Aunova Home Care LLC

The registered nurse failed to update / revise the comprehensive assessment for a change in the patient's condition for 1 of 1 records reviewed with a change in the patient's condition.

The agency failed to ensure all clinical document entries were complete, appropriately authenticated, dated, and timed for 6 of 7 records reviewed (#1, 2, 3, 4, 5, 6).

The agency failed to ensure it adhered to patient rights by failing to ensure all agency patients were informed in advance of (but not limited to) any changes in the care such as types, discharges or frequency of visits to be furnished for 1 of 4 discharged records reviewed (#4), and failed to…

The agency failed to ensure all patients received all services outlined in the individualized plans of care for 2 of 7 records reviewed (#1, 7).

The home health agency failed to ensure all agency patients were advised of the Indiana Department of Health toll free home health telephone hot line, its contact information, or its hours of operation.

The home health agency failed to arrange a safe and appropriate transfer to other care entities when the needs of the patient exceeded the HHA's capabilities and/or the agency was no longer able to meet the patient's needs, based on the patient's acuity in 2 of 7 clinical records reviewed.

The agency failed to document both the existence of a complaint and the resolution of the complaint for 2 of 2 records reviewed with complaint(s) made to the agency.

The agency failed to ensure a registered nurse (RN) conducted the initial assessment visit for 1 of 1 records reviewed for patients who received both nursing and therapy services (#1); failed to ensure the initial assessment visit was made either within 48 hours of referral, or within 48 hours of…

The clinician failed to ensure the comprehensive assessment included a complete picture of the patient's current health status for 5 of 7 clinical records reviewed (#1, 2, 3, 4, 5).

The agency failed to ensure admitting clinicians completed a medication profile that included drug regimen review as part of the initial comprehensive assessment, and failed to immediately notify the physician to resolve issues identified for 4 of 7 records reviewed (#1, 2, 3, 6).

The home health agency failed to incorporate the OASIS (Outcome and Assessment Information Set) data collected at inpatient facility admission or discharge only, and include the sensory and integumentary status in the OASIS data items in 1 of 7 clinical records reviewed.

The agency failed to ensure all patients' plans of care included all required elements for 6 of 7 patient's plans of care reviewed (#1, 2, 3, 4, 5, 6).

The agency failed to ensure all disciplines assigned to the patients maintained effective interdisciplinary communication to meet the patient's needs and treatment effectiveness for 2 of 7 records reviewed (#1, 4).

The home health agency failed to ensure it provided patient education and documentation of the patient's response and comprehension of the education for 2 of 7 records reviewed (#1, 2).

The agency failed to provide all agency patients with a written copy of the plan of care, which included (but was not limited to) all treatments to be provided to the patient by agency personnel for 1 of 1 records reviewed with a home visit (#7).

The agency failed to provide the patient with the name of the agency's clinical manager for 1 of 1 records reviewed with a home visit (#7).

The home health agency failed to ensure the skilled professionals provided patient and caregiver education in 1 of 7 clinical records reviewed.