Every finding on record at Able Health Care Services, Inc.

The following Statement of Deficiencies represents the results of a standard re-certification survey of Able Health Care Services, Inc., Certified Home Health Agency located at 50 Clinton Street, Suite 208, Hempstead, New York, 11550, conducted from 11/18/2024 to 11/22/2024 to evaluate the Agency's compliance with the Federal Conditions of Participation and State Requirements. Deficient practices were identified within level 1 Standards in Plan of Care CoP 484.60 (G574) expanding to a partially extended survey. The Home Health Agency reported an active patient census of five-hundred and eighty-six (586) during the entrance conference on 11/18/2024. The survey consisted of three (3) observational home visits, review of eight (8) clinical records, including two (2) discharged records, eight (8) professional personnel records, and one (1) contract for paraprofessional personnel. The survey included a review of pertinent policies and procedures, the Health Commerce System, Home Care Worker Registry, Criminal History Record Check, Patient Care Management Assessment Policy, Infection Control Policy, Complaint Policy and Procedure, Emergency Preparedness Policy, Quality Assurance Improvement Meeting Minutes for the past twelve (12) months, the Agency's Admission packet, Emergency Preparedness Plan and Complaint Log. Pre-Survey activities consist of a review on 11/13/2024, 11/14/2024 and 11/15/2024 of the Certification and Survey Provider Enhanced Reports (CASPER) for the period of 09/2023 to 08/2024, the Health Commerce Systems Account, the agency's compliance with statistical reports for 2022, and the Emergency Drill Submission for 2019. The following deficiencies were identified as a result of the survey: Federal Deficiencies: G-0432- Make Complaints to the HHA. G-0574- Plan of Care Must Include the Following. G-0580- Only as Ordered by the Physician. G-1012-Required Items in Clinical Record. State Deficiencies: J-0432-Policies and Procedures of Service Delivery. J-1156- Governing Authority. J-1272-Governing Authority. J-1412-Personnel. J-1424-Personnel. J- 1444-Personnel. J- 1460-Personnel.

Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This ELEMENT is not met as evidenced by: Based on home visit observations, clinical records review and staff interview, the Agency failed to ensure patients are provided with the complaint procedure and complaint hot line number. This was evident in three (3) of three (3) home visits conducted (Patients #1, #2 and #3). Failure to inform patients of their rights to lodge complaints has the potential for negative patient outcomes. The findings are: 1) Patient #2 has a start of care date of 03/20/2013 with diagnoses of "Other Disorders of Psychological Development, Spastic Quadriplegia Cerebral Palsy, Sensorineural Hearing Loss Bilateral, Other Dystonia, Postural Kyphosis, Congenital Rubella Syndrome, Specific Developmental Disorder of Motor Function and Dependence on Wheelchair" as documented on the "Home Health Certification and Plan of Care" for certification period 11/17/2024 to 01/15/2025. The "Home Health Certification and Plan of Care" for certification period 11/17/2024 to 01/15/2025 documents an order "Skilled Nurse 1 wk1 (one visit a week for one week), Physical Therapy 4wk1, 3wk1, 4wk3, 1wk1, 4wk2. 3wk1 (four visits a week for one week, three visits a week for one week, four visits a week for three weeks, one visits a week for one week four visits a week for two weeks, three visits a week for one week), and Occupational Therapy 2wk9 (two visits a week for nine weeks)". A Home Visit was conducted on 11/19/2024 with the Physical Therapist. Two patient admission packages were observed in the home. There was no evidence of a written patient complaint procedure and complaint hot line number. The patient's caregiver reported she is unaware of the complaint number. An interview was conducted with the Director of Patient Services and Director of Nursing on 11/20/2024 at 11:19 AM, no explanantion was provided. The Agency did not ensure that the patient have available the home health agency complaint number and procedure. The survey findings were reviewed with the Director of Patient Services and Director of Nursing on 11/21/2024 at 03:55 PM. 2) Patient #3 has a start of care date of 04/08/2015 with diagnoses of Type 2 Diabetes Mellitus, Anoxic Brain Damage, Aphasia, Epilepsy, Retention of Urine, Hypothyroidism, Gastro-esophageal Reflux Disease, Long term use of Aspirin, Long term use of Hypoglycemis drugs, and Dependence on wheelchair as documented on the "Home Health Certification and Plan of Care" for certification period 10/17/2024 to 12/15/2025. The "Home Health Certification and Plan of Care" for certification period 10/17/2024 to 12/15/2025 documents an order "Skilled Nurse 1 wk1 (one visit a week for one week), Speech Therapy 1wk1,3wk8. Skilled Nurse to "evaluate and develop the plan of care". A Home Visit was conducted on 11/19/2024 with the Speech Therapist. The patient admission packet was not available in the home. There was no evidence of a written patient complaint procedure and complaint hot line number. The patient's caregiver reported she is unaware of the complaint number. An interview conducted on 11/20/2024 at 11:40 AM with the Director of Patient Services and Director of Nursing. No explanation was provided. The Agency did not ensure that the patient have available the home health agency complaint number and procedure. The survey findings were reviewed with the Director of Patient Services and Director of Nursing on 11/21/2024 at 03:55 PM. 3) Patient # 1 has a start of care date of 05/13/2015 with diagnoses of “Schizophrenia, Hypertension, Diabetes type 2, Disorder of Thyroid and long-term use of Insulin” as documented on the “Home Health Certification and Plan of Care” for certification period 09/22/2024 to 11/20/2024. The “Home Health Certification and Plan of Care” for certification period 09/22/2024 to 11/20/2024 documents orders for services "Skilled Nurse effective 1-week x1 weeks, 1 every 4-week times 4(one visit a week for one week, one visits every four weeks for four weeks). Skilled nurse to administration of Haldol 50mg per milliliter via intramuscular injection monthly. Insulin and Thyroid medication is monitored by Endocrinologist. Licensed professional to report vital signs falling outside the parameters(temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90)”. DME supplies: Glucometer, Medication includes Insulin Aspart 100 unit/milliliter-9units with lunch and 8 unit with dinner daily, and Tresiba FlexTouch 100-unit insulin pen of 15 units at bedtime hold for blood sugar less than 100mg/dl. A Home Visit was conducted on 11/19/2024 at 10 AM with the Register Nurse. Another agency patient admission package was observed in the home, patient stated “I throw it out” when ask about the agency admission packet, and the patient reported she is unaware of the complaint number. On review of clinical record it lacked documented evidence of a written patient complaint procedure with the department of health complaint hot line number. The survey findings and interview were conducted on 11/19/2024 at 3:00 PM with the Director of Patient Services and Director of Nursing. No explanation was provided.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on observational home visits, record review and staff interview, the governing authority failed to ensure patient's plan of care is comprehensive and individualized to meet patient's medical, psychosocial, and functional limitations needs. This was evident for three (3) of eight (8) records reviewed (Patients #1, #3, and #5). Failure to ensure plan of care is individualized and comprehensive to meet patients needs has the potential for negative outcomes. The findings are: 1) Patient # 1 has a start of care date of 05/13/2015 with diagnoses of “Schizophrenia, Hypertension, Diabetes type 2,, Disorder of Thyroid and long term use of Insulin” as documented on the “Home Health Certification and Plan of Care” for certification period 09/22/2024 to 11/20/2024. The “Home Health Certification and Plan of Care” for certification period 09/22/2024 to 11/20/2024 documents orders for services "Skilled Nurse effective 1-week x1 weeks, 1 every 4-week times 4(one visit a week for one week, one visits every four weeks for four weeks). Skilled nurse to administration of Haldol 50mg per milliliter via intramuscular injection monthly. Insulin and Thyroid medication is monitored by Endocrinologist. Licensed professional to report vital signs falling outside the parameters(temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90)”. DME supplies: Glucometer, Medication includes Insulin Aspart 100 unit/milliliter-9units with lunch and 8 unit with dinner daily, and Tresiba FlexTouch 100-unit insulin pen of 15 units at bedtime hold for blood sugar less than 100mg/dl. The plan of care lacked documented evidence on who is monitoring finger stick and administering insulin injections. The Plan of Care lacked documented evidence to include the specific task of skilled nursing services of the Registered Nurse to include teaching/instruction of patient and caregiver in signs and symptoms of hyper/hypoglycemia, blood sugar parameters to report, instruct patient/caregiver in methods in insulin injection and prevention of skin breakdown, infection control, hand washing and safe disposal of sharps. The survey findings and interview were conducted on 11/19/2024 at 3:00 PM with the Director of Patient Services and Director of Nursing. No explanation was provided. 2) Patient # 5 has a start of care date of 06/20/2022 with diagnoses of “Congenital Malformation Syndrome, Chronic Respiratory failure with Hypoxia or Hypercapnia, Cerebral Palsy, Severe Intellectual disabilities, Contracture of right wrist and hand, Legal blindness, Gastrostomy status and Oxygen dependency” as documented on the “Home Health Certification and Plan of Care” for certification period 10/07/2024 to 12/05/2024. The “Home Health Certification and Plan of Care” for certification period 10/07/2024 to 12/05/2024 documents “Occupational therapy 3 times per week for eight weeks, one time a week for one week, therapy to focus on passive range of motion, . Licensed professional to report vital signs falling outside the parameters(temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90)”. DME supplies: catheter supplies, ceiling tract Hoyer lift, G-tube, Oxygen tank/concentrator, percussion vest and trach supplies”. The plan of care lacked documented evidence of who is responsible for assess and monitoring patient other health care needs, no indication of another agency providing nursing services for Foley catheter, trach, and G-tube. The survey findings and interview were conducted on 11/21/2024 at 3:00 PM with the Director of Patient Services and Director of Nursing. No explanation was provided. 3) Patient #3 has a start of care date of 04/08/2015 with diagnoses of Type 2 Diabetes Mellitus, Anoxic Brain Damage, Aphasia, Epilepsy, Retention of Urine, Hypothyroidism, Gastro-esophageal Reflux Disease, Long term use of Aspirin, Long term use of Hypoglycemic drugs, and Dependence on wheelchair as documented on the "Home Health Certification and Plan of Care" for certification period 10/17/2024 to 12/15/2024. The "Home Health Certification and Plan of Care" (Plan of Care) for certification period 08/18/202 to 10/16/2024 and 10/17/2024 to 12/15/2024 documents an order "Skilled Nurse 1 wk1 (one visit a week for one week), Speech Therapy 1wk1,3wk8. Skilled Nurse to "evaluate and develop the plan of care". Skilled Nurse to assess/evaluate co-morbid conditions including TBI (Traumatic Brain Injury), Aphasia, and other conditions". The "RN recertification with skills" (Comprehensive Assessment) visit note dated 10/15/2024, the Skilled Nurse documents the patient's "Genito-urinary system assessment: Indwelling/Suprapubic Catheter", and Durable Medical Equipment includes "Foley Catheter 16 French and drainage bag". A Home Visit was conducted on 11/19/2024 with the Speech Therapist. The patient was observed to have an Indwelling Urinary Catheter attached to a Urine Drainage Bag. The Plan of Care lacks an order for the Indwelling/Suprapubic Catheter, Foley catheter size 16fr, balloon size, catheter care, frequency of catheter change and care giver education. The Agency did not establish an individualized Plan of Care that includes the indwelling catheter and treatments. An interview was conducted on 11/20/2024 at 11:40 AM with the Director of Patient Services and Director of Nursing. No explanation was provided. The survey findings were reviewed with the Director of Patient Services and Director of Nursing on 11/21/2024 at 03:55 PM.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the governing authority failed to ensure clinicians conform to physician orders, frequency and duration as specified in the patient's plan of care. This was evident in the review of record for one (1) of eight (8) patient records (Patient #5). Failure to ensure patients receive care in accordance with physician orders have the potential for negative outcomes. The findings are: Patient # 5 has a start of care date of 06/20/2022 with diagnoses of Congenital Malformation Syndrome, Chronic Respiratory failure with Hypoxia or Hypercapnia, Cerebral Palsy, Severe Intellectual disabilities, Contracture of right wrist and hand, Legal blindness, Gastrostomy status and Oxygen dependency as documented on the “Home Health Certification and Plan of Care” for certification period 10/07/2024 to 12/05/2024. The “Home Health Certification and Plan of Care” for certification period 10/07/2024 to 12/05/2024 documents “Occupational therapy three times per week for eight weeks, one time a week for one week, therapy to focus on passive range of motion, Licensed professional to report vital signs falling outside the parameters (temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90)”. DME (Durable Medical Equipment) supplies: catheter supplies, ceiling tract Hoyer lift, G-tube, Oxygen tank/concentrator, percussion vest and trach supplies”. The clinical record lacks documented evidence of the Occupational Therapy visits conducted for 10/21/24, 10/25/24 and 111/09/24, no documentation of MD notification and replacement of service. Documented on the plan of care for certification period 10/07/2024 to 12/05/2024 “Licensed professional to report vital signs falling outside the parameters (temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90).” The Occupational Therapy "Recertification of Care" comprehensive assessment dated 10/04/2024 lacks documentation of the patient’s vital signs: Blood Pressure and Temperature readings. The Occupational Therapy "visit note reports" from 10/08/2024 to 11/18/2024 lacks documentation of the patient’s vital signs: Blood Pressure and Temperature readings. The therapist failed to follow the plan of care to assess all vital signs or indicate if they are within the parameters indicated in the plan of care. The survey findings and interview were conducted on 11/21/2024 at 3:00 PM with the Director of Patient Services and Director of Nursing. No explanation was provided.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on home visit observations, clinical record reviews and staff interviews, the Agency failed to ensure clinicians follow physician orders and patient records are accurate and contain all assessments and clinical interventions. This was evident in one (1) of three (3) observational home visits and records reviewed (Patient #5). Failure to ensure patients receive care as ordered and clinical records are comprehensive has the potential for negative patient outcomes. The findings are: Patient #2 has a start of care date of 03/20/2013 with diagnoses of "Other Disorders of Psychological Development, Spastic Quadriplegia Cerebral Palsy, Sensorineural Hearing Loss Bilateral, Other Dystonia, Postural Kyphosis, Congenital Rubella Syndrome, Specific Developmental Disorder of Motor Function and Dependence on Wheelchair" as documented on the "Home Health Certification and Plan of Care" for certification period 11/17/2024 to 01/15/2025. The "Home Health Certification and Plan of Care" for certification period 11/17/2024 to 01/15/2025 documents an order "Skilled Nurse 1 wk1 (one visit a week for one week), Physical Therapy 4wk1, 3wk1, 4wk3, 1wk1, 4wk2. 3wk1 (four visits a week for one week, three visits a week for one week, four visits a week for three weeks, one visits a week for one week four visits a week for two weeks, three visits a week for one week), and Occupational Therapy 2wk9 (two visits a week for nine weeks)". The clinical record lacks documented evidence of a patient consent for services. A Home Visit was conducted on 11/19/2024 with the Physical Therapist. Two patient admission packages were observed in the home. There was no evidence of a written bill of rights, patient complaint procedure, and complaint hot line number. The patient's caregiver reported she is unaware of the complaint number. The Agency was unable to provide evidence of patient consent for services, bill of rights, complaint procedure and complaint hot line. The survey findings and interview were conducted on 11/20/2024 at 11:19 AM with the Director of Patient Services and Director of Nursing, no explanation was provided. Patient # 5 has a start of care date of 06/20/2022 with diagnoses of “Congenital Malformation Syndrome, Chronic Respiratory failure with Hypoxia or Hypercapnia, Cerebral Palsy, Severe Intellectual disabilities, Contracture of right wrist and hand, Legal blindness, Gastrostomy status and Oxygen dependency” as documented on the “Home Health Certification and Plan of Care” for certification period 10/07/2024 to 12/05/2024. The “Home Health Certification and Plan of Care” for certification period 10/07/2024 to 12/05/2024 documents “Occupational therapy 3 times per week for eight weeks, one time a week for one week, therapy to focus on passive range of motion, Licensed professional to report vital signs falling outside the parameters(temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90)”. DME supplies: catheter supplies, ceiling tract Hoyer lift, G-tube, Oxygen tank/concentrator, percussion vest and trach supplies”. The clinical record lacks documentation of the Register Nurse comprehensive assessment of the start for evaluation of services on 06/20/2022. Documented on the plan of care for certification period 10/07/2024 to 12/05/2024 “Licensed professional to report vital signs falling outside the parameters(temp101, pulse 100, respirations 29 and blood pressure systolic 150, diastolic 90).” The Occupational Therapy " Recertification of Care" comprehensive assessment dated 10/04/2024 lacks documentation of the patient’s vital signs: Blood Pressure and Temperature readings. The Occupational Therapy "visit note reports" from 10/ 08/11/2023 to 11/18/2024 lacks documentation of the patient’s vital signs: Blood Pressure and Temperature readings. The survey findings and interview were conducted on 11/21/2024 at 3:00 PM with the Director of Patient Services and Director of Nursing. No explanation was provided.

The following Statement of Deficiencies represents the results of a Standard re-certification Survey of Able Health Care Services, Inc., Certified Home Health Agency located at 50 Clinton Street, Hempstead, NY 11550, conducted from 12/13/2021 through 12/16/2021 and included complaint investigation of two (2) complaints (#NY00276227 and NY00256872). The deficient practices were identified within high priority Cop 484.60: Plan of Care must include the following, and Conformance with physician orders, resulting in a Partial Extended Survey. The agency's total active patient census reported on 12/13/2021 is 323. The survey consisted of review of eleven (11) Clinical Records identified as Patients #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, and #11 including three (3) discharge records, twelve (12) Personnel Records for professional and paraprofessional personnel identified as Employees #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, and #12, two (2) Contracts, and two (2) observational Home Visits. The survey included review of pertinent policies and procedures including the Health Commerce System, Home Care Worker Registry, Criminal History Record Check, Discharge Planning Policy, COVID-19 and Infection Control. The agency's Quality Improvement and Governing Authority Meeting Minutes for the past twelve (12) months, the Agency's Admission Packet, the Emergency Preparedness Plan, and Complaint Logs from 11/19/2020 to 12/09/2021 were reviewed. Pre-survey activities consisted of review on 11/29/21 of the agency's Health Commerce System Account, Home Care Registry, Criminal History Record Check, Certification and Survey Provider Enhanced Reports (CASPER) for the period of 09/2020 to 08/2021, and the Agency's compliance with report submissions for the 2019 Statistical Report and the Emergency Drill conducted 06/11/2019 through 06/13/2019. The Chief Executive Officer (CEO) and Director of Nursing (DON) were interviewed. The findings were reviewed at the Exit Conference on 12/16/21 at 3:15 PM. The following deficiencies are identified as a result of the survey: G0574 Plan of Care must include the following G0578 Conformance with Physician Orders G0590 Promptly alert relevant physician of changes G01022 Discharge and transfer summaries J1108, J1128, and J1172 Governing Authority J1512 Record and Reports L0001 - Unacceptable Infection Control Procedure W0614 Responsibilities of Home Care Services Entities - Home Care Worker Registry

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record reviews and interview, the agency failed to ensure all Plans of Care are complete. This was evident for one (1) of eleven (11) clinical records reviewed. (Patient #5). Failure to ensure all Plans of Care are complete, has the potential for negative patient outcomes. Findings are: Patient # 5 has a start of care date of 5/1/03 with diagnosis Subdural Hemorrhage following injury without mention of open Intracranial wound, with moderate loss of consciousness, Speech Disturbance, and Neuromuscular Dysfunction of Bladder documented on the Home Health Certification and Plan of Care for Certification period 11/22/21 to 1/20/22. The Home Health Certification and Plan of Care for Certification period 11/22/21 to 1/20/22 documents, “Speech Therapy (ST) 1-2 x a week x 60 days; Speech Therapy continues to do exercises to improve or maintain correct breathing patterns; Patient may experience some level of dyspnea at times” The Plan of Care lacks documented evidence of patient-specific intervention for abnormal breathing patterns or when the patient experience some level of dyspnea and Neuromuscular Dysfunction of Bladder. There is no documented evidence the plan of care is complete. On 12/15/21 at 2:07 PM the Administrator was interviewed. The administrator did not provide an explanation.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on Clinical Records review, and interviews with Agency Staff, the Agency failed to ensure that services were provided in accordance with Physician Orders. This was evident in one (1) of eleven (11) records reviewed (Patient #2). Failure to ensure that services are provided in accordance with Physician Orders and Agency policy has the potential for negative patient outcome and for health care needs to go unmet. The finding are: 1. Patient # 2 has a start of care date of 4/27/2007 with diagnoses that include Spastic Quadriplegic Cerebral Palsy as documented on the " Home Health Certification and Plan Of Care" for the Certification Period of 10/9/21 to 12/7/21. The " Home Health Certification and Plan Of Care" for the Certification Period of 10/9/21 to 12/7/21 document: Orders for Discipline and Treatments: Skilled Nurse 1 every other month, and two times as needed to monitor clinical status, report significant changes to authorizing practitioner, review, revise, and implement personal care plan and supervise Home Health Aide for the next 60 days. Home Health Aide services three to five days per week two hours per day in the morning and six hours per day in the afternoon when in program, 10-12 hours per day three to five days per week when not in program and 10-12 hours per day on weekend Saturday- Sunday on and as needed basis for the next 60 days to assist with Activities of Daily Living and personal care needs". On 12/15/ 21 during the survey, a review of the aide activity sheets for the months of October and November 2021 document the following: For the month of October 2021 , there was no aide services for the two hours per day in the morning on the following dates: 10/9/21 to 10/31/21- no aide services 10/11/21, 10/12, 10/13,10/14, 10/15, 10/18, 10/19, 10/20, 10/21, 10/22, 10/25, 10/27, 10/28, 10/29. For the month of November 2021,there was no aide services for the two hours per day in the morning on the following dates: 11/8,11/9, 11/10, 11/12, 11/15, 11/16, 11/17,11/18, 11/23, 11/24, 11/25,11/26, 11/29. The " Patient/ Client Change of Status" document : Case on hold , AM services on hold effective 11/17/21. An " interim order'' dated 11/23/21document:" Service resumed as of 11/23/21." For the month of December 2021, no aide services were provided in the morning on 12/1, 12/2, 12/3, 12/6, 12/7. There is no documented evidence the services were provided in accordance with the Physician orders and the Plan Of Care. On 12/15/21 at 1:40 PM, the Administrator was interviewed and did not provide an explanation. 2) Patient #1 has an admission date of 04/26/19 with diagnoses Cerebral Palsy, Epilepsy, Asthma, and Muscle Disorder as documented on the "Home Health Certification and Plan of Care" for the certification period from 02/20/20 to 04/19/20. The Home Health Certification and Plan of Care for the certification period of 02/20/20 to 04/19/20 documents the Order for "PT 1-2 x Week 9 (Physical Therapy one to two x a week x nine weeks). Physical Therapist reviews and revise HEP (Home Exercise Program) as needed, instruct caregivers in follow through, therapeutic exercises PROM (Passive Range of Motion), transfer training and muscle re education for maintenance and prevention of decline." The "Patient / Client Change of Status" form dated 03/19/2020 documents: "Case on Hold" Effective 03/19/2020 all therapy service will be on "HOLD" until further notice due to COVID - 19 precautions". There is no documented evidence that the agency staff consulted with the physician prior to placing this patient's services on hold. The Clinical Record lacks documented evidence that the agency made any effort to find a replacement Physical therapist and/or the patient/family refused replacement Physical Therapy. There is no documented evidence that the Physical Therapy (PT) services were provided in accordance with Physician Orders and the Plan of Care. During interview on 12/15/21 at 2:00PM the Chief Executive Officer (CEO), was informed of the survey findings. The CEO acknowledged the survey findings.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on Clinical Record reviews and staff interview, the Agency failed to promptly notify the Physician of changes in Plan of Care that suggest that outcomes are not being achieved and/or the Plan of Care may require alteration. This was evident in one (1) of eleven (11) Clinical Records reviewed (Patient #1). Failure to notify the Physician of the services on hold or/and need to alter the plan of care has the potential for the patients to not receive interventions in which may result in negative outcomes. Findings are: Patient #1(date of birth 4/26/2001) has an admission with diagnoses Cerebral Palsy, Epilepsy, Asthma, and Muscle Disorder as documented on the "Home Health Certification and Plan of Care" certification period from 02/20/20 to 04/19/20. The Home Health Certification and Plan of Care for the certification period of 02/20/20 to 04/19/20 documents the Order for "PT 1-2 x Week 9 (Physical Therapy one to two x a week x nine weeks). Physical Therapist reviews and revise HEP (Home Exercise Program) as needed, instruct caregivers in follow through, therapeutic exercises PROM (Passive Range of Motion), transfer training and muscle re education for maintenance and prevention of decline." The "Patient / Client Change of Status" form dated 03/19/2020 documents: "Case on Hold" Effective 03/19/2020 all therapy service will be on "HOLD" until further notice due to COVID - 19 precautions". The Clinical Record lacks documented evidence of communication with the physician regarding services on hold. There is no documented evidence that the physician was promptly notified of the need to alter the Plan of Care. The survey findings were reviewed with the Chief Executive Officer (CEO) on 12/15/21 at 2:00 PM. On 12/16/21 at 10:00 AM, the CEO acknowledged the survey findings.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on Clinical Record review and staff interview, the agency failed to document discharge planning, and physician notification for patients no longer receiving services from the agency. This was evident for one (1) of three (3) discharge records reviewed. (Patient #1) Failure to document discharge planning, and physician notification has the potential for negative patient outcomes. The findings are: The findings are: Patient #1 (date of birth 4/26/2001) has an admission date of 04/26/19 with date of birth 04/26/2001 has diagnoses Cerebral Palsy, Epilepsy, Asthma, and Muscle Disorder as documented on the "Home Health Certification and Plan of Care" for the certification period from 02/20/20 to 04/19/20. The Home Health Certification and Plan of Care for the certification period of 02/20/20 to 04/19/20 documents the Order for "PT 1-2 x Week 9 (Physical Therapy one to two x a week x nine weeks). Physical Therapist reviews and revise HEP (Home Exercise Program) as needed, instruct caregivers in follow through, therapeutic exercises PROM (Passive Range of Motion), transfer training and muscle re education for maintenance and prevention of decline." The patient discharge OASIS was initiated on 4/19/2020 and completed on 5/8/2020. The record lacks documented evidence the discharge summary was sent/ faxed to the Physician. On 5/8/20, the agency sent an interim order documenting effective 4/19/20 patient was being discharged due to being on hold for prolonged period of time due to COVID-19.There is no documented evidence the discharge summary was sent to the physician within five (5) days of the patient's discharge. During interview on 12/15/21 at 2:00 PM the Chief Executive Officer (CEO), was informed of the survey findings. The CEO acknowledged the survey findings.