Every finding on record at Centerwell Certified Healthcare Corp.

An emergency preparedness survey was conducted at CenterWell Home Health on 01/23/23 to 01/25/23 as part of a recertification survey conducted during the same survey period. The agency is in compliance with the Emergency Preparedness Conditions of Participation for Home Health Agencies.

A recertification survey was conducted at CenterWell Home Health on 01/23/23 to 01/25/23. The agency has one (1) branch location, located in Princeton, and provides Skilled Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, and Social Work services to residents of Fayette, McDowell, Mercer, Raleigh, Summers, and Wyoming counties. At the time of the survey, the patient census was six hundred fifteen (615) with an unduplicated patient census of four thousand three hundred and forty-four (4,344) in the past twelve (12) months. A total of seventeen (17) medical records were reviewed and seven (7) home visits were conducted. A COVID -19 vaccination rule survey was conducted, and the agency is in compliance with the COVID-19 Vaccination rule. One (1) standard level deficiency was cited at G 682.

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, document review, and staff interview, it was determined the agency failed to ensure the use of standard precautions to prevent the transmissions of infections and communicable diseases. This failure was identified in one (1) of two (2) patients (patient #1) observed to receive physical therapy (PT) sessions utilizing a reusable balance pad. This failure has the potential to adversely affect all patients ordered PT sessions utilizing a reusable balance pad. An observation was conducted on 01/24/23 starting at 3:20 p.m. of a PT session being performed at the home of Patient #1 by a Physical Therapy Assistant (PTA). The PTA was utilizing a reusable balance pad that was being cleaned prior to, and following, each session with an over-the-counter cleaning wipe that was located in the PTA’s bag. An observation was conducted on 01/24/23 starting at 12:24 p.m. of the facility’s branch office supply area. Multiple containers of disinfectants and alcohol-based wipes were noted to be available to staff. An observation was conducted on 01/24/23 starting at 4:40 p.m. of the facility’s main branch supply area. Multiple containers of disinfectants and alcohol-based wipes were noted to be available to staff. A review of the agency’s policy titled “Bag Technique and Equipment Cleaning Job Aid,” dated 04/2018, revealed: “The patient care equipment … should be cleaned after each use … Cleaning products selected below meet regulatory guidelines for infection control. Alcohol-based products must be 70% isopropyl alcohol for optimal effectiveness. Quaternary + [plus] Alcohol disinfectants offer broad coverage of microorganisms and meet CDC [Center for Disease Control], OSHA [Occupational Safety and Health Administration], and CMS [Centers for Medicare and Medicaid Services] guidelines.” A review of employee training revealed the PTA received training in infection control on 09/28/22. An interview was conducted on 01/24/23 at 3:30 p.m. with the PTA regarding the balance pad utilized for Patient #1’s PT session. The PTA stated that the balance pad assists with balance training; the patient stands on the pad during its use, and the balance pad is reused among patients. The PTA stated that the balance pad is cleaned prior to and after each use. The PTA then pulled a container of over-the-counter cleaning wipes from their bag. The PTA stated that the agency supplies disinfectant wipes to staff, but the over-the-counter cleaning wipes in the bag had been purchased by the PTA. An interview was conducted on 01/25/23 at 8:55 a.m. with the Branch Director (BD) of the branch office who confirmed that the over-the-counter cleaning wipes that were being used by the PTA were not a disinfectant and were not approved by the agency for use. The BD stated that the main and branch offices were fully stocked with the agency approved disinfectants and alcohol products that staff were to use, and it was the staff’s responsibility to pick up the supplies that they needed for infection control.

An Emergency Preparedness Survey was conducted at Kindred at Home, Beckley on 03/01/21 through 03/03/21. The agency provides Skilled Nursing, Physical Therapy, Occupational Therapy, Home Health Aides, and Social Workers to Fayette, McDowell, Mercer, Raleigh, Summers, and Wyoming counties. The Emergency Preparedness Plan was comprehensive and updated as needed to reflect an all-hazards approach. No deficiencies were cited.

A recertification survey was conducted at Kindred at Home from 03/01/21 through 03/03/21. The agency has one (1) branch location in Princeton, WV. The agency provides Skilled Nursing, Physical Therapy, Occupational Therapy, Social Work and Home Health Aide services to Fayette, McDowell, Mercer, Raleigh, Summers, and Wyoming counties. The agency had an unduplicated patient census of one thousand two hundred eighty-two (1282) in the past twelve (12) months. A total of nineteen (19) medical records were reviewed, and five (5) telephone visits were conducted. Two (2) deficiencies were cited at G 434 and G 464.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: A. Based on record review and staff interview it was determined the facility failed to ensure the patient was afforded the right to participate in their care with respect to the completion of all assessments. This failure was identified in one (1) of eight (8) patients referred for physical therapy (PT) services (patient #11). This failure has the potential to adversely affect all patients. Findings include: 1. A review of the medical record for patient #11 revealed the patient had a start of care (SOC) date of 12/22/20. An order was obtained for PT to evaluate the patient week of 12/28/20. An order was obtained to delay the evaluation by PT on 12/31/20, and a second order to delay the evaluation of PT was obtained on 1/7/21. No documentation was noted in the medical record the patient participated in the delay of the PT services. 2. An interview was conducted with the Director of the parent office on 3/2/21 at 2:16 p.m. She concurred no communication with the patient was documented in the medical record to delay the PT visits. B. Based on record review and staff interview it was determined the facility failed to ensure the patient was afforded the right to participate in their care with respect to the completion of all assessments. This failure was identified in two (2) of seven (7) patients referred for occupational therapy (OT) services (patients #13 and 14). This failure has the potential to adversely affect all patients. Findings include: 1. A review of the medical record for patient #13 revealed the patient had a SOC of 2/16/21. An order was obtained on 2/16/21 for OT to evaluate the patient week of 2/21/21. No OT evaluation was completed. No documentation was noted in the medical record the patient participated in the delay in the OT evaluation. 2. A review of the medical record for patient #14 revealed the had a SOC of 2/19/21. An order was obtained on 2/19/21 for OT to evaluate patient #14. Documentation was noted in the medical record the physician's office was called and the physician's office agreed to move the OT evaluation to 3/1/21. No documentation was noted in the medical record the patient participated in the delay of the OT evaluation. 3. An interview was conducted with the Director of the branch office on 3/3/21 at 3:37 p.m. She concurred no documentation of communication with patients #13 and 14 was noted in their medical records for a delay in OT evaluation.

Advise the patient of discharge for cause CFR(s): 484.50(d)(5)(i) (i) Advise the patient, representative (if any), the physician(s) or allowed practitioner(s), issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered; This ELEMENT is not met as evidenced by: A. Based on record review and staff interview it was determined the agency failed to notify the patient's physician of their pending discharge due to non-compliant behaviors in one (1) out of six (6) discharged patients (patient #7). This failure has the potential to negatively impact all patients of the agency. Findings include: 1. The medical record of patient #7 was reviewed. The patient's Start of Care (SOC) date was 12/29/20 with a diagnosis of Rheumatoid Arthritis. The patient received physical therapy and occupational therapy services. Physical therapy discharged the patient on 01/22/21. It is documented the patient reached maxed potential. It is documented her short-term goals (STG) and long-term goals (LTG) were not met. On 02/22/21 a care conference was held to discuss the patient's discharge. It stated, "Patient discharge secondary to STG met and patient noncompliance to Occupational therapy POC (plan of care) and activities." The patient was notified and agreed to the pending discharge. No discussion was documented with the physician to notify of the pending discharge. The patient was discharged from the agency on 02/22/21. 2. An interview was conducted with the Clinical Manager on 02/02/21 at 2:58 p.m. She stated regarding patient #7 discharge, "The Discharge case conference is transmitted to the physician. No documented discussion was made with the physician about the patient's pending discharge." B. Based on record review and staff interview it was determined the agency failed to notify the patient of their pending discharge due to non-compliant behaviors in one (1) out of six (6) discharged patients (patient #8). This failure has the potential to negatively impact all patients of the agency. Findings include: 1. The medical record of patient #8 was reviewed. The patient's SOC date was 11/09/20 with a primary diagnosis of Hypertension. The patient had nursing services, and physical therapy. It was documented the patient was non-compliant with her plan of care (POC). On 01/04/21 a case conference stated the following: "PT (patient) is noncompliant with POC and MD (Physician) had been notified PT (patient) and caregiver have been educated on elevation of legs to prevent the edema and PT (patient) has been advised to not sleep in her recliner that a bed is needed to help with elevation of her legs, but she refuses to get a bed and remove her sofa. A caregiver is only available one day a week for her and the staff at the bayberry cannot wrap legs as needed." The pending discharge was discussed with the patient's daughter, who did not reside with the patient. There is no documentation the pending discharge was discussed with the patient. The patient was discharged from the agency for noncompliance with POC on 01/05/21. 2. An interview was conducted on 03/02/21 with the Executive Director of the parent office at 12:10 p.m. She stated regarding patient #8 discharge, "Discussions took place with the patient's daughter and the physician, not with the patient."