Every finding on record at Visiting Nurse Services of Iowa

As directed by the Centers for Medicare and Medicaid Services (CMS) Kansas City location, the Iowa Department of Inspections, Appeals and Licensing conducted a complaint survey for complaints #3055924-C from 7/20/26 through 7/22/26. The complaint survey identified the following: Condition of Participation 42 CFR 418.56 IDG, Care Planning and Coordination of Services, was investigated and no condition level deficiency was identified and one standard level deficiency was identified (G574); and Condition of Participation 42 CR 418.58 Discharge planning, was investigated and no condition level deficiency and no standard level deficiency was identified. The agency reported a current census of 221 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 home visit observations, patient interviews, clinical record reviews and agency policy reviews, the agency failed to ensure the accurate completion of all components comprising the Plan of Care, including safety measures to protect against injury for 1 of 6 sampled patients (Patient #5). Failure to maintain complete and accurate Plans of Care with current orders placed patients at risk to not receive services, medications, supplies and/or treatments according to assessed needs and physician orders. Findings include: According to the agency policy titled Plan of Care, last reviewed 4/10/25, each patient's needs are reflected in an individualized plan of care that is specific to needs and contains all required elements. The plan of care, developed in consultation with the care team, covers all pertinant diagnosis, including mental status, types of services and equipment required, frequencly of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, any safety measures to protect against injury, instructions for timely discharge or referral and any other appropriate items. 1.Patient #5 had a start of care date of 9/4/25 and discharge date of 4/14/26. Clinical record review revealed the following: a. The plans of care (POC's), dated 9/4/25 to 11/2/25 and 3/3/26 to 5/1/26, identified the patient had a diagnosis of severe lewy body dementia with agitation. The POC included interventions to assess/instruct patinet/caregiver regarding satety of home environment/potential hazards and removal of hazards. b. The comprehensive assessment at the start of care, dated 9/4/26, Staff E, RN, (Registered Nurse) indentified the patient had a Brief Interview for Mental Status (BIMS) of 8 on a scale of 0 to 15 points, which idicataed the patient had moderate cognitive impairment. The assessment documented the patient alone-most of the time, declines lifeline, has telephone access, no functional factors of concern, and is aware of safety recommendations. The assessment lacked documentation the caregiver instructed due to the BIMS score of 8, the patient is not to be left alone. c. The skilled nurse note, dated 9/17/25, Staff E, RN, documented the patient left home alone while the spouse going out of town. Staff E notified the primary care provider and he stated the patient not able to be left alone. The patient transported to the hospital to stay while the spouse out of town. d. During an interview on 7/21/26 at 1:20 PM the primary caregiver stated agency staff did not provide instruction to not leave the patient alone. e. During an interview on 7/22/26 at 8:37 AM, Staff E stated she was sure she had talked with primary caregiver to not leave the patient alone for safety, prior to the incident on 9/17/25. Staff E further stated the documentation on the assessment at start of care incorrect. She stated the spouse never left the patient alone prior to the incident on 9/17/25. The agency failed to include education on the POC and oral education to not leave the patient alone. The above findings reviewed with the Administrator, Director and Clinical Manager.