Indiana Signal Health Group Skilled Inc

The agency failed to notify the physician of missed skilled nursing visits for 1 of 3 wound care patients reviewed.

The home health agency failed to obtain a signed physician order for services in 1 of 3 new admissions reviewed.

The home health agency failed to ensure that all medical equipment in the home was listed on the Plan of Care for 3 of 3 home visits completed.

The agency failed to follow physician orders for wound care in 3 of 3 wound care patients reviewed.

The agency failed to provide initial and on-going wound care training/education to the caregiver for wound care that was to be provided in the absence of agency nursing staff in 1 of 3 wound care patients reviewed.

The Home Health Aide (HHA) failed to report a change in condition to the Registered Nurse in 1 of 3 active records reviewed with HHA services.

The agency failed to ensure that an updated, in-person, patient-specific, comprehensive nursing assessment reflecting the patient's current health status was completed for 1 of 7 patients reviewed (Patient 1) (See G0518 and G0544), resulting in an Immediate Jeopardy finding at 484.55 Comprehensive…

The agency's immediate jeopardy removal of immediacy plan and actions were determined to have removed the immediacy component of the immediate jeopardy on 1/27/2023 at 2:30 p.m.. The Immediate Jeopardy began on 1/8/2023 when the HHA (home health aide) N failed to notify the RN (registered nurse) of…

The agency failed to ensure that an updated, in-person, patient-specific, comprehensive nursing assessment reflecting the patient's current health status was completed in 1 of 7 patients reviewed (Patient 1).

The agency failed to ensure that an updated, in-person, patient-specific, comprehensive nursing assessment reflecting the patient's current health status was completed in-person in 1 of 7 records reviewed (Patient 1).

The agency failed to ensure that physician orders were followed in 1 of 7 records reviewed (Patient 6).

The agency failed to ensure basic infection control standards were met during home visits completed by the RN (registered nurse) in 1 of 2 home visits completed (Patient 2).

The agency failed to ensure the RN (registered nurse) completed an initial assessment within 48 hours of the physician's ordered service in 1 of 7 records reviewed (Patient 5).

The agency failed to ensure training and competency evaluations for HHA's (home health aides) were completed by the contracted RN (registered nurse) hired by the agency, as a result of condition level findings on the previous Federal and State survey dated 3/21/2022, in 1 of 1 agency reviewed.

The agency failed to ensure that the HHA N (home health aide) reported a change in the patient's health condition to the RN (registered nurse) that could have contributed to the patient's death in 1 of 1 agency reviewed.

The agency failed to ensure HHA (home health aide) N provided quality care due to the HHA failed to report a change in the patient's health condition to the RN (registered nurse) that could have contributed to the patient's death in 1 of 1 agency reviewed.

The agency failed to ensure all staff were fully vaccinated and/or had religious exemptions authenticated/authorized by the Administrator and/or Clinical Manager (see G0687) and failed to ensure that direct care staff were provided with personal protective equipment and supplies (see G0682).

The agency failed to ensure an Administrator/Alternate Administrator and Clinical Manager/Alternate Clinical Manager were on staff to oversee and manage all employees and patient care and services (see G0944);the administrator failed to report to the governing body (see G0946); administrator failed…

The agency failed to ensure staff were supplied with appropriate PPE (personal protective equipment) to prevent the transmission of infectious agents in 1 of 1 agency.

The agency failed to ensure all employees were either fully vaccinated for COVID-19 or had an authorized religious or medical exemption on file in 1 of 1 agency reviewed.

The agency failed to ensure that employees were knowledgeable of and had access to P & P (policies and procedures) in 1 of 1 agency.

The administrator failed to complete all responsibilities/obligations within the agency in 1 of 1 agency reviewed.

The agency failed to ensure a Clinical Manager provided oversight of all patient services and personnel in 1 of 1 agency observed.

The agency failed to ensure that an updated comprehensive assessment was completed in 4 of 15 patients reviewed.

The agency failed to ensure a physician order was obtained for home health services in 1 of 14 patients reviewed.

Employee D indicated both the Administrator/Alternate Clinical Manager and the Clinical Manager/Alternate Administrator did not show up for work that day.

The agency failed to ensure the Administrator and Clinical Manager were available to oversee the management of the agency in 1 of 1 agency observed.

The agency failed to ensure home health aide visits were completed per physician order in 3 of 14 records reviewed.

The agency failed to ensure HHA's (home health aides) completed documentation of tasks and authenticated services provided in 3 of 14 records reviewed.

The agency failed to ensure HHA (home health aide) supervisory visits were completed by the RN (registered nurse) every 60 days when skilled services were not provided in 8 of 15 records reviewed.

The Administrator failed to report to the governing body in 1 of 1 agency reviewed.

The agency failed to ensure the day-to-day operations of the agency were met in 1 of 1 agencies observed.

The agency failed to ensure a Clinical Manager was available during all operating hours in 1 of 1 agency observed.

The agency failed to ensure a qualified, pre-designated person was available to assume responsibility/obligations in his/her absence in 1 of 1 agency observed.

The agency failed to ensure the administrator was available during all operating hours in 1 of 1 agency reviewed.

The Clinical Manager failed to ensure patient and personnel assignments were completed in 1 of 1 agency reviewed.

The Clinical Manager failed to ensure the coordination of patient care in 1 of 1 agency observed.

The Clinical Manager failed to coordinate referrals in 1 of 1 agency reviewed.

The Clinical Manager failed to ensure the needs of the patients were continually assessed in 1 of 1 agency observed.

The Clinical Manager failed to assure the development, implementation, and update of the POC (Plan of Care) in 1 of 1 agency observed.

The agency failed to arrange a safe and appropriate transfer to other home health agencies in 1 of 5 records reviewed.

The agency failed to establish and maintain a comprehensive emergency preparedness program in 1 of 1 agency reviewed.

The agency failed to follow and clarify physician orders at the start of care in 1 of 7 patients reviewed.

The agency failed to screen and document signs and symptoms of COVID-19 for patients, visitors, and staff members.

The agency failed to obtain the patient's and/or patient's representative's signature confirming that he/she received a copy of the notice of rights and responsibilities in 2 of 7 patients reviewed.

The agency failed to investigate and document all complaints, including the resolution, in 1 of 1 agency reviewed.

The agency failed to ensure that the initial assessment was completed within 48 hours of a referral in 4 of 7 patients reviewed.

The agency failed to complete physician ordered HHA (home health aide) visits in 2 of 7 patients reviewed.

The agency failed to ensure that HHA (home health aides) were documenting completed tasks as ordered by the physician in the plan of care for 3 of 7 records reviewed.

The agency failed to maintain compliance with the Condition of Participation of Patient Rights as evidenced by failure to provide documentation the patient or the patient's family had received written notice of patient's rights (See Tag G 422) , failure to ensure all services outlined in the POC…

The agency failed to ensure they accepted patients with an expectation that the agency would meet their needs for 1 out of 4 patients receiving SN (Skilled Nurse) and 4 of 4 patient's receiving HHA services (Patients #1, 2, 4, 5) (See G 570), failed to ensure all services outlined in the POC (Plan…

The agency failed to meet the Conditions of Participation for Home Health Aide Services as evidenced by the failure to ensure the personnel files included documentation the home health aide competed a competency evaluation program before patient contact (See tag G 766), failure to update the HHA…

The Administrator failed to ensure the home health parent location did not relocate without notification and prior approval of CMS for 1 of 1 agency (See Tag G 940) and the clinical manager failed to ensure the HHA (Home Health Aide) documentation notes were completed and entered into the clinical…

The agency failed to ensure all services outlined in the POC (Plan Of Care) was provided in 1 out of 4 (Patient #1) record reviewed of patients receiving SN (Skilled Nurse) and 4 of 4 patient (Patients # 1, 2, 4 and 5) record reviewed of patients receiving HHA (Home Health Aide) in a sample of 7…

The SN (skilled nurse) failed to ensure the clinical record included documentation of coordination with the HHA (home health aide) regarding a change in the patient's skin condition that progressed from irritation to a stage 3 pressure ulcer for 1 of 4 patient's receiving home health aide services…

The RN (Registered Nurse) failed to ensure the aide care plan contained accurate information in regards to oral intake and failed to ensure the aide care plan was updated after a major change in the patient's condition for 1 of 4 patients receiving HHA services (Patient #1) in a sample of 4…

The (DON) Director of Nursing Services failed to ensure the HHA (Home Health Aide) documentation notes were completed and entered into the clinical record for 2 of 4 patient's receiving HHA services (Patient's #1 and 5) in a sample of 7 clinical records.

The agency failed to provide documentation that the patient or the patient's family had received written notice of the patient's rights for 1 of 1 patient's (Patient' # 5 ) in a sample of 7 clinical records reviewed.

The agency failed to inform the patient in writing the disciplines and the frequency of the services to be provided for 2 of 7 clincial record reviewed (Patient # 2 and 5) in a sample of 7. Findings Include: 1. An agency policy titled, "Home Care Bill of Rights" was reviewed and stated, "Clients…

The agency failed to ensure all services outlined in the POC (Plan Of Care) was provided in 1 out of 4 (Patient #1) record reviewed of patients receiving SN (Skilled Nurse) and 4 of 4 patient (Patients # 1, 2, 4 and 5) record reviewed of patients receiving HHA (Home Health Aide) in a sample of 7…

The agency failed to inform the patient in writing the extent to which payment for HHA services may be expected from federally-funded programs for 2 of 7 clincial record reviewed (Patient # 2 and 5) in a sample of 7. Findings Include: 1. An agency policy titled, "Home Care Bill of Rights" was…

The agency failed to investigate complaints that were made in regards to lack of care being provided by the agency for 3 of 7 clinical records reviewed.

The agency failed to document and resolve complaints for 3 of 7 patients record reviews.

The agency failed to complete the comprehensive assessment the last 5 days of every 60 days for 1 of 7 (Patient #1) clinical records reviewed.

The agency failed to accurately complete the plan of care to include the frequency and duration of visits to be conducted for 4 of 7 (Patients # 1, 2, 4, 5 ), the nutritional requirements for 2 of 7 (Patient #1, 3) , all medications and treatments for 3 of 7 (Patient # 1, 2, 3) , and measurable…

The agency failed to ensure communication occurred with the nephrologist caring for 1 ESRD (End State Renal Dialysis) for 1 of 1 patient receiving hemodialysis (Patient # 3) in a sample of 7 clinical records.

The agency failed to ensure the clinical record included documentation of coordination between the SN (skilled nurse) and the HHA (home health aide) regarding a change in the patient's skin condition that progressed from irritation to a stage 3 pressure ulcer for 1 of 4 patient's receiving home…

The RN (Registered Nurse) failed to accurately complete the plan of care to include the frequency and duration of visits to be conducted for 4 of 7 (Patients # 1, 2, 4, 5 ), the nutritional requirements for 2 of 7 (Patient #1, 3) , all medications and treatments for 3 of 7 (Patient # 1, 2, 3) , and…

The SN (Skilled Nurse) failed to provide services outlined on the POC (Plan Of Care) for 1 of 4 (Patient #1) records reviewed of patients receiving SN services in a sample of 7. Findings Include: A policy titled, "Plan of Care" was reviewed and stated, "Home care services are furnished under the…

The administrator failed to ensure the personnel file included documentation that the home health aide competed a competency evaluation program before patient contact for 1 of 1 home health aide records reviewed (Employee E) Findings Include: An agency policy titled, "Personnel Records" was…

The HHA (Home Health Aide) failed to provide all services outlined in the POC (Plan Of Care) for 4 of 4 patient receiving HHA services (Patients # 1, 2, 4 and 5) in a sample of 4 records.

The agency failed to provide Skilled Nurse (SN) supervision to the HHA (Home Health Aides) every 14 days for 2 of 2 patient's receiving skilled nursing services (Patient # 1 and 2) in a sample of 4 records.

The agency failed to provide Skilled Nurse (SN) supervision to the HHA (Home Health Aides) every 60 days for 1 of 2 patient receiving non-skilled nursing services (Patient # 4) in a sample of 2 non-skilled clinical records.

The agency failed to accurately complete the plan of care to include the frequency and duration of visits to be made for 4 of 7 (Patients # 1, 2, 4, 5 ), the nutritional requirements for 2 of 7 (Patient #1, 3), all medications and treatments for 3 of 7 (Patient # 1, 2, 3), measurable goals for 1 of…