Taylor County Public Health Agency

“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 agency policy review, clinical record review and agency staff interview review the agency failed to ensure accurate and thorough completion of a comprehensive assessment of wounds for 1 of 1 sampled patients with wounds (Patient #4). Failure to accurately and thoroughly complete a thorough comprehensive assessment to address individualized pertinent areas of health to obtain baseline findings placed patients at an increased risk of unidentified condition. Findings include: According to the undated agency policy, titled Wound Measurement, three-dimensional measurement includes the length, width, and depth. For undermining, there may be a larger area, measure the location of undermining and the area covered. May document as follows: 3 cm of undermining form 12 to 3 o’clock, 2 cm of undermining from 4 to 6 o’clock, etc. Accuracy and consistency are most important. Wound measurements are done with routine wound care procedures at minimum of weekly. If possible, the same person should do the measurements for consistency. During an interview on 12/16/25 at 9:15 AM the Clinical Manager stated the wound measurements are documented weekly and include the length, width and depth of the wound. Patient #4 had a start of care date of 3/9/15. Clinical record review revealed the following: a. The plans of care (POCs), dated 9/12/25 to 11/10/25 and 11/11/25 to 1/9/25, identified the patient had a diagnosis of sepsis. The POCs included orders for skilled nurse services and wound care. b. The comprehensive assessment at resumption of care, dated 11/26/25, Staff C, Registered Nurse (RN) documented the patient had a wound on the midline inner buttock rectal area, right ischial decubitus ulcer. The wound documentation included measurements of 2 centimeters (cm) length by 5.2 cm width with 1.3 cm depth. The wound included undermining located at 11 o’clock. Staff C failed to include documentation of measurements of the undermining. b. The skilled nurse visit notes, dated 12/3, 12/5, 12/8, 12/10 and 12/12/25, Staff C, RN documented the patient had a wound on the midline inner buttock rectal area, right ischial decubitus ulcer. The wound documentation included measurements of length, width and depth. The wound identified undermining located at 11 o’clock. Staff C failed to include documentation of measurements of the undermining. The agency failed to document complete wound assessments. The above findings were reviewed with the Clinical Manager.”

“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, 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 Drug Regimen Review, revised 10/2/25, the comprehensive drug regimen review (DRR) assessment completed at the time of admission and at least every 60 days as part of and at the time of the comprehensive assessment, the Registered nurse (RN) will review with the patient/caregiver all medications, prescribed as well as over-the-counter, that the patient is taking in order to identify: medication orders discrepancies between patient understanding, RN initial orders, discharge orders and/or hospital discharge summaries and addition or discontinuance of medication. During an interview on 12/16/25 at 9:15 AM, the Clinical Manager stated the DRR is completed on admission, with each comprehensive assessment, resumption of care and at discharge. 1.Patient #1 had a start of care date of 7/18/22. Clinical record review revealed: a. The Plan of Care (POC), dated 11/9/25 to 1/7/26, identified the patient had a diagnosis of atherosclerosis and included physician orders for medications and skilled nursing services. Medication orders included Magnesium 400 milligrams (mg) with calcium 1000 mg and zinc 25 mg daily. b. The recertification comprehensive assessment, dated 11/4/25, completed by Staff C, Registered Nurse (RN), included documentation a DRR was completed. c. During a home observation visit on 12/2/25 at 11:15 AM with Staff D, RN, the surveyor noted the RN set up the patient’s medications. The patient’s bottle identified the magnesium 500 mg and observed to be 1/2 empty. 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 1/3/25. Clinical record review revealed: a. The POC, dated 10/30/25 to 12/28/25, identified the patient had a diagnosis of diabetes mellitus and included physician orders for medication and skilled nursing services. b. The recertification comprehensive assessment, dated 10/27/25, completed by Staff C, RN, included documentation a DRR was completed. c. During a home observation visit on 12/17/25 at 10:00 AM with Staff C, RN, the surveyor identified a bottle of Acetaminophen 500 mg tablets on the table next to the recliner. During the same observation visit, the patient stated he/she takes 2 tablets 1 time a day as needed for pain. The DRR failed to include an accurate review of all medications taken by the patient. The above findings reviewed with the Clinical Manager.”

“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 observations, staff and patient interviews, clinical record review and policy review, the agency failed to ensure the accurate completion of all components comprising the Plan of Care, including all supplies and equipment used by the patient for 2 of 3 sampled patients with surveyor home visit observation (Patients #2 and #3). Failure to maintain complete and accurate Plans of Care with current orders placed the patients at risk to not receive services, medications and/or treatments according to assessed needs and physician orders. Findings include: According to agency policy titled Home Health Clinical Record, dated 10/2/25, the original plan of care is signed and dated by the physician who is responsible for the care of the patient and incorporated into the clinical record in a timely manner. Total plan of care will be reviewed as frequently as the patient’s condition dictates, but at least every sixty (60) days. 1.Patient #1 had a start of care date of 12/5/25. Clinical record review and home observation revealed the following: a. The plan of care (POC) dated 1/15/25 to 3/16/25, included a diagnosis of collapsed vertebrae thoracic region. Services, supplies, and equipment utilized by the patient included bedside commode, hand-held shower, grab bars/safety rails, reacher/grabber, medication reminder boxes, incontinence pads, shower wand and 2 wheeled walker. b. During a home observation visit 12/17/25, at 8:30 AM with Staff D, Registered Nurse (RN), the surveyor also noted the patient stated he/she also had a heating pad he/she had used following the admission for home health services. The agency failed to include all of the services, supplies, and equipment the patient utilized to include the heating pad on the POC. 2. Patient #3 had a start of care date of 1/3/25. Clinical record review and home observation revealed the following: a. The POC, dated 10/30/25 to 12/28/25, included a diagnosis of diabetes mellitus. Services, supplies, and equipment utilized by the patient included rolling walker, shower chair, hand-held shower, long handled sponge and grab bars/safety rails. b. During a home observation visit 12/17/25, at 10:00 AM with Staff D, RN, the surveyor also noted the patient utilized a chair cushion, urinal, CPAP (continuous positive airway pressure), reacher, glucometer, and diabetic supplies. The agency failed to include all of the services, supplies, and equipment the patient utilized to include the chair cushion, urinal, CPAP, reacher, glucometer, and diabetic supplies on the POC. The above findings were reviewed with the Clinical Manager.”

“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 staff interview, policy review and clinical record review, the agency failed to ensure home health aides provided care to agency patients only as ordered by the physician in the Plan of Care and/or as directed by the skilled professional assigning the home health aide to the patient for 2 of 4 sampled patients receiving home health aide services (Patients #3 and #5). The agency reported 12 patients who received care provided by a home health aide. Failure to ensure that home health aide services are provided only as ordered by the physician 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 Services, dated 10/2/25, the supervising Registered Nurse (RN) prepares written instructions outlining the individualized care needed by the patient based on an assessment of the client’s needs. Plan will be in accordance with physician orders for home care aide cases. Home Care Aide will provide only the care/services listed on the assignment sheet and not alter, add to, or change the tasks in any way without authorization form the supervisor. During an interview on 12/16/25 at 9:15 AM, the Clinical Manager reported aides are to document in the narrative portion of the document if the patient refused a task. The aides are to reach out to the nurse to report a patient request for a task not on the care plan. 1.Patient #3 had a start of care date of 1/3/25. Clinical record review revealed: a. The Plan of Care (POC), dated 10/30/25 to 12/28/25, included primary diagnosis of diabetes mellitus and physician orders for skilled nursing and home health aide services. b. The home health aide assignment, with an effective date of 10/30/25, directed the home health aides to ambulate the patient using assistive device, report to RN if no bowel movement, clean bathroom after patient care, assist patient with dressing, partial bath, shower chair, encourage to wear glasses/hearing aide, lotion to back and feet as requested with non-medicated lotion and universal precautions. c. The home health aide visit notes, dated 10/22, 10/24 and 10/27/25, Staff E, HCA, documented both partial bath and shower completed. The visit notes also included documentation a shampoo completed, not included in the assigned tasks. The HCA failed to follow the aide care plan as written. 2. Patient #5 had a start of care date of 10/24/25 and received services out of the Bedford parent office. Clinical record review revealed: a. The POC, dated 10/24/25 to 12/22/25, included primary diagnosis of pleural effusion and physician orders for skilled nursing and home health aide services. b. The home health aide assignment, with an effective date of 10/24/25, directed the home health aides to ambulate the patient using assistive device, assist patient with home exercise program, assist with dressing and undressing, partial sponge bath as requested, shower chair as requested, lotion as requested with non-medicated lotion as requested, perineal care shampoo as requested, remind to wear emergency call system and standard precautions. c. The home health aide visit notes, dated 11/10/25, Staff E, HCA, failed to documented the partial bath completed or not completed. d. The home health aide visit note, dated 11/18/25, Staff E, HCA, documented both partial sponge bath and shower chair completed. The HCA failed to follow the aide care plan as written. The above findings were reviewed with the Clinical Manager.”

“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 agency policy review, clinical record review and agency staff interview, the agency failed to complete and send a transfer summary to the physician caring for the patient at the inpatient facility after transfer within 2 business days of the patient’s transfer and/or failed to complete and send a discharge summary to the physician and other health care professionals who would be providing care to the patient after discharge within 5 calendar days for 3 of 3 sampled patients with transfers/ discharges (Patients #4, #6 and #7). Failure to send the physician and other health care professionals 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 the agency policy titled, Discharge/Transfer Criteria for Home Health Services, dated 5/21/24, within 2 business days of when the agency becomes aware that a client is transferred to another health care facility or moves out of the agency’s geographic service area, but still needs care, a written referral/transfer form will be completed and sent to the new agency. During an interview on 12/17/25 at 12:30 PM the Clinical Manager stated the agency did not have documentation a transfer summary sent to the receiving facility. 1.Patient #4 had a start of care date of 4/4/25. Clinical record review revealed: a. The plans of care (POCs), dated 10/1/25 to 11/29/25 and 11/30/25 to 1/28/25, identified the patient had a diagnosis of sepsis. The POC included orders for skilled nursing services. b. An interim physician’s order, dated 9/29/25, ordered to place services on hold due to transfer to the hospital. c. A home health transfer summary, dated 10/7/25, Staff C, RN documented the patient transferred to the hospital (6 business days after the transfer and 4 days late per policy) and the transfer summary sent to the primary care physician. The agency failed to complete the transfer summary within 2 business days and failed to send the transfer summary to the receiving hospital. 2. Patient #6 had a start of care date of 10/10/25 and discharge date of 11/12/25. Clinical record review revealed: a. The POCs, dated 10/10/25 to 12/8/25, identified the patient had a diagnosis of B-cell lymphoma. The POC included orders for skilled nursing services and aide. b. An interim physician’s order, dated 10/29/25, ordered to place services on hold due to transfer to the hospital. c. A home health transfer summary, dated 11/13/25, Staff D, RN documented, 9 business days after the visit and 7 days late (per agency policy), the patient transferred to the hospital and the transfer summary sent to the primary care physician. The agency failed to complete the transfer summary within 2 business days and failed to send the transfer summary to the receiving hospital. 3. Patient #7 had a start of care date of 11/5/25 and discharge date of 11/17/25. Clinical record review revealed: a. The POC, dated 11/4/25 to 1/3/26, identified the patient had a diagnosis of hepatic encephalopathy. The POC included orders for skilled nursing services. b. A home health transfer summary, dated 11/17/25, Staff D, RN documented the patient transferred to the hospital on 11/14/25 and the transfer summary sent to the primary care physician. The agency failed to send the transfer summary to the receiving hospital. The above findings reviewed with the Clinical Manager.”