Every finding on record at Heights Home Health, Inc.

A Recertification Survey was conducted by the Iowa Department of Inspections, Appeals & Licensing from 2/9/26 through 2/11/26 and the home health agency was found to be operating in compliance with the requirements of the Establishment of Emergency Preparedness.

The Iowa Department of Inspections, Appeals & Licensing conducted a Recertification Survey from 2/9/26 through 2/11/26. 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 18 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 observations, patient interviews, staff interview, clinical record reviews 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 Drug Regimen Review (DRR), dated 2/28/22, a medication reconciliation along with a DRR is completed at start of care, resumption of care, recertification, significant change in condition and discharge. During an interview on 2/11/26 at 10:03 AM, Staff A, Administrator stated the registered nurse (RN) completes a DRR at all assessment time points and when new medications are added. 1.Patient #2 had a start of care date of 1/26/26. Clinical record review revealed: a. The Plan of Care (POC), dated 1/26/26 to 3/26/26, identified the patient had a primary diagnosis of chronic obstructive pulmonary disease (COPD) and included physician orders for medication set up and skilled nursing services. b. The comprehensive assessment at start of care, dated 1/26/26, completed by Staff B, RN, included documentation a DRR was completed. c. During a home observation visit on 2/9/26 at 11:50 AM with Staff B, RN, the patient interview revealed the following medication discrepancy orders and patient stated medication schedule: 1) The agency medication list identified Calcium 600 milligram (mg) -D3 tablet twice a day. Patient stated he/she takes Calcium 500mg twice a day and his/her bottle of medication was over half gone. 2) The agency medication list identified Hydroxyzine hydrochloride 10mg tablet within instructions to take 88 micrograms (mcg) in the morning. Patient reported he/she takes Levothyroxine 88 mcg daily in the morning. The RN failed to accurately identify the patient was taking Levothyroxine 88 mcg daily. 3) The agency medication list identified Montelukast 10 mg tablet with instructions to get 0.4 milliliters (ml) subcutaneous monthly. Patient reported he/she gets a monthly Nucala injection (for COPD). The RN failed to accurately identify the route and name of the medication the patient received for monthly injections. 4) The agency medication list identified Oxycodone-Acetaminophen 5 mg/325 mg tablet every 6 hours as needed for pain. Patient reported he/she had not taken the medication since weeks prior to admission and does not have any of the medication in his/her home. 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 11/11/25. Clinical record review revealed: a. The POC, dated 1/10/26 to 3/10/26, identified the patient had a primary diagnosis of cellulitis of the face and included physician orders for medications and skilled nursing services. b. The resumption of care comprehensive assessment, dated 2/2/26, completed by Staff B, RN, included documentation a DRR was completed. c. During a home observation visit on 2/10/26 at 10:50 AM with Staff B, RN, the patient/caregiver interview revealed the following medication discrepancy orders and patient/caregiver stated medication schedule: 1) The agency medication list identified Acetaminophen 500 mg oral tablet, two tablets twice daily. Patient/caregiver reported patient takes Tylenol 650 mg, two tablets twice daily. 2) The agency medication list identified Prednisone 10 mg oral tablet daily. Patient/caregiver reported patient does not take this medication and does not have it available in the home. The DRR failed to include an accurate review of all medications taken by the patient. The above findings were reviewed with the Administrator.

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 home observation visits, patient interviews and clinical record reviews, the agency failed to ensure accurate completion of all components comprising the Plan of Care, including all medical supplies/equipment used by the patient for 5 of 7 sampled patients (Patients #2, #3, #4, #6 and #7). Failure to maintain complete and accurate Plans of Care placed patients at risk to not receive services, supplies, medications and/or treatments according to assessed needs and physician orders. Findings include: 1.Patient #2 had a start of care date of 1/26/26. Clinical record review revealed: a. The Plan of Care (POC), dated 1/26/26 to 3/26/26, identified the patient had a primary diagnosis of chronic obstructive pulmonary disease (COPD) 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: cane, grab bars, respiratory equipment, tub/shower bench, walker, medication planner, nebulizer, bath mat and hand held shower. b. During a home observation visit on 2/9/26 at 11:50 AM with Staff B, Registered Nurse (RN), the surveyor identified a heating pad on the couch. The patient stated during the same home visit he/she uses the heating pad for pain relief. The agency failed to include all medical supplies/equipment on the patient's POC, including the heating pad. 2. Patient #3 had a start of care date of 11/11/25. Clinical record review revealed: a. The POC, dated 1/10/26 to 3/10/26, identified the patient had a primary diagnosis of cellulitis of the face 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: bedside commode, dressing supplies, elevated toilet seat, grab bars, tub/shower bench, walker, wheelchair, wound supplies, lift stand, medication planner, lift chair and support hose. b. The resumption of care comprehensive assessment, dated 2/2/26, completed by Staff B, RN, identified the patient utilizes incontinence products. c. During a home observation visit on 2/10/26 at 10:50 AM with Staff B, RN, the patient's caregiver identified the patient wears incontinence products. The agency failed to include all medical supplies/equipment on the patient's POC, including incontinence products. 3. Patient #4 had a start of care date of 1/16/26. Clinical record review revealed: a. The POC, dated 1/16/26 to 2/14/26, identified the patient had a primary diagnosis of sepsis and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: grab bars, tub/shower bench, walker, wheelchair, medication planner, bath mat, lift chair and grabber. b. The start of care comprehensive assessment, dated 1/16/26, completed by Staff B, RN, identified the patient utilizes incontinence products. The agency failed to include all medical supplies/equipment on the patient's POC, including incontinence products. 4. Patient #6 had a start of care date of 9/8/25 and a discharge date of 10/6/25. Clinical record review revealed: a. The POC, dated 9/8/25 to 11/6/25, identified the patient had a primary diagnosis of encounter for surgical aftercare following surgery on the central nervous system and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: cane, grab bars, tub/shower bench, walker, wound supplies, medication planners, hand held shower and outdoor ramp. b. The start of care comprehensive assessment, dated 9/8/25, completed by Staff B, RN, identified the patient utilizes a spirometer and incontinence products. The agency failed to include all medical supplies/equipment on the patient's POC, including spirometer and incontinence products. 5. Patient #7 had a start of care date of 7/2/25 and a discharge date of 8/1/25. Clinical record review revealed: a. The POC, dated 7/2/25 to 8/30/25, identified the patient had a primary diagnosis of malignant neoplasm of head of pancreas and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: cane, grab bars, tub/shower bench, walker, medication planner, and glucometer and supplies. b. The physical therapy evaluation, dated 7/3/25, completed by Staff D, Physical Therapist, identified the patient wears compression stockings to reduce edema and also identified the patient has a ramp entrance into the home. The agency failed to include all medical supplies/equipment on the patient's POC, including compression stockings and ramp. The above findings were reviewed with the Administrator.

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 2 sampled patients receiving home health aide services (Patient #3). 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 Instructions & Notes, dated 3/4/22, home health aide tasks and instructions are developed at the time of admission by the admitting registered nurse (RN) and the tasks are updated by the RN as needed. During an interview on 2/11/26 at 10:03 AM, Staff A, Administrator, stated the admitting RN is responsible for completing the home health aide care plan. The home health aide care plan is reviewed at recertifications, resumptions of care and as needed. Patient #3 had a start of care date of 11/11/25. Clinical record review revealed: a. The Plan of Care (POC), dated 11/11/25 to 1/9/26, identified the patient had diagnoses of Sepsis due to Escherichia coli and included physician orders for skilled nurse and home health aide services. b. The aide care plan, dated 11/11/25, included aide instructions to transfer the patient. The assignment failed to include specific instructions on what assistive devices were needed to transfer the patient. The home health RN failed to include specific instructions to the aide on what assistive devices were needed to transfer the patient. The above findings were reviewed with the Administrator.

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 1 of 2 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patient #3). The agency reported 1 patient who received home health aide services with every 14 days 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: According to the agency policy titled Home Health Aide Instructions & Notes, dated 3/4/22, home health aide supervision will be provided and documented every 14 days while the patient receives skilled nursing services. During an interview on 2/11/26 at 10:03 AM, Staff A, Administrator, stated aide supervision is required every 14 days for patients receiving skilled services and aide supervision is documented within the registered nurse's visit note in the electronic medical record. Patient #3 had a start of care date of 11/11/25. Clinical record review revealed: a. The Plan of Care (POC), dated 11/11/25 to 1/9/26, identified the patient had a primary diagnosis of Sepsis due to Escherichia coli and included physician orders for skilled nurse and home health aide services. b. Skilled nurse visits notes, dated 11/14/25, 11/17/25, 11/24/25, 12/2/25 and 12/11/25, completed by Staff B, Registered Nurse (RN), failed to document home health aide supervision. The agency failed to provide home health aide supervision every 14 days. The above findings were reviewed with the Administrator.

The Department of Inspections and Appeals conducted a recertification survey, dated 2/20/23 to 2/23/23, 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 from 2/20/2023 through 2/23/2023. The recertification survey found the agency operating out of compliance with the following standard level regulatory requirements. The agency reported a current census of 32 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, home visit observation, patient and agency staff interview, the agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all equipment used by the patient to meet their needs and an accurate list of the patient's current medications for 1 of 3 sampled patients with home observation visits (Patient #4). Failure to maintain complete and accurate Plans of Care with current orders placed the patients at risk to not receive services, medications and/or treatments according to assessed needs and physician orders. Patient #4 had a start of care date of 1/18/23. Clinical record review revealed the Plan of Care, dated 1/18/23 to 3/18/23, included cane, elevated toilet seat, grab bars, tub/shower bench, walker, medication planner, smoke alarm, blood pressure cuff, stethoscope, thermometer and hand held shower as medical equipment used by the patient. The medications on the plan of care included atorvastatin, baclofen, ferrous gluconate, gabapentin, glipizide extended release, super vitamin B12, Januvia, Lasix, lisinopril, Lumigan, metformin, miralax, naproxen, pantoprazole sodium, ropinirole, sertraline, and timolol-dorzolamid-latanoprost eye drops as medications used by the patient. During a home observation visit, on 2/21/23 at 11:05 AM, with Staff C, Physical therapy assistant, the surveyor observed a reacher on the table next to the recliner in the living room. The patient reported using the reacher for a couple of years. Staff C reported the patient utilized a wheelchair for mobility around the house until last week when they started to use the walker to get around the house. The surveyor reviewed the patient’s medications sitting on the kitchen table. The container included a bubble pack of bisacodyl 5 milligrams tablets, 5 of the 15 tablets were missing. The patient reported using the bisacodyl tablets as needed for bowel issues and has taken a few over the past 2 months. The wheelchair and reacher failed to be included on the Plan of Care as equipment used by the patient. The bisacodyl failed to be included on the Plan of Care as medication used by the patient. The Plan of Care failed to identify accurate equipment and medication used by the patient. The above stated findings were reviewed with Staff A, Administrator, and Staff B, Registered Nurse. The agency provided no additional 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 and agency staff interview, the agency failed to obtain physician orders for the addition of services provided to the patient by the home health agency for 2 of 7 sampled patients (Patient's #2 and #3). Failure to ensure staff obtain physician orders for administration of medications and/or treatments provided by agency staff placed agency patients at risk for inconsistent care/treatment and possible harm. Findings include: 1.Patient #2 had a start of care date of 8/29/21. Clinical record review revealed: a. Plan of Care, dated 12/22/22 to 2/19/23, included orders for skilled nursing services 1 time a week for 9 weeks. b. An update to the comprehensive assessment completed for resumption of care, dated 1/10/23, was marked as completed on 1/12/23. The clinical record lacked documentation of a resumption of care physician order that included an order frequency for skilled nursing services. During an interview on 2/23/23 at 8:30 AM, the Administrator reported agency process is for a resumption of care order to be completed and included on an updated plan of care. 2. Patient #3 had a start of care date of 1/31/23. Clinical record review revealed: a. Plan of Care, dated 1/31/23 to 3/1/23, included orders for physical therapy services 2 times a week for 8 weeks. b. Comprehensive assessment completed at start of care, dated 1/31/23, was marked as completed on 2/2/23 by skilled nurse. The plan of care failed to include physician orders for skilled nursing to complete the start of care comprehensive assessment. During an interview on 2/23/23 at 8:35 AM, the Administrator reported the agency practice is to have the skilled nurse complete the comprehensive assessments for therapy only cases. The agency does not include skilled nursing services as a frequency on the plan of care. The above stated findings were reviewed with Staff A, Administrator, and Staff B, Registered Nurse. The agency provided no additional information prior to the end of the survey.