Larris-Ify Home Care

The agency failed to provide current written medication instructions for 1 of 1 skilled home visit observation with a nurse; and failed to provide a current written home exercise program for 1 of 1 skilled home visit observation with a physical therapist (PT).

The agency failed to remove gloves and perform hand hygiene during a bath, disinfect equipment and discard a cloth barrier after care for 2 of 3 home visit observations.

The agency failed to assess a wound and complete a medication review during 1 of 1 observed RN home visits (Patient #3).

The agency failed to ensure field staff followed appropriate infection control practices per agency policy while providing patient care in 1 of 3 home visits conducted.

The agency failed to evidence the retention of clinical records for patients for 9/11/21 through 11/8/21 in 1 of 2 discharged records (Patient #1), of 9 patient records reviewed.

The agency failed to ensure the registered nurse completed thorough reviews of patients' current medication, in 1 of 9 clinical records reviewed.

The agency failed to ensure patients were provided with a written schedule detailing staff visit frequency, in 2 of 3 home visits observed.

The agency failed to ensure patients had written medication schedules/instructions for current medication regimen in the home, for 2 of 3 home visits observed.

The agency failed to ensure the patients have the correct information to contact the HHA's clinical manager via phone or email in 2 of 3 home visits conducted.

The agency failed to maintain compliance with the condition of participation of Emergency Preparedness, 42 CFR 484.102. The agency failed to implement its policy related to an emergency preparedness plan by having failed to complete a facility-based and community-based all-hazards risk assessment…

The agency failed to maintain compliance with the condition of participation of Quality Assessment/Performance Improvement, 42 CFR 484.65. The agency failed to ensure it implemented policy requiring quality assessment performance improvement (QAPI) activities to collect and measure data, evaluate…

The agency failed to implement its policy related to an emergency preparedness plan by having failed to complete a facility-based and community-based all-hazards risk assessment for 1 of 1 agency's emergency preparedness plan reviewed.

The agency failed to implement its policy related to an emergency preparedness plan by having failed to identify and documents emergency events and strategies for addressing them for 1 of 1 agency's emergency preparedness plan reviewed.

The agency failed to ensure its emergency prepardedness plan documented the process for cooperation and collaborations with local, regional, State, and Federal emergency preparedness officials in order to maintain an integrated response during a disaster or emergency situation for 1 of 1 home…

The agency failed to ensure it had solicited volunteers for service during a disaster or emergency, to include the their roles for integration with health care professionals during the disaster/ emergency for 1 of 1 home health agency disaster preparedness plan.

The agency failed to ensure it implemented its policy and developed an emergency preparedness communication plan to include the names and contact information for staff, clinician providing services under arrangement, and all patients' physicians, for 1 of 1 home health agency emergency preparedness…

The agency failed to ensure care visits were furnished as ordered on the plan of care for 3 (Patients#3, 6, and 7) of 7 patients.

The agency failed to ensure the occupational therapist implemented agency policy and documented coordinated care activities with the physical therapist for 1 of 2 patients with occupational therapy and physical therapy services ordered on the plan of care (Patient #3) of a total sample of 7…

The agency failed to ensure it implemented policy requiring quality assessment performance improvement (QAPI) activities to collect and measure data, evaluate the data, set acceptable limits for findings, and show measurable improvement in indicators for 39 of 49 indicators required by policy.

The agency failed to ensure it completed data collection and documentation required by policy quality indicators to implement its designed quality assurance and performance improvement (QAPI) program for 39 of 49 indicators.

The agency failed to ensure the governing body discharged its duty to maintain an ongoing quality improvement program (QAPI) for 2018. The findings included: 1. Review of an undated policy, "Performance Improvement Plan," evidenced the policy stated, "Objectives ... The purpose and objective of the…

The Registered Nurse failed to ensure the home health aide care plan included care and maintenance of a patient's fistula access site for 1 of 2 records reviewed (Patient #4) of patients who attended in center hemodialysis treatments.

The agency failed to ensure all entries into the clinical record were authenticated with the time, of the entry for 5 of 5 active patients (Patients #1-5) of a total sample of 7 clinical records reviewed.

The agency failed to ensure the patient was informed of the disciplines and frequencies of visits prior to furnishing services for 2 of 7 (Patients #1 and 3) records reviewed.

The agency failed to ensure patient rights were accorded to include provision of all services ordered by the physician for 3 (Patient #3, 6, and 7) of 7 patients.

The agency failed to ensure a registered nurse conducted an initial assessment to determine the patients' immediate care and support needs for 5 of 7 (Patients #2, 4, 5, 6, and 7) patients with skilled nursing care.

The agency failed to ensure the physical therapist conducted an initial assessment to determine the patients' immediate care and support needs for 2 of 2 (Patients #1 and 3) patients with referral for therapy services only, of a total sample of 7 patients.

The agency failed to ensure the comprehensive assessment was performed no more than 5 days after the establishment of a start of care, rather than before the establishment of a start of care for 4 of 7 (Patients #1, 2, 3, and 4) patients.

The agency failed to ensure the plan of care included all durable medical equipment for 1 of 7 (Patient #3) patients; fluid restriction requirement, renal diet requirement, and care and maintenance of a fistula access site for 1 of 2 patients (Patients #4) who attended in center hemodialysis…

The agency failed to ensure the clinical record evidenced documentation of a verbal order authorizing disciplines, frequencies, and specific care orders prior to furnishing services for 4 (Patients #1, 3, 6 and 7) of 7 patients.

The agency failed to ensure the plan of care was updated to include all required information for 2 of 7 patients -durable medical equipment (Patient #3) and all nutritional requirements (Patient #4).

The agency failed to ensure care was coordinated for 1 (Patient #4) of 2 patients who received services from an outside dialysis provider, of a total sample of 7 patients.

The agency failed to ensure it implemented agency quality assurance and performance improvement (QAPI) policy to collect data which would enable the agency to take actions aimed at performance improvement for 38 of 49 quality indicators required by agency policy.

The skilled professionals failed to ensure the plan of care included all durable medical equipment for 1 of 7 (Patient #3) patients; fluid restriction requirement, renal diet requirement, and care and maintenance of a fistula access site for 1 of 2 patients (Patients #4) who attended in center…

The skilled professionals failed to ensure care visits were furnished as ordered on the plan of care for 3 (Patients#3, 6, and 7) of 7 patients.

The Occupational therapist failed to ensure the entries into the clinical record were complete and accurate for 1 of 7 (Patient #3) patient records reviewed.

The skilled professionals failed to ensure care visits were furnished as ordered on the plan of care for 1 (Patients #6) of 7 patients.

The agency failed to ensure the governing body made necessary revisions to a policy, and failed to ensure the governing body discharged its duty to maintain an ongoing quality improvement program (QAPI) for 2018.The findings included: The findings included: 1. Review of an undated policy…

The agency failed to ensure implementation of its policy which required the clinical record contain a completed discharge summary for 2 of 2 discharged patients (Patients #6 and 7), of a total sample of 7 patients.