Harrison County Public Health

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 of Care for 2 of 2 sampled patients with missed visits…

The agency failed to ensure 2 of 4 sampled home health aides (Staff F and G), demonstrated completion of all of the assigned extra skills while observed by a registered nurse to determine competency in each task prior to being allowed to care for agency patients independently for 2 patients…

The agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 2 of 3 sampled patients receiving home health aide services (Patients #5 and #7).

The agency failed to ensure a registered nurse or other appropriate professional completed an annual on-site visit to observe and assess each aide while the home health aide present and providing direct patient care (Staff F and G).

The home health agency failed to ensure all clinical documentation was completed in a timely manner for 4 of 7 sampled patients (Patients #1, #4, #6 and #7).

The agency failed to complete a drug regimen review with each comprehensive assessment and failed to identify patient specific medications issues for 4 of 7 sampled patients (Patients #2, #3, #4 and #5).

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

The agency failed to ensure home health aides provided care to patients only as ordered by a physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 3 sampled patients receiving home health aide services (Patients #5…

The agency failed to ensure the development of a written policy and procedure to inform State and local officials of any on duty directly hired staff and patients they are unable to contact in the event of an interruption of services related to an emergency.

The agency failed to ensure training in the agency's emergency preparedness policies and procedures at hire and every 2 years thereafter for 4 of 5 sampled directly hired staff and for 7 of 7 sampled contracted staff consistent with their expected roles in the event of an emergency/disaster.

The agency failed to ensure 4 of 5 sampled home health aides (Staff G, H, I and J), demonstrated completion of all of the assigned extra skills while observed by a registered nurse to determine competency in each task prior to being allowed to care for agency patients independently for 2 patients…

The agency failed to ensure authentication of staff documentation in each patient's clinical record included the signature and credentials of the author of the document and the date and time of the signature of the author for 8 of 8 sampled patients (Patient #1, #2, #3, #4, #5, #6, #7 and #8).

The agency failed to complete drug regimen reviews within the regulatory timing guidelines at the time of start of care and recertification for 4 of 8 sampled patients (Patients #1, #4, #5 and #6).

The agency failed to ensure accurate completion of all required components of the recertification comprehensive assessments with accompanying drug regimen review between day 56 and 60 of each 60 day certification period for 2 of 4 sampled patients requiring an update to the comprehensive assessment…

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

The agency failed to ensure completion of the discharge comprehensive assessments within 2 calendar days of identification of the need to discharge a patient for 1 of 1 sampled patients requiring a discharge comprehensive assessment (Patient #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 and accurate medication/treatment orders for 3 of 8 sampled patients (Patients #2, #3 and #5).

The agency failed to maintain a working Plan of Care for patients and update the working Plans of #2, #3, #5 and #6) The agency reported a current census of 27 patients at the time of the survey.

The agency skilled professionals failed to follow the physician ordered Plan of Care for 2 of 7 sampled patients receiving a skilled service (Patients #1 and #6).

The agency failed to ensure home health aides provided care to agency patients 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 4 sampled patients receiving home health aide services…

The agency failed to ensure agency staff completed documentation in a timely manner and according to the agency policy for 5 of 8 sampled patients (Patients #1, #3, #5, #6 and #8).

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 31 employees between 10/28/18 and 10/9/18. Failure to complete the required backgrounds checks according to the State of Iowa requirements placed agency patients at risk for potential harm.

5. Patient #2 had a start of care date of 4/11/17. The patient's clinical record lacked documentation of an individualized emergency plan based on the results of a risk assessment.

The agency failed to ensure the development of a written policy and procedure to inform State and local officials of any on duty staff and patients they are unable to contact in the event of an interruption of services related to an emergency.

The agency failed to ensure training in emergency preparedness for all employed staff and all individuals providing services under arrangement (contract staff), consistent with their expected roles on or prior to November 15, 2017. The agency reported utilizing a total of 31 contracted staff (Home…

The agency failed to obtain and follow a written Plan of Care established and periodically reviewed by a doctor of medicine, osteopathy or podiatry for 1 of 7 sampled patients (Patient #2).

The agency clinicians failed to complete supervision of licensed practical nurses periodically to evaluate the services furnished to ensure the patient's needs are met for 2 of 7 patients sampled (Patients #2 and #5).

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 home health patient to determine satisfactory competency prior to allowing the home health aide to provide care independently to agency…

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 4 sampled patients receiving home health aide services (Patients #2, #5 and #7).

The agency failed to ensure authentication of all hand written entries made by the home health aide in each patient's clinical record included the aide's signature, title, including the date and time of the signature for 4 of 4 sampled patients (Patients #2, #5, #6 and #7).

The agency failed to ensure the completion of all pertinent components of the start of care comprehensive assessments by the fifth day after the start of care for 1 of 7 sampled patients admitted after 10/28/15 (Patient #6).

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

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 5 sampled patients requiring a recertification assessment (Patients #2, #6 and #7).

The agency failed to ensure accurate completion of all pertinent components of the resumption of care comprehensive assessments within 48 hours of the agency's knowledge of return home from an inpatient facility for 2 of 2 sampled patients requiring a resumption of care assessment (Patients #6 and…

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 3 of 7 sampled patients (Patients #1, #2 and #5).

The agency failed to provide wound care only as ordered by the physician for 3 of 3 sampled patients receiving wound care from the agency (Patients #2, #5 and #6).

The agency clinicians failed to including measurements of wounds, including length, width and depth, weekly as required for 3 of 3 sampled patients with wounds (Patients #5 and #6).

The agency failed to ensure a registered nurse (RN) completed home health aide supervision at least every 60 days while observing each 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…