Franklin County Public Health

The agency failed to perform complete an accurate drug regimen reviews with each comprehensive assessment and identify patient specific medication issues for 3 of 3 sampled patients with home visit observations (Patients #1, #2 and #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 information related to advanced directives for 2 of 3 sampled patients with home visit observations (Patients #1 and #3).

The agency failed to complete and send a transfer summary to physician caring for the patient at the inpatient facility within 2 business days of a planned transfer for 1 of 2 sampled patients with transfers/discharges (Patient #2).

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 #3 and #5).

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 1 of 1 sampled patients (Patient #2) with a home visit observation of contracted staff.

The hospice failed to ensure all clinical entry notes included a date and time and staff signature with title completed in a timely manner for 2 of 7 sampled patients (Patients #6 and #7).

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies and equipment used by the patient to meet his/her needs and an accurate list of the patient's current medications for 2 of 7 sampled patients (Patients #1 and #6).

The agency failed to complete and send a transfer summary to other health care professionals responsible for providing care to the patient after transfer within 5 business days of the patient's transfer for 2 of 2 sampled patients requiring transfer.

The agency: 1) 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 (G574); 2) failed to include all verbal orders in a working Plan of Care used by all clinicians to reflect current orders (G576)…

The agency hired 7 directly hired employees and contract employees between 12/30/15 and 12/12/18. Failure to complete the required backgrounds checks according to the State of Iowa requirements placed agency patients at risk for potential harm.

5. Patient #3 had a start of care date of 8/28/18. The clinical record included documentation of an emergency preparedness plan on the Plans of Care, dated 8/28/18 to 10/26/18 and 10/27/18 to 12/25/18. The clinical record lacked a copy of the individualized emergency preparedness plan agency staff…

The agency failed to ensure training in emergency preparedness to all existing staff consistent with their expected roles for 4 of 9 directly hired staff.

The agency failed to provide individualized and specific written patient care instructions from a registered nurse to agency home health aides for 2 of 4 sampled patients receiving home health aide services (Patients #1 and #6).

The agency failed to ensure authentication of hand written entries made in each patient's clinical record included the employee's signature, title, date and time of the signature for 3 of 3 sampled patients (Patients #3, #4 and #6).

The agency failed to include an individualized assessment relating to the patient's current health status when completing comprehensive assessments for 3 of 3 sampled patients (Patients #1, #3 and #5).

The agency failed to accurately identify all medications taken by the patient with each comprehensive assessment/drug regimen review and/or failed to maintain an accurate list of medications, including times of administration for 5 of 7 sampled patients (Patients #1, #3, #4, #5 and #7).

The agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies/equipment used by the patient, advanced directive information and hospital risk assessment for 7 of 7 sampled patients (Patients #1, #2, #3, #4, #5, #6 and #7).

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 7 of 7 sampled patients.

The agency failed to provide wound care only as ordered by the physician for 2 of 7 sampled patients (Patients #1 and #5).

The agency failed to report changes in patient clinical findings to the physician as directed on the Plan of Care for 2 of 7 sampled patients (Patients #1 and #5).

The agency failed to provide agency patients with written contact information for the agency's clinical manager, including the clinical manager's name and contact information (telephone number and/or email address).

The agency clinicians failed to include measurements of wounds, including length, width and depth, weekly as required for 2 of 3 sampled patients with wounds (Patients #1 and #3).

The agency failed to complete and send a discharge summary to the physician or other health care professionals responsible for providing care to the patient after discharge within 5 business days of the patient's discharge for 1 of 1 sampled patients requiring discharge after the change in…