Open Arms Home Health Care - Des Moines, LLC

“Home health aide services CFR(s): 484.80 Condition of participation: Home health aide services. All home health aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section. This Condition is not met as evidenced by: Based on clinical record review, agency policy review and agency staff interview, the agency failed to: 1) determine satisfactory competency may be evaluated through written examination (G768); 2) assure written patient care instructions for home health aide prepared by registered nurse (G798); 3) assure home health aides provide services included in the plan of care (G800); 4) supervise home health aides every 14 days when provided in conjunction with a skilled services (G808); and 5) assure annual supervision completed by registered nurse (G812). The cumulative and egregious effects of these systemic practices resulted in the failure to ensure the organizational framework of the agency promoted and supported the coordination of safe and effective delivery of care to the agency’s 122 patients, 76 of who received home health aide services.”

“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 policy review, clinical record review and agency staff interview, 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 for Care for 4 of 6 sampled patients. (Patient #1, #3, #5 and #6) 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: According to the agency policy, titled Assessment and Plan of Care Policy: Plan of Care Contents, dated 3/1/21, it is the responsibility of agency personnel to promptly alert the physician or allowed practitioner to any changes that suggest a need for an alteration in the plan of care. During an interview on 7/24/25 at 8:45 AM, Staff B, Regional Administrative Assistant reported the missed visits are documented in coordination notes and this goes to a work flow process that will fax the notification of missed visit information to physician. 1.Patient #3 had a start of care date of 3/19/24. Clinical record review revealed: a. Plan of Care, dated 5/13/25 to 7/11/25, included diagnosis of essential hypertension (high blood pressure) and orders for home health aide services 15 times a week for one week, 21 times a week for 7 weeks and 18 times a week for 1 week. b. Home health aide visit notes identified 3 notes, dated 6/29/25, 6/30/25, 7/1/25, 7/2/25, 7/3/25 and 7/4/25, and 1 visit note, dated 7/5/25, for a total of 19 visits for the week starting 6/29/25. The agency failed to complete the 21 visits as ordered or document a reason why the visits were not completed as ordered. c. Plan of Care, dated 7/12/25 to 9/9/25, included diagnosis of essential hypertension (high blood pressure) and orders for home health aide services 3 times a week for 1 week, 21 times a week for 8 weeks and 9 times a week for 1 week. d. Home health aide visit notes identified 2 notes, dated 7/12/25, and lacked a third visit note as ordered or documentation of a reason why the third visit was not completed. e. Home health aide visit notes identified 3 visit notes, dated 7/13/25, 7/14/25, 7/15/25, 7/16/25, 7/17/25 and 7/18/25, and 2 visit notes dated 7/19/25, for a total of 20 visits for the week starting 7/13/25. The agency failed to complete the 21 visits as ordered or document a reason why the visits were not completed as ordered. The agency failed to notify the physician of the failure to complete home health aide visits as ordered. 2. Patient #5 had a start of care date of 1/10/24. Clinical record review revealed: a. Plan of Care, dated 5/4/25 to 7/2/25, included diagnosis of Type 2 Diabetes mellitus without complications and orders for home health aide services 16 times a week for 8 weeks and 9 times a week for 1 week. b. Home health aide visit notes identified 15 notes for the weeks starting, 5/11/25, 5/18/25, 5/25/25, 6/1/25, 6/8/25, 6/15/25 and 6/22/25. The agency failed to document a 16th visit for these weeks or a reason why the 16th visit was not completed. c. Home health aide visit notes identified 8 notes for the week starting 6/29/25. The agency failed to document a 9th visit for the week or a reason why the 9th visit was not completed. The agency failed to notify the physician of the failure to complete home health aide visits as ordered. 3. Patient #6 had a start of care date of 1/16/25. Clinical record review revealed: a. Plan of Care, dated 1/16/25 to 3/16/25, included diagnosis of osteoporosis and orders for home health aide services once a week for 8 weeks. b. Interim physician order, dated 2/4/25, included orders for home health aide services 14 times a week for 1 week, 23 times a week for 5 weeks and 3 times a week for 1 week. c. Home health aide visit notes identified 5 notes for the week starting 2/2/25. The agency failed to document 9 additional visits to total 14 visits for the week or document a reason why the visits were not completed as ordered. d. Home health aide visit notes identified 17 notes for the week starting 2/9/25. The agency failed to document 6 additional visits to total 23 visits for the week or document a reason why the visits were not completed as ordered. e. Home health aide visit notes identified 18 notes for the week starting 3/2/25. The agency failed to document 5 additional visits to total 23 visits for the week or document a reason why the visits were not completed as ordered. f. Home health aide visit notes identified 20 notes for the weeks starting 2/16/25 and 2/23/25. The agency failed to document 3 additional visits to total 23 visits for the week or document a reason why the visits were not completed as ordered. The agency failed to notify the physician of the failure to complete home health aide visits as ordered. 4. Patient #1 had a start of care date of 4/15/25. Clinical record review revealed: a. Plan of Care, dated 4/15/25 to 6/13/25, included diagnosis of anemia and orders for home health aide services once a week for one week and then twice a week for 8 weeks. b. Home health aide visit notes, dated 5/15/25, 5/22/25, 5/29/25 and 6/2/25. The agency failed to complete a second visit for the weeks starting 5/18/25 and 5/25/25 or document a reason why a home health aide visit was not completed as ordered. The agency failed to notify the physician of the failure to complete home health aide visits as ordered. The above stated findings were reviewed with Regional Administrator and Regional Administrative Assistant.”

“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 and staff interview, the agency failed to ensure a registered nurse or other appropriate skilled professionals in consultation with a registered nurse as appropriate performed direct observation of home health aide performance of all required basic home health aide skills on a home health patient to determine satisfactory competency prior to allowing the home health aide to provide care independently to agency patients for 1 of 9 sampled home health aides hired since 4/10/23. (Staff F). The agency hired 18 new home health aides since 4/10/23. The agency currently employed 27 home health aides and provided home health aide services to 76 patients at the time of the survey. The agency reported a current census of 122 patients at the time of the survey. Failure to ensure home health aides successfully complete a written competency evaluation placed agency patients at risk to receive inadequate or unsafe home health aide services. Findings include: The Medicare Conditions of Participation require home health agencies to ensure all newly hired home health aides are competent in all of the basic home health aide skills by successfully demonstrating competency in the performance of all of the “hands on” basic home health aide skills with a home health patient, exactly as these tasks will be performed with an actual home health patient, a pseudo-patient or by written examination, in the presence of a qualified RN before being assigned to provide any patient care independently. The list of “hands on” basic home health aide tasks are: communication skills, reading and recording temperature, pulse, respirations, bed bath, sponge bath, tub bath and shower bath, shampoo in a sink, tub and bed, skin care, oral care, nail care, toileting and elimination, transfers/ambulation, positioning, nutrition and fluid intake and range of motion. During an interview on 7/24/25 at 11:36 AM, Staff B, Regional Administrative Assistant reported she corrects and reviews all home health aide written competency examinations. During an interview on 7/24/25 at 1:10 PM, Staff A, Regional Administrator, reported Staff B, Regional Administrative Assistant is responsible for onboarding all new staff and review the home health aide written competency examination. Staff F, Home Health Aide, had a hire date of 2/11/25. Staff F’s personnel file lacked a written competency examination answer sheet. Staff F currently provided independent care to agency patients. Staff F provided care to agency patients without determined satisfactory competency in all basic skills by completion of written competency examination. During an interview on 7/24/25 at 11:36 AM, Staff B, Regional Administrative Assistant, reported she was unable to locate a written competency examination test sheet for Staff F. The above stated findings were reviewed with Staff A, Regional Administrator, and Staff B, Regional Administrative Assistant.”

“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 job description 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 1 of 6 sampled patients receiving home health aide services (Patients #1). 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: According to the agency job description, titled Home Health Aide Job Description, dated 12/6/18, includes follows the written patient care plan as written by the registered nurse that indicates what tasks are to be completed and the frequency of those tasks. Patient #1 had a start of care date of 4/15/25. Clinical record review revealed: a. Plan of Care, dated 4/15/25 to 6/13/25, included diagnosis of anemia and orders for skilled nurse and home health aide services. b. Home health aide visit notes, dated 5/1/25, 5/5/25, 5/8/25, 5/12/25, 5/15/25, 5/22/25, 5/29/25, 6/2/25 and 6/5/25, included the task to assist with apply dry dressing. The home health aide assignment directed the aides to assist with apply dry dressing. The assignment lacked documentation of what dry dressing to apply and location where to apply the dry dressing. During an interview on 7/24/25 at 8:45 AM, Staff A, Regional Administrator, agreed staff should have more specific instructions regarding applying dry dressings for home health aides. The assignment did not include specific instructions to meet the needs of Patient #1. The above stated findings were reviewed with Staff A, Regional Administrator, and Staff B, Regional Administrative Assistant.”

“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, agency job description review and 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 3 of 6 sampled patients receiving home health aide services (Patients #2, #5 and #6). 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 job description, titled Home Health Aide Job Description, dated 12/6/18, includes follows the written patient care plan as written by the registered nurse that indicates what tasks are to be completed and the frequency of those tasks. During an interview on 7/24/25 at 8:45 AM, Staff A, Regional Administrator, reported the home health aides mark the task report to registered nurse changes in usual condition as completed and the nurse is responsible for documenting the coordination in a coordination note. 1.Patient #6 had a start of care date of 1/16/25 and a discharge date of 3/16/25. Clinical record review revealed: a. Plan of Care, dated 1/16/25 to 3/16/25, included diagnosis of osteoporosis and orders for skilled nurse and home health aide services. b. Home health aide visit notes, titled Medication Reminder, dated 2/5/25 at 9:45 AM, 2/5/25 at 3:29 PM, 2/7/25 and 2/8/25, included documentation the following tasks were completed: identified by patient name and identified by visual recognition but lacked documentation of tasks: AM cue- routine prompting, cueing and reminding; Noon cue- routine prompting, cueing and reminding; PM cue- routine prompting, cueing and reminding; assistance with self-administration-med bottle/planner handed to patient, provided water to patient; observe patients physical consumption of designated medications. c. Home health aide visit note, titled Medication Reminder, dated 2/6/25, included documentation the following task was completed: identified by patient name but lacked documentation of tasks: identified by visual recognition, AM cue- routine prompting, cueing and reminding; Noon cue- routine prompting, cueing and reminding; PM cue- routine prompting, cueing and reminding; assistance with self-administration-med bottle/planner handed to patient, provided water to patient; observe patients physical consumption of designated medications. d. Home health aide visit notes, titled Medication Reminder, dated 2/17/25 at 9:47 PM and 3/7/25 at 3:05 PM, included documentation the following tasks were completed: identified by patient name and identified by visual recognition, assistance with self-administration-med bottle/planner handed to patient, provided water to patient; observe patients physical consumption of designated medications and the following tasks were not completed: AM cue- routine prompting, cueing and reminding; Noon cue- routine prompting, cueing and reminding; and PM cue- routine prompting, cueing and reminding. Home health aides failed to address and/or complete all assigned tasks as ordered. 2. Patient #2 had a start of care date of 12/12/23 and a discharge date of 4/28/25. Clinical record review revealed: a. Plan of Care, dated 4/5/25 to 6/3/25, included diagnosis of neurocognitive disorder with Lewy Bodies and orders for skilled nurse and home health aide services. b. Home health aide visit note, dated 4/14/25, included the task report to registered nurse changes in usual condition and the task was marked completed: Yes. Clinical record lacked documentation of what was reported by home health aide to registered nurse. 3. Patient #5 had a start of care date of 1/10/24. Clinical record review revealed: a. Plan of Care, dated 5/4/25 to7/2/25, included diagnosis of Type 2 Diabetes Mellitus and orders for skilled nurse and home health aide services. b. Home health aide visit notes, dated 5/12/25 and 6/12/25, included task report to registered nurse changes in usual condition and the task was marked completed: Yes. Clinical record lacked documentation of what was reported by home health aide to registered nurse. The above stated findings were reviewed with Staff A, Regional Administrator, and Staff B, Regional Administrative Assistant.”

“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 clinical record review, agency policy review and agency staff interview, the agency failed to ensure a registered nurse (RN) or other appropriate health care professional completed home health aide supervision at least every 14 days for 1 of 6 sampled patients who received hands on personal care services in conjunction with skilled service provision (Patient #1). 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: According to the agency policy titled, Supervision of Home Health Aides, dated 8/15/22, if a patient is receiving skilled nursing or therapy services, a registered nurse shall make an onsite visit no less than every 14 days. Patient #1 had a start of care date of 4/15/25. Clinical record review revealed: a. Plans of Care, dated 4/15/25 to 6/13/25 and 6/14/25 to 8/12/25, included diagnosis of anemia and orders for skilled nurse and home health aide services. b. Skilled nurse visit note, dated 4/29/25, included home health aide supervision. c. Skilled nurse visit note, dated 5/28/25, included home health aide supervision, 29 days after the last skilled nurse visit and 15 days after the 14 day time frame. d. Recertification comprehensive assessment visit note, dated 6/10/25, lacked documentation of home health aide supervision. e. Skilled nurse visit note, dated 6/24/25, included documentation of home health aide supervision, 27 days after the last skilled nurse visit with aide supervision and 13 days after the 14 day time frame. f. Skilled nurse visit note, dated 7/8/25, lacked documentation of home health aide supervision. The clinical record lacked documentation of any further skilled nurse visits. The agency failed to complete home health aide supervision every 14 days as required. The above stated findings were reviewed with Staff A, Regional Administrator, and Staff B, Regional Administrative Assistant.”

“If area of concern is noted CFR(s): 484.80(h)(1)(iii) If an area of concern in aide services is noted by the supervising registered nurse or other appropriate skilled professional, then the supervising individual must make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while he or she is performing care. This Element is not met as evidenced by: Based on clinical record review and agency policy review, the agency failed to ensure a registered nurse completed home health aide supervision on-site annually while observing each home health aide providing direct patient care for 1 of 9 sampled home health aides hired prior to 2025. Failure to supervise home health aide services 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 Supervision of Home Health Aides, dated 8/15/22, if a patient is receiving skilled nursing or therapy services, a registered nurse shall make an onsite visit, no less frequently than every 14 days. The home health aide need not be present. For such patients, the registered nurse must make at least an annual visit while the home health aide is present. Staff E, Home health aide, had a hire date of 9/5/23. Staff E’s personnel file lacked documentation of an annual supervisory visit for 2024. During an interview on 7/24/25 at 11:36 AM, Staff B, Regional Administrative Assistant, reported she was unable to find a supervisory visit for Staff E from 2024. The agency failed to complete annual home health aide supervisory visits on all staff as required. The above stated findings were reviewed with Staff A, Regional Administrator, and Staff B, Regional Administrative Assistant.”