Iowa Home Care, L L C

“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, staff interview, and agency policy, the agency failed to ensure the home health aides successfully completed competencies in home health aide skills that exceed basic skills, which require a registered nurse (RN), or other appropriate skilled professional in consultation with a registered nurse, to evaluate the competency of the aide by direct observation for 3 of 4 sampled home health aides (Staff C, D, and E). Failure to ensure home health aides were competent in a skill which exceed the level of basic home health aide skills placed agency patient at risk to receive inadequate or unsafe home health aide services. Findings include: According to agency policy titled Home Health Training, last revised January 2014, the competency evaluation program is conducted at the time of orientation prior to delivery of services and annually. The program includes observation of performance of the following skills: taking and recording temperature, pulse, and respiration; appropriate and safe techniques in personal hygiene and grooming that include bed bath, sponge, tub, or shower bath, shampoo in sink, tub or bed, nail and skin care, oral hygiene, toileting and elimination; safe transfer techniques and ambulation assistance; normal range of motion and positioning. Additional training will be provided and documented when clients are receiving high technology or complex services. Home health aide personnel files must contain competency training and /or evaluation and competency skills checklist. In an interview on 3/4/26 at 9:56 AM, when asked about Staff E’s competency testing for simple dressing changes, the Administrator reported that she was not employed at the agency during Staff E’s employment period and was not aware of why the competency testing was not performed. In an interview on 3/4/26 at 10:13 AM, the Chief of Organizational Performance reported that the agency did not start skills testing for feeding until after Staff C was hired. 1.Patient #1 had a start of care date of 12/27/24. Clinical record review revealed the following: a.The Plan of Care (POC), dated 12/22/25 to 2/19/26, directed the aide to shave the patient’s face at the direction of the client. The clinical record identified that Staff C provided care to the patient. b.Staff C had a hire date of 3/1/24. Staff C’s personnel file lacked documentation of competency testing to ensure competency evaluation was completed for shaving the patient’s face. 2. Patient #4 had a start of care date of 8/19/25. Clinical record review revealed the following: a.Home health aide care plan, dated 2/15/26, directed the aide to apply orthotic braces to feet and assist with feeding. The clinical record identified that Staff C provided care to the patient. b.Staff C had a hire date of 3/1/24. Staff C’s personnel file lacked documentation of competency testing to ensure competency evaluation was completed to apply orthotic braces to feet and assist with feeding. In an interview on 3/4/26 at 10:13 AM, the Chief of Organizational Performance reported that the agency did not start skills testing for feeding until after Staff C was hired. 3.Patient #7 had a start of care date of 3/29/25. Clinical record review revealed the following: a.The POC, dated 7/27/25 to 9/24/25, directed the aides to perform a simple dressing change every visit to the patient’s right shin and to the patient’s sacral (base of spine) wound. The clinical record identified that Staff D and E provided care to the patient. b.Staff D had a hire date of 7/16/24. Staff D’s personnel filed lacked documentation of competency testing to ensure competency evaluation was completed for simple dressing changes. c.Staff E had a hire date of 4/10/25. Staff E’s personnel file lacked documentation of competency testing to ensure competency evaluation was completed for simple dressing changes. The above findings were reviewed with the Chief of Organizational Performance, Administrator/Clinical Manager, and Office 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 home observation visits, patient interview, clinical record review, and agency policy review, the agency failed to ensure accurate completion of all components comprising the Plan of Care (POC), including all medical supplies/equipment and all medication for used by the patient for 3 of 3 home visits (Patients #1, #2, and #3). Failure to maintain complete and accurate POCs with current orders placed patient at risk to not receive services, supplies, and/or medication according to assessed needs and physician orders. Findings include: 3. Patient #3 had a start of care date of 4/21/23. Clinical record review revealed: a. The POCs, dated 12/6/25 to 2/3/26 and 2/4/26 to 4/4/26, identified the patient had a primary diagnosis of Hypertensive heart disease with kidney disease and included physician orders for medications and medical supplies/equipment used by the patient including: cane, grab bars, hand-held shower, nebulizer, oxygen, oxygen concentrator, oxygen tubing, pill splitter, shower chair, urinal, walker, medication planner, humidifier, nonsterile gloves and personal protective equipment. b. During a home observation visit on 3/3/26 at 10:00 AM with Staff G, Registered Nurse (RN), the surveyor identified the patient had a incentive spirometer (device to help with strengthening the lungs) located on the dining table. The patient stated the incentive spirometer used since hospitalization in January, 2026. c. During the same home observation visit, the surveyor identified the patient had the medication polyethylene glycol (laxative) and took 17 grams daily as needed for constipation. The patient stated the medication used for greater than 2 months. The agency failed to include all medical supplies/equipment on the patient’s POC, including an incentive spirometer and the medication polyethylene glycol. The above findings reviewed with the Administrator/Clinical Manager, Chief of Organizational Performance and Office Manager. According to the agency policy titled Care Planning Process, last revised October 2024, the patient specific clinical plan of care includes: supplies and equipment required and medications including dose/frequency/route/purpose. 1.Patient #1 had a start of care date of 12/27/24. Clinical record review revealed: a.The POC, dated 12/22/25 to 2/19/26, identified the patient had a primary diagnosis of lymphedema (swelling in the body) 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, hand held shower, incontinent supplies, lymphedema pumps, pill splitter, scale, sock slider, compression hose, TENS unit (transcutaneous electrical nerve stimulation), wound care supplies, wood shelf in tub to sit on. The POC identified the patient receives skilled nursing visits every other week. b.During a home observation visit on 3/2/26 at 3:00 PM with Staff G, Registered Nurse (RN), a walker was present in the home. The patient reported that he uses the walker in the home and started using the walker 1 month ago. The patient patient reported that he received two therapeutic seat cushions (used to prevent pressure ulcers and/or skin breakdown) 2 years ago and placed them in the chairs he uses daily. The agency failed to include all medical supplies/equipment on the patient’s POC, including a walker and therapeutic seat cushions. 2.Patient #2 had a start of care date of 5/16/22. Clinical record review revealed: a.The POC, dated 2/24/26 to 4/24/26, identified the patient had a primary diagnosis of essential hypertension (high blood pressure) and included physician orders for medication used by the patient. The POC included albuterol sulfate (to treat or prevent sudden breathing problems) 90 micrograms/actuation aerosol inhaler 2 puffs every 4 hours as needed for shortness of breath. b.During a home observation visit on 3/3/26 at 10:00 AM, with Staff B, Licensed Practical Nurse (LPN), the patient reported that she has never used albuterol. The agency failed to include current medications used by the patient.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on home observation visit, clinical record review, staff and patient interview and agency policy review, the agency failed to provide services only as ordered by the physician for 3 of 3 home visit observations (Patients #1, #2. and #3). Failure to ensure staff follow physician orders for treatments provided by agency staff placed patient at risk for inconsistent care/treatment and possible harm. Finding include: 3. Patient #3 had a start of care date of 3/21/23. Clinical record review revealed the following: a. The POC, dated 2/4/26 to 4/4/26, included primary diagnosis of Hypertensive heart disease with kidney disease and physician orders for skilled nurse and medications including: Varenicline (smoking cessation) 1 milligram (mg) 2 times a day, Finasteride (5 alpha reductase inhibitor) 5 mg daily, Iron (supplement) 325 mg daily and Tamsulosin (alpha blocker) 0.4 mg 2 times a day. b. During a home observation visit on 3/3/26 at 10:00 AM with Staff G, RN, set up the patients medications in a medication planner. The surveyor noted the following medications not set up in the planner: Varenicline, Fenasteride, Iron and Tamsulosin. c. During an interview at the same home visit the patient stated Varenicline discontinued after approximately 30 days (start date 1/19/26). The clinical record failed to include orders to discontinue the medication. d. During an interview at the same home visit, Staff G, RN, stated the medications Fenasteride, Iron and Tamsulosin not added to the patient’s medication planner due to the primary physician will not order until the patient seen at the urology clinic. Staff G stated the medications not taken for 2 weeks and the urology appointment not scheduled. Agency staff failed to discontiue medications and/or place medications on hold when no longer administered. The above stated findings were reviewed with Administrator/Clinical Manager, Chief of Organizational Performance and Office Manager. According to agency policy, titled Care Planning Process, last revised October 2024, the Plan of Care (POC) will be based upon the physician’s orders and will encompass the services required to meet the patient’s needs and any other pertinent instruction related to the patient’s care and treatments that the organization will provide, specific to the patient’s care needs. 1.Patient #1 had a start of care date of 12/27/24. Clinical record review revealed: a.The POC, dated 12/22/25 to 2/19/26, identified the patient had a diagnosis of lymphedema (swelling of the body) and failed to include orders for physical therapy (PT). b.A clinical record document titled Medical Documentation, dated 12/11/25, included a new order for in home PT to evaluate and treat for 2 visits per week for 6 weeks. The Clinical Record failed to reveal that PT performed home visits or why the PT did not perform home visits. 2.Patient #2 had a start of care date of 5/16/22. Clinical record review revealed: a.The POC, dated 2/24/26 to 4/24/26, identified the patient had a diagnosis of essential hypertension (high blood pressure)and included skilled nurse orders of no blood pressure to left arm due to lymph node removal. b.During a home observation visit on 3/3/26 at 10:00 AM, Staff B, Licensed Practical Nurse (LPN) performed a blood pressure procedure on the patient’s left arm. Agency staff failed to follow physician’s orders to not use the patient’s left arm to obtain blood pressure.”

“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 clinical record review, policy review and agency staff interview, 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 1 of 6 sampled patients receiving home health aide services (Patients #4). The agency reported 49 patients 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 policy, titled Plan of Care, dated October, 2024, the patinet’s Registered Nurse (RN) Case Manager or other appropriate skilled professional, upon initialization of aide services, will develop the written home health aide plan of care, consistent with the comprehensive plan of care and physician orders. The home health aide care plan will be individualized to the specific patient and will include safety measures, including use of specific equipment. During an interview on 3/3/26 at 3:15 PM, The Administrator/Clinical Manager stated the aide documentation was completed on the aide documentation visit and If a task not completed, the aide informs the RN. Patient #4 had a start of care date of 12/4/2020. Clinical record review revealed the following: a. The Plans of Care (POC), dated 12/17/25 to 2/14/26 and 2/15/26 to 4/15/26, included primary diagnosis of Chromosomal abnormality and physician orders for skilled nurse and home health aide services. b. The aide care plan, dated 2/15/26, identified the following home health aide tasks: two person assist with transfers or use mechanical lift. c. Aide visit notes, dated 2/17/26, 2/18/26, 2/19/26, 2/20/26 and 2/23/26, completed by Staff H, Home Care Aide (HCA), included documentation transfer completed but failed to identify the transfer completed by a 2 person transfer or use of a mechanical lift. The agency failed to document the actudal type of transfer completed using 2 person assist or mechanical lift. The above stated findings were reviewed with the Administrator/Clinical Manager, Chief of Organizational Performance and Office Manager.”