Nurse at Home

The agency failed to follow a Plan of Care or notify the physician of missed visits for 2 of 3 sampled patients with missed visits.

The agency failed to ensure staff provided care in accordance with accepted infection control standards of practice for 2 of 3 sampled patients (Patient #1 and #3) with home observation visits.

The agency failed to provide agency patients with the Administrator name, business address and business phone number.

The agency failed to complete an accurate drug regimen review with each comprehensive assessment and failed to identify patient specific medication issues for 6 of 7 sampled patients (Patients #1, #2, #3, #4, #5 and #7).

The agency failed to ensure accurate completion of all components comprising the Plan of Care, including the functional limitations, nutritional requirements, safety measures to protect against injury, and all supplies/equipment used by the patient for 6 of 7 sampled patients (Patients #1, #2, #3…

The agency failed to maintain a working Plan of Care for patients and update the working Plan of Cre with any new verbal/interim physician orders for 2 of 4 sampled patients (Patient #3 and #7) with interim physician orders Failure to update the Plan of Care increase the potential for medication…

The agency failed to provide agency patients with visit schedule, including frequency of visit by agency personnel and personnel acting on behalf of the agency.

The agency failed to provide agency patients with written information on any treatments to be administered by agency personnel acting on behalf of the agency, including therapy services.

The agency failed to provide wound care as ordered by a physician for 1 of 1 sampled patients with wounds (Patient #7).

The agency failed to follow a Plan of Care established and periodically reviewed by a physician or notify the physician of the inability to perform treatments/services as originally ordered on the Plan for Care for 1 of 10 sampled patients (Patients #2).

The agency failed to accurately complete a drug regimen review (DRR), including identification of the medications taken by the patient at the time of the review and/or identification of duplication of medications after completing the comprehensive assessment for 3 of 8 sampled patients (Patients…

The agency failed to ensure the accurate completion of all components of 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 6 of 10 sampled patients (Patients #1, #2, #5, #6, #7 and #8 ).

The agency was found operating out of compliance with this Condition of Participation for the following reasons: 1) the agency failed to investigate complaints received (G478); 2) the agency failed to document the resolution to all complaints received (G484); and 3) the agency failed to take…

The agency was found operating out of compliance with with the requirements of this Condition of Participation for the following reasons: 1) failed to ensure home care aides received competency testing for extra skills assigned by the nurse as an extension of nursing services (G768); 2) failed to…

The agency hired 9 new employees since 7/1/2022. The systemic practice resulted in the failure to ensure the organizational framework of the agency promoted and supported the adherence to state regulations and coordination of safe and effective delivery of care to the agency's 138 patients. 481 IAC…

The agency was found operating out of compliance with with the requirements of this Condition of Participation for the following reasons: 1) the agency failed to ensure agency staff completed routine visit documentation according to administrative expectations (G1024); 2) the agency failed to…

The agency failed to complete a full scale exercise that is community based every 2 years or activate the emergency plan due to an actual or manmade emergency/disaster.

The agency failed to accept religious exemption forms for 4 of 4 contracted staff (Staff C, Staff G, Staff H, and Staff I) documenting exemption requests including status pending and granted, failed to maintain policies/procedures including a process for ensuring recognized clinical…

The agency failed to ensure the home health aides successfully completed competencies in all home health aide skills that exceed basic skills, which require a registered nurse, or other appropriate skilled professional in consultation with a registered nurse, to evaluate the competency of the aide…

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 7 of 8 sampled patients receiving home health aide services (Patients #1, #3, #4, #6, #7, #8 and #10).

The agency failed to ensure documentation of routine visit notes were completed within the agency's administrative expectations and/or were dated as date documented for 6 of 9 sampled patients (Patients #1, #3, #4, #6, #7 and #8).

The agency failed to maintain documentation completed in the agency's electronic medical record system for 5 years after the patient's discharge from services for 1 of 9 sampled patients (Patient #7).

The agency failed to investigate complaints made by the patient, patient's representative, caregivers and family members for 1 of 1 sampled patients with complaints (Patient #7).

The agency failed to document a resolution to all complaints received for 1 of 1 sampled patients with a complaint (Patient #7).

The agency failed to take further action related to a complaint registered with the agency to prevent reoccurrence in the future for 1 of 1 sampled patients with a complaint (Patient #7).

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 6 of 8 sampled patients receiving home health aide services…

The agency failed to do the following: 1) ensure patients had the right to request access to their own home health medical record (G438); 2) ensure agency staff documented communication with the physician patient's request for discharge due to refusal of ordered skilled services, measures taken to…

The agency failed to do the following: 1) ensure comprehensive assessments were updated timely by direct assessment in the patient's home (G520); 2) ensure comprehensive assessments included the patient's current health, psychosocial, functional, and cognitive status (G528); 3) ensure comprehensive…

The agency failed to failed do the following: 1) ensure the clinical manager assigned patients and agency staff (G960); and 2) ensure the clinical manager coordinated intake for patient referrals (G964).

The agency failed to follow a Plan of Care established and periodically reviewed by a physician or notify the physician of the need to vary frequency of visits or inability to perform treatments/services as originally ordered on the Plan for Care for 4 of 8 sampled patients (Patients #2, #4, #6 and…

The agency failed to effectively coordinate and oversee patient care provided by a licensed practical nurse (LPN) by a registered nurse (RN) for 3 of 3 sampled patients receiving care provided by an LPN (Patients #2, #3 and #6).

The agency failed to honor patient rights to access to their own home health medical record for 1 of 1 sampled patients who wished to review/receive copies of the medical record (Patient #3).

The agency failed to document communication with the physician to discuss patient refusal of skilled services, failed to document any measures taken to investigate the reason for refusal of the skilled services and failed to document interventions/education attempted in order to obtain the…

The agency failed to advise patients and/or the physician providing home health orders for the patient that discharge for cause is being considered for 2 of 2 sampled patients discharged for behaviors or non-compliance (Patients #3 and #6) The agency reported a current census of 128 patients.

The agency failed to initiate any efforts to resolve problems presented by the patient's behavior or a situation prior to discharging the patient for cause for 2 of 2 sampled patients discharged for behaviors or non-compliance (Patients #3 and #6) The agency reported a current census of 128…

The agency failed to provide the patient with contact information for other agencies or providers who may be able to provide care prior to discharging the patient for cause for 2 of 2 sampled patients discharged for behaviors or non-compliance (Patients #3 and #6) The agency reported a current…

The agency failed to ensure completion of the update to the comprehensive assessment with accompanying drug regimen review by performing an onsite assessment of the patient for 1 of 7 sampled patients (Patient #3).

The agency failed to ensure accurate and thorough completion of all pertinent components of each comprehensive assessment for 8 of 8 sampled patients (Patients #1, #2, #3, #4, #5, #6, #7 and #8).

The agency failed to ensure accurate completion of all required components of the recertification comprehensive assessments between day 56 and 60 of each 60 day certification period for 5 of 6 sampled patients requiring a recertification assessment (Patients #2, #3, #4, #6 and #7).

The agency failed to ensure completion of the update to the comprehensive assessment with accompanying drug regimen review within 48 hours of the agency's knowledge of return home from an inpatient facility by performing an onsite assessment of the patient for 1 of 1 sampled patients requiring a…

The agency failed to ensure completion of all required components of the discharge comprehensive assessments within 2 calendar days of identification of the need to discharge a patient for 3 of 3 sampled patients requiring a discharge comprehensive assessment (Patients #2, #3 and #6).

The agency failed to notify the physician of changes in patient condition or needs that suggest an alteration to the Plan of Care for 1 of 8 sampled patients (Patient #2).

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 4 sampled patients receiving home health aide services…

The agency failed to ensure the Clinical Manager scheduled staff to make patient visits, allowing a non-clinical staff to assign staff to patients.

The agency failed to ensure the Clinical Manager received and coordinated patient referrals, allowing a non-clinical staff to receive and participate in coordination of intake referrals.

The agency failed to complete and send a transfer summary to the physician caring for the patient at the inpatient facility after transfer within 2 business days of the patient's transfer and/or failed to complete and send a discharge summary to the physician and other health care professionals who…

The agency failed to do the following: 1) ensure patients had the right to be informed about changes in the plan of care and refuse care in advance of or during treatment with respect to the disciplines providing care and frequency of visits (G0434); 2) ensure agency staff informed patients of the…

The agency: 1) failed to ensure agency staff followed the plan of care in the delivery of services and alerted the physician to changes in the plan of care (G0572); 2) failed to ensure the Plan of Care accurately reflected care, treatment and services provided to the patient (G0574); and, 3) failed…

The agency failed to ensure agency home health aides followed the care plan to meet the assessed needs of the patients (G0800) The systemic practice identified the agency's failure to have a process in place to ensure agency staff met the needs of the agency's 98 patients receiving home health aide…

The agency failed to do the following: 1) ensure entries in the clinical record related to interventions provided by staff were accurate and complete (G1014); and, 2) ensure staff appropriately authenticated the completion of documentation in the clinical record (G1024).

The agency failed to follow a Plan of Care established and periodically reviewed by a doctor of medicine, osteopathy or podiatry or notify the physician of the need to vary from the physician ordered Plan for Care for 9 of 24 sampled patients with home health aide services (Patients #7, #8, #9…

The agency failed to ensure agency staff properly authenticated all clinical entry notes for 18 of 24 sampled patients (Patients #1, #2, #4, #5, #7, #10, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #23 and #25) receiving home home health services.

The agency failed to ensure patients had the right to be informed about changes in the plan of care and refuse care in advance of or during treatment with respect to the disciplines providing care and frequency of visits for 13 of 24 patients sampled with home health aide services (Patients #1, #2…

The agency failed to ensure agency staff advised the patient of the extent to which payment for agency services may be expected and the charges for services that may not be covered from Medicare, Medicaid, or any other federally-funded or federal aide program known to the agency and the charges the…

The agency failed to ensure agency staff discharged a patient with just cause and documented the behaviors and circumstances that warranted the discharge for 1 of 2 sampled discharged patients (Patient #18).

The agency failed to ensure agency staff advised the patient and the patient's physician that agency staff were considering discharging the patient for cause prior to discharging the patient for 1 of 2 discharge patients sampled (Patient #18).

The agency failed to show evidence of providing the patient with contact information for other resources or providers or may have been able to provide care for 1 of 2 discharge patients sampled (Patient #18).

The agency failed to ensure agency staff documented problems and efforts to resolve problems related to the agency determining to discharge the patient for cause for 1 of 2 discharge patients sampled (Patient #18).

The agency failed to ensure the investigation complaints made by agency patients or the representative of the patient for 13 of 24 sampled patients (Patients #1, #2, #4, #5, #8, #11, #12, #13, #14, #16, #20, #23 and #25) who received home health aide services.

The agency failed to ensure agency staff investigated complaints of care that failed to be furnished for 13 of 24 sampled patients (Patients #1, #2, #4, #5, #8, #11, #12, #13, #14, #16, #20, #23 and #25) who received home health aide services.

The agency failed to ensure the documentation of complaints and the resolution of a complaints made by agency patients for 13 of 24 sampled patients (Patients #1, #2, #4, #5, #8, #11, #12, #13, #14, #16, #20, #23 and #25) who received home health aide services.

The agency failed to ensure staff took action to resolve complaints and prevent further violations for 6 of 24 sampled patients (Patients #1, #5, #8, #14, #23 and #25) receiving home health aide services.

The agency failed to ensure the accurate completion of all components comprising the Plan of Care for 5 of 16 sampled patients (Patients #3, #6, #17, 24 and #26).

The agency failed to ensure agency staff coordinated the delivery of care in a way to meet patient individualized needs for 20 of 24 sampled patients (Patients #1, #2, #4, #5, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18, #20, #23, #24 and #25) receiving home health aide services.

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician in the Plan of Care and/or as directed by the skilled professional assigning the home health aide to the patient for 21 of 24 sampled patients receiving home health aide services…

The agency failed to ensure the patient's clinical record included accurate and complete documentation of interventions in the patient record for 19 of 26 sampled patients (Patients #1, #2, #4, #5, #7, #8, #9, #10, #11, #13, #14, #15, #16, #17, #18, #20, #23, #25).

The agency: 1) failed to develop a Quality Assessment and Performance Improvement (QAPI) program which showed measurable improvements in indicators related to patient health, safety and quality of care outcomes and ensure the agency measured, analyzed and tracked quality indicators, including…

The agency: 1) failed to ensure agency staff performed an ongoing interdisciplinary assessment of the patient (G706); 2) failed to ensure agency staff provided services ordered by the physician and as indicated on the plan of care (G710); 3) failed to ensure agency staff communicated with all…

Failure to complete the required backgrounds checks according to the State of Iowa requirements placed agency patients at risk for potential harm.

The agency failed to ensure the development of a procedure to inform State and local officials of homebound patients in need of evacuation due to an emergency situation.

The agency's emergency preparedness communication plan failed to include contact information for regional, state, federal and tribal officials and other sources of assistance.

The agency failed to ensure participation in 2 emergency preparedness exercises.

The agency failed to develop a Quality Assessment and Performance Improvement (QAPI) program which showed measurable improvements in indicators related to patient health, safety and quality of care outcomes and ensure agency staff measured, analyzed and tracked quality indicators, including adverse…

The agency failed to ensure agency staff used quality indicator data, including data derived from Outcome and Assessment Information Set (OASIS) and other relevant data to monitor the effectiveness, safety of services and quality of care, identify opportunities for improvement and ensure the…

The agency failed to ensure agency staff identified performance improvement activities to track adverse patient events, analyze cause and implement preventative actions.

The agency failed to ensure agency staff conducted performance improvement projects reflecting the scope, complexity and past performance of the agency's services, documented the reasons for conducting the performance improvement projects chosen and the measurable progress achieved on those…

The agency failed to ensure the governing body oversaw an ongoing Quality Assessment and Performance Improvement (QAPI) program that addressed priorities for improved quality of care and patents safety, ensure the governing body evaluated all improvement actions for effectiveness; ensure the…

The agency failed to ensure the home health aides successfully completed competencies in all basic home health aide skills which require a registered nurse, or other appropriate skilled professional in consultation with a registered nurse, to evaluate the competency of the aide either verbally, in…

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 2 of 4 sampled patients receiving home health aide services (Patients #2 and #7).

The hospice failed to ensure all clinical entry notes included a date and time and staff signature with title 4 of 7 sampled patients (Patients #2, #4, #5 and #7).

The agency failed to ensure agency staff advised the patient of the extent to which payment for agency services may be expected and the charges for services that may not be covered from Medicare, Medicaid, or any other federally-funded or federal aide program known to the agency and the charges the…

The agency failed to ensure accurate and thorough completion of all pertinent components of comprehensive assessments for 3 of 3 sampled patients (Patients #1, #3 and #6) with a surgical wound.

The agency failed to ensure agency professional staff completing a drug regimen review included a review of all of the required components of a drug regimen review with the completion of each comprehensive assessment for 6 of 7 sampled patients (Patients #1, #2, #3, #4, #5 and #6).

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 4 of 7 sampled patients (Patient #1, #2, #3 and #7) The agency reported a current census of 57 patients.

The agency failed to update the Plan of Care with all new physician orders for 2 of 7 sampled patients (Patient #1 and #3).

The agency failed to ensure agency staff focused performance improvement activities on high risk, high volume or problem prone areas.

The agency failed to ensure agency staff considered incidence, prevalence and severity of a problems associated with high risk, high volume and problem prone areas.

The agency failed to ensure agency staff identified whether there was a high risk, high volume, problem prone area that directly or potentially threaten the health and safety of patients and required immediate correction.

The agency failed to ensure agency staff took action aimed at performance improvement and measured the success of implementation of those actions and tracked performance to ensure agency staff sustained the improvements.

The agency failure to ensure skilled professional staff involved in the patient's plan of care completed an ongoing interdisciplinary wound assessment at least weekly for 2 of 3 sampled patients with wounds (Patients #2 and #6).

The agency failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care for 2 of 7 sampled patients (Patients #2 and #5).

The agency failed to ensure that agency nurses communicated and coordinated care with each other, other disciplines, the patient and/or family and with the patient's physician for 3 of 7 sampled patients (Patients #1, #2 and #3).

The agency failed to ensure agency registered nursing staff supervised licensed practical nursing staff per agency policy every 30 days for 1 of 4 sampled patients (Patient #2) receiving agency services including those services provided by a licensed practical nurse for longer than 30 days.

The agency failed to ensure 5 of 5 sampled home health aides (Staff F, G, H, I and J), assigned to perform tasks requiring extra skills exceeding the level of basic home health skills for 3 of 4 sampled patients (Patients #1, #3 and #4) with home health aide services, had documented evidence of…

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician and/or as directed by the skilled professional assigning the home health aide to the patient for 4 of 4 sampled patients (Patients #2, #3, #4 and #7) receiving home health aide services.

The agency failed to ensure the patient's clinical record included accurate and specific documentation of interventions for 1 of 7 sampled patients (Patient #2).

The agency failed to complete and send a transfer summary to the physician or other health care professionals responsible for providing care to the patient while in a health care facility within 2 business days of knowledge of the occurrence of the transfer for 2 of 2 sampled patients (Patients #3…