Every finding on record at Centre Homecare Inc

Based upon an unannounced on site Medicare recertification conducted February 21, 2023 through February 24, 2023, Centre Homecare, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based upon an unannounced on site Medicare recertification conducted February 21, 2023 through February 24, 2023, Centre Homecare, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: 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 reviews of agency policy, clinical records (CR), and interview with the Vice President of Clinical (EMP#1), it was determined the agency failed to obtain the countersignature of the physician within seven (7) days for five (5) of thirteen (13) CRs reviewed. (CR# 3, CR# 4, CR# 6, CR# 7 and CR# 12) and failed to ensure plan of treatment was followed, including but not limited to prescribed medications for one (1) of thirteen (13) CRs reviewed. (CR# 4) Findings included: Review of agency policy on February 23, 2023, at approximately 2:00 p.m. titled, ‘VNA HEALTH SYSTEM POLICY AND PROCEDURE FOR VERBAL AND TELEPHONE ORDERS' states, "PROCEDURE… 5. The physician orders are to be sent to the physician via fax or liaison the next business day for physician signature. Verbal orders/plans of care are to be returned signed by the physician within 7 days. Outstanding verbal order reports are to be run twice weekly to determine any outstanding verbal orders and the physician is to be called, order faxed again, etc. All attempts to receive the signed vernal order back from the physician timely are to be documented…." Review of agency policy on February 23, 2023, at approximately 2:30 p.m. titled, ‘VNA HEALTH SYSTEM POLICY AND PROCEDURE ON GUIDELINES FOR MEDICATION MANAGEMENT' states, "Purpose: To provide medication regimen review, identification of clinically significant drug issues, notification of the physician responsible for the plan of care of those issues or discrepancies, reconciliation of medication issues/discrepancies as appropriate, and education of the patient/caregiver(s)...Procedure: ...2a. Ongoing assessments are made during visits by the registered nurse and include, but are not limited to:...REMINDER: Oxygen is included as a medication....2. patient's compliance with the medication regimen... Review of CRs on February 23, 2023, between approximately 12:00 p.m. to 3:00 p.m. revealed the following: CR# 3, Start of Care (SOC), 6/10/2022: Plan of Treatment (POT) recertification period reviewed 2/5/2023-4/5/2023. POT sent to the physician on 2/8/2023. POT signed by physician on 2/16/2023 (11 days after start of certification period.) No documentation provided showing additional attempts to make contact with physician after the initial 7 days of the recertification period. CR# 4, SOC, 11/2/2022: POT recertification period reviewed: 1/1/2023-3/1/2023. Primary diagnosis: Type 2 Diabetes with diabetic peripheral angiopathy (a blood vessel disease caused by high blood sugar levels (glucose) w/o (without) gangrene (death of body tissue due to a lack of blood flow or a serious bacterial infection). Other diagnosis included but were not limited to: Dependence on supplemental oxygen. Medication orders included but were not limited to: Oxygen 2-4 LPM (liters per minute) continuously. 3 LPM at rest and 4 LPM with activity. Skilled nursing orders include: Perform and assess vital signs…Assess, teach, manage and evaluate and perform medication regimen to include name, dose, frequency, route, desired action, side effects, interactions, adverse reactions recognition of problems and how to report, including high risk medications… - - Skilled Nursing Visit Assessment on 1/18/2023 showed vital sign of Oxygen documented as “2LPM”. No documentation provided of skilled nurse educating patient on setting the oxygen on the incorrect LPM dose, educating patient on desired action, discussing why the patient lowed the oxygen dose and no inquiry of whether or not the oxygen prescription needs to be changed to meet the needs of the patient. - - Skilled Nursing Visit Assessment on 1/25/2023 showed vital sign of Oxygen documented as “97% on RA (room air)”. No documentation provided of skilled nurse educating patient on the continuous oxygen prescription, educating patient on desired action, discussing why the patient was not continuously wearing her oxygen and no inquiry of whether or not the oxygen prescription needs to be changed to meet the needs of the patient. - - Skilled Nursing Visit Assessment on 2/2/2023 showed vital sign of Oxygen documented as “97% on RA (room air)”. No documentation provided of skilled nurse educating patient on the continuous oxygen prescription, educating patient on desired action, discussing why the patient was not continuously wearing her oxygen and no inquiry of whether or not the oxygen prescription needs to be changed to meet the needs of the patient. - - Skilled Nursing Visit Assessment on 2/10/2023 showed vital sign of Oxygen documented as “97% on RA (room air)”. No documentation provided of skilled nurse educating patient on the continuous oxygen prescription, educating patient on desired action, discussing why the patient was not continuously wearing her oxygen and no inquiry of whether or not the oxygen prescription needs to be changed to meet the needs of the patient. - - Skilled Nursing Visit Assessment on 2/15/2023 showed vital sign of Oxygen documented as “93% on RA (room air)”. No documentation provided of skilled nurse educating patient on the continuous oxygen prescription, educating patient on desired action, discussing why the patient was not continuously wearing her oxygen and no inquiry of whether or not the oxygen prescription needs to be changed to meet the needs of the patient. - OT sent to the physician on 1/17/2023 (16 days after the start of the recertification period). POT signed by physician on 1/18/2023. (17 days after start of certification period.) No documentation provided of POT being sent to the physician for signature the next business day per the agency’s policy. No documentation provided of POT being sent to the physician for signature within the first 7 days of the restart of certification period. No documentation provided showing additional attempts to make contact with physician after the initial 7 days of the recertification period. CR# 6, SOC, 1/24/2023: POT certification period reviewed 1/24/2023-3/24/2023. POT sent to the physician on 1/27/2023. POT signed by physician on 2/6/2023 (13 days after start of certification period.) No documentation provided showing additional attempts to make contact with physician after the initial 7 days of the recertification period. CR# 7, SOC, 1/25/2023: POT certification period reviewed 1/25/2023-3/25/2023. POT sent to the physician on 1/31/2023. POT signed by physician on 2/8/2023 (14 days after start of certification period.) No documentation provided showing additional attempts to make contact with physician after the initial 7 days of the recertification period. CR# 12, SOC, 2/23/2022: POT certification period reviewed 2/23/2022-4/23/2022. Physical therapy evaluation visit was conducted on 2/25/2022. Physical therapy plan of care sent to the physician on 3/9/2022. Physical therapy plan of care signed by physician on 3/9/2022 (12 days after the physical therapy plan of care was created.) No documentation provided showing additional attempts to make contact with physician after the initial 7 days of the physical therapy plan of care. Interview with EMP# 1 on 2/23/2023 at approximately 3:00 p.m. confirmed above findings.

Based on the findings of an unannounced, onsite, complaint investigation conducted on June 9, 2022, Centre HomeCare, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on review of agency policy, registered nurse job description, clinical records (CRs) and interviews with agency Vice President Clinical Eastern Region (EMP# 1), it was determined that the registered nurse failed to ensure documentation was current, accurate and consistent for one (1) of one (1) CRs reviewed. (CR# 1) Findings: Policy 'Medical Record Documentation' reviewed on June 9, 2022 at approximately 10:30 a.m. reads, "Procedure...5. Make sure that all your entries are accurate, timely, objective, specific, concise, consistent, comprehensive, logical, legible, clear, descriptive, and reflect your thought processes as you are making them...." 'Job Description Registered Nurse' reviewed on June 9, 2022 at approximately 11:00 a.m. reads, "Documentation:...Maintain current and accurate medical records on all patients...." Policy 'Medical Record (with Patient Drug regimen Review) and Patient Medication Profile' reviewed on June 9, 2022 at approximately 11:45 a.m. reads, "Policy:...The Medication Record is utilized to document all patient medication information upon admission to service and to be continually updated so as to reflect a current patient medication list...." Review of CR was conducted on June 9, 2022 between approximately 11:00 a.m. and 3:00 p.m. revealed the following: CR# 1, Start of Care (SOC): 7/25/2020: Certification Period reviewed: 5/16/2022-7/14/2022. Medications Listed included: "Suboxone 2 films daily, Lisinopril 20 mg (milligrams) daily, Zofran 4 mg every 6 hours as needed, Santyl 1 application daily and Dakins Solution 1 application daily if odor." - Resumption of Care Comprehensive Assessment dated 5/5/2022 under section, 'Endocrine' was typed, "Diabetes, Insulin Dependent, Able to Administer Insulin, Able to Draw Up Insulin" and under section, 'Medication' an 'X' was marked next to, "No injectable medications prescribed." -Recertification Comprehensive Assessment dated 5/11/2022 under section, 'Endocrine' was typed, "Diabetes, Insulin Dependent, Able to Administer Insulin, Able to Draw Up Insulin" and under section, 'Medication' an 'X' was marked next to, "No injectable medications prescribed." - Skilled Nursing Visit Assessment dated 5/13/2022 under section, 'Endocrine' was typed, "Diabetes, Insulin Dependent, Able to Administer Insulin, Able to Draw Up Insulin" and under the 'Medications' section it states, "All medications were reviewed for duplication, dose, action, S/E (side effects), drug interaction, new/changes medication, patient need for education." - Skilled Nursing Visit Assessment dated 5/16/2022 under section, 'Endocrine' was typed, "Diabetes, Insulin Dependent, Able to Administer Insulin, Able to Draw Up Insulin" and under the 'Medications' section it states, "All medications were reviewed for duplication, dose, action, S/E (side effects), drug interaction, new/changes medication, patient need for education." Registered nurse failed to ensure documentation consistent, accurate and reflected medication list. No insulin was listed on the Medication list. An interview conducted with EMP# 1 on June 9, 2022 at approximately 2:15 p.m. confirmed the policy/procedure as current and the above findings.