Every finding on record at Senior Home Care Inc

An unannounced recertification survey was conducted 11/12/34 through 11/14/24 at Centerwell Home Health, a Home Health Agency in Port Charlotte, Florida. Centerwell Home Health Agency is not in compliance with Code of Federal Regulations (CFR) 42, Part 484, Conditions of Participation for Home Health Services. The following is a description of the noncompliance.

HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator's name, business address, and business phone number in order to receive complaints. This ELEMENT is not met as evidenced by: Based on observation, record review and interview, the agency failed to provide the Home Health Agency’s administrator’s contact information for reporting complaints for 1 (#13) patient out of 7 patients sampled. The findings included: On 11/13/2024 at 11:05 a.m., during a home visit with patient #13, observation showed there was not an agency admission binder, which contains administrator contact information for the Home Health Agency, in the home. On 11/13/2024 at 11:10 a.m., during interview with patient #13 he said the Registered Nurse did not bring an admission binder on the initial visit. He said they forgot to bring one and he has never received one. Record review of a sample of the agency’s admission binder, showed the administrator contact information in the binder. On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said the binder is brought to the home during the initial visit. If there is not one in the home on subsequent visits, someone will bring one on the next visit.

OASIS privacy notice CFR(s): 484.50(a)(1)(iii) (iii) An OASIS privacy notice to all patients for whom the OASIS data is collected. This ELEMENT is not met as evidenced by: The agency failed to provide an OASIS (Outcome and Assessment Information Set), privacy notice to 1 (#13) patient out of 7 patients sampled. The findings included: On 11/13/2024 at 11:05 a.m., during a home visit with patient #13, observation showed there was not an admission binder which contains the OASIS privacy notice in the home. On 11/13/2024 at 11:10 a.m., during an interview with patient #13, he said the Registered Nurse did not bring an admission binder on the initial visit. He said he has never received one. Record review of the agency’s sample admission binder showed the OASIS privacy notice in the binder. On 11/14/2024 at 5:00 p.m., during an interview, the Executive of Clinical Quality, said the binder is brought to the home during the initial visit. If they don’t notice one in the home during a visit, someone will bring one on the next visit.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on documents reviewed, incident reporting log, policy review and interviews the agency failed to ensure 1 patient (#18) of 18 sampled patients was free from verbal abuse. The home health agency failed to provide evidence of complying with the state law for reporting abuse. The findings included: During review of complaint/grievance log revealed on 1/4/24 Complaint Report. The complaint report was made by agency staff member L. Staff L reported to the agency's Branch Director he witnessed contractor Nurse K, verbally abusing a patient using profanity and verbally threatening the patient. On 11/14/24, at 3:22 p.m., during an interview with staff member L confirmed patient #18 had a cervical infusion dressing changed by the nurse. During the treatment on 1/4/24 he witnessed Nurse K nurse verbally threatening the patient. "It was boarding on verbal abuse. I called the Branch Director." The Branch Director called to smooth things out with the patient while I was present. The patient appeared to be okay after talking with the Director. Review of the Home Health Policy Abuse/Neglect/ Exploitation Policy: The Clinical Manager Must ensure prompt same-day notification to the appropriate agency/authorities (adult protective services, policy department) and the patient's physician/allowed practitioner. is responsible for follow-up on notifying appropriate agencies/authorities and the patient's physician /allowed practitioner. On 11/14/24 during an interview with the Branch Director she said, "We did not file an Abuse report to the state because we informed the Staffing Agency, who referred Contractor K to us."

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: The agency failed to provide the Florida state home health telephone hot line, contact information, the hours of operation and the information that the hotline is to be used for complaints and questions about home health agencies for 1 (#13) patient out of 7 patients sampled. The agency failed to provide the Florida state home health telephone hot line, contact information, the hours of operation and the information that the hotline is to be used for complaints and questions about home health agencies for 1 (#13) patient out of 7 patients sampled. The findings included: On 11/13/2024 at 11:05 a.m., during a home visit with patient #13, observation showed the admission binder, which contains the Florida State home health telephone hot line, was not in the home. On 11/13/2024 at 11:10 a.m., during an interview with patient #13, he said the Registered Nurse did not bring an admission binder on the initial visit. He said he has never received one. Record review of the agency’s admission sample binder showed the information for the Florida state home health telephone hot line in the binder. On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said the binder is brought to the home during the initial visit. If one is not located within the home, someone will bring one on the next visit.

Contact info Federal/State-funded entities CFR(s): 484.50(c)(10)(i,ii,iii,iv,v) Be advised of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: (i) Agency on Aging (ii) Center for Independent Living (iii) Protection and Advocacy Agency, (iv) Aging and Disability Resource Center; and (v) Quality Improvement Organization. This ELEMENT is not met as evidenced by: The agency failed to provide the contact information for the Florida department of Elder Affairs for 1 (#13) patient out of 7 patients sampled. The findings included: On 11/13/2024 at 11:05 a.m., during a home visit with patient #13, observation showed there was not an admission binder which contains the contact information for the Florida department of elder affairs, in the home. On 11/13/2024 at 11:10 a.m., during an interview with patient #13, he said the Registered Nurse did not bring an admission binder on the initial visit. He said he has never received one. Record review of the agency’s sample admission binder showed the contact information for the Florida department of elder affairs is in the binder. On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said the binder is brought to the home during the initial visit. If there is not one in the home during a visit, someone will bring one on the next visit.

Access to auxiliary aids and language service CFR(s): 484.50(c)(12) Be informed of the right to access auxiliary aids and language services as described in paragraph (f) of this section, and how to access these services. This ELEMENT is not met as evidenced by: The agency failed to inform the client of the right to have information for auxiliary aids and language services for 1 (#13) patient out of 7 patients sampled. The findings included: On 11/13/2024 at 11:05 a.m., during a home visit with patient #13, observation showed there was not an admission binder which contains the information for auxiliary aids and language services in the home. On 11/13/2024 at 11:10 a.m., during an interview with patient #13, he said the Registered Nurse did not bring an admission binder on the initial visit. He said he has never received one from the agency. Record review of the agency’s sample admission binder showed the information for auxiliary aids and language services in the binder. On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said the binder is usually brought to the home during the initial visit. If there is not one in the home on a visit, someone will bring one on the next visit.

Transfer and discharge CFR(s): 484.50(d) Standard: Transfer and discharge. The patient and representative (if any), have a right to be informed of the HHA's policies for transfer and discharge. The HHA may only transfer or discharge the patient from the HHA if: This STANDARD is not met as evidenced by: The agency failed to inform the client of the Home Health Agency’s transfer and discharge policy for 1 (#13) patient out of 7 patients sampled. The findings included: On 11/13/2024 at 11:05 a.m., during a home visit with patient #13, observation showed there was not an admission binder which contains the Home Health Agency’s transfer and discharge policy in the home. On 11/13/2024 at 11:10 a.m., during an interview with patient #13, he said the Registered Nurse did not bring an admission binder on the initial visit. He said he has never received one. Record review of the agency’s admission binder showed the agency’s transfer and discharge policy in the sample binder. On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said the binder is brought to the home during the initial visit. If one is not in the home, someone will bring one on the next visit.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based upon observation, record review and interview, the agency failed to reconcile the patient’s medication profile during admission assessment and after medication changes for 2 (#12and #13) out of 7 patients sampled. The findings included: On 11/13/2024 at 09:15 a.m., during a home visit observation with patient #12, it was noted that the patient’s current medications were not reconciled in the patient’s record. On 11/13/2024 at 09:30 a.m., during an interview with patient #12’s caregiver, he said the patient was taking magnesium 200mg daily and CoQ10 occasionally. These supplements were not reviewed with the caregiver or patient by staff C or added to the patients plan of care. The caregiver said the patient saw her cardiologist on 11/4/2024 and was told to stop taking Diltiazem and Metoprolol and to start taking Labetalol. These medication changes were not added to the plan of care medication profile by the nurse during the visit on 11/6/2024. The Physical Therapist (Staff C) added the changes to Diltiazem, Metoprolol and Labetalol medications after the visit on 11/13/2024. On 11/13/2024 at 11:15 a.m., during a home visit, it was observed that patient #13’s list of current medications was not updated, current and located in the home for the patient to access. On 11/13/2024 at 11:25 a.m., it was observed that a hospital discharge medication reconciliation listed the following medications. Amlodipine Besylate 10 mg(milligrams) daily Ascorbic Acid 250 mg daily Aspirin 81mg daily Cholecalciferol 1000 units daily Docusate Sodium 100 mg daily Multivitamin 1 tablet daily Omega-3 Acid 1000 mg daily On 11/12/2024 during record review of the agency’s medication profile for patient #13, the only medications listed were oxycontin-acetaminophen 5 mg 325 mg every 6 hours as needed and Amlodipine 10 mg daily. On 11/13/2024 at 11:15 a.m., during an interview with the patient #13, he said he had been taking Tylenol for discomfort. Record review of nursing note dated 10/27/2024 showed the patient had reported he was taking Tylenol. Tylenol was not listed as a medication on his plan of care until 11/13/2024. Record review of the Home Health Agency’s 03-41, Medication Review and Documentation Policy stated, “Medication review will be performed by a Clinical Associate each visit to ensure medications are current, accurate and documented on the medication profile within the patients’ medical record.” On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said medications and supplements should be reviewed with the patient every visit and any changes added to the plan of care. A copy of the updated medication list is then mailed to the patient and placed in their binder. If the list is not present at a subsequent visit, the staff will bring a copy at the next visit. On 11/13/2024 at 1:25 p.m., during a home visit, it was observed that the medication profile for patient #14 was not available in the home. On 11/13/2024 at 1:30 p.m., Staff B applied Diclofenac 1% topical gel and did not measure out the medication accurately. The order reads, Diclofenac 1% topical gel, 1 inch topical daily. Record review of the Home Health Agency’s 03-41, Medication Review and Documentation Policy stated, “Medication review will be performed by a Clinical Associate each visit to ensure medications are current, accurate and documented."

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based upon observation, record review and interview the agency failed to ensure a current, accurate medication list that reflects the plan of care, including name, dosage, frequency and administration in 3 (#12, #13, and #14) of 7 patients sampled. The findings included: On 11/13/2024 at 9:15 a.m., during a home visit patient #12, it was observed that the current medication regimen was not updated in the patient’s plan of care and was not accessible to the patient in the home. On 11/13/2024 at 09:30 a.m. it was observed that Staff C did not review the patient #12's supplements with the patient or her caregiver. On 11/13/2024 at 09:30 a.m. during an interview with patient #12’s caregiver, he said the patient was taking magnesium 200mg daily and CoQ10 occasionally. These supplements were not reviewed with the caregiver or patient by staff C or added to the patients plan of care. The caregiver said the patient saw her cardiologist on 11/04/2024 and was told to stop taking Diltiazem and Metoprolol and to start taking Labetalol. These medication changes were not added to the plan of care medication list by the nurse during the visit on 11/06/2024. The Physical Therapist (Staff C) added the Diltiazem, Metoprolol and Labetalol medication changes to the plan of care on 11/13/2024. On 11/13/2024 at 11:15 a.m., during a home visit, it was observed that patient #13’s list of current medications was not available in the home for the patient to access. On 11/13/2024 at 11:25 a.m., observed that a hospital discharge medication reconciliation listed the following medications. Amlodipine Besylate 10 mg(milligrams) daily Ascorbic Acid 250 mg daily Aspirin 81mg daily Cholecalciferol 1000 units daily Docusate Sodium 100 mg daily Multivitamin 1 tablet daily Omega-3 Acid 1000 mg daily On 11/12/2024 during record review of the agency’s medication profile for patient #13, showed the only medications listed were oxycontin-acetaminophen 5 mg 325 mg every 6 hours as needed and Amlodipine 10 mg daily. On 11/13/2024 at 11:15 a.m., during an interview with patient #13, he said he had been taking Tylenol for discomfort. Record review of the nursing note from a visit dated 10/27/2024 showed the patient had reported that he was taking Tylenol. Tylenol was not listed as a medication on his medication profile until 11/13/2024. On 11/13/2024 at 1:25 p.m., during a home visit, it was observed that the medication profile for patient #14 was not available in the home. Record review of the Home Health Agency’s 03-41, Medication Review and Documentation Policy stated, “Medication review will be performed by a Clinical Associate each visit to ensure medications are current, accurate and documented on the medication profile within the patients’ medical record.” On 11/14/2024 at 5:00 p.m., during an interview with the Executive of Clinical Quality, she said medications and supplements should be reviewed with the patient every visit and any changes added to the plan of care. A copy of the updated medication list is then mailed to the patient and placed in their binder. If the list is not present at a subsequent visit, the staff will bring a copy at the next visit.

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 upon observation, record review and interview, the facility failed to follow infection control standards during dressing changes and potentially exposed the patient to infectious organisms in 3 (#13, #14, and #17) out of 7 patients sampled. The findings included: On 11/13/2024 at 11:30 a.m., during a home visit with patient #13 it was observed the patient’s cat jumped onto a table and contaminated staff D’s clean field where her bag and equipment had been placed. The bag was then placed on dirty chair by a neighbor. The outside of the bag had not been sanitized properly before staff D left the house. On 11/13/2024 at 1:30 p.m., during a home visit with patient #14, it was observed that staff A did not sanitize their scissors upon removal from the equipment bag and used them to cut clean dressing supplies. After completing the dressing, the clean field where soiled dressings had been placed, were bundled up by the patient and placed in the box with clean dressing supplies. It was never disposed of properly. On 11/13/2024 at 3:40 p.m., staff B did not clean the scissors when she removed them from the equipment bag and then used them to remove a soiled dressing. Staff B then used them to cut a clean dressing without sanitizing the scissors between. Staff B then placed the scissors back into her bag without sanitizing them. During a record review of the Home Health Agency policy 10-03 Patient Care: Standard Precautions states, “Standard Precautions include but are not limited to: …clean and disinfected environmental surfaces used as workspace…clinician bag technique.” On 11/14/2024 at 5:00 p.m., during an interview with the Clinical Quality Manager, she said the scissors are cleaned before being put into the bag, so they are considered clean when taken out of the bag. She said the staff should clean off the scissors before putting them back in the bag.

Coordinate referrals; CFR(s): 484.105(c)(3) Coordinating referrals, This ELEMENT is not met as evidenced by: Based on observation, record review and interview the agency failed to coordinate a home health aide referral for a patient in 1 (#13) out of 7 patients sampled resulting in potential harm to the patient. The findings included: On 11/13/2024 at 11:15 a.m., during a home visit with patient #13, it was observed that the patient had hospital discharge orders that included a referral for a home health aide. On 11/13/2024 at 11:25 a.m., during an interview with the neighbor of patient #13, she said she is leaving the state and would be unable to help him. She said the patient requires more care from a home health aide. On 11/13/2024 at 10:30 a.m., observation showed the patient lived alone and had difficulty walking to the bathroom unassisted. On 11/13/2024 at 11:30 a.m., during an interview with the patient, he said that he is unable to walk to his bedroom and has been sleeping in the living area. He has been wiping himself clean with wipes because he cannot get into the shower by himself. On 11/14/2023 at 3:15 p.m., during an interview with the Clinical Care Manager, she said the referral was missed. Record review of the patient’s electronic record, showed a copy of the order for a home health aide.

An unannounced recertification survey was conducted on 3/7/22 through 3/9/22 at Kindred at Home, a Home Health Agency in Port Charlotte and Estero, Florida. Kindred at Home is not in compliance with Code of Federal Regulations (CFR) 42, Part 484, Conditions of Participation for Home Health Services. The following is a description of noncompliance.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on medical record review, interviews and policy review the home health agency failed to ensure all services were performed based on the patient’s needs, as ordered, and as documented in the Home Health Certification and Plan of Care for 1(patient #9) of the 11 patients sampled. Policy: 03-02A Assignment of Clinicians, Revised: 1/19/2018: 1. Staff will be assigned to provide care for each patient based on professional qualification and competency, patient’s needs… Resident #9 medical record review revealed and initial Start of Care Date of 12/1/21 with 2 Certification Periods, 12/1/21 to 1/29/21, and 1/30/22 to 3/30/22. The home health agency is to provide the following skilled services, Physical Therapy, Occupational Therapy and Skilled Nursing. Skilled Nursing visit as ordered, 1 visit 1 week, then 1 visit every 2 weeks for 8 weeks. The Skilled Nurse orders, as noted on the Plan of Care, to assess/evaluate patient’s co-morbid conditions to include, diabetes II (DM II), and other conditions that present themselves during the episode to identify changes and intervene to minimize complication. Review of the medical record revealed: Nursing Notes12/1/21: Admission Assessment performed by a Skill Nurse, failed to provide documentation of the patient’s weight or the patient’s blood sugar. Nursing Notes 12/15/21: Skilled Nurse visit failed to provide document of the patient’s weight or the patient’s blood sugar. Nursing Notes 12/29/21: Skilled Nurse visit failed to provide document of the patient’s weight or the patient’s blood sugar. (Phone Visit) Nursing Notes 1/13/22: Skilled Nurse visit failed to provide document of the patient’s weight or the patient’s blood sugar. Nursing Notes 1/26/22: Skilled Nurse Recertification Assessment failed to provide document of the patient’s blood sugar. Nursing Notes 2/9/22: Skilled Nurse visit failed to provide document of the patient’s weight or the patient’s blood sugar Nursing Notes 2/24/22: Skilled Nurse visit failed to provide document of the patient’s weight. The Coordination Notes Report sheet, dated 2/24/22, notes the patient’s, blood sugar. This is the very first documentation of the patient’s blood sugar. On 3/8/22 at 12:03 p.m. during interview with Patient #9, she said: "Now I am doing my blood sugars. I don’t have a scale. The nurse does not weigh me. I give the home health nurse the weight from the doctor’s office. They weigh me at the doctor’s office; I give that weight". On 3/8/22 at 12:30 p.m. during interview with the Branch Director, she said the weights were not done. She confirmed blood sugar tests were not done during the Skilled Nurse’s visits.