Avera at Home of Spencer Hospital

The agency failed to complete a drug regimen review with each comprehensive assessment and identify patient specific medication issues for 2 of 7 sampled patients (Patients #1 and #2).

The agency failed to include all Durable Medical Equipment (DME) and treatments in Plans of Care for 4 of 7 sampled patients (Patients #1, #3, #4, and #6).

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 5 of 7 sampled patients (Patients #2, #3, #4, #5 and #6).

The agency skilled professionals failed to follow the physician ordered Plan of Care for 4 of 7 sampled patients receiving a skilled service (Patients #1, #2, #3 and #4).

The agency failed to ensure training in emergency preparedness to all individuals providing services, including directly hired employees and those hired under arrangement, consistent with their expected roles.

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/ equipment and medications for 8 of 9 sampled patients (Patients #1, #2, #3, #4, #5, #6, #7 and #8).

The agency failed to administer medication only as ordered by the physician for 1 of 2 sampled patients with home visits for medication set up observation (Patient #3).

The agency clinician's failed to assess, including measurements, each would at least weekly as identified by agency policy for 1 of 2 sampled patients with wounds.

The agency failed to complete and send a transfer summary to either the primary care physician or physician and other health care professionals responsible for providing care to the patient where the patient was transferred to for 1 of 1 sampled patients who were transferred to an inpatient…