Every finding on record at Caregivers Home Health, LLC

A Recertification Survey was conducted by the Iowa Department of Inspections, Appeals and Licensing from 2/15/26 through 2/18/26 and the home health agency was found to be operating out of compliance with the following standard requirements of the Establishment of Emergency Preparedness.

HHA Comprehensive Assessment in Disaster CFR(s): 484.102(b)(1) §484.102(b)(1) Condition for Participation: [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (1) The plans for the HHA's patients during a natural or man-made disaster. Individual plans for each patient must be included as part of the comprehensive patient assessment, which must be conducted according to the provisions at §484.55. This STANDARD is not met as evidenced by: Based on clinical record review, home visit observation, patient interview, and staff interview, the agency failed to ensure the patients had an emergency plan in their home for 2 of 4 home visit observations (Patients #2 and #3). Failure to ensure patients had individualized emergency plans in their home placed patient at risk to be unaware and unprepared to respond in an effective manner for emergencies that may occur. Findings include: 2. Patient #2 had a start of care date of 1/2/26. Clinical record review revealed: a. The Plan of Care (POC), dated 1/2/26 to 3/2/26, identified the patient had a primary diagnosis of open wound to the left hip and identified the need for skilled nurse, occupational therapy and physical therapy services. b. The start of care comprehensive assessment, dated 1/2/26, Staff E, Registered Nurse (RN), identified she reviewed and provided patient/caregiver with a copy of the individualized priority disaster information/emergency preparedness plan. c. During a home observation visit on 2/17/26 at 10:30 AM, with Staff F, Physical Therapist (PT), surveyor observed a blank Emergency Preparedness Plan in the patient's folder. During the same home visit, the patient identified he/she could not recall the RN reviewing an emergency plan with him/her on admission. The agency failed to provide the patient with a completed emergency preparedness plan individualized for the patient. The above findings were reviewed with the Administrator and Clinical Manager. According to agency policy titled Emergency Preparedness Plan, last updated 12/4/25, the agency will provide and discuss the following information about emergency preparedness with each client: the actions and responsibilities of the home health agency staff during and immediately following an emergency, the client's responsibilities in the agency's emergency preparedness and response plan, materials that describe survival tips and plans for evacuation and sheltering in place, and a list of community disaster resources that may assist a client during a disaster and other community disaster resources provided by local, state, and federal management agencies. The agency's list of community disaster resources must include information on how to contact the resources directly or instruction to call 2-1-1 for more information about community disaster resources. In an interview on 2/18/26 at 8:02 AM, the Administrator reported they complete an emergency plan with the patient but do not leave a copy in the home. 1.Patient #3 had a start of care date of 1/6/26 and had a diagnosis of aftercare following surgery for neoplasm. Home visit observation and patient interview revealed the following: a.The emergency plan form located in the patient's admission folder from his admission to the agency was not completed. b.In an interview on 2/17/26 at 10:30 AM, the patient reported that emergency information was not provided by Staff C, Registered Nurse (RN), when he was admitted to the agency.

The Iowa Department of Inspections, Appeals & Licensing conducted a Recertification Survey from 2/15/26 through 2/18/26. The recertification survey identified the home health agency was operating out of compliance with the following standard level home health regulations. The agency identified a current census of 25 patients.

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient's status, and must include, at a minimum, the following information: (1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on staff interview, policy review, and clinical record review, the agency failed to comprehensively provide wound or ostomy assessments for 3 of 3 sampled patients with wounds, Patient #3, #9, and #10. Failure to accurately and thoroughly complete wound, ostomy, or stoma assessments placed patients at an increased risk of unidentified condition changes. Findings include: 3.Patient #3 had a start of care date of 1/6/26. Clinical record review revealed the following: a.The patient had a Plan of Care (POC), dated 1/6/26 to 3/26/26, and had a diagnosis of aftercare following surgery for neoplasm. The patient had skilled nursing visits 2 times per week. b.The skilled nursing admission assessment on 1/6/26 performed by Staff C, Registered Nurse (RN), identified that the patient had a ostomy (surgically created opening with a stoma protruding that allows stool to leave the body which is collected in a bag attached to the abdomen) surgical procedure to his lower left quadrant. The patient also had multiple laparoscopic sites to his right lower abdomen they are covered and will be assessed 1/7/26 at a physician appointment. The clinical record did not contain assessments of the multiple laparoscopic sites or documentation of why the assessments were not performed. c.The skilled nursing notes from Staff E, RN, dated 1/30/26, 2/3/26, 2/6/26 documented clean and dry in the area to indicate appearance of ostomy and surrounding skin. d.The skilled nursing note from Staff E dated 1/10/26 documented the peri stoma as slightly red. The skilled nursing notes did not include assessment of the color, moisture, shape, and size of the stoma or why the assessments were not performed. The above findings were shared with the Administrator and the Clinical Manager. 2. Patient #9 had a start of care date of 12/17/24 and a discharge date of 3/7/25. Clinical record review revealed: a. The POC, dated 12/17/24 to 2/14/25, identified the patient had diagnoses of Parkinson's disease, type II diabetes mellitus and pressure ulcer of the sacral region. The POC included physician orders for skilled nursing services to assess skin integrity and provide teaching and intervention related to pressure ulcer to coccyx. b. The skilled nurse visit notes, dated 1/28/25 and 2/4/25, Staff C, RN, identified stage II pressure ulcer to left medial, low buttock assessed and documented in Swift (digital wound care management platform). c. Review of the clinical record lacked documentation of wound measurements on 1/28/25 and 2/4/25. The agency failed to include complete comprehensive assessments of the patient's wound, including wound measurements. According to the agency policy titled Manual Wound Measurement, dated 12/4/19, wound size is one of the fundamental parameters used to judge healing and resolution of a wound. Three dimensional measurement includes the length, width, and depth; it is the method most often used because it provides a more detailed description of the wound. Wound measurements are to be completed weekly. Documentation of wound measurements is part of the required documentation for all wound care procedures. According to agency policy titled Ostomy Care, dated 12/4/19, purpose was to allow for examination of skin around stoma. Part of the procedure was to measure the stoma and cut the appliance opening 1/16 to 1/8 inch larger than the stoma. The policy did not include directives to document the color, moisture, shape, and size of the stoma, as well as the integrity of the peristomal skin. During an interview on 2/16/26 at 11:00 AM, the Clinical Manager reported that the agency uses a computer application for wound measurements that flows into the skilled nurse note. The Clinical Manager reported that photos and measurement is assessed at every skilled nursing visit to include length, depth, and width. 1.Patient #1 had a start of care date of 3/14/25 and discharge dated of 4/3/25. a. The Plan of Care (POC), dated 3/14/25 to 5/12/25, identified the patient had a diagnosis of Diabetes mellitus with foot ulcer. The POC included physician orders for skilled nurse services to provide teaching and intervention related to left heal wound. b. The comprehensive assessment at the start of care, dated 3/14/25, Staff G, Registered Nurse (RN) the patient had a right anterial, proximal dorsum diabetic ulcer. The wound not assessed or measured. The wound identified assessed and documented in swift (an application used by the agency to assess wounds with use of pictures of the wound). The clinical record lacked documentation of the assessment. b. The skilled nurse visit note, dated 3/18/25, Staff G, RN, documented the patinet had a right proximal dorsum diabetic ulcer. The wound identified deteriorating with moderate purulent exudate. The wound included loosely adherent yellow slough and eschar firmly adherent, hard and black. The surrounding wound skin pink or normal. The would measured 4.41 centemeters (cm) length by 2.85 cm width by 0.54 cm depth. c.The skilled nurse visits, dated 3/25/25, 3/28/25, and 4/1/25, Staff G, RN, lacked documentation of and assessment or measurements of the left proximal dorsum diabetic ulcer. d. The comprehensive assessment at discharge, dated 4/3/25, Staff G, RN, lacked documentation of wound measurements of the right proximal dorsum diabetic ulcer. The agency skilled nurse failed to documen weekly wound assessment or measurements.

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 agency staff interviews, clinical record reviews, and policy review, the home health agency failed to ensure the drug regimen review identified at a minimum the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and/or patient compliance with medications for 4 of 10 sampled patients (Patients #1, #2, #8 and #9). Failure to ensure medications reviewed at the time of each drug regimen review are current and accurate and failure to identify actual/ potential concerns increased the potential for unidentified medication interactions and side effect risks to the patient at the time of each comprehensive assessment. Findings include: 2. Patient #1 had a start of care date of 9/13/24. Clinical record review revealed: a. The POC, dated 1/6/26 to 3/6/26, identified the patient had a diagnosis of Hypertension and included physician orders for skilled nurse to prefill patient's medication planner every 14 days. b. The recertification comprehensive assessment, dated 1/5/26, completed by Staff C, RN, included documentation a DRR was completed. c. During a home observation visit on 2/16/26 at 1:00 PM with Staff C, RN, the surveyor identified the following medication discrepancy orders: 1) Agency medication list identified patient takes Atorvastatin (lowers cholesterol) 20 milligram (mg) tablet daily. Bottle in the home stated Atorvastatin 40 mg tablet daily. RN interview during the same home visit confirmed medication planner filled per the bottle in the home; 40 mg daily. 2) Patient identified he/she takes docusate sodium 100mg tablets as needed for constipation. RN interview during the same home visit confirmed RN puts docusate sodium 100mg tablets in the medication planner to be taken as needed by the patient. The plan of care lacked an order for docusate sodium 100 mg tablets. The DRR failed to include an accurate review of all medications taken by the patient. 3. Patient #2 had a start of care date of 1/2/26. Clinical record review revealed: a. The POC, dated 1/2/26 to 3/2/26, identified the patient had diagnosis of Left hip open wound and included physician orders for skilled nurse to review patient's prescription and over the counter medications. b. The start of care comprehensive assessment, dated 1/2/26, completed by Staff E, RN, included documentation a DRR was completed. c. During a home observation visit on 2/17/26 at 10:30 AM with Staff F, Physical Therapist (PT), the surveyor identified the following medication discrepancy orders and patient stated medication schedule: 1) Agency medication list identified patient takes Oyster shell + D3 (supplement) 250 mg-3.125 micrograms (mcg) tablet daily. Prefilled bubble pack in the home identified patient takes Citracal + D3 600/500 mg 1 tablet daily. Patient identified he/she takes her medication per the prefilled bubble packs in her home. 2) Agency medication listed identified patient takes Ferrous sulfate (iron supplement) 325 mg tablet daily. Prefilled bubble pack in the home identified patient takes Ferrous sulfate 325 mg tablet every other day. Patient identified he/she takes her medication per the prefilled bubble packs in her home. 3) Agency medication list identified patient has Lidocaine 5 % topical patch (for pain) with instructions to apply 1 adhesive patch daily. Patient identified he/she does not have Lidocaine patches in his/her home and has not utilized them for a long time. The DRR failed to include an accurate review of all medications taken by the patient. 4. Patient #9 had a start of care date of 12/17/24 and a discharge date of 3/7/25. Clinical record review revealed: a. The POC, dated 2/15/25 to 4/15/25, identified the patient had a primary diagnosis of Parkinson's disease and included physician orders for medications and skilled nurse services. b. The comprehensive assessment at the time of discharge, dated 3/7/25, Staff C, RN, included documentation of patient assessment and identified medication compliance reviewed. The assessment lacked documentation of completion of a drug regimen review. The agency skilled nurse failed to complete a drug regimen review at the time of the discharge comprehensive assessment as regulated. The above findings were reviewed with the Administrator and Clinical Manager. According to the agency policy, titled Medication Reconciliation, Review and Administration, dated 10/14/24, each comprehensive assessment will include the Drug Regimen Review (DRR) process, which includes all of the medications that the patinet is currently taking, such as prescription, non-prescription/over the counter (OTC) medications, vitamins, herbal remedies, and other alternative treatments that could affect drug therapy on an ongoing basis. Qualifies clinicians iwll review all medication that the patinet is currently using in order to identify any potential adverse effects and/or drug reactions and are accountable for evaluating the following, which includes but is not limited to: ineffective drug therapy, significant drug side effects, immediate desired effects, unusual and unexpected effects, significant drug interactions, duplicate drug therapy, noncompliance with drug therpy, drug therapy currently associated with laboratory monitoring, allergic reactions and chnages in the patient's condition that contraindicate continued adminstration of the medication. During an interview on 2/16/26 at 11:00 AM, the Clinical Manager stated the DRR completed by the skilled nurse at the time of all comprehensive assessments. 1.Patient #8 had a start of care date of 9/17/25. Clinical record review revealed: a. The Plan of Care (POC), dated 1/17/25 to 11/15/25, included primary diagnosis of Diabetes mellitus and physician orders for skilled nurse services. b. The comprehensive assessment at the time of discharge, dated 10/25/25, Staff H, Registered Nurse (RN) included documentation of an assessment of the patient and identified no potential clinically significant medication issues were identified since the start of care. The current reconciled medication list provided to the patient, family and/or caregiver. The assessment lacked documentation of completion of a drug regimin review. The agency skilled nurse failed to complete a drug regimen review at the time of the discharge comprehensive assessment as regulated.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) 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. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on patient interview, staff interview, agency policy, clinical record, and observation, the agency failed to include all medical supplies, equipment and medications on Plans of Care (POCs) for 4 of 10 sampled patients, Patient #1, #2, #3, and #4. Failure to maintain complete and accurate POCs with current orders for medical supplies, equipment and medications placed the patients at risk to not receive services according to assessed needs and physician orders. Findings include: According to the agency policy titled Plan of Care and Coordination of Care, dated 3/4/25, the agency will develop a written plan of care for each patient accepted to care/services. The POC will be developed in consultation with the patient, legal caregiver (if applicable), physician or allowed practitioner, and agency staff. The POC includes medications: dose/frequency/route and equipment and supply needs. All care/service orders, including verbal orders, will be recorded in the POC along with any revisions or additions. The POC will also be reviewed when physician or allowed practitioner orders change. 1.Patient #3 had a start of care date of 1/6/26. Clinical record review, patient interview, and staff interview revealed the following: a.The POC, dated 1/6/26 to 3/26/26, had a diagnosis of aftercare following surgery for neoplasm and the following medication. b.Enoxaparin (blood thinner) 40 milligrams (mg)/0.4 milliliters (mL) subcutaneous (injection into the fatty tissue layer between the skin and muscle) every morning with a start date of 1/6/26. c.In an interview on 2/17/26 at 10:30 AM, the patient reported that he stopped taking enoxaparin 2-3 weeks ago. d.In an interview on 2/17/26 at 10:30 AM, Staff D, Registered Nurse (RN), reported that the patient reported that he stopped taking enoxaparin last week and that she forgot to update the patient's medication list. The clinical record did not contain an updated medication list to reflect the medications the patient was currently taking. 2.Patient #4 had a start of care date of 9/17/25. Clinical record review, observation, patient interview, and staff interview revealed the following: a.The POC, dated 1/15/26 to 3/15/26, had a diagnosis of malignant neoplasm of extrahepatic bile duct and the following medications. b.Oxygen gas for inhalation, 2 liters, continuous with a start date of 9/22/25. c.Magnesium (a supplement) 400 mg 1 tablet every morning with a start date of 10/29/25. d.In a home visit observation on 2/17/26 at 3:00 PM, the patient was observed to have an oxygen concentrator and oxygen tubing next to the chair she was sitting in, but was not using oxygen. e.In an interview on 2/17/26 at 3:00 PM, the patient and Staff E, RN, reported that the patient's oxygen order was changed from a frequency of continuous to as needed. The clinical record did not contain the order to change the patient's oxygen frequency to as needed. f.During a medication set up procedure on 2/17/26 at 3:00 PM, Staff E asked the patient where her magnesium bottle was. The patient reported that she does not take magnesium due to adverse side effects she experienced when she the medication before she started with home health services. Staff E then reported to the patient that this medication was filled in her pill planner last week. The patient reported to Staff E, again, that she does not take magnesium. The clinical record did not contain information related to patient's report of not taking magnesium. g.In a home visit observation on 2/17/26 at 3:00 PM, a container of Miralax (medication to treat constipation) was observed in one of the patient's kitchen cupboards. h.In an interview on 2/17/26 at 3:00 PM, the patient reported that when her physician ordered oxycodone as needed for pain (a medication that has a potential side effect of constipation), her physician ordered her to take Miralax when the patient took oxycodone. The patient reported that she has taken oxycodone 3 times since the start of the year. i.In an interview on 2/17/26 at 3:00 PM, Staff E reported that she thought the patient's physician advised Staff E that the patient should not use Miralax, but that she would report to the physician that the patient took Miralax. The clinical record did not contain communication from the patient's physician regarding Miralax use. 3. Patient #1 had a start of care date of 9/13/24. Clinical record review revealed: a. The POC, dated 1/6/26 to 3/6/26, identified the patient had a primary diagnosis of Hypertension and included physician orders for medical supplies and equipment used by the patient. The POC included the following medical supplies and equipment used by the patient: adaptive living aids, back brace, blood pressure cuff, cane, cushion, grab bars, knee brace, medication planner, ramp and scooter. b. During a home observation visit on 2/16/26 at 1:00 PM with Staff C, RN, the surveyor identified a pill cutter used by the RN to cut the patient's Jardiance (diabetic medication prescribed to the patient in July 2025) in half. The agency failed to include all medical supplies/equipment on the patient's POC, including the pill cutter. 4. Patient #2 had a start of care date of 1/2/26. Clinical record review revealed: a. The POC, dated 1/2/26 to 3/2/26, identified the patient had primary diagnosis of open wound to the left hip and included physician orders for medical supplies and equipment used by the patient. The POC included the following medical supplies and equipment used by the patient: incontinence products, adaptive living aids, bedside commode, gait belt, grab bars, lift chair, medication planner, shower chair, stair lift, walker and wheelchair. b. During a home observation visit on 2/17/26 at 10:30 AM with Staff F, Physical Therapist (PT), the surveyor identified a life alert device in the home. The patient stated during the same home visit he/she has had a life alert button since prior to the start of care. The agency failed to include all medical supplies/equipment on the patient's POC, including life alert button. The above findings were reviewed with the Administrator and Clinical Manager. According to the agency policy titled Plan of Care and Coordination of Care, dated 3/4/25, the agency will develop a written plan of care for each patient accepted to care/services. The POC will be developed in consultation with the patient, legal caregiver (if applicable), physician or allowed practitioner, and agency staff. The POC includes medications: dose/frequency/route and equipment and supply needs. All care/service orders, including verbal orders, will be recorded in the POC along with any revisions or additions. The POC will also be reviewed when physician or allowed practitioner orders change. 1.Patient #3 had a start of care date of 1/6/26. Clinical record review, patient interview, and staff interview revealed the following: a.The POC, dated 1/6/26 to 3/26/26, had a diagnosis of aftercare following surgery for neoplasm and the following medication. b.Enoxaparin (blood thinner) 40 milligrams (mg)/0.4 milliliters (mL) subcutaneous (injection into the fatty tissue layer between the skin and muscle) every morning with a start date of 1/6/26. c.In an interview on 2/17/26 at 10:30 AM, the patient reported that he stopped taking enoxaparin 2-3 weeks ago. d.In an interview on 2/17/26 at 10:30 AM, Staff D, Registered Nurse (RN), reported that the patient reported that he stopped taking enoxaparin last week and that she forgot to update the patient's medication list. The clinical record did not contain an updated medication list to reflect the medications the patient was currently taking. 2.Patient #4 had a start of care date of 9/17/25. Clinical record review, observation, patient interview, and staff interview revealed the following: a.The POC, dated 1/15/26 to 3/15/26, had a diagnosis of malignant neoplasm of extrahepatic bile duct and the following medications. b.Oxygen gas for inhalation, 2 liters, continuous with a start date of 9/22/25. c.Home visit observation on 2/17/26 at 3:00 PM, the patient was observed to have an oxygen concentrator and oxygen tubing next to the chair he/she was sitting in, but was not using oxygen. d.Interview on 2/17/26 at 3:00 PM, Patient #4 and Staff E, RN, reported that the patient's oxygen order was changed from a frequency of continuous to as needed. The clinical record did not contain the order to change the patient's oxygen frequency to as needed. e.In a home visit observation on 2/17/26 at 3:00 PM, a container of Miralax (medication to treat constipation) was observed. f.In an interview on 2/17/26 at 3:00 PM, the patient reported that when her/him physician ordered oxycodone as needed for pain (a medication that has a potential side effect of constipation), the physician ordered to take Miralax when the patient took oxycodone. The patient reported that she/he had taken oxycodone 3 times since the start of the year. g.In an interview on 2/17/26 at 3:00 PM, Staff E reported that she thought the patient's physician advised Staff E that the patient should not use Miralax, but that she would report to the physician that the patient took Miralax. The clinical record did not contain physician orders for Miralax. 3. Patient #1 had a start of care date of 9/13/24. Clinical record review revealed: a. The POC, dated 1/6/26 to 3/6/26, identified the patient had a primary diagnosis of Hypertension and included physician orders for medical supplies and equipment used by the patient. The POC included the following medical supplies and equipment used by the patient: adaptive living aids, back brace, blood pressure cuff, cane, cushion, grab bars, knee brace, medication planner, ramp and scooter. b. During a home observation visit on 2/16/26 at 1:00 PM with Staff C, RN, the surveyor identified a pill cutter used by the RN to cut the patient's Jardiance (diabetic medication prescribed to the patient in July 2025) in half. The agency failed to include all medical supplies/equipment on the patient's POC, including the pill cutter. 4. Patient #2 had a start of care date of 1/2/26. Clinical record review revealed: a. The POC, dated 1/2/26 to 3/2/26, identified the patient had primary diagnosis of open wound to the left hip and included physician orders for medical supplies and equipment used by the patient. The POC included the following medical supplies and equipment used by the patient: incontinence products, adaptive living aids, bedside commode, gait belt, grab bars, lift chair, medication planner, shower chair, stair lift, walker and wheelchair. b. During a home observation visit on 2/17/26 at 10:30 AM with Staff F, Physical Therapist (PT), the surveyor identified a life alert device in the home. The patient stated during the same home visit he/she has had a life alert button since prior to the start of care. The agency failed to include all medical supplies/equipment on the patient's POC, including life alert button. The above findings were reviewed with the Administrator and Clinical Manager.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on staff interview, clinical record reviews and agency policy review, the agency failed to ensure the registered nurse (RN), developed home health aide instructions for patient care that were specific and individualized to the patient's needs for 1 of 4 sampled patients receiving home health aide services (Patient #5). Failure to identify specific tasks for the home health aide to perform or a specific frequency for the task increases the potential risk that patients may fail to receive necessary services ordered on the plan of care in a safe and effective manner. Findings include: According to the agency policy titled Home Health Aide Assignments and Duties, dated 3/5/25, a home health aide will be assigned to each specific patient by the RN or other appropriate skilled professional. Written patient care instructions for the home health aide will be prepared by the RN or other appropriate skilled professional. During an interview on 2/16/26 at 11:00 AM, Staff B, Clinical Manager, stated the RN is responsible for developing the aide care plan. Patient #5 had a start of care date of 1/9/26. Clinical record review revealed: a. The Plan of Care (POC), dated 1/9/26 to 3/9/26, identified the patient had a primary diagnosis of pressure ulcer of other site, Stage 2 and included physician orders for skilled nurse and home health aide services. b. The aide care plan, dated 1/11/26, included aide instructions to provide skin care. The assignment did not include specific instructions on what skin care the aide should provide to the patient. The home health RN failed to include specific instructions to the aide on what skin care the aide should provide to the patient. The findings were reviewed with the Administrator and Clinical Manager.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on agency staff interview, clinical record review and agency policy review, the agency failed to ensure a registered nurse or other appropriate health care professional completed home health aide supervision at least every 14 days for 2 of 4 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patients #5 and #7). The agency reported 26 patients who received home health aide services with every 14 day supervision. Failure to supervise home health aide services at least every 14 days, increased the risk that patients received unsatisfactory or inappropriate care from home health aides. Findings include: 2. Patient #7 had a start of care date of 11/14/25. Clinical record review revealed: a. The POC, dated 1/13/26 to 3/13/26, identified the patient had a primary diagnosis of Hypertensive Heart Disease and included physician orders for skilled nurse and home health aide services. b. The skilled nurse visit note, dated 12/22/25, Staff D, RN, included documentation of home health aide supervision. c. The skilled nurse visit note, dated 12/31/25, Stadd D, RN, failed to document home health aide supervision. d. The skilled nurse visit note, dated 1/7/26, Staff D, RN, included documentation of home health supervision (2 days late). The agency failed to provide home health aide supervision every 14 days. The above findings reviewed with the Administrator and Clinical Manager. According to the agency policy titled Supervision of Home Health Aides, dated 7/17/24, a Registered Nurse (RN) or other appropriate skilled professional who is familiar with the patient, the patient's plan of care and the written patient care instructions will make an on-site visit to the patient's home no less frequently than every 14 days for patients who are receiving home health aide services and skilled nursing services. During an interview on 2/16/26 at 11:00 AM, Staff B, Clinical Manager, stated aide supervision is documented in the skilled nurse note. 1.Patient #5 had a start of care date of 1/9/26. Clinical record review revealed: a. The Plan of Care (POC), dated 1/9/26 to 3/9/26, identified the patient had a primary diagnosis of Pressure ulcer to other site, Stage 2 and included physician orders for skilled nurse and home health aide services. b. The skilled nurse visit note, dated 1/16/26, Staff D, RN, included documentation of home health aide supervision. c. The skilled nurse visit note, dated 2/2/26, Staff C, RN, included documentation of home health aide supervision (3 days late). The agency failed to provide home health aide supervision every 14 days.

The Department of Inspections and Appeals conducted a recertification survey, dated 2/13/23 to 2/15/23, and found the agency to be operating in substantial compliance under the Emergency Preparedness Condition of Participation.

The Department of Inspections and Appeals conducted a recertification survey for the home health agency, dated 2/13/23 to 2/15/23. The survey identified the following standard level deficient practices. The agency reported a census of 175 patients at the time of the survey.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) 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. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record review, agency policy review, home visit observation, patient and agency staff interview, the agency failed to ensure the accurate completion of all components comprising the Plan of Care for 3 of 4 sampled patients (Patients #1, #3 and #4) with a home visit observation. Failure to maintain complete and accurate Plans of Care with current orders placed the patients at risk to not receive medications and/or treatments according to assessed needs and physician orders. Findings include: Review of the undated agency policy, titled Care Planning, identified agency staff will provide services to the patients based on an individualized Plan of Care (POC) specific to the patient's assessed needs. The POC will include the patient's medications and equipment and supplies. 1. Patient #1 had a start of care date of 10/21/21. Review of the clinical record revealed the following: The POCs, dated 12/15/22 to 2/12/23 and 2/13/23 to 4/23/23, included an order for skilled nursing services and orders for the following medications: Famotidine Oral 20 milligrams (mg) 0.5 tab, take one half tablet everyday; Rosuvastatin Calcium (generic Crestor) oral 40 mg 1 tab, take 1 tablet everyday at bedtime; and, Crestor Oral 40 mg 1 tab, take 1 tablet everyday in the morning. On 2/13/23 at 11:00 AM, during a home visit observation, Staff C, Registered Nurse (RN), assessed the patient and set up the patient’s medications. Staff C, RN, set up the patient’s medications for a week per the POC and the agency’s current medication list with the exception of Famotidine and Crestor. In an interview, during the same home visit observation, the surveyor asked Staff C, RN, if they were done setting up the patient’s medication. They confirmed they were done. The surveyor asked Staff C, RN, about not setting up the Famotidine and Crestor. Staff C, RN, reported she thought the Crestor was a duplicate medication and had been discontinued. Staff C, RN, looked for the Famotidine medication bottle and reported they could not find it. Staff C, RN, then called the patient’s pharmacy. Staff C, RN, reported the patient still had active prescriptions for both Famotidine and Crestor. Staff C, RN, requested a refill for both medications. Staff C, RN, was unsure the last time they had set up both medications in the patient’s medication box. On 2/14/23 at 1:15 PM, during an interview, the Administrator called the patient's pharmacy and the pharmacy reported the healthcare practitioner discontinued the Famotidine on1/9/23. On 2/14/23 at 1:43 PM, during an interview, the Administrator called the patient's primary care practitioner's (PCP) nurse representative. The PCP's nurse representative reported there was no record of the patient ever being on Crestor; just the generic version, Rosuvastatin. The PCP discontinued the Famotidine on 12/20/22. The POC failed to include current and accurate medication orders for the patient. 2. Patient #3 had a start of care date of 1/17/23. Review of the clinical record revealed the following: a. The POC, dated 1/17/23 to 3/17/23, included orders for skilled nursing, occupational and physical therapy services and orders for medications. b. A skilled nursing visit, dated 1/20/23, included documentation the patient reported using Tylenol twice per day to relieve pain. 2/14/23 at 9:00 AM, during a home visit observation, Staff D, Physical Therapy Assistant (PTA), assessed the patient and instructed the patient on exercises to complete. In an interview, during the same home visit observation, the patient reported use of Tylenol Extra Strength 500 mg 1 to 2 tabs daily as needed for pain for years. The POC failed to identify the patient took Tylenol Extra Strength to relieve pain. 3. Patient #4 had a start of care date of 1/19/23. Review of the clinical record revealed the following: The POC, dated 1/19/23 to 3/19/23, included orders for skilled nursing, occupational and physical therapy services and identified the patient used the following medical equipment and supplies: cane, grab bars tub/shower bench, walker, med box planner, pill splitter, quad cane, walker, grasp extender, built in seat in shower, removeable shower head and incontinence products. On 2/14/23 at 9:45 AM, during a home visit observation, Staff E, Occupational Therapist Assistant (OTA), assessed the patient and instructed the patient on shoulder, arm and wrist exercises bilaterally. The surveyor observed the patient with a facility alert necklace on and a neck brace on the bedside table. In an interview, during the same home visit observation, the patient reported wearing the neck brace as needed for the last 15 years. The patient reported having had the facility alert button to contact assisted living staff since moving into the assisted living apartment and prior to agency services. The patient and Staff E, OTA, both reported the patient’s use of the facility alert button for assistance after 2 recent falls. Staff E, OTA, reported they observed the patient wearing the neck brace during a previous therapy visit. The POC failed to identify all necessary medical equipment/supplies used by the patient. The Administrator and Director of Quality received the above findings and agency staff provided no further information prior to the end of the survey.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record review, agency policy review and agency staff interview, the agency failed to ensure registered nurses provided individualized and specific written patient care instructions to agency home health aides for 1 of 2 sampled patients receiving home health aide services (Patients #2). Failure to ensure agency registered nurses provided patient specific written instructions directing the care provided by the agency's home health aides for each patient increased the risk agency patient's would receive inappropriate or inconsistent home health aide services. Findings include: Review of the agency's undated policy, titled Home Health Aide, identified skilled professional staff were responsible for creating patient specific written instructions for the home health aides to follow. On 2/13/23 at 2:55 PM, during an interview, the Clinical Manager reported the patient's primary registered nurse (RN) was responsible for creating, reviewing and revising the home health aide care plan as needed and at least every 60 days. Patient #2 had a start of care date of 9/16/22. a. The Plans of Care (POCs), dated 11/15/22 to 1/13/23 and 1/14/23 to 3/14/23, included orders for skilled nursing and home health aide services. b. The home health aide care plans, dated 11/15/22 and 1/14/23, included RN instructions to the home health aide to complete the tasks of ambulating and transferring the patient as needed every visit. The instructions failed to specify under what circumstances or how the home health aide should make the determination of when the patient needed the home health aide to perform the tasks of ambulation and transfer assist. The Administrator and Director of Quality received the above findings and agency staff provided no further information prior to the end of the survey.