Winneshiek County Public Health Nursing Service

The agency failed to: 1) ensure patients were admitted with a reasonable expectation that the agency could meet the patient's medical, nursing and rehabilitation needs in his/her place of residence (See G570 information); 2) ensure all supplies/equipment/medications/treatments required by the…

The agency failed to follow state pharmaceutical laws by storing patient medication in the agency office and dispensing patient medications on a weekly basis from the stored medications for 2 of 2 patients sampled (Patients #8 and #9).

The governing body failed to: 1) maintain oversight of the day to day operation of the agency while the agency was operating out of compliance with multiple Conditions of Participation (G942); and 2) ensure the Administrator appointed a qualified, pre-designated person, authorized in writing by the…

The agency policy lacked a procedure for staff requesting approval for non medical exemptions according to title VII and the EEOC, (Equal Employment Opportunity Commission).

The agency failed to involve the governing body in the overall management and operation of the organization resulting in the governing body not being aware the agency was operating out of compliance with multiple condition level regulations.

The agency failed to ensure the Plan of Care included complete medication and treatment orders for accurate completion of all components comprising the Plan of Care, including all supplies/equipment and medications used by the patient for 2 of 7 sampled patients (Patients #3 and #6).

The agency failed to provide treatments only as only as ordered by the physician for 1 of 1 sampled patients (Patient #3).

The agency failed to authorize in writing by the administrator and the governing body a qualified pre-designated person who assumes the same responsibilities and obligations as the administrator.

The agency failed to ensure the integrated health emergency preparedness plan addressed the agency's home health population.

The agency failed to ensure agency staff developed and implemented policies and procedures specific to home health agency patients.

The clinical records lacked a copy of an individualized written emergency preparedness plan provided to the patient for Patient's #1, #2, #3, #4, #5 and #6. Based on clinical record review, home visit observation, review of the agency's integrated health emergency preparedness plan and related…

The agency failed to ensure agency staff developed a policy and procedures to inform State and local emergency officials about homebound patients in need of evacuation due to an emergency situation.

The agency failed to ensure agency staff developed policies and procedures to inform State and local officials of on-duty staff and patients they are unable to contact in the event of an emergency.

The agency failed to ensure agency staff developed policies to address a system of medical documentation that preserves patient information, protects confidentiality and secures and maintains availability of patient records during an emergency situation.

The agency failed to ensure agency staff developed and maintained an emergency communication plan that included a method of sharing information and medical documentation for the agency clients to maintain the continuity of care.

The agency failed to ensure agency staff, both hired and contracted, completed initial and annual emergency preparedness training for 7 hired staff and 25 contracted staff.

The agency failed to ensure a registered nurse, or other appropriate skilled professionals in consultation with a registered nurse as appropriate, performed direct observation of a home health aide's performance of all required health aide skills on a home health patient to determine satisfactory…

The agency failed to ensure agency staff advised the patient 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 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 2 of 6 sampled patients (Patients #3 and #4).

The agency failed to ensure the timely completion of all pertinent components of the resumption of care comprehensive assessment within 48 hours of the agency's knowledge of the patient's return home from an inpatient facility for 1 of 2 sampled patients requiring a resumption of care assessment…

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 #1 and #3).

The agency failed to update the Plan of Care with new physician orders for 1 of 1 sampled patients (Patient #3) with therapy services.

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 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 #3).

The agency failed to ensure a registered nurse or other appropriate health care professional completed home health aide supervision at least every 14 days for 1 of 3 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patient #2).

The agency failed to ensure the supervision of home health aides by registered nurses 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…

The agency failed to ensure the clinical record included the patient's current physician orders for 2 of 7 sampled patients (Patients #3 and #7).