Harrison County Public Health

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on agency staff interviews and clinical record reviews the agency failed to follow a Plan of Care established and periodically reviewed by a physician or notify the physician of the need to vary frequency of visits or inability to perform treatments/services as originally ordered on the Plan of Care for 2 of 2 sampled patients with missed visits (Patients #4 and #5). Failure to follow a Plan of Care established by a physician placed patients at risk of not receiving safe, individualized and consistent care designed to meet each patient’s health care needs. Findings include: 2. Patient #5 had a start of care date of 5/17/24. Clinical record review revealed the following: a. The POC, dated 7/16/24 to 9/13/24, included physician orders for skilled nursing services. b. The physician’s order, dated 8/1/24, included orders for bath aide 3 times a week. b. The electronic record lacked documentation of home health aide visits the week of 8/4/24 to 8/10/24. The clinical record lacked documentation of physician notification of the 3 missed home health aide visits. The agency failed to notify the physician of missed visits and/or the need to vary visit frequency. The above findings shared with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, Licensed Practical Nurse (LPN). During an interview on 8/21/24 at 11:30 AM, Staff B, Clinical Manager, identified the agency notifies the physician of all missed visits. 1.Patient #4 had a start of care date of 7/18/24. Clinical record review revealed the following: a. The Plan of Care (POC), dated 7/18/24 to 9/15/24, included physician orders for skilled nursing services two times per week for two weeks effective 7/18/24. b. The week of 7/14/24 to 7/20/24 included documentation of one skilled nursing visit to complete admission paperwork and review medication. The clinical record lacked documentation of physician notification of the missed skilled nursing visit. During an interview on 8/21/24 at 10:00 AM, Staff C, Registered Nurse (RN) revealed skilled nursing services were initially ordered only to complete admission paperwork and review medications and should not have included skilled nursing visits twice a week for two weeks effective 7/18/24. The agency failed to notify the physician of missed visits and/or the need to vary visit frequency.”

“Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide’s performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This Standard is not met as evidenced by: Based on personnel file review, agency policy review and clinical record review, the agency failed to ensure 2 of 4 sampled home health aides (Staff F and G), demonstrated completion of all of the assigned extra skills while observed by a registered nurse to determine competency in each task prior to being allowed to care for agency patients independently for 2 patients (Patient #4 and #7). Failure to ensure that home health aides demonstrated completion of all of the assigned extra skills while observed by a registered nurse (RN) to determine competency in each task prior to being allowed to care for agency patients independently, increased the potential risk of harm to the patient. Findings include: According to the agency policy, titled Home Health Aide Care Plan and revised 3/2022, the home health aide shall be oriented by a RN via phone or in person to the client’s care needs prior to initiating the care and updated on modifications or changes in the client’s care. If the home health aide is assigned to delegated nursing junctions, such ass assisting to administer medications that are normally self-administered, i.e., eye drops; the home health aide must be oriented to the procedure by a RN who documents evidence of competency. 1.Patient #4 had a start of care date of 7/18/24. Clinical record review revealed the following: a. The Plans of Care, dated 7/18/24 to 9/15/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home health aide services. b. The home health aide care plan, dated 7/18/24, directed the aide to apply edema wear and apply miconazole powder to skin folds that are red. c. The application of edema wear and medicated topicals require extra skills competency testing prior to assigning the aide to perform the tasks as an extension of nursing services. The clinical record documented Staff F, Home Health Aide, provided care to Patient #4. Personnel file review revealed the following: d. Staff F, Home Health Aide, had a hire date of 1/13/21. Staff F had never been competency tested to perform the application of a medicated topical powder. 2. Patient #7 had a start of care date of 4/8/22 and discharge date of 5/26/24. Clinical record review revealed the following: a. The Plans of Care, dated 1/28/24 to 3/27/24 and 3/28/24 to 5/26/24, included physician orders for skilled nursing and home health aide services. b. The home health aide care plan, dated 3/28/24, directed the aide to weight the patient, apply light dusting of nystatin powder and apply lidocaine 4% roll on liquid or patch to affected areas across upper back and shoulder blades. c. The weight, application of medicated topicals and application of medicated patch require extra skills competency testing prior to assigning the aide to perform the tasks as an extension of nursing services. The clinical record documented Staff G, Home Health Aide, provided care to Patient #7. Personnel file review revealed the following: d. Staff G, Home Health Aide, had a hire date of 4/22/22. Staff G had never been competency tested to perform the application of a medicated patch. During an interview on 8/21/24 at 10:10 AM Staff D, RN stated she remembered showing Staff G, home health aide, how to apply the medicated patch. Staff D, RN unable to locate documentation of Staff G’s competency testing. The above findings were reviewed with the Administrator and Clinical Manager.”

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on clinical record review, agency policy review, and agency staff interview, the agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 2 of 3 sampled patients receiving home health aide services (Patients #5 and #7). Failure to ensure agency registered nurses provided patient specific written instructions directing the care provided by the agency’s home health aides for each patient increased the risk agency patients would receive inappropriate or inconsistent home health aide services. Findings include: 2.Patient #7 had a start of care date of 4/8/22, a discharge date of 5/26/24 and received skilled nursing and home health aide services. Clinical record review revealed the following: The home health aide care plan, dated 3/28/24, directed the home health aide to provide foot care every visit and to apply lotion every visit. The home health aide care plan failed to identify what foot care included and where the home health aide was to apply lotion. The above findings shared with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, Licensed Practical Nurse (LPN). According to the agency policy, titled Home Health Aide Care Plan, revised 3/2022, following the initial nursing assessment and consultation with the clint/caregiver, written instructions for home care are prepared by a RN or therapist, as appropriate. The care plan shall be developed in plain, non-technical lay terms and identify the duties to be performed such as, but not limited to: personal care, ambulation and exercise, household services essential to health care at home, assistance with treatments, medications and procedures as needed and per State/Federal standards and conditions of participation and meal planning and preparation when supportive of health maintenance and promotion. 1. Patient #5 had a start of date of 5/17/24. Clinical record review revealed: a. The Plan of care, dated 7/16/24 to 9/13/24, included orders for skilled nursing services. b. The physician’s order, dated 8/1/24, included orders for a bath aide 3 times a week. c. Review of the clinical record, dated 8/12, 8/14 and 8/16/24, included documentation aide services provided to the patient. d. The clinical record lacked documentation of a written home health aide care plan. e. During an interview on 8/20/24 at 2:45 PM the Clinical Manager stated she failed to complete a home health aide care plan but did give verbal instruction to the aide for services provided. The agency failed to provide written instruction for the aide assignment.”

“Basis and Scope CFR(s): §484.80(h)(1)(iv) A registered nurse or other appropriate skilled professional must make an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while he or she is performing care. This Standard is not met as evidenced by: Based on agency policy review and clinical record review, the agency failed to ensure a registered nurse or other appropriate professional completed an annual on-site visit to observe and assess each aide while the home health aide present and providing direct patient care (Staff F and G). Failure to supervise home health aide services, at least annually while the aides provided direct patient care, increased the risk that patients received unsatisfactory or inappropriate care from home health aides. Findings include: According to the agency policy titled Home Health Aide Supervision, dated November, 2019, when skilled nursing care is being furnished to a client, a RN must make a supervisory visit to the client’s residence at least every 2 weeks to assess relationships and determine whether goals are being met. If home health aide services are provided to a patient who is not receiving skilled nursing care, physical therapy or occupational therapy or speech-language pathology services, the RN must make a supervisory visit to the patient’s home no less frequently than every 60 days for each aide providing routine care. In these cases, to ensure that the aide is properly caring for the patient, each supervisory visit must occur while the home health aide is providing patient care. 1. Staff F, Home Health Aide (HHA) had a hire date of 1/13/21. Review of Staff F’s employee file lacked documentation of annual direct supervision by an RN or other appropriate professional. The agency failed to provide annual on-site visit to observe and assess each aide while the HHA provided direct patient care. 2. Staff G, HHA had a hire date of 4/22/22. Review of Staff G’s employee file lacked documentation of annual direct supervision by an RN or other appropriate professional. The agency failed to provide annual on-site visit to observe and assess each aide while the HHA provided direct patient care. The above findings were reviewed with the Administrator and Clinical Manager.”

“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 agency interviews, clinical record reviews and agency policy reviews, the home health agency failed to ensure all clinical documentation was completed in a timely manner for 4 of 7 sampled patients (Patients #1, #4, #6 and #7). 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: According to the agency policy titled Home Health Documentation, dated 5/2023, all clinical documentation is to be completed, signed and marked permanent by midnight of the 3rd business day following a visit. During an interview on 8/20/24 at 8:14 AM, the Clinical Manager confirmed routine visit documentation is to be completed within 3 days. 1.Patient #1 had a start of care date of 1/17/20. Clinical record review revealed the following: a. The skilled nurse visit note, dated 6/28/24, signed completed 7/5/24 (2 days late). b. The skilled nurse visit note, dated 7/9/24, signed completed 7/15/24 (1 day late). c. The skilled nurse visit note, dated 7/23/24, signed completed 8/16/24 (15 days late). d. The skilled nurse visit note, dated 8/2/24, signed completed 8/16/24 (7 days late). e. The skilled nurse visit note, dated 8/6/24, signed completed 8/12/24 (1 day late). The agency clinical record failed to include timely documentation. 2.Patient #4 had a start of care date of 7/18/24. Clinical record review revealed the following: a. The skilled nurse visit note, dated 7/23/24, signed completed 8/12/24 (11 days late). b. The skilled nurse visit note, dated 7/30/24, signed completed 8/8/24 (4 days late). c. The skilled nurse visit note, dated 8/2/24, signed completed 8/14/24 (5 days late). The agency clinical record failed to include timely documentation. 3.Patient #6 had a start of care date of 9/9/23 and a discharge date of 7/24/24. Clinical record review revealed the following: a. The skilled nurse visit note, dated 6/11/24, signed completed 6/25/24 (7 days late). b. The skilled nurse visit note, dated 6/18/24, signed completed 6/25/24 (2 days late). c. The skilled nurse visit note, dated 7/2/24, signed completed 7/9/24 (2 days late). d. The skilled nurse visit note, dated 7/16/24, signed completed 7/31/24 (8 days late). The agency clinical record failed to include timely documentation. 4.Patient #7 had a start of care date of 4/8/22 and a discharge date of 5/26/24. Clinical record review revealed the following: a. The skilled nurse visit note, dated 4/9/24, signed completed 4/18/24 (4 days late). b. The skilled nurse visit note, dated 4/17/24, signed completed 4/25/24 (3 days late). c. The skilled nurse visit note, dated 4/24/24, signed completed 5/6/24 (5 days late). d. The skilled nurse visit note, dated 5/8/24, signed completed 5/20/24 (5 days late). The agency clinical record failed to include timely documentation. The above findings were reviewed with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, LPN.”

“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, agency staff interviews, clinical record reviews and agency policy reviews, the agency failed to complete a drug regimen review with each comprehensive assessment and failed to identify patient specific medications issues for 4 of 7 sampled patients (Patients #2, #3, #4 and #5). Failure to ensure medications were reviewed at the time of each comprehensive assessment, using a current and accurate list of medications taken by the patient at the time of the assessment, increased the potential for unidentified medication interactions, patient noncompliance, ineffective medication therapy, duplicate drug therapy and side effect risks to the patient. Findings include: 2. Patient #2 had a start of care date of 11/20/23. Clinical record review revealed the following: a. The plans of care (POCs), dated 5/8/24 to 7/16/24 and 7/17/24 to 9/14/24, included orders for medications. b. The comprehensive assessment, dated 7/15/24, completed by Staff D, Registered Nurse (RN), included documentation a DRR completed. The DRR lacked review of ineffective drug therapy, significant side effects, duplicate rug therapy and noncompliance with drug therapy. The agency failed to complete a drug regimen review with all comprehensive assessments. 3. Patient #3 had a start of care date of 8/16/24. Clinical record review revealed the following: a. The POC, dated 8/16/24 to 10/14/24, included orders for medications. b. The comprehensive assessment at the start of care, dated 8/16/24, completed by Staff B, Clinical Manager, included documentation a DRR completed. The DRR lacked review of ineffective drug therapy, significant side effects, duplicate rug therapy and noncompliance with drug therapy. The agency failed to complete a drug regimen review with all comprehensive assessments. 4. Patient #5 had a start of care date of 5/17/24. Clinical record review revealed the following: a. The plans of care (POCs), dated 5/17/24 to 7/15/24 and 7/16/24 to 9/13/24, included orders for medications. b. The comprehensive assessment completed at start of care, dated 5/17/24, completed by Staff B, Clinical Manager, included documentation a DRR completed. The DRR lacked review of ineffective drug therapy, significant side effects, duplicate rug therapy and noncompliance with drug therapy. c. The comprehensive assessment, dated 7/11/24, completed by Staff B, Clinical Manager, included documentation a DRR completed. The DRR lacked review of ineffective drug therapy, significant side effects, duplicate rug therapy and noncompliance with drug therapy. The agency failed to complete a drug regimen review with all comprehensive assessments. The above findings shared with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, Licensed Practical Nurse (LPN). According to the agency policy titled Comprehensive Assessment, dated 5/2023, the comprehensive assessment will include a drug regimen review (DRR) that identifies potential medication drug reactions including ineffective drug therapy, significant side effects, drug interactions, duplicate drug therapy and noncompliance with drug therapy. During an interview on 8/20/24 at 8:14 AM, Staff B, Clinical Manager identified the DRR is completed by the nurse at admission, recertifications, resumptions of care, with the addition of new medications and at discharge. The DRR is sent to the doctor each time for review. 1.Patient #4 had a start of care date of 7/18/24. Clinical record review revealed the following: a. The Plan of Care (POC), dated 7/18/24 to 9/15/24, included orders for medications. b. A case communication note completed by Staff C, Registered Nurse (RN), identified she completed admission paperwork and a medication review only; skilled nursing was not ordered for patient. The DRR lacked review of ineffective drug therapy, significant side effects, duplicate drug therapy and noncompliance with drug therapy. c. The comprehensive assessment, dated 7/18/24, completed by Staff I, Physical Therapist (PT), lacked documentation a drug regimen review had been completed. The agency failed to complete a drug regimen review with all comprehensive assessments.”

“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 all supplies/equipment and medications used by the patient for 3 of 3 patients (Patients #1, #2 and #3) with home visit observations. 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, dated 5/2023, an individualized plan of care is required for each client receiving home health and personal care services. The plan of care includes but is not limited to the following: medications, treatments and procedures, medical supplies and equipment required, type, frequency and duration of all visits/services, rehabilitation potential, prognosis and special dietary or nutritional requirements. 1.Patient #1 had a start of care date of 1/17/20. Clinical record review revealed the following: a. The Plan of Care (POC), dated 6/24/24 to 8/22/24 included an order for the following medication: Calcium-Vitamin D3 with instructions to take 1 tablet by mouth twice daily. The order lacked medication dosage. b. The POC included the following durable medical equipment (DME) used by the patient: CPAP/BiPAP, Oxygen, Incentive Spirometer, Nebulizer, Shower Chair, Walker and Med box. c. During a home visit observation on 8/19/24 at 1:00 PM, with Staff C, Registered Nurse (RN), the surveyor identified the following additional DME in the home: life alert button and glucose monitor. During this same visit, an interview with the patient revealed both devices have been utilized by the patient for greater than a year. The POC failed to identify complete medication orders with dosage and all DME the patient required for use. 2. Patient #2 had a start of care date of 11/20/23. Clinical record review revealed the following: a. The POCs, dated 5/8/24 to 7/16/24 and 7/17/24 to 9/14/24, included an order for the following medications: Acetaminophen milligram (mg)as needed every 6 hours, Vitamin D units twice daily and Baclofen (muscle relaxant) mg twice daily in AM and PM. The orders lacked medication dosage. b. The POC included the following durable medical equipment (DME) used by the patient: CPAP/BiPAP, nebulizer, shower chair, walker, wheelchair cushion, B/P cuff, oximeter, catheter bag purses x 2 and scale. c. During a home visit observation on 8/19/24 at 11:30 AM, with Staff D, RN, the surveyor identified the following additional DME in the home: hand held shower and bed rail. During this same visit, an interview with the patient revealed both devices have been utilized by the patient prior to the start of home health services. The POC failed to identify complete medication orders with dosage and all DME the patient required for use. 3. Patient #3 had a start of care date of 8/16/24. Clinical record review revealed the following: a. The POC, dated 8/16/24 to 10/14/24, included the following DME used by the patient: LVAD (left ventricular device) sterile dressing supplies. b. During a home visit observation on 8/19/24 at 11:30 AM, with Staff B, Clinical Manager, the surveyor identified the following additional DME in the home: wheelchair, walker, scale and a reacher. During this same visit, an interview with the patient revealed all devices have been utilized by the patient prior to the start of home health services. The POC failed to identify all DME including a wheelchair, walker, scale and reacher the patient required for use. The above findings were shared with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, Licensed Practical Nurse (LPN). According to the agency policy titled Plan of Care, dated 5/2023, an individualized plan of care is required for each client receiving home health and personal care services. The plan of care includes but is not limited to the following: medications, treatments and procedures, medical supplies and equipment required, type, frequency and duration of all visits/services, rehabilitation potential, prognosis and special dietary or nutritional requirements. 1.Patient #1 had a start of care date of 1/17/20. Clinical record review revealed the following: a. The Plan of Care (POC), dated 6/24/24 to 8/22/24 included an order for the following medication: Calcium-Vitamin D3 with instructions to take 1 tablet by mouth twice daily. The order lacked medication dosage. b. The POC included the following durable medical equipment (DME) used by the patient: CPAP/BiPAP, Oxygen, Incentive Spirometer, Nebulizer, Shower Chair, Walker and Med box. c. During a home visit observation on 8/19/24 at 1:00 PM, with Staff C, Registered Nurse (RN), the surveyor identified the following additional DME in the home: life alert button and glucose monitor. During this same visit, an interview with the patient revealed both devices have been utilized by the patient for greater than a year. The POC failed to identify complete medication orders with dosage and all DME the patient required for use. 2. Patient #2 had a start of care date of 11/20/23. Clinical record review revealed the following: a. The POCs, dated 5/8/24 to 7/16/24 and 7/17/24 to 9/14/24, included an order for the following medications: Acetaminophen milligram (mg)as needed every 6 hours, Vitamin D units twice daily and Baclofen (muscle relaxant) mg twice daily in AM and PM. The orders lacked medication dosage. b. The POC included the following medical equipment used by the patient: CPAP/BiPAP, nebulizer, shower chair, walker, wheelchair cushion, B/P cuff, oximeter, catheter bag purses x 2 and scale. c. During a home visit observation on 8/19/24 at 11:30 AM, with Staff D, RN, the surveyor identified the following additional medical equipment in the home: hand held shower and bed rail. During this same visit, an interview with the patient revealed both devices have been utilized by the patient prior to the start of home health services. The POC failed to identify complete medication orders with dosage and all DME the patient required for use. 3. Patient #3 had a start of care date of 8/16/24. Clinical record review revealed the following: a. The POC, dated 8/16/24 to 10/14/24, included the following medical equipment used by the patient: LVAD (left ventricular device) sterile dressing supplies. b. During a home visit observation on 8/19/24 at 11:30 AM, with Staff B, Clinical Manager, the surveyor identified the following additional medical equipment in the home: wheelchair, walker, scale and a reacher. During this same visit, an interview with the patient revealed all devices have been utilized by the patient prior to the start of home health services. The POC failed to identify all DME including a wheelchair, walker, scale and reacher the patient required for use. The above findings were shared with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, Licensed Practical Nurse (LPN).”

“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 interviews, clinical record reviews and agency policy reviews, the agency failed to ensure home health aides provided care to patients only as ordered by a physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 3 sampled patients receiving home health aide services (Patients #5 and #7). Failure to ensure 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 plan of care increased the risk that the patient’s personal care needs were not adequately met. Findings include: 2. Patient #5 had a start of date of 5/17/24. Clinical record review revealed: a. The Plan of care, dated 7/16/24 to 9/13/24, included orders for skilled nursing services. b. The physician’s order, dated 8/1/24, included orders for a bath aide 3 times a week. c. Review of the clinical record, dated 8/12, 8/14 and 8/16/24, included documentation aide services provided to the patient. The documentation failed to include what tasks completed by the home health aide. d. The clinical record lacked documentation of a written home health aide care plan. e. During an interview on 8/20/24 at 2:45 PM the Clinical Manager stated she failed to complete a home health aide care plan but did give verbal instruction to the aide for services provided. The aide unable to document due to no care plan available. The agency failed to include documentation of tasks provided during aide services. The above findings shared with the Administrator, Clinical Manager, Staff C, RN, Staff D, RN and Staff F, Licensed Practical Nurse (LPN). According to the agency policy titled Home Health Aide Care Plan, dated 5/2023, a Registered Nurse (RN) or Therapist completes and appropriate care plan identifying the duties to be performed by the Home Health Aide. The home health aide cannot be responsible for doing any procedure that is not assigned to him/her in writing by the RN. During an interview on 8/20/24 at 8:14 AM, Staff B, Clinical Manager, identified when a patient requests a home health aide to complete an unassigned task, the home health aide should contact the Clinical Manager. 1.Patient #7 had a start of care date of 4/8/22 and a discharge date of 5/26/24. Clinical record review revealed the following: a. The Plan of Care (POC), dated 3/28/24 to 5/26/24, included physician orders for skilled nursing services twice monthly and home health aide visits twice weekly to assist with personal cares. b. The home health aide care plan, dated 3/28/24 to 5/26/24, identified the following interventions: weight once a week, shower every visit, skin care-apply lotion and foot care. c. Home health aide visit notes for weeks of 3/31/24 to 4/6/24, 4/14/24 to 4/20/24 and 4/21/24 to 4/27/24 failed to include documentation the home health aide performed the task of weighing the patient one time a week and failed to document why the task was not performed. d. Home health aide visit notes dated 4/5/24, 4/12/24 and 4/26/24 identified the home health aide performed a sponge bath instead of a shower per patient request. The home care aide failed to notify the Clinical Manager and/or RN regarding completion of a task not assigned on the patient’s POC. The home health aide failed to provide services ordered by the physician and included in the patient’s POC.”