Together Homecare of Greenwood LLC

The agency failed to ensure field staff followed appropriate infection control practices while providing patient care in 1 of 3 home health aide (HHA) and 1 of 2 licensed practical nurse (LPN) home visits conducted.

The agency failed to ensure services were provided in accordance with the plan of care, failed to ensure each patient received an individualized care plan, failed to ensure visit frequencies were individualized to be specific to the patients' needs, failed to identify patient-specific and…

The agency failed to ensure nursing staff performed and abided by standards of practice in regard to medication administration (G704); failed to develop the plan of care with the patient and/or representative prior to implementation (G708); failed to ensure they provided the services as ordered by…

The agency failed to ensure they adhered to professional documentation standards; failed to ensure documentation in the patient’s records was accurate (See G1008); failed to ensure the clinical record was complete with medication administration record (MAR), where skilled nursing provided frequent…

The agency failed to ensure services were provided in accordance with the plan of care, failed to ensure each patient received an individualized care plan, failed to ensure the frequency of care visits was specific to patients' needs, and failed to identify patient-specific and measurable outcomes…

The agency failed to ensure clinicians followed accepted standards of practice, including the use of standard precautions, to prevent transmission of infections and communicable diseases in 3 of 4 home visits conducted.

The agency failed to ensure that skilled clinical staff performed and abided by standards of practice in regard to medication administration in 1 (Patient 2) in a sample of 9 clinical records reviewed.

The Governing Body failed to ensure they were fully aware of Federal and State Regulations, failed to ensure governing body meeting minutes were created and maintained showing the exercise of their full legal and fiscal responsibilities, to include the directive to create appropriate seizure…

The agency failed to ensure the annual budget was developed under the direction of the Governing Body and approved by the Governing Body, for 1 of 1 home health agency Governing Body.

The agency failed to ensure the clinical record was complete to include the medication administration record (MAR), where skilled nursing provided daily medication administration, for 1 (Patient 2) out of 4 home visits observed, in a total sample of 9 clinical records reviewed.

The agency failed to ensure patient complaints were documented in accordance with agency policy, to include documentation of outcomes/resolutions, complete with patient/family response, in 2 (Patients 2 and 6) of 9 clinical records reviewed.

The agency failed to ensure patients received visit frequencies as ordered in the plan of care, for 2 (Patients 6 and 8) in a sample of 9 clinical records reviewed.

The agency failed to ensure a complete and accurate assessment of the patients' specific goals, strengths, and care preferences in 5 of 9 records reviewed.

The agency failed to ensure a medication review was performed during the nursing reassessment and failed to ensure an accurate medication administration record was created, in the home, and used as a basis for care in 3 (Patients 2, 3, and 5) in a sample of 9 clinical records reviewed.

The agency failed to ensure patients received care visits as ordered by the physician in the plan of care, for 2 (Patients #6 and 8) in a sample of 9 clinical records reviewed.

Agency failed to prepare and provide patients and families with written information containing patient medication schedule and instructions, including medication name, dosage, route, frequency and failed to identify which medications would be administered by agency staff in 1 (Patient 3) of 4 home…

The agency failed to develop the plan of care with the patient and/or representative prior to implementation in 1 of 9 patients reviewed.

The agency failed to ensure they provided the services ordered by the physician in 2 patient record reviews of 9. (Patients #6 and 8) Findings include: 1. A review of an agency's policy titled, 'Admission Policy C-120,' dated 12/30/21, revealed, "POLICY Patients are accepted for treatment in the…

The agency failed to ensure clinical documentation of medication administration included: medication name, medication route, medication dosage, and patient response/tolerance to administration.

Nursing staff failed to ensure they communicated discrepancies with the ordering physician upon initial discovery of inaccurate routes of administration of g-tube feedings and hydration boluses as indicated on the Plan of Care in 1 of 9 records reviewed.

The administrator failed to be responsible for the day-to-day operations of the home health agency in relation to failure to ensure all complaints were recognized and documented with a complete resolution in the complaint log; failure to ensure that patients received care visits as ordered in the…

The agency failed to ensure the plan of care was developed accurately in 1 of 9 record reviews.

The agency failed to ensure the skilled nurses provided home health services in accordance with current clinical practice guidelines in regard to medication administration and documentation for 1 (Patient 2) of 4 home visits, in a total sample of 9 clinical records reviewed.

The agency failed to ensure skilled nursing documented assessments in the clinical record, the patient's response/tolerance after administration of medications for 1 (Patient 2) of 4 home visit observations, out of a total sample of 9 clinical records reviewed.

The home health agency failed maintain compliance with the Condition of Participation of Patient Rights, 42 CFR 484.50, by having failed to respect a patient's dignity by failure to document an adequate resolution to a complaint of invasion of a patient's privacy, by a home health aide, when the…

The agency failed to maintain compliance with the Condition of Participation of Care Planning, coordination of services, and quality of care, by having failed to ensure the plan of care visit hours for home health aide visits were individualized and based on meeting the patients identified needs…

The agency failed to maintain compliance with the Condition of Participation of Quality Assurance and Performance Improvement.

The agency failed to maintain compliance with the Condition of Participation of Organization and Administration of Services.

The agency failed to ensure its registered nurses conducted and documented a complete comprehensive assessment as a basis for care planning for 1 (Patients #4) 2 patients who received skilled nursing care, of a total sample of 6 patients whose clinical records were reviewed.

The agency failed to ensure the nurse visit hours on the plan of care were individualized and based on the patient's needs for 1 (Patient #4) of 2 patients who received skilled care, in a sample of 6 patients whose clinical records were reviewed; failed to ensure the plan of care visit hours for…

The registered nurse failed to ensure the plan of care was evaluated and updated at the time of recertification for 2 (Patients #1 and #4) of 4 patients on service more than 60 days.

The agency failed to implement their policy by having failed to have identified measurable improvement for home health aide misconduct and missed care visits, both areas which would improve patient safety, outcomes, and quality of care, for 1 of 1 year reviewed, the 2020 quality assurance…

The agency failed to implement its policy which required it to utilize measures derived from OASIS (Outcome Assessment and Information Set) in order to monitor the effectiveness and safety of services and quality of care in the design of 1 of 1 year reviewed, the 2020 quality assessment and…

The agency failed to implement its policy which required the quality assessment and performance improvement (QAPI) program collected and analyzed data for adverse event reports for 1 (2020) of 1 year of QAPI reviewed.

The agency failed to ensure its quality assessment performance improvement (QAPI) program addressed the past performance of the home health agency's services and operation, by having failed to implement performance improvement projects designed to show measurable progress for 1 (2020) of 1 year…

The agency failed to respect a patient's dignity by having failed to document an adequate resolution to a complaint of invasion of privacy and stolen property (Patient #1), by home health aide (HHA), employee A, when the HHA recorded video content in patient #1's home showing patient #1's home and…

The agency failed to ensure 1 (Patient #4) of 1 patient with guardian's allegation of verbal abuse of patient #4, was determined to be free from verbal abuse, by having failed to obtain and review all video tapes recorded in the home during skilled nurse shift at issue; having failed to take…

The agency failed to ensure patients received all the care visits ordered in the plan of care for 1 (Patient #1) of 4 patients with home health aide only services, of 6 patients whose clinical records were reviewed.

The home health agency failed to document as a complaint and therefore failed to document a responsive resolution to a complaint of physical and verbal abuse, to include an injury of unknown origin, for 1 of 1 (Patient #4) a minor patient, whose clinical record was reviewed and whose plan of care…

The agency failed to document completed and responsive resolutions to patient complaints for 12 of 16 complaints reviewed from 2019 and 2020. The findings included: 1. Review of an undated start of care packet, with patients' rights enumerated, "Rights and Responsibilities," evidenced, " ...…

The agency failed to ensure a patient had a competent caregiver in the home to provide care, as required by agency policy, for 1 (Patient 1) of 6 patients whose clinical record was reviewed.

The agency failed to ensure the plan of care included a measurable hygiene goal for 1 (Patient #1) of 4 patients who received home health aide services only, out of a sample of 6 patients.

The agency failed to ensure physicians who were responsible for aspects of a patient's care were contacted to coordinate care in relation to a patient's need for a seizure care and management plan, nutrition requirements and care of a gastrostomy feeding tube, for 1 (Patient #4) of 2 patients with…

The agency failed to implement their policy which required the quality assurance performance improvement (QAPI) program select performance improvement plans (PIPs) which focused on high-risk, high-volume, or problem-prone areas for 1 of 1 year reviewed, the 2020 QAPI program.

The agency failed to ensure the evaluation of the plans of care for 2 (Patients #1 and 6) of 6 clinical records reviewed.

The agency failed to ensure the nurses provided and documented education as ordered on the plan of care for 1 (Patient #4) of 2 patients who received skilled services, in a sample of 6 patients.

The registered nurses (employees B and C) failed to document in the clinical record accurate and complete visit notes for the care furnished for 1 (Patient #4) of 2 patients who received skilled nursing services, of a sample of 6 patients whose clinical records were reviewed.

The agency failed to ensure a home health aide (HHA) assigned care tasks included only the provision of hands on care, the performance of simple procedures as an extension of nursing services, assistance in ambulation or exercises, and assistance with administering medications which were ordinarily…

The agency failed to ensure supervisor visits of the home health aide were regularly reviewed for compliance with the home health aide care plan as required by agency policy for 1 (Patient #1) of 4 patients with home health aide only services, of a total of 6 patients whose clinical records were…

The administrator failed to be responsible for the day-to-day operations of the home health agency in relation to failure to provide the names and current addresses of members of the governing body; failure to ensure all complaints were recognized and documented in the complaint log; failure to…

The director of clinical services failed to ensure 1 (Patient #4) of 1 patient with an injury of unknown origin needs were continually assessed, out of a sample of 6 patients.

The director of clinical services (DOCS) failed to ensure patients' plans of care were evaluated and updated for 3 (Patients #1, 4, and 6) of 6 patients whose clinical records were reviewed.

The agency failed to maintain compliance with the Condition of Participation Infection Control, 42 CFR 484.70, by failing to provide timely and complete education/ instruction regarding infection prevention/ control measures to 68 employed direct care providers, pertinent to the ongoing COVID-19…

The agency failed to ensure care visits were provided as ordered on the plan of care for 3 (Patients #1, 2, and 4) of 4 records reviewed.

The agency failed to provide timely, complete education and guidance regarding infection prevention/control measures pertinent to the ongoing novel Coronavirus pandemic to its 68 direct care providers with the potential to affect all 54 patients under the agency's care.

The registered nurse failed to update the home health aide care plan/ assignment sheet after a major change in the patient's condition, positive COVID-19 (pandemic virus) status per test result, for 2 or 4 patients whose records were reviewed (Patients #1 & 2) in a total sample of 4 records.

The agency failed to ensure the plan of care contained all pertinent diagnoses; failed to ensure the plan of care provided care orders for the care and maintenance of a patient's dialysis access site (See G 574); the agency failed to ensure the registered nurse put into writing the contents of a…

The administrator failed to liaise with the governing body in relation to adoption of integumentary documentation, assessment, and care (See G 942); the administrator failed to manage the day to day activities to ensure the establishment of skills competency for home health aides was not a…

The administrator failed to implement its policy to ensure the home health agency quality assurance performance improvement program (QAPI) objectively and systematically reviewed patient complaints for trends for 4 of 4 quarters in 2018; failed to ensure the QAPI objectively and systematically…

The administrator failed to ensure the home health agency quality assurance performance improvement program (QAPI) documented objective data as a basis for the data points selected/monitored to identify areas of concerns as high-risk, high-volume, or a problem-prone area, and failed to document the…

The administrator failed to ensure the reasons for selection and how improvement would be measured for 1 (home health aides following plan of care orders) of 1 performance improvement plan in 2018. The findings included: Review of an agency policy, "Performance Improvement, B-260) last…

The agency failed to ensure the establishment of skills competency was not a simulation performed in the office laboratory, on a fully clothed patient for 2 (employees E, F, ) of 2 home health aides whose establishment of skills competency was reviewed, of a total of 127 home health aides employed.

The administrator failed to liaise with the governing body in relation to adoption of integumentary documentation, assessment, and care, for 1 of 1 home health agency.

The agency failed to ensure it offered skilled nursing service and skilled nurse care visits were provided, as required by agency policy, to a patient on service for unskilled care, who developed a need for skilled nursing services for integumentary impairment, for 1 (Patient #1) of 1 patients with…

The comprehensive assessment failed to be accurate and complete in the assessment of a patient's dialysis access site for 1 (Patient #9) of 1 patients who received dialysis treatments, in a total sample of 9 patients.

The home health agency failed to ensure all the patient's medication were on the medication profile for 1 (Patient #4) of 3 patients for whom a home visit was made, out of a total sample of 9 patients.

The agency failed to ensure the plan of care contained all pertinent diagnoses for 1 (Patient #1) of 9 patients; failed to ensure all medications in the home and being used were on the plan of care for 1 (Patient #4) of 3 patients with home visit; and failed to ensure the plan of care provided care…

The agency failed to ensure the registered nurse put into writing the contents of a verbal order taken at the time of recertification, and failed to ensure the physician was sent a written version of the verbal order, for review and counter-signature for 7 (Patient #1, 2, 3, 4, 5, 8, and 9) of 8…

The agency failed to ensure the registered nurse case manager, employee G, updated the plan of care in relation to a change in integumentary status, to document the wound care orders the spouse of a patient was providing for patient's left heel unstageable pressure ulcer (Patient #1) for 1 of 6…

The agency failed to ensure the registered nurse developed a plan of care to address all the patient's diagnoses, need for skilled services to provide integumentary care, implementation of preventative and rehabilitative interventions, for 1 (Patient #1) of 9 patients whose clinical record was…

Failed to obtain pertinent medical information in relation to a patient's pressure wound status and care, for 1 of 6 active patients, of a total sample of 9 patients.

The agency failed to ensure the home health aide (HHA) performed only duties within the scope of practice of an HHA, and assigned on the HHA care plan, for 1 (Patient #1) of 2 home visit observations of an HHA made, in a sample with 6 patients who received home health aide services, of a total…

The registered nurse (employee G) failed to supervise the home health aide (employee E) in relation to the performance of an assigned task for a patient who received only non-skilled services, for 1 of 6 patients who received only non-skilled services, of a total sample of 9 patients.

The administrator failed to ensure the agency policy which covered establishment of skills competency required no simulated experiences were used; failed to ensure the establishment of skills competency for home health aides was not a simulation performed in the agency laboratory setting, on a…

The clinical manager failed to ensure follow up actions were taken to coordinate care in relation to a physician order to evaluate a patient for wound care for 1 (Patient #1) of 1 patients with a new integumentary issue, of a total sample of 9 patients.

The agency failed to ensure a home health clinical visit note documented observations of a patient's integumentary change for 1 (Patient #1) of 1 patients who developed a new integumentary issue and received only home health aide services, of 6 patients who received non-skilled services, of a total…