Pathwell Home Health & Hospice
Inspection 2018-06-28
· Recertification, Sample Validation · 26 deficiencies · CMS source report (PDF)The agency failed to ensure and document that patients were informed verbally and in writing prior to services being provided regarding patient rights (see G412); failed to provide the contact information for the Administrator (see G414); failed to provide the OASIS privacy notice (see G416)…
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The agency failed to provide care to patients according to their plans of care (refer to G572); failed to ensure that all plans of care were complete and accurate (refer to G574 and G576), and administer drugs and treatments ordered by the patient's doctor (refer to G580).
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The Governing Body and/or Administrator failed to ensure the overall management and organization of resources in order to attain and provide the highest practicable functional status.
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The agency failed to document contact information for Federal and State emergency preparedness officials and other sources of assistance.
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The agency failed to provide initial training in emergency preparedness policies and procedures that are consistent with their roles in an emergency to all new and existing staff, individuals providing services under arrangement, and volunteers.
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The agency failed to ensure the OASIS data accurately reflected the patient's status at the time of assessment in 1 of 17 medical records reviewed in the survey sample.
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The agency failed to ensure care was provided according to the plan of care for nine (9) of seventeen (17) medical records reviewed in the survey sample.
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The agency failed to ensure at least one skilled service was furnished directly by agency employees.
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The agency failed to ensure written notice of the patient's rights and responsibilities and the HHA's transfer and discharge policies were provided to each patient in one (1) of seventeen (17) medical records reviewed in the survey sample.
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The agency's admission packet failed to contain the contact information for the HHA (home health agency) Administrator, specifically the Administrator's name and address in order to receive complaints.
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The agency failed to ensure an OASIS privacy notice was provided to each patient for whom OASIS data is collected in one (1) of seventeen (17) records reviewed in the survey sample.
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The agency failed to obtain the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities in one (1) of seventeen (17) medical records reviewed in the survey sample.
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The agency failed to ensure each patient was informed and consented to care in advance of the care to be furnished in one (1) of seventeen (17) medical records reviewed in the survey sample.
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The agency failed to ensure the confidentiality of each patient's medical record in eight (8) of seventeen (17) medical records reviewed in the survey sample.
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The agency failed to ensure each patient was advised in advance of providing care the extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, the charges for services that may not be covered by…
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The agency failed to provide written notice to patients in advance of terminating on-going care in four (4) of five (5) closed medical records reviewed in the survey sample.
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The agency failed to document the resolution of a patient complaint in one (1) of three (3) complaints reviewed for 2018. Findings: Three (3) complaints were reviewed in the agency on 06/25/2018. One complaint consisted of a series of emails between a patient's (patient #18) family and the agency's…
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The agency failed to ensure it completed a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and…
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The agency failed to ensure the patient's individualized plan of care included a description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors and measurable outcomes and/or goals identified by the…
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The agency failed to ensure all patient care orders were recorded in the plan of care in two (2) of seventeen (17) medical records reviewed in the survey sample.
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The agency failed to ensure drugs, services, and treatments were administered only as ordered by a physician for three (3) of seventeen (17) clinical records reviewed in the survey sample.
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The agency failed to provide each patient with a medication schedule and instructions in two (2) of seventeen (17) medical records reviewed in the survey sample.
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Agency staff failed to ensure patients were advised of the name and contact information of the Home Health Agency's clinical manager for fourteen (14) of fourteen (14) patients admitted on or after 01/13/2018. (Medical Records # 1-13, and 16).
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The agency failed to ensure the Administrator was appointed by and reported to the governing body.
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The Governing Body failed to ensure a qualified, pre-designated person was authorized in writing by the administrator and the governing body to assume the same responsibilities and obligations as the administrator.
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The agency failed to ensure contracts for services under arrangement contained information on how supervision of services would occur to ensure the HHA maintained responsibility for patient care in two (2) of two (2) contracts reviewed in the survey sample.
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