Floyd County Public Health/ Home Health Care

“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 visits, patient interviews and clinical record reviews, the agency failed to ensure accurate completion of all components comprising the Plan of Care, including all medical supplies/equipment used by the patient for 3 of 7 sampled patients (Patients #2, #3 and #6). Failure to maintain complete and accurate Plans of Care placed patients at risk to not receive services, supplies, medications and/or treatments according to assessed needs and physician orders. Findings include: 3. Patient #2 had a start of care date of 12/27/24. Clinical record review revealed: a. The POCs, dated 10/25/25 to 12/21/25 and 12/22/25 to 2/29/26, identified the patient had a primary diagnosis of acute kidney failure and included physician orders for medical supplies/equipment used by the patient. The POCs included the following medical supplies/equipment used by the patient: cane, grab bars, tub/shower bench, walker, walker with seat, medication planner, reacher, life alert, glucometer and diabetic supplies, incontinence supplies, hand-held shower head, and high rise toiler. b. During a home observation visit on 1/12/26 at 3:00 PM with Staff D, Registered Nurse (RN), Staff D reviewed the patient’s weight log. During the home visit, the patient was seated in a lift chair. The patient stated during the same home visit she has used both the scale and lift chair since start of care. The agency failed to include all medical supplies/equipment on the patient’s POC, including the scale and lift chair. These findings were reviewed with Administrator. 1.Patient #3 had a start of care date of 1/5/26. Clinical record review revealed: a. The Plan of Care (POC), dated 1/5/26 to 3/5/26, identified the patient had a primary diagnosis of malignant neoplasm of left kidney and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: bedside commode, grab bars, wheelchair, wound supplies, electric wheelchair, Hoyer lift and sling, bed pan, incontinence supplies, walk in shower with bench, lift chair, Continuous Positive Airway Pressure (CPAP), hemi-walker, medication planners, pill cutter, diabetic supplies, reacher, medical marijuana and card, adjustable side table, bariatric adjustable bed, bidet, electric blood pressure cuff, peripheral oxygen saturation monitor, ramp, gait belt and knee pads. b. During a home observation visit on 1/13/26 at 8:30 AM with Staff B, Clinical Manager, the surveyor identified the following medical supplies/equipment next to the patient’s bed: emesis bags and urinals. The patient stated during the same home visit he has used both the urinal and emesis bags since start of care. The agency failed to include all medical supplies/equipment on the patient’s POC, including emesis bags and urinals. 2. Patient #6 had a start of care date of 8/14/25 and a discharge date of 9/19/25. Clinical record review revealed: a. The POC, dated 8/14/25 to 10/12/25, identified the patient had a primary diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side and included physician orders for medical supplies/equipment used by the patient. The POC included the following medical supplies/equipment used by the patient: grab bars, wheelchair, walk in shower with seat, gait belt, two wheeled walker, lift chair, wound care supplies, hand-held shower head, chair pads, elevated toilet seat, slipper socks, pill cutter, electronic blood pressure cuff, latitude home monitor and pressure relief ankle foot orthosis boot. b. The skilled nurse start of care visit note, dated 8/14/25, completed by Staff B, Clinical Manager, identified the patient wears incontinence products. The agency failed to include all medical supplies/equipment on the patient’s POC, including incontinence supplies.”

“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 review 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 4 sampled patients who received hands on personal care services in conjunction with a skilled service provision (Patients #1 and #2). The agency reported 25 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 #2 had a start of care date of 12/27/24. Clinical record review revealed: a. The Plans of Care (POC), dated 10/23/25 to 12/21/25 and 12/22/25 to 2/29/26, identified the patient had a primary diagnosis of acute kidney failure and included physician orders for skilled nursing and home health aide services. b. The skilled nurse visit note, dated 12/18/25, Staff D, RN, included documentation of home health aide supervision. c. The skilled nurse visit note, dated 1/12/26, Staff D included documentation of home health aide supervision. Home health aide supervision was 25 days late. The agency failed to provide home health aide supervision every 14 days. These findings were reviewed with the Administrator. According to the agency’s policy titled Documentation Instructions for Home Care Aide Plan and Supervision, dated August 2009, home care aide supervision is documented every 14 days and can be done with the home care aide absent or present. During an interview on 1/13/26 at 1:31 PM, Staff B, Clinical Manager, stated home health aide supervision is completed a minimum of every 14 days and documented by the Registered Nurse (RN), in the skilled nurse visit note. 1.Patient #1 had a start of care date of 9/3/25. Clinical record review revealed: a. The Plan of Care (POC), dated 11/2/25 to 12/31/25, identified the patient had a primary diagnosis of congestive heart failure and included physician orders for skilled nursing and home health aide services. b. The skilled nurse visit note, dated 12/15/25, Staff C, RN, included documentation of home health aide supervision. c. The skilled nurse visit note, dated 12/30/25, Staff C, RN, included documentation of home health aide supervision (1 day 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 clinical record, agency policy, and staff interview, 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 of all assigned tasks, complying with infection prevention and control policies, reporting changes in patient condition, and honoring patient rights for 1 of 4 sampled patient receiving home health aide services (Patient #2). 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 patient’s personal care needs. Findings include: According to agency policy titled Documentation Instructions for Home Care Aide Plan and Supervisions, dated August 2009, documentation every 14 days can be done with the HCA (Home Care Aide) absent or present and should include client response to aide service, effectiveness of aide service, introduction, instructions, demonstrations, revisions to aide assignments, and review of aide’s notes. Patient #2 had a start of care date of 12/27/24. Clinical record review revealed the following: 1. The Plans of Care (POC) dated 10/23/25 to 12/21/25 and 12/22/25 to 2/29/26 included orders for skilled nursing and home health aide services. The POC identified the patient a diagnosis of acute kidney failure, weakness, and malaise (feeling tired). 2. Skilled nursing visit notes dated 11/3/25, 11/17/25, 12/1/25, 12/15/25, 1/12/26 included documentation that home health supervision was completed. The notes lacked documentation of all required supervisory elements including following the patient plan of care, maintaining open communication with patient/caregiver, demonstrating competency of all assigned tasks, complying with infection prevention and control policies, reporting changes in patient condition and honoring patient rights. In an interview on 1/14/26 at 8:21 AM, the Administrator reported that the supervisory form button has to be checked to open the form in order to check off the components to select for the required components of the aid supervision and that this was not done. The findings were reviewed with the Administrator.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on clinical record review, agency policy, and staff interview, the agency failed to maintain documentation showing transfer summaries were sent to the physician caring for the patient at the inpatient facility after transfer within 2 business days of the agency becoming aware of the patient’s transfer for 1 of 2 patients reviewed with transfers (Patient #7). Failure to send the physician a summary of the patient’s care while receiving services from the agency in a timely manner may result in inadequate or inappropriate follow-up during inpatient care or after discharge. Findings include: According to agency policy, titled Transfer/Discharge Criteria dated December 2017, if a patient is hospitalized or transferred to another facility a patient transfer summary will be sent to that facility notifying them of home care services. Notification will be made timely. In a concurrent review of facility policy and interview on 1/14/26 at 8:28 AM, the Administrator reported that timely notification from facility policy for a patient transfer was defined as within 48 hours after the agency becoming aware that the patient was admitted to a facility. Patient #7 had a start of care date of 4/24/25. Clinical record review revealed the following: The Journal Note, dated 7/11/25, revealed that the patient’s husband called the agency to report that the patient was hospitalized. The Transfer Assessment, dated 7/11/25, revealed that the patient hospitalized on 7/11/25. The Transfer Order, dated 7/11/25, revealed the transfer summary was sent to the patient’s primary care physician. The agency failed to send the patient’s transfer summary to the receiving facility. 2. The journal note, dated 7/28/25, revealed that the patient’s husband called the agency to report that the patient was hospitalized. The Transfer Assessment, dated 8/8/25, revealed that the patient was transferred to a skilled nursing facility on 8/8/25. The agency failed to send the patient’s transfer summary to the receiving facility in a timely manner. The findings were reviewed with the Administrator.”