Every finding on record at Cloud County Home Health Agency

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey (ASPEN 72QT11) at the above-named Home Health Agency from 05/11/21 to 05/12/21 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.22

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey (ASPEN #72QT11) at the above-named Home Health Agency from 05/11/21 to 05/12/21 resulted in a finding of substantial compliance respective to applicable COP under 42 CFR 484, Subpart A through C, with the following standard deficiencies.

Written notice of patient's rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient's rights and responsibilities under this rule, and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This ELEMENT is not met as evidenced by: Based on document review, policy review and interview, the Home Health Agency (HHA) failed to ensure a written notice of the Home Health Agency's transfer and discharge policies as set forth in paragraph (d) of this section was provided to the patient and patient's legal representative (if any), during the initial evaluation visit, in advance of furnishing care to patients. The home health agency's failure to ensure patients received written transfer and discharge policies in advance of furnishing care has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of U.S. Code of Federal Regulations at 42 CFR 484.50(d) required: Standard: Transfer and discharge: The patient and representative (if any), have a right to be informed of the HHA's policies for transfer and discharge. The HHA may only transfer or discharge the patient from the HHA if: The transfer or discharge is necessary for the patient's welfare because the HHA and the physician who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; The patient or payer will no longer pay for the services provided by the HHA; The transfer or discharge is appropriate because the physician who is responsible for the home health plan of care and the HHA agree that the measurable outcomes and goals set forth in the plan of care in accordance with §484.60(a)(2)(xiv) have been achieved, and the HHA and the physician who is responsible for the home health plan of care agree that the patient no longer needs the HHA's services; The patient refuses services, or elects to be transferred or discharged; 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: (i) Advise the patient, representative (if any), the physician(s) issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered; (ii) Make efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation; (iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and (iv) Document the problem(s) and efforts made to resolve the problem(s) and enter this documentation into its clinical records; The patient dies; or The HHA ceases to operate. Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d). Review of the home health agency's patient admission packet showed the agency did not include written information on transfer and discharge policies as set forth in 42 CFR 484.50(d), within the packet provided to patients on admission. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include the patient's right to be informed of the agency's policies for transfer and discharge and to include all required elements. The agency failed to develop transfer and discharge policies for disclosure to patients as required on admission.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to be free from mental and sexual abuse, including injuries of unknown source, neglect and misappropriation of property. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill Of Rights And Responsibilities" showed each patient shall have the right to be free from verbal, physical and psychological abuse and to be treated with dignity. The Patient's Bill Of Rights And Responsibilities did not include the right to be free from mental, sexual abuse; including injuries of unknown source, neglect and misappropriation of property. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to make complaints to the HHA regarding the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill Of Rights And Responsibilities" showed each patient shall have the right to be free from verbal, physical and psychological abuse and to be treated with dignity. The Patient's Bill Of Rights And Responsibilities did not include the right to make complaints to the HHA regarding the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to participate in, be informed about, and consent or refuse care during treatment, where appropriate, with respect to; Completion of all assessments; The care to be furnished, based on the comprehensive assessment; Establishing and revising the plan of care and, any factors that could impact treatment effectiveness. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill of Rights and Responsibilities" showed the written notice of Patient Rights did not include the right to participate in, be informed about, and consent or refuse care during treatment, where appropriate, with respect to; Completion of all assessments; The care to be furnished, based on the comprehensive assessment; Establishing and revising the plan of care and, any factors that could impact treatment effectiveness. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to receive all services outlined in the plan of care. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill of Rights and Responsibilities" showed the written notice of Patient Rights did not include the right to receive all services outlined in the plan of care. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill of Rights and Responsibilities " showed the written notice of Rights did not include the right to receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

Contact info Federal/State-funded entities CFR(s): 484.50(c)(10)(i,ii,iii,iv,v) Be advised of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: (i) Agency on Aging (ii) Center for Independent Living (iii) Protection and Advocacy Agency, (iv) Aging and Disability Resource Center; and (v) Quality Improvement Organization. This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to be advised of the names, addresses, and telephone numbers of the following federally-funded and state-funded entities that serve the area where the patient resides that included: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center and Quality Improvement Organization. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill of Rights and Responsibilities" showed the written notice of Rights did not include the right to be advised of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides that included: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center and Quality Improvement Organization. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

Access to auxiliary aids and language service CFR(s): 484.50(c)(12) Be informed of the right to access auxiliary aids and language services as described in paragraph (f) of this section, and how to access these services. This ELEMENT is not met as evidenced by: Based on document review and interview, the Home Health Agency (HHA) failed to ensure the written notice of patient's rights and responsibilities included the right to be informed of the right to access auxiliary aids and language services as described in paragraph (f) of this section, and how to access these services. The home health agency's failure to ensure patients received a comprehensive written Bill of Rights has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights. Findings Include: Review of the home health agency's patient admission packet showed the agency's written notice of Patient Rights provided to the patients was not inclusive of all patient rights as required. Review of agency document titled "Patient's Bill of Rights and Responsibilities" showed the written notice of Rights did not include the right to be informed of the right to access auxiliary aids and language services as described in paragraph (f) of this section, and how to access these services. During an interview on 05/12/20 at 8:51 AM, Staff A, Administrator, confirmed the agency written notice of patient's rights had not been updated to include all required patient rights.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on document review, policy review and interview, the Home Health Agency (HHA) failed to ensure the agency only may transfer or discharge the patient from the agency if is necessary for the patient's welfare because the HHA and the physician who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA failed to ensure safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities. The home health agency's failure to ensure adopt a comprehensive transfer and discharge policy has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d) that required the HHA to ensure the agency only may transfer or discharge the patient from the agency if is necessary for the patient's welfare because the HHA and the physician who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA failed to ensure safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities. Review of the home health agency's patient admission packet showed the agency did not include written information on transfer and discharge policies as set forth in 42 CFR 484.50(d), within the packet provided to patients on admission. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include all required elements.

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 document review, policy review and interview, the Home Health Agency (HHA) failed to ensure agency only may transfer or discharge the patient from the agency if 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 home health agency's failure to ensure adopt a comprehensive transfer and discharge policy has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d) that required the HHA to ensure the agency only may transfer or discharge the patient from the agency if 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. Review of the home health agency's patient admission packet showed the agency did not include written information on transfer and discharge policies as set forth in 42 CFR 484.50(d), within the packet provided to patients on admission. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include all required elements.

Advise the patient of discharge for cause CFR(s): 484.50(d)(5)(i) (i) Advise the patient, representative (if any), the physician(s) or allowed practitioner(s), issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered; This ELEMENT is not met as evidenced by: Based on document review, policy review and interview, the Home Health Agency (HHA) failed to ensure the agency advised the patient, representative (if any), the physician(s) issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered, prior to discharge of patients for cause. The home health agency's failure to ensure adopt a comprehensive transfer and discharge policy has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d) that required the HHA to ensure the agency advised the patient, representative (if any), the physician(s) issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered, prior to discharge of patients for cause. Review of the home health agency's patient admission packet showed the agency did not include written information on transfer and discharge policies as set forth in 42 CFR 484.50(d), within the packet provided to patients on admission. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include all required elements.

Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation; This ELEMENT is not met as evidenced by: Based on document review, policy review and interview, the Home Health Agency (HHA) failed to ensure the agency made efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation, prior to discharging patients for cause. The home health agency's failure to ensure adopt a comprehensive transfer and discharge policy has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d) that required the HHA to ensure the agency made efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home G, or situation, prior to discharging patients for cause. Review of the home health agency's patient admission packet showed the agency did not include written information on transfer and discharge policies as set forth in 42 CFR 484.50(d), within the packet provided to patients on admission. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include all required elements.

Provide contact info other services CFR(s): 484.50(d)(5)(iii) (iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and This ELEMENT is not met as evidenced by: Based on document review, policy review and interview, the Home Health Agency (HHA) failed to ensure the HHA provided the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care, prior to discharging patients for cause. The home health agency's failure to ensure adopt a comprehensive transfer and discharge policy has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d) that required the HHA to ensure the HHA provided the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care, prior to discharging patients for cause. Review of the home health agency's patient admission packet showed the agency did not include written information on transfer and discharge policies as set forth in 42 CFR 484.50(d), within the packet provided to patients on admission. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include all required elements.

Document efforts to resolve problems CFR(s): 484.50(d)(5)(iv) (iv) Document the problem(s) and efforts made to resolve the problem(s), and enter this documentation into its clinical records; This ELEMENT is not met as evidenced by: Based on document review, policy review and interview, the Home Health Agency (HHA) failed to ensure the agency documented the problem(s) and efforts made to resolve the problem(s) and entered this documentation into its clinical records prior to discharging patients for cause. The home health agency's failure to ensure adopt a comprehensive transfer and discharge policy has the potential to place all patients at risk for compromised understanding and preservation of individual patient rights during transfer and discharge from the agency. Findings Include: Review of a policy titled, "Discharge/Termination of Home Health Services," reviewed by the Agency 03/01/13, showed when a patient is dismissed form Home Health Services, this termination is noted in the progress notes and a Discharge Summary is completed and becomes part of the Clinical Record. The policy did not include required written information on transfer and discharge policies as set forth in 42 CFR 484.50(d) that required the HHA to ensure the agency documented the problem(s) and efforts made to resolve the problem(s) and entered this documentation into its clinical records prior to discharging patients for cause. During an interview on 05/12/20 at 9:05 AM, Staff A, Administrator, confirmed the agency written notice of transfer and discharge had not been updated to include all required elements.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on document review, policy review and interview the home health agency failed to ensure the home health aide provided services that were included in the plan of care for three of three patients (Patients 2, 3 and 4)who received home health aide services. Failure of the hospice to ensure the hospice aides followed the written plan of care, has the potential to affect the type, quality and provision of individualized personal care needs to agency patients. Findings Include: Review of a policy titled, "Home Health Aide Services," reviewed 02/13 by the agency, showed Personal care of certain patients may be assigned to the Home Health Aides by the RN who is managing the patient. The RN will make the aide a care plan according to the needs of the patient and will assign very specific duties to the home health aide. Review of a position Summary titled, Home Health Aide/Homemaker," showed the position provided Home Health Aide services in the homes of sick or disabled persons with the essential function to observe and report any change in patient health habits, behavior patterns, or variance from Care Plan. 1. Patient 3 Review of Patient 3's medical record showed she was admitted for service on 03/09/21 with a primary diagnosis of Unilateral primary Osteoarthritis, left hip. She received Home Health Aide Services two times a week for the assigned tasks that included; Skin Care, Lotion, Shampoo, Hair Care, Peri Care, Tidy Patient Care Area, Assist with Dressing, and Assist with Transfers. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of the patient's skin care, as required by the agency's "Home Health Aide Care Plan" between the dates of 04/01/21 and 05/06/21. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of the patient's lotion, as required by the agency's "Home Health Aide Care Plan" for the dates of 04/05/21, 4/22/21, 4/29/21, and 05/06/21. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of the patient's Hair Care, as required by the agency's "Home Health Aide Care Plan" for the dates of 04/15/21, 04/29/21, 04/26/21, and 05/06/21. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of the patient's Shampoo, as required by the agency's "Home Health Aide Care Plan" for the dates of 04/12/21, 04/15/21, 04/22/21, 04/26/21, 04/29/21 and 05/06/21. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of the patient's Peri Care, as required by the agency's "Home Health Aide Care Plan" for the dates of 04/12/21, 04/15/21, 04/21/21, 04/26/21, 04/29/21 and 05/06/21. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of Tidying Patient Care Area, as required by the agency's "Home Health Aide Care Plan" between the dates of 04/01/21 and 05/06/21. Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of Assisting with Dressing, as required by the agency's "Home Health Aide Care Plan" on 04/29/21, Review of Patient 3's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 3, failed to document the completion of the patient's Assist with Transfers, as required by the agency's "Home Health Aide Care Plan" on 04/15/21. There was no documented refusal of the services, as indicated each date, by the patient. During an interview on 05/12/20 at 12:30 PM, Staff B, RN, confirmed home health aides are required to document care according to the Home Health Aide Care Plan and to report to the nurse any changes or services not completed according to the Home Health Aide Care Plan. Staff B confirmed she did not document all assigned tasks during her visits, as required by the Aide Care Plan and did not revise the Home Health Aide Plan of Care to reflect changes. 2. Patient 5 Review of Patient 5's medical record showed she was admitted for service on 04/07/21 with a primary diagnosis of Aftercare following joint replacement surgery. She received Home Health Aide Services two times a week for the assigned tasks that included; Skin Care, Shampoo, Hair Care, Peri Care, Tidy Patient Care area, Assist with Dressing, and Spend Time with Patient. Review of Patient 5's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 5, failed to document the completion of the patient's skin care, as required by the agency's "Home Health Aide Care Plan" between the dates of 04/13/21 and 04/21/21. Review of Patient 5's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 5, failed to document the completion of the patient's Hair Care, as required by the agency's "Home Health Aide Care Plan" on 04/23/21. Review of Patient 5's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 5, failed to document the completion of the patient's Shampoo, as required by the agency's "Home Health Aide Care Plan" between the dates of 04/12/21, 04/15/21, 04/22/21, 04/26/21, 04/29/21 and 05/06/21. Review of Patient 5's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 5, failed to document the completion of the patient's Peri Care, as required by the agency's "Home Health Aide Care Plan" for the dates of 04/13/21 and 04/21/21. Review of Patient 5's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 5, failed to document the completion of Tidying Patient Care Area, as required by the agency's "Home Health Aide Care Plan" between the dates of 04/13/21 and 04/21/21. Review of Patient 5's "Home Health Aide Visit Note," showed Staff B, RN completing personal care services to Patient 5, failed to document the completion of Assisting with Dressing, as required by the agency's "Home Health Aide Care Plan" on 04/16/21 and 04/23/21. There was no documented refusal of the services, as indicated each date, by the patient. During an interview on 05/12/20 at 12:30 PM, Staff B, RN, confirmed home health aides are required to document care according to the Home Health Aide Care Plan and to report to the nurse any changes or services not completed according to the Home Health Aide Care Plan. Staff B confirmed she did not document all assigned tasks during her visits, as required by the Aide Care Plan and did not revise the Home Health Aide Plan of Care to reflect changes. 3. Patient 7 Review of Patient 7's medical record showed she was admitted for service on 05/19/20 with a primary diagnosis of Wedge Compression Fracture of T11-T12 Vertebra. She received Home Health Aide Services two times a week for the assigned tasks that included; Peri Care, Tidy Patient Care Area, Assist with Dressing, and Assist with Ambulation. Review of Patient 7's "Home Health Aide Visit Note," showed Staff C, HHA, failed to document the completion of the patient's Peri Care, as required by the agency's "Home Health Aide Care Plan" for the dates of 05/22/20, 05/26/20, 05/29/20, and 06/05/20 through 06/19/20. Review of Patient 7's "Home Health Aide Visit Note," showed Staff C, HHA, failed to document the completion of Assist with Dressing, as required by the agency's "Home Health Aide Care Plan" between the dates of 05/22/20 and 06/19/20. Review of Patient 7's "Home Health Aide Visit Note," showed Staff C, HHA, failed to document the completion of the patient's Assist with Ambulation, as required by the agency's "Home Health Aide Care Plan" between the dates of 05/22/20 and 06/19/20. There was no documented refusal of the services, as indicated each date, by the patient not documentation to support the Home Health Aide notified the RN of the variance from the Care Plan. During an interview on 05/12/20 at 12:30 PM, Staff B, RN, confirmed home health aides are required to document care according to the Home Health Aide Care Plan and to report to the nurse any changes or services not completed according to the Home Health Aide Care Plan.