Waterloo Visiting Nurse Association

The agency failed to do the following: 1) ensure initial assessments are completed within 48 hours of referral, return home or on physician ordered start of care (G514); 2) ensure comprehensive assessments were updated timely by direct assessment in the patient's home (G520); 3) ensure…

The agency: 1) failed to ensure each patient received services that were established by a doctor of medicine, osteopathy or podiatry (G572); 2) failed to ensure all patient care orders, including verbal orders, must be recorded in the plan of care (G576); and 3) failed to provide medications…

The agency failed to do the following: 1) ensure agency staff follow infection prevention and control policies(G682).

The agency hired 5 new employees and contracted 12 new employees since 12/10/2020. 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 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 5 of 7 sampled patients (Patients #2, #3, #4, #5…

The agency failed to ensure staff provided care in accordance with accepted infection control practices observed during a home visit for 1 of 3 sampled patients with home visits observed.

The agency failed to provide an initial assessment visit within 48 hours of receipt of referral, within 48 hours of the of the agency's knowledge of the patient's return home from an inpatient facility or on the physician ordered start of care date for 1 of 7 sampled patients (Patient #4).

The agency failed to ensure the comprehensive assessment was completed in a timely manner consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care for 1 of 7 sampled patients (Patient #1).

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

The agency failed to complete a drug regimen review within the required time frames as part of the initial comprehensive assessment, update to the comprehensive assessment at the time of recertification, resumption of care or discharge for 4 of 7 sampled patients (Patients #1, #2, #5 and #7).

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 3 of 3 sampled patients requiring a recertification assessment (Patients #2, #4 and #5).

The agency failed to ensure completion of the update to the comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 1 of 1 sampled patients requiring a resumption of care assessment (Patient #5).

The agency failed to maintain a working Plan of Care for patients and update the working Plans of Care with any new verbal/interim physician orders for 5 of 6 sampled patients with new verbal/interim orders.

The agency failed to provide medications, treatments or services only as ordered by the physician for 1 of 3 sampled patients with wounds (Patient #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: 1) ensure comprehensive assessments included a complete, accurate assessment of the patient's current health, psychosocial, functional, and cognitive status (G528); 2) ensure the clinician completed a drug regimen review with each comprehensive assessment, identifying any…

The agency failed to: 1) ensure each patient received services that were established by a doctor of medicine, osteopathy, podiatry or by an allowed practitioner (clinical specialist, physician assistant or nurse practitioner) and/or notified the physician or practitioner of the inability to follow…

The agency failed to: 1) the registered nurse (RN) or other appropriate professional assigned tasks to the home health aides in a specific, individualized manner (G798); and 2) the home health aide provided care to agency patients only as ordered by the physician and following the assigned tasks as…

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 10 sampled patients (Patients #2, #7, #9…

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 4 of 4 sampled patients receiving home health aide services (Patients #3, #7, #9 and #10).

The agency failed to ensure accurate and thorough completion of all pertinent components of each comprehensive assessment for 4 of 10 sampled patients (Patients #2, #3, #5 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 3 of 6 sampled patients requiring a recertification assessment (Patients #2, #4 and #9).

The agency failed to report changes in patient clinical findings or changes in patient needs to the physician for 6 of 10 sampled patients (Patients #2, #3, #4, #6, #7 and #9).

The agency failed to ensure agency staff coordinated the delivery of care in a way to meet patient individualized needs for 4 of 10 sampled patients (Patients #2, #5, #6 and #9).

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 4 of 4 sampled patients receiving home health aide services…

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 for 5 of 5 sampled patients with transfers (Patients #2, #3, #6, #7, and #8).

3. Patient #2 had a start of care date of 5/20/2020. Review of the clinical record revealed the following: The updates to the comprehensive assessment completed at the time of recertification, dated 7/14, 9/15 and 11/11/2020, and the update to the comprehensive assessment completed at the time of…

The agency failed to complete a written emergency preparedness plan that included procedures to inform State and local officials of any on duty staff and patients they are unable to contact in the event of an interruption of services related to an emergency.

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 3 sampled patients receiving home health aide services (Patients #6 and #7).

The agency failed to ensure accurate and thorough completion of all pertinent components of comprehensive assessments for 2 of 7 sampled patients (Patients #2 and #5).

The agency failed to perform complete and accurate drug regimen reviews with corresponding comprehensive assessments for 6 of 7 sampled patients (Patients #1, #2, #3, #4, #5 and #7).

The agency failed to ensure the timely completion of all pertinent components of the update to the comprehensive assessment at the resumption of care within 48 hours of the agency's knowledge of the patient's return home from an inpatient facility for 1 of 3 sampled patients requiring a resumption…

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/equipment used by the patient and accurate medication orders for 3 of 7 sampled patients (Patients #2, #3 and #4).

The agency failed to administer treatments only as ordered by the physician for 2 of 7 sampled patients (Patients #4 and #6).

The agency failed to promptly alert the relevant physician(s) to any changes in the patient's condition or that the plan of care should be altered, for 1 of 7 sampled patients (Patients #7).

The agency failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care for 3 of 7 sampled patients (Patients #2, #5 and #6).

The agency failed to ensure that registered nurses communicated and coordinated care and services with a patient's physician providing care for 1 of 7 sampled patients (Patient #2).

The agency failed to ensure agency registered nursing staff supervised licensed practical nursing staff for 2 of 2 sampled patients (Patient #2 and #7) who received agency skilled nursing services through a licensed practical nurse in addition to a registered nurse.

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 1 of 3 sampled patients receiving home health aide services (Patient…

The agency failed to ensure the patient's clinical record included accurate and specific documentation of interventions and maintained pertinent current information in the patient record for 3 of 7 sampled patients (Patients #2, #5 and #6).

The agency failed to complete and send a transfer/discharge summary to the receiving facility in 2 business days of the patient's transfer and send a discharge summary to the physician responsible for providing care to the patient and any other health care providers who will care for the patient…

The agency: 1) failed to ensure skilled professionals adequately reassessed patients to identify changes in condition (G706); 2) failed to ensure skilled professionals provided care as ordered by the physician in the Plan of Care (G710); and 3) failed to ensure the agency skilled staff promptly…

The agency failed to complete a written procedure to outline the use of volunteers in an emergency or other emergency staffing strategies.

The agency failed to ensure training in emergency preparedness to all individuals providing services under arrangement, consistent with their expected roles.

The agency failed to ensure a registered nurse performed direct observation of home health aide performance of all required basic home health aide skills on a patient and failed to evaluate written examination test results in order to determine satisfactory competency prior to allowing the home…

The agency failed to ensure accurate completion of all pertinent components of the resumption of care comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 1 of 2 sampled patients requiring a Resumption of Care Assessment (Patient #5).

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/ equipment and medications for 2 of 3 sampled patients (Patients #1 and #2).

The agency failed to provide agency patients with written contact information for the agency's clinical manager, including the clinical manager's name and contact information (telephone number and/ or email address).

The agency clinicians failed to including measurements of wounds, including length, width and depth, weekly as identified by agency procedure requirements for 3 of 3 sampled patients with wounds (Patients #2, #3 and #7).

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 (Patients #3 and #4).

The agency skilled staff failed to report changes and coordinate care with the patient's physician for 2 of 7 sampled patients (Patient #7 and #3) . The agency reported a census of 169 patients at the time of the survey.

The agency failed to document whether extra skills competencies were evaluated in a laboratory setting using a pseudo patient or in a home setting while being performed on an actual patient for 3 of 3 sampled home health aides (Staff G, H and I).

The agency failed to ensure a registered nurse (RN) or other appropriate health care professional completed home health aide supervision at least every 14 days for 2 of 3 sampled patients who received hands on personal care services in conjunction with skilled service provision (Patients #4 and #5).