Carroll Area Nursing Services

The agency failed to ensure participation in emergency preparedness exercises annually included an after action report.

The agency failed to complete an accurate drug regimen review within the required time frame as part of the comprehensive assessment at the time of admission, resumption of care, or discharge from agency services in 3 of 13 sampled patients.

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/equipment used by the patient for 4 of 13 sampled patients (Patients #1, #5, #7 and #10).

The agency failed to update the Plan of Care with all new physician orders for 2 of 8 sampled patients with interim orders.

The agency failed to provide services and treatments are administered only as ordered by the physician for 2 of 13 sampled patients (Patient's #3 and #13).

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 3 of 6 sampled patients receiving home health aide services…

The agency failed to ensure the patient's clinical record included accurate and specific documentation of interventions and maintained pertinent current information in the patient record for 4 of 8 sampled patients (Patients #3, #4, #5 and #10) with wounds.

The agency failed to ensure staff provided care in accordance with accepted infection control standards of practice observed during a home visit for 1 of 5 sampled patients (Patient #2) with home visits.

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 4 of 8 sampled patients receiving home health aide services (Patients #6 #7, #11 and #12).

The agency failed to ensure authentication of electronic entries made in each patient's clinical record included the employee's signature, title, date and time of the signature for 2 of 4 sampled patients with therapy services (Patients #2 and #9).

The agency failed to assess each patients medications for duplication, side effects, ineffectiveness, actual or potential interactions and non-compliance within the required time frames, identifying medication discrepancies, as part of the initial comprehensive assessment at admission and as part…

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/equipment used by the patient to meet individualized needs, specific treatments and patient-specific interventions/education for 10 of 13 sampled patients (Patients #1, #2, #4…

The agency failed to report changes in patient clinical findings or changes in patient needs to the physician for 2 of 2 sampled patients experiencing a change in condition requiring physician notification (Patients #1 and #7).

The agency failed to perform ongoing interdisciplinary assessments of the patient for 1 of 6 sampled patients with alteration of skin integrity (Patient #7).

The agency failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care for 4 of 11 sampled patients (Patients #1, #9, #11 and #12).

The agency failed to ensure clinician's completed routine visit notes in a timely manner according to the agency policy and administrative expectations for 6 of 14 sampled patients (Patients #1, #5, #6, #7 #8 and #12).

The agency: 1) Failed to notify the physician of the inability to complete interventions on the Plan of Care as ordered (Please refer to G 572); 2) Failed to ensure the agency skilled staff completed an individualized Plan of Care that contained accurate information.

The agency failed to: 1) determine satisfactory competency with all extra skills provided as an extension of nursing prior to assigning an aide to a patient who required the task to be performed (Please refer to G764); 2) determine satisfactory competency with all required basic home health aide…

Failure to complete the required backgrounds checks according to the State of Iowa requirements placed agency patients at risk for potential harm.

The agency failed to ensure the emergency preparedness program addressed the continuity of operations including delegations of authority and succession plans.

The agency failed to ensure the policy included the development of a procedure to inform State and local officials specifically of homebound patients in need of evacuation due to an emergency situation.

The agency failed to complete a written emergency preparedness plan that included procedures to inform State and local officials of any on duty staff they are unable to contact in the event of an interruption of services related to an emergency.

The agency failed to complete a written policy or procedure to outline the use of emergency staffing strategies which included State and Federally designated health care professionals.

The agency's emergency preparedness communication plan failed to include contact information for state and federal official emergency staff.

The agency failed to ensure training in emergency preparedness for all employed staff and all individuals providing services under arrangement (contract staff), consistent with their expected roles on or prior to November 15, 2017. The agency reported currently utilizing a total of 53 employed…

The agency failed to transmit OASIS data within 30 days of the OASIS M0090 date for 2 of 8 sampled patients requiring transmission of OASIS data (Patients #7 and #12).

The agency failed to ensure agency staff provided services according to an individualized plan of care and contacted the patient's physician to notify the physician to possibly make changes due to an inability to follow the plan of care for 2 of 13 sampled patients (Patients #1 and #8).

The agency failed to ensure the home health aides successfully completed competencies in all basic home health aide skills which require a registered nurse, or other appropriate skilled professional in consultation with a registered nurse, to evaluate the competency of the aide by direct…

The agency failed to provide individualized and specific written patient care instructions from a registered nurse to agency home health aides for 7 of 9 sampled patients receiving home health aide services (Patients #2, #6, #7, #10, #12, #13 and #15).

The agency failed to furnish skilled nursing services and at least one other therapeutic service with at least one service provided only by direct employees (by issuance of a W2 for tax purposes).

The agency failed to perform complete and accurate drug regimen reviews with corresponding comprehensive assessments for 7 of 13 sampled patients (Patients #1, #2, #3, #4, #8, #11, and #13).

Agency clinicians failed to complete updates to the comprehensive assessment at recertification in the last 5 days of each certification period for 3 of 8 sampled patients requiring a recertification assessment (Patients #1, #7 and #10).

The agency failed to ensure accurate completion of all pertinent components of the update to the comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 3 of 4 sampled patients requiring a resumption of care assessment (Patients #1, #7 and…

The agency failed to ensure completion of all required components of the discharge comprehensive assessments within 2 calendar days of identification of the need to discharge a patient for 2 of 3 sampled patients requiring a discharge comprehensive assessment (Patients #9 and #11).

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies and equipment used by the patient to meet his/her needs and an accurate list of the patient's current medications for 4 of 13 sampled patients (Patients #2, #3, #4, and #12).

The agency failed to update the Plan of Care with all new physician orders for 10 of 11 sampled patients with interim/verbal orders.

The agency failed to provide services only as ordered by the physician for 3 of 14 sampled patients (Patients #5, #8 and #14).

The agency failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care for 2 of 13 sampled patients (Patients #8 and #10).

The agency failed to ensure 7 of 8 sampled home health aides (Staff I, J, N, O, P, Q and R), assigned to perform tasks requiring extra skills exceeding the level of basic home health skills for 3 of 7 sampled patients (Patients #2, #7 and #8) with home health aide services, had documented evidence…

The agency failed to document whether extra skills competencies were evaluated in a laboratory setting using a pseudo patient or in a home setting while being performed on an actual patient for 9 of 13 sampled home health aides (Staff J, K, L, N, O, P, Q, S and T).

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician in the Plan of Care and/or as directed by the skilled professional assigning the home health aide to the patient for 3 of 9 sampled patients receiving home health aide services (Patients…

The agency failed to ensure a registered nurse or other appropriate health care professional completed home health aide supervision at least every 14 days for 3 of 8 sampled patients who received hands on personal care services in conjunction with skilled service provision (Patients #7, #8 and #12).

The agency failed to document all required components of home health aide supervision including following the patient plan of care, maintaining open communication with patient/caregiver, demonstrating competency of all assigned tasks, complying with infection prevention and control policies…

The agency failed to ensure the patient's clinical record included current documentation of visit notes in patient clinical records for 3 of 3 sampled patients with hand written documentation completed by agency staff (Patients #8, #10 and #15) and 15 additional patients who were not part of the…