Hamilton County Public Health Nursing Services

The agency failed to provide an initial assessment visit within 48 hours of receipt of referral for 2 of 7 sampled patients (Patients #1 and #5).

The agency failed to comprehensively provide wound assessments for 1 of 1 sampled patients with wounds (Patient #1).

The agency failed to include all required components of the Plan of Care (POC) for 6 of 7 sampled patients (Patients #1, #2, #3, #4, #5, and #7).

The agency failed to provide medications, treatments or services only as ordered by the physician for 2 of 7 sampled patients (Patients #4 and #7).

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 2 of 2 sampled patients receiving home health aide services…

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 2 of 2 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patients #4 & #5).

The home health agency: 1) failed to determines under policy set by the agency of addressing discharge for cause (G462) 2) failed to advise the patient, representative, the physician issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care…

The agency failed to document the patient's behaviors and circumstances that warranted patient's discharge for cause and the agency's efforts to resolve the problems prior to discharging the patient for cause for 1 of 1 sampled patients discharged for behaviors or non-compliance (Patients #3) The…

The agency failed to notify the patient or the physician prior to discharging the patient for cause for 1 of 1 sampled patients discharged for behaviors or non-compliance (Patients #3) The agency reported a current census of 61 patients.

The agency failed to initiate any efforts to resolve problems presented by the patient's behavior or a situation prior to discharging the patient for cause for 1 of 1 sampled patients discharged for behaviors or non-compliance (Patients #3) The agency reported a current census of 61 patients.

The agency failed to initiate any efforts to resolve problems presented by the patient's behavior or a situation prior to discharging the patient for cause for 1 of 1 sampled patients discharged for behaviors or non-compliance (Patients #3) The agency reported a current census of 61 patients.

The agency failed to obtain physician orders for the addition of over-the-counter medications to the patient's medication regimen for 3 of 4 sampled patients (Patient's #1, #2 & #3).

The agency failed to report changes in patient clinical findings to the physician for 2 of 4 sampled patients (Patient #7).

The agency failed to ensure 3 of 3 sampled home health aides (Staff D, E and F), assigned to perform tasks requiring extra skills exceeding the level of basic home health skills for 1 of 2 sampled patients (Patient #3) with home health aide services, had documented evidence of competency by a…

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 2 sampled patients receiving home health aide services (Patient #2 & #3).

1. Patient #6 had a start of care date of 4/23/2021. Clinical record review revealed the following: a.

The skilled nursing notes, dated 1/11, 2/1, 2/19, 3/22, 4/6, 4/17 and 5/17/2021, included the electronic signature of Staff D, Licensed Practical Nurse (LPN), but failed to identify the credentials of the LPN in the electronic signature. d.

The clinical record lacked documentation of any follow up with the referring physician to report the inability to reach the patient to set up the initial visit.

The clinical record included documentation of an update to the comprehensive assessment at the time of recertification with accompanying drug regimen review, dated 3/25/2021, and documentation of an update to the comprehensive assessment at the time of resumption of care following hospitalization…

The discharge assessment lacked documentation of any physical assessment findings.

The Plan lacked documentation of the dose of Folic Acid in each tablet.

The update to the Plan of Care, dated 5/14/2021, included the frequency and duration of planned physical and occupational therapy visits; however, lacked documentation of any planned treatments, modalities or goals for either therapy service.

The order lacked any planned interventions for the home health aide. c.

Patient #5's clinical record included only one supervisory note, dated 2/8/2021. The clinical record lacked any other documentation of home health aide supervision from admission through the end of the survey.

The patient remained and was transferred to the hospital on Tuesday 5/4/2021 The patient remained in the hospital until Saturday 5/8/2021, at which time the patient was transferred to a long term care facility for permanent placement and did not return to home health services. c.

The agency: 1) failed to ensure each Start of Care Comprehensive Assessment was completed within 5 days following each patient's start of care date (G520); 2) failed to ensure each comprehensive assessment included a current health assessment, psychosocial assessment, functional assessment and…

The agency failed to: 1) appropriately authenticate hand written documentation (G1024); 2) electronically authenticate all documentation being stored electronically (G1024); 3) complete transfer summaries and send to the physician caring for the patient at the inpatient facility within 2 business…

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

The agency failed to transmit OASIS data within 30 days of the OASIS M0090 date for 1 of 7 sampled patients requiring transmission of OASIS data (Patient #9) and 43 assessments for 34 additional patients.

The agency failed to notify the physician of changes in visit frequency ordered on the Plan of Care (missed visits) or perform interventions as ordered in the Plan of Care for 5 of 8 sampled patients (Patients #1, #3, #4, #7 and #8).

The agency failed to assure clinicians followed agency policies and procedures when providing care to agency patients for 2 of 3 sampled patients with wounds (Patients #2 and #9).

The agency failed: to authenticate all hand written/type written entries in the clinical record with a clinician's signature with date and time of the signature; failed to document accurate, current patient information when completing visit notes; and/or failed to electronically sign documents…

The agency failed to ensure accurate completion of all required components of the start of care comprehensive assessments within 5 days following the patient's start of care date for 7 of 7 sampled patients reviewed for compliance (Patients #2, #3, #4, #6, #7, #8 and #9).

The agency failed to include an individualized assessment relating to the patient's current health status when completing comprehensive assessments for 6 of 9 sampled patients (Patients #2, #3, #4, #6, #7 and #8).

The agency failed to complete a drug regimen review, including all required components, with each comprehensive assessment within the allowed time frames for 9 of 9 sampled patients (Patients #1, #2, #3, #4, #5, #6, #7, #8 and #9).

The agency failed to ensure accurate completion of all required components of the recertification comprehensive assessments between day 56 and 60 of each 60 day certification period for 2 of 2 sampled patients requiring a recertification assessment (Patients #1 and #5).

The agency failed to ensure accurate completion of all pertinent components of the resumption of care comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 2 of 2 sampled patients requiring a Resumption of Care Assessment (Patients #4 and…

The agency failed to ensure accurate completion of all required components of the discharge comprehensive assessments within 2 calendar days of identification of the need to discharge a patient for 3 of 3 sampled patients requiring a discharge comprehensive assessment (Patients #6, #8 and #9).

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 the patient's needs for 2 of 3 sampled patients with home visits (Patients #2 and #3).

The agency failed to ensure an ongoing and continual interdisciplinary assessment approach between all professional staff involved in the plan of care from the initial assessment through discharge for 3 of 3 sampled patients ( Patients #3, #4 and #6) receiving therapy (physical therapy…

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 and/or complete and send a discharge…