Every finding on record at Chmg of Griffin, LLC.

A Recertification Survey was conducted at Centerwell Home Health on November 18, 2024, and concluded on November 20, 2024. At the time of the survey, the agency was in compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 infection control.

A Recertification Survey was conducted at Centerwell Home Health on November 18, 2024, and concluded on November 20, 2024. At the time of the survey, the agency was not in compliance with Chapter 42 CFR Part 418, Rules and Requirements for Home Health and Hospice Agencies. The census was 1159. The following deficiency was cited.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on the Centers for Medicare & Medicaid Services (CMS) Home Health Agency (HHA) Error Summary by Agency Report, review of policy “Patient Assessments,” and staff interview, it was determined that the agency failed to electronically transmit Outcome and Assessment Information Set (OASIS) data to CMS system within 30 days of completing the assessment. Findings include: Review of policy titled “Patient Assessments,” number 03-05, revised 8/2024, revealed the following: OASIS Data Collection • OASIS data items will be collected and transmitted within 30 calendar days of the completion of the OASIS assessment. Review of CMS report titled “HHA Error Summary by Agency,” dated 10/31/2024, revealed the agency failed to transmit OASIS data to CMS system within 30 days. On 11/20/2024 at approximately 11:00 am, an interview with the Branch Director (BD) confirmed OASIS data had not been submitted to CMS within 30 days of completion. The BD revealed OASIS transmission problems were identified in July of 2024 but have since been resolved.

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, facility document review, and staff interviews, it was determined that the Licensed Practical Nurse (LPN) AA failed to follow standard precautions during wound care treatment to prevent the transmission of infectious and communicable diseases for one patient (P) (P#9) of seven sampled home-visit patients. Findings include: During observation of wound care at a home visit on 11/19/2024 at approximately 1:30 p.m., LPN AA performed wound care on P#9. LPN AA dropped gloves on the floor, picked up the gloves and used them during the wound care treatment. LPN AA cleaned bilateral leg wounds of P#9 with 4x4 gauzes, applied Dakin’s solution (used as an antiseptic, e.g. to cleanse wounds in order to prevent infection) and wiped the wounds in a circular motion three times. LPN AA used same scissors to cut dirty wound dressing and to cut alginate (a biodegradable dressing made from seaweed that absorbs exudate and forms a gel). LPN AA placed the dressing on the left leg wound of P#9. LPN AA failed to follow standard precautions during the wound care and to prevent the transmission of infectious and communicable diseases for P#9. Review of the document titled ““Lippincott Procedures for Wound Care,” dated February 20, 2024, revealed the following: Clean the wound with normal saline solution or another prescribed wound cleanser to remove exudate, crusts, and old topical medication • To clean the wound mechanically, start at the center of the wound and clean the wound gently with a moistened gauze pad, working outward toward the edges in a circular pattern Clean at least 1 inch beyond the edged of the area to be dressed, using a fresh gauze pad for each circle. Don’t return to the center of the wound with the gauze pad after cleaning it to avoid recontaminating the wound. Remove loose tissue with the gauze pad. Discard the soled gauze in the sealable waterproof trash bag. Remove and discard your soiled gloves. Perform hand hygiene. Put on new gloves. During the interview with the Administrator on 11/19/2024 at approximately 2:30 p.m., the Administrator verbalized that LPN AA has been trained to use infection control techniques. At approximately 2:30 p.m., on 11/19/2024, an interview was conducted with LPN AA who verbalized understanding for the potential infection control breech during wounds care and acknowledged she did not clean scissors before using them to cut the clean dressing to put on the wound.

At the time of the survey, Kindred At Home in Peachtree city , Georgia, was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a recertification survey conducted on 12/1/21. A Focus Infection Control Survey was completed at the time of the survey. Census was 936. No deficiencies were cited.

At the time of the survey, Kindred At Home in Peachtree city in Georgia was in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of a recertification survey conducted on 12/1/21. A Focus Infection Control Survey was completed at the time of the survey. Census 936. Following deficiencies were cited.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency staff failed to include orders to cover all pertinent diagnoses and ensure patients' needs were addressed to include disease specific treatments/interventions were included on plans of treatment for four of seventeen (#1, #3, #11 and#17.) sampled patients (P). Findings include: 1. During a home visit observation on 12/1/21 at approximately 9:30 a.m, with the skilled nurse (SN) for P#1 with a certification period of 11/11/21 to 1/9/22, this surveyor observed the SN assessing the patient’s vital signs. The SN attempted to take the blood pressure in the left arm however, the patient stopped the SN and informed the SN that blood pressures could not be taken in the left arm as he/she has a fistula located there which is used for dialysis treatments. The SN then proceeded to take the blood pressure in the right arm. Additionally, during the home visit, the spouse informed this surveyor that the patient is currently on a 32-ounce daily fluid restricted diet. During a review of the plan of care, the plan of care lacked any safety measures to protect the patient’s arteriovenous fistula such as no blood pressures or venipuncture on the left arm. Also, the plan of care lacked any documentation of fluid restrictions. The agency failed to ensure the plan of care covered all pertinent precautions and interventions for the comprehensive care of the patient. During an interview on 12/1/21 at 12:00 p.m., the Administrator and Clinical Manager acknowledged the plan of care was incomplete and that precautionary measures should be listed on the plan of care to ensure patient safety. 2. During a home visit observation on 11/30/21 at approximately 1:30 p.m, with the physical therapist (PT) for P#3 with a certification period of 11/15/21 to 1/13/22, the spouse informed this surveyor that the patient is currently on a 40-ounce daily fluid restricted diet. During a review of the plan of care, the plan of care lacked any documentation of fluid restrictions. The agency failed to ensure the plan of care covered all pertinent interventions for the comprehensive care of the patient. During an interview on 12/1/21 at 12:00 p.m., the Administrator and Clinical Manager acknowledged the plan of care was incomplete in that the fluid restriction was not identified on the plan of care. 3. Review of the plan of care for patient #11 with a certification period of 5/16/21 to 8/14/21 revealed the patient has a pertinent diagnosis of Type 2 diabetes mellitus. The plan of care instructs the SN to report blood glucose values outside of parameters to physician however, the plan of care does not contain blood glucose parameters and also lacks patient specific interventions such as blood glucose monitoring frequency which would prompt the staff to notify the physician for early intervention and treatment of a diabetic exacerbation. The agency failed to ensure the plan of care was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 12/2/21 at 12:00 p.m., the Administrator and Clinical Manager acknowledged the plan of care was incomplete and did not include clear instruction for the care of the patient’s diabetic status. 4. Review of the plan of care/treatment for P #17 with a certification period of 10/15/21 to 12/13/21, revealed that patient has a history of long-term use of anticoagulants and patient is currently taking Eliquis (blood thinner) 2.5 mg twice daily for anticoagulant therapy. However, the plan of care lacks teaching on anticoagulant therapy and prevention of bleeding caused by anticoagulant therapy. The agency failed to ensure that the plan of care included all pertinent interventions for the care and treatment of anticoagulation therapy. During an interview on 12/1/21, at 2:00 p.m. the Administrator and the Clinical Manager (CM) confirmed the plan of care/treatment lacked teaching and assessment of anticoagulation therapy.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency failed to ensure the clinical records contained clear, complete, and accurate documentation for three of seventeen (#1, #4, and #13) patients (P) who were current hospice beneficiaries. The findings include: 1. Review of the plan of care for patient #4 with a recertification period of 10/2/21 to 11/30/21 required the skilled nurse (SN) to perform multiple wound care as follows: Cleanse left dorsal 3rd toe with wound cleanser or normal saline, pat dry, apply betadine-soaked emulsion gauze. Cover with dry gauze secure with tape. Cleanse right medial heel with wound cleanser or normal saline. Apply antifungal ointment three times a week. Dress heel with mepliplex silver foam and secure with Band-Aid. The SN visited the patient on 11/8, 11/10, 11/12, 11/16 and 11/18/21, and documented the wound care was provided as per order. However, the SN failed to document the specific steps and supplies used to complete the wound care as required, the SN did not specify the steps taken or products used during the procedure. The SN failed to completely document wound care procedure as required. Clinical notes must include clear, accurate, and contain complete documentation of any and all services provided. 2. Review of the plan of care for patient #13 (closed record) with a certification period of 6/15/21 to 8/13/21, revealed a diagnosis of type 2 diabetes mellitus with foot ulcer. The plan of care required the skilled nurse (SN) to perform wound care to bilateral feet diabetic ulcers as follows: Cleanse with wound cleanser and gauze, apply hydrogel, cover with bordered foam dressing, using clean/aseptic technique. Change dressing every other day and as needed. May use equivalent products. The SN visited the patient on 7/18 and 7/23, and documented the wound care was provided as per order. However, the SN failed to document the specific steps and supplies used to complete the wound care as required, the SN did not specify the steps taken or products used during the procedure. The SN failed to completely document wound care procedure as required. Clinical notes must include clear, accurate, and contain complete documentation of any and all services provided. During an interview on 12/1/21, at 1:00 p.m., the Administrator and the Clinical Manager confirmed the SN failed to document the specific steps and supplies used to complete the wound care as required. 3. Review of the plan of care for Patient #1 with a recertification period of 11/11/21 to 1/9/22 revealed an order for wound care to right lower leg which reads as follows:" cleanse with wound cleanser, apply medihoney, cover with adaptic and gauze. Secure with roll gauze and tape. May use equivalent products. Change dressing 3 times a week and as needed. The skilled nurse (SN) visited the patient on 11/17/21 and documented patient complained of pain during wound care however, the SN failed to document specific products and step taken to complete wound care. The agency failed to ensure that the wound care procedure was performed and documented according to clear and concise instructions as ordered by the physician. During an interview on 12/1/21 at 12:00 p.m., the Administrator and Clinical Manager acknowledged the documentation regarding the wound care was incomplete.