Floyd County Public Health/ Home Health Care

The agency failed to ensure accurate completion of all components comprising the Plan of Care, including all medical supplies/equipment used by the patient for 3 of 7 sampled patients (Patients #2, #3 and #6).

The agency failed to ensure a registered nurse or other appropriate health care professional completed home health aide supervision at least every 14 days for 2 of 4 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patients #1 and #2).

The agency failed to ensure registered nurses supervising home health aides maintained documentation of a review of all required supervisory elements including following the patient plan of care, maintaining open communication with patient/caregiver, demonstrating competency of all assigned tasks…

The agency failed to maintain documentation showing transfer summaries were sent to the physician caring for the patient at the inpatient facility after transfer within 2 business days of the agency becoming aware of the patient's transfer for 1 of 2 patients reviewed with transfers (Patient #7).

The agency failed to follow a Plan of Care established and periodically reviewed by a physician or notify the physician of the need to vary frequency of visits or inability to perform treatments/services as originally ordered on the Plan for Care for 2 of 7 sampled patients (Patients #1 and #6).

The agency failed to ensure staff provided care in accordance with agency expectations and accepted infection control standards of practice observed during a home visit for 2 of 3 sampled patients (Patient #2 and #3) with a home visit observation.

The agency failed to ensure the accurate completion of all components compromising the Plan of Care, including all supplies/equipment and medications used by the patient for 2 of 3 sampled patients with surveyor home visit observation (Patient #1 and #3).

The agency failed to ensure patients were not discharged without just cause (G458).

The agency: 1) failed to ensure each patient received services that were established by a doctor of medicine, osteopathy or podiatry (G572); 2) failed to ensure all supplies/equipment/medications/treatments required by the patient to meet his/her needs were included on each patient's Plan of Care…

The agency hired 7 new employees since 3/29/2018. The systemic practice resulted in the failure to ensure the organizational framework of the agency promoted and supported the adherence to state regulations and coordination of safe and effective delivery of care to the agency's 98 patients. 481 IAC…

The agency failed to involve the governing body in the overall management and operation of the organization resulting in the governing body not being aware the agency was operating out of compliance with several condition level regulations (G942).

The home health agency failed to complete an individualized emergency plan developed as part of the comprehensive assessment, maintaining documentation of the plan in the patient's chart and in the patient's home setting, for 7 of 7 sampled patients (Patients #1, #2, #3, #4, #5, #6 and #7).

The agency failed to ensure training in emergency preparedness to all existing staff consistent with their expected roles at the time of orientation and every other year thereafter for 11 of 11 sampled employees (Staff D, G, H, I, J, K, L, M, N, O and P).

The agency failed to follow a Plan of Care established and periodically reviewed by a physician or notify the physician of the need to vary frequency of visits or inability to perform treatments/services as originally ordered on the Plan for Care for 4 of 7 sampled patients (Patients #3, #5, #6 and…

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

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 3 of 5 sampled patients receiving home health aide services (Patients #4 #7, and #8).

The agency failed to involve the governing body in the overall management and operation of the organization resulting in the governing body not being aware the agency was operating out of compliance with several condition level regulations.

The agency failed to ensure authentication of hand written entries made in each patient's clinical record included the employee's signature of the author of the documentation, title of the author, and date/time of the signature for 2 of 2 sampled patients receiving therapy services (Patients #1 and…

The agency failed to ensure the physician responsible for the patient's home health services and the agency agree on the appropriateness of patient discharge for 2 of 2 sampled patients discharged from agency services (Patients #6 and #7).

The agency failed to complete a drug regimen review within the required time frames as part of the update to the comprehensive assessment at the time of resumption of care or discharge for 4 of 4 sampled patients requiring resumption of care or discharge from agency services (Patients #3, #4, #6…

The agency failed to ensure accurate completion of all required components of the recertification comprehensive assessments between day 56 and 60 of each 60 day certification period for 3 of 6 sampled patients requiring a recertification assessment (Patients #2, #5 and #8).

The agency failed to ensure completion of the update to the comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 1 of 3 sampled patients requiring a resumption of care assessment (Patient #3).

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 #1, #2, #3, #4, and #5).

The agency failed to maintain a working Plan of Care for patients and update the working Plans of Care with any new verbal/interim physician orders for 6 of 7 sampled patients.

The agency failed to provide medications, treatments or services only as ordered by the physician for 5 of 8 sampled patients (Patients #3, #5, #6, #7 and #8).

The agency failed to report changes in patient clinical findings or changes in patient needs to the physician for 6 of 8 sampled patients (Patients #1, #3, #4, #6, #7 and #8).

The agency failed to assure communication with all physicians involved in the Plan of Care 2 of 2 sampled patients receiving cares from clinical nurse specialists (Patients #6 and #7).

The agency failed to ensure home health aides provided care to agency patients only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 5 sampled patients receiving home health aide services…

The agency failed to ensure a registered nurse completed home health aide supervision at least every 60 days while observing the home health aide present and providing direct patient care for 1 of 1 sampled patients who received hands on personal care services with no skilled service provision.

The agency failed to ensure the clinical record included the patient's current documentation and a complete chart for 6 of 8 sampled patients (Patients #1, #2, #4, #5 #6 and #8).

The agency failed to complete and send a transfer summary to the physician responsible for caring for the patient while in an inpatient facility within 2 business days of knowledge of the occurrence of the transfer for 3 of 3 sampled patients with transfers to an inpatient facility requiring the…

The home health agency failed to ensure the clinical record included a copy of the patient's individualized emergency plan developed as part of the comprehensive assessment for 6 of 6 sampled patients (Patients #1, #2, #3, #4, #5 and #7) with a record review which included a comprehensive…

The home health agency failed to ensure training in emergency preparedness policies and procedures to all hospice employees and individuals providing services under arrangement.

The agency failed to follow written physician's orders, failed to ensure physician's order were incorporated into the Plan of Care and/ or failed to notify the physician of changes in visit frequency for 2 of 7 sampled patients (Patients #5 and #7).

The agency failed to ensure a registered nurse performed direct observation of home health aide performance of all required basic home health aide skills on a patient in order to determine satisfactory competency prior to allowing the home health aide to provide care independently to agency…

The agency failed to ensure all documentation included a signature and date and time of signature for 2 of 2 sampled patients who received speech therapy services (Patients #6 and #7) The agency reported a census of 82 patients.

The agency failed to provide agency patients with contact information for the agency's administrator which included the administrator's name, business address and business phone number.

The agency failed to ensure accurate completion of all pertinent components of the start of care comprehensive assessment within the required time frame for 2 of 7 sampled patients (Patients #1 and #6) with a start of care date after the last survey (4/1/15).

The agency failed to ensure accurate and thorough completion of all pertinent components of comprehensive assessments for 2 of 7 sampled patients (Patients #4 and #6).

The agency failed to complete a drug regimen review, including all required components, with each comprehensive assessment for 7 of 7 sampled patients (Patients #1, #2, #3, #4, #5, #6 and #7).

The agency failed to ensure completion of all pertinent components of resumption of care comprehensive assessment within 2 days of the patient's discharge from an inpatient facility for 1 of 1 sampled patients requiring a resumption of care assessment (Patient #6).

The agency failed to ensure the accurate completion of all components comprising the Plan of Care and/or failed to ensure the Plan of Care contained current, accurate information for 2 of 3 sampled patients (Patients #1 and #2) with home visit observations.

The agency failed to provide to the patients medication lists that included medication name, dosage, frequency and which medications will be administered by agency personnel for 3 of 3 sampled patients with home visit observations (Patients #1, #2 and #3).

The agency failed to ensure the agency's nurses adequately reevaluated the patient's status and response to care, in order to provide appropriate individualized care for 2 of 2 sampled patients with open wounds (Patients #1 and #6).

The agency failed to document whether extra skills competencies were evaluated in a laboratory setting using a pseudo patient or in a home setting while being performed on an actual patient for 4 of 5 sampled home health aides (Staff D, G, H and I).

The agency failed to complete home health aide supervision with all required components for 4 of 4 sampled patients who received home health aide services (Patients #1, #4, #5 and #8).

The agency failed to ensure all interim physician orders were signed by a physician for 1 of 7 sampled patients (Patient #6).

The agency failed to ensure the patient's clinical record included accurate documentation of medication and treatment interventions completed by the registered nurse for 4 of 7 sampled patients (Patient #1, #2, #4 and #5).