Myrtue Med Center Home Health

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 1 of 2 sampled patients receiving home health aide services (Patient #3).

The agency failed to ensure completion of signature to include discipline credentials for routine visit notes were completed for 3 of 3 sampled patients with occupational therapy services.

The agency failed to comprehensively provide wound assessments for 2 of 3 sampled patients with wounds (Patients #4 and #7) and failed to provide a comprehensive patient assessment with recertification assessments 2 of 2 patients (Patients #4 and #5).

The agency failed to include all Durable Medical Equipment (DME) in Plans of Care for 5 of 7 sampled patients (Patients #1, #2, #3, #5, and #7).

The agency failed to ensure registered nurses supervising home health aides maintained documentation of a review of all required supervisory elements including following the patient plan of care, maintaining open communication with patient/caregiver, demonstrating competency of all assigned tasks…

The agency failed to provide complete discharge instructions for 1 of 2 sampled patients with discharges (Patient #7) The agency reported a census of 31 patients.

The home health agency failed to complete an individualized emergency plan developed as part of the comprehensive assessment, maintaining documentation of the plan in the patient's chart and in the patient's home setting, for 7 of 7 sampled patients (Patients #1, #2, #3, #4, #5, #6 and #7).

The agency failed to assure all clinician's followed basic infection control practices when providing care to agency patients for 2 of 3 sampled patients with home visits (Patients #1 and #2).

The agency failed to ensure clinicians followed agency policies and procedures when assessing wounds to agency patients for 1 of 2 sampled patients who required wound assessments (Patient #3).

The agency failed to ensure 3 of 3 sampled home health aides (Staff I, J, and K), assigned to perform tasks requiring extra skills exceeding the level of basic home health skills for 1 of 1 sampled patients (Patient #4); had documented evidence of competency by a registered nurse in the assigned…

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 1 of 3 sampled patients receiving home health aide services (Patients #4).

The agency failed to accurately complete a drug regimen review, including completion of all required components and identification of any findings within the required time frames as part of the comprehensive assessment for 6 of 7 sampled patients.

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including a list of current medications taken by the patient and/or equipment/supplies used to meet the patient's individualized needs for 5 of 7 sampled patients (Patients #1, #2, #3, #6 and #7).

The agency failed to provide medications, treatments or services only as ordered by the physician for 5 of 7 sampled patients (Patients #1, #2, #5, #6 and #7).

The agency failed to complete and send a transfer summary to the physician responsible for caring for the patient while in an inpatient facility within 2 business days of knowledge of the occurrence of the transfer for 1 of 1 sampled patients with transfers to an inpatient facility (Patient #6) and…

The agency failed to follow a Plan of Care and orders authorized by a licensed physician (doctor of medicine, osteopathy or podiatry) and/or notify the physician of changes in visit frequency ordered on the Plan of Care for 2 of 7 sampled patients (Patients #1 and #2).

The agency failed to ensure the accurate completion of all components comprising the Plan of Care and/or failed to ensure the Plan of Care contained current, accurate information for 2 of 7 sampled patients (Patients #2 and #4).

The agency failed to administer treatments only as ordered by the physician for 2 of 7 sampled patients (Patients #1 and #5).

The agency failed to ensure registered nurses provided care as ordered by the physician in the Plan of Care for 2 of 7 sampled patients receiving a skilled nursing service (Patients #4 and #5).

The agency failed to ensure that registered nurses coordinated with physicians for 1 of 7 sampled patients (Patient #1).