Every finding on record at Mary Greeley Medical Center

A Recertification Survey was conducted by the Department of Inspections and Appeals from 12/6/23 through 12/12/23 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 and Appeals conducted a Recertification Survey from 12/6/23 through 12/12/23. The recertification survey identified the home health agency was operating out of compliance with the following standard level home health regulations. The agency identified a census of 97 current patients.

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 agency policy review, clinical record review and agency staff interview, the agency failed to complete a drug regimen review with all of the required components and patient specific for each patient for 4 of 7 sampled patients requiring drug regime reviews (Patients #3, #4, #5 and #6 ). Failure to ensure medications reviewed at the time of each drug regimen review are current and accurate and failure to identify actual/ potential concerns increased the potential for unidentified medication interactions and side effect risks to the patient at the time of each comprehensive assessment. 3. Patient #3 had an admission date of 11/29/23. Review of the clinical record revealed the following: a. The POC, dated 11/29/23 to 1/27/24, included orders for skilled nursing services and orders for medications. The medication orders included medications with potential adverse interactions which included sildenafil and verapamil. b. The comprehensive assessment completed by the RN, dated 11/29/23, included the following documentation related to the DRR: "all interactions called to the physician." The document failed to include which medications identified with potential adverse reactions. The agency staff failed to identify individual patient outcomes of the DRR including potential adverse interactions. 4. Patient #5 had an admission date of 9/11/23. Review of the clinical record revealed the following: a. The POC, dated 9/11/23 to 11/9/23 and 11/10/23 to 1/8/24, included orders for skilled nursing services and orders for medications. The medication orders included potential adverse interactions which included bupropion (antidepressant) and ondansetron (treats nausea). b. The comprehensive assessment completed by the RN, dated 9/11/23, included the following documentation related to the DRR: "all interactions called to the physician." The document failed to include which medications identified with potential adverse reactions. The agency staff failed to identify individual patient outcomes of the DRR including potential adverse interactions. The above findings were reported to the Administrator, Clinical Manager, Staff C, Certified Nurse Assistant (CNA), and Staff D, Registered Nurse (RN) prior to the end of the survey. No additional information was provided. According to the agency policy titled Comprehensive Drug Regimen Review, dated 9/2023, the clinician will review and assess all of the patient's medications (both prescription and non-prescription) and the effect those medications have on the patient. The drug therapy review includes, but not limited to, identification of the following: effectiveness of drug therapy, significant side effects, significant drug interactions, duplicate drug therapy and patient non-compliance. During an interview on 12/11/23 at 2:15 PM the Clinical Manager stated staff go through each patient's medication and ensure they are on the medication list. Staff review whether or not the patient had taken the medication in the last 30 days and confirm any discrepancies with the pharmacy. 1. Patient #4 had an admission date of 10/12/23. Review of the clinical record revealed the following: a. The POC, dated 10/12/23 to 12/11/23, included orders for skilled nursing services and orders for medications. The medication orders included medications with potential adverse interactions which included zolpidem (sleep aide) and metoprolol tartrate (high blood pressure). b. The comprehensive assessment completed by the RN, dated 10/12/23, included the following documentation related to the DRR: "all interactions called to the physician." The document failed to include which medications identified with potential adverse reactions. The agency staff failed to identify individual patient outcomes of the DRR including potential adverse interactions. 2. Patient #6 had an admission date of 11/23/21 and date of death of 12/26/21. Review of the clinic al record revealed the following: a. The POC, dated 11/23/21 to 1/21/21, included orders for skilled nursing services and orders for medications. The medication orders included with potential adverse interactions which included Fentanyl, Oxycodone and Hydromorphone (narcotic analgesics). b. The comprehensive assessment completed by the RN, dated 10/12/23, included the following documentation related to the DRR: "all interactions called to the physician." The document failed to include which medications identified with potential adverse reactions. The agency staff failed to identify individual patient outcomes of the DRR including potential adverse interactions.

Documentation of competency evaluation CFR(s): 484.80(c)(5) The HHA must maintain documentation which demonstrates that the requirements of this standard have been met. This ELEMENT is not met as evidenced by: Based on clinical record review, personnel file review, review of agency policy, and staff interview, the home health agency failed to document how additional skills beyond the basic skills were taught and tested for 3 out of 7 sampled home health aides (Staff E, F, and G). Failure to ensure home health aides were competent in any assigned extra skills which exceed the level of basic home health aide skills placed agency patients at risk to receive inadequate or unsafe home health aide services. Findings include: The Medicare Conditions of Participation require home health agencies to determine competence of home health aides in those skills which exceed the 13 basic home health aide skills areas prior to assigning the home health aide to a patient who would require the task to be performed. According to the agency policy titled “Skilled Case Manager Education Related to Home Care Aide Core Competencies”, revised on 7/2023, you must obtain a skill checklist template from the home care of office above the home health aide desk in a 3 ring binder labeled Health Aide Skills Competencies, fill it out, teach the home care aide (HCA), have the HCA demonstrate the skill, complete the checklist, have the HCA and Case Manager sign and return to Health Care Aide Manager. It will also be important to record this in your client’s documentation. On 12/12/23 at 3:35 P.M., interview with Staff C, home care aide supervisor, confirmed that agency failed to provide appropriate documentation of the competency that exceeded the basic skill set for staff E, F, and G. 1.Patient #4 had a start of care date of 10/12/23. a. The plan of care (POC) dated 10/12/23 to 12/12/23 included orders for home health aide services. Effective 11/1/23, the interventions/tasks assigned to the home care aide was: Assist with shaving, shave patient using electric razor on face; frequency is each visit. b. Review of personnel records for Staff E, home health aide, with a hire date of 8/19/19, revealed she did not have a competency training for the skill of shaving. The agency failed to provide competency training for skills that exceeded basic skills that included shaving. 2. Patient #5 had a start of care date of 9/11/23. a.The original plan of care (POC) and the current POC dated 11/10/23 to 1/8/24 included orders for home health aide services. Effective 9/11/23, one the interventions/tasks assigned to the home care aide was: Assist with shaving, shave patient using electric razor on face; frequency is each visit. b. Review of personnel records for Staff F, home health aide, with a hire date of 2/19/18, revealed she did not have a competency training for the skill of shaving. c. Review of personnel records for Staff G, home health aide, with a hire date of 12/7/15, revealed she did not have a competency training for the skill of shaving. The agency failed to provide competency training for skills that exceeded basic skills that included shaving. The above findings were reviewed with Director, the Assistant Director, Staff C, Home Care Aide Supervisor, Staff D, RN. No further information was provided 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 agency policy review, clinical record review and staff interview, the agency failed to ensure Home Health Aides (HHA) a change in patient condition for 1 of 5 sampled patients receiving HHA services (Patient #5). Failure to ensure that changes in patient condition observed by the HHA are provided to the patient’s nurse increased the risk that patients' personal care needs were not adequately met. Findings including: According to the agency policy, Home Health Aide Training Policy, with a revised date of May 2023, revealed in pertinent part, a training topic offered to HHAs was how to monitor, evaluate, and report patient condition. In an interview on 12/12/23 at 12:55 PM, Staff C, Certified Nurse Assistant (CNA) and HHA Supervisor agreed that the lack of medical supply available observed by the HHA needed reporting to the patient’s nurse and that she was not able to find communication between the HHA and nurse in the patient’s clinical record. Patient #5 had a start of care date of 9/11/23. The Plan of Care (POC), dated 9/11/23 to 11/9/23 and 11/10/23 to 1/8/24, included physician orders for weekly skilled nursing services and HHA services 3 times per week. Clinical record review revealed a HHA care plan that directed the HHA to place a sheet of wicking material in the abdominal fold after each shower. Clinical record revealed the HHA documented there was no wicking material available in the patient’s home: 1. 10/30/23 2. 11/1/23 3. 11/3/23 4. 11/8/23 5. 11/17/23 6. 11/20/23 7. 11/22/23 The Clinical Record lacked documentation that the HHA reported the lack of wicking material to a nurse. The above findings were reviewed with the Administrator, Clinical Manager, Staff C, Certified Nurse Assistant (CNA), and Staff D, Registered Nurse (RN) prior to the end of the survey. No additional information was provided.