Every finding on record at Orange City Area Health System

A Recertification Survey was conducted by the Iowa Department of Inspections, Appeals & Licensing from 1/15/26 through 1/21/26 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 1/15/26 through 1/21/26. 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 38 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 a home observation visit, patient interview, clinical record reviews and agency policy review, the agency failed to ensure accurate completion of all components comprising the Plan of Care, including all medical supplies/equipment and all medications and treatments used by the patient for 3 of 7 sampled patients (Patients #1, #3 and #7). Failure to maintain complete and accurate Plans of Care with current orders placed patients at risk to not receive services, supplies, medications and/or treatments according to assessed needs and physician orders. Findings include: According to the agency policy titled Home Health Plan of Care, last revised February 2025, the plan of care must include but is not limited to all pertinent diagnoses, types of services, supplies and equipment required and all medications and treatments. The plan of care will be reviewed and updated as the patient's condition warrants, but no less frequently than every 60 days. 1.Patient #1 had a start of care date of 7/3/24. Clinical record review revealed: a. The Plan of Care (POC), dated 12/25/25 to 2/22/26, identified the patient had a primary diagnosis of Parkinson's disease and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: bath bench/chair, cane, grab bars, incontinence supplies, lift chair, mediset, raised toilet seat, walker, life alert, hand held shower and heating pad. b. During a home observation visit on 1/15/26 at 11:00 AM with Staff C, Registered Nurse (RN), the surveyor identified a pill cutter with the patient's medications. The patient's spouse stated he/she utilizes the pill cutter to cut one of the patient's bedtime medications. The agency failed to include all medical supplies/equipment on the patient's POC, including a pill cutter. 2. Patient #3 had a start of care date of 1/14/26. Clinical record review revealed: a. The POC, dated 1/14/26 to 3/14/26, identified the patient had a primary diagnosis of unspecified fracture of right femur. The POC included the following medications and treatments used by the patient: acetaminophen, apixaban, atorvastatin, bisacodyl, calcium citrate + D3, cran-max, docusate sodium, glipizide, hyrdochlorothiazide, lisinopril, magnesium, melatonin, metformin, metoprolol tartrate, omeprazole, pioglitazone, miralax and prenatal vitamin with folic acid. b. During a home observation visit on 1/20/26 at 1:00 PM with Staff F, Physical Therapist (PT), the surveyor observed a bottle of artificial tears sitting next to the patient's chair. The patient stated during the same home visit he/she places one drop in each eye one to two times per day and has done so since start of care. The agency failed to include all medications/treatments on the POC, including the artificial tears. 3. Patient #7 had a start of care date of 4/29/25 and a discharge date of 7/11/25. Clinical record review revealed: a. The POC, dated 4/29/25 to 6/27/25, identified the patient had a primary diagnosis of chronic obstructive pulmonary disease. The POC included the following medical supplies and equipment used by the patient: bath bench, grab bars, hand held shower, incentive spirometer, incontinence supplies, linen savers, oxygen concentrator, oxygen supplies, wound supplies, walker, pulse oximeter, nebulizer, aerobika (breathing device) and waffle boots. b. The start of care comprehensive assessment, dated 4/29/25, completed by Staff G, RN identified the patient uses a medication planner. The agency failed to include all medical supplies/equipment on the patient's POC, including medication planner. 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 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 #1). 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 Assignment of Duties for Home Health Aides, last revised February 2024, home health aides are assigned to a patient by the Registered Nurse (RN) who determines the home health aide schedule based on the patient's individual needs. Aide assignments reflect the plan of care ordered by the patient's physician. During an interview on 1/20/26 at 11:44 AM, Staff B, Clinical Manager, stated the RN that initiates the aide services develops the aide care plan. The care plan is reviewed with each supervisory visit. Patient #1 had a start of care date of 7/3/24. Clinical record review revealed: a. The Plan of Care (POC), dated 12/25/25 to 2/22/26, identified the patient had a primary diagnosis of Parkinson's disease and included physician orders for skilled nurse and home health aide services. b. The aide care plan, last reviewed 1/13/26, included aide instructions to assist with exercises as directed by physical therapist. The assignment did not include specific instructions on what exercises the aide should assist with. The home health RN failed to include what specific exercises the aide should assist the patient with. The above findings were reviewed with the Administrator and Clinical Manager.

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 #5). The agency reported 9 patients who received home health aide services with every 14 day 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 Supervision, last revised June 2024, when home health aide services are provided to a patient receiving skilled care, a registered nurse or other appropriate skilled professional familiar with the patient, the patient's plan of care and written care plan instructions must make an onsite visit to the patient's home no less frequently than every 14 days for a supervisory visit. During an interview on 1/20/26 at 11:44 AM, Staff B, Clinical Manager, stated aide supervision is required at a minimum of every 14 days for patients receiving skilled services. Patient #5 had a start of care date of 11/16/23. Clinical record review revealed: a. The Plan of Care (POC), dated 11/5/25 to 1/3/26, identified the patient had a primary diagnosis of atherosclerotic heart disease and included physician orders for skilled nurse and home health aide services. b. The skilled nurse visit note, dated 11/13/25, Staff E, Registered Nurse (RN), included documentation of home health aide supervision. c. The skilled nurse visit note, dated 11/28/25, Staff H, RN, included documentation of home health aide supervision (1 day late). d. The skilled nurse visit note, dated 12/11/25, Staff H, RN, included documentation of home health aide supervision. e. The skilled nurse visit note, dated 12/26/25, Staff H, RN, included documentation of home health aide supervision (1 day late). The agency failed to provide home health aide supervision every 14 days. The above findings were reviewed with the Administrator and Clinical Manager.

The Department of Inspections and Appeals conducted a recertification survey, dated 1/30/23 to 2/2/23, 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 for the home health agency, dated 1/30/23 to 2/2/23. The survey identified the following standard level deficient practices. The agency reported a census of 60 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 agency policy review, clinical record review, home visit observation and patient and staff interviews, the agency failed to ensure the accurate completion of all components compromising the Plan of Care, including all supplies/equipment and medications used by the patient for 1 of 3 sampled patients with surveyor home visit observation (Patients #2). 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 physicians orders. Findings include: According to the agency policy, titled Patient Plan of Care, dated, 9/19, the plan of treatment must include all medications and treatments. Patient #3 had a start of care date of 9/20/21. Clinical record review, home visit observation and accompanying interviews revealed the following: a. The Plan of Care, dated 1/5/23 to 3/5/23, included the following durable medical equipment (DME): cane, bath chair, hand held shower, mediset, grab bars, reacher, incontinence supplies and braces. During a home visit observation on 1/31/23 at 1:10 PM, with Staff E, Registered Nurse (RN), the patient reported they also utilized a lifeline bracelet and necklace. During the same home visit the patient stated they had the lifeline equipment for greater than a year. During the same home visit, Staff E, RN stated the patient had the lifeline since shortly after the start of care for home health services. The plan of care failed to include the patient's lifeline bracelet and necklace. b. The plan of care included the following medications: Vitamin C 100 mg (milligrams) daily. Staff E, RN set up the patient's medications into a 1 week mediset. Staff E, RN filled the Vitamin C and completed the task. The surveyor asked about the dosage of the Vitamin C. She identified she filled the mediset with 250 mg tablets and not the 100 mg tablet ordered. The bottle had a total of 110 doses and identified approximately 1/2 empty. The plan of care failed to include the correct dosage of Vitamin C taken by the patient. The Patient Care Coordinator and Education Coordinator 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 home visit observation, the agency failed to ensure agency staff provided wound care treatments only as ordered by the physician for 2 of 2 sampled patients (Patient #1 and #6) with wounds. Failure to ensure staff obtain/follow physician orders for wound care treatments placed agency patients at risk for inconsistent care/treatment and possible harm. Findings include: Review of the agency policy, titled Care Planning and Care Coordination, dated 3/30/22, identified the Plan of Care (POC) should be patient-specific and include treatments. According to the agency policy, titled Wound Care, dated 4/22, wound documentation will include assessment of wound characteristics including but not limited to; color, size, drainage and wound bed appearance if wound is open. The size of the wound will be measured on a weekly basis however nursing clinical judgment may necessitate assessment of size more frequently should the wound deteriorate or improve significantly. During an interview on 2/2/23 at 9:30 AM the Patient Care Coordinator stated patient wounds are to be measured on a weekly basis and more often if ordered by the physician. The measurements should include wound length, width and depth. 1. Patient #1 had a start of care date of 10/15/21. Review of the clinical record revealed the following: a. The plan of care (POC), dated 12/14/22 to 2/11/23, included orders for the skilled nurse to perform wound care to the left lower leg wounds 2 times per week by cleansing the wounds with hibiclens, wash with sterile water and pat dry with 4 by 4 cleanse with microsyn to dry. Paint leg with betadine and allow to dry, apply 4 by 4 gauze folded in half and secure with tape, apply eucerin cream to left lower leg twice a week. The POC also included the order to measure the wound with each visit. b. The skilled nurse visit dated 1/24/23 included documentation the skilled nurse completed wound care for the patient's left lower leg. The note failed to include documentation of measurements of the patient's wound. Agency staff failed to measure the patient's wound each visit per physician's order. 2. Patient #6 had a start of care date of 10/3/22. Review of the clinical record revealed the following: a. The POC, dated 10/3/22 to 12/1/22, included orders for the skilled nurse to perform wound care to the left 4th distal toe wound 2 times per week by cleansing the wound with water/hibiclens, wash with water. Cleanse with microcyn and pat dry. Apply skin prep to peri-ulcer skin, let dry. Apply Mepilex dressing and secure with paper tape. b. The skilled nurse visit, dated 10/17/22, included documentation the skilled nurse completed wound care for the patient's left 4th distal toe. The note failed to include documentation of measurements of the patient's wound. Agency staff failed to measure the patient's wound each week. The Patient Care Coordinator and Education Coordinator received the above findings and agency staff provided no further information prior to the end of the survey.