Every finding on record at Centerwell Home Health

E000 A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the New Mexico Department of Health. An unannounced on-site Recertification Survey at the above-named Home Health Agency (HHA) from 04/04/22 to 04/06/22 resulted in a finding of standard level deficiencies/citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.22.

Emergency Officials Contact Information CFR(s): 484.102(c)(2) §403.748(c)(2), §416.54(c)(2), §418.113(c)(2), §441.184(c)(2), §460.84(c)(2), §482.15(c)(2), §483.73(c)(2), §483.475(c)(2), §484.102(c)(2), §485.68(c)(2), §485.625(c)(2), §485.727(c)(2), §485.920(c)(2), §486.360(c)(2), §491.12(c)(2), §494.62(c)(2). [(c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. *[For LTC Facilities at §483.73(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) The State Licensing and Certification Agency. (iii) The Office of the State Long-Term Care Ombudsman. (iv) Other sources of assistance. *[For ICF/IIDs at §483.475(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. (iii) The State Licensing and Certification Agency. (iv) The State Protection and Advocacy Agency. This STANDARD is not met as evidenced by: E0031 Based on document review and interview, the home health agency (HHA) failed to ensure its communication plan included the contact information for the State, tribal, and regional emergency preparedness staff. This deficient practice had the potential to affect the current 90 patients and any future patient admitted for home health services. Findings include: Review of the "Home Health Emergency Preparedness and Business Continuity Plan," contained in the HH agency's Emergency Preparedness binder, included a section for the contact information for the "Local Emergency Management" office. There was no documentation present for the contact information for the State, tribal, and regional emergency preparedness staff. In an interview on 04/06/22 at 1:07 PM, Area Director of Operations (ADO) confirmed that the agency's communication plan did not include the contact information for the State, tribal, and regional emergency preparedness staff.

Information on Occupancy/Needs CFR(s): 484.102(c)(6) §403.748(c)(7), §416.54(c)(7), §418.113(c)(7) §441.184(c)(7), §482.15(c)(7), §460.84(c)(7), §483.73(c)(7), §483.475(c)(7), §484.102(c)(6), §485.68(c)(5), §485.68(c)(5), §485.727(c)(5), §485.625(c)(7), §485.920(c)(7), §491.12(c)(5), §494.62(c)(7). [(c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (7) [(5) or (6)] A means of providing information about the [facility's] occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee. *[For ASCs at 416.54(c)]: (7) A means of providing information about the ASC's needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee. *[For Inpatient Hospice at §418.113(c):] (7) A means of providing information about the hospice's inpatient occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee. This STANDARD is not met as evidenced by: E0034 Based on record review and interview, the home health agency (HHA) failed to ensure its communication plan included a process for providing information on the HHA's occupancy, needs, and the ability to assist the authority having jurisdiction, the Incident Command Center, or designee. This deficient practice had the potential to affect the current 90 patients and any future patient admitted to the agency for home health services. Findings include: Review of the "Home Health Policy Manual 03-18: Emergency Preparedness," presented by Area Director of Operations (ADO) for review, indicated there was no process or policy developed that addressed the means for providing information on the HHA's occupancy, needs, and the ability to assist the authority having jurisdiction, the Incident Command Center, or designee during an emergency/disaster. In an interview on 04/06/22 at 1:07 PM, ADO confirmed the agency's emergency preparedness communication plan did not address the means for providing information on the HHA's occupancy, needs, and the ability to assist the authority having jurisdiction, the Incident Command Center, or designee.

G000 A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of New Mexico Department of Health. An unannounced on-site Recertification Survey conducted at the above-named Home Health Agency (HHA) facility from 04/04/22 to 04/06/22 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.

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: G580 Based on record reviews, observations, and interviews, the home health agency (HHA) failed to ensure medications were administered only as ordered by the physician and the medication profile included all medications as taken by the patient for two (Patient (P) 2, P3) of three patients observed during home visits from a sample of 10 patients. This deficient practice had the potential to affect the 90 current patients and any future patient admitted for home health services. Findings include: Review of the policy titled "Physician/Provider Orders," revised January 2022, indicated ". . . Upon full review of the patient's drug regimen to include prescribed, over-the-counter, herbal products, and non-prescribed drugs, the physician/allowed practitioner will be contacted to change orders for medications, treatment, or services as applicable. . ." 1. Review of P2's medication profile for the certification period of 02/23/22 to 04/23/22, copied and presented to the surveyor by Branch Director, indicated 12 medications were listed. Observation of medications presented by P2 during a home visit on 04/05/22 at 3:30 PM revealed Milk Thistle (used for diabetes in combination with standard treatment and has also been used for liver disease) 175 milligrams (mg) (over-the-counter medication) was present while P2's medication profile indicated the Milk Thistle dosage as 600 mg to be taken daily. Further observation revealed Turmeric with black pepper (help with burning fat faster, stronger joints, and feel better) 1000 mg (over-the-counter) was present in the home while P2's medication profile indicated the Turmeric with black pepper dosage was 500 mg to be taken daily. Further observation revealed AZO D-Mannose (a daily approach to help flush the urinary tract and protect it from bacteria adhesion) 500 mg capsule and B-12 Dots (formation of healthy red blood cells for energy and alertness) 500 mcg (micrograms) were present and listed on the medication profile to be taken daily. Further observation revealed Glucosamine HCL (may offer benefits in the treatment of chronic venous insufficiency, diabetes, high cholesterol, and inflammatory bowel disease) 1500 mg and Calcium Magnesium Zinc Softgels (supports strong bones and teeth, as well as healthy enzymatic activity) were present with no documentation of either medication listed on the medication profile. Review of P2's "Visit Note Report" dated 03/26/22 and 04/04/22 documented by Licensed Practical Nurse (LPN) 1 indicated "no changes in frequency/duration, medications, or treatments." In an interview during a home visit on 04/05/22 at 3:30 PM, P2 stated P2 didn't take AZO D-Mannose and B-12 Dots regularly (ordered daily). P2 stated he/she took Milk Thistle 175 mg as the bottle was labeled and Turmeric with black pepper 1000 mg as labeled and not 500 mg as noted on the medication profile. P2 stated he/she took Glucosamine HCL as needed for thumb pain and Calcium Magnesium Zinc Softgels one softgel daily. In an interview on 04/06/22 at 8:30 AM, Area Director of Operations (ADO) confirmed the observation of medications made by the surveyor in P2's home on 04/05/22 did not match what was documented and ordered on the medication profile. ADO stated over-the-counter medications should be included on the medication profile. ADO confirmed the medications as taken by P2 had not been administered as ordered by the physician. 2. Review of P3's medication profile for the certification period of 02/08/22 to 04/08/22, copied and presented to the surveyor by Branch Director, indicated 16 medications were listed. Observation of medications presented by P3 during a home visit on 04/05/22 at 2:00 PM revealed Metoprolol Tartrate (used to treat high blood pressure) 25 mg with instructions on the bottle to take one table twice daily with the medication profile indicating to take one tablet daily. Further observation revealed Vitamin D3 2000 units (supplement to improve overall health or used to treat osteoporosis) was present with the medication profile indicating to take 5000 units one tablet daily. Review of P3's medication profile, copied and presented to the surveyor by Branch Director, created during the nurse visit by Registered Nurse (RN) 1 on 04/05/22 at 10:53 AM (prior to the surveyor's visit) indicated Metoprolol Tartrate 25 mg table, take one tablet daily, and Metoprolol Tartrate 25 mg tablet, take two times daily, were listed on the medication profile. Further review of the newly created medication profile indicated Vitamin D3 5000 units was listed to be taken one tablet daily. In an interview on 04/05/22 during a home visit at 2:00 PM, P3 stated he/she took Metoprolol Tartrate 25 mg, two tablets daily, and took Vitamin D3 daily from the bottle labeled as 2000 units. In a telephone interview with RN1 on 04/06/22 at 9:08 am with ADO present, RN1 stated he/she was trying to contact P3's physician to clarify the Metoprolol dose. RN1 stated he/she doesn't remember if the Vitamin D3 in the home was a 5000-unit container or a 2000-unit container. RN1 then stated he/she entered Vitamin D3 125 mcg (5000 units) but saw 1000 units on the bottle. RN1stated the options in the computer system for Vitamin D3 doesn't have 1000 units, so RN1 chose 5000 units. In an interview on 04/06/22 at 9:08 AM after the telephone interview with RN1, ADO confirmed the medication profile for certification period of 02/08/22 to 04/08/22 and the newly created medication profile of 04/05/22 by RN1 did not match what P3 was taking. ADO confirmed the medications as taken by P3 had not been administered as ordered by the physician.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: G710 Based on record reviews and interviews, the home health agency (HHA) failed to ensure services were provided as ordered by the physician as indicated in the patient's plan of care for two (Patient (P) 1, P3) of 10 patient records reviewed for implementing physician orders from a sample of 10 patients. This deficient practice had the potential to affect the 90 current patients and any future patient admitted for home health services. Findings include: Review of the policy titled "Physician/Provider Orders," revised January 2022, indicated "Physician or Allowed Practitioner orders must be obtained for services (excluding supervisory visits) by all healthcare personnel if required by state regulation. Physician/Allowed Practitioner orders are comprised of the Home Health Certification and Plan of Care form and all subsequent orders received during the patient's 60-day episode of care. . . Verbal Order: A physician/allowed practitioner order that is spoken for the purposes of documenting, establishing or revising a patient's Plan of Care (POC). This may include initial orders, recertification (renewal), or interim orders and may be accepted from a person serving as an "agent" of the physician/allowed practitioner . . . followed by written or faxed orders authenticated and dated by the physician/allowed practitioner. . ." 1. Review of P1's "Home Health Certification and Plan of Care dated 12/16/21 to 02/13/22," located in the "Orders" tab under the "Medical Records Info" tab indicated an order for the licensed professional to report vital signs falling outside the established parameter of systolic blood pressure less than 90 and above 150 and diastolic blood pressure less than 50 and above 90. Review of P1's "Visit Note Report," dated 02/03/22 and located in the "Visit Notes" tab under the "Medical Records Info" tab, indicated P1's blood pressure was 180/80. Further review indicated documentation by Licensed Practical Nurse (LPN) 2 that showed "This SN [skilled nurse] called and spoke to [name of doctor] who advised patient to take ½ [one-half] tab of Amlodipine now, re check [sic] BP [blood pressure] in 30-60 min. [minutes]. If BP is above 160 patient is to take another ½ tab. Patient also to take [his/her] regular dose of 5mg [5 milligrams] at bedtime tonight. [name of doctor] advises these instructions are one time only and if BP continues to be elevated pt [patient] is to contact PCP [primary care physician] for further instructions. Spoke to [name of patient's daughter], patients [sic] daughter, and advised above information, [name of daughter] and patient voiced understanding. Patient and this SN were unable to find Amlodipine bottle. This SN spoke to daughter who states she thinks she was only able to fill the med box with Amlodipine through Tuesday and will contact the pharmacy to pick up the refill. Patient did not take Amlodipine while this SN was present however [name of daughter] was going to pharmacy to pick up the medication. . . SN visit report given to supervisor/case manager." There was no documentation of the specific information relayed by LPN2 to the supervisor/clinical manager to determine if report was given that the physician orders were not implemented. There was no documentation that LPN2 reported to P1's physician that the orders given to treat the elevated blood pressure were not implemented. There was no documentation that a verbal/telephone order had been written by LPN2 and sent to the physician for signature. In an interview on 04/04/22 at 1:00 PM, Clinical Manager (CM) stated LPN2 should have reported to P1's physician that his/her orders to treat the elevated blood pressure were not implemented. CM confirmed the physician's verbal order was not documented in the electronic medical record (EMR) and should have been documented and sent for the physician's signature. 2. Review of P3's "Home Health Certification and Plan of Care dated 02/08/22 to 04/08/22," located in the "Orders" tab under the "Medical Records Info" tab indicated an order for "Skilled Nurse to perform fingerstick blood glucose analysis every visit if patient/caregiver unable/unwilling." Further review indicated no orders for blood glucose parameters to determine the level of blood glucose that needed to be reported to the physician. Review of P3's "Client Coordination Note Report dated 02/21/22," located in the "Coordination Notes" tab under the "Medical Records Info" tab, indicated documentation by LPN1 that ". . . Pt stated that he forgot to check BS [blood sugar] this morning. . ." There was no documentation that LPN1 assessed P3's blood glucose as ordered when the patient is unable or unwilling to do so. Review of P3's "Vital Signs Report," located in the "Vital Signs" tab under the "Medical Records Info" tab, indicated no documentation of a blood glucose result for 02/21/22. Review of P3's "Visit Note report" dated 02/21/22, located in the "Visit Notes" tab under the "Medical Records Info" tab, indicated no documentation by LPN1 that LPN1 assessed P3's blood glucose as ordered. In an interview on 04/04/22 at 1:42 PM, CM confirmed P3's blood glucose was not documented by LPN1 on 02/21/22. CM indicated P3's plan of care did not include blood glucose parameters to determine the level of blood glucose that needed to be reported to the physician. CM stated CM had not noticed that blood glucose parameters weren't ordered. CM indicated a request should have been made of P3's physician to determine what level of blood glucose needed to be reported. In an interview on 04/05/22 at 11:28 AM, LPN1 stated LPN1 does not assess P3's blood glucose as ordered when P3 has not checked it before LPN1's arrival. LPN1 stated LPN1 was not aware that there was a physician's order for the nurse to assess the patient's blood glucose if the patient or caregiver was unable or unwilling to it. LPN1 stated LPN1 was not aware that P3's plan of care did not include blood glucose levels parameters that needed to be reported to the physician.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: G718 Based on record reviews and interviews, the home health agency (HHA) failed to ensure the nurse communicated with the physician related to the plan of care related to wound care, elevated blood pressure orders, and a change in frequency for three (Patient (P) 1, P5, P9) of 10 sampled patients. This deficient practice had the potential to affect the 90 current patients and any future patient admitted for home health services. Findings include: Review of the policy titled, "Care Planning," revised January 2022, indicated ". . . The clinician or clinical manager will communicate with all physicians or allowed practitioners involved in the POC [plan of care] and other health care practitioners (as appropriate) related to the current POC. . . If the patient or patient representative refuses care that could impact the patient's clinical well-being (such as dressing changes or essential medication) on more than one occasion, the HHA staff must attempt to identify the reason for the refusal. . ." 1. Review of P1's "Home Health Certification and Plan of Care dated 12/16/21 to 02/13/22," located in the "Orders" tab under the "Medical Records Info" tab indicated an order for the licensed professional to report vital signs falling outside the established parameter of systolic blood pressure less than 90 and above 150 and diastolic blood pressure less than 50 and above 90. Review of P1's "Visit Note Report," dated 02/03/22 and located in the "Visit Notes" tab under the "Medical Records Info" tab, indicated P1's blood pressure was 180/80. Further review indicated documentation by Licensed Practical Nurse (LPN) 2 that showed "This SN [skilled nurse] called and spoke to [name of doctor] who advised patient to take ½ [one-half] tab of Amlodipine now, re check [sic] BP [blood pressure] in 30-60 min. [minutes]. If BP is above 160 patient is to take another ½ tab. Patient also to take her regular dose of 5mg [5 milligrams] at bedtime tonight. [name of doctor] advises these instructions are one time only and if BP continues to be elevated pt [patient] is to contact PCP [primary care physician] for further instructions. Spoke to [name of patient's daughter], patients [sic] daughter, and advised above information, [name of daughter] and patient voiced understanding. Patient and this SN were unable to find Amlodipine bottle. This SN spoke to daughter who states she thinks she was only able to fill the med box with Amlodipine through Tuesday and will contact the pharmacy to pick up the refill. Patient did not take Amlodipine while this SN was present however [name of daughter] was going to pharmacy to pick up the medication. . . SN visit report given to supervisor/case manager." There was no documentation that LPN2 reported to P1's physician that the orders given to treat the elevated blood pressure were not implemented. In an interview on 04/04/22 at 1:00 PM, Clinical Manager (CM) stated LPN2 should have reported to P1's physician that his/her orders to treat the elevated blood pressure were not implemented. 2. Review of P5's "Home Health Certification and Plan of Care dated 01/28/22 to 03/28/22," located in the "Orders" tab under the "Medical Records Info" tab, indicated an order for the skilled nurse to "perform/teach pressure ulcer care to right and left buttock. Cleanse with normal saline or wound cleanser, apply zinc paste cover with foam border dressing using clean/aseptic technique. SN [skilled nurse] to change dressing I times per week and PRN [as needed] soiling/dislodgement. . . Once taught, patient/caregiver to perform on days skilled nurse is not in home. . ." Review of P5's "Client Coordination Note Report" dated 03/01/22, located in the "Coordination Notes" tab under the "Medical Records Info" tab, documented by LPN1 indicated ". . . Pt refused dressing this visit, buttocks red with little purple. No open areas still. . ." Review of P5's "Client Coordination Note Report" dated 03/10/22 documented by LPN1 indicated ". . . This nurse only assessed buttocks. Pt refused wound care because she was getting in the bath after I left. . ." There was no documentation in the Visit Note Report" for 03/01/22 and 03/10/22, located in the "Visit Notes" tab under the "Medical Records Info" tab, that LPN1 notified P5's physician of the refusal of wound care to be done during both nursing visits. In an interview on 04/05/22 at 10:18 AM, Area Director of Operations (ADO) stated LPN1's documentation did not include that LPN1 notified P5's physician of P5's refusal of wound care as required by agency policy. ADO stated LPN1 should have notified P5's physician of the refusal to have wound care performed during the visit. 3. Review of P9's "Home Health Certification and Plan of Care dated 12/21/21 to 02/18/22," located in the "Orders" tab under the "Medical Records Info" tab, indicated the skilled nurse frequency was two times a week for one week then three times a week for eight weeks with two as needed visits for wound complications. Review of P9's physician order dated 12/22/21 indicated "effective 12/26/21" the skilled nurse frequency was two times a week for eight weeks with two as needed visits for wound care or complications. Review of P9's visits for the week of 01/16/22, located in the "Visit Notes" tab under the "Medical Records Info" tab, indicated a skilled nurse visit was missed 01/21/22 with documentation of a note that P9's physician was notified. There was no documentation that a second visit the same week was performed or attempted, and there was no documentation that P9's physician was notified that a nursing wound care visit was missed. In an interview on 04/05/22 at 10:08 AM, ADO stated a skilled nurse visit was missed the week og 01/16/22, and there was no documentation that P9's physician was notified of the missed wound care visit. ADO stated there should be either a visit note or a missed visit note with documentation that the physician was notified of the missed visit.

Supervise skilled professional assistants CFR(s): 484.75(c) Standard: Supervision of skilled professional assistants. This STANDARD is not met as evidenced by: G724 Based on record reviews and interviews, the home health agency (HHA) failed to ensure there was documentation in the electronic medical record (EMR) of communication between the registered nurse (RN) and the licensed practical nurse (LPN) regarding the patient's plan of care for two (Patient (P) 1, P9) of 10 sampled patients. This deficient practice had the potential to affect the 90 current patients and any future patient admitted for home health services. Findings include: Review of the policy titled "Care Planning," revised January 2022, indicated ". . . The case manager may delegate specific care management activities to another licensed paraprofessional such as a Licensed Practical Nurse (LPN). . .The licensed paraprofessional: . . .will collaborate and participate in the planning with the licensed professional on modification of the plan based on identification and communication of changes in the patient's status in collaboration with the ordering physician or allowed practitioner. . ." 1. Review of P1's "Home Health Certification and Plan of Care dated 12/16/21 to 02/13/22," located in the "Orders" tab under the "Medical Records Info" tab indicated an order for the licensed professional to report vital signs falling outside the established parameter of systolic blood pressure less than 90 and above 150 and diastolic blood pressure less than 50 and above 90. Review of P1's "Visit Note Report," dated 02/03/22 and located in the "Visit Notes" tab under the "Medical Records Info" tab, indicated P1's blood pressure was 180/80. Further review indicated documentation by Licensed Practical Nurse (LPN) 2 that showed "This SN [skilled nurse] called and spoke to [name of doctor] who advised patient to take ½ [one-half] tab of Amlodipine now, re check [sic] BP [blood pressure] in 30-60 min. [minutes]. If BP is above 160 patient is to take another ½ tab. Patient also to take her regular dose of 5mg [5 milligrams] at bedtime tonight. [name of doctor] advises these instructions are one time only and if BP continues to be elevated pt [patient] is to contact PCP [primary care physician] for further instructions. Spoke to [name of patient's daughter], patients [sic] daughter, and advised above information, [name of daughter] and patient voiced understanding. Patient and this SN were unable to find Amlodipine bottle. This SN spoke to daughter who states she thinks she was only able to fill the med box with Amlodipine through Tuesday and will contact the pharmacy to pick up the refill. Patient did not take Amlodipine while this SN was present however [name of daughter] was going to pharmacy to pick up the medication. . . SN visit report given to supervisor/case manager." There was no documentation that LPN2 reported to the RN case manager that the orders given to treat the elevated blood pressure were not implemented. In an interview on 04/04/22 at 1:00 PM, Clinical Manager (CM) stated LPN2 should have reported to the RN case manager that the orders to treat the elevated blood pressure were not implemented. 2. Review of P9's "Home Health Certification and Plan of Care dated 12/21/21 to 02/18/22," located in the "Orders" tab under the "Medical Records Info" tab, indicated the skilled nurse frequency was two times a week for one week then three times a week for eight weeks with two as needed visits for wound complications. Review of P9's physician order dated 12/22/21 indicated "effective 12/26/21" the skilled nurse frequency was two times a week for eight weeks with two as needed visits for wound care or complications. Review of P9's visits for the week of 01/16/22, located in the "Visit Notes" tab under the "Medical Records Info" tab, indicated a skilled nurse visit was missed 01/21/22 with documentation of a note that P9's physician was notified. There was no documentation that a second visit the same week was performed or attempted, and there was no documentation that the RN case manager was notified that a nursing wound care visit was missed. In an interview on 04/05/22 at 10:08 AM, ADO stated a skilled nurse visit was missed the week of 01/16/22, and there was no documentation that the RN case manager was notified of the missed wound care visit. ADO stated there should be either a visit note or a missed visit note with documentation that the physician and the RN case manager was notified of the missed visit.