Divinity Home Care

The agency failed to ensure the plan of care included patient specific measurable outcomes and goals in 8 (P-4, P-5, P-6, P-7, P-8, P-9, P-10, and P-11) of 13 records reviewed resulting in the failure of the agency to determine the patient’s progress towards the goals of care.

The agency failed to ensure staff followed accepted standards of practice during 2 (P-6 and P-12) of 5 joint surveyor home visits potentially resulting in the transmission of infections or diseases.

The agency failed to ensure the Skilled Nurse prepared clear written patient care instructions for the home health aide regarding client needs, and safety precautions prior to the provision of care in 1 (P-13) of 2 records in which Home Health Aide services were ordered, from a total of 13 sampled…

The agency failed to ensure the patient’s right to consent or refuse disciplines that would furnish care in advance of treatment, was completed in 2 (P-6 and P-12) of 13 records reviewed, resulting in the potential for caregiver burnout and unmet needs.

The agency failed to have a system in place to record, track and investigate all complaints to prevent further potential violations for 3 (2023, 2024, and 2025) of 3 years reviewed, resulting in the potential for poor patient outcomes and unmet care needs.

The agency failed to ensure the Registered Nurse conducted the initial assessment visit within 48 hours of referral to determine the immediate care and support needs of the patient, including homebound status and eligibility for the Medicare home health benefits for 1 (P-2) of 11 records in which…

The agency failed to ensure the comprehensive assessment accurately reflected the patient’s health status at the time of admission in 5 (P-1, P-2, P-4, P-10, and P-13) of 13 records reviewed, resulting in incomplete clinical information used to determine the needs of the patients.

The agency failed to ensure activity of daily living needs were adequately met in the patient's home for 1 (P-2) of 2 patients who required assistance with grooming, from a total of 13 sampled records reviewed, resulting in the potential for poor hygiene, low self-esteem and unmet care needs.

The agency failed to perform a drug interaction review to identify potential adverse effects or drug interactions following the addition of new medications in 1 (P-10) of 13 records reviewed, resulting in the potential for poor patient outcomes.

The agency failed to ensure the plan of care accurately reflected the needs of the patient for 5 (P-1, P-2, P-9, P-10, and P-11) records, from a total of 13 sampled records reviewed, resulting in patients not receiving care specific to their individual needs and the potential for poor patient…

The agency failed to ensure services were provided in accordance with the Physician's ordered frequency for 1 (P-1) of 1 patient discharged prior to completion of the ordered visits, from a total of 13 sampled records reviewed, resulting in the potential for untreated health concerns and unmet care…

The agency failed to ensure the physician was notified of relevant changes for 2 (P-10 and P-11) of 13 records reviewed, resulting in the potential for unmet care needs and poor patient outcomings.

The agency failed to ensure skilled professionals followed the orders indicated in the plan of care in 3 (P-4, P-8, and P-10) of 13 records reviewed, resulting in the potential for unmanaged symptoms and poor patient outcomes.

The agency failed to ensure the home health aide was supervised every 14 days for 1 (P-7) of 2 records reviewed of patients receiving home health aide services, resulting in the potential for unmet care needs and poor patient outcomes.

The agency failed to ensure a discharge summary was completed, provided the patient's current health status at the time of discharge, progress toward goals, and forwarded to the physician within 5 days of discharge in 6 (P-1, P-2, P-4, P-5, P-7, and P-10) of 6 records of patients discharged from…

The agency failed to ensure the skilled nurse followed the physician's order for 2 of 2 (MR#3 and 11) records reviewed with an order for a urine culture (MR 3); and failed to follow orders to weigh a patient diagnosed with Congestive Heart Failure as ordered (MR 11), resulting in the potential for…

The agency failed to inform all patients of the appropriate phone number for the State of Michigan's toll-free hotline for 6 of 7 (MR# 4, 5, 7, 8, 16, 17) joint survey home visits, resulting in a lack of required information to enable patients or caregivers to voice complaints or ask questions.

The agency failed to ensure the comprehensive assessment included an accurate reflection of the patient’s current health and functional status in 2 of 17 records reviewed (MR#s 9 and 17) resulting in incomplete clinical information to aid in determining the needs of this patient.

The agency failed to ensure the comprehensive assessment included a review of all medications used by the patient to identify potential adverse effects, significant drug interactions, and duplicate drug therapy in 6 of 17 records reviewed (MR# 2, 4, 5, 6, 8 and 10), and failed to have a registered…

The agency failed to include objectively measurable goals on the Plan of Care for 6 of 17 (MR#s 8, 9, 10, 11, 12, and 17) records reviewed from a total of 17 records reviewed, resulting in the potential for poor patient outcomes due to a lack of quantifiable measures to determine progress towards…

The agency failed to document patient care without the use of unknown abbreviations in 1 of 17 (MR#8) records reviewed resulting in records that fail to appropriately document and communicate the care provided to the patient.

The agency failed to ensure a transfer summary was sent to the receiving health care facility within 2 business days of becoming aware of the transfer for 2 of 2 (MR#s 3 and 10) records reviewed with transfers to other health care facilities, resulting in a lack of information to ensure continuity…

The Agency failed to include contact information for the Home Health Agency's Administrator in the Patient Admission/Orientation Packet, resulting in the potential for unaddressed patient concerns for all patients serviced by this agency.

The agency failed to ensure the plan of care included all pertinent interventions, monitoring precautions, and reportable parameters for 3 (MR# 4, 7 and 12), out of a total of 17 records reviewed, resulting in patients not receiving care specific to their individual needs and the potential for poor…

MR #7: The plan of care dated 9-11-19 stated the patient was admitted for nursing, aide, occupational therapy and physical therapy services with the diagnosis of Aftercare following surgery for colon cancer/new illeostomy.

The Agency failed to include contact information for the Home Health Agency's Clinical Manager in the Patient Admission/Orientation Packet, resulting in the potential for unaddressed patient concerns.

The Agency failed to ensure the clinical record was completed and included detailed Physical Therapy and Skilled Nursing notes for 1 (MR #) of 1 patient who underwent total knee replacement, from a total of 17 sampled records reviewed, resulting in the potential for unidentified health concerns and…

The agency failed to ensure skilled nursing notified the physician in 1 of 3 resumption of care records reviewed (MR#17) regarding significant clinical findings from a total of 17 records reviewed, resulting in the potential for poor patient outcomes.

The Agency failed to ensure the clinical record was complete and included a discharge summary that accurately captured the status of the patient at the time of discharge for 1 (MR #5) of 5 discharged records; and failed to update the clinical status in 1 (MR #17) of 3 resumption of care records…