Home Care Services of Boone Co

“Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This Standard is not met as evidenced by: Based on staff interview, clinical record reviews and agency policy review, the home health agency failed to ensure all clinical documentation was completed in a timely manner for 3 of 7 sampled patients (Patients #2, #3 and #5). Failure to ensure all clinical record documentation was completed in a timely manner increased the risk of ineffective communication between staff members providing services to its patients. Findings include: 3. Patient #3 had a start of care date of 10/31/25. Clinical record review revealed: a. The POC, dated 10/31/25 to 12/29/25, identified the patient had a diagnosis of chronic diastolic congestive heart failure and included orders for home health aide services 2 times a week. b. The home health aide visit note, dated 11/18/24, completed and signed 11/23/25 by Staff E, Home Heath Aide Aide 5 days after the visit and 2 days late (per agency policy). Agency staff failed to complete documentation in a timely manner. The above findings reviewed with the Aministrator. According to the agency’s Home Care Aide policy, dated 1/2025, documentation by the home care aide will be completed in the medical record within one business day of the completed visit. During an interview on 12/8/25 at 3:57 PM, Staff A, Administrator, reported documentation has to be completed, done and signed within three business days. 1.Patient #2 had a start of care date of 12/6/22. Clinical record review revealed: a. The home health aide visit note, dated 10/13/25, signed completed 10/17/25 (3 days late) by Staff E, Aide. b. The home health aide visit note, dated 10/27/25, signed completed 10/31/25 (3 days late) by Staff E, Aide. c. The home health aide visit note, dated 11/12/25, signed completed 11/17/25 (4 days late) by Staff E, Aide. d. The home health aide visit note, dated 11/19/25, signed completed 11/23/25 (3 days late) by Staff E, Aide. e. The home health aide visit note, dated 11/26/25, signed completed 12/1/25 (4 days late) by Staff F, Aide. Agency staff failed to complete documentation in a timely manner. 2. Patient #5 had a start of care date of 10/3/25. Clinical record review revealed: The home health aide visit note, dated 10/13/24, signed completed 10/17/25 (3 days late) by Staff F, Aide. Agency staff failed to complete documentation in a timely manner.”

“Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient’s status, and must include, at a minimum, the following information: (1) The patient’s current health, psychosocial, functional, and cognitive status; This Element is not met as evidenced by: Based on staff interview, clinical record reviews and agency policy review, the agency failed to provide a complete comprehensive assessment for patients with wounds during start of care, recertifications, resumption of care and discharge assessments for 4 of 4 sampled patients with wounds (Patients #1, #5, #6 and #7). Failure to accurately and thoroughly complete wound assessments or provide a comprehensive assessment placed patients at an increased risk of unidentified condition changes. Findings include: 4. Patient #5 had a start of care date of 10/3/25. Clinical record review revealed: a. The POC, dated 10/3/25 to 12/1/25, identified the patient had a diagnosis of Severe sepsis with septic shock, identified the patient had wounds and included orders for skilled nursing services 1 time a week for 1 week and then 2-3 times a week. b. The start of care comprehensive assessment, dated 10/3/25, completed by Staff A, Administrator, identified the patient had an open area on the coccyx. The skilled nurse completed wound measurements of 1 centimeter (cm) by 1 cm but failed to measure the depth of the wound. The agency failed to include accurate and complete comprehensive assessments of the patient’s wounds. The above findings were reviewed with the Administrator. According to the agency policy titled Wound Care Protocol, dated 4/2024, the primary care nurse or designee is responsible for performing wound/skin assessment and wound treatments per physicians order. During an interview on 12/9/25 at 8:55 AM, the Clinical Manager stated wound care and measurements documented under wound assessment in the medical record. Wounds are expected to be measured every 7 days and measurements include length, width and depth measured in centimeters. 1.Patient #1 had a start of care date of 12/5/25. Clinical record review revealed the following: a. The Plan of Care (POC), dated 12/5/25 to 2/2/26, identified the patient had diagnoses of fracture of the unspecified part of neck of femur and diabetes mellitus and included orders for skilled nursing services every 3 days. b. The start of care comprehensive assessment, dated 12/5/25, completed by Staff C, Registered Nurse (RN), identified the patient had an open pressure ulcer on the mid back. The skilled nurse completed wound measurements of 0.39 inches by 0.39 inches and failed to measure the depth of the wound. The skilled nurse failed to include a complete initial assessment of patient’s wound. The agency failed to include accurate and complete comprehensive assessments of the patients wounds. 2. Patient #6 had a start of care date of 5/22/25 and discharged on 7/17/25. Clinical record review revealed the following: a. The POC, dated 5/22/25 to 7/19/25, identified the patient had diagnoses of right knee hemarthrosis and included orders for skilled nursing services 1 time a week. b. The skilled nurse note, dated 7/1/25, completed by Staff D, RN, identified the patient had a skin tear on the right forearm and an open wound on the right knee. 1) The skilled nurse completed wound measurements of the right forarm skin tear of 0.8 inches by 2.8 inches and failed to measure the depth of the wound. The skilled nurse failed to document a a complete assessment of patient’s wound. 2) The skilled nurse completed wound mearements of the right knee of 0.79 inches by 1.588 inches and failed to measure the depth of the wound. The skilled nurse failed to document a complete assessment of the patient’s wound. The agency failed to include accurate and complete comprehensive assessments of the patients wounds. 3. Patient #7 had a start of care date of 12/5/25 and discharge date of 10/20/25. Clinical record review revealed the following: a. The POC, dated 9/30/25 to 11/28/25, identified the patient had diagnoses of dementia and included orders for skilled nursing services 1 time a week. b. The start of care comprehensive assessment, dated 12/5/25, completed by Staff D, RN, identified the patient had a small skin tear on the top of the right arm, near the elbow. The wound wrapped in gauze. Staff failed to document an assessment of the wound. The agency failed to include accurate and complete assessments of the patients wound.”

“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 observations, patient interviews, staff interview, clinical record reviews and agency policy review, the agency failed to complete an accurate drug regimen review with each comprehensive assessment for 2 of 3 sampled patients with home observation visits (Patients #1 and #3). Failure to ensure medications reviewed at the time of each drug regimen review are current and accurate placed the patients at risk for increased potential unidentified medication interactions, side effects and duplication of medications. Findings include: According to the agency policy titled Medication Regimen Review, dated 4/2024, when the patient is admitted to the Home Health Program the Registered Nurse takes a medication history and obtains an accurate list of all prescribed and over-the-counter medications being taken regularly and on an as needed basis by the patient. During an interview on 12/9/25 at 8:55 AM the Clinical Manager stated the agency nurse looks at the medications in the patient’s home. 1.Patient #1 had a start of care date of 12/5/25. Clinical record review revealed the following: a. The Plan of Care (POC), dated 12//525 to 2/2/26, identified the patient had diagnoses of Fracture of unspecified part of neck of femur and diabetes mellitus and included physician orders for medication and skilled nursing services. b. The comprehensive assessment at start of care, dated 12/5/25, completed by Staff C, RN, included documentation a DRR was completed. c. During a home observation visit on 12/8/25 at 1:00 PM with Staff C, RN the patient interview revealed the following medication discrepancies orders and patient stated medication schedule: 1) Jardiance 25 mg tablet daily. Patient stated had not been taking since prior to home care admission. 2) Metoprolol succinate 50 mg twice a day. Patient stated takes 1 time a day. 3: Metformin 1000 mg daily. Patient stated not taking since prior to home care admission. 4) Aspirin 81 mg 1 tablet daily. Patient stated taking 2 tablets daily. The DRR failed to include an accurate review of all medications taken by the patient. 2. Patient #3 had a start of care date of 10/31/25. Clinical record review revealed the following: a. The POC, dated 10/31/25 to 12/29/25, identified the patient had a diagnosis of Chronic diastolic congestive heart failure and included physician orders for medication and skilled nursing services. b. The comprehensive assessment at start of care, dated 10/31/25, completed by Staff B, RN, included documentation a DRR was completed. c. During a home observation visit on 12/9/25 at 2:00 PM with Staff H, Physical Therapist, the surveyor noted Tylenol 500 mg capsules in the home. In an interview during the same home visit the patient stated he/she takes 2 capsules every morning and every evening and has since prior to home health admission. The DRR failed to include an accurate review of all medications taken by the patient. The above findings were reviewed with the Administrator.”

“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 observation visit, patient interview and staff interview, the agency failed to ensure accurate completion of all components comprising the Plan of Care, including all medical supplies/equipment and all medications and treatments used by the patient for 3 of 7 sampled patients (Patients #2, #4 and #5). Failure to maintain complete and accurate Plans of Care with current orders placed patients at risk to not receive services, supplies, medications and/or treatments according to assessed needs and physician orders. Findings include: 1.Patient #2 had a start of care date of 12/6/22. Clinical record review revealed: a. The Plan of Care (POC), dated 11/20/25 to 1/18/26, identified the patient had a diagnosis of Ventricular fibrillation and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: scale, pillboxes, nebulizer supplies, incontinence supplies, walker, cane and bilevel positive airway pressure (BIPAP). b. The skilled nurse recertification visit note, dated 11/17/25, completed by Staff D, Registered Nurse (RN), identified the patient checks his/her blood sugars regularly. c. During a home observation visit on 12/9/25 at 10:00 AM with Staff D, RN, the surveyor identified the following medical supplies/equipment used by the patient: pill cutter and diabetic supplies. The patient stated during the same home visit he/she had been checking his/her blood sugars for about one year. Staff D reported she had been utilizing the pill cutter to cut patients pills for greater than 1 month. The agency failed to include all medical supplies/equipment on the patient’s POC, including a pill cutter and diabetic supplies. 2. Patient #4 had a start of care date of 5/16/25. Clinical record review revealed: a. The POC, dated 11/12/25 to 1/10/26, identified the patient had a diagnosis of Chronic pulmonary embolism. The POC included the following medical supplies/equipment used by the patient: walker, cane, scooter, medication boxes, continuous positive airway pressure (CPAP) and supplies, sharps container, hearing aids, eye glasses, walk in shower, grab bars, grabber and scale. b. The skilled nurse recertification visit note, dated 11/11/25, completed by Staff G, RN, identified the patient uses elastic hose for edema and also identified the patient uses diabetic supplies to check blood sugars. The agency failed to include all medical supplies/equipment on the patient’s POC, including elastic hose and diabetic supplies. 3. Patient #5 had a start of care date of 10/3/25. Clinical record review revealed: a. The POC, dated 10/3/25 to 12/1/25, identified the patient had a diagnosis of Severe sepsis with septic shock and identified the patient had wounds. The POC included the following medical supplies/equipment used by the patient: wheelchair, walker, utility cart, sara steady, reacher, shoe horn, sock assist, ramps, bed rails, mechanical bed, shower chairs, commode, gait belt and sharps disposal. b. The start of care comprehensive assessment, dated 10/3/25, completed by Staff A, Administrator, identified the patient hah a closed wound to right upper chest treated by cleansing, antimicrobial fabric and foam cover changed Monday, Wednesday and Friday. The assessment identified an open wound to coccyx treated with cream twice a day and covered with Mepilex and also identified the patient used an incentive spirometer and wears tubigrips. c. The occupational therapist visit note, dated 10/8/25, completed by Staff I, Occupational Therapist (OT), identified the patient used a lift chair and wheelchair cushion. The agency failed to include all medical supplies/equipment and treatments on the patient’s POC, including incentive spirometer, tubigrips, lift chair, wheelchair cushion and wound care orders. The above findings were reviewed with the Administrator.”

“Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This Element is not met as evidenced by: Based on agency policy review, clinical record review and staff interview, the agency failed to ensure home health aides provided care to agency patients only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 6 sampled patients receiving home health aide services (Patients #3 and #7). The agency reported 16 patients who received home health aide services. Failure to ensure that home health aide services are provided only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient and according to the home health aide care plan increased the risk that patients’ personal care needs were not adequately met. Findings include: According to the agency policy, titled Home Care Aide Policy, dated 1/2025, the Registered Nurse (RN) will provide written instructions to the aide and the significant other. On the job instruction will be given to the Home Care Aide as needs identified. During an interview on 12/9/25 at 8:55 AM AM the Clinical Manager the nurse completes the care plan and it is reviewed at a minimum of every 2 weeks. If the aide is unable to complete an assigned task, the aide needs to document a reason as to why the task wasn’t completed. 1.Patient #3 had a start of care date of 10/31/25. Review of the clinical record revealed the following: a. The Plan of Care (POC), dated 10/31/24 to 12/29/25, identified the patient had a diagnosis of Chronic diastolic congestive heart failure and included physician orders for physical therapy and home health aide services. b. The aide visit notes, dated 11/14/25, 11/18/25, 11/21/25 and 11/25/25, included RN instructions to assist with the patient’s weight. Staff E, Home Health Aide failed to include documentation the task of assist with the patient’s weights accomplished or the reason the task not accomplished. c. The aide visit notes, dated 12/2/25 and 12/5/25, included RN instructions to assist with the patient’s weight. Staff F, Home Health Aide failed to include documentation the task of assist with the patient’s weights accomplished or the reason the task not accomplished. The home health aide failed to provide services that are ordered by the physician, included in the plan of care, permitted under state law, and consistent with home health aide training. 2. Patient #7 had a start of care date of 9/30/25 and discharge date of 10/20/25. Review of the clinical record revealed the following: a. The POC, dated 10/31/24 to 12/29/25, identified the patient had a diagnosis of dementia and included physician orders for skilled nursing and home health aide services. b. The aide visit notes, dated 10/7/25 and 10/10/25, included RN instructions to complete the task of shower/partial bath and bed bath. Staff K, Home Health Aide failed to include documentation the actual task complete, shower, partial bath or bed bath. The home health aide failed to provide services that are ordered by the physician, included in the plan of care, permitted under state law, and consistent with home health aide training. The above findings reviewed with the Administrator.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on agency staff interview, clinical record reviews and agency policy review, the agency failed to ensure a registered nurse or other appropriate health care professional completed home health aide supervision at least every 14 days for 2 of 6 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patients #2 and #6). The agency reported 16 patients who received home health aide services with every 14 day supervision. Failure to supervise home health aide services at least every 14 days, increased the risk that patients received unsatisfactory or inappropriate care from home health aides. Findings include: 2. Patient #6 had a start of care date of 5/22/25 and discharge date of 7/17/25. Clinical record review revealed: a. The POC, dated 5/22/25 to 7/20/25, identified the patient had a diagnosis of right knee hemarthrosis and included physician orders for skilled nursing and home health aide services. b. The skilled nurse visit note, dated 7/1/25, Staff D, RN, included documentation of home health aide supervision. c. The skilled nurse visit note, dated 10/29/25, Staff J, RN, included documentation of home health aide supervision 16 days after the previous documented aide supervision (2 days late). The agency failed to provide home health aide supervision every 14 days. The above findings reviewed with the Administrator. According to the agency’s Home Care Aide policy, dated 1/2025, the Registered Nurse (RN) will supervise outcome of service by the Home Health Aide as needs indicate but at least every 14 days. During an interview on 10/9/25 at 8:55 AM, Staff B, Clinical Manager, reported home health aide supervision is completed a minimum of every 14 days and documented by the RN in the skilled nurse visit note. 1.Patient #2 had a start of care date of 12/6/22. Clinical record review revealed: a. The Plans of Care (POC), dated 9/21/25 to 11/19/25 and 11/20/25 to 1/18/26, identified the patient had a diagnosis of Ventricular fibrillation and included physician orders for skilled nursing and home health aide services. b. The skilled nurse visit note, dated 9/23/25, Staff D, Registered Nurse (RN), included documentation of home health aide supervision. c. The skilled nurse visit note, dated 10/29/25, Staff D, RN, included documentation of home health aide supervision (22 days late). The agency failed to provide home health aide supervision every 14 days.”

“HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient’s plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient’s condition; and (vi) Honoring patient rights. This Element is not met as evidenced by: Based on staff interview, clinical record reviews and agency policy review, the agency failed to ensure registered nurses supervising home health aides maintained documentation of a review of all required supervisory elements including following the patient plan of care, maintaining open communication with patient/caregiver, demonstrating competency with assigned tasks, complying with infection prevention and control policies, reporting changes in patient condition and honoring patient rights for 3 of 6 sampled patients receiving home health aide services (Patients #2, #5 and #7). A total of 15 patients received home health aide services requiring every 14 day supervision and the agency employed 4 home health aides at the time of the survey. Failure to ensure the supervision of home health aides by registered nurses maintained documentation of a review of all required supervisory elements increased the risk of agency staff not meeting the patients’ personal care needs. Findings include: 3. Patient #7 had a start of care date of 0/30/25 and discharge date of 10/20/25. Clinical record review revealed: a. The POC, dated 9/30/25 to 11/28/25, identified the patient had a diagnosis of dementia and included orders for skilled nursing and home health aide services. b. Skilled nursing notes, dated 10/13/25, included documentation home health aide supervision was completed and the aide followed the care plan. The notes lacked documentation the nurse assessed the aide’s ability to meet the following required supervisory elements: maintaining an open communication process with patient/caregiver and family, demonstrating competency with assigned tasks, complying with infection prevention and control policies, reporting changes in patient condition and honoring patient rights. The agency failed to supervise home health aide services to include all supervisory elements. The above findings were reviewed with the Administrator. According to the agency’s Home Care Aide policy, dated 1/2025, the Registered Nurse (RN) will supervise outcome of service by the Home Health Aide as needs indicate but at least every 14 days. During an interview on 10/9/25 at 8:55 AM, Staff B, Clinical Manager, reported home health aide supervision is documented by the RN in the skilled nurse visit note. 1.Patient #2 had a start of care date of 12/6/22. Clinical record review revealed: a. The Plans of Care (POC), dated 9/21/25 to 11/19/25 and 11/20/25 to 1/18/26, identified the patient had a diagnosis of Ventricular fibrillation and included orders for skilled nursing and home health aide services. b. Skilled nursing notes, dated 10/29/25, 11/5/25, 11/12/25, 11/17/25, 11/24/25 and 12/4/25, included documentation home health aide supervision was completed and the aide followed the care plan. The notes lacked documentation the nurse assessed the aide’s ability to meet the following required supervisory elements: maintaining an open communication process with patient/caregiver and family, demonstrating competency with assigned tasks, complying with infection prevention and control policies, reporting changes in patient condition and honoring patient rights. The agency failed to supervise home health aide services to include all supervisory elements. 2. Patient #5 had a start of care date of 10/3/25. Clinical record review revealed: a. The POCs, dated 10/3/25 to 12/1/25 and 12/2/25 to 1/30/26, identified the patient had a diagnosis of Severe sepsis with septic shock and included orders for skilled nursing and home health aide services. b. Skilled nursing notes, dated 10/16/25, 10/29/25, 11/19/25, 11/26/25 and 11/28/25, included documentation home health aide supervision was completed and the aide followed the care plan. The notes lacked documentation the nurse assessed the aide’s ability to meet the following required supervisory elements: maintaining an open communication process with patient/caregiver and family, demonstrating competency with assigned tasks, complying with infection prevention and control policies, reporting changes in patient condition and honoring patient rights. The agency failed to supervise home health aide services to include all supervisory elements.”