Every finding on record at Johnson County Hospital

Johnson Co. Hospital Home Health Services is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

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 record review, policy and procedure review, and staff interview, the agency failed to conduct an onsite supervisory assessment of the home health aide services every 14 days for 1 of 1 patients (Patient 5) reviewed who received skilled nursing and home health aide services. The total sample size was 7. The census was 22. Findings are: A. Review of the agency policy and procedure titled HH 3.5 Home Health Aide, effective 8/1/25 revealed: 1. The agency employs certified nursing assistants (CNAs) to provide home health aide services to patients receiving skilled home health care. 2. CNAs (HHAs) are supervised by a registered nurse (RN) or licensed therapist. 3. Ongoing supervisory visits are conducted at least every 14 days. 4. Supervisory visits are to be documented in the clinical record. B. Review of Patient 5's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 9/21/25 through 11/19/25 included orders for skilled nursing services. 2. The Home Health Certification and Plan of Care for the certification period of 11/20/25 through 1/18/26 included orders for skilled nursing services and home health aide services (HHA) 1 time per week for 2 weeks, then 2 times a week for 7 weeks to assist with showering and activities of daily living (ADLs). 3. A Physician Order dated 9/22/25, for HHA 2 times a week for 8 weeks, then 1 time a week for 1 week. 4. During the record review timeframe of 10/12/25 through 12/13/25, HHA supervisory visits by the RN were conducted on 10/13/25, 10/30/25, 11/18/25 and 12/5/25 (18 days, 18 days, and 17 days between supervisory visits respectively). C. During an interview on 12/15/25 at 3:40 PM, the Director of Home Health confirmed onsite supervisory assessments of home health aide services for Patient 5, by the RN were not conducted every 14 days per agency policy and regulatory requirements.