ࡱ> q %bjbjt+t+ JAAh!i]4444444$P^zt1&ZZppp,&,&,&((((F(TR-T1$3414,&  &",&,&1'44ppZ''',&|4p4p(XTb4444,&(''(44(pl7&p(Home Health & Hospice Annual Agency Review  Administration  Yes No Comments Does the Agency have a current license?    Are the charter by-laws on file? (Administrative Book)    Is a doctor, registered nurse or appropriately credentialed individual designated as Agency advisor or supervisor? (Policies)    Are the responsibilities of the Agency supervisor clearly defined? (Administrator Job Description) Responsibilities for staffing?    Assigning of personnel?    Evaluation of personnel?    Evaluation of care?    Current physicians orders?    Coverage of local physicians?    Discharge criterium?    Staff development?    Coordination of services?    Objectives Does the Agency have program objectives? (Policy manual)    Do the objectives cover: Who is to receive service?    Who is to give service?    Type of additive service available?    Defines skilled nursing?    Defines therapeutic services?    Defines intermittent basis?    Job Descriptions Are there written job descriptions for each category of personnel? (Job Description Book)    Do the job descriptions define: Qualifications (Education and experience)?    General functions?    Specific functions?    Do the job descriptions for RNs and LPNs concur with state law? (State Nurse Practice Act)    Are all RNs and LPNs currently licensed in the state of Missouri? (Personnel files)    Personnel File Is there a personnel file for each employee?    Does a sampling of personnel files include: Application for employment?    Evaluations?    Pre-Employment Are background checks being performed as state requires?    Is there an adequate orientation program for all personnel?    Do all employees have pre-employment physicals?    Ongoing Employment Is there an active inservice program being carried on for all categories of personnel? (Inservice manual)    Is a record of automobile insurance and current drivers license kept on file?    Is there a current license for personnel for whom it is required?    Board of Directors Are there by-laws for the Advisory Committee? (Administrative Manual)    Do these by-laws spell out: Method of selection of members?    Composition of the committee?    Length of term of committee members?    Recording and filing of minutes?    Functions of the committee?    Do the functions of the Board of Directors include the regular review and approval of policies?    Do the functions of the Advisory Committee include: Liaison between Agency and community?    Review of utilization of services?    Public relations?    Evaluation of programs?    Contracts Does the Agency have contracts for additive services, if not provided within the Agency? (Contracts Folders) With another agency or organization?    With an individual?    Is the contract(s) current?    Does the contract include: Description of service to be provided?    Specific length of time contract is in effect?    Provision for periodic review of contract?    Defines the role of the Agency in relation to: Supervision?    Reimbursement?    Billing?    Orientation?    Record keeping?    Defines the role of the agency (or individual) in relation to: Qualifications?    Following Agency policies?    Maintaining the required records?    Participating in any educational programs?    Providing service(s) as necessary?    Patient Care Do the admission policies of the Agency take into consideration: (Policy Manual) Staff competency?    Patients ability to meet their responsibilities?    Agencys ability to meet the patients needs?    Safety of the patients residence?    Availability of patients physician?    Geographical limitations?    Have the reasons for refusal of referrals been studied?    Were refusals justified by admission policies?    Are there established policies and procedures ensuring that service will be provided only under a physicians plan of treatment?    Do the policies require: An original plan of treatment signed by the patients physician?    Agency reporting the patients progress to the patients physician as necessary and/or at least every two months?    Orders are reviewed and recertified at least every two months?    All verbal orders are signed by a physician?    Is there a clinical record for each patient?    Are the clinical records regularly reviewed to check completeness, accuracy and quality?    Nursing Services Is there a current written plan of care for each patient?    Is there a nursing procedure manual?    Date written    Date reviewed    Are patient progress notes and 60 day summary current and do they give an accurate picture of the patients condition and progress?    Does an RN make every 14 day supervisory visits with home health aides?    Is there a regular staff conference?    Home Health Aide Does the job description and/or Agency policies for the selection of a home health aide require: Help patient with bath?    Help patient to ambulate?    Help patient with prescribed exercises?    Record activities and observations in the patients clinical record?    Does the job description provide that the home health aide work under the direct supervision of a registered nurse or, where applicable, a qualified physical therapist?    Does the Agency provide formal training for the home health aide?    Is there a copy of the home health aide written test in each aides personnel file?    Is there a copy of the home health aides practice portion of certification in each aides personnel file?    Is there a home health aide specific planned orientation to the Agency?    Have the aides received the required twelve hours of inservices for the year?    Do the Agency policies call for regular supervision of the home health aides?    How often?    Is a supervised visit recorded?    Is the home health aide included in regular staff conferences?    Therapy Services Are the physical therapy treatments incorporated into the plan of care?    Are therapy services provided under a physicians plan of treatment?    Are the therapists qualified and currently licensed in the state of Missouri?    Does the physical therapist regularly supervise the home health aides who assist in physical therapy?    Do the therapists maintain current progress notes in the patients clinical record?    Does the job description or contract for service include the physical therapist instructing the patient on the use of braces, crutches, etc.?    Does the physical therapist regularly report to the Administrator or the Team Leader(s)?    Are the speech therapy plans incorporated in the Agencys patient care plan?    Is the occupational therapist qualified and registered by the AOTA?    Does the job description or contract for service include the occupational therapist applying diagnostic and prognostic procedures?    Does the job description or contract for service include the occupational therapist guiding the use of therapeutic creative and self-care devices?    Does the job description or contract for service include the following functions of the medical social worker: Assisting in understanding significant social and emotional factors.    Assessing social and emotional factors.    Helping patients and family follow medical recommendations.    Assisting patients and family with personal and environmental difficulties.    Utilizing community resources.    Summary of Evaluation Strengths Found        Weaknesses Found         Signature of person completing report Date Howard County Home Health & Hospice Summary of Agency Evaluation  The following strengths were found during the Agency evaluation:                The following weaknesses were found during the Agency evaluation:               Immediate and Long-Range improvement plans:             Home Health and Hospice Annual Agency Review (cont.)  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