Every finding on record at Baxter County Regional Hospital, Inc.

On 04/29/26 at 9:20 a.m., an entrance conference was conducted with Agency Representatives. The Representatives were informed the purpose of the visit was to conduct a Medicare complaint investigation. On 04/29/26 at 3:00 p.m., an exit conference was conducted with Agency Representatives. The findings of the survey were discussed. The Agency Representatives were given an opportunity to present additional information for the findings discussed. No additional information was presented.

Before discharge for cause HHA must: CFR(s): 484.50(d)(5) The HHA determines, under a policy set by the HHA for the purpose of addressing discharge for cause that meets the requirements of paragraphs (d)(5)(i) through (d)(5)(iii) of this section, that the patient's (or other persons in the patient's home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the HHA to operate effectively is seriously impaired. The HHA must do the following before it discharges a patient for cause: This ELEMENT is not met as evidenced by: Based on clinical record review, policy and procedure review, and personnel interviews, it was determined the agency failed to ensure efforts were made to resolve an issue prior to a discharge for cause for 1 of 1 (#1) clinical record reviewed. This failed practice had the potential to affect all patients in that a discharge without required procedure followed could result in a patient not receiving care leaving that patient in a potentially harmful situation. Findings follow: Review of Clinical Record #1 with a start of care date of 03/21/26 revealed a patient with a diagnosis of Acute Posthemorrhagic anemia.On 04/14/26 the agency's Administrator documented a discharge for cause situation which involved inappropriate behavior of a sexual nature toward a female nurse. The email noted the agency Administrator called and spoke to the patient about the situation, it was not denied by the patient, and he was immediately discharged. On 04/29/26 at 10:00 a.m., a Policy and Procedure titled, "Home Health Transfer and Discharge Policy and Procedures" was reviewed. It documented, "...BHHH [Baxter Health Home Health] will do the following before a patient is discharged for cause:...Make efforts to resolve the problem(s) presented by the patient's behavior... Document in the patient's EMR [Electronic Medical Record] the behaviors and circumstances that warranted patient discharge for cause as well as the efforts put forth to resolve the problem(s). The clinical record should reflect a. Identification of the problems encountered. b. Assessment of the situation c. Communication among HHA [Home Health agency] management, patient caregiver, legal representative and the physician responsible for the POC [plan of care]. d. A plan to resolve the issues. e. Results of the plan implementation..." On 04/29/26 at 12:20 p.m., an interview was conducted with the named nurse from this interaction. She stated she felt "overall uncomfortable" but did not feel in danger during this interaction. She stated when she told him his non-physically aggressive behavior was inappropriate "he let her [hand] go".On 04/29/26 at 12:45 p.m., an interview was conducted with the named patient's primary nurse. She reported that he did not have any inappropriate interactions with her, nor the two other nurses that were on-call and completed visits at his home. She stated there are two male nurses that are assigned to two patients that have a history of sex offender status and historically two nurses were assigned to complete a skilled nurse visit for a particular patient the agency deemed to be unsafe. On 04/29/26 at 1:30 p.m., an interview was conducted with the Administrator and the Nurse Manager. The Administrator was asked what types of training has been conducted by the agency to train the staff on what to do during inappropriate sexual behavior from a patient. The Administrator stated the staff are told repeatedly that at any time, they can leave the home if they feel unsafe, but the agency does not have any documentation of in-services completed of this nor of this topic specifically. The Administrator concurred there was one last visit scheduled for this patient and was asked why the last visit was not completed with one of the male nurses or two nurses assigned as they have demonstrated they were capable of doing. She stated, "Honestly, I was just thinking about his (the named patient's) behavior." On 04/29/26 at 3:00 p.m., the Administrator was not able to provide any further documentation or evidence that the agency made efforts to resolve this issue prior to the discharge for cause.

On 5/24/2022 at 11:45 AM an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification Survey of compliance with the Conditions of Participation for Home Health.

A review of all current medications CFR(s): 484.55(c)(5) 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 noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview, it was determined the Skilled Nurse (SN) failed to include the chemotherapy drugs during the review of the patient's medications in one (#5) of 10 (#1-#10 records reviewed). This failed practice by the SN posed a risk of potential harm for patients on census receiving chemotherapy by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients' medication regimen related to potential for adverse effects, drug reactions, significant side effects or significant drug interactions. A review of Clinical Records #5 revealed the following: 1. A document titled "Home Health Certification and Plan of Care" dated 03/03/2022 through 05/01/2022 lists the primary diagnosis of "Antineoplastic chemotherapy induced pancytopenia", "Agranulocytosis secondary to cancer chemotherapy", "Adverse effect of antineoplastic and immunosuppressant drugs" 2. A document titled "Medication Profile" dated 05/02/2022 through 06/30/2022 lists no current or discontinued chemotherapy medications. 3. During an interview with Agency Staff #1, it was confirmed there was no chemotherapy medications listed on the Medication Profile.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on Clinical Record review and staff interview, it was determined the Agency Staff did not follow the Attending Physicians orders contained in the Plan of Care (POC) for 1 (#2) of 10 (#1-#10) records reviewed. This failed practice had the potential of delaying the psycho/social goals and possible impact on the dignity of the patient. 1. A review of Clinical Record #2 revealed a physician's order dated 5/03/2022 for Home Health Aide (HHA). a. There were no HHA visits completed in the record. b. There was no discontinuation of the HHA in the physician's orders. c. During interview with Agency Staff #1, it was stated' "No, there's no order to D/C (discontinue) the Aide Visits." Agency Staff #1 agreed no visits were made by HHA as ordered for patient #2.