Centerwell Home Health

The agency failed to transmit all comprehensive assessments within the 30 day timeframe as required by CMS Conditions of Participation (CoP).

The Agency failed to ensure there was a documented complete review of the medication side effects and possible drug interactions for 1 (# 11) of 17 (#1-#17) client records reviewed.

The Agency failed to ensure the Physician’s order was followed for 2 (#11 and #12) of 5 (#11 -#15) patient wound treatments observed.

The Agency failed to ensure a complete Discharge/Transfer Summary completed and sent to the Physician after Transfer in 1 (#1) of 17 Clinical Records Reviewed (#1-#17).

The Agency failed to provide care in accordance with the written Plan of Care (POC) in 1 (#2) of 10 (#1 - #10) Clinical Records reviewed.

The Skilled Nurse (SN) failed to include all medications Patient is taking during the review of the patients medications in 1 (#5) of 10 (#1 - #10) Clinical Records reviewed.

The Agency failed to transmit Outcome and Assessment Information Set (OASIS) patient data within 30 days of the assessment completion date for 2 (#3 and #6 ) of 7 (#1 - #7) Clinical Records reviewed.

The Agency failed to include assessment of the patients current health status, relevant past medical history and all active diagnosis in the Resumption of Care (ROC) comprehensive assessment for 1 (#5) of 7 (#1 - #7) Clinical Records reviewed.

The Skilled Nurse failed to clarify a discrepancy in medications in the home with the ordering Physician in 1 (#3) of 3 (#1 - #3) home visits performed.

The Agency Skilled Nursing (SN) staff failed to develop accurate and timely written Plans of Care (POC) in that the POCs did not include current diagnosis in 2 (#3 and #5) of 7 (#1 - #7) and all current medications in 3 (#1, #3 and #5) Clinical Records reviewed.

The Agency failed to alert the Physician to changes in patients condition which may have necessitated an alteration in the Plan of Care (POC) in 2 (#5 and #6) of 7(#1 - #7) Clinical Records reviewed.

The Agency failed to provide patients with a written copy of medication schedule / instructions in 2 ( #1 and #3) of 3 (#1 - #3) home visits performed.

The Skilled Nurse failed to adhere to the patients written Plan of Care (POC), in that, the Physician was not notified of Blood Pressures (BP) outside of ordered parameters in 2 (#3 and #5) and failed to provide interventions as ordered in 3 (#3, #5 and #6) ) of 7 (#1 - #7) Clinical Records…