Every finding on record at Veterans Memorial Hospital City of Waukon Ia

A Recertification Survey was conducted by the Department of Inspections, Appeals and Licensing completed on 10/18/23 through 10/25/23 and the home health agency was found to be operating in compliance with the requirements of the Establishment of Emergency Preparedness.

A recertification survey was conducted by the Department of Inspections, Appeals and Licensing from 10/18/23 through 10/25/23. The recertification survey found the agency operating out of compliance with the following standard level regulatory requirements: The home health agency reported a census of 53 patients at the time of the survey.

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 clinical record review, agency policy review and agency staff interview, the agency failed to complete a drug regimen review with each comprehensive assessment within the allowed time frames for 1 of 2 sampled patients with resumption of care visits (Patient #7) and 1 of 2 sampled discharged patients (Patient #6). Failure to complete a drug regimen review with each comprehensive assessment placed the patient at risk for increased potential unidentified medication interactions, side effects and duplication of medications. Findings include: According to the agency policy, titled Drug Regimen Review Policy, dated 7/1/23, a drug regimen and review will be done for all skilled nursing clients with every comprehensive assessment including Start of Care, Recertification, Other Follow Up, Discharge and Death at Home assessments. During an interview on 10/25/23 at 9:17 AM, the Clinical Manager reported drug regimen reviews are completed with comprehensive assessments at Start of Care, Resumption of Care, Recertification and Discharge assessments. The completed drug regimen review will be on the updated plan of care at the time of the agency discharge. 1. Patient #6 had a start of care date of 6/21/23 and a discharge date of 7/12/23. Clinical record review revealed the following: a. Discharge comprehensive assessment, dated 7/12/23, lacked documentation a drug regimen review had been completed. b. Discharge summary, dated 7/12/23, lacked documentation a drug regimen review had been completed. c. Updated plan of care, dated 7/12/23, lacked documentation a drug regimen review had been completed. During an interview on 10/25/23 at 2:20 PM, the Clinical Manager reported she had reviewed the clinical record and was unable to locate a drug regimen review completed at the time of the discharge comprehensive assessment. 2. Patient #7 had a start of care date of 4/26/23 and a discharge date of 6/6/23. Clinical record review revealed the following: a. Plan of Care, dated 4/26/23 to 6/24/23, that included physician orders for skilled nursing and physical therapy services. b. Resumption of Care comprehensive assessment, dated 5/6/23, lacked documentation a drug regimen review had been compelted. c. Updated Plan of Care, dated 5/6/23, included physician orders to resume skilled nursing services but lacked documentation a drug regime review had been completed. The above stated findings were reviewed with the Clinical Manager and the Public Health Manager and the agency provided no additional information prior to the end of the survey.

Within 48 hours of the patient's return CFR(s): 484.55(d)(2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This ELEMENT is not met as evidenced by: Based on agency policy review and clinical record review, the agency failed to ensure completion of the update to the comprehensive assessment within 48 hours of the agency's knowledge of return home from an inpatient facility for 1 of 2 sampled patients requiring a resumption of care comprehensive assessment (Patient #7). The agency performed 10 resumption of care assessments in the previous 6 months. Failure to complete resumption of care comprehensive assessment in a timely manner increased the potential that patients might not receive services in a manner to meet individualized patient needs. Findings include: According to the agency policy, titled Comprehensive Assessment Policy, dated 9/12/12, the Resumption of Care comprehensive assessment must be completed within 48 hours of a patient’s return to home after an inpatient stay of more than 24 hours for any reason other than diagnostic testing. Patient #7 had a start of care date of 4/26/23 and a discharge date of 6/6/23. Clinical record review revealed the resumption of care comprehensive assessment, dated 5/6/23, documented the patient was discharged from the hospital on 5/5/23. The nurse initiated the resumption of care comprehensive assessment on 5/6/23 but did not complete the assessment until 5/11/23, 6 days after the patient's return home from the inpatient stay. The assessment was completed 4 days late as required by regulation and the agency's own policy. The above stated findings were reviewed with the Clinical Manager and the Public Health Manager. The agency provided no additional information prior to the end of the survey.