Amberkare Home Health, Inc

The agency failed to ensure the emergency preparedness plan included the process for collaboration with the regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation.

The agency failed to ensure the emergency preparedness plan included procedures to inform State and local emergency preparedness officials about HHA patients in need of evacuation from their residences at any time due to an emergency situation based on the patient's medical and psychiatric…

The agency failed to ensure the emergency preparedness plan included procedures to inform State and local officials of any on-duty staff or patients that they are unable to contact.

The agency failed to ensure the emergency preparedness P&P included a system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains availability of records.

The agency failed to ensure the emergency preparedness plan included the use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency.

The agency failed to ensure the emergency preparedness plan included a communication plan that showed the contact information for tribal and regional emergency preparedness staff.

The agency failed to ensure the emergency preparedness plan included method for sharing information and medical documentation for patients under the agency's care, as necessary, with other health providers to maintain the continuity of care.

The agency failed to ensure the emergency preparedness communication plan included a means of providing information about the agency's occupancy, needs, and its ability to provide assistance to the authority having jurisdiction, the Incident Command Center, or designee.

The agency failed to send all necessary medical information pertaining to the patient's current course of illness and treatment, post-discharge goals of care, and treatment preferences to the receiving facility to ensure the safe and effective transition of care for one of eight sampled patients…

The agency failed to ensure the SN and the CHHA missed visits were rescheduled for two of eight sampled patients (Patients 2 and 7).

The agency failed to ensure the initial assessment visit was conducted within 48 hours of referral for one of eight sampled patients (Patient 3).

The agency failed to ensure the initial comprehensive assessments were completed in a timely manner, consistent with the patient's immediate needs, but no later than five calendar days after the SOC date for one of eight sampled patients (Patient 3).

The agency failed to ensure the medication profiles were reviewed and updated to reflect the current medications and include specific indications and parameters for its use for two of eight sampled patients (Patients 3 and 4).

The agency failed to ensure the comprehensive assessment was updated within the last five days of every 60 days for one of eight sampled patients (Patients 6).

The agency failed to ensure the POCs included specific information related to medications, DME and blood sugar instructions for five of eight sampled patients (Patients 1, 3, 6, 7, and 8).

The agency failed to ensure the treatment was provided only as ordered by the physician for three of eight sampled patients (Patients 1, 7, and 8).

The agency failed to revise and update the POC for one of eight sampled patients (Patient 1).

The agency failed to ensure the wound care, PT, and OT services were coordinated for five of eight sampled patients (Patients 1, 3, 6, 7, and 8).

The agency failed to provide a written instruction outlining the visit schedule for one of eight sampled patients (Patient 3).

The agency failed to provide care and services as per the written plan of care for two of eight sampled patients (Patients 1 and 7).

The agency failed to ensure the instructions or teachings on wound care as advised by wound care consults were provided to patients/caregiver for one of eight sampled patients (Patient 7).

The agency failed to ensure the agency's skilled professionals prepared accurate clinical notes for four of eight sampled patients (Patients 1, 3, 7, and 8).

The agency failed to ensure the HHA’s RN provided supervision to the LVN to ensure quality of care and services were provided for two of eight sampled patients (Patients 1 and 6).

The agency failed to ensure the agency's RN provided the onsite supervision for the CHHA no less frequently than every 14 days to ensure quality of care and services provided for one of eight sampled patients (Patient 1).

The agency's Administrator failed to be responsible for the day-to-day operations related to the following: -The written agreements with Contractors 1, 2, 3, 4, 5, and 6 did not include the roles, rights and responsibilities. -The PT/OT evaluation was not conducted timely for five of eight sampled…

The agency failed to send a completed Transfer Summary to the receiving hospital within two business days for one of eight sampled patient (Patient 7).

The agency failed to ensure the emergency preparedness plan consistently included facility-based and community-based risk assessment and the strategies addressing the emergency events identified by the risk assessment, creating the potential risk of not providing the necessary care and services to…

The agency failed to ensure the emergency preparedness plan included the process for collaboration with the regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation.

The agency failed to ensure the emergency preparedness P&P included procedures to inform the state and local officials of any on-duty staff or patients that they are unable to contact.

The agency failed to ensure the emergency preparedness P&P included a system of medical documentation that protected confidentiality of the patient information; and secured and maintained availability of records.

The agency failed to ensure the emergency preparedness P&P included the use of volunteers in an emergency or other emergency staffing strategies including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency.

The agency failed to develop the communication plan to include contact information for the staff, entities providing services under arrangement, and volunteers, creating the risk of not able to contact or request for assistance during emergency events.

The agency failed to develop the communication plan to include contact information for Federal, State, and regional preparedness staff, creating the risk of not able to contact or request for assistance during emergency events.

The agency failed to ensure the emergency preparedness communication plan included a method for sharing information and medical documentation for patients under the HHA's care, as necessary, with other health providers to maintain the continuity of care.

The agency failed to ensure the emergency preparedness communication plan included a means of providing information about the agency's occupancy, needs, and its ability to provide assistance to the authority having jurisdiction, the Incident Command Center, or designee.

The agency failed to ensure the trainings in the emergency preparedness program was provided to all staff, creating the risk of the HHA's staff not knowing what to do in case of emergency.

The agency failed to analyze the quality indicators to assess the processes of care as part of the QAPI program.

The agency failed to implement infection control practices related to the use of a medical equipment for one of seven sampled patients (Patient 4).

The agency failed to implement and maintain the infection control program which included surveillance, identification, prevention, and control, creating the risk of spread of infections.

The agency failed to ensure their COVID-19 P&P included the process of ensuring all staff were fully vaccinated for COVID-19; and the process by which staff may request an exemption from the COVID-19 vaccination requirements.

The agency failed to ensure the medication profiles were updated to reflect the current medications, including specific indications and parameters for their use; all side effects, actual or potential drug interactions; and duplicate drug therapy for five of seven sampled patients (Patients 2, 3, 5…

The agency failed to coordinate the care to meet the patients' care needs for four of seven sampled patients (Patients 1, 2, 3, and 5).

The agency failed to ensure the SN provided education to the patient/PCG related to the patient’s disease process for one of seven sampled patients (Patient 3), creating the risk of not providing the necessary care and services to this patient.

The agency failed to provide the written instructions outlining the visit schedules for two of seven sampled patients (Patients 4 and 5).

The agency failed to ensure the care and services were provided in accordance with the POC for five of seven sampled patients (Patients 1, 2, 3, 6, and 7).

The agency failed to ensure the agency's skilled professionals prepared accurate clinical notes for two of seven sampled patients (Patients 2 and 6).

The agency's Administrator failed to ensure the responsibility for the day-to-day operations of the agency as follows: * The agency failed to ensure three of the five employee files reviewed (RNs 2, 3, and LVN 2) had their health assessments completed in a timely manner. * The agency failed to…

The agency failed to ensure the discharge summary was completed for one of the seven sampled patients (Patient 6).