County of Wright

The initial comprehensive assessment completed by Staff D, Registered Nurse (RN), at the start of care, dated 8/6/19, lacked documentation the nurse completed an individualized emergency preparedness plan with the patient.

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

The agency failed to ensure the development of a written policy and procedure to inform State and local officials of any patients they are unable to contact in the event of an interruption of services related to an emergency.

The agency failed to ensure training in emergency preparedness to all existing staff consistent with their expected roles for 17 of 19 direct hired employees and 20 of 20 contracted staff in 2019. Lack of emergency preparedness training for staff puts patients at risk should an emergency situation…

The agency failed to ensure participation in two emergency preparedness exercises in 2018 and 2019 with analysis of the exercises.

The agency failed to notify the physician of changes in visit frequency ordered on the Plan of Care for 2 of 7 sampled patients (Patients #4 and #6) . The agency reported a current census of 100 patients.

The agency failed to ensure all documentation in the clinical record included a date, time, staff signature and staff title for 2 of 7 sampled patients (Patients #3 and #6).

The agency failed to ensure agency staff advised the patient of the extent to which payment for agency services may be expected and the charges for services that may not be covered from Medicare, Medicaid, or any other federally-funded or federal aide program known to the agency and the charges the…

The agency failed to ensure accurate completion of all required components of the update of the comprehensive assessment completed at the time of recertification between day 56 and 60 of each 60 day certification period for 2 of 4 sampled patients requiring a recertification assessment (Patients #1…

The agency failed to ensure the timely completion of all pertinent components of the update to the comprehensive assessment at the resumption of care within 48 hours of the agency's knowledge of the patient's return home from an inpatient facility for 1 of 1 sampled patients requiring a resumption…

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all medications and medical equipment used by the patient and accurate dates for 3 of 6 sampled patients (Patients #2, #3 and #4).

The agency failed to update the Plan of Care with all new physician orders for 3 of 7 sampled patients (Patients #3, #6 and #7) with interim physician orders (orders obtained during a certification period).

The agency failed to ensure patient's received the name and contact information of the agency's clinical manager.

The agency failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care for 2 of 7 sampled patients (Patients #1 and #7).

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 1 of 2 sampled patients receiving home health aide services (Patient…

The agency failed to ensure home health aides reported patient concerns to a registered nurse for 1 of 2 sampled patients receiving home health aide services (Patient #7).

The agency failed to ensure registered nurses supervising home health aides maintained documentation of a review of all required supervisory elements including following the patient plan of care, maintaining open communication with patient/caregiver, demonstrating competency of all assigned tasks…

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 2 of 7 sampled patients (Patients #4 and #7).

The agency failed to complete and send a transfer summary to the physician or other health care professionals responsible for providing care to the patient while in a health care facility within 2 business days of knowledge of the occurrence of the transfer for 1 of 1 sampled patients requiring a…

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/equipment and medications used by the patient, for 3 of 7 sampled patients (Patients #2, #5 and #6).

The agency failed to provide medications, treatments or services only as ordered by the physician for 2 of 7 patients receiving services from the agency (Patients #2 and #5).

The agency failed to ensure patient care delivery was coordinated in a way to meet patient individualized needs for 6 of 7 sampled patients (Patients #1, #2, #2, #4, #6, #7 and #8).

The agency failed to provide to the patients medication lists written in plain language that included medication name, dosage, frequency, administration times and which medications will be administered by agency personnel for 1 of 2 sampled patients with home visit observations (Patient #5).