficiencies were cited at G 436, G 610, G 714, G 966 and G 968.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, observation and staff interview it was determined the facility failed to provide all services outlined in the plan of care for two (2) out of four (4) patients (Patients #9 and 10). This failure creates the potential for harm or injury to all patients. Findings include: 1. Review of the clinical record for Patient #9 revealed a start of care (SOC) of 2/9/21 with a diagnosis of Infection, Cardiovascular Device. The record revealed physician orders for "Furosemide (generic Lasix) 80 mg {milligrams} two (2) times daily orally." Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/reconcile medications, instruct/reinforce medication management." The record also revealed in part, "Advance Directives: None." 2. A home visit was conducted with Patient #9 on 3/30/21 at 10:35 a.m. by the Licensed Practical Nurse (LPN). The patient told the LPN that he had been taking Lasix 20 mg daily but on the date of the visit he took two (2) Lasix 20 mg tabs (total 40 mg). She did not address this issue until the State surveyor began questioning the patient about the change in Lasix dosage (at 10:50 a.m.) The patient and his wife stated he adjusts the Lasix himself because his physician told him he could. When asked how long he had been taking Lasix at the 20 mg daily dosage, he responded, "Quite a while now." The nurse did not educate the patient and his wife about the intended effects, side effects, and precautions for Lasix. Further, she did not counsel the patient and his wife against adjusting the dosage further until she could consult with the physician and did not conduct a medication reconciliation. Additionally, the State surveyor observed there was no information posted on the patient's refrigerator indicating his resuscitation status. 3. An interview was conducted on 3/30/21 at 10:00 a.m. with the LPN prior to her home visit with Patient #9. She stated she did not know the patient's resuscitation status. When questioned what she would do if the patient coded, she stated she would check his refrigerator for his resuscitation status. 4. Review of the clinical record for Patient #10 revealed a SOC of 11/5/20 with a diagnosis of Diabetes Type 2 with diabetic peripheral angiopathy. Review of the record revealed in part: "Advance Directives: Living Will, Med. Pwr of Atty {medical power of attorney}." Review of the record revealed it did not include information from the living will. The Executive Director searched the record and did not find the information. Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/medications, instruct/reinforce medication management." 5. A home visit was conducted with Patient #10 on 3/30/21 at 12:10 p.m. by the Registered Nurse (RN). She did not conduct a medication reconciliation. Additionally, there was no information posted on the patient's refrigerator indicating her resuscitation status. 6. An interview was conducted on 3/30/21 at 12:10 p.m. with the RN prior to her home visit with Patient #10. She stated she did not know the patient's resuscitation status. When questioned what she would do if the patient coded, she stated she would check the patient's refrigerator for her resuscitation status. She stated if there was no information on the refrigerator, she would do Cardiopulmonary Resuscitation (CPR). She then stated, "It would be terrible to do CPR if they wanted to be DNR {Do Not Resuscitate}." She stated she could look in her tablet for the resuscitation status. She acknowledged the time taken to access the information would take valuable time away from starting CPR. 7. On 3/30/21 at 3:05 p.m. the Executive Director stated it is her expectation medication reconciliation is to be conducted during every home visit by every clinician providing care. The Executive Director also stated it is her expectation the Plan of Care is to be reviewed by every clinician prior to every home visit.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on record review, observation and staff interview it was determined the facility failed to provide medication reconciliation with education for two (2) out of four (4) patients (Patients #9 and 10). This failure creates the potential for harm to all patients. Findings include: 1. Review of the clinical record for Patient #9 revealed a start of care (SOC) of 2/9/21 with a diagnosis of Infection, Cardiovascular Device. The record revealed physician orders for "Furosemide (generic Lasix) 80 mg two (2) times daily orally." Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/reconcile medications, instruct/reinforce medication management." 2. A home visit was conducted with Patient #9 on 3/30/21 at 10:35 a.m. by the Licensed Practical Nurse (LPN). The patient told the LPN that he had been taking Lasix 20 mg daily but on the date of the visit he took two (2) Lasix 20 mg tabs (total 40 mg). She did not address this issue until the State surveyor began questioning the patient about the change in Lasix dosage (at 10:50 a.m.) The patient and his wife stated he adjusts the Lasix himself because his physician told him he could. When asked how long he had been taking Lasix at the 20 mg daily dosage, he responded, "Quite a while now." The nurse did not educate the patient and his wife about the intended effects, side effects, and precautions for Lasix. Further, she did not counsel the patient and his wife against adjusting the dosage further until she could consult with the physician and did not conduct a medication reconciliation. 3. Review of the clinical record for Patient #10 revealed a SOC of 11/5/20 with a diagnosis of Diabetes Type 2 with diabetic peripheral angiopathy. Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/medications, instruct/reinforce medication management." 4. A home visit was conducted with Patient #10 on 3/30/21 at 12:10 p.m. by the Registered Nurse. She did not conduct a medication reconciliation nor provide medication education. 5. On 3/30/21 at 3:05 p.m. the Executive Director stated it is her expectation medication reconciliation is to be conducted during every home visit by every clinician providing care. The Executive Director also stated it is her expectation the Plan of Care is to be reviewed by every clinician prior to every home visit.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on record review, observation and staff interview it was determined the facility failed to provide medical reconciliation with education for two (2) out of four (4) patients (Patients #9 and 10). This failure creates the potential for harm to all patients. Findings include: 1. Review of the clinical record for Patient #9 revealed a start of care (SOC) of 2/9/21 with a diagnosis of Infection, Cardiovascular Device. The record revealed physician orders for "Furosemide (generic Lasix) 80 mg two (2) times daily orally." Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/reconcile medications, instruct/reinforce medication management." 2. A home visit was conducted with Patient #9 on 3/30/21 at 10:35 a.m. by the Licensed Practical Nurse (LPN). The patient told the LPN that he had been taking Lasix 20 mg daily but on the date of the visit he took two (2) Lasix 20 mg tabs (total 40 mg). She did not address this issue until the State surveyor began questioning the patient about the change in Lasix dosage (at 10:50 a.m.) The patient and his wife stated he adjusts the Lasix himself because his physician told him he could. When asked how long he had been taking Lasix at the 20 mg daily dosage, he responded, "Quite a while now." The nurse did not educate the patient and his wife about the intended effects, side effects, and precautions for Lasix. Further, she did not counsel the patient and his wife against adjusting the dosage further until she could consult with the physician and did not conduct a medication reconciliation. 3. Review of the clinical record for Patient #10 revealed a SOC of 11/5/20 with a diagnosis of Diabetes Type 2 with diabetic peripheral angiopathy. Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/medications, instruct/reinforce medication management." 4. A home visit was conducted with Patient #10 on 3/30/21 at 12:10 p.m. by the Registered Nurse. She did not conduct a medication reconciliation nor provide medication education. 5. On 3/30/21 at 3:05 p.m. the Executive Director stated it is her expectation medication reconciliation is to be conducted during every home visit by every clinician providing care. The Executive Director also stated it is her expectation the Plan of Care is to be reviewed by every clinician prior to every home visit.

Assure patient needs are continually assessed CFR(s): 484.105(c)(4) Assuring that patient needs are continually assessed, and This ELEMENT is not met as evidenced by: Based on record review, observation and staff interview it was determined the facility failed to provide oversight of clinicians providing care by not ensuring the clinicians were continually assessing patients in two (2) out of four (4) patients (Patients #9 and 10). The facility failed to ensure clinicians were conducting medication reconciliation with assessment of adherence to ordered medications. This failure creates the potential for harm to all patients. Findings include: 1. Review of the clinical record for Patient #9 revealed a start of care (SOC) of 2/9/21 with a diagnosis of Infection, Cardiovascular Device. The record revealed physician orders for "Furosemide (generic Lasix) 80 mg two (2) times daily orally." Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/reconcile medications, instruct/reinforce medication management." 2. A home visit was conducted with Patient #9 on 3/30/21 at 10:35 a.m. by the Licensed Practical Nurse (LPN). The patient told the LPN that he had been taking Lasix 20 mg daily but on the date of the visit he took two (2) Lasix 20 mg tabs (total 40 mg). She did not address this issue until the State surveyor began questioning the patient about the change in Lasix dosage (at 10:50 a.m.) The patient and his wife stated he adjusts the Lasix himself because his physician told him he could. When asked how long he had been taking Lasix at the 20 mg daily dosage, he responded, "Quite a while now." The nurse did not educate the patient and his wife about the intended effects, side effects, and precautions for Lasix. Further, she did not counsel the patient and his wife against adjusting the dosage further until she could consult with the physician and did not conduct a medication reconciliation. 3. Review of the clinical record for Patient #10 revealed a SOC of 11/5/20 with a diagnosis of Diabetes Type 2 with diabetic peripheral angiopathy. Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/medications, instruct/reinforce medication management." 4. A home visit was conducted with Patient #10 on 3/30/21 at 12:10 p.m. by the Registered Nurse. She did not conduct a medication reconciliation nor provide medication education. 5. On 3/30/21 at 3:05 p.m. the Executive Director stated it is her expectation medication reconciliation is to be conducted during every home visit by every clinician providing care. The Executive Director also stated it is her expectation the Plan of Care is to be reviewed by every clinician prior to every home visit.

Assure implementation of plan of care CFR(s): 484.105(c)(5) Assuring the development, implementation, and updates of the individualized plan of care. This ELEMENT is not met as evidenced by: Based on record review, observation and staff interview it was determined the facility failed to ensure patients' plan of care were kept current for one (1) out of four (4) patients (Patient #9). The facility failed to ensure the medication list was kept current. This failure creates the potential for harm to all patients. Findings include: 1. Review of the clinical record for Patient #9 revealed a start of care (SOC) of 2/9/21 with a diagnosis of Infection, Cardiovascular Device. The record revealed physician orders for "Furosemide (generic Lasix) 80 mg two (2) times daily orally." Review of the Plan of Care revealed in part: "Skilled nurse to review medication profile/reconcile medications, instruct/reinforce medication management." 2. A home visit was conducted with Patient #9 on 3/30/21 at 10:35 a.m. by the Licensed Practical Nurse (LPN). The patient told the LPN that he had been taking Lasix 20 milligram (mg) daily but on the date of the visit he took two (2) Lasix 20 mg tabs (total 40 mg). The nurse did not address this issue until the State surveyor began questioning the patient about the change in Lasix dosage (at 10:50 a.m.) The patient and his wife stated he adjusts the Lasix himself because his physician told him he could. When asked how long he had been taking Lasix at the 20 mg daily dosage, he responded, "Quite a while now." The nurse did not educate the patient and his wife about the intended effects, side effects, and precautions for Lasix. Further, she did not counsel the patient and his wife against adjusting the dosage further until she could consult with the physician and did not conduct a medication reconciliation. 3. On 3/30/21 at 3:05 p.m. the Executive Director stated it is her expectation medication reconciliation is to be conducted during every home visit by every clinician providing care. The Executive Director also stated it is her expectation the Plan of Care is to be reviewed by every clinician prior to every home visit.