Dayspring Healthcare Services, Inc

The Agency failed to establish policies and procedures based on the risk assessment.

The Agency lacked policies and procedures concerning the availability of Pt. information.

The Agency failed to conduct the required testing of its Emergency Preparedness Plan.

In 8 of 25 assessments submitted for the last 12 months, the Agency failed to submit all timely reports, resulting in a warning.

In 4 of 7 (Pts. #2, 3,1, and 7) clinical records reviewed, the PsOC lacked Pt. specific interventions.

In 7 of 7 (Pts. #1, 2, 3, 4, 5, 6, and 7) clinical records reviewed, the Agency failed to provide the Pt./patient's representative information regarding the Administrator.

In 7 of 7 (Pts. #1, 2, 3, 4, 5, 6 and 7) clinical records reviewed, the Agency failed to provide Pts. information regarding the Agency's transfer and discharge policies.

In 4 of 7 (Pts. #3, 4, 2, and 6) clinical records reviewed, the Agency failed to ensure a referral was obtained to initiate service or that the initial assessment visit was done within 48 hours of receipt of the referral.

(Pts. # 1, 2, 3 and 4) the Agency failed to ensure that the comprehensive assessments included a complete review of body systems.

The Agency failed to provide Pts. with a copy of the Agency’s transfer/discharge policies.

The Agency failed to ensure Pts. were screened for symptoms of COVID-19, prior to providing service.

The Agency failed to ensure informed consents were obtained for services, and the Pt. was informed of visit frequencies, prior to the SOC.

The Agency failed to ensure the initial assessment visit was done within 48 hours of the referral date.

The Agency failed to ensure immunization screening for the administration of the Influenza and Pneumococcal vaccinations was assessed at the SOC.

The Agency failed ensure the POC was followed.