Hcr Home Care

In 1 patient record (patient #5) the agency failed to have an effective process in place to ensure that all complaints related to patient care are documented, investigated, and resolved.

For 5 of 18 patients (patients #1, 3, 12, 13, and 17) the agency failed to ensure initial comprehensive nursing assessments were of sufficient scope to ensure all patient needs were identified.

In 4 of 18 patient records, (patients #3, 8, 14, and 17) that clinical staff failed to provide care as ordered by the physician.

The skilled nurse (SN) failed to follow accepted standards of infection control practices.

In both records, the skilled nurse (SN) failed to develop complete and accurate aide written instructions.

In 2 of 18 records, (patients #5 and 10) the skilled nurse (SN) failed to perform comprehensive medication reviews.

In 1 out of 18 records (patient #10) the skilled nurse (SN) failed to assess the patient within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more.

In 3 of 18 records (patients #1, 4 and 14) the agency failed to develop complete and accurate plans of care that were individualized to address the total needs of the patients.

For 2 out of 18 patients (patients #9 and 14) agency staff failed to provide coordinated care to meet the needs of the patients.

The agency: Failed to ensure assessments were comprehensive, accurate, patient-specific, and reflected the patient's current status and needs.

The condition was not met: As evidenced by: Failure to develop comprehensive plans of care which address each patient's individual needs.

In 6 of 8 patients (patient # 1, 2, 3, 4, 6, and 8) the comprehensive assessments were incomplete, inaccurate and failed to identify the patient's current status.

3 of 8 records (patients # 1, 7 and 8), agency staff failed to provide care as ordered by the physician.

The skilled nurse (SN) failed to follow accepted standards of infection control practices.

In 2 of 8 records (patients #3 and 6) the skilled nurse (SN) failed to perform comprehensive medication reviews.

In 4 of 8 records (patients # 1, 2, 3, and 8) that the plan of care developed failed to contain all relevant information necessary to meet the patient's needs.

In 2 of 8 records (patients # 3 and 6), agency staff failed to ensure drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner.

For 3 of 8 records (Patients # 1, 3, and 6) the Skilled Nurse (SN) failed to communicate with the physician when changes in the patient's condition occurred.

In 5 out of 8 patients (patients # 1, 2, 3, 6 and 7) the agency failed to provide coordinated care to meet the needs of the patients.

In 3 of 11 records (Patients # 1, 2, and 5) the agency failed to coordinate care to meet all patient needs: This was evidenced by: 1. Patient #1 was admitted to the agency on 03/11/21 with diagnoses of methicillin resistant staphylococcus aureus (MRSA) sepsis, endocarditis, atrial fibrillation, a…

The agency failed to adequately document, investigate, and resolve complaints for 3 of 19 patients (Patients # 4, 5, and 15).

For 12 of 19 records (Patients #1, 2, 3, 8, 9, 10, 11, 14, 15, 16, 17, and 19) the agency failed to ensure initial comprehensive nursing assessments were of sufficient scope to ensure all patient needs were identified.

The agency failed to have a QAPI program that was of sufficient scope to self identify, and correct, agency wide quality of care issues.

The skilled nurse (SN) failed to follow accepted standards of infection control practices.

Frequency and specificity of tasks The 12/02/20 HHA care plan failed to include: type of bath (shower, tub, sponge bath).

In 5 of 17 records (Patients #2, 4, 6, 15, and 19), agency staff failed to perform complete and accurate medication reviews.

In 8 out of 19 records (Patients # 1, 3, 6, 10, 13, 15, 17, and 19), the agency failed to develop individualized plans of care that were complete and accurate, and addressed the total needs of the patients.

For 4 out of 19 records (Patients # 2, 3, 8, and 19) the skilled clinicians failed to consult with the physician when changes in the patient's condition occurred.

In 8 of 19 records (Patients # 2, 3, 8, 12, 13, 15, 18, and 19) the agency failed to ensure the patient's plan of care was effectively coordinated: This was evidenced by: HV 1. Patient # 3 was admitted to the agency 11/18/20 with diagnosis of cerebral infarction (stroke), dysphagia (difficulty…

In 6 of 19 records (Patients # 4, 8, 9, 10, 12, and 16) patient care provided was not in accordance with the written plan of care, and the physician's orders.

For 7 of 8 patients (patients 2-8) , clinical manager failed to ensure a program was in place to provide adequate nursing services to patient's requiring assessment and treatment during after hours and weekends.

For one of 1 of 8 patient records reviewed, that the agency failed conduct an initial assessment assessment visit within 48 hours of discharge from the hospital.

In 7 of 8 patient records (patients # 2 - 8) that the Director of Patient Services (DPS), fulfilling the role of the clinical manager, failed to ensure that the patient's needs were continually assessed, that adequate staff were assigned to visit patient's after hours to avoid emergency room visits…

The agency failed to adequately document, investigate, and resolve complaints for 1 of 10 patients (Patients #5).

In 2 of 8 records (Patients # 1 and 4) the agency failed to coordinate to ensure all patient's needs were addressed.

In 5 of 5 records of patients with home health aide (HHA) services ordered (Patients # 3, 4, 6, 7 and 10) the agency failed to initiate and provide HHA service according to the written plan of care and the physician's orders.

For 1 of 10 records (Patient #5) , the clinician failed to document any visit findings in the patient record from the initial evaluation visit.

For one RN (Employee #2) the agency failed to provide supervision to ensure the employee was able to perform high-tech nursing care confidently.

In 3 of 17 records (Patients # 4, 13 and 14) the agency failed to conduct the initial assessment visit within 48 hours of referral to determine immediate care needs.

The 01/26/18 HHA instructions failed to the following: - On 01/23/18 the SN documented the patient was bedbound and required a mechanical lift to leave the bed.

In 6 out of 16 records, (Patients # 6, 7, 11, 13, 16, and 17) that the initial comprehensive assessments were not of sufficient scope to ensure that all patient's needs are identified.

In 2 of 17 records (Patients # 7 and 15), agency staff failed to perform complete and accurate medication reviews.

The agency failed to ensure comprehensive assessments are updated and revised within 48 hours of patient's return home from hospital admission in 2 out of 4 records of patients returning from the hospital (Patients # 10 and 14).

In 7 out of 17 records (Patients # 3, 6, 7, 8, 11, 12, and 17), the agency failed to develop individualized plans of care that were complete and accurate, and addressed the total needs of the patients.

For 5 out of 17 records (Patients #1, 8, 13, 14, and 17) the Skilled Nurse (SN) failed to consult with the physician when changes in the patient's condition occurred.

In 4 of 17 records (Patients # 6, 9, 13, and 14) the agency failed to ensure the patient's plan of care was effectively coordinated: This was evidenced by: 1. Patient # 6 was admitted to the agency on 03/16/18 for wound care following surgery to the cervical spine.

In 2 of 17 records (Patients # 9 and 10) patient care provided was not in accordance with the written plan of care, and the physician's orders.