Interim Healthcare (Lynchburg)

The agency staff failed to follow the individualized plans of care for two (2) of seven (7) patients in the survey sample (Clinical records #1 and #5).

The agency failed to complete the discharge OASIS (Outcome and Assessment Information Set) for two (2) of five (5) discharged patients in the survey sample (Clinical records #4 and #6).

The agency failed to send the patient's discharge summary to the primary care physician within 5 business days of the patient's discharge for two (2) of five (5) discharged patients in the survey sample (Clinical records #4 and #6).

The agency failed to provide a Notice of Medicare Non-Coverage (NOMNC) to Medicare patients in advance of terminating care for four (4) of seven (7) closed/discharge clinical records reviewed in the survey sample, for which a NOMNC was applicable.

The agency failed to ensure discharge Outcome and Assessment Information Set (OASIS) was completed within two (2) calendar days of the discharge date for five (5) of seven (7) closed/discharged clinical records in the survey sample, for which required OASIS completion.

The agency failed to ensure a completed discharge summary was sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the Home Health Agency (HHA) (if any) within 5 business days of the…

Staff member interviews it was identified that the agency's staff failed to comply with accepted professional standards and principles that apply to professionals furnishing services in regards to infection prevention for three (3) of three (3) home visits in the survey sample (Patient #5, #6 & #8).

The agency failed to ensure the patient's individualized plan of care included the description of all medications, the patient's risk for emergency department visits and hospital re-admission, all necessary interventions to address the underlying risk factors, and goals identified by the patient…

The agency failed to ensure services, and treatments were administered only as ordered by a physician for two (2) of eight (8) medical records reviewed in the survey sample.

The agency failed to ensure that agency's professional staff promptly alerted the patient's physician to any changes that suggest a need to alter the patient's plan of care for one (1) of eight (8) medical records in the survey sample (Patient #7).

The agency's staff failed to coordinate care delivery to meet the patient's needs, and involve the patient and their representative in the coordination of care activities for two (2) of three (3) home visits conducted during the survey process (Patient #5 & #8).

The agency's Home Health Aide (HHA) failed to provide services based on the physician ordered Plan of Care (POC) for two (2) of two (2) patients in the survey sample receiving HHA services (Patient #5 & #6).