Every finding on record at Centerwell Health Services (Certified) Inc

During the recertification survey conducted from 12/27/21-12/29/21, the Emergency Preparedness Plan was reviewed. Kindred At Home was in compliance with 42 CFR 484 Subpart A-C, requirements for Home Health Agencies.

Complaint investigation #2021004921 was conducted in conjunction with the recertification survey from 12/27/21-12/29/21. Kindred At Home was in compliance with 42 CFR 484 Subpart A-C, requirements for Home Health Agencies.

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on Interview and record review, the home health agency failed to document both the existence of the complaint and resolution of the complaint for 1 of 18 sampled patients (#17). Review of patient #17's plan of care revealed her start of care was 9/29/21 with a certification period of 9/29/21 to 11/27/2021. Resident #17's diagnoses included a history of falling, type 2 diabetes with chronic kidney disease, and chronic obstructive pulmonary disease. Her orders had skilled nursing one time weekly for nine weeks. Physical therapy one time weekly for nine weeks and Occupational therapy one time weekly for nine weeks. Patient #17's functional limitations included endurance and ambulation. Her safety measures included fall precautions using a walker and wheelchair as tolerated. An 11/23/21 Occupational Therapist (OT) A completed an evaluation visit note. The document listed that OT A instructed the patient and caregiver in therapeutic exercises and home exercise program with return demonstration and understanding. ON 11/25/21, An RN-data collection document revealed patient #17 transferred to the hospital for injury related to a fall. A completed hospital transfer- discharged Outcome and Assessment Information (OASIS) dated 11/29/21 also listed injury related to fall. Patient #17 was re-admitted on 12/24/2021. Her new start of care is 12/25/21, with a certification period of 12/25/21 to 2/21/2021. Her primary diagnosis listed as a fracture of unsp part of the neck of the left femur. On 12/29/21 at 12:20 PM, patient #17's spouse stated that his wife had received services from Kindred at Home for over one year. He said on 11/23/21 (OT), A "threatened that if his wife didn't start doing more for herself, she would be discharged; my wife fell a few days after because she tried to do what the OT said." Patient #17's spouse said he complained to the Branch Director about the OT not keeping her appointment times, but he never told her he felt threatened by her. On 12/29/2021 at 3:58 PM, the branch director was informed of the allegation. The branch director stated she knew OT A's lateness, as the spouse did notify her. She also said that she spoke to OT A. She did not document the complaint and the resolution. Review of the agency's "Complaint Management Policy," dated 06/2021, revealed all complaints made by patients, family, or the patient's responsible party either verbally or in writing will be reviewed, evaluated, and forwarded to the appropriate manager for resolution. Actions and resolutions will be documented on the Complaint Log." Class III

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to promptly notify the physician of a patient’s left heel wound and obtain treatment orders for 1 of 18 sampled patients (#16). Findings: Patient #16’s start of care date was 9/10/21. Review of his plan of care for the recertification period, 11/9/21 to 1/7/22, included diagnoses of a stroke with left nondominant sided hemiplegia. His plan of care orders for the recertification period included skilled nursing services, physical therapy services, and occupational therapy services, and medical social worker services. On 11/4/21, patient #16’s nursing recertification assessment was conducted by RN J for the above recertification period. It indicated that patient #16 had decreased strength, limited range of motion, and contractures in this lower left extremity. The patient required substantial to maximal assistance of two or more helpers to roll from his back to his left and right side. He was dependent on helpers for his mobility activities. RN J had assessed him to be low risk for developing a pressure ulcer. . At this time, there was not any documented evidence of any pressure ulcers or other wounds. On 11/10/21, one week later, a skilled nurse visit note by LPN H indicated that resident #16 had a dry scab on his left heel, same side as his hemiplegia. The visit note narrative read, “…patient lying in hospital bed on left side. Complains of pain to left foot from knee down. Patient has dry black scab to left foot [heel] . . . . Encourage wife to keep foot floating on pillow and to reposition pain every 2 hours in bed to prevent skin breakdown . . . .” There was not any documented evidence that LPN H had measured the heel wound and had notified her clinical manager and the physician. There was no treatment order found in the patient’s record for patient #16’s left heel wound. On 12/15/21, LPN H’s visit note indicated that patient #16 continued to have a wound to his left heel. The nurse’s narrative read, “Dry scab to left heel has decreased in size.” Again, there was not any evidence of measurements, description, and/or assessment of the left heel wound. There was no evidence the physician was notified and there were not any treatment orders in the clinical record. There was not any evidence that the left heel wound was being treated. On 12/22/21, LPN H’s visit note continued to indicate that patient #16 continued to have a dry scab on his left heel. The visit notes did not include any measurements, description, and/or assessment of the left heel wound. There continued to not be any evidence that the physician had been notified and/or that any treatment orders had been obtained. On 12/29/21 at 3:40 PM, interview with the DON from the HHA’s Orlando parent office stated that patient #16 came out of their Kissimmee branch HHA location. She stated that the clinical record did not show any evidence that LPN H had notified the physician and obtained treatment orders for the patient’s left heel wound. At 3:45 PM, phone interview with LPN H stated when she started working with patient #16, she saw that he had a dark dried thick scab on his left heel. She said that the patient’s spouse told her that the physician wanted the scab to dry up and fall off. The LPN said she did not call the physician to obtain clarification treatment orders for the left heel wound. LPN H stated that at the time she thought it was not necessary to call because of what the wife had said. At 3:58 PM, phone interview with the DON from the HHA’s Kissimmee branch location stated that she did not know about patient #16’s left heel wound prior to the survey. She said the expectation would have been for the nurse to call the physician and obtain orders. She also would expect the nurse to call the HHA office and inform the clinical manager. The DON stated after being informed of the patient’s wound, they sent RN I to assess it and obtain wound care orders. At 4:30 PM, phone interview with RN I said the left heel scab was now about the size of a quarter. She said the outer edges had started to peel off but there was still a scab of unknown depth at the center of the wound. RN I said that the physician gave orders to cleanse the heel with normal saline, paint with betadine, cover with gauze and secure with a Kerlix dressing every other day and as needed. Review of the HHA’s Wound Assessment and Treatment policy and procedure included weekly assessment and measurements of wounds. It also included that nurses were to notify the physician and obtain treatment orders. Class III