Guthrie County Phns

“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 review of employee personnel files and staff interview, the hospice failed to ensure 1 of 2 sampled home health aides (Staff D) satisfactorily demonstrated competency on the written skills examination prior to the home health aide providing services to patients. The home health agency employed 4 home health aides at the time of the survey. Failure to ensure home health aides have successfully completed a competency evaluation program increased the risk for patients to receive inadequate or inappropriate care. Findings include: Staff D, Home Health Aide, had a hire date of 3/27/23. Staff D’s personnel file lacked documentation a Registered Nurse (RN) had administered and reviewed the written competency test, dated 4/4/23. On 8/7/24 at 10:00 AM, during an interview, the Director of Finance and Quality confirmed the written examination lacked a signature identifying an RN had administered and reviewed the written competency test. The above information was reviewed with the Administrator, Director of Finance and Quality, Staff C, Registered Nurse (RN), Staff E, RN, Staff F, RN and Staff G, RN.”

“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 observation, agency staff interviews, clinical record review and policy review, the agency failed to ensure agency staff properly authenticated all clinical entry notes and/or completed within the agency’s expected timeframe for 6 of 7 sampled patients( Patient #1, #2, #3, #5 #6, and #7). Failure to ensure all clinical record documentation was dated, timed and signed with staff title and/ or completed within the agency’s expected timeframe, increased the risk of ineffective communication between staff members providing services to its patients. 4. Patient #3 had a start of care date of 4/14/24. Clinical record review revealed the following: a. The POC, dated 6/14/24 to 8/12/24, included physician orders for skilled nursing and home health aide services. b. The home health aide notes signed by Staff I, Home Health Aide, dated 6/14, 6/18, 6/21, 6/25, 7/2 and 7/30/24, lacked a title next to the signature. The agency failed to include the home health aide title in the electronic signature. 5. Patient #5 had a start of care date of 6/12/24. Clinical record review revealed the following: a. The POC, dated 6/10/24 to 8/8/24, included physician orders for skilled nursing and home health aide services. b. The home health aide notes signed by Staff I, Home Health Aide, dated 6/12, 6/17, 6/20, 6/24, 6/26, 7/1, 7/3, 7/8, 7/11, 7/15, 7/18, 7/22, 7/25, 7/29 and 8/1/24, lacked a title next to the signature. The agency failed to include the home health aide title in the electronic signature. 6. Patient #7 had a start of care date of 10/17/24 and discharge date of 4/3/24. Clinical record review revealed the following: a. The POC, dated 12/16/23 to 2/13/24, included physician orders for skilled nursing and home health aide services. b. The home health aide notes signed by Staff C, Registered Nurse, dated 12/5, 12/12 and 12/21/24, lacked a title next to the signature. The agency failed to include the Registered Nurse title in the electronic signature. The above stated findings shared with the Administrator, Staff C, RN, Staff E, RN, Staff F, RN, Staff G, RN and the Director of Finance and Quality. 3.Patient #2 had a start of care date of 6/30/2020. Clinical record review revealed the following: a. The Plan of Care (POC), dated 6/9/24 to 8/7/24 included physician orders for skilled nursing and home health aide services. b. The home health aide notes signed by Staff D, dated 7/5/24, 7/22/24 and 8/2/24 lacked credentials. Agency staff failed to appropriately authenticate the clinical record documents. According to the policy , clinical documentation, dated 10/2022, all routine notes are completed, signed and locked within 24 hours of the visit. 1. Patient #1 had a start of care date of 6/21/24 Clinical record revealed the following: a. The plan of care, dated 6/21/24 to 8/19/24, included physician orders for skilled nursing. a. The routine skilled nursing note dated 8/2/24, was not created or signed as completed until 8/6/24, 3 days late according to the agency’s policy. The agency failed to complete and sign, electronic skilled nursing note timely based on the agency’s policy. According to the policy, Clinical Documentation, dated 10/2022, a separate note will be completed for each visit and signed and dated by the appropriate personal. 2. Patient #6 had a start of care date of 3/9/24. Clinical Record Revealed the Following: a. The Plan of care, dated 03/29/2024 to 05/27/2024, included orders for skilled nursing, physical therapy, occupational therapy and home health aide services. a. The initial Physical Therapy Evaluation, dated 4/3/24, included a digital signature, but lacked credentials. b. The routine Physical Therapy visit notes dated, 4/30/24 and 5/6/24, included a digital signature, but lacked credentials. c. The home health aide routine visit notes, dated 4/3/24, 4/5/24 ,4/8/24, 4/15/524, 4/19/24, and 4/22/24, included a digital signature, but lacked credentials. Agency staff failed to appropriately authenticate the clinical record documents.”

“Duties of a HH aide CFR(s): 484.80(g)(3) The duties of a home health aide include: (i) The provision of hands-on personal care; (ii) The performance of simple procedures as an extension of therapy or nursing services; (iii) Assistance in ambulation or exercises; and (iv) Assistance in administering medications ordinarily self-administered. This Element is not met as evidenced by: Based on agency policy review, clinical record review, staff and patient 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 5 sampled patients receiving home health aide services (Patients #3 and #5). 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, dated 10/5/22, titled Home Health Aide: Assignment, any change in the assignment must be approved by the professional managing the client’s care. The client/caregiver will be notified of all changes. 1. Patient #3 had a start of care date of 4/15/24. a. The Plans of Care (POCs), dated 4/15/24 to 6/13/24 and 6/14/24 to 8/12/24, included physician orders for skilled nursing services for assessment every week and home health aide services 1-2 times per week to assist with personal care. a. The Aide Care Plan, dated 6/13/24, included the following assigned tasks: assist with transfer in/out of shower as requested, light housekeeping pull up bath mat/rinse shower/drape towel, assist dress upper/lower body as requested, comb hair assist as requested, shampoo hair each visit, skin care lotion as requested, shower each visit, universal precautions each visit, deodorant each visit, desitin to bottom as requested, assist with sock/shoes as requested and weight each visit-may refuse if not wearing prothesis. b. Home health aide visit notes, dated 6/4, 6/7, 6/11, 614, 6/18, 6/21, 6/25, 6/28, 7/2, 7/5, 7/9, 7/12, 7/16, 7/19, 7/23, 7/26, 7/30 and 8/2/24, included documentation the patient weight taken with no documentation of weight results. c. During an interview on 8/6/24 at 8:30 AM the patient stated he/she had not requested the home health aide take his/her weight and also stated the home health aide never asked him/her to obtain the patient’s weight. The home health aide failed to provide services that are ordered by the physician, included in the plan of care. 2. Patient #5 had a start of care date of 6/10/24. a. The POC, dated 6/10/24 to 8/8/24, included physician orders for skilled nursing services for assessment every other week and home health aide services 2 times per week to assist with personal care. a. The Aide Care Plan, dated 6/10/24, included the following assigned tasks: change linen per request, tidy bathroom q visit, pull up bathmat, assist dress upper body every visit, comb hair every visit, nail care fingernails per request, shampoo hair every visit, shave every visit, skin care-lotion per request, shower every visit, universal precautions every visit, assist dressing lower body every visit, assist with socks and shoes every visit, light housekeeping tasks and clean bathroom weekly. b. Home health aide visit notes, dated 6/12, 6/17, 6/20, 6/24, 6/26, 7/1, 7/3, 7/8, 7/11, 7/15, 7/18, 7/22, 7/25, 7/29 and 8/1/24, included documentation the home health aide completed the task of clean the bathroom 2 times a week. The home health aide failed to provide services as ordered by the physician, included in the plan of care. The above stated findings were reviewed with the Administrator, Staff C, RN, Staff E, RN, Staff F, RN, Staff G, RN and the Director of Finance and Quality.”

“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 observations, agency staff interviews, record review and policy review, the agency failed to send a discharge summary to the physician and other health care professionals who would be providing care to the patient after discharge within 5 business days for 2 of 2 sampled patients discharged from the agency. ( Patient #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: 2. Patient #7 had a start of care date of 10/17/23 and a discharge date of 1/25/24. Clinical record review revealed the following: a. The Plan of Care, dated 10/17/23 to 12/15/23 and 12/16/23 to 2/13/24, included orders for skilled nursing services and home health aide services. b. The discharge order, dated 1/25/24, included information of the patient’s discharge date, physician responsible for the home health plan of care, reason for admission, discharge condition and outcomes in meeting the goals in the plan of care. The discharge order lacked discharge summary requirements including the following: admission date, medications the patient had been taking at discharge, the type and frequencies of all services provided and teaching provided to the patient and caregiver. c. The clinical record lacked evidence, a discharge summary completed and sent to the physician. The agency failed to complete a thorough discharge summary to send to the physician within 5 days of discharge. The above stated findings shared with the Administrator, Staff C, RN, Staff E, RN, Staff F, RN, Staff G, RN and the Director of Finance and Quality. According to the policy, Client Discharge Process, dated 10/15/22, a completed discharge summary will be sent to the primary care practitioner, or other health care professional who will be responsible for providing care and services to the client after discharge, within 5 days of the discharge. 1.Patient #6 had a start of care date of 3/9/24 and a discharge date of 6/7/24. a. During an interview on 8/6/24 at 3:30 PM, with Staff H, Director of Finance and Quality, stated the software the agency is currently using does not have the option of creating a discharge summary with the required components, staff instructed to add a summary to the discharge order, which is signed by the physician. b. During an interview on 8/7/24 at 8:45 AM, with Staff C, Registered Nurse, the agency does not complete a separate discharge summary, but instead will write a brief summary on the discharge order that is sent to the physician upon discharge. Clinical record review revealed the following: c. The Plan of Care, dated 3/9/24-5/27/24, and 5/28/24 - 7/26/24 included orders for skilled nursing services, physical therapy, occupational therapy and home health aide services. d. The discharge order sent to the physician, dated 6/7/24, included information of the patient’s discharge date, physician responsible for the home health plan of care, reason for admission, discharge condition and outcomes in meeting the goals in the plan of care. The discharge order lacked the summary requirements including: admission date, medications patient was taking at discharge, and type and frequencies of all services provided. e. The clinical record lacked evidence, a discharge summary was completed and sent to the physician. The agency failed to complete a thorough discharge summary to send to the physician within 5 days of discharge.”