Advanced Home Health Care Incorporated

The skilled professional failed to ensure the following: failed to develop and evaluate the plan of care (See tag G0708); failed to provide the services as indicated in the plan of care (See tag G0710); failed to provide the patient and caregiver education (See tag G0714); and failed to prepare…

The agency failed to develop and maintain an emergency preparedness communication plan which included names and contact information for staff, entities providing services under arrangement, patients' physicians, and other agencies.

The agency failed to ensure the comprehensive assessment was updated and revised to include a new wound in 1 of 2 active clinical records reviewed with wounds.

The agency failed to ensure all necessary medical information pertaining to the patient’s current course of illness and treatment was sent to the receiving health care practitioner to ensure the safe and effective transition of care in 1 of 2 closed records reviewed (#3) and in 1 of 1 active…

The registered nurse (RN) failed to provide written instructions for patient care by the home health aide (HHA) which followed the patient’s plan of care in 1 of 1 clinical record reviewed with home health aide services.

The agency failed to ensure the entries into the clinical record included a signature and date in 1 of 3 active clinical records reviewed.

The agency failed to protect the clinical record and safeguard against loss or unauthorized use.

The agency failed to ensure the patients were provided the name of the administrator in order to receive complaints in 2 of 2 home visits conducted.

The agency failed to ensure the comprehensive assessment reflected the patient’s current status in 2 of 2 home visits.

The agency failed to ensure the comprehensive assessment included the patient’s primary caregiver and other available support, including their willingness and ability to provide care in 2 of 5 clinical records reviewed.

The agency failed to ensure the plan of care was reviewed by the physician responsible for the plan of care at least every 60 days in 3 of 5 clinical records reviewed.

The agency failed to ensure revisions to the plans for patient discharge was communicated to the physician responsible for the plan of care in 1 of 1 closed record reviewed for discharge not at the patient’s request.

The agency failed to ensure the caregiver received education and training provided by the agency regarding the care and services identified in the plan of care for 2 of 5 clinical records reviewed.

The agency failed to provide the patient and caregiver in writing a copy of treatments to be administered by the agency in 2 of 2 home visits conducted.

The registered nurse failed to provide services as directed in the plan of care in 3 of 4 clinical records reviewed with wounds.

The home health aide (HHA) failed to provide services as included in the plan of care in 1 of 1 clinical record review with home health aide services.

The home health aide (HHA) failed to report changes in the patient’s condition to the registered nurse in 1 of 1 clinical record review with home health aide services.

The clinical manager failed to provide oversight of the patient and personnel assignments.

The administration failed to ensure services provided under arrangement had a written agreement.

The agency failed to ensure a completed discharge summary was sent to the primary care physician within 5 days of discharge from the agency in 2 of 2 closed records reviewed.

The home health agency failed to ensure: the plan of care was reviewed by the physician, individualized and followed by all agency staff (See tag G0572); the plan of care included all required information / elements for the treatment of the patient (See tag G0574); all patient care orders…

The agency failed to develop and implement individualized emergency preparedness plans for agency patients which provided appropriate instructions in the event of an emergency in 5 of 7 clinical records reviewed.

The agency failed to develop and maintain an emergency preparedness communication plan which included a method for sharing information and medical documentation for patients under the agency's care.

The agency failed to ensure the patients received the services as directed in the plan of care and the plan of care was individualized in 3 of 5 active clinical records reviewed (#3, #4, #7) The findings include: 5. Clinical record review on 10/14/2021 for patient #7, start of care 5/7/2021…

The home health agency failed to provide services and treatment as ordered by a physician in 2 of 5 active clinical records reviewed.

The agency failed to document the quality improvement projects, the reasons for conducting these projects, and the measurable progress achieved.

The home health agency failed to ensure all employees practiced standard precautions and followed agency infection control policies and procedures at 3 of 3 home health visits with a registered nurse.

The home health agency failed to maintain a program for identification, prevention, control and investigation of infectious and communicable diseases specific to care and services provided in the home setting The findings include: Review of an agency policy received on 10/14/2021 titled “Infection…

The home health agency failed to ensure patients received all services ordered in the plan of care in 1 of 5 active clinical records reviewed.

The home health agency failed to review all medications the patient was currently taking in order to identify any potential adverse effects and drug reactions in 5 of 7 clinical records reviewed.

The agency failed to ensure the individualized plan of care included all medications and treatments in 3 of 5 active clinical records reviewed (#1, #3, #7) The findings include: 4. Clinical record review on 10/14/2021 for patient #7, start of care 5/7/2021, evidenced an agency document titled “Home…

The agency failed to provide treatments only as ordered by a physician in 2 of 7 clinical records reviewed.

The agency failed to promptly alert the physician to changes in the patient's condition in 4 of 5 active clinical records reviewed.

The home health agency failed to revise the plan of care to reflect current health status and nursing needs in 2 of 5 active clinical records reviewed.

The agency failed to coordinate care of services provided to the patient in 2 of 5 active clinical records reviewed.

The home health agency failed to ensure the written visit schedule was provided to patients in 2 of 3 home visit patients observed (#1, #5) The findings include: 1. An agency policy titled "Care Planning Process," revised April 2021, stated " ...

The agency failed to provide written instructions to the patient regarding, patient's medication schedule and medication instructions in 2 of 3 home visits conducted.

The agency failed to ensure the performance improvement activities focused on high risk or problem-prone areas.

The skilled nurse failed to provide patient and caregiver education and/or the correct education in 2 of 5 active clinical records reviewed.

The home health agency failed to ensure the skilled nurse prepared clinical notes per the agency's policy in 1 of 5 active clinical records reviewed.

The skilled nurse failed to communicate with the physician and other health care practitioners in 1 of 5 active clinical records reviewed.

The administrator failed to ensure the day-to-day operations of the home health agency.

The clinical manager failed to provide oversight for the coordination of referrals.

The clinical manager failed to provide oversight and develop, implement and update the individualized plan of care in of 2 of 5 active clinical records reviewed.

The home health agency: failed to develop and maintain a comprehensive emergency preparedness plan that is reviewed and updated at least every 2 years (see tag E0004); failed to develop and maintain a comprehensive emergency preparedness plan which included a documented, facility-based and…

Requesting HCA [home care aide] 1x/week for safety with showering SN 1x/week HCA 1x/week...." Clinical Record review evidenced an agency document titled "Recert [recertification] Case Conference" dated 3/31/21, and signed by office coordinator which stated "Please get auth [authorization] for HCA…

The quality assurance and performance improvement (QAPI) program: failed to measure, analyze and track quality indicators and other aspects of performance that enable the agency to assess processes of care, agency services and operations and failed to show measurable improvement in indicators which…

The home health agency failed to ensure the organization and management of the home health agency as follows: failed to ensure the administrator maintained the day to day operations of the agency (see tag G0948); failed to ensure the clinical manager provided oversight of the storage of medication…

The agency failed to review the emergency preparedness plan at least every 2 years.

The agency failed to follow the agency's policy to annually evaluate the risk assessment.

The agency failed to ensure an emergency preparedness plan was developed and maintained to include a process for cooperation and collaboration with local, regional, State and Federal emergency preparedness officials' and efforts were made to maintain an integrated response during a disaster or…

6. Clinical record review on 7/13/2021 for patient #1, start of care 6/9/2021, evidenced an agency document titled "Home Health Certification and Plan of Care", electronically signed by RN [Registered Nurse] L , which stated, "... Emergency Plan Developed...." Clinical record review failed to…

The agency failed to develop and implement emergency preparedness policies and procedures which included procedures to inform State and local emergency preparedness officials about on-duty staff or patients the agency was unable to contact.

The agency failed to ensure the emergency preparedness policies and procedures included the use of volunteers or other emergency staffing strategies to address surge needs during an emergency.

The agency failed to develop and maintain an emergency preparedness communication plan which included names and contact information for staff, entities providing services under arrangement, patients' physicians, volunteers and other agencies.

The agency failed to develop and maintain an emergency preparedness communication plan which included contact information for Federal, State, tribal, regional, and local emergency preparedness staff and other sources of assistance.

The agency failed to develop and maintain an emergency preparedness communication plan which included a method for sharing information and medical documentation for patient's under the agency's care, as necessary, with other health providers to maintain the continuity of care and a means for…

The agency failed to develop and maintain an emergency preparedness communication plan which included a method for sharing information and medical documentation for patient's under the agency's care, as necessary, with other health providers to maintain the continuity of care and a means for…

The agency failed to provide and maintain documentation of initial training and every 2 years thereafter in emergency preparedness policies and procedures to all new and existing staff and individuals providing services under arrangement and failed to demonstrate staff knowledge of emergency…

The agency failed to conduct an additional exercise of choice every 2 years, opposite the year the full-scale exercise was conducted, to include, but not limited to, another full-scale or facility-based functional exercise, table top exercise, workshop or mock drill.

The home health agency failed to ensure the Oasis was completed, accurate and reflected the patient's current status in 5 of 8 complete clinical records reviewed (#2, #5, #6, #7, #8) and 2 of 2 partial clinical records (#9, #10) reviewed.

The agency failed to ensure the comprehensive assessment was updated and revised as frequently as the patient's condition warranted due to a major decline in the patient's health status in 1 of 2 closed clinical records reviewed.

9. Clinical record review on 7/13/2021 for patient #3, start of care 5/10/2021, evidenced an agency document titled "Home Health Certification and Plan of Care" for certification period 5/10/2021 - 7/8/2021, the diagnoses included, but were not limited to, pressure ulcer [open sore] of the left…

The home health agency failed to provide services and treatment as ordered by a physician in 1 of 2 closed clinical records reviewed.

The agency failed to measure, analyze and track quality indicators, including adverse patient events and other aspects of performance that enable the agency to assess processes of care and agency services and failed to show measurable improvement in indicators which will improve health outcomes…

The home health agency failed to ensure the governing body approved the frequency and detail of the data collection for quality indicator data utilized by the Quality Assessment and Performance Improvement (QAPI) program.

The agency failed to ensure the performance improvement activities tracked adverse patient events, analyzed their causes and implemented preventative actions.

The home health agency failed to ensure they documented the quality improvement projects undertaken, the reasons for conducting these projects and the measurable progress achieved on these projects.

The home health agency's governing body failed to ensure an ongoing program for quality improvement and patient safety was implemented and maintained and that the quality assessment and performance improvement (QAPI) efforts addressed priorities for improved quality of care and patient safety.

The home health agency failed to ensure all employees practiced standard precautions and followed agency infection control policies and procedures at 1 of 1 home health visits with a licensed practical nurse.

This document stated [Patient] was given antibiotics in the hospital due to recurrent infection Review of the agency's infection control documents on 7/13/21, failed to evidence any entries for patient #1 for the year 2021. During an interview on 7/13/21 at 1:22 PM, the clinical manager indicated…

The agency failed to provide infection control education to staff in 7 of 10 personnel records reviewed.

The skilled nurse failed to assess the patient's pain per agency policy in 3 of 8 complete clinical records reviewed.

Requesting HCA [home care aide] 1x/week for safety with showering SN 1x/week HCA 1x/week...." Clinical record review failed to evidence the skilled nurse created a home health aide care plan and assigned a home health aide to patient #4. 17-14-1(m) 17-13-2(a) Based on record review and interview…

The clinical manager failed to provide oversight of the storage of medication used to provide tuberculosis (TB; a contagious bacterial infection usually affecting the lungs) skin tests to agency personnel.

Review failed to evidence the patient was informed and consented to the care to be provided, the frequency of visits, and failed to evidence the patient participated in and was informed of the plan of care.

The home health agency failed to ensure patients received all services documented in the plan of care in 5 of 8 complete clinical records (#1, #3, #5, #6, #7) and 2 of 2 partial clinical records (#9, #10) reviewed.

The agency failed to ensure the comprehensive assessment was completed within 30 calendar days after the start of care in 1 of 2 closed clinical records reviewed.

6. Clinical record review on 7/13/2021 for patient #3, start of care 5/10/2021, evidenced an agency document titled "Patient Medication Record." This document stated " ... Metoprolol [treats high blood pressure] Tartrate Oral 100 MG [milligrams] 1 Tab (s) [tablets] Daily BETA BLOCKER [reduced blood…

4. Clinical record review on 7/14/21 for patient #4, start of care 5/30/21, evidenced an agency document titled "Plan of Care," signed by RN E dated 5/24/21, and signed by physician G, which had a subsection titled "Medications," which stated Lasix [treats fluid retention] Oral 40 MG 1 tab (s)…

SN [skilled nurse] 1w1[once a week for one week]; 3w1 [three times a week for one week] ; 2w1 [twice per week for one week] and 2 PRN [as needed] visits for VAC problem...." This document failed to be authenticated and dated by the physician.

The agency failed to provide services and treatments only as ordered by a physician in 6 of 8 complete clinical records reviewed.

SN [skilled nurse] 1w1[once a week for one week]; 3w1 [three times a week for one week] ; 2w1 [twice per week for one week] and 2 PRN [as needed] visits for VAC problem...." This document failed to be authenticated and dated by the physician.

The alternate clinical manager indicated she was unsure as to why there was not a plan of care for this certification period 17-13-1(a)(2) Based on record review and interview, the agency failed to ensure the individualized plan of care was reviewed by the physician at least every 60 days in 2 of 6…

This document had a subsection titled "Wounds Assessed on this Visit" which stated Wound 1-Location R [right] foot top of 2nd toe Status: open, Present on admission Thickness: Full Type Diabetic Size: Length 2 cm [centimeter] Width 1.5 cm Depth 0.7 cm Woundbed pink , pink/red 40% Wound edges…

The home health agency failed to revise the plan of care to reflect current health status and nursing needs in 4 of 8 complete clinical records reviewed.

The agency failed to coordinate care of services provided to the patient in 4 of 8 complete clinical records reviewed (#1, #3, #6, #7) and 2 of 2 partial clinical records (#9, #10) reviewed.

The home health agency failed to ensure the written visit schedule was provided to patients in 3 of 3 home visit patients observed (#1, #4, #6) The findings include: 1. An agency policy titled "CARE PLANNING PROCESS" revised November 2017 stated " ...

The folder did not contain a medication schedule for patient #4. During an interview on 7/15/21 at 12:16 PM, patient #4 indicated she had a medication list she wrote and follows.

The agency failed to ensure the performance improvement activities focused on high risk, high volume or problem-prone areas.

The home health agency failed to ensure the performance improvement activities considered incidence, prevalence and severity of problems.

The licensed practical nurse (LPN) failed to provide ongoing interdisciplinary involvement of all skilled professionals involved in the patient's care in 1 of 2 clinical records reviewed receiving skilled care from a LPN.

The skilled nurse failed to develop and evaluate the plan of care in 2 of 6 active clinical records reviewed.

3. Clinical record review on 7/13/2021 for patient #3, start of care 5/10/2021, evidenced an agency document titled "Home Health Certification and Plan of Care" for certification period 5/10/2021 - 7/8/2021, the diagnoses included, but were not limited to, pressure ulcer [open sore] of the left…

3. Clinical record review on 7/13/2021 for patient #3, start of care 5/10/2021, evidenced an agency document titled "Home Health Certification and Plan of Care" for certification period 5/10/2021 - 7/8/2021, the diagnoses included, but were not limited to, pressure ulcer [open sore] of the left…

The home health agency failed to ensure the physical therapist and skilled nurse prepared clinical notes per the agency's policy in 5 of 8 clinical records reviewed.

The skilled nurse failed to communicate with the physician and other health care practitioners in 1 of 8 clinical records reviewed.

All skilled professional staff failed to participate in the agency's quality assurance and performance improvement (QAPI) program.

All licensed professionals providing services on behalf of the agency failed to participate in agency-sponsored in-service training in 5 of 7 skilled professional personnel records reviewed.

The home health agency failed to ensure the home health aides provided services that were ordered and included in the plan of care and consistent with the aide care plan in 3 of 3 clinical records reviewed with home health aide services ordered.

The home health aide failed to report changes in the patient's condition to a registered nurse in 1 of 2 clinical records reviewed receiving home health aide services.

The home health aide supervision failed to ensure the home health aides followed the aide care plan in 2 of 2 clinical records reviewed receiving home health aide services.

The administrator failed to ensure the day to day operations of the home health agency.

The clinical manager failed to provide oversight in making patient and personnel assignments.

The clinical manager failed to provide oversight for the coordination of patient care.

The clinical manager failed to provide oversight for the coordination of referrals.

The clinical manager failed to provide oversight and develop, implement and update the individualized plan of care.

The agency failed to ensure the clinical record included all clinical notes and plans of care in 2 of 6 active clinical records reviewed.

The agency failed to ensure the clinical record included the patient's goals and progress towards the goals in the plan of care in 1 of 2 closed clinical records reviewed.

The home health agency failed to ensure the transfer and discharge summary was completed and sent to the primary care physician in 1 of 2 clinical records reviewed with a transfer to a hospital (#1) and 2 of 2 closed clinical records (#7, #8) reviewed.