Every finding on record at Patwell Ct, Inc

Unannounced visits were concluded at Pathwell CT Inc. on 12/07/2023 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits concluded on 12/07/2023 at Pathwell CT Inc. in Stratford for the purpose of recertification. Standard-level deficiencies were identified.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on review of the clinical record, review of agency policies and interview with agency personnel for one of seventeen patients (Patient #13) in the survey sample, the agency nurses failed to provide the services. The findings include: Patient #13 had a start of care date of 6/07/23 and diagnoses that included hypertensive heart and chronic kidney disease and type II diabetes mellitus. The physician's orders dated 6/07/23 included nursing services once weekly for assessments. Interview and review of LPN #3’s documentation dated 6/28/23, 7/14/23 and 7/21/23 with the Administrator and SCS on 12/07/23 at 10:20 AM identified a weekly visit was attempted, but the patient didn’t answer the phone and/or did not answer the door, but agency nurse failed to notify the physician of an alteration in the plan of care. Review of agency policy for Plan of Care directed that each patient must receive home health services that are written in an individualized plan of care. If the agency misses a visit as required by the plan of care, the agency must notify the responsible physician of such missed service.

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 clinical record review, observation, review of agency policies and interview with agency personnel, for one of seven patients (Patient #5) visited during the survey, the agency nurse failed to maintain accepted infection control practice. The findings include: Patient #5 had a start of care date of 8/22/23 and diagnoses that included stage II pressure ulcers of the left buttock and left medial posterior lower leg and venous thrombosis. The physician's orders for the certification period of 10/21/23 to 12/19/23 included nursing services three times a week for wound care to the left medial posterior lower leg by cleansing with normal saline followed by the application of Opticel, covering with an ABD pad and wrapping the left lower leg with Kerlix and general assessments. During a joint home visit with LPN #2 on 12/06/23 at 10:35 AM, the surveyor observed LPN #2 wash his/her hands with soap and water upon arrival, don gloves, remove the left lower leg dressing, discard the dressing in a bag, doff gloves, then reapply clean gloves to cleanse the wound without the benefit of sanitizing hands between glove changes. Subsequent to surveyor inquiry, LPN #2 indicated that the agency policy was to wash /sanitize hands at the end of the visit. Interview and review of LPN #2’s joint home visit with the Administrator and Supervisor of Clinical Services/SCS on 12/06/23 at 12:15 PM failed to indicate that LPN #2 followed the agency policies on hand hygiene between glove changes. The agency policy on Hand Hygiene directed the staff must perform hand hygiene using soap and water or an alcohol-based hand sanitizer before and after patient contact, after touching potentially contaminated surfaces and after removing gloves.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on clinical record review, review of agency policies and interview with the agency personnel, for two of five patients (Patient’s #1 and # 5) receiving wound care, the agency licensed personnel failed to follow agency policies. The finding includes: Patient # 1 had a start of care date of 7/13/23 with diagnoses that included Diabetic Mellitus with Right Foot Diabetic Ulcer, and Chronic Kidney disease with Peritoneal Dialysis. The physician's orders for the certification period 11/10/23 through 1/8/2024 included nursing services 2 times (2) a week for wound care including weekly wound measurements, nursing assessments for diabetic management, diet, and peritoneal dialysis monitoring, education and fluid overload monitoring, and medication management. Review of the clinical documentation with the Supervisor of Clinical Services (SCS) on 12/6/23 at 12:15pm, identified in the clinical nursing notes, for 11/14/23, 11/17/23, 11/21/23, 11/29/23, and 12/5/23, the notation " wound care provided as ordered", but failed to identify within the clinical note, the wound care provided, the physical location of the wound and the wound bed characteristics, in accordance to the agency Wound Care policy. Patient #5 had a start of care date of 8/22/23 and diagnoses that included stage II pressure ulcers of the left buttock and left medial posterior lower leg and venous thrombosis. The physician's orders for the certification period of 10/21/23 to 12/19/23 included nursing services three times a week for wound care to the left medial posterior lower leg by cleansing with normal saline followed by the application of Opticel, covering with an ABD pad and wrapping the left lower leg with Kerlix and general assessments. The patient’s left buttock wound was healed. Interview and review of LPN #2’s nursing notes dated 10/27/23, 11/03/23 and 11/17/23 with the Administrator on 12/06/23 at 1 PM identified that wound care was provided per physician’s orders but failed to identify the specific wound care provided and the physical characteristics of the wound according to agency policy. Review of agency Wound Care policy directed to assess and accurately document physical characteristics such as location, stage, size, tissue type, wound bed and peri wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, necrotic tissue, odor, presence/absence of granulation tissue and epithelialization.

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: Based on clinical record review, review of agency policies, observation and interview with agency personnel, for one of five patients (Patient #5) receiving wound care, and/or for one of seventeen patients (Patient #13) in the survey sample, the agency licensed personnel failed to ensure the care delivered was in accordance with the physician's orders. The findings include. Patient #5 had a start of care date of 8/22/23 and diagnoses that included stage II pressure ulcers of the left buttock and left medial posterior lower leg and venous thrombosis. The physician's orders for the certification period of 10/21/23 to 12/19/23 included nursing services three times a week for wound care to the left medial posterior lower leg by cleansing with normal saline followed by the application of Opticel, covering with an ABD pad and wrapping the left lower leg with Kerlix and general assessments. During a joint home visit with LPN #2 on 12/06/23 at 10:35 AM, the surveyor observed LPN #2 cleansing the left lower leg wound with a gallon of clear solution. Subsequent surveyor observation of the solution identified the solution was distilled water. LPN #2 indicated that the normal saline solution was unavailable in the home and was on reorder. Upon arrival to the next joint home visit with LPN #2, the surveyor inquired about the availability of additional supplies on hand in his/her bag or trunk and the LPN identified the s/he had normal saline in his/her bag showing the surveyor but failed to utilize it for Patient #5’s wound care instead of using distilled water. Interview and review of LPN #2’s joint home visit with the Administrator and SCS on 12/06/23 at 12:15 PM identified that the LPN failed to follow physician’s orders for wound care and should have accessed the normal saline in his/her bag. Interview and review of the clinical record with the SCS on 12/06/23 at 2PM identified that LPN #2 was unable to visit for wound care on 11/24/23 (the third visit of the week), no subsequent visit was attempted, and failed to follow the physician-certified plan of care for three times a week wound care. Patient #13 had a start of care date of 6/07/23 and diagnoses that included hypertensive heart and chronic kidney disease and type II diabetes mellitus. The physician's orders dated 6/07/23 included nursing services once weekly for assessments. Interview and review of LPN #3’s documentation dated 6/28/23, 7/14/23 and 7/21/23 with the Administrator and SCS on 12/07/23 at 10:15 AM identified a visit was attempted but the patient didn’t answer the phone and/or did not answer the door, no subsequent visit was attempted and failed to follow the physician- certified plan of care for once weekly visits. Review of agency policy for Plan of Care directed that each patient must receive home health services that are written in an individualized plan of care.

Unannounced visits were concluded at Shamrock Home Care on 5/20/2021 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits were concluded at Shamrock VNA HHA Agency on 5/20/2021 for the purpose of recertification. Standard-level deficiencies were identified.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on clinical record review and interview with the agency personnel, for one of one patient (Patient #2) who required medication management, the agency nurses failed to document medication pre-pour in accordance with the agency policy. The findings include: Patient #2 had a start-of-care date of 12/15/2020 and diagnoses that included Parkinson's disease and chronic kidney disease. The physician's orders for the certification period of 4/14/2021 through 6/12/2021 included nursing services one to two times a week for weekly medication pre-pouring and general assessments. ii. Interview and review of RN #1's nursing note dated 4/19/2021 with the Administrator on 5/20/2021 at 10 AM indicated that medications were pre-poured from the current medication profile dated 2/12/2021 (instead of the current medication profile dated 4/14/2021) through 4/26/2021 and failed to identify the interval of the weekly pre-pouring that the medications were poured for. ii. Interview and review of RN #1's nursing note dated 4/27/2021 with the Administrator on 5/20/2021 at 10 AM indicated that medications were pre-poured from the current medication profile dated 4/14/2021 through next nursing visit dated 5/4/2021 and failed to identify the interval of the weekly pre-pouring that the medications were poured for. The agency policy on Medication Pre-pouring directed the nurse to document the pre-pouring activities in the Medication Management section of the electronic record that the medication box was pre-filled from the current medication profile list with the from (date) to (date).

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on clinical record review and interview with agency personnel, for one of two patients (Patient #4) requiring wound care, the agency nurses failed to provide the necessary assessments. The findings include: 2. Patient #4 had a start of care date of 9/22/2020 and diagnoses that included stage II pressure ulcer of the sacrum, Lewey bodies dementia and type II diabetes mellitus. The physician's orders for the certification period of 3/21/2021 through 5/19/2021 included skilled nursing services one to two times a week to assess, teach, measure weekly and provide wound care using wound wash followed by calcium alginate Ag into the open area and covered with a bordered foam dressing two times a week by nursing and as needed by the private caregiver. Interview and review of the nursing notes with the Administrator on 5/20/2021 at 11 AM identified weekly nursing services provided to Patient #4 but failed to identify documentation of wound measurements by RN #2 for the week of 3/21/2021 (RN # 2 visited on 3/23/2021 and 3/25/2021) and/or the week of 4/04/2021 (RN # 2 visited on 4/06/2021) and/or the week of 4/11/2021 (RN #2 visited on 4/15/2021) and/or the week of 5/02/2021 (RN #2 visited on 5/04/2021 and 5/06/2021. The agency policy on Wound Care directed nursing to evaluate and measure wounds upon admission and at least weekly thereafter.

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: Based on clinical record review and interview with agency personnel, for one of seven patients (Patient #4) in the survey sample, the agency nurses failed to ensure the care delivered was in accordance with the physician's orders. The findings include: Patient #4 had a start of care date of 9/22/2020 and diagnoses that included stage II pressure ulcer of the sacrum, Lewey bodies dementia and type II diabetes mellitus. The physician's orders for the certification period of 3/21/2021 through 5/19/2021 included skilled nursing services one to two times a week to assess, teach, measure weekly and provide wound care two times a week by nursing and as needed by the private caregiver. Interview and review of the nursing notes with the Administrator on 5/20/2021 at 11 AM failed to identify twice weekly visits by nursing for the week of 4/04/2021 (RN # 2 visited on 4/06/2021 only) and/or the week of 4/11/2021 (RN #2 visited on 4/15/2021 only) and failed to identify the delivery of nursing services in accordance with the physician's orders.