Home health agencies throughout Iowa cited for violations

Fifteen of Iowa’s 135 home-health agencies have been inspected by the state so far this year and 14 of them have been cited for violations.

Four of the agencies cited for violations are run by county health departments.

At one privately operated agency, inspectors found that patients were in immediate jeopardy caused by a nurse who failed to follow a patient’s orders for resuscitation and then left the patient’s home without calling 911 after concluding the man was dead.

In 2022, 34 home-health agencies were inspected by the state, and five were cited for 10 or more violations. At four of the 34 agencies, the violations were serious enough that the agency and its registered nurses were prohibited from providing any basic-skills training to home-health aides and barred from evaluating the aides’ competency for two years.

For a more detailed look at all of Iowa’s home-health agencies, including those that have yet to be inspected this year, visit the Center for Medicare and Medicaid Services’ Care Compare website or the Iowa Department of Inspections, Appeals and Licensing website.

Here’s a summary of the inspectors’ findings at each of the agencies visited by the state so far in 2023. Along with the inspectors’ findings, you’ll find CMS’ quality ratings, which are based on a scale of one to five stars, for each agency. (Some ratings are listed as “not available” due to insufficient data on which to base a rating.)

Angels Care Home Health of Iowa, Des Moines – This agency has a CMS quality rating of three and a half stars, and a patient-survey rating of three stars. In March, state officials substantiated a complaint against the agency. In reviewing the care provided to four patients, inspectors found that the agency failed to follow the physician-ordered plan of care for three of those patients. In all three cases, the home health workers were to check the patients’ weight, but repeatedly failed to do so. The agency was also cited for failing to obtain physician orders for some of the treatments that were being provided to patients. The state inspections department did not require the agency to develop a plan of correction to address the deficiencies, according to the inspector’s report.

Caregivers Home Health, Centerville — This agency has a CMS quality rating of four stars, and a patient-survey rating of four stars. In February, inspectors reviewed the care provided to four of the agency’s 175 patients and concluded that in three of the four cases, the agency failed to provide all of the care that was called for as part of the patients’ written care plans.

The inspector observed that a nurse failed to provide one patient with two prescribed medications, and on further investigation, it appeared that the plan of care conflicted with physicians’ orders. The agency was also cited for failing to have registered nurses provide home care aides with individualized, patient-specific instructions for delivering care.

Regional Medical Center Home Care, Manchester – In May, this agency with 71 home-care patients was inspected by the state and no deficiencies were cited. The inspection was prompted by a complaint determined to be unsubstantiated. .

Community Health Services, Algona – This agency has a CMS quality rating of two stars, and a patient-survey rating of five stars. In February, the agency was cited for failing to ensure that home health aides who were assigned tasks requiring extra skills had successfully completed competency testing for those tasks.

One aide who was assigned to help two separate patients with exercises had completed the forms documenting the assistance she provided by adding a one-word notation: “Done.” The inspector found the agency lacked any documentation indicating the aide had been provided “any type of competency training” for either of the two patients’ exercise programs.

The agency was also cited for failing to have registered nurses provide home care aides with individualized, patient-specific instructions for delivering care, and for failing to provide patients’ physicians with timely discharge summaries.

Good Samaritan Society Home Care, Davenport – This agency has a CMS quality rating of three stars, and a patient-survey rating of four stars. In March, state inspectors completed an investigation of a complaint and concluded the agency had placed residents in immediate jeopardy. After finding the agency was not complying with the conditions for participation in the Medicare program, the agency and its registered nurses were barred for two years from providing evaluations of home health aides’ basic skills and competency.

The agency also was cited for failing to follow care plans for a patient who died unexpectedly at home. The patient in question had resuscitation orders in place that called on medical personnel to initiate CPR and emergency medical treatment if the patient was found unresponsive.

A licensed practical nurse for Good Samaritan had gone to the patient’s home on Feb. 14 and consulted briefly with an in-home caregiver before entering the patient’s bedroom and finding the man cold and stiff with no pulse. The nurse then called the patient’s physicians and the county coroner to inform them of the death. The nurse didn’t take any vital signs, attempt CPR or call 911, and then left the home before police or EMS personnel were contacted. The nurse was later informed by the medical examiner that only EMS personnel could pronounce a patient dead.

Des Moines County Health Department – During a January visit, inspectors cited the agency for failing to accurately complete all updates to a patient’s comprehensive assessment after the individual was discharged to their home from a hospital. In addition, inspectors reviewed seven patient files and found that in four cases, the agency failed to update patients’ care plans, in some cases by having incorrect medications listed in the plans.

In three of seven cases, the agency failed to provide only those medications and treatments that were ordered by a health care practitioner. Inspectors reported that the agency also failed to ensure one patient’s clinical record included accurate and specific documentation of all interventions by neglecting to periodically measure the patient’s open wounds to chart their progress. At the time of the inspection, the agency had only eight patients.

Heights Home Health, Mapleton – This agency has a CMS quality rating of two stars. No patient-survey rating is available. In February, the agency was cited for failing to accurately complete all elements of a patient’s plan of care by neglecting to include in the plan all equipment used by the patient to meet their needs, and for failing to obtain physician orders for all services provided.

Iowa Home Care, Ottumwa – This agency has a CMS quality rating of two stars, and a patient-survey rating of three stars. In March, state officials completed an investigation into a complaint and cited the agency for failing to ensure that patients had access to a free-of-charge copy of their clinical record within 10 days of it being requested. A former patient had waited at least two months to obtain a copy of their clinical record to give to her doctor, despite making several requests for the information.

In early 2022, Iowa Home Care was fined $123,219 by the federal government. That penalty was tied to a Dec. 7, 2021, visit by state inspectors who were responding to a complaint against Iowa Home Care of Ottumwa. The state agency cited the business for 17 regulatory violations — an extraordinarily high number of violations for a home health provider. CMS subsequently imposed a $3,213 daily civil monetary penalty against the business for each of the 59 days the business was deemed to be out of compliance.

Those daily fines totaled $189,567. Because Iowa Home Care waived its right to appeal the penalty, CMS automatically reduced the fine by 35% to $123,219.

Later in January 2022, Iowa Home Care was cited for 10 additional regulatory violations. Among the problems cited at the time: failure to ensure initial visits with patients occurred within 48 hours of a referral, failure to complete accurate drug regimen reviews, failure to accurately complete a plan of care in five of the 17 cases that were reviewed, failure to provide medications and treatment as ordered by a physician in four of the 17 cases that were reviewed, failure to report to a physician any changes in clinical findings in three of 17 cases that were reviewed, and failure to coordinate patient care in four of 17 cases reviewed.

In August 2022, inspectors returned and cited the agency for three additional violations: failure to follow a patient’s plan of care by not providing the physician-recommended number of home-care visits, failure to keep a patient’s plan of care up to date with new physician orders, and failure to provide care as ordered by a physician.

Iowa Home Care, Webster City – CMS has no quality rating and no patient-survey rating available for this agency. In April, inspectors reviewed a sample of the agency’s files and found that in three out of seven cases, the agency had failed to follow the physicians’ care plans for patients. In all three cases, the staff failed to conduct scheduled home visits and did not notify the patients’ physicians of those missed visits.

The agency was also cited for failing to accurately complete all elements of three patients’ written care plans, and for failing to ensure that skilled professionals provided care as ordered by physicians. The inspector noted that in caring for a pediatric patient with chronic respiratory failure, the aides repeatedly failed to check the patient’s temperature as ordered by the physician and repeatedly measured the child’s urinary output based only on the number of diapers that were used.

Orange City Home Health, Orange City – This agency has a CMS quality rating of three stars, and a patient-survey rating of five stars. In February, inspectors cited the agency for failing to accurately complete all elements of three patients’ written care plans, with one patient’s care plan failing to make note of the patient having a Lifeline bracelet and necklace to summon emergency assistance over the past year. The agency was also cited for failing to provide patients with wound care as ordered by a physician.

Sanford Home Health and Hospice, Sheldon —  In January, inspectors cited the agency for failing to follow patients’ care plans in two of the seven patient files that were reviewed. In addition, in all of three patient files that were reviewed, the agency failed to accurately complete all elements of the patients’ care plans. In two of seven cases that were reviewed, the agency failed to update care plans with new orders received from physicians.

Pella Regional Home Health Agency, Pella – This agency has a CMS quality rating of three stars, and a patient-survey rating of four stars. In February, the agency was cited for failing to participate in any disaster-preparedness tests and exercises in both 2021 and 2022. The agency was also cited for failing to ensure assessments of patients treated for open wounds included measurements of the wounds to chart their progress.

Also, in four of the five cases reviewed by inspectors, the agency failed to update the patients’ care plans to include all medical orders from health care practitioners. In addition, inspectors cited the agency for failing to ensure the patients’ clinical record included accurate and specific documentation of any interventions, and for failing to provide physicians with patient discharge summaries within five business days of the patient being discharged.

Webster County Health Department, Fort Dodge – CMS has no quality rating and no patient-survey rating available for this agency. In February, the agency was cited for failing to accurately and thoroughly complete updates of a patient’s comprehensive assessment, and for failing to accurately complete all elements of care plans in two of three cases reviewed by inspectors. In addition, inspectors cited the agency for failing to have a registered nurse provide aides with individualized and specific care instructions for one patient, and for failing to have aides provide care only as ordered by a physician.

Floyd County Public Health Home Care, Charles City – In January, inspectors cited the agency for failing to follow patients’ care plans in two of the seven patient files that were reviewed.  In both cases, the staff failed to conduct scheduled home visits and did not notify the patients’ physicians of those missed visits. Also, in two out of three cases, the agency failed to accurately complete all elements of the patients’ care plans and failed to ensure adequate infection-control procedures.

Louisa County Public Health Nursing Services, Wapello – In January, the agency was cited for failing to accurately complete all elements of patients’ care plans and for failing to update care plans to include all current physician orders.