Eastern Iowa county leads the state in home-health violations

The Iowa County Public Health Department’s home-health agency has been cited for 37 violations over the past six months — far more violations than any other home-health provider in the state.

As a result of the state inspectors’ findings, Iowa County Public Health and its registered nurses have been barred from evaluating the skills and competency of the county’s home-health aides through November 2024, according to the Iowa Department of Inspections and Appeals.

Since mid-November 2022, 13 of Iowa’s home-health agencies have been cited by DIA for violations, although most of the 13 were cited for three or fewer violations. Five of the 13 agencies that were cited for violations are run by county public health departments.

The Iowa County Public Health Department’s home-health agency was cited for 34 violations in November and three additional violations in December. Many of the violations were related to nursing assessments, medication reviews, incomplete care plans, competency evaluations, personnel qualifications, emergency preparedness and numerous organizational issues.

The organization’s 37 violations is roughly 10 times the average number of violations cited by state inspectors at other home-health agencies statewide.

According to state inspectors, Iowa County’s new public health administrator and the Iowa County Board of Health met in July 2022 and discussed the need to inform state and federal regulators of a change in management for the home-health agency, but then neglected to provide the regulators with that information.

A month later, in August 2022, the county was working with a consultant on a mock audit to help prepare for the anticipated state inspection. The state inspectors later noted that when they attempted to inform the administrator of the violations that were uncovered, the administrator indicated she didn’t expect to be surprised since the violations would likely be the same as those noted by the consultant and which had yet to be corrected.

The inspectors noted that the county had failed to conduct the required competency testing for aides to ensure they were capable of delivering adequate care and that the county had initiated services for one patient a week late without notifying the patient’s doctor. The inspectors also found the county had failed to conduct the required review of patients’ medications in three of the seven cases that were reviewed; had failed to identify duplicate drug regimens for patients, and had failed to have in place accurate, timely care plans for patients that included all of their medications.

The county also had failed to update patients’ care plans with new physician orders; had failed to give one patient the prescribed skin-care treatment on 12 occasions in during a four-week period; and had failed to adequately assess or provide transfer summaries for patients who required hospitalization, according to inspectors.

The county was also cited for failing to give its home-health patients the name and contact information for either the administrator or the clinical manager so that any concerns pertaining to their care could be properly reported and addressed.

The agency’s administrator, Lorinda Sheeler, declined to comment on the matter, as did Dr. Steven Rippentrop, the chairman of the Iowa County Board of Health. They referred all questions about the county’s home-health operations to the sheriff and to the county attorney, each of whom also declined to comment.

Other home-health agencies cited

Here’s a summary of the inspectors’ findings at the 12 other Iowa home-health agencies cited for violations since mid-November 2022. Along with the inspectors’ findings is each agency’s CMS ratings, which are based on a scale of one to five stars. (Some home-health providers, including Iowa County, have provided insufficient data on which to base a rating.)

For a more detailed look at all of Iowa’s home-health agencies visit CMS’ Care Compare website or the Iowa Department of Inspections and Appeals’ website.

Angels Care Home Health of Iowa, Des Moines: In March, the agency was inspected as the result of a complaint and was cited for two violations: repeatedly failing to follow patients’ care plans by neglecting to record the patients’ weight, and failure to deliver services only as ordered by a physician. Angels Care has a CMS quality rating of three and a half stars, and patient-survey rating of three stars.

Caregivers Home Health, Centerville: In February, the agency was cited for two violations: inadequate care plans for patients and the improper assignment of home-health aides’ duties. One patient’s care plan did not include an accurate description of a patient’s currently prescribed medications, and another patient’s care plan made no mention of the neck brace they’d been using for 15 years or their emergency-alert bracelet. Caregivers has a CMS quality rating of three and a half stars, and patient-survey rating of three stars.

Community Health of Algona: In February, the agency was cited for three violations: Failure to ensure the competency of home-health aides, the improper assignment of home-health aides’ duties, and inadequate patient-discharge and transfer records.

One home-health aide who was assigned to provide personal exercise programs for patients had no record of any training in such skills and was documenting the exercises provided with the one-word notation, “Done,” in the patients’ files. One home-health aide was documenting that she provided assistance with a patient’s skin care, ambulation and exercises. The patient, however, indicated the aide had provided no such assistance. Community Health has a CMS quality rating of two stars, and a patient-survey rating of five stars.

Des Moines County Health Department: In January, the agency was cited for six violations, including failure to complete a patient assessment within 48 hours of a patient’s return home from the hospital, inadequate patient care plans, failure to include in patient care plans all physician orders, and failure to deliver care only as ordered by a physician.

One patient’s plan of care was at least two months out of date, listing seven medications the patient no longer took; another patient’s care plan failed to include orders for wound care; a third patient’s care plan was at least a year out of date and included erroneous references to medications the resident didn’t take; and one patient didn’t receive her prescribed B-12 injection during the month of September. Des Moines County has no CMS quality ratings.

Floyd County Health Department: In January, the agency was cited for three violations including inadequate patient-care plans and inadequate infection control. One patient did not receive the prescribed physical therapy and the physician was not notified; other patients’ care plans did not include all of their medications or medical equipment; and a home-health aide was not sanitizing her equipment between visits to different homes. Floyd County has a CMS quality rating of two and a half stars, and a patient-survey rating of four stars.

Heights Home Health, Mapleton: In February, the agency was cited for two violations: incomplete patient-care plans and failure to deliver care only as ordered by a physician. Heights Home Health has a CMS quality rating of two stars, and no patient-survey rating.

Iowa Home Care, Ottumwa: In March, the agency was cited for failing to provide a patient with their requested medical records. The patient had requested the records in early February but didn’t receive them until late March after state inspectors intervened. Regulations give home-health providers four days, or until the next home visit, whichever comes first, to provide patients with a free copy of their clinical record. Iowa Home Care of Ottumwa has a CMS quality rating of one and a half stars, and a patient-survey rating of three stars.

Louisa County Public Health Nurses: In January, the agency was cited for three violations: incomplete patient-care plans, patient care plans that failed to include all medical orders, and inadequate patient medication schedules or instructions. One patient’s care plan included medication the patient had not been taking for a year and a half and failed to include dosage information for other supplements or medications. Also, in four of the seven patient files that were reviewed, the agency failed to update the patients’ care plans to include all relevant physician orders. Louisa County has no CMS quality ratings.

Orange City Home Health: In February, the agency was cited for two violations: Incomplete patient-care plans and failure to deliver care as ordered by a physician. One patient was administered a different dose of a vitamin than the care plan called for, and another patient’s wound was not being assessed as the physician ordered. Orange City has a CMS quality rating of two and a half stars, and a patient-survey rating of five stars.

Pella Regional Home Health Agency: In February, the agency was cited for six violations, including inadequate medication reviews and failure to include all orders in patient-care plans. According to inspectors, four of the five patient files reviewed indicated that the patients’ records were not kept up to date with current physician orders, and one patient’s wounds were not being assessed as ordered. Pella Regional has a CMS quality rating of three stars, and a patient-survey rating of four stars.

Sanford Home Health & Hospice, Sheldon: In January, the agency was cited for inadequate patient-care plans, incomplete patient-care plans, and failure to include all physician orders in patient-care plans. The agency allegedly failed to notify physicians when home visits were missed by the staff, and in all three patient files that were reviewed, the care plans included inaccurate information as to the medications that were being taken or the equipment that was being used. Sanford has a CMS quality rating of two and a half stars, and a patient-survey rating of four stars.

Webster County Health Department: In February, the agency was cited for four violations, including failure to update patient assessments at the time of discharge; incomplete patient-care plans; and improper assignment of home-health aides’ duties. In two of the three patient files that were reviewed, the agency failed to include in its patient-care plans several pieces of medical equipment and medications. Webster County has no CMS quality ratings.