Every finding on record at Greenbelt Home Care

A Recertification Survey was conducted by the Iowa Department of Inspections, Appeals & Licensing from 1/5/26 through 1/7/26 and the home health agency was found to be operating out of compliance with the requirements of the Establishment of Emergency Preparedness.

Plan Based on All Hazards Risk Assessment CFR(s): 484.102(a)(1)-(2) §403.748(a)(1)-(2), §416.54(a)(1)-(2), §418.113(a)(1)-(2), §441.184(a)(1)-(2), §460.84(a)(1)-(2), §482.15(a)(1)-(2), §483.73(a)(1)-(2), §483.475(a)(1)-(2), §484.102(a)(1)-(2), §485.68(a)(1)-(2), §485.542(a)(1)-(2), §485.625(a)(1)-(2), §485.727(a)(1)-(2), §485.920(a)(1)-(2), §486.360(a)(1)-(2), §491.12(a)(1)-(2), §494.62(a)(1)-(2) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following:] (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.* (2) Include strategies for addressing emergency events identified by the risk assessment. * [For Hospices at §418.113(a):] Emergency Plan. The Hospice must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach. (2) Include strategies for addressing emergency events identified by the risk assessment, including the management of the consequences of power failures, natural disasters, and other emergencies that would affect the hospice's ability to provide care. *[For LTC facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents. (2) Include strategies for addressing emergency events identified by the risk assessment. *[For ICF/IIDs at §483.475(a):] Emergency Plan. The ICF/IID must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing clients. (2) Include strategies for addressing emergency events identified by the risk assessment. This STANDARD is not met as evidenced by: Based on staff interview, clinical record review and agency policy review, the agency failed to complete a hazard risk assessment (HVA), create an Emergency Preparedness Plan (EPP) from a HVA, and formulate strategies to use for events on a HVA. Failure to complete a HVA may lead to creating an EPP that does not include hazards identified as at risk for the agency. Failure to identify strategies for the agency to use for risk identified on a HVA may lead to the inability to care for patients in the event of an emergency. Findings include: According to the agency policy titled Emergency Preparedness Plan, dated 9/23/25, examples of events include: tornadoes, floods, snowstorms, chemical spills, industrial accidents, automobile accidents involving multiple injuries, earthquakes, biohazardous weapons, pandemic, and Avian influenza. The policy did not include directives about how the events were determined, or information about using a HVA to create the EPP. The policy did not include strategies to use for the emergency events listed in the EPP. Review of agency documents for emergency preparedness revealed a HVA was performed in 2023. Agency documents failed to reveal a HVA for 2025 or 2024. In an interview on 1/7/26 at 8:45 AM, Staff E, Registered Nurse (RN), reported that the list of emergency events identified on the EPP were from a HVA performed by Staff E for the county as Staff E is also the county Public Health Coordinator. Staff E and the Administrator reported that they were not aware that a HVA was required for the home health agency. Staff E reported that the agency did not have strategies to use for the emergencies listed in the EPP. The above findings were reviewed with the Administrator and Clinical Manager.

The Iowa Department of Inspections, Appeals & Licensing conducted a Recertification Survey from 1/5/26 through 1/7/26. The recertification survey identified the home health agency was operating out of compliance with the following standard level home health regulations. The agency reported a current census of 118 patients at the time of the survey.

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 home visit observations, patient interviews, staff interview, clinical record review and agency policy review, the agency failed to complete an accurate drug regimen review with each comprehensive assessment for 2 of 3 sampled patients with home observation visits (Patients #2 and #3). Failure to ensure medications reviewed at the time of each drug regimen review are current and accurate placed the patients at risk for increased potential unidentified medication interactions, side effects and duplication of medications. Findings include: According to the agency policy titled Medication Profile/Drug Regimen Review (DRR), dated January 2020, the admission nurse will check all medications the client may be taking and will perform a DRR to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, drug interactions, duplicate drug therapy and contraindicated medication. The medication profile will be updated and a DRR will be completed during start of care, recertification, resumption of care, discharge or any time there is a change or discontinuation of a medication. During an interview on 1/6/26 at 1:42 PM, Staff B, Clinical Manager stated DRRs are completed at all assessment time points and whenever medication changes occur. 1.Patient #2 had a start of care date of 8/28/18. Clinical record review revealed: a. The Plan of Care (POC), dated 11/19/25 to 1/17/26, identified the patient had a diagnosis of Schizoaffective disorder, bipolar type and included physician orders for medication and skilled nursing services. b. The recertification comprehensive assessment, dated 11/18/25, completed by Staff F, Registered Nurse (RN), included documentation a DRR was completed and no discrepancies identified. c. During a home observation visit on 1/6/26 at 10:30 AM with Staff G, Licensed Practical Nurse (LPN), the surveyor identified the following medication discrepancy: The agency medication profile, dated 1/5/26, identified the patient takes Quetiapine Fumarate 25 milligrams (mg) with instructions to take 1 tablet by mouth 1 time daily as needed for anxiety; start date 9/1/25. The bottle in the home, last filled 9/25/25, identified the patient takes Quetiapine Fumarate 25 mg with instructions to take 1 tablet by mouth 2 times daily as needed for anxiety. The DRR failed to include an accurate review of all medications taken by the patient. 2. Patient #3 had a start of care date of 3/4/25. Clinical record review revealed: a. The POC, dated 12/29/25 to 2/26/26, identified the patient had a diagnosis of Type II diabetes and included physician orders for medication and skilled nursing services. b. The recertification comprehensive assessment, dated 12/24/25 completed by Staff F, RN, included documentation a DRR was completed and no discrepancies identified. c. During a home observation visit on 1/5/26 at 3:00 PM with Staff F, RN, the surveyor identified Famotidine (acid reducer) on the patient's active medication profile; however, the RN did not set up the medication in the patient's medication planner. d. During an interview, the patient identified he/she does not have Famotidine and he/she has not taken the medication for greater than 2 months. The DRR failed to include an accurate review of all medications taken by the patient. 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 review and agency policy review, the agency failed to complete a specific home health aide care plan for foot care for 2 of 3 sampled patients with home health aide services (Patients #1 and #7). Failure to create a specific home health aide care plan to direct the home health aide in how to provide foot care for patients could lead to inaccurate care which could lead to adverse outcomes to patients. Findings include: 2. Patient # 7 had a start of care date of 8/6/25 and a discharge date of 9/25/25. Clinical record review revealed: a. The POC, dated 8/6/25 to 10/4/25, included orders for skilled nurse and home health aide services. b. The Aide care plan, dated 8/6/25, included instructions that directed the aide to provide foot care weekly. The nurse failed to specify what foot care the aide should provide to the patient. The above findings were reviewed with the Administrator and Clinical Manager. According to the agency policy titled Home Health Aide Care Plan, dated January 2020, the purpose of the home health aide care plan was to provide a means of assigning duties to the home health aide that are clear to the nurse, home health aide, and to the client/caregiver being served. 1. Patient # 1 had a start of care date of 11/16/24. Clinical record review revealed: a. The Plan of Care (POC), dated 11/11/25 to 1/9/26, included orders for skilled nurse and home health aide services. b. The Aide care plan, dated 11/11/25, included instructions that directed the aide to provide foot care at every visit. The nurse failed to specify what foot care the aide should provide to the patient.

The Department of Inspections and Appeals conducted a recertification survey, dated 12/5/22 to 12/7/22, and found the agency to be operating in substantial compliance with regulations found under the Emergency Preparedness Condition of Participation.

The Department of Inspections and Appeals conducted a recertification survey for the home health agency, dated 12/5/22 to 12/7/22. The survey identified the following standard level deficient practices. The agency reported a census of 124 patients at the time of the survey.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on clinical record review, agency policy review and agency staff interview, the agency failed to follow a Plan of Care established and periodically reviewed by a healthcare practitioner or notify the patient's healthcare practitioner of the need to vary from the ordered Plan for Care for 3 of 7 sampled patients (Patients #1, #4 and #6). Failure to follow a Plan of Care established by a physician placed patients at risk of not receiving safe, individualized and consistent care designed to meet each patient's health care needs. Findings include: 1. Patient #1 had a start of care date of 11/6/22. Clinical record review revealed: a. Plan of Care, dated 11/6/22 to 1/4/23, included physician orders for skilled nursing services 2 times a week and home health aide services 2 times a week. b. Missed visit form, dated 11/9/22, documented a missed home health aide visit on 11/9/22, no answer to door and attempted visit two more times before speaking with patient. During an interview on 12/5/22 at 4:30 PM, Clinical Manager reported the documentation was meant to reflect two missed visits for the week instead of just the one visit on 11/9/22. The home health aide failed to document two missed visits for the week of 11/6/22. Review of the agency policy, titled Plan of Care (POC), dated 4/2022, identified agency staff will furnish home care services under the supervision of the patient's physician. Each patient shall receive services based on an individualized POC signed by a healthcare practitioner. Professional staff shall promptly alert the healthcare practitioner to any changes that suggest a need to alter the POC and staff shall obtain orders to make changes to the POC. Review of the agency policy, tiled Therapy Services, dated 4/2022, identified if the physician orders therapy services at the start of care, therapy staff will do the initial assessment within 5 days of the start of care or document the need for another schedule. On 12/6/22 at 8:23 AM, during an interview, the Administrator reported the agency had a policy for therapy to start services within 5 days of the start of care. 1. Patient #4, a pediatric patient, had a start of care date of 11/14/22. Review of the clinical record revealed the following: a. The POC, dated 11/14/22 to 1/12/23, identified a diagnosis of moderate hypoxic ischemia and included orders for skilled nursing and orders for a one time evaluation for both physical and occupational therapy services effective 11/14/22. b. The clinical record included documentation of a physical therapy initial evaluation, dated 11/22/22 (7 days after the start of care). The clinical record lacked documentation to explain why the patient did not receive a physical therapy evaluation within 5 days from the start of care per agency policy. 2. Patient #6 had a start of care date of 11/16/22 and discharged from agency services on 12/21/22. Review of the clinical record revealed the following: The POC, dated 11/16/22 to 1/14/23, included orders for skilled nursing services one time per week. a. An interim physician order, dated 12/1/22, included an order for the nurse to obtain a blood draw for a complete blood count (CBC) and basic metabolic panel (CMP) on 12/7/22. A skilled nursing visit, dated 12/7/22, included documentation the nurse attempted to obtain the blood draw for the CBC and BMP labs, but was unsuccessful. The visit note lacked documentation the nurse contacted the patient's physician to notify the physician of the inability to obtain blood for the ordered labs. b. An interim physician order, dated 12/13/22, included an order for the nurse to obtain a urinalysis (UA) sample for a possible urinary tract infection. A skilled nursing visit, dated 12/14/22, included documentation the nurse was unable to obtain the UA sample, but the clinical record lacked documentation the nurse contacted the patient's physician to notify the physician of the inability to obtain the UA sample. On 12/7/22 at 10:55 AM, during an interview, the Clinical Manager confirmed the clinical record lacked documentation the nurse contacted the physician about the inability to complete the blood draw and UA for the labs. The Administrator and Clinical Manager received the above findings and agency staff provided no further information prior to the end 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, home visit observation, agency policy review, patient and agency staff interview, the agency failed to ensure the accurate completion of all components comprising the Plan of Care for 2 of 8 sampled patients (Patients #3 and #6). Failure to maintain complete and accurate Plans of Care with current orders placed the patients at risk to not receive medications or needed medical equipment and supplies according to assessed needs and physician orders. Review of the agency policy, titled Plan of Care (POC), dated 4/2022, identified agency staff will furnish home care services under the supervision of the patient's physician. Each patient shall receive services based on an individualized POC signed by a healthcare practitioner. Professional staff shall promptly alert the healthcare practitioner to any changes that suggest a need to alter the POC and staff shall obtain orders to make changes to the POC. The POC shall include medications and medical equipment and supplies used by the patient. 1. Patient #3 had a start of care date of 9/24/22. On 12/6/22 at 9:55 AM, during a home visit observation, Staff C, Physical Therapy Assistant (PTA) reviewed therapy exercises with the patient including seated lower leg exercises with the patient’s red therapy band. During the visit, the surveyor observed the patient was wearing a necklace with an emergency response button. The surveyor observed a bottle of Docusate Sodium tablets. In an interview, during the same home visit observation, the patient reported having had the red therapy band since the start of therapy services. Staff C, PTA, confirmed the patient’s use of the red therapy band for exercises throughout the course of services. The patient reported having had the emergency response button since the end of October 2022. The patient reported taking Docusate Sodium 100 mg tabs by mouth one tab every day since prior to the start of agency services. Review of the clinical record revealed the following: a. The POCs, dated 9/24/22 to 11/22/22 and 11/23/22 to 1/21/23, included orders for skilled nursing, home health aide and therapy services. b. The POCs failed to identify the patient took the Docusate Sodium. c. The POC, dated 11/23/22 to 1/21/23, failed to identify the patient was using a red therapy band to complete physical therapy prescribed exercises and failed to identify the patient had an emergency response button for medical equipment. 2. Patient #6 had a start of care date of 11/16/22 and discharged from agency services on 12/21/22. Review of the clinical record revealed the following: a. The comprehensive assessment completed by a registered nurse at the start of care, dated 11/16/22, identified the patient was incontinent of urine and used incontinent briefs. The POC, dated 11/16/22 to 1/14/23, included orders for skilled nursing services one time per week. The POC failed to identify the patient used incontinent briefs for a medical supply. The Administrator and Clinical Manager received the above findings and agency staff provided no further information prior to the end of the survey.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on clinical record review, agency policy review and agency staff interview, the agency staff failed to provide wound care treatments only as ordered by the physician for 1 of 1 sampled patients (Patient #1) with a wound. Failure to ensure staff obtain/follow physician orders for administration of medications and treatments placed agency patients at risk for inconsistent care/treatment and possible harm. Findings include: 1. Patient #1 had a start of care date of 11/6/22. Clinical record review revealed: a. Plan of Care, dated 11/6/22 to 1/4/23, included physician orders for skilled nursing services 2 times a week, skilled nurse to instruct the patient on wound care as follows: Patient to go to wound clinic & skilled nurse will follow orders. b. Skilled nursing visit, dated 11/11/22, documented extra visit completed for right leg wound drainage. Right lower extremity washed with soap and water. Covered wounds with telfa and gauze. c. Interim physician order, dated 11/11/22, included documentation as needed skilled nurse visit on 11/11/22 due to concerns of right leg cellulitis (infection) with weeping (draining fluid) wounds. During an interview on 12/5/22 at 4:15 PM, Clinical Manager reviewed the clinical record and reported no interim physician order for the wound care completed on 11/11/22. The skilled nurse failed to provide services as ordered by the physician. Review of the agency policy, titled Plan of Care (POC), dated 4/2022, identified agency staff will furnish home care services under the supervision of the patient's physician. Each patient shall receive services based on an individualized POC signed by a healthcare practitioner. Professional staff shall promptly alert the healthcare practitioner to any changes that suggest a need to alter the POC and staff shall obtain orders to make changes to the POC.

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, patient 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 1 sampled patients receiving home health aide services and an onsite visit to the patient's home (Patients #3). 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 policy, titled Home Health Aide: Assignment, dated 4/2022, identified a registered nurse (RN) develops a home health aide care plan assignment based on the assessed needs of the patient. Any changes made to the assignment must be approved by the professional staff managing the patient's care. On 12/6/22 at 8:36 AM, during an interview, the Clinical Manager reported the admission nurse or RN Case Manager developed and updated the home health aide care plan assignment. If the patient requested the home health complete an unassigned task, the home health aide must call the RN Case Manager for approval prior to doing the task. The RN Case Manager determines if the home health aide can do the task and adds the task to the home health aide care plan. Patient #3 had a start of care date of 9/24/22. On 12/6/22 at 9:55 AM, during a home visit observation, Staff C, Physical Therapy Assistant (PTA) reviewed therapy exercises with the patient. In an interview, during the same home visit observation, the patient reported the home health aides had been applying Betamethasone cream up until recently, as the patient could not reach the spot where the medication needed to be applied. The patient now felt the medication was not effective and just had the home health aides apply lotion. The patient was unsure of the discontinuation date of the medicated cream. Review of the clinical record revealed the following: a. The POCs, dated 9/24/22 to 11/22/22 and 11/23/22 to 1/21/23, included orders for skilled nursing, home health aide and therapy services. The POCs included the following order: "Betamethasone Dipropionate External 0.05 %. Apply thin layer to shoulder blades once every other day at bedtime for 6 weeks and then twice weekly for itchiness to the skin." b. The home health aide care plans, dated 9/25 and 11/23/22, included instructions for the home health aide to complete the task of skin care by "monitoring closely for any areas of concern". c. The home health aide visit notes, dated 10/10, 10/14, 10/20, 10/24, 10/28, 10/31, 11/4, 11/11, 11/14, 11/18, 11/21, 11/24, 11/29 and 12/1/22, included documentation the home health aides had completed the tasks of monitoring the skin closely for any areas of concern. The visit notes lacked documentation of whether or not the home health aides had applied regular lotion or the Betamethasone cream. The home health aide visit notes identified Staff E, Home Health Aide, Staff F, Home Health Aide, and Staff G, Licensed Practical Nurse (LPN), had provided home health aide services to the patient over the last 2 certification periods. On 12/6/22 at 4:13 PM, during an interview, Staff E, Home Health Aide, reported she had applied both regular body lotion on the patient and Betamethasone cream to the patient's shoulder blades. She reported she had applied the Betamethasone cream on the patient the last time she had worked with the patient (11/24/22). On 12/6/22 at 4:17 PM, during an interview, Staff F, Home Health Aide, reported she has not applied the Betamethasone cream the last 3 to 4 visits due to the patient saying it was not effective. She confirmed she had been applying the Betamethasone regularly before this along with applying regular skin lotion. On 12/7/22 at 9:12 AM, during an interview, Staff G, LPN, reported she applied regular lotion after bathing the patient; she never applied the Betamethasone topical cream. 12/7/22 at 8:40 AM, during an interview, Staff D, Registered Nurse (RN), reported being aware the home health aides had been applying lotion on the patient and also the medicated Betamethasone cream. She thought the POC identified the home health aides could assist the patient with the application of the Betamethasone. She was not aware the application of lotion or the medicated cream was not on the home health aide assignment. She reported being aware the patient was no longer using the Betamethasone as of Monday (12/5/22) due to it not being effective. The RN failed to include instructions on the home health aide assignment for the home health aide to apply lotion and the Betamethasone cream on the patient. The Administrator and Clinical Manager received the above findings and agency staff provided no further information prior to the end of the survey.

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 clinical record review, agency policy review and staff interview, the agency failed to ensure home health aides provided care to agency patients only as ordered by the physician in the Plan of Care and/or as directed in writing by the skilled professional assigning the home health aide to the patient for 2 of 4 sampled patients receiving home health aide services (Patients #3 and #5). Failure to ensure that home health aide services are provided only as ordered by the physician and according to the home health aide care plan increased the risk that patients' personal care needs were not adequately met. Findings include: Review of the agency policy, titled Home Health Aide: Assignment, dated 4/2022, identified a registered nurse (RN) develops a home health aide care plan assignment based on the assessed needs of the patient. Any changes made to the assignment must be approved by the professional staff managing the patient's care. Review of the agency policy, titled Home Health Aide: Care Plan, dated 4/2022, identified the home health aide will follow the home health aide care plan assignment. On 12/6/22 at 8:36 AM, during an interview, the Clinical Manager reported the admission nurse or RN Case Manager developed and updated the home health aide care plan assignment. If the home health aide is unable to complete an assigned task, the home health aide must document the reason why. 1. Patient #3 had a start of care date of 9/24/22. Review of the clinical record revealed the following: a. The Plans of Care (POCs), dated 9/24/22 to 11/22/22 and 11/23/22 to 1/21/23, included orders for skilled nursing and home health aide services. b. The home health aide care plan assignment, dated 9/25/22, included instructions to the home health aide to take the patient's temperature every visit. c. The home health aide visit notes, dated 10/14, 10/20, 10/24, 10/28, 10/31, 11/4, 11/11, 11/14, 11/18 and 11/21/22, lacked documentation the home health aide took the patient's temperature and lacked documentation to explain a reason why the home health aide did not complete the assigned task. 2. Patient #5 had a start of care date of 2/13/19. Review of the clinical record revealed the following: a. The POCs, dated 9/25/22 to 11/23/22 and 11/24/22 to 1/22/23, included orders for skilled nursing and home health aide services. b. The home health aide care plan assignments, dated 9/25 and 11/24/22, included instructions to the home health aide to take the patient's temperature every visit. c. The home health aide visit notes, dated 11/4, 11/18 and 12/2/22, lacked documentation the home health aide took the patient's temperature and lacked documentation to explain a reason why the home health aide did not complete the assigned task. The Administrator and Clinical Manager received the above findings and agency staff provided no further information prior to the end of the survey.