Tiffco CARE2 LLC

The agency failed to develop and maintain an emergency preparedness plan and review and update it every 2 years (E-0004), complete a facility and community-based All-hazards approach document and the plan to address the identified emergency (E-0006), address the patient at-risk population and how…

Failed to ensure a complete and accurate assessment of the patient's strengths, goals, and care preferences (See G530), and failed to ensure a complete and accurate assessment of the patient's medical, nursing, rehabilitative, social, and discharge planning needs (See G534).

The agency failed to ensure patients received the frequency of services listed in the POC (G0572), POCs were individualized and included all pertinent information (G0574), treatments were administered only as ordered by a physician (G0580), provided a current POC (G0612), and provided a current…

The Governing Body failed to develop, implement, evaluate, and maintain an ongoing, agency-wide QAPI program that measured, analyzed, and tracked measurable and data-driven quality indicators, including adverse events, for health, safety, agency operations, and quality of care (G642); failed to use…

The governing body failed to ensure they developed and maintained an agency-wide QAPI program where they tracked and analyzed data (G0942), appointed the Administrator (G0946), ensure the Administrator was responsible for all day-to-day operations including involvement in an Emergency Preparedness…

The agency failed to ensure all patients received all services as ordered on the POC for 4 of 8 active clinical records reviewed.

The agency failed to ensure 1 of 3 patients (Patient #1) who received HHA services had a current plan of care.

The agency failed to ensure staff had access to gloves, hand sanitizers, soap and paper towels, and failed to ensure staff used standard precautions to prevent the transmission of infections and communicable diseases with proper use of hand hygiene, and gloving for 3 of 4 home visits conducted.

The agency failed to ensure the patient’s clinical records were protected against loss for 1 of 1 home health agencies.

The agency failed to ensure the personnel qualifications for 1 of 1 HHA personnel records reviewed.

The agency failed to evidence the comprehensive assessments were complete and accurately reflected the patient’s status, including current health, and psychosocial status in 4 of 8 active records reviewed.

The agency failed to ensure a complete and accurate assessment of the patient's strengths, goals, and care preferences in 1 of 1 (Patient: #1) active clinical records reviewed of patients receiving SN and HHA services.

The agency failed to ensure a complete and accurate assessment of the patient's medical, nursing, rehabilitation potential, and discharge planning needs in 4 of 8 active clinical records reviewed.

The agency failed to ensure the individualized plan of care included all pertinent diagnoses, specific frequency and duration of visits, all supplies and equipment, as needed medication indications, safety measures, discharge planning, psychosocial status, measurable outcomes, and goals identified…

The agency failed to provide the patients with visit schedules of when services were to be provided for 4 of 4 admission packets reviewed during home visits.

The agency failed to ensure all home health aides provided hands-on personal care as ordered per the plan of care for 2 of 8 active clinical records reviewed.

The agency failed to ensure a completed transfer summary had been sent within 2 business days of becoming aware of an unplanned transfer to an acute care facility, where the patient had been receiving care, for 1 of 1 clinical records of patients being transferred.

The agency failed to protect a patient's right to a thorough complaint investigation, the right to be free from physical harm and injury while receiving care, the right to receive care based on specific care preferences, and the right to be protected from retaliation and/or harm during…

The agency failed to ensure all patients received a patient-specific comprehensive assessment that reflected the patient’s current status (G526); included the patient’s health, psychosocial, functional, and cognitive status (G528); included the patient’s strengths, goals, and care preferences…

The agency failed to ensure they met the needs of 7 of 7 active (Patients: #1, 2, 3, 4, 5, 6, and 7) clinical records reviewed by failing to provide all services written in the plan of care (G572), failing to provide patient-specific interventions, education, and measurable outcomes and goals…

The Governing Body failed to develop, implement, evaluate, and maintain an ongoing, agency-wide QAPI program that measured, analyzed, and tracked measurable and data-driven quality indicators, including adverse events, for health, safety, agency operations, and quality of care (G642); failed to use…

The agency failed to maintain an infection control program with a goal of prevention, control of infections and communicable diseases.

The agency failed to ensure home health aide services were provided by qualified individuals who successfully completed an approved training and competency program, including the required minimum number of hours for classroom and practical training, and are in good standing on the state aide…

The agency failed to ensure the agency policies were reviewed and revised annually (G 948).

The agency failed to ensure all patients received a comprehensive assessment that reflected the patient’s current status at the time of assessment, for 2 of 7 active clinical records reviewed.

The agency failed to ensure patients received an updated comprehensive assessment when a change in condition was identified, for 1 of 7 active patient records reviewed.

The agency failed to ensure a current medication profile and goals were sent to the physician for 2 of 2 inactive clinical records reviewed.

The agency failed to ensure patients received all services as outlined in a plan of care that included patient-specific, measurable, and pertinent goals for 5 of 7 active clinical records (Active Patients: #2, 4, 5, 6, and 7) and 1 of 2 closed clinical records (Patient: #8) reviewed.

The agency failed to ensure infection control practices were followed according to the agency’s policy in 2 of 3 home visits for hand hygiene and gloving.

The agency failed to track, trend and investigate infectious and communicable diseases for 40 of 40 active patients.

The agency failed to ensure all home health aides successfully completed a competency evaluation program that included the subjects indicated in 484.80(c)(3), in advance of providing care, for 1 of 1 terminated home health aide (HHA 1) and 5 of 5 active home health aides (HHA 2, 3, 4, 5, 6).

The agency failed to respect the patient's specific requests and care preferences resulting in a patient injury, for 1 of 1 complaint of injury reviewed.

The agency failed to ensure patients received the physician ordered frequency and duration of services and the home health aide services ordered on the plan of care for 1 of 7 active clinical records reviewed.

The agency failed to investigate complaints made by the patient or representative for 1 of 1 complaint reviewed for suspected injury.

The agency failed to ensure all complaints of potential mistreatment were investigated, for 1 of 1 complaint of injury reviewed.

The agency failed to ensure all complaints and concerns were documented and evidenced a resolution for 1 of 3 active records (Patient #4) reviewed with a home visit and 1 of 2 inactive records reviewed (Patient #8).

The agency failed to ensure all patients were protected from potential harm and/or retaliation during investigation of a complaint of suspected injury, for 1 of 1 complaints of suspected injury reviewed.

The agency failed to ensure all patients received a comprehensive assessment that accurately reflected their current health status, such as assessment of body systems; psychosocial status, such as support systems, living arrangements, and ability to communicate; functional status, such as level of…

The agency failed to ensure all patient’s received a comprehensive assessment that reflected their current strengths, patient-specific and measurable goals, and care preferences, for 6 of 7 active clinical records reviewed.

The agency failed to indicate the patient’s medical, nursing, rehabilitative, and discharge planning needs for 6 of 7 active records reviewed.

The agency failed to ensure the comprehensive assessment included the patient’s primary caregiver or a potential temporary caregiver and their availability for 5 of 7 active clinical records reviewed.

The agency failed to ensure all patients received a comprehensive assessment at least every 60 days, for 1 of 7 active patient records reviewed.

The agency failed to implement its policy requiring the plan of care to be individualized to include all pertinent diagnoses, all supplies and equipment necessary to meet the patient’s needs, mental status, nutritional requirements, type, frequency, and duration of all services the patient was…

The agency failed to ensure all physician orders, including verbal orders, were listed on the plan of care for 1 of 3 active clinical records reviewed with a home visit.

The agency failed to ensure orders were obtained in advance of providing care and failed to ensure verbal/phone orders were obtained by a Registered Nurse, then documented, read back, and verified at the time of receipt and in advance of providing care for 3 of 7 active clinical records reviewed.

The agency failed to notify the physician of a patient's change in condition, for 1 of 7 active patient records reviewed.

The agency failed to ensure all patients received a revised plan of care that reflected current information from an updated comprehensive assessment, including but not limited to the patient's progress toward previous goals, changes since the previous care plan, updated medications, and all orders…

The agency failed to ensure the physician was notified of a change in the patient's condition requiring a discharge and transfer to another agency for 1 of 7 active clinical records reviewed.

The agency failed to coordinate care with all individuals and other agencies and facilities involved in the patient’s care for 6 of 7 clinical records reviewed.

The agency failed to ensure all home health aides successfully completed a training and competency program or successfully completed a nurse aide training and competency program and are in good standing on the state aide registry for 1 of 1 terminated home health aide (HHA 1) and 5 of 5 active home…

The agency failed to ensure all home health aides received training that included classroom and supervised practical training totaling at least 75 hours under the supervision of a registered nurse for 1 of 1 terminated home health aides (HHA 1) and 5 of 5 active home health aides.

The agency failed to ensure all home health aides completed a training and competency program including, but not limited to communication skills, observation/reporting/documentation, basic elements of body functioning, recognizing and reporting changes in skin integrity, and appropriate and safe…

The agency failed to maintain documentation of aide training for 5 of 5 active home health aides (HHA 2, 3, 4, 5) and 1 of 1 terminated home health aides.

The agency failed to maintain documentation of competency verification for all aides, including a description of the program, qualification of instructors, method used to determine competency, such as direct care or use of a pseudo-patient, for 1 of 1 terminated aide (HHA 1) and 5 of 5 active aides.

The Administrator failed to ensure the agency’s policies and procedures were reviewed and revised at least annually by 1 of 1 Governing Body.

The agency failed to ensure that all home health aides were qualified to provide patient care services, including but not limited to verification of previous experience, verification of completion of a qualified home health aide or certified nursing assistant program, verification of references…

The agency failed to ensure the comprehensive assessments were completely filled out, accurately reflected the patients current health status and past medical history, failed to ensure assessments included patient's strengths, goals, and care preferences, failed to ensure assessments included the…

The agency failed to ensure they accepted pediatric patients on the reasonable expectation that they were able to meet pediatric patients nursing needs (See G570); failed to ensure services were provided per the plan of care and failed to ensure each patient received an individualized care plan…

The agency failed to ensure they implemented and maintained an effective Quality Assessment and Performance Improvement (QAPI) program, involved all agency services, utilized quality indicators data, including data from OASIS data, failed to focus on high risk, high volume, or problem prone areas…

The agency failed to ensure all staff wear masks while in patients home and failed to ensure the agency developed and maintained an agency wide infection control program and failed to ensure agency staff were instructed to follow CDC guidelines in regards to symptoms and self quarantine when…

The agency failed to ensure a home health aide completed a skills competency upon hire, failed to ensure a the agency had a copy of the home health aide skills competency on file, failed to ensure all aides completed a 12 hour in-service training that was supervised by a Registered nurse and…

The agency failed to ensure all Governing Body and Administrative staff were knowledgeable in the Federal and State regulations, were qualified to organize, manage, and ensure staff provided quality of care to achieve goals and outcomes that would be identified through a complete accurate…

The agency failed to ensure that they maintain a clinical record containing current and accurate information, as well as adhere to current clinical record documentation standards (See G1008); failed to ensure visit notes were incorporated within the clinical record within a timely manner (See…

The agency failed to ensure services were provided per the plan of care, failed to ensure each patient received an individualized care plan, frequencies specific to patient needs, and identified patient specific and measurable outcomes and goals for 5 (Patient #1, 2, 3, 4, 5) of 5 active patients…

The home health aide failed to wear a mask while providing services in a patient's home for 1 of 3 home visits conducted.

The agency failed to ensure they maintained an agency wide infection control program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases, failed to ensure agency staff were instructed to follow CDC guidelines in regards to symptoms…

The agency failed to ensure a home health aide skills competency was observed for 1 of 1 employee hired as a home health aide.

The agency failed to ensure all home health aides completed 12 hours of in-service training during the year of 2019 for 5 of 5 personnel records reviewed of employees working in 2019. (Employees X, BB, CC, DD, EE, and FF) Findings include: The training file for Employee X, date of hire 9/13/18…

The Case Manager failed to ensure the aide care plan was individualized and patient specific for 2 (Patient #2 and #3) out 2 active pediatrics and 2 (Patient #1, #5) of 3 active adult patient records reviewed in a sample of 7. Findings include: 1. Review of an undated agency policy titled "Home…

The agency failed to ensure that a home health aide met the competency requirements by providing a skills competency for the tasks/ services they are providing for 1 (Employee E) of 1 personnel records reviewed of an employee registered as a home health aide and 10 (Employee D, H, J, K, L, M, N, S…

The agency failed to ensure they notified the Indiana Department of Health in advance of the changes of the Alternate Director of Clinical Services.

The Governing Body failed to ensure they periodically reviewed the written bylaws and ensure that it contained an outline of the agency's organization, operational procedures, and assuming the full legal authority and responsibility for the operation of the home health agency, failed to ensure they…

The agency failed to ensure all entries were clear, complete, authenticated, dated and timed for 4 of 5 (Patients #1, 2, 3, 5) active records reviewed and 1 of 2 (Patient #6) closed records reviewed in a sample of 7. Findings include: 1. The clinical record of patient #2 was reviewed and contained…

The agency failed to ensure they obtained a signature from the patient's legal guardians/ patient representative and not from another family member who was working as an agent for the agency for 1 of 1 pediatric records reviewed in a sample of 7. (Patient #3) Findings include: The clinical record…

The agency failed to ensure all patients receive all services outlined in the plan of care for 2 of 7 records reviewed.

The agency failed to evidence the comprehensive assessments were complete and accurately reflected the patients status, including current health, psychosocial, functional, and cognitive status in 7 of 7 (Patients #1, 2, 3, 4, 5, 6, 7).

The agency failed to ensure a complete and accurate assessment of the patient's strengths, goals, and care preferences in 5 of 5 (Patients #1, 2, 3, 4, 5) active records reviewed and 1 of 2 (Patient #6) closed records reviewed in a sample of 7. Findings included: 1. A review of an undated policy…

The agency failed to ensure a complete and accurate assessment of the patient's medical, nursing, rehabilitative, social, and discharge planning needs in 5 of 5 (Patients #1, 2, 3, 4, 5) active records reviewed and 1 of 2 (Patient #6) closed records reviewed in a sample of 7. Findings included: 1.…

The registered nurse (RN) failed to reconcile all medications with the patient, health care representative, outside agencies and ordering physicians, and medication profiles were maintained accurately in 4 of 5 (Patients #1, 2, 3, 5) active records reviewed in a sample of 7. Findings included: 1. A…

The agency failed to ensure the comprehensive assessment identified the patient's primary caregivers, their willingness and ability to provide care, and their availability and schedule in in 5 of 5 (Patients #1, 2, 3, 4, 5) active records reviewed and 1 of 2 (Patient #6) closed records reviewed in…

The agency failed to ensure the assessment included information concerning a patient selected representative in 4 of 5 (Patients #1, 2, 3, 4, 5) active records reviewed and 1 of 2 (Patient #6) closed records reviewed in a sample of 7. Findings included: 1. A review of undated policy C120A, titled…

The agency failed to ensure the individualized plan of care included all pertinent diagnoses and their onset date, all supplies and equipment, specific frequency and duration of visits, nutritional requirements, all accurate medications, treatments, all safety measures, infection control…

The agency failed to ensure the plan of care was created in conjunction with the primary care physician after an assessment, verbal start of care and recertification orders obtained from the physician for 4 (Patient #1, 2, 3, 5) of 5 active records reviewed in a sample of 7. Findings include: 1.…

The agency failed to ensure verbal orders were complete and contained duties/ services that the home health aides were to provide and the specific education the nurses were to educate to whom, and date and time of when orders when verbal orders were received for 3 (Patient #2, 3, and 5) of 5 active…

The agency failed to ensure the physician was notified of the agency's inability to provide services in 2 (Patient #5, 6) of 7 records reviewed.

The agency failed to ensure the primary care physician, patients, and patient representatives were informed in advance of the agency's intent to discharge and readmit due to administrative correctives for 2 (Patients #2, 3) of 2 active pediatric records reviewed in a sample of 7. Findings include…

The agency failed to ensure they communicated with the prescribing physician in regards to wrong patient information on a face to face encounter document for 1 of 1 active patient record of a patient receiving home visiting physician services in a sample of 10. (Patient #5) Finding includes: The…

The agency failed to ensure patient clinical records included information about the services the patient receives by other agencies and failed to ensure they coordinated care delivery to meet the patient's needs for 4 of 5 (Patients #1, 2, 3, 4, 5) active patient records reviewed of patients…

The agency failed to ensure they maintained a copy of the home health aide skills competency for 1 of 1 Employees hired as a home health aide.

The agency failed to ensure all in-service training during the year of 2019 was supervised by a Registered Nurse for 5 of 5 personnel records reviewed of employees working in 2019. (Employees X, BB, CC, DD, EE, and FF) Findings include: Review of the training files for the following employees, the…

The agency failed to ensure they maintained documentation that all home health aides completed 12 hours of in-service training was supervised by a Registered Nurse, during the year of 2019 for 5 of 5 personnel records reviewed of employees working in 2019. (Employees X, BB, CC, DD, EE, and FF)…

The agency failed to ensure home health aides (HHA) provided services per the plan of care and failed to ensure HHA's did not provide services beyond the scope of their practice for 1 (Patient #2) of 1 pediatric observation in a sample of 3 and 1 (Patient #3) of 1 interview with a family member of…

The agency failed to ensure all home health aides provided hands on personal care as ordered per the plan of care for 1 of 1 active records reviewed of a patient receiving dialysis services in a sample of 7. (Patient #1) Findings include: Review of an undated policy titled "Home Health Aide…

The agency failed to ensure Case Managers accurately documented supervisory visits in regards to inaccurately indicating an aide was following the plan of care and completing tasks assigned for 2 out of 5 active records reviewed in a sample of 7. (Patient #1, 5) Findings include: 1. Review of an…

The agency failed to ensure there was evidence of the Administrator being appointed by the Governing Body.

The Administrator failed to ensure they were responsible for the day to day operation of the home health agency in regards to incomplete documentation on comprehensive assessments and medication profiles, lack of individualization of care plans, coordination of care, and services being provided to…

The Administrator failed to ensure the agency followed their agency policies when ensuring staff hired is qualified to provide services.

The agency failed to ensure there was a qualified, pre-designated person authorized in writing by the Administrator and Governing Body to assume the same responsibilities and obligations as the administrator for 1 of 1 agency.

The Director of Clinical Services (DOCS) failed to ensure personnel assignments were directed by her, patient assignments were based on employee experience and knowledge, and failed to ensure part-time staff were knowledgeable about the patient's medical history and their expected duties.

The Director of Clinical Services failed to ensure patient clinical records included information about the services the patient receives by other agencies and failed to ensure they coordinated care delivery to meet the patient's needs for 4 of 5 active patient records reviewed of patients receiving…

The Director of Clinical Services failed to ensure patient needs were continuously assessed for 5 (Patient #1, 2, 3, 4, 5) of 5 active records and 1 (Patient #6) of 1 closed records reviewed in a sample of 7. Findings include: Review of an undated agency policy titled "Clinical Manager B-105"…

The Director of Clinical Services failed to ensure the Registered Nurse accurately developed and updated an individualized plan of care and failed to ensure services were provided as ordered per the plan of care for 5 (Patients #1, 2, 3, 4, 5) active records and 1 (Patient #6) of 1 closed record…

The agency failed to ensure they had written agreements in place with agencies who they share patients with in 4 of 4 active records reviewed of patient's receiving in a sample of 7. (Patients #2, 3, 4, 5) Findings include: 1. On 09/09/20, the Indiana Department of Health conducted a survey and…

The agency failed to ensure they had written agreements with agencies who they share patients with, outlining who has the overall responsibility for all services provided in 4 of 4 active records reviewed of patients receiving services from outside agencies in a sample of 7. (Patient #2, 3, 4, 5)…

The agency failed to ensure visit notes were incorporated within the clinical record within a timely manner for 2 out of 5 active records reviewed in a sample of 7. (Patients #2, 6) Findings include: 1. Review of an undated policy titled "Home Health Aide Services" C-220, indicated " ... Special…

The agency failed to ensure a discharge summary was written and sent to the primary care physician who is responsible for the patient's care after discharge within 5 business days of the patients discharge (Patient #6) and within 2 days of patients being transferred to another facility (Patient #7)…

The agency failed to ensure the Registered Nurse assessed all wounds, especially with patients shared with other agencies, in 1 of 1 recertification record reviewed of a patient with a wound in a sample of 6 active records.

The agency failed to ensure oxygen route and liter flow was included on the medication profile for 3 of 3 (Patient #2, #3, #5) active patient records reviewed who were on oxygen.

The facility failed to coordinate care delivery with shared agencies to meet the patient's needs for 2 of 2 active records reviewed.

The agency failed to ensure the home health aide provided services as ordered on the plan of care for 1 of 3 active records reviewed.

The agency failed to ensure they had a written agreement with shared agencies entailing who will be the primary agency/ maintain overall responsibility of the patient and the manner in which services will be provided between both agencies.

The Administrator failed to ensure: patients were heard, treated with respect, kept safe during an investigation; all complaints in regards to theft, staffing, and quality of care were documented, investigated with resolution; and patients received written notice of the investigation per agency…

The Governing Body failed to ensure they were responsible for the agency's overall management and operation by failing to ensure the appointed Administrator was appropriately trained and had the tools to successfully manage a home health agency; the Administrator and Director of Nursing/ Alternate…

The agency failed to ensure a recertification comprehensive assessment had been completed within the last five (5) days of every sixty (60) days, beginning with the start of care date for 2 of 2 focused records reviewed.

The agency failed to ensure certification periods listed on the plan of care were in 60 day intervals starting from the date of admission for 1 of 2 focused records reviewed.

The agency failed to ensure that a physician reviewed and revised an individualized plan of care no less frequently than once every 60 days, or as frequently as the patient's condition or needs requires, beginning with the start of care date for 1 of 2 focused records reviewed.

The agency failed to ensure revised plan of cares were supported by the recertification comprehensive assessments for 2 of 2 focused records reviewed.

The agency failed to ensure the home health aide failed to followed the plan of care.

The agency failed to ensure initial assessments were completed within 48 hours of a referral or a physician-ordered start of care in 3 of 8 records reviewed.

The agency failed to include all medications on the plan of care or to include advanced directives on the plan of care in 2 of 8 records reviewed.

The agency failed to ensure the skilled nurse informed the physician of the need to adjust the plan of care in 1 of 8 records reviewed.

The agency failed to ensure the registered nurse completed the initial assessment within 48 hours of a referral or a physician-ordered start of care in 3 of 8 records reviewed.

The skilled nurse failed to notify the physician of an elevated blood pressure as ordered per the physician's orders in the plan of care in 1 of 8 records reviewed.

The home health aide failed to follow the plan of care.