Every finding on record at Home Health & Hospice of Dickinson County

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey (iQIES 65CCD-H1) at the above -named Home Health Agency (HHA) on 04/08/25 to 04/10/25 resulted in compliance with the Emergency Preparedness Program Condition of Participation (CoP) under 42 CFR 484.102.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site (Recertification) survey (iQIES 65CCD-H1) conducted at the above-named Home Health Agency (HHA) from 04/08/25 to 04/10/25 resulted in a findings of substantial compliance respective to applicable Condition of Participation (CoP) under 42 CFR 484, Subpart C through E with the following standard level deficiencies cited.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on observation, record review, and staff interview, the home health agency (HHA) failed to provide the patient and caregiver a copy of written medication administration instructions in a language that they can understand in 6 of 7 Patients (Patients 1 - 6). The home health agency's failure to ensure the patients received written instruction regarding medication administration placed all patients, currently on service, at risk for adverse medication outcomes, and unmet needs. Findings Include: Patient 1 Review of Patient 1's plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that most of the patient medications were written to be administered "PO" (by mouth) and should have been listed as oral or by mouth. Patient 2 Review of Patient 2's plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that most of the patient medications were written to administered "PO" and "PRN" (as needed) and should have been listed as oral or by mouth and as needed instead of "PRN". Patient 3 Review of Patient 3's plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that several of the patient medications were written to be administered "PO" and should have been listed as oral or by mouth. Patient 4 Review of Patient 4's plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that several of the patient medications were written to be administered "PO" and should have been listed as oral or by mouth. Patient 5 Review of Patient 5's plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that several of the patient medications were written to be administered "PO" and should have been listed as oral or by mouth. Patient 6 Review of Patient 6's plan of care indicated that the patient was taking multiple mediations. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that most of the patient medications were written to administered "PO" and "PRN" and should have been listed as oral or by mouth and as needed instead of "PRN". During an interview on 04/09/25 at 2:15 PM, Staff A, agency Administrator stated that the medication list should be written using words that the patients can understand. She also confirmed the above findings of the agency not providing the medication list in a language the patients could understand.

Report all branch locations to SA CFR(s): 484.105(d)(1) The parent HHA is responsible for reporting all branch locations of the HHA to the state survey agency at the time of the HHA's request for initial certification, at each survey, and at the time the parent proposes to add or delete a branch. This ELEMENT is not met as evidenced by: Based on document review, and staff interview, the above-named Home Health Agency failed to report all agency branch locations to the state survey agency (KDHE) when adding a location and prior to current survey. This deficient practice had the potential to place patients at risk of adverse outcomes and potential patient safety risk due to possible risk of not being surveyed by the state agency. Findings Include: Review of agency information and paperwork given to patients at admission to services by the agency revealed a separate location other than the agency's parent location address. The start of care information packet provided for review show an address in Herington, KS as a "Charting Station". This location had its own telephone number and after hours on call number, and both were different from the parent agency's numbers. During an interview on 04/08/25 at 10:00 AM, Staff A, agency Administrator, explained that this location also had its own supervisor. She also stated that the location takes its own patient referrals and makes their own assignments. She explained that as the Administrator she does call in for a team meeting with them daily. The Administrator stated that the agency had always had this other location. Review of the agency information in iQIES revealed that this branch location was reported as closed in 2014.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review, and staff interview, the home health agency (HHA) failed to ensure the clinical record included all interventions, including medication administration, treatments, and services provided for 4 of 7 sample records reviewed (Patients 3 - 6). The home health agency's failure to ensure the clinical records included documentation of all treatments and services provided placed all patient currently on service at risk for adverse outcomes and unmet care needs. Findings Include: Patient 3 Review of Patient 3's plan of care for episode dates 03/14/25 through 05/02/25 showed orders for Skilled Nursing to perform wound care to patient's left lower extremity as follows: cleanse with wound cleanser, apply aquacel silver, cover with telfa and tape on Monday, Wednesday, and Friday. Review of the Skilled Nursing visits for the episode dates showed that the visits were made on Monday, Wednesday, and Friday. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was "provided as ordered". Also, there was no documented patient response to the wound care treatments. Patient 4 Review of Patient 4's plan of care for episode dates 02/28/25 through 04/28/25 showed orders for Skilled Nursing or caregiver to perform wound care to abdomen as follows: cleanse with wound cleanser, cover with hydrofera blue, and absorbent dressing, change Monday, Wednesday, Friday. Review of the Skilled Nursing visits for the episode dates showed that the Skilled Nurse made visits on Mondays throughout the episode. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was "provided as ordered". Also, there was no documented patient response to the wound care treatments. Patient 5 Review of Patient 5's plan of care for episode dates 02/12/25 through 04/12/25 showed orders for wound care to the right buttock to be provided as follows: cleanse wound with wound cleanser, apply silver alginate to wound bed, cover with meplex. Skilled Nurse to complete one time per week and patient's daughter to change two times weekly and when saturated or soiled. Review of the Skilled Nursing visits for the episode dates showed that the Skilled Nurse made visits one time per week throughout the episode. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was "provided as ordered". Also, there was no documented patient response to the wound care treatments. Patient 6 Review of Patient 6's plan of care for episode dates 08/22/24 through 10/12/24 showed orders for Skilled Nurse to provide wound care to right foot, 4th toe as follows: clean with wound wash, pat dry, apply aqucel AG, cover with a foam dressing 2-3 times per week. Review of the Skilled Nursing visits for the episode dates showed that the Skilled Nurse made visits one tie per week throughout the episode. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was "provided as ordered". Also, there was no documented patient response to the wound care treatments. During an interview on 04/09/25 at 3:15 PM, Staff A, Administrator confirmed that the Skilled Nurses had not documented the exact treatments being provided nor the patient's response to the wound care provided.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on record review, and staff interview, the Home Health agency failed to ensure all documentation entries were authenticated with an occupational title of the author of the visit notes for 7 of 7 sample patient records. This deficient practice had the potential to affect patient safety and to place the patients at risk for adverse outcomes. Findings Include: Review of Patient records 1 through 7 revealed several Skilled Visit Note by various clinicians for each patient that lacked an occupational title after the stamped electronic signature at the bottom of each page of the note. The clinical notes had a statement at the bottom of each page which stated, "signed by:" and the name of the clinician but lacked an occupational title on any page. During an interview on 04/10/25 at 9:00 AM, Staff A, Administrator stated that she was unaware as to why the clinician's title was not showing up with their signature.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey ASPEN #0FIT11 at the above-named Home Health Agency (HHA) from 10/12/21 to 10/14/21 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 #0FIT11 conducted at the above-named Home Health Agency (HHA) from 10/12/2021 to 10/14/2021 resulted in a finding of substantial compliance respective to applicable Condition of Participation (CoP) under 42 CFR 484, Subpart A through C with the following standard-level deficiencies cited. Unduplicated census: 75 Sample Size: 7

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 interview, record reviews, and policy review, the Home Health agency failed to conduct a medication regimen review (a review of all patient medications done to avoid medication errors such as duplications or drug interactions) for two of two patients (Patients 4 and 5) when new medications were added to Patient 4's and 5's Plans of Care (POCs - a comprehensive plan that includes medications and interventions that guides the staff in providing patient care) after the patients' admissions to the agency. These failures had the potential for the patients to experience negative side effects from drug interactions. Findings Include: Review of agency policy titled, "Medication Reconciliation," dated 2020, showed that medications ordered while a patient was receiving agency services would be compared to the patient's current medication regimen. 1. Review of Patient 4's clinical record, "Home Health Certification and Plan of Care (POC)," dated 10/01/21, showed that Patient 4 was admitted to the agency on 10/01/21, with diagnoses that included peripheral artery disease (narrowing of arteries which results in reduced blood flow to head, arms, stomach and legs and pain) and pressure ulcers on the left and right buttocks (bedsores). Review of Patient 4's clinical record, "Chart/Clinical Notes," dated 10/13/21, showed that on 10/08/21, Patient 4 was prescribed Cipro (an antibiotic used to treat infections) 500 milligram (mg) to treat wounds on Patient 4's foot. Review of Patient 4's clinical record did not show that a medication regimen review had been completed after the Cipro had been added to Patient 4's medication regimen. 2. Review of Patient 5's clinical record, "POC," dated 09/05/21, showed that Patient 5 was admitted to the agency on 09/05/21, with diagnoses that included hypertensive chronic kidney disease (a condition characterized by a gradual loss of kidney function) and bladder cancer. Review of Patient 5's clinical record, an untitled fax document, dated 09/14/21, showed that on 09/14/21, Patient 5 was prescribed Zoloft (an antidepressant) 50 mg to treat depression. Review of Patient 5's clinical record, an untitled fax document, dated 09/15/21, showed that on 09/15/21, Patient 5 was prescribed Prednisone (a medication used to treat allergies) 50 mg to treat itching. Review of Patient 5's clinical record did not show that a medication regimen review had been completed after the Zoloft and the Prednisone had been added to Patient 5's medication regimen. During an interview on 10/13/21 at 2:45 PM, Staff A, Clinical Manager (CM), stated that staff were to complete a medication regimen review when a new medication was added to a patient's POC after the patient's admission date. Staff A confirmed that the agency could not provide evidence that medication regimen reviews had been completed after the Cipro had been added to Patient 4's POC and after the Zoloft and Prednisone had been added to Patient 5's POC. Staff A acknowledged that the agency had not followed policy.

Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This ELEMENT is not met as evidenced by: Based on interview, record reviews, and policy reviews, the Home Health agency failed to complete a comprehensive assessment OASIS document (a document that identified the patient's need for home care and that meets the patient's medical, nursing, rehabilitative, social, and discharge planning needs) for one of two patients (Patient 7) when Patient 7 was transferred to a hospital while receiving agency services. This failure had the potential for patient to receive lower quality of care. Findings Include: Review of an agency policy titled, "Reassessments/Update of the Comprehensive Assessment," undated, showed that agency staff were to complete a comprehensive assessment including an OASIS document when a patient was transferred to an inpatient facility (hospital or other facility and requires at least one overnight stay). Review of Patient 7's clinical record, "Home Health Certification and Plan of Care (POC)," dated 02/19/21, showed that Patient 7 was admitted to the agency on 02/19/21, with diagnoses that included essential hypertension (high blood pressure) and congestive heart failure (CHF - a progressive heart disease that affects pumping action of the heart muscles, and that causes fatigue and shortness of breath.). Review of Patient 7's clinical record, "Occupational Therapy Evaluation/Reassessment," dated 03/02/21, showed that Patient 7 had been admitted to a hospital. Review of Patient 7's clinical record, did not show that a comprehensive assessment OASIS document had been completed after Patient 7's admission to a hospital. During an interview on 10/14/21 at 10:05 AM, Staff A, Clinical Manager (CM), stated that staff were to complete a comprehensive assessment OASIS document when patients were admitted to a hospital. Staff A confirmed that the agency could not provide evidence that a comprehensive assessment OASIS document had been completed when Patient 7 was admitted to a hospital. Staff A acknowledged that the agency had not followed policy.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on interview, record reviews, and policy reviews, the Home Health agency failed to provide the number of therapy visits ordered by the physician for two of four patients (Patients 1 and 4). These failures had the potential for the patients to not receive necessary therapies. Findings Include: Review of agency policy titled, "Plan of Care (Physician Orders)," dated 2020, showed that care and services were to be provided as ordered by the physician. 1. Review of Patient 1's clinical record, "Home Health Certification and Plan of Care (POC)," dated 09/03/21, showed that Patient 1 was admitted to the agency on 09/03/21, with diagnoses that included Alzheimer's disease (a condition characterized by a gradual loss of thinking and decision-making abilities) and repeated falls. Further review showed that Patient 1 was ordered a one-time physical therapy (PT) evaluation appointment and a one-time occupational therapy (OT) evaluation appointment. Review of Patient 1's clinical record, "Physical Therapy Evaluation/Reassessment," dated 09/03/21, showed that on 09/03/21, Patient 1 was prescribed one additional PT visit during Patient 1's first week of receiving agency services and two PT visits per week for the next three weeks. Review of Patient 1's clinical record did not show two PT visits completed during Patient 1's first week of receiving agency services. Review of Patient 1's clinical record, "Occupation Therapy Evaluation/Reassessment," dated 09/08/21, showed that on 09/08/21, Patient 1 was prescribed one additional OT visit during Patient 1's second week of receiving agency services and one OT visit for the next week. Review of Patient 1's clinical record did not show two OT visits completed during Patient 1's second week of receiving agency services. 2. Review of Patient 4's clinical record, "POC," dated 10/01/21, showed that Patient 4 was admitted to the agency on 10/01/21, with diagnoses that included peripheral artery disease (narrowing of arteries which results in reduced blood flow to head, arms, stomach, and legs and pain) and pressure ulcers on the left and right buttocks (bedsores). Review of Patient 4's clinical record, "Physical Therapy Evaluation/Reassessment," dated 10/04/21, showed that on 10/04/21, Patient 4 was prescribed an additional two PT visits during Patient 4's second week of receiving agency services and two PT visits for the following week. Review of Patient 4's clinical record did not show three PT visits completed during Patient 4's second week of receiving agency services. Review of Patient 4's clinical record, "Occupation Therapy Evaluation/Reassessment," dated 10/04/21, showed that on 10/04/21, Patient 4 was prescribed an additional two OT visits during Patient 4's second week of receiving agency services and two OT visits for the next two weeks. Review of Patient 4's clinical record did not show three OT visits completed during Patient 4's second week of receiving agency services. During an interview on 10/13/21 at 1:20 PM, Staff B, Physical Therapy Assistant (PTA), stated that the PT and OT evaluations were prescribed in the PT and OT visit orders documented on the therapy evaluation records and replaced the prescribed therapy evaluation orders on the patient's POCs. During an interview on 10/14/21 at 12:40 PM, Staff A, Clinical Manager (CM), confirmed that the agency was to provide services as ordered by a patient's physician. Staff A, CM could not provide evidence that Patient 1 received two PT and two OT visits in the first week of service as ordered by Patient 1's physician. Staff A could not provide evidence that Patient 4 received three PT visits and three OT visits in the second week of service as ordered by Patient 4's physician. Staff A could not provide evidence of any orders to discontinue any therapy visits ordered for Patients 1 and 4. Staff A acknowledged that the agency had not followed policy.