Every finding on record at B & B Interim Healthcare Services Inc

This visit was for a Complaint survey. Complaint: IN00345859 - substantiated with findings Survey Dates: 7/7/2021 Facility #: IN005271 These deficiencies reflect State Findings cited in accordance with 410 IAC 17. Refer to state form for additional state findings.

Treatment or care CFR(s): 484.50(e)(1)(i)(A) (i)(A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; and This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to investigate complaints made by the patient's caregiver/family related to care that failed to be furnished in 2 of 2 closed clinical records reviewed. (#1, #2) The findings include: 1. Review of an agency policy, dated 9/2/11, and obtained 7/7/2021, titled "Complaints" stated, "... Interim Healthcare Hospice receives, investigates and resolves complaints. Patients/families are advised on admission of their right to voice a complaint ... Interim Healthcare Hospice provides follow-up to a complainant within seventy-two (72) hours of receipt or sooner, and resolves complaints within two (2) weeks of receipt or sooner...." 2. Review of an agency document, dated 2018 and obtained 7/7/2021, titled "Statement of Patient's/Client's Rights" stated, "... As a Patient/Client, you have the right to: ... Make complaints ... regarding the care that is (or fails to be) provided, or the lack of respect for property and/or respect for you. Although not required, we request that if you have any complaints or concerns that you to contact our Administrator...." 3. During an interview on 7/7/2021 at 10:45 AM, the alternate administrator indicated she was informed by person A that home health aide C did not provide home heath aide services on 12/25/2020 for patient #1, start of care 7/6/2020, but home health aide C documented a visit was conducted. The alternate administrator indicated home health aide C and person A had been changing dates and times of home health aide visits other than what was scheduled by the agency without the agency's knowledge. The alternate administrator indicated there was a "blow-up" between person A and home health aide C, at which time person A came into the agency to request to see the home health aide's notes to see if a visit was documented for 12/25/2020, which person A informed the agency home health aide C did not work. The alternate administrator indicated home health aide C was brought into the office and admitted to mistakenly documenting a visit completed on 12/25/2020, and the agency did not bill for the visit which was not conducted. Clinical record review on 7/7/2021, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet" which indicated home health aide C provided personal care for the patient on 12/25/2020, from 8:00 AM to 12:00 PM. The clinical record failed to evidence the caregiver's complaint was investigated related to the home health aide not providing home health aide services as documented on 12/25/2020. Review of the agency's complaint binder on 7/7/2021, failed to evidence the caregiver's complaint was investigated regarding the home health aide not providing home health aide services on 12/25/2020. During an interview on 7/7/2021 at 9:13 AM, person A indicated home health aide C did not provide home health aide services on 12/25/2020, and explained home health aide C asked person A to sign the home health aide visit note indicating home health aide C had provided services that day. Person A indicated she did not sign the home health aide visit note for 12/25/2020, but later noticed her signature was on the visit note for 12/25/2020, which she did not sign. Person A explained she went to the office of the agency and informed the alternate administrator home health aide C did not work on 12/25/2020, and she did not sign the home health aide visit note for 12/25/2020. Person A indicated the agency did not follow-up with her regarding her complaint and did not offer a resolution. During an interview on 7/7/2021 at 11:18 AM, the alternate administrator indicated the agency did not investigate the caregiver's complaint regarding home health aide C not providing services on 12/25/2020, and stated, "The aide hadn't done this before." 4. Clinical record review on 7/7/2021 for patient #2, start of care 7/27/2020, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 3/29/2021 and 3/30/2021 from 5:30 AM to 1:30 PM. This document failed to be complete to include a patient/family's signature for the home health aide services on 3/29/2021 and 3/30/2021. During an interview on 7/7/2021 at 2:43 PM, person B indicated on 3/30/2021, home health aide C became frustrated at person B's direction to retake the patient's temperature with a different thermometer and home health aide C left the patient's home by 9:00 AM and did not return. Person B indicated she informed the office home health aide C left the patient's home and the agency did not send a replacement. Person B indicated she remained with the patient the remainder of the day. Person B indicated often times the home health aides did not work as scheduled and did not provide personal care as directed per the plan of care. Person B indicated she had informed the office of her complaints but did not receive any follow-up. Person B indicated the alternate administrator was not responsive to her concerns, did not follow-up or provide a solution. Person B indicated the alternate administrator did not care about her concerns because the office was aware Person B was planning to transfer the patient to another facility. Review on 7/7/2021, of the agency's complaint binder, failed to evidence an investigation of Person B's concerns related to agency staff. During an interview on 7/7/2021 at 3:45 PM, home health aide C indicated Person B frequently had "major problems" with the home health aides and home health aide C indicated she informed the alternate administrator of Person B's complaints. During an interview on 7/7/2021 at 3:45 PM, the alternate administrator indicated Person B had concerns with where the staff would park and wanted additional home health aide services through the night for the patient. The alternate administrator indicated there was not a documented investigation of the complaints made by person B related to concerns with the home health aides. 17-12-3(c )(1)(A)

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to document the existence of a complaint and the resolution of the complaint in 2 of 2 closed clinical records reviewed. (#1, #2) The findings include: 1. Review of an agency policy, dated 9/2/11 and obtained 7/7/2021, titled "Complaints" stated, "... Interim Healthcare Hospice receives, investigates and resolves complaints. Patients/families are advised on admission of their right to voice a complaint ... Interim Healthcare Hospice provides follow-up to a complainant within seventy-two (72) hours of receipt or sooner, and resolves complaints within two (2) weeks of receipt or sooner...." 2. Review of an agency document, dated 2018 and obtained 7/7/2021, titled "Statement of Patient's/Client's Rights" stated, "... As a Patient/Client, you have the right to: ... Make complaints ... regarding the care that is (or fails to be) provided, or the lack of respect for property and/or respect for you. Although not required, we request that if you have any complaints or concerns that you to contact our Administrator...." 3. During an interview on 7/7/2021 at 10:45 AM, the alternate administrator indicated she was informed by person A that home health aide C did not provide home heath aide services for patient #1, start of care 7/6/2020, on 12/25/2020, but home health aide C documented a visit was conducted. The alternate administrator indicated home health aide C and person A had been changing dates and times of home health aide visits other than what was scheduled by the agency without the agency's knowledge. The alternate administrator indicated there was a "blow-up" between person A and home health aide C at which time person A came in to the agency to request to see the home health aide's notes to see if a visit was documented for 12/25/2020, which person A informed the agency home health aide C did not work. The alternate administrator indicated home health aide C was brought in to the office, admitted to mistakenly documenting a visit completed on 12/25/2020, and the agency did not bill for the visit which was not conducted. Clinical record review on 7/7/2021, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet" which indicated home health aide C provided personal care for the patient on 12/25/2020, from 8:00 AM to 12:00 PM. The clinical record failed to evidence the caregiver's complaint and its resolution related to home health aide C not providing home health aide services as documented on 12/25/2020. Review of the agency's complaint binder on 7/7/2021, failed to evidence a complaint and its resolution was logged regarding the caregiver's concern of home health aide C not providing home health aide services on 12/25/2020. During an interview on 7/7/2021 at 9:13 AM, person A indicated home health aide C did not provide home health aide services on 12/25/2020 and explained home health aide C asked person A to sign the home health aide visit note indicating home health aide C had provided services that day. Person A indicated she did not sign the home health aide visit note for 12/25/2020, but later noticed her signature was on the visit note for 12/25/2020, which she did not sign. Person A explained she went to the office of the agency and informed the alternate administrator home health aide C did not work on 12/25/2020 and she did not sign the home health aide visit note for 12/25/2020. Person A indicated the agency did not follow-up with her regarding her complaint and did not offer a resolution. During an interview on 7/7/2021 at 10:45 AM, the alternate administrator indicated the documentation regarding the caregiver's complaint should be completed on the complaint form in the complaint log. The alternate administrator stated, "I remember dealing with that because we didn't' bill for the holiday." 4. Clinical record review on 7/7/2021 for patient #2, start of care 7/27/2020, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 3/29/2021 and 3/30/2021 from 5:30 AM to 1:30 PM. Review failed to be complete to include the patient/family's signature for home health aide services on 3/29/2021 and 3/30/2021. During an interview on 7/7/2021 at 2:43 PM, person B indicated on 3/30/2021 home health aide C became frustrated at person B's direction to retake the patient's temperature with a different thermometer and home health aide C left the patient's home by 9:00 AM and did not return. Person B indicated she informed the office home health aide C left the patient's home and the agency did not send a replacement. Person B indicated she remained with the patient the remainder of the day. Person B indicated often times the home health aides did not work as scheduled and did not provide personal care as directed per the plan of care. Person B indicated she had informed the office of her complaints but did not receive any follow-up. Person B indicated the alternate administrator was not responsive to her concerns, did not follow-up or provide a solution. Person B indicated the alternate administrator did not care about her concerns because the office was aware the Person B was planning to transfer the patient to another facility. Person B indicated 3/30/2021 was the last day the agency sent staff to provide home care services. Review on 7/7/2021 of the agency's complaint binder failed to evidence Person B's complaints and resolutions related to agency staff were documented. During an interview on 7/7/2021 at 3:45 PM, home health aide C indicated Person B frequently had "major problems" with the home health aides and home health aide C indicated she informed the agency of Person B's complaints. During an interview on 7/7/2021 at 3:45 PM, the alternate administrator indicated Person B had concerns with where the staff would park and wanted additional home health aide services through the night for the patient. The alternate administrator indicated there was not a documented investigation of the complaints made by person B related to concerns with the home health aides. 17-12-3(c )(2)

Aides are members of interdisciplinary team CFR(s): 484.80(g)(4) Home health aides must be members of the interdisciplinary team, must report changes in the patient's condition to a registered nurse or other appropriate skilled professional, and must complete appropriate records in compliance with the HHA's policies and procedures. This ELEMENT is not met as evidenced by: Based on record review and interview, the home health aide failed to complete appropriate records in compliance with the agency's policies and procedures in 4 of 4 clinical records reviewed. (#1, #2, #3, #4) The findings include: 1. Review of an agency policy, dated 8/16/13 and obtained 7/7/2021, titled "Entries into the Patient/Client Record" stated, "... Entries by employees are made in accordance with law and regulation and with Interim HealthCare policies and procedures ... Entries into the patient/client record include at least the following: ... Accurate and pertinent data regarding patient/client: ... Care/Services delivered ... Standards for entries into the patient/client record include: ... The employee signs the entries using their initial, and surname and title...." 2. Review of an agency policy, dated 5/16/15 and obtained 7/7/2021, titled "Time Slip Instructions" stated, "... Time slips are to be signed by either the patient or a family member ... If you make a mistake, line it out and place ERROR above it with your initials ... When you sign your time slip, always put your title (HHA [home health aide], RN [registered nurse], LPN [licensed practical nurse]) after signature...." 3. During an interview on 7/7/2021 at 10:45 AM, the alternate administrator indicated she was informed by person A that home health aide C did not provide home heath aide services for patient #1, start of care 7/6/2020, on 12/25/2020, but home health aide C documented a visit was conducted. The alternate administrator indicated home health aide C was brought in to the office who admitted to mistakenly documenting a visit completed on 12/25/2020 and the agency did not bill for the visit which was not conducted. Clinical record review on 7/7/2021, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 12/25/2020, from 8:00 AM to 12:00 PM, and failed to evidence the document was accurate to reflect home health aide services were not provided. Review failed to evidence home health aide C included her title on the document for 12/21/2020, 12/22/2020, 12/23/2020, 12/24/2020 and 12/25/2020. During an interview on 7/7/2021 at 11:18 AM, the alternate administrator indicated the home health aide visit note was not correct because the care documented on 12/25/2020, was not performed and home health aide C should have corrected her visit note. 4. Clinical record review on 7/7/2021 for patient #2, start of care 7/27/2020, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 3/29/2021 and 3/30/2021 from 5:30 AM to 1:30 PM, and failed to evidence the document was complete to include the patient/family's signature for 3/29/2021 and 3/30/2021. Review failed to evidence home health aide C included her title on the document for 3/29/2021 and 3/30/2021. 5. Clinical record review on 7/7/2021 for patient #3, start of care 6/21/2021, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 6/28/2021 from 9:00 AM to 11:00 AM, and failed to evidence the document was complete to include the patient/family's signature for 6/28/2021. Review failed to evidence home health aide C included her title on the document for 6/28/2021, 6/29/2021, 6/30/2021 and 7/1/2021. 6. Clinical record review on 7/7/2021 for patient #4, start of care 5/16/2017, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide D provided personal care for the patient on 6/9/2021 and 6/11/2021, from 9:00 AM to 5:00 PM, and failed to evidence the document was complete to include the patient/family's signature for 6/9/2021 and 6/11/2021. Review failed to evidence home health aide D included her title on the document for 6/9/2021 and 6/11/2021. 7. During an interview on 7/7/2021 at 11:18 PM, the alternate administrator indicated agency staff should include their title on entries in the clinical record. At 12:29 PM, the alternate administrator indicated the home health aide should have the patient or family sign the visit note each visit.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview, the administrator failed to ensure the day to day operations of the home health agency. The findings include: 1. Review of an agency policy, dated 6/16/06 and obtained 7/7/2021, titled "Administrator/Manager" stated, "... The Administrator/Manager is primarily responsible for directing the day-to-day operations. The Administrator/Manager develops, revises and reviews office processes that support compliance with applicable law and regulation and contract provisions as well as applicable government guidelines and manuals ... Informing employees of applicable law and regulation and monitoring their compliance ... Effective quality improvement, including monitoring patient/client satisfaction; complaints and their resolution as well as occurrences and the resulting outcome...." 2. Review of an agency policy, dated 9/2/11 and obtained 7/7/2021, titled "Complaints" stated, "... Interim Healthcare Hospice receives, investigates and resolves complaints. Patients/families are advised on admission of their right to voice a complaint ... Interim Healthcare Hospice provides follow-up to a complainant within seventy-two (72) hours of receipt or sooner, and resolves complaints within two (2) weeks of receipt or sooner. ... The Hospice Administrator ensures that a process is in place to receive, investigate and resolve complaints. The Hospice Administrator and Hospice DHCS [Director Health Care Services] are knowledgeable of state law and regulation that relate to the receipt, investigation and resolution of complaints. ... The Hospice Administrator or designee is responsible for receiving and investigating complaints...." The administrator failed to ensure the day to day operations of the home health agency as evidenced by: The administrator failed to investigate complaints made by the patient or the patient's caregivers and family related to care that failed to be furnished. Please see tag G0480. The administrator failed to ensure complaints and resolutions were documented completely. Please see tag G0484. The administrator failed to ensure the clinical manager provided oversight of all patient care services and personnel. Please see tag G0958. The administrator failed to ensure all clinical notes were complete and appropriately authenticated. Please see tag G1024. During an interview on 07/07/2021 at 3:50 PM, the alternate administrator stated, "Who should fill-out and investigate complaints? I think it should be clinical." 17-12-1( c)(1)

Ensure clinical manager is available CFR(s): 484.105(b)(1)(iii) (iii) Ensure that a clinical manager as described in paragraph (c) of this section is available during all operating hours; This ELEMENT is not met as evidenced by: Based on record review and interview, the administrator failed to ensure the clinical manager was available during all operating hours. The findings include: Review of an agency policy, dated 6/16/06 and obtained 7/7/2021, titled "Administrator/Manager" stated, "... The Administrator/Manager responsible for the performance of the office, including, but not limited to: a) Compliance with applicable law and regulation ... The Administrator/Manager selects a qualified Director of Health Care Services (DHCS) to oversee the delivery of care/services...." During an interview at the entrance conference on 7/7/2021 at 9:34 AM, the alternate administrator indicated the clinical manager and the alternate clinical manager were not available. The alternate administrator indicated the clinical manager was in the hospital and the alternate clinical manager was only available when needed by the agency. During a phone interview on 7/7/2021 at 2:32 PM, the administrator stated, "[Clinical manager] will be replaced. She's only been in the office minimally for awhile and not really participating in the office. I'm not sure what's going on with [clinical manager]." The administrator indicated the alternate clinical manager used to be in the office a few days a week until she took another job and now only comes in occasionally if needed. When queried how often the alternate clinical manager was called in, the administrator indicated the alternate clinical manager really did not come in anymore. 17-12-1(d)(3)

Clinical manager CFR(s): 484.105(c) Standard: Clinical manager. One or more qualified individuals must provide oversight of all patient care services and personnel. Oversight must include the following-- This STANDARD is not met as evidenced by: Based on record review and interview, the clinical manager failed to provide oversight of all patient care services and personnel. The findings include: 1. Review of an agency policy, dated 6/16/06 and obtained 7/7/2021, titled "Director of Health Care Services (DHCS)" stated, "... The Director of Health Care Services (DHCS): ... Directs the effective and efficient delivery of all care/services provided ... Establishes and evaluates that the provision of care/services are provided in accordance with established policies and procedures, applicable standards of practice, law and regulation ... The DHCS designates a similarly qualified individual to act in his/her absence with the approval of the Administrator/Manager." 2. During an interview on 7/7/2021 at 10:45 AM, the alternate administrator indicated she was informed by person A that home health aide C did not provide home heath aide services for patient #1, start of care 7/6/2020, on 12/25/2020, but home health aide C documented a visit was conducted. The alternate administrator indicated home health aide C and person A had been changing dates and times of home health aide visits other than what was scheduled by the agency without the agency's knowledge. The alternate administrator indicated there was a "blow-up" between person A and home health aide C at which time person A came in to the agency to request to see the home health aide's notes to see if a visit was documented for 12/25/2020, which person A informed the agency home health aide C did not work. The alternate administrator indicated home health aide C was brought in to the office who admitted to mistakenly documenting a visit completed on 12/25/2020, and the agency did not bill for the visit which was not conducted. Review of the personnel record on 7/7/2021 for home health aide C, date of hire 6/23/17, and first patient contact date 6/26/17, evidenced an agency document titled "Rules and Regulations for Interim Health Care", signed by home health aide C on 7/26/18. This document stated, "... The following occurrences will result in immediate termination: ... Falsifying HHA [home health aide] notes, or time slips ...." Review failed to evidence corrective action related to home health aide C's documentation of a visit made on 12/25/2020, which was not conducted. During an interview on 7/7/2021 at 3:52 PM, the alternate administrator indicated the clinical manager was supposed to follow-up with home health aide C regarding the visit documented on 12/25/2020, which was not conducted. The alternate administrator stated, "Another reason we need someone who will be here to do these things." 3. During an interview on 7/7/2021 at 2:43 PM, person B indicated on 3/30/2021, home health aide C became frustrated at person B's request to retake the patient's temperature with a different thermometer and home health aide C left the patient's home by 9:00 AM, and did not return. Person B indicated she informed the office home health aide C left the patient's home and the agency did not send a replacement. Person B indicated she remained with the patient the remainder of the day. Person B indicated often the home health aides did not work as scheduled and did not provide personal care as directed per the plan of care. Person B indicated she had informed the office of her complaints but did not receive any follow-up. During an interview on 7/7/2021 at 3:45 PM, home health aide C indicated Person B frequently had "major problems" with the home health aides and home health aide C indicated she informed the agency of Person B's complaints. During an interview on 7/7/2021 at 3:47 PM, the alternate administrator indicated the clinical manager and alternate clinical manager were not providing clinical oversight regularly and stated, "You see all of this stuff and know what to do. We need a DON [director of nursing] who can do that. Someone who can be here to do that." When queried if Person B's complaints related to the home health aide services were investigated, the alternate administrator stated, "We just don't have anyone in here who can do that. That's why we need to make some changes in here." 4. During an interview at the entrance conference on 7/7/2021 at 9:34 AM, the alternate administrator indicated the clinical manager and the alternate clinical manager were not available. The alternate administrator indicated the clinical manager was in the hospital and the alternate clinical manager was only available when needed by the agency. 5. During an interview on 7/7/2021 at 12:58 PM, coordinator B indicated she assigned the staff to the patients and made the patients' schedules. Coordinator B indicated she asks the patient and the family what hours the patient needs care when making the patient's schedule. Coordinator B indicated the clinical manager and alternate clinical manager were not usually available if she had questions about patients. 6. During a phone interview on 7/7/2021 at 2:32 PM, the administrator stated, "[Clinical manager] will be replaced. She's only been in the office minimally for awhile and not really participating in the office. I'm not sure what's going on with [clinical manager]." The administrator indicated the alternate clinical manager used to be in the office a few days a week until she took another job and now only comes in occasionally if needed. When queried how often the alternate clinical manager was called in, the administrator indicated the alternate clinical manager really did not come in anymore. 17-12-1(d)

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure all entries in the clinical record were complete and accurate in 4 of 4 clinical records reviewed. (#1, #2, #3, #4) The findings include: 1. Review of an agency policy, dated 8/16/13 and obtained 7/7/2021, titled "Entries into the Patient/Client Record" stated, "... Entries by employees are made in accordance with law and regulation and with Interim HealthCare policies and procedures ... Entries into the patient/client record include at least the following: ... Accurate and pertinent data regarding patient/client: ... Care/Services delivered ... Standards for entries into the patient/client record include: ... The employee signs the entries using their initial, and surname and title ...." 2. Review of an agency policy, dated 5/16/15 and obtained 7/7/2021, titled "Time Slip Instructions" stated, "... Time slips are to be signed by either the patient or a family member ... If you make a mistake, line it out and place ERROR above it with your initials ... When you sign your time slip, always put your title (HHA [home health aide], RN [registered nurse], LPN [licensed practical nurse]) after signature ...." 3. During an interview on 7/7/2021 at 10:45 AM, the alternate administrator indicated she was informed by person A that home health aide C did not provide home heath aide services for patient #1, start of care 7/6/2020, on 12/25/2020 but home health aide C documented a visit was conducted. The alternate administrator indicated home health aide C was brought in to the office who admitted to mistakenly documenting a visit completed on 12/25/2020 and the agency did not bill for the visit which was not conducted. Clinical record review on 7/7/2021 evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 12/25/2020 from 8:00 AM to 12:00 PM and failed to evidence the document was accurate to reflect home health aide services were not provided. Review failed to evidence a title for home health aide C was included on the document for 12/21/2020, 12/22/2020, 12/23/2020, 12/24/2020 and 12/25/2020. During an interview on 7/7/2021 at 11:18 AM, the alternate administrator indicated the home health aide visit note was not correct because the care documented on 12/25/2020 was not performed and home health aide C should have corrected her visit note. 4. Clinical record review on 7/7/2021 for patient #2, start of care 7/27/2020, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 3/29/2021 and 3/30/2021 from 5:30 AM to 1:30 PM and failed to evidence the document was complete to include the patient/family's signature for 3/29/2021 and 3/30/2021. Review failed to evidence a titled for home health aide C was included on the document for 3/29/2021 and 3/30/2021. 5. Clinical record review on 7/7/2021 for patient #3, start of care 6/21/2021, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide C provided personal care for the patient on 6/28/2021 from 9:00 AM to 11:00 AM and failed to evidence the document was complete to include the patient/family's signature for 6/28/2021. Review failed to evidence a title for home health aide C was included on the document for 6/28/2021, 6/29/2021, 6/30/2021 and 7/1/2021. 6. Clinical record review on 7/7/2021 for patient #4, start of care 5/16/2017, evidenced an agency document titled "Home Care Aide Visit/Shift Charting Sheet". This document indicated home health aide D provided personal care for the patient on 6/9/2021 and 6/11/2021 from 9:00 AM to 5:00 PM and failed to evidence the document was complete to include the patient/family's signature for 6/9/2021 and 6/11/2021. Review failed to evidence a title for home health aide D was included on the document for 6/9/2021 and 6/11/2021. 7. During an interview on 7/7/2021 at 11:18 PM, the alternate administrator indicated agency staff should include their title on entries in the clinical record. At 12:29 PM, the alternate administrator indicated the home health aide should have the patient or family sign the visit note each visit. 17-15-1(a)(7)