Med-Staff Home Health, LLC

The home health provider failed to ensure that the patients received the home health services that were written on their individualized plan of care when the patients did not receive visits according to the visit frequency as ordered on the plan of care in one of five full records reviewed…

The home health provider failed to provide documentation that showed the governing body provided oversight and approved of the provider’s QAPI program.

The home health provider failed to provide documentation that showed the governing body assumed responsibility for the overall clinical and financial operations of the home health and it’s quality assessment performance improvement program (QAPI).

The home health provider failed to ensure a complete and accurate list of all the medications that the patient was currently using in, three of three home visit observations (Records/Patients #1, #2 and #3).

The home health provider failed to ensure the clinicians provided services as ordered by the physician or allowed practitioner in one of five full records reviewed (Record/Patient #1).

The agency failed to provide annual Alzheimer's disease training, to one of six employee files reviewed (Employee/E3).

The home health provider failed to provide documentation that showed a complete discharge summary was sent to the patient’s primary physician in two of two discharge records reviewed (Records/Patients #5 and #6).

The agency failed to develop and provide the patient and/or representative with a written notice of patient rights that included all required information.

The agency failed to meet the requirements of 484.58 Condition of Participation: Discharge Planning, when the agency: - Failed to implement an effective discharge planning process (G562); and - Failed to document/send all necessary medical information to the receiving facility or health care…

The agency failed to: -Provide each patient an individualized written plan of care (G572); -Include all patient care orders on the plan of care (G576); -Ensure conformance with physician orders (G578); -Ensure drugs, services and treatments are administered only as ordered by a physician (G580)…

The agency failed to: - Ensure a complete discharge summary that is 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 within 5 business days of the patient's…

The agency failed to address the use of volunteers in an emergency or other staffing strategies to address surge needs during an emergency.

The agency failed to develop and implement an emergency preparedness communication plan that included the names and contact information for all staff, entities providing services under contract, and the patient's physicians.

The agency failed to ensure their emergency preparedness communication plan included a clear method for sharing medical information about patients with other healthcare providers.

The agency failed to comply with all federal, state, and local emergency preparedness requirements when the agency failed to establish and maintain a program that developed and maintained an emergency preparedness communication plan that included a means of providing information about the agency's…

The agency failed to ensure staff were provided emergency preparedness training annually for one (Employee #1) of five agency employee files reviewed.

The agency failed to include the patient right; information must be provided to patients in a language and in a manner that is accessible and timely to persons with disabilities, including accessible web sites and the provision of auxiliary aids services that are at no cost to the individual and…

The agency failed to ensure the patient's received effective discharge planning in one (Record/Patient #5) of two discharge records reviewed.

The agency failed to ensure a discharge summary that included all necessary information pertaining to the patient's current course of illness and treatment, post-discharge goals of care and treatment preferences was sent to the patient's health care practitioner to ensure the safe and effective…

The agency failed to provide each patient with a written individualized plan of care (POC) that was established by the physician in, but not limited to, 17 (Records/Patients #2, #3, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, and #21 ) of the 76 current agency patients that…

The agency failed to conform with physician orders when the treatments documented did not follow the orders on the plan of care (POC) and the agency failed to provide a physical therapy (PT) evaluation as ordered by the physician in one (Record/Patient #5) of five records reviewed.

The agency failed to ensure all documented entries included appropriate authentication that included the correct date and time the plan of care was completed in, but not limited to, three (Records/Patients #2, #3 and #4) of five full records reviewed and three (Records/Patients #27, #28 and #29)…

The agency failed to ensure accurate information provided to the patients regarding the retrieval of clinical records, specifically that the clinical record must be made available to the patient, free of charge, and upon request at the next home visit or within four business days (whichever comes…

The agency failed to provide the patient and representative (if any) correct contact information for the current home health agency administrator, to receive complaints in three (Records/Patients #1, #2, and #3) of three home visits conducted.

The agency failed to provide written information regarding the patient's right to participate in, be informed about, and consent or refuse care, with respect to completion of all assessments, care to be furnished based on the comprehensive assessment, establishing and revising the plan of care, the…

The agency failed to update the written notice of patient rights to include that the patient has the right to be advised of the names, addresses, and telephone numbers of the Federally-funded and state-funded entities that serve the area where the patient resides and to include the name, address…

The agency failed to ensure agency staff followed the policy and procedure related to discharging a patient for cause in one (Record/Patient #5) of two discharge records reviewed.

The agency failed to advise the patient/representative and the primary care practitioner that a discharge for cause was being considered in one (Record/Patient #5) of two discharge records reviewed.

The agency failed to ensure efforts were made/documented to resolve problems prior to the patient being discharged for cause in one (Record/Patient #5) of two discharge records reviewed.

The agency failed to ensure they provided the patient/representative with contact information of community resources and other agencies that may provide care prior to discharging a patient for cause in one (Record/Patient #5) of two discharge records reviewed.

The agency failed to document efforts to resolve problems prior to discharging a patient for cause, in one (Record/Patient #5) of two discharge records reviewed.

The agency failed to have a registered nurse (RN) complete the initial assessment of the patient within 48 hours of the referral to home care, or on the physician ordered start of care date in, but not limited to, one (Record/Patient #3) of five full records reviewed and one (Record/Patient #7)…

The agency failed to review all of the patient's current medications to maintain an accurate/updated medication profile in, but not limited to, one (Record/Patient #1) of three home visit observations.

The agency failed to ensure that all patient care orders were included on the plan of care (POC) for one (Record/Patient #5) of two plans of care for the five full records reviewed (three of the five full records failed to have a plan of care).

The agency failed to ensure treatments were administered only as ordered by the physician in, but not limited to, one (Record/Patient #5) of five records reviewed.

The agency failed to ensure staff coordinated care in one (Record/Patient #5) of five records reviewed.

The agency failed to ensure the skilled nurse (SN) provided ongoing assessments in, but not limited to, one (Record/Patient #5) of five records reviewed.

The agency may not train or competency evaluate their home health aides for a period of two (2) years following the date of this survey.

The agency failed to ensure a qualified, pre-designated person who is authorized in writing by the administrator and the governing body assumes the same responsibilities and obligations as the administrator when the administrator is not available.

The agency failed to ensure patients and/or representatives were provided written information regarding the Missouri case law "The Cruzan Case" in, but not limited to, three (Record/Patients #1, #2 and #3) of three home visit observations.

The agency failed to ensure a complete, comprehensive discharge summary containing relevant information was sent to the primary care practitioner or other health care professional who will be responsible for providing care to the patient after discharge within five business days of the patient's…

The agency failed to develop and provide the patient and/or representative with a written notice of patient rights that included all required information based on the new home health regulations effective 01/13/18. The agency failed to provide in writing, in advance of furnishing care the following…

The agency failed to provide care using effective infection prevention and control methods, when: - Accepted standards of practice to prevent the transmission of infections were not used (G682); and - The agency failed to maintain a coordinated agency-wide program for the surveillance…

The agency failed to ensure the competency and supervision of the home health aide (aide) when: - The home health aide competency evaluation was not completed and the aide was not yet found to be competent to perform services prior to patient contact (G768) - The aide had not received at least 12…

The agency failed to develop an emergency preparedness plan based on and include a documented facility based and community based risk assessment utilizing an all hazards approach.

The agency failed to ensure each patient had an individualized emergency plan documented as part of the patient's comprehensive assessment in four of five applicable records (Record/Patient #1, #2, #3, and #5).

The agency failed to develop an emergency preparedness plan that included a communication plan with contact information for federal, state, or local emergency preparedness staff.

Employee file review and interview the agency failed to develop an emergency preparedness plan training program that included initial training in emergency preparedness policies and procedures to all new and existing staff, maintained documentation of all emergency preparedness training, and…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the notice that if a patient has been adjudged to lack legal capacity to make health care decisions under state law by a court of proper…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that information must be provided to patients in a language and in a manner that is accessible and timely to persons with disabilities…

The agency failed to ensure the skilled nurse (SN) documented a complete and accurate comprehensive assessment in but not limited to one (Record/Patient #5) of six records reviewed.

The agency failed to ensure that the plan of care was followed in, but not limited to two (Record/Patient #2 and #5) of five applicable cases.

The agency's 2018 QAPI plan failed to: - Be capable of showing measurable improvements in indicators; and - Show how quality indicators are measured, analyzed and tracked.

The agency's 2018 QAPI plan failed to: - Utilize quality indicator data, including measures derived from OASIS (Outcome and Assessment Information Set) and other relevant data; and - Use the data collected to monitor services and quality of care and identify opportunities for improvement.

The agency failed to ensure nursing staff followed accepted standards of practice for wound care in one (Record/Patient #1) of one applicable case and failed to follow accepted standards of practice for cleaning of reusable patient equipment for one patient (Record/Patient #2) observed during home…

The agency failed to maintain a coordinated agency-wide program for surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is a part of the agency's quality assessment and performance improvement (QAPI) program.

The agency failed to ensure that the home health aide competency evaluation was completed and that the home health aide was competent to perform services before the aide performed personal care to patients in one (Aide A) of one home health aide employee file reviewed.

The agency failed to ensure that the home health aide received at least 12 hours of in-service training during each 12 month period in one (HHA A) of one home health aide employee file reviewed.

The agency failed to ensure the home health aide followed the plan of care or documented why the plan of care was not followed in one (Record/Patient #5) applicable case.

The agency failed to obtain an up-dated proof of registered nurse (RN) licensure in the State of Missouri for one (RN D) of two RN employee files reviewed.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include: - Transfer and discharge policies; - Rights and responsibilities that are understandable to persons who have limited English…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the administrator's name and contact information in order to receive patient complaints.

The agency failed to provide a patient or representative's signature confirming receipt of a copy of the notice of rights and responsibilities to one (Record/patient #3), but not limited to, six charts reviewed.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include verbal notice of the patient's rights and responsibilities in the individual's language, free of charge, no later than the completion of…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the written notice to the patient about their right to have a copy of the patient's rights and responsibilities provided to a…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient has the right to be free from verbal, mental, sexual and physical abuse, including injuries of unknown source, neglect and…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient has the right to participate in, be informed about, and consent or refuse care, with respect to completion of all…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient has the right to receive all services outlined in the plan of care The deficient practice has the potential to affect the…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient has the right to be advised of financial liability changes as soon as possible, in advance of the next home health visit.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient has the right to be advised of the names, addresses, and telephone numbers of federal and state-funded entities that serve…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient has the right to be informed of the right to access auxiliary aids and language services and how to access these services.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the patient and representative (if any) have a right to be informed of the agency's policies for transfer and discharge when the…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the patient and representative (if any) have a right to be informed of the agency's policies for transfer and discharge when the…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient and representative (if any) have a right to be informed of the agency's policies for transfer and discharge if the physician…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the patient and representative (if any) have a right to be informed of the agency's policies for transfer and discharge when the…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the agency policy for discharge for cause: - Determines that the patient's or other persons in the home, behavior is disruptive…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the agency must advise the patient or representative, physicians, and healthcare professionals who will be responsible for…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that if the patient is being considered for discharge for cause, the agency must make efforts to resolve the problem.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that if the patient is being considered for discharge for cause, the agency must provide the patient or representative with contact…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the agency must document the problem and efforts made to resolve the problem, if the patient is considered for discharge for cause.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the patient and representative (if any) have a right to be informed of the agency's policies for transfer and discharge if the…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include the patient and representative (if any) have a right to be informed of the agency's policies for transfer and discharge if the agency…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the agency must investigate mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown…

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that the agency must take action to prevent further potential violations while investigating a complaint.

The agency failed to update the written notice of patient rights to meet the requirements of the new federal home health regulations effective 01/13/18 to include that any agency staff in the normal course of providing services to patients, who identifies, notices, or recognizes incidences of…

The agency failed to ensure the registered nurse (RN) performed an accurate review/update of all medications the patient was currently using in, but not limited to, three (Records/Patients #1, #2, and #5) of six cases.

The agency failed to conduct an updated and revised comprehensive assessment not less frequently than the last five days of every 60 days beginning with the start-of-care date in two (Record/Patient #1 and #6) of two patients in the sample with Veteran's Administration (VA) as payer.

The agency failed to ensure the plan of care was complete in but not limited to, one (Record/Patient #1) of six cases.

The agency failed to develop a revised plan of care to be reviewed by the physician at least once every 60 days in two (Record/Patient #1 and #6) of two patients with Veteran's Administration (VA) as payer.

The agency failed to ensure coordination of care between all disciplines assigned to care for the patient, and failed to effectively coordinate care and support the objectives outlined in the plan of care, in but not limited to one (Record/Patient #5) of six cases reviewed.

The agency failed to ensure that the home health aide reported changes in the patient's condition in one (Record/Patient #5) of one applicable record.

The agency failed to ensure the registered nurse (RN) performed aide supervisory visits at least every 14 days in, but not limited to, one (Record/Patient #5) of one applicable case.

The agency failed to ensure that all employees met the federal requirements for hepatitis B vaccination and the state requirements for Alzheimer's and related dementia training in, but not limited to, two (MSW A and Aide A)of six employee files reviewed.

The agency failed to ensure the clinical record contained accurate assessment of the patient in, but not limited to, one (Record/Patient #2) of six patients reviewed.

The agency failed to ensure the discharge summary was completed and sent to the physician within five business days of discharge in one (Record/Patient #4) of one applicable case.