Every finding on record at Nhc Op LP

Based on clinical record review and staff interview it was determined the agency failed to ensure the plan of care for each patient contained measurable outcomes/goals and/or the plan of care failed to include a reason that would necessitate the use of PRN (as needed) visits included on the plan of care for thirteen of (13) of thirteen (13) clinical records reviewed in the survey sample. Clinical records (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11 # 12 and #13) Findings: Thirteen (13) clinical records were reviewed in the agency on 09/07/2022 and 09/08/2022 with the following findings 1. The clinical record for patient #1 was reviewed for the timeframe of 08/15/2022 to 11/12/2022.The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 2. The clinical record for patient #2 was reviewed for the timeframe of 08/28/2022 to 11/25/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 3. The clinical record for patient #3 was reviewed for the timeframe of 08/31/2022 to 11/28/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 4. The clinical record for patient #4 was reviewed for the timeframe of 08/31/2022 to 11/10/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 5. The clinical record for patient #5 was reviewed for the timeframe of 08/03/2022 to 10/31/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 6. The clinical record for patient #6 was reviewed for the timeframe of 07/22/2022 to 10/19/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 7. The clinical record for patient #7 was reviewed for the timeframe of 08/17/2022 to 11/14/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 8. The clinical record for patient #8 was reviewed for the timeframe of 08/23/2022 to 11/20/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 9. The clinical record for patient #9 was reviewed for the timeframe of 08/06/2022 to 11/03/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 10. The clinical record for patient #10 was reviewed for the timeframe of 06/26/2022 to 09/26/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for three (3) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 11. The clinical record for patient #11 was reviewed for the timeframe of 08/23/2022 to 10/21/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. 12. The clinical record for patient #12 was reviewed for the timeframe of 06/27/2022 09/24/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. 13. The clinical record for patient #13 was reviewed for the timeframe of 08/24/2022 to 11/21/2022. The plan of care for the above noted time frame failed to contain measurable goals/outcomes. Goals were generalized. In addition, the plan of care contained a physician's order for six (6) PRN (As Needed) Skilled Nursing Visits. The plan of care failed to include a reason that would necessitate the use of a PRN Skilled Nurse visit. The lack of measureable goals and the reason that would necessitate the use of a PRN (As Needed) visit on the above noted plans of care were reviewed with the Administrator prior to and during the exit conference conducted in the agency on 09/08/2022.

Based on clinical record review and staff interview it was determined the Registered Nurse (RN) failed to develop an individualized aide care plan for each patient. Specifically, the aide care plan failed to include which tasks specifically must be performed and the specific frequency of these tasks and/or the RN failed to document that the patient is cognitively and functionally able to choose and perform each task in which per patient request was identified for four (4) of thirteen (13) clinical records in the survey sample. (Clinical records #7, #10, #11 and #13) Findings: Thirteen (13) clinical records were reviewed in the agency on 09/07/2022 and 09/08/2022 with the following findings: 1. Clinical record #7 was reviewed for the certification period to 08/17/2022 to 10/14/2022. According to patient #1's plan of care, the patient was to receive home health aide services one (1) time per week for one (1) week then three (3) times a week for twelve (12) weeks. The following tasks were included on patient's plan of care and aide care plan were assigned with a frequency of per patient request or PRN (as needed): Bathing-Bed Bath every visit, per patient request Shampoo every visit per patient request Skin Care every visit per patient request Perineal Care every visit per patient request Assist To Bedside Commode per patient request Dressing every visit per patient request Offer Fluid every visit per patient request Change Linens every visit per patient request 2. Clinical record #10 was reviewed for the certification period to 06/29/2022 to 09/26/2022. According to patient #10's plan of care, the patient was to receive home health aide services two (2) times a week for twelve (12) weeks. The following tasks were included on patient's plan of care and aide care plan were assigned with a frequency of per patient request or PRN (as needed): Change Linens per patient request Make Bed per patient request 3. Clinical record #11 was reviewed for the certification period to 08/23/2022 to 10/21/2022. According to patient #11's plan of care the patient was to receive home health aide services one (1) time a week for one (1) week then two (2) times a week for twelve (12) weeks. The following tasks were included on patient's plan of care and aide care plan were assigned with a frequency of per patient request or PRN (as needed): Shampoo per patient request Turn And Position In Bed per patient request 4. Clinical record #13 was reviewed for the certification period to 08/24/2022 to 11/21/2022. According to patient #13's plan of care the patient was to receive home health aide services two (2) times a week for one (1) week then three (3) times a week for twelve (12) weeks. The following tasks were included on patient's plan of care and aide care plan were assigned with a frequency of per patient/family request or PRN (as needed): Change Linens every visit per patient request The Registered Nurse (RN) failed to develop an individualized aide care plan for the above noted patients that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient is cognitively and functionally able to choose and perform each task in which "as requested or per patient request was identified. The above noted findings were acknowledged by the Administrator during the clinical record reviews and again during the exit conference conducted in the agency on 09/08/2022.