Home Health & Hospice of Dickinson County

“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 record review, and staff interview, the Home Health agency failed to ensure all documentation entries were authenticated with an occupational title of the author of the visit notes for 7 of 7 sample patient records. This deficient practice had the potential to affect patient safety and to place the patients at risk for adverse outcomes. Findings Include: Review of Patient records 1 through 7 revealed several Skilled Visit Note by various clinicians for each patient that lacked an occupational title after the stamped electronic signature at the bottom of each page of the note. The clinical notes had a statement at the bottom of each page which stated, “signed by:” and the name of the clinician but lacked an occupational title on any page. During an interview on 04/10/25 at 9:00 AM, Staff A, Administrator stated that she was unaware as to why the clinician’s title was not showing up with their signature.”

“Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on observation, record review, and staff interview, the home health agency (HHA) failed to provide the patient and caregiver a copy of written medication administration instructions in a language that they can understand in 6 of 7 Patients (Patients 1 - 6). The home health agency’s failure to ensure the patients received written instruction regarding medication administration placed all patients, currently on service, at risk for adverse medication outcomes, and unmet needs. Findings Include: Patient 1 Review of Patient 1’s plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that most of the patient medications were written to be administered “PO” (by mouth) and should have been listed as oral or by mouth. Patient 2 Review of Patient 2’s plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that most of the patient medications were written to administered “PO” and “PRN” (as needed) and should have been listed as oral or by mouth and as needed instead of “PRN”. Patient 3 Review of Patient 3’s plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that several of the patient medications were written to be administered “PO” and should have been listed as oral or by mouth. Patient 4 Review of Patient 4’s plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that several of the patient medications were written to be administered “PO” and should have been listed as oral or by mouth. Patient 5 Review of Patient 5’s plan of care indicated that the patient was taking multiple medications. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that several of the patient medications were written to be administered “PO” and should have been listed as oral or by mouth. Patient 6 Review of Patient 6’s plan of care indicated that the patient was taking multiple mediations. Review of Start of Care Assessment documentation indicated that a written medication list was provided to the patient. Review of the medication list provided to the patient revealed that most of the patient medications were written to administered “PO” and “PRN” and should have been listed as oral or by mouth and as needed instead of “PRN”. During an interview on 04/09/25 at 2:15 PM, Staff A, agency Administrator stated that the medication list should be written using words that the patients can understand. She also confirmed the above findings of the agency not providing the medication list in a language the patients could understand.”

“Report all branch locations to SA CFR(s): 484.105(d)(1) The parent HHA is responsible for reporting all branch locations of the HHA to the state survey agency at the time of the HHA’s request for initial certification, at each survey, and at the time the parent proposes to add or delete a branch. This Element is not met as evidenced by: Based on document review, and staff interview, the above-named Home Health Agency failed to report all agency branch locations to the state survey agency (KDHE) when adding a location and prior to current survey. This deficient practice had the potential to place patients at risk of adverse outcomes and potential patient safety risk due to possible risk of not being surveyed by the state agency. Findings Include: Review of agency information and paperwork given to patients at admission to services by the agency revealed a separate location other than the agency’s parent location address. The start of care information packet provided for review show an address in Herington, KS as a “Charting Station”. This location had its own telephone number and after hours on call number, and both were different from the parent agency’s numbers. During an interview on 04/08/25 at 10:00 AM, Staff A, agency Administrator, explained that this location also had its own supervisor. She also stated that the location takes its own patient referrals and makes their own assignments. She explained that as the Administrator she does call in for a team meeting with them daily. The Administrator stated that the agency had always had this other location. Review of the agency information in iQIES revealed that this branch location was reported as closed in 2014.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on record review, and staff interview, the home health agency (HHA) failed to ensure the clinical record included all interventions, including medication administration, treatments, and services provided for 4 of 7 sample records reviewed (Patients 3 - 6). The home health agency’s failure to ensure the clinical records included documentation of all treatments and services provided placed all patient currently on service at risk for adverse outcomes and unmet care needs. Findings Include: Patient 3 Review of Patient 3’s plan of care for episode dates 03/14/25 through 05/02/25 showed orders for Skilled Nursing to perform wound care to patient’s left lower extremity as follows: cleanse with wound cleanser, apply aquacel silver, cover with telfa and tape on Monday, Wednesday, and Friday. Review of the Skilled Nursing visits for the episode dates showed that the visits were made on Monday, Wednesday, and Friday. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was “provided as ordered”. Also, there was no documented patient response to the wound care treatments. Patient 4 Review of Patient 4’s plan of care for episode dates 02/28/25 through 04/28/25 showed orders for Skilled Nursing or caregiver to perform wound care to abdomen as follows: cleanse with wound cleanser, cover with hydrofera blue, and absorbent dressing, change Monday, Wednesday, Friday. Review of the Skilled Nursing visits for the episode dates showed that the Skilled Nurse made visits on Mondays throughout the episode. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was “provided as ordered”. Also, there was no documented patient response to the wound care treatments. Patient 5 Review of Patient 5’s plan of care for episode dates 02/12/25 through 04/12/25 showed orders for wound care to the right buttock to be provided as follows: cleanse wound with wound cleanser, apply silver alginate to wound bed, cover with meplex. Skilled Nurse to complete one time per week and patient’s daughter to change two times weekly and when saturated or soiled. Review of the Skilled Nursing visits for the episode dates showed that the Skilled Nurse made visits one time per week throughout the episode. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was “provided as ordered”. Also, there was no documented patient response to the wound care treatments. Patient 6 Review of Patient 6’s plan of care for episode dates 08/22/24 through 10/12/24 showed orders for Skilled Nurse to provide wound care to right foot, 4th toe as follows: clean with wound wash, pat dry, apply aqucel AG, cover with a foam dressing 2-3 times per week. Review of the Skilled Nursing visits for the episode dates showed that the Skilled Nurse made visits one tie per week throughout the episode. However, there was no documentation found to explain how the wound care was performed. Each Skilled Nurse visit note stated that the wound care was “provided as ordered”. Also, there was no documented patient response to the wound care treatments. During an interview on 04/09/25 at 3:15 PM, Staff A, Administrator confirmed that the Skilled Nurses had not documented the exact treatments being provided nor the patient’s response to the wound care provided.”