Best Home Care Corporation

The DON failed to follow and complied with accepted professional standards and principles in 1 out of 3 Sample Patients (SP) with home visits done.

The provider failed to document in the home health aide supervision the following elements: maintaining an open communication process with the patient, representative (if any), caregivers, and family: reporting changes in the patients’ condition; in 2 out of 8 sampled patients (SP).

The home health agency administrator/director of nursing failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases for 1 out of 3 SP (Sampled Patients) with home visits made.

The provider was unable to demonstrate a completed discharge summary for 2 out of 8 sampled Patients (SP), SP#6 and SP#7. The surveyor conducted closed record reviews of SP#6 and SP#7 on 12/12/23-12/14/23. The clinical record for SP#6 contained a discharge summary from the agency with a discharge…

The provider failed to demonstrate it has reviewed and updated the emergency preparedness plan that is based on and include a documented, facility-based and community-based risk assessment, utilizing an all hazards approach and that include strategies for addressing emergency events identified by…

The provider failed to demonstrate that all new and existing staff have received training on the emergency preparedness updated policies and procedures.

The provider failed to demonstrate the physician was consulted to approve additions or modifications to the original plan of care on 1 out of 10 Sampled Patients (SP).

The provider failed to demonstrate that 5 (Staff A, B, C, D, and E) out of 11 active staff received annual in-service on infection control.

The provider failed to ensure that the written instructions for the home health aide (HHA) are prepared by the Registered Nurse in 2 out of 10 Sample Patients (SP).

The provider failed to include in the individualized plan of care (POC) the frequency and duration of visits to be made on 6 out of 10 Sampled Patients (SP).

The home health agency failed to demonstrate the staff(s) prepare and record clinical notes for 1 out of 10 Sampled Patients (SP).

The provider failed to develop, establish and maintain a comprehensive emergency preparedness plan that must be reviewed and updated at least annually.

The provider failed to develop and maintain an emergency preparedness plan that must be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach and include strategies for addressing emergency events identified by the risk assessment.

The provider failed to develop an emergency preparedness plan that addresses patient/client population, the type of services the [facility] has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.

The provider failed to develop an emergency preparedness plan that include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation, including…

The provider failed to develop and implement emergency preparedness policies and procedures that must be reviewed and updated at least annually.

The provider failed to ensure its emergency preparedness plan addressed the procedures to inform State and local emergency preparedness officials about patients in need of evacuation from their residences at any time due to an emergency situation based on the patient's medical and psychiatric…

The provider failed to ensure its emergency preparedness plan included procedures to follow up with on-duty staff and patients to determine services that are needed, in the event that there is an interruption in services during or due to an emergency, and procedures on how the home health agency…

The provider failed to develop emergency preparedness policies and procedures to address a system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains availability of records.

The provider failed to develop and implement emergency preparedness policies and procedures that must address the use of volunteers in an emergency or other emergency staffing strategies.

The provider failed to develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least annually.

The provider failed to develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws that includes Names and Contact information for the following: Staff; Entities providing services under arrangement; Patients' physicians; Other [facilities] and…

The provider failed to ensure its emergency preparedness communication plan included contact information for Federal, State, tribal, regional, and local emergency preparedness staff and other sources of assistance.

The provider failed to develop and maintain an emergency preparedness communication plan that includes primary and alternate means for communicating with the staff and Federal, State, tribal, regional, and local emergency management agencies.

The provider failed to develop and maintain an emergency preparedness communication plan that include method for sharing information and medical documentation for patients under the [facility's] care, as necessary, with other health providers to maintain the continuity of care.

The provider failed to develop and maintain an emergency preparedness communication plan that include a means of providing information about the occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee.

The provider failed to develop an emergency preparedness training and testing program that is based on the emergency plan.

The provider failed to conduct initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role; provide emergency preparedness training at least annually; maintain…

The provider failed to participate in a full-scale exercise that is community-based and/or an individual facility-based exercise; failed to conduct additional exercise and failed to analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency…

The provider failed to ensure that an accurate and complete OASIS (Outcome and Assessment Information Set) data is electronically transmitted at least monthly on 3 out of 7 Sampled Patients (SP).

The provided failed to notify the physician of a review and revision of the plan of care for 1 out of 4 Sampled Patients (SP).

The provider failed to give the contact information for the Home Health Agency's administrator, including the administrator's name, business address, and business phone number in order to receive complaints for 7 out of 7 Sampled Patient (SP).

The provider failed to provide proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care for 1 out of 7 Sampled Patients (SP).

The provider failed to advise of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource…

The provider failed to ensure that a review of all medications the patient is taking in 1 out of 3 Sampled Patients (SP) with home visits.

The provider failed to include in the individualized plan of care the following: a description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors; and information related to any advanced directives…

The provider failed to record all patient care orders in the plan of care for 3 out of 7 Sampled Patients (SP).

The provider failed to have policy developed in consultation with a physician on influenza and pneumococcal vaccines.

The provider failed to give the name and contact information of the Home Health Agency clinical manager for 7 out of 7 Sampled Patient (SP).

The provider failed to have a complete and accurate medical record that includes all interventions, including medication administration and responses to those interventions made by the home health agency staff for 1 out of 7 Sampled Patients (SP).

The provider failed to ensure the clinical record included a completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the Home Health Agency (if any) within…