Every finding on record at St Anthony Regional Hospital and Nursing Home

A Recertification Survey was conducted by the Department of Inspections and Appeals from 10/16/23 through 10/18/23 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 10/16/23 through 10/18/23. 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 census of 67 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 observation, clinical record, agency policy, patient interview, and staff interview, the agency failed to include all Durable Medical Equipment (DME) in Plans of Care for 2 of 3 home visits (Patient #1 and #3). Failure to maintain complete and accurate Plans of Care with current orders placed the patients at risk to not receive services according to assessed needs and physician orders. Findings include: According to agency policy, titled Initial Assessments/Resumption of Care Assessments Policy last revised September 2023 revealed in pertinent part that during the initial patient assessment, all baseline data and other relevant information should be documented in the patient’s record, including as appropriate the following information: equipment presently in home and potentially needed by patient. According to agency policy, titled On Going Assessment Policy last revised September 2023 revealed in pertinent part: Purpose to provide guidelines for assessments of patients during on-going care. The scope and intensity of on-going assessments will be determined by the patient’s diagnoses, condition, need, and desire for care/service, response to previous care/service and the care/service setting. During each home visit, the case manager or other discipline will re-evaluate the patient according to the problems identified during the initial visit and thereafter. In an interview on 10/18/23 at 12:05 PM, the Director reported that she expected all DME to be included with an initial assessment. 1. Patient #1 had a start of care date of 9/15/23 and received services from the agency. Clinical record review, home visit observation and accompanying interviews revealed the following: During a home visit observation on 10/16/23 at 4:00 PM with Staff D, Registered Nurse (RN), a foam boot was found laying next to the patient. During the home visit, the patient reported that he used the boot during his recent hospitalization and continued to wear the boot several hours per day. The Plan of Care lacked that the patient had a foam boot. The Plan of Care, DME and supply section, dated 9/15/23 to 11/13/23 lacked the foam boot listed as DME. 2. Patient #3 had a start of care date of 10/17/19 and received services from the agency. During a home visit observation on 10/17/23 at 9:00 AM with Staff C, Licensed Practical Nurse (LPN), the patient reported that he has an upcoming surgery and will need to wear compression hose after the surgery, he has had a pair of compression stocking for the past year, but does not wear them very often as they are hard to put on. The Plan of Care lacked that the patient had compression stockings. The Plan of Care, DME and supply section, dated 9/26/23 to 11/24/23 lacked compression stockings listed as DME. The above findings were reviewed with the Director and Clinical Manager and no further information provided prior to the end of the survey.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on clinical record, agency policy, patient interview, and staff interview, the agency failed to ensure coordination of patient between Licensed Practical Nurse (LPN) and Registered Nurse (RN) for 1 of 1 sampled patients (Patient #3) and failed to ensure clinicians followed agency policies and procedures when assessing wounds and performing negative pressure wound therapy (NPWT) procedure to agency patients for 1 of 2 sampled patients had wounds (Patient #1). Failure to follow agency policies and procedures when providing patient care may result in inadequate and unsafe patient care practices. Findings include: According to agency policy titled, Ulta VACVacuum Assisted Closure Device (V.A.C.) Policy last revised December 2022 revealed in pertinent part: 1. Trim foam to fit into wound. 2. Place foam dressing into wound cavity. 3. Documentation of cassette/tubing change at least every 96 hours/4 days. According to agency policy titled, Photo Documentation of Wounds and Skin Conditions Policy last revised March 2023 revealed in pertinent part: Purpose to document clear and accurate status of patient’s skin condition. Wounds are to be measured weekly. In an interview on 10/16/23 at 8:50 AM, the Clinical Manager reported that wound measurements should be taken weekly and documented in the clinical record. In an interview on 10/18/23 at 11:35 AM, the Director reported that the agency does not have a policy on coordination between LPN and RN, the agency recently started hiring LPNs and they were not aware of how care of patients should be coordinated with RNs. 1. Patient #1 had a start of care date of 9/15/23 and received services from the agency. Clinical Record revealed: During a home visit on 10/16/23 at 4:00 PM, observation was of Non Pressure Wound Therapy (NPWT ) dressing change to Patient #1’s lower left lateral leg. Staff B, Registered Nurse (RN), did not apply drape to the peri wound skin. Staff B placed the black foam on the wound bed with black foam extending out of the wound bed onto peri wound skin. After negative pressure was initiated, black foam remained on peri wound skin. The Clinical Record revealed that the NPWT canister was only changed on 10/6/23 and 10/13/23. The Clinical Record revealed the patient’s inner lower left leg surgical incision was measured only at start of care on 9/15/23. No further measurements were in the Clinical Record. 2. Patient #3 had a start of care date of 10/17/19 and received services from the agency. Clinical Record revealed: Case Conference Report on 9/7/23 attended by Staff D, Registered Nurse (RN) and Staff E, RN. The report lacked documentation related to the patient’s new medication, Colace, started 8/29/23 and that his health care provider requested that the patient have a colonoscopy. Staff C, Licensed Practical Nurse (LPN) was the nurse that performed the skilled nursing visit on 8/29/23 in which the information concerning the new medication and procedure was found. During a skilled nurse visit on 9/12/23, the patient reported he will visit his health care provider every 3 months for routine check ups. Staff C, Licensed Practical Nurse (LPN) was the nurse that performed the skilled nursing visit on 9/12/23. The patient’s Clinical Record lacked documentation that Staff C reported the patient's reported information or the patient’s new medication to a RN. The above findings were reviewed with the Director and Clinical Manager and no further information provided prior to the end of the survey.