Community Home Health Inc

The agency failed to ensure care was provided in accordance with the established plan of care and physician orders for one (1) of seven (7) CR reviewed (CR #3).

The employee failed to follow basic infection control practices for one (1) of three (3) observations (OBS).

The agency failed to ensure initial and annual clinical staff competency evaluations were documented for three (3) of the nine (9) PFs reviewed (PF#4-5, PF#8); failed to ensure initial and annual skills assessments evaluations were documented for seven (7) of nine (9) PFs reviewed.

The agency failed to provide documentation that the hazard vulnerability assessment and the emergency preparedness plan were reviewed and updated every two (2) years.

The agency failed to demonstrate that initial training in emergency preparedness policies and procedures was provided to newly hired employees, and that ongoing employee training was completed at least every 2 years.

The agency failed to provide evidence that the emergency preparedness plan was tested annually.

The agency failed to provide documentation related to the vaccination or exemption status for an individual who provides care, treatment or other services to patients for one (1) of eight (8) personnel files reviewed: PF#3, and failed to provide evidence that two religious exemptions were formally…

The agency failed to provide the patient with the names, addresses and telephone numbers of the following Federally-Funded and State-Funded entities that service the area where the patient resides: Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center…

The agency failed to maintain documentation for review/update of the emergency preparedness plan with all required elements every two years.

The agency failed to base the emergency preparedness plan on and to include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.

The agency failed to conduct an exercise to test the emergency plan at least annually.

The agency failed to maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program.