Summit Home Health Care

The agency failed to assist consumers and representatives with contact information for other agencies or providers who may be able to provide care after a discharge.

The agency failed to evaluate, and maintain an effective, ongoing, agency-wide, data driven quality assessment and performance improvement (QAPI).

The agency failed to develop and implement a fully compliant emergency preparedness plan to manage the patients' care and safety during emergency situations, which might impact the patients' in their homes.

The agency failed to ensure the individualized plan of care included all the required items.

The agency failed to ensure all treatments were administered by agency staff as ordered by the physician in 2 of 7 patient records reviewed ( Patient #1 and #5).

The agency failed to ensure an accurate and complete clinical record for 2 of 7 sample patients (Patient #1 and #5).

The agency failed to complete a discharge summary that is sent to the primary care practitioner (PCP) who will be responsible for providing care and services after discharge from the HHA within 5 days of the patients discharge for 1 of 7 patients (Patient #7).

Specifically, the agency failed to ensure each patient received home health services in accordance with a written plan of care established, reviewed and authorized by a physician prior to rendering services; to ensure services and treatments were provided in conformance with physician's orders; to…

The agency failed to ensure each patient's individualized written plan of care was established and periodically reviewed by a physician.

The agency failed to ensure services and treatments were provided in accordance with physician's orders for 4 of 8 active patients reviewed (Patients #2, #4, #6 and #7).

The agency failed to ensure patient-specific written care instructions for the certified nurse aides (CNA) were prepared by the registered nurse (RN) for 1 of 1 patient record reviewed who received CNA services which included a bowel program (Patient #6).

The agency failed to ensure an initial assessment visit to determine the immediate care and support needs of the patient within 48 hours of referral, or within 48 hours of the patient's return home from a hospitalization for 3 of 8 clinical records reviewed (Patients #1, #2, and #4) and for 3 of 21…

The agency failed to ensure each patient's status was comprehensively assessed the last five days of every 60-day period for 1 of 6 patients who was on service more than 60 days (Patient #5).

The agency failed to ensure each patient's plan of care included all medications, including allergies, and treatments for 1 of 1 patient records reviewed with an established plan of care and receiving peripherally inserted central catheter (PICC) line care (Patient #7).

The agency failed to provide services and treatments only as ordered by the physician for 2 of 2 patients' record reviewed who received catheter irrigation (Patient #2 and #6).

The agency failed to ensure each patient's total plan of care was reviewed by the physician at least every 60 days.

The agency failed to ensure a registered nurse (RN) or other appropriate skilled professional familiar with the patient, the patient's plan of care and the written patient care instructions made an onsite visit to the patient's home no less frequently than every 14 days to conduct certified nurse…

The Administrator failed to adequately and effectively organize and direct the agency's day-to-day operations.

The agency failed to ensure clinical records contained current and accurate documentation of patient's clinical notes, plans of care and orders for 4 of 8 patient records reviewed (Patients #2, #5, #6 and #7).

Specifically, the agency failed to ensure plans of care were followed as ordered by the physicians, ensured physicians who were responsible for the care of the patients were promptly alerted with change of conditions and/or a change to the plan of care; and ensured the plans of care were accurate…

The agency failed to ensure services and treatments were provided in accordance with physician's orders for 4 of 7 active patients reviewed (Patients #2, #5, #7 and #9).

The agency failed to implement performance improvement projects (PIPs) of the quality assessment and performance improvement (QAPI) which documented the projects undertaken, the reasons for conducting the projects, and the measurable progress achieved on the projects.

The agency failed to ensure each patient's individualized Plan of Care included the types of services, treatments, and treatment parameters for 4 of 10 patient records reviewed (Patient #1, #6, #7, and #8).

The agency failed to provide services and treatments only as ordered by the physician for 1 of 3 patients' record reviewed who received wound care (Patient #5).

The agency failed to ensure the plan of care contained patient's accurate current information and pertinent goals based on updated comprehensive assessment of the patients for 1 of 3 active patients records reviewed who had a recertification assessment (Patient #1).

The agency failed to have evidence of communication with the physician for orders and delays in providing therapy services to 1 of 1 patients who required occupational (OT) and/or speech therapy (ST) (Patient #2).

The agency failed to ensure a registered nurse (RN) or other appropriate skilled professional familiar with the patient, the patient's plan of care and the written patient care instructions made an onsite visit to the patient's home no less frequently than every 14 days to conduct home care aide…

The agency failed to promptly alert and notify the physician of changes in the patient's condition for 1 of 2 discharged patient records reviewed (Patient #2).

The agency failed to coordinate care delivery with external care providers in coordination of care activities in order to meet the needs of the patient for 1 of 2 discharged patient records reviewed (Patient #2).