Total Nursing Services, Inc.

The agency failed to provide infection control on 1 out of 3 Sampled Patients (SP) during home visits.

Direct observation and interview the agencies staff failed to follow the orders written in 1 out of 3 Sampled Patients (SP).

The home health agency is unable to demonstrate a completed termination summary, including the type of services being provided, frequency of services, lab data (as applicable) and medication list at the time of discharge for 2 out of 5 Sampled Patients (SP).

The provider failed to demonstrate that 3 out of 10 (Staff D, G, and I) active staff received annual in-service on infection control.

The provider failed to demonstrate it had obtained the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities for 1 out of 12 Sampled Patients (SP).

The provider failed to maintain the content of a clinical record that includes services rendered by the home health agency staff for 1 out of 12 Sampled Patients (SP).

The Home Health Agency failed to develop strategies for addressing emergency events that were identified by the risk assessment.

The Home Health Agency failed to develop and implement an emergency preparedness plan that contained policies and procedures based on the plan.

The Home Health Agency failed to prepare an individualized emergency preparedness form for 1 out 7 Sampled Patients (SP).

The Home Health Agency failed to ensure that an existing staff demonstrated knowledge of the agency's Federal emergency plan policy/procedures and of their expected role during an emergency.

The Home Health Agency failed to develop an individualized Plan of Care (POC) that contains the home health services to be provided; that identifies patient-specific measurable outcomes and goals; and which is established; periodically reviewed and signed by a physician for 2 out of 7 Sampled…

The Home Health Agency failed to show that 1 out of 3 Home Health Aides received at least 12 hours of in-service training during each 12-month period.

The Home Health Agency failed to ensure that a Registered Nurse (RN) or other appropriate skilled professional provided written care instructions for the Home Health Aides (HHA) to follow for 1 out 7 Sampled Patients (SP) reviewed.

The Home Health Agency failed to ensure that one Sampled Patient (SP)'s record contained the required documentation.

The Home Health Agency failed to provide: to 2 out of 7 Sampled Patients (SP) and the patients' legal representatives (if any) a completed service agreement.

The Home Health Agency failed to demonstrate that written notice of the patient's rights and responsibilities, and the Home Health Agency's transfer and discharge policies were provided to 1 out of 7 Sampled Patients (SP).

The Home Health Agency failed to ensure that a Registered Nurse (RN) conducted an initial assessment to determine the immediate care and support needs of 2 out of 7 Sampled Patients (SP).

The Home Health Agency failed to develop influenza and pneumococcal vaccines policy and procedures in consultation with a physician that addressed the management of adverse reactions (if any).

The Home Health Agency failed to coordinate care delivery for 2 out 7 Sampled Patients (SP).

The Home Health Agency failed to provide to 1 out of 7 Sampled Patients (SP) the visit schedule, including frequency of visits to be made by the Home Health Agency personnel and personnel acting on behalf of the Home Health Agency.

The Home Health Agency failed to ensure that a Registered Nurse or other appropriate skilled professional made an annual on-site visit to the location where a patient is receiving care to observe and assess each home health aide.

The Home Health Agency failed to ensure that a registered nurse made an on-site visit to the location where a patient is receiving care no less frequently than every 60 days to observe and assess each Home Health Aide (HHA) while he or she is performing care for 1 out of 7 Sampled Patients (SP).

The Home Health Agency failed to have in the clinical record the admission and consent documents from the most recent home health admission for 1 out of 7 Sampled Patients (SP).