Every finding on record at Recover Health of Iowa, Inc

A complaint investigation, from 7/11/22 to 7/13/22, for complaint number 70811-C identified the following: The complaint related to 484.50 Patient Rights was unsubstantiated; The complaint related to 484.60 Care planning, Coordination, Quality of Care was substantiated; (See G572 and G580) The complaint related to 484.75 Skilled Professional Services was unsubstantiated; The complaint related to 484.105 Organization and Administration of Services was unsubstantiated; The survey investigation found the agency to have the following standard level deficiencies and be in substantial compliance with the above mentioned Conditions of Participation. The agency identified a census of 98 current patients.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on agency policy review, clinical record review and agency staff interviews, the agency failed to follow a Plan of Care established and periodically reviewed by a physician or notify the physician of the need to vary frequency of visits or inability to perform treatments/services as originally ordered on the Plan for Care for 2 of 7 sampled patients (Patients #2 and #5). Failure to follow a Plan of Care established by a physician placed patients at risk of not receiving safe, individualized and consistent care designed to meet each patient's health care needs. Findings include: According to the agency policy titled Missed Services, dated 6/14/16, when scheduled services, visits or shifts are not provided for any reason, the appropriate notification should be completed and sent to the physician or other appropriate entity in a timely manner. A copy of the notification is placed in the patient's record to reflect the alteration of the plan of care. 1. Patient #2 had a start of care date of 12/21/21. The patient received private duty nursing services and had a diagnosis of epilepsy. Clinical record review and associated agency staff interviews revealed the following: a. The Plans of Care, dated 4/20/22 to 6/18/22 and 6/19/22 to 8/17/22, included physician orders for skilled nursing services 7 to 10 hours per day for 4 to 7 days per week. b. Skilled nursing notes for the week of 5/8/22 through 5/14/22, included documentation of 4 days of skilled nursing services provided. Nursing service provided on the dates of 5/9/22, 5/10/22, 5/11/22, and 5/12/22. The notes identified the patient received only 5.25 hours of service on 5/9/22, 7 hours of service on 5/10/22, only 5 hours of service on 5/11/22 and only 5 hours of service on 5/12/22. The patient received the ordered service on 1 day (5/10/22) and lacked receiving the ordered number of hours (7 hours) per day the 3 additional days per week of skilled nursing services as ordered on the Plan of Care. The Missed Services and Physician Notification Report, dated 5/31/22, documented for the week of 5/8/22 through 5/15/22 the physician notified of 1 day, 5/13/22, missed skilled nursing services. The document lacked notification of the remaining 2 days when services provided failed to meet the 7 hour per day minimum requirements. b. Skilled nursing notes for the week of 5/15/22 through 5/21/22, included documentation of 4 days of skilled nursing services provided. Nursing service provided on the dates of 5/16/22, 5/17/22, 5/18/22, and 5/20/22. The notes identified the patient received only 5 hours of service on 5/16/22, only 3 hours of service on 5/17/22, only 3.5 hours of service on 5/18/22 and 8 hours of service on 5/20/22. The patient received the ordered service on 1 day (5/20/22) and lacked receiving the ordered number of hours (7 hours) per day the 3 additional days per week of skilled nursing services as ordered on the Plan of Care. The Missed Services and Physician Notification Report, dated 5/31/22, documented for the week of 5/15/22 through 5/21/22 the physician notified of 1 day, 5/19/22, missed skilled nursing services. The document lacked notification of the remaining 2 days when services provided failed to meet the 7 hour per day minimum requirements. d. Skilled nursing notes for the week of 5/22/22 to 5/28/22, included documentation of 2 days of skilled nursing services provided. Nursing service provided on the dates of 5/25/22 and 5/27/22. The notes identified the patient received only 4 hours of service on 5/16/22, only 2.5 hours of service on 5/27/22. The patient lacked receiving the ordered number of hours (7 hours) per day the 4 days per week of skilled nursing services as ordered on the Plan of Care. The Missed Services and Physician Notification Report, dated 5/31/22, documented for the week of 5/15/22 through 5/21/22 the physician notified of 3 days, 5/23/22, 5/24/22 and 5/26/22, of missed skilled nursing services. The document lacked notification of the remaining 1 day when services provided failed to meet the 7 hour per day minimum requirements. e. Skilled nursing notes for the week of 5/29/22 through 6/4/22, included documentation of 1 days of skilled nursing services provided. Nursing service provided on the date of 5/31/22. The notes identified the patient received only 3.25 hours of service on 5/31/22. The patient lacked receiving the ordered number of hours (7 hours) per day the 4 days per week of skilled nursing services as ordered on the Plan of Care. The Missed Services and Physician Notification Report, dated 7/6/22, documented for the week of 5/29/22 through 6/4/22 the physician notified of 3 days, 6/1/22, 6/2/22 and 6/3/22, missed skilled nursing services. The document lacked notification of the remaining 1 day when services provided failed to meet the 7 hour per day minimum requirements. f. Skilled nursing notes for the week of 6/12/22 through 6/18/22, included documentation of 4 days of skilled nursing services provided. Nursing services provided on the dates of 6/13/22, 6/14/22, 6/15/22, and 6/16/22. The notes identified the patient received only 3.75 hours of service on 6/13/22, only 4.25 hours of service on 6/14/22, only 6.5 hours of service on 6/15/22 and 5.5 hours of service on 6/16/22. The patient lacked receiving the ordered number of hours (7 hours) per day 3 additional days per week of skilled nursing services as ordered on the Plan of Care. The Missed Services and Physician Notification Report, dated 7/6/22, documented for the week of 6/12/22 through 6/18/22 the physician notified of 1 day, 6/17/22, missed skilled nursing services. The document lacked notification of the remaining 3 days when services provided failed to meet the 7 hour per day minimum requirements. g. Skilled nursing notes for the week of 6/19/22 through 6/24/22, included documentation of 5 days of skilled nursing services provided. Nursing service provided on the dates of 6/20/22, 6/21/22, 6/22/22, 6/23/22 and 6/24/22. The notes identified the patient received only 4 hours of service on 6/20/22, only 4 hours of service on 6/21/22, 8 hours of service on 6/22/22, only 3.5hours of service on 6/23/22 and only 3.5 hour of service on 6/24/22. The patient received the ordered service on 1 day (6/22/22) and lacked receiving the ordered number of hours (7 hours) per day the 3 additional days per week of skilled nursing services as ordered on the Plan of Care. h. Skilled nursing notes for the week of 6/26/22 through 7/2/22, included documentation of 5 days of skilled nursing services provided. Nursing service provided on the dates of 6/27/22, 6/28/22, 6/29/22, 6/30/22 and 7/1/22. The notes identified the patient received only 4 hours of service on 6/27/22, 7.5 hours of service on 6/28/22, only 4 hours of service on 6/29/22, only 2.5 hours on 6/30/22 and only 3 hours of service on 7/1/22. The patient received the ordered service on 1 day (6/28/22) and lacked receiving the ordered number of hours (7 hours) per day the 3 additional days per week of skilled nursing services as ordered on the Plan of Care. During an interview on 7/13/22 at 9:10 AM, Staff B, Clinical Manager stated the system notifies staff of missed visits and does not account for days services are provided but less than the ordered amount of hours. The clinical record lacked documentation of physician notification for the variance in skilled nursing services ordered on the Plan of Care. 2. Patient #5 had a start of care date of 3/4/22 and discharge date of 5/2/22. Clinical record review and associated agency staff interviews revealed the following: a. The Plan of Care, dated 3/4/22 to 5/2/22, included physician orders for skilled nursing services 1 visit per week times 1 week, 5 visits per week times 1 week, 2 times a week times 2 weeks and 1 time a week times 6 weeks. b. Skilled nursing visit notes for the week of 3/6/22 through 3/12/22, included documentation of 2 skilled nursing visits provided on 3/7/22 and 3/11/22. During an interview on 7/12/22 at 1:25 PM Staff A, Clinical manager stated he could not locate physician notification of missed visits for the week of 3/6/22 through 3/12/22. He further stated the order on the plan of care should have been written 2 times a week and not 5 times per week. The clinical record lacked physician notification of 3 missed visits for the week of 3/6/22 through 3/12/22. The findings were reviewed with the Clinical Manager. 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, agency policy review and agency staff interview, the agency failed to provide services as ordered by the physician ror skin integrity assessment with wound care for 1 of 2 sampled patients with wounds (Patients #5). Failure to ensure staff obtain physician orders for provision of services provided by agency staff placed agency patients at risk for inconsistent care/treatment and possible harm. Findings include: According to the agency policy tilted Wound Care, dated 7/1/19, wounds will be measured (minimum 1 time per week or as ordered by the physician) by the clinician. During an interview on 7/12/22 at 11:10 AM, Staff A, Clinical Manager stated the expectation for staff to measure wounds weekly. Measurements include width, length and depth of the wound. Patient #5 had a start of care date of 3/4/22 and discharge date of 5/2/22. Review of the clinical record revealed the following. a. The Plan of Care (POC), dated 3/4/22 to 5/2/22, included orders for skilled nursing services to observe and assess integumentary status to identify changes and intervene to minimize complications. Skilled nurse to provide skilled teaching related to altered skin integrity including pathophysiology, nutrition, medication regimen and wound care. Skilled nurse to report significant changes in status to physician for early intervention. b. The comprehensive skilled nursing visit at start of care identified the patient had 2 current wounds. Wound #4, upper midline abdominal wound, measured 1.5 centimeters (cm) by 0.5 cm by 0.5 cm. Wound #5, lower midline abdominal wound, measured 1.5 cm by 0.5 cm by 0.6 cm. c. Skilled nurse visit notes, dated 3/7, 3/11 and 3/14/22, lacked documentation of wound measurements. The clinical record lacked documentation that wound measurements completed for the weeks of 3/6/22 though 3/12/22 and 3/13/22 through 3/19/22. The findings were reviewed with the Clinical Manager. The agency provided no additional information prior to the end of the survey.