The example continues.

Findings include:

• The agency's policy reads: "Admission of Patients—If the initial referral does not contain an order to make an evaluation visit, the registered nurse (RN) will call the physician and obtain a telephone order for the evaluation visit and any other orders the physician believes necessary to establish the plan of care. The RN will write the telephone order(s). The orders(s) will be immediately sent to the physician for his countersignature. The orders(s) will be placed in the clinical record."
• Review of the clinical record of Client #6 revealed a start of care date of 06/06/19. The clinical record did not contain a plan of care, nor did the clinical record contain physician orders authorizing the agency to provide skilled nursing services. The agency provided skilled nursing visits on the following dates without physician's orders: 06/06/19, 06/08, 06/13, 06/15, 06/20, 06/22, 06/27, 06/29, and 07/03/19.
• An interview was conducted on 08/06/19 with the Alternate Administrator (RN) at 10:00 AM. The Alternate Administrator stated, "I received the physician's orders for home health services, but I did not write them down. The plan of care was not in the chart because our office person was not coming in."

Example continues on next page.