Apple Tree Home Health Care Services, LLC

The agency failed to ensure the comprehensive emergency preparedness program met all requirements to ensure the health, safety, and security needs of their staff and patient population for 1 of 1 agency (E0001); failed to ensure an emergency preparedness plan was in place and reviewed every 2 years…

The agency failed to ensure patients received the frequency of services listed in the POC (G0572), POCs were individualized and included all pertinent information (G0574), treatments were administered only as ordered by a physician (G0580), the physician was notified of the POC not being followed…

The agency failed to provide evidence to show measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care (G642), failed to utilize quality indicator data, including measures derived from…

The agency failed to ensure patients received the frequency of the services listed in their POCs for 3 of 7 active clinical records (Patients #4, #8, and #12) reviewed with HHA services only and 1 of 1 patient receiving SN services only.(Patient #5) Findings Include: 5. Review of the clinical…

The agency failed to ensure the patients were provided current plans of care for 4 of 4 admission packets reviewed in patient residences.

The agency failed to perform hand hygiene and maintain infection prevention practices for 3 of 3 home visits (HHA 1, HHA 2, and HHA 3).

The governing body failed to ensure the Quality Assurance Performance Improvement Plan (QAPI) was maintained for 1 of 1 Governing body.

The agency failed to ensure the patient’s rights were included in the admission packet for 3 of 4 admission packets reviewed during a home visit.

The agency failed to ensure the plan of care was individualized and included all necessary elements including allergies, advanced directive, caregiver status, medication frequency, DME, seizure plan, correct enteral feeding rate, vital sign parameters, psychosocial status, hospitalization risk…

The agency failed to provide services as ordered by the physician for 4 of 7 clinical records (Patient #4, 6, 8, and 12) reviewed with HHA services only and 2 of 3 patient receiving SN services (Patient #3 & Patient #5).

The agency failed to ensure the physician was notified of the frequency of visits not being followed according to the POC for 3 of 7 active clinical records reviewed with HHA services only (Patient #6, #8, and #12) and 1 of 1 active clinical record reviewed with SN services only.

The agency failed ensure the RN coordinated care for 4 of 4 active records reviewed with patients receiving outside services (Patient #4, 5, 6, and 12).

The agency failed to ensure the patients were provided a current schedule of when services would be provided for 4 of 4 admission packets reviewed during home visits (Patient #4, #7, #8, and #11).

The agency failed to ensure the patients were provided current medication lists for 4 of 4 admission packets reviewed in patient residences.

The agency failed to ensure RN supervisory visits were completed for 2 of 3 active records reviewed with patients receiving SN and HHA services (Patient # 3 and Patient #13).

The agency failed to update and review a community-based risk assessment for 2 years (2022-present).

The agency failed to ensure home health aide (HHA) 3 followed standard infection prevention precautions while performing a bed bath for 1 of 1 bed bath observation, with the potential to affect all patients who require a bed bath.

The agency failed to ensure that an individualized plan of care orders was established for 1 of 1 patient without valid current physician orders (#4).

The agency failed to ensure patients and caregivers were notified or received at least a 15-day discharge notice prior to termination of services for 2 of 2 discharge records reviewed (#4, 5).

The skilled nurse (SN) failed to complete a thorough and complete assessment of the patient for 2 of 2 skilled nursing assessments observed (#1, 3).

The agency failed to ensure the patients were provided privacy practice notices, patient rights information, information regarding a confidential clinical record, correct contact information for the state and funded programs required, access to auxiliary aides, discharge notice, and adequate…

The registered nurse (RN) failed to ensure all components were present on the comprehensive assessment.

The agency failed to ensure an accurate and complete plan of care was completed, coordination of care was completed, and that patients were provided with required documents.

The agency failed to develop, implement, evaluate, and maintain an effective, ongoing, agency wide, data-driven quality assurance performance improvement program (QAPI), failed to indicate the frequency and method in which quality indicators were to be measured, analyzed, and tracked, failed to…

The agency failed to ensure all staff followed infection control policies, standard precautions, and that an effective infection control program was created and utilized.

The agency failed to ensure staff knew who the administrator and alternate administrator were for 1 of 2 home health aide's (HHA) interviewed during home visits (employee H), the the governing body, administrator, and director of nursing fulfilled all responsible duties.

The agency failed to ensure staff documentation was not copy and pasted each visit to ensure it met documentation standards for 2 of 5 active records reviewed (#1,5), failed to complete a discharge summary and sent to the primary practitioner (See Tag G 1022), failed to ensure staff visits were…

The registered nurse (RN) failed to ensure outcome and assessment information set (OASIS) questions were answered accurately for 2 of 5 active records reviewed (#2, 3).

The registered nurse (RN) failed to update the comprehensive assessment with updated and revised information for 2 of 5 active records reviewed (#1, 4), in a sample of 10. Findings include: 1. An undated agency policy titled "Comprehensive client assessment," Policy# C-145 stated "POLICY: The…

The agency failed to ensure all staff followed standard precautions and infection control policies for 3 of 3 home visits observed (# 1, 2, 3).

The agency failed ensure an agency-wide infection control program was maintained for the surveillance, identification, prevention, control, and investigation of patient and staff infections with the addition of data regarding the public health emergency related to COVID-19. These practices had the…

The registered nurse (RN) failed to assign home health aides to specific patients and failed to ensure the aide care plan contained patient specific/individualized directions for the home health aide (HHA) to follow that was created by an RN for 5 of 5 active records reviewed with home health aide…

The governing body minutes failed to evidence information regarding policy review updates, and approvals, fiscal operation approvals, budget approvals, operational plans and approvals, and quality assessment performance improvement (QAPI) approvals.

The agency failed to ensure staff visits were authenticated to ensure the visits occurred when they were documented for 2 of 5 active records reviewed (#4, 5), in a total sample of 10. Findings include: 1. An undated agency policy titled "clinical documentation," Policy# C-680 stated " ...PURPOSE…

The agency failed to ensure all clinical records were safeguarded against loss or unauthorized use for 20 of 20 partial or full missing records (#4, 5, 9, 20, 21, 22, 23, 24, 25, 26, 28, 31, 32, 34, 35, 36, 37, 39, 40, and 41).

The agency failed to ensure an Outcome and assessment information set (OASIS) privacy notice was given to all patients who received an OASIS assessment for 3 of 3 home visit observations (#1, 2, 3).

The agency failed to ensure a written copy of the patent's rights and responsibilities were given to the patient/caregiver and maintained in the home folder, to be reviewed periodically with the patient/caregiver by agency staff, for 2 of 3 home visit observations (#2, 3).

The agency failed to ensure all patients were notified of their right to a confidential clinical record and failed to ensure that every patient had a confidential clinical record maintained for 19 of 19 partial or full missing records (#4, 5, 20, 21, 22, 23, 24, 25, 26, 28, 31, 32, 34, 35, 36, 37…

The agency failed to ensure all patients were advised orally and in writing of the charges for home care service before care is initiated for 7 of 8 full records reviewed, in a total sample of 10 (#1, 3, 4, 5, 8, 9, 29).

The agency failed to ensure their policy correlated with regulatory requirements for discharge notice and failed to ensure patients received a 15 day notice of discharge for 3 of 3 discharged records reviewed, in a total sample of 10 (# 8, 9, 29).

The agency failed to advise that patients of the correct hours of operation for the Indiana Department of Health.

The agency failed to provide the names, addresses, and telephone numbers of the following federally-funded and state-funded entities that serve the patients' area of residence, to include the following: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and…

The agency failed to ensure patients were informed of access to auxiliary aids and language services, and how to access them.

The agency failed to ensure all complaints with resolutions were documented.

The registered nurse (RN) failed to ensure the comprehensive assessment reflected the patient's current health psychosocial, functional, and cognitive status for 8 of 8 complete records reviewed, in a sample of 10 total (1, 2, 3, 4, 5, 8, 9, 29).

Failed to ensure the comprehensive assessment contained the patient's goals, and care preferences, as well as information to demonstrate progress toward achievement of goals identified by the patient and measurable outcomes identified by the agency for 8 of 8 complete record reviews, in a total…

The registered nurse (RN) failed to ensure the comprehensive assessment contained information regarding the patient's medical, nursing, rehabilitative, social, and discharge planning needs for 8 of 8 complete record reviews, in a total sample of 10 (#1, 2, 3, 4, 5, 8, 9, 29).

The registered nurse (RN) failed to ensure the comprehensive assessment contained a complete review of medications, drug interactions were identified, and medication lists were accurately maintained for 8 of 8 complete records reviewed, in a sample of 10 total (1, 2, 3, 4, 5, 8, 9, 29).

The registered nurse (RN) failed to ensure the comprehensive assessment contained information regarding the patient's primary caregiver, or lack of one, and their willingness and ability to provide care, availability, and schedule for 8 of 8 complete record reviews, in a total sample of 10 (#1, 2…

The registered nurse (RN) failed to ensure the comprehensive assessment reflected the patient's representative for 3 of 3 records reviewed with needed representatives (#1, 4, 9), in a total sample of 10. Findings include: 1. An undated agency policy titled "Comprehensive client assessment," Policy#…

The registered nurse (RN) failed to ensure the recertification comprehensive assessment was completed the last 5 days of the 60 day period for 2 of 5 active record reviews, in a total sample of 10 (#3, 4).

The agency failed to ensure the plan of care contained all pertinent diagnoses, allergies, measurable goals and outcomes established by the agency and patient, frequency and duration of visits, the patient's risk for emergency room visits and hospitalization with interventions to address the…

The agency failed to ensure care was not provided absent of a physician's order for the start of care for 1 of 5 active records (#3), in a total sample of 10. Findings include: The clinical record of patient #3 was reviewed on 10/28/20 and indicated a start of care date of 5/14/20. The record…

The registered nurse failed to ensure physician verbal orders indicated who the order was received from, and orders were signed in an appropriate amount of time for 5 of 5 active records reviewed, in a sample of 10 (# 1, 2, 3, 4, 5).

The agency failed to ensure the plan of care was reviewed and revised to ensure accurate information was recorded for 1 of 5 active records (#1), in a total sample of 10. Findings include: The clinical record of patient #1 was reviewed on 10/27/20 and indicated a start of care date of 7/11/17. The…

The director of nursing failed to ensure the physician was notified of changes in condition for 1 of 1 skilled nurse visits observed (#3).

The agency failed to ensure coordination of care was completed with the group homes where the patients resided for 1 of 1 active patients who lived in a group home (#1), in a total sample of 10. Findings include: The clinical record of patient #1 was reviewed on 10/27/20 and indicated a start of…

The agency failed to ensure the patient/family received a copy of the visit schedule for home health staff for 3 of 3 home visit observations (#1, 2, 3).

The agency failed to ensure the patient/family received a written copy of the plan of care in order to have knowledge of any treatments to be administered (including teaching, or medication set up) for 3 of 3 home visit observations completed (#1, 2, 3).

The agency failed to ensure the name and contact information of the director of nursing was given to the patients in writing for 3 of 3 home visit observations completed (#1, 2, 3).

The skilled nurse (SN) failed to complete a thorough and complete assessment of the patient during subsequent nursing visits for 2 of 4 patients with skilled nursing (#3, 5), in a sample of 10. Findings include: 1. The clinical record of patient #3 was reviewed on 10/28/20 and indicated a start of…

The skilled nurse (SN) failed to follow the written plan of care for 4 of 4 active records reviewed with skilled nursing services, in a total of 10 records reviewed (#1, 2, 3, 5).

The home health aide failed to follow the plan of care for 8 of 8 complete clinical records reviewed, in a total sample of 10 records (#1, 2, 3, 4, 5, 8, 9, 29).

The home health aides (HHA) failed have knowledge that all changes in patient's condition must be reported to a registered nurse for 2 of 2 interviewed HHA's (employees H and OO).

The administrator failed to be responsible for the day to day functions of the agency.

The administrator failed to ensure that the director of nursing was available during all operating hours.

The agency failed to ensure the alternate administrator was authorized in writing by the governing body.

The administrator failed to be available during all operating hours.

The director of nursing (DON) failed to make all personnel and patient assignments.

The director of nursing (DON) failed to coordinate agency referrals.

Citation Text for Tag 0968, Regulation D101 Stout, Amber Based on record review and interview, the director of nursing (DON) failed to ensure plans of care were developed, implemented, and updated per the individualization of the patient for 5 of 5 active records reviewed (# 1, 2, 3, 4, 5 ), in a…

The agency registered nurse (RN) failed to complete a discharge summary and sent to the primary practitioner for 3 of 3 discharged records reviewed (#8, 9, 29).