Every finding on record at Advance Home Health Care, Ltd

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 09/26/25. The Agency was in compliance with the Condition, 42 CFR 484.102, Establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 09/26/2025. Standard deficiencies cited. Abbreviations: Pt./ Pts. = Patient/Patients POC = Plan of Care RN = Registered Nurse SN = Skilled Nurse SOC = Start of care OASIS = Outcome and Assessment Information Set

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on the review of the Agency’s Error Summary report and Staff interview, the Agency failed to submit timely reports for 188 of 1023 reports submitted for the last 12 months. Finding include: 1. The Agency’s Error Summary report for 09/01/2024 thru 08/31/2025, was reviewed on 09/23/25 at 2:40 PM. The report included 18.38% of the OASIS reports were not submitted timely, resulting in a warning. 2. The above findings were confirmed, during the interview with the Administrator, on 09/24/25 at 10:43 AM.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on the clinical records reviewed and Staff interview, the Agency failed in 2 of 7 (Pts. #4 and 6) clinical records reviewed, to ensure the patient care was provided as ordered in the plan of care. Findings include: 1. Pt. #4 was admitted to the Home Health Services on 07/02/25 with the diagnosis of Orthostatic Hypotension. The clinical record was reviewed on 09/23/25. The clinical record contained a POC dated 07/02/25, that required the SN to visit the patient 2 times a week for 2 weeks and 1 time a week for 7 weeks, to complete a physical assessment each visit with emphasis on orthostatic hypotension. The SN failed to assess the patient for orthostatic hypotension on admission 07/02/25 and on revisit 07/04/25 (week #1). The ortho BP was not assessed until the 3rd visit 07/09/25 (week #2). 2. Pt. #6 was admitted to the Home Health Services on 04/23/25 with the diagnosis of Acute Post Hemorrhagic Anemia. The clinical record was reviewed on 09/23/25. The clinical record contained a POC dated 06/16/25, that required the SN and Aide to visit the patient 1 time a week for 9 weeks. The SN failed to visit during the week of 6/25/25 (week #1). The Aide failed to visit during the week of 08/14/25 (week #8). 3.The findings were confirmed during the interview with the Administrator and Director of Nursing on 09/24/25 between 9:30 AM and 11:00 AM.

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, policy review and staff interviews, for 3 of 7 (Pts. #1, 2 and 5) clinical records reviewed, the Agency failed to ensure Plans of Care included all the requirements. Findings include: 1. Pt. #1 was admitted for Home Health Services on 08/06/24 with the diagnosis of Pressure Ulcer Left Buttock Stage 2. The clinical record was reviewed on 09/22/25. The POC effective 01/01/25 included documentation “Home Health Aide to provide assistance with personal care, ADLs as indicated by limitations on functional and physical status impeding self-care.” The POC lacked documentation of the frequency and duration of the Home Health Aide. 2. Pt. #2 was admitted for Home Health Services on 04/02/25 with the diagnosis of Urinary Tract Infection. The clinical record was reviewed on 09/22/25. The SN notes for from 08/05/25 through 09/16/25 included documentation that Pt. #2 had a urinary catheter and that Home Health, and that the urinary catheter was changed on 09/02/25. The POC effective 07/31/25 lacked procedure and equipment for urinary catheter use, removal and replacement. 3. Pt. #5 was admitted for Home Health Services on 07/23/25 with the diagnoses of, but not limited to Hypertensive Heart and Chronic Kidney Disease with Heart Failure and Stage 1 to 4 Unspecified Chronic Kidney, Type 2 Diabetes Mellitus and Unspecified Diastolic Congestive Heart Failure (CHF). The clinical record was reviewed on 09/23/25. The POC effective 09/01/25 lacked documentation of interventions related to monitoring weight and fluids for CHF. 4. The undated Agency Policy titled “Congestive Heart Failure Policy” was reviewed on 09/23/25 at 2:00 PM and required, “Purpose: To clinically guide the care of the heart failure patients and standardize the practice to quickly identify the problems to ultimately prevent hospitalizations and exacerbations. Policy and Procedure: 2. Fully explain the procedure of weighing every skilled nursing visit and daily for the patient is necessary on this type of condition…4.The doctor should be notified if the condition of the patient restricts him/her in taking weight and create an order for the doctor to sign. 5. During an interview with the Administrator and Director of Nursing on 09/23/25 at 1:45 PM, it was stated that patients with CHF are to be weighed. During the same interviews, it was stated that the POC should include all of the required items, and the above-mentioned findings were confirmed.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on a review of clinical records, and staff interview, for 5 of 7 (Pts. #1, 2, 3 and 4 and 5) clinical record reviewed, the Agency failed to ensure forms and records were complete and accurate. Findings include: 1. The following clinical records were reviewed on 09/22/25 to 09/23/25 and included the form “Notice of Medicare Non-Coverage.” The forms were signed by the Pt. or Pt. representative at the SOC. The forms were incomplete. Pt. #1. SOC: 08/06/24 –The section, “The Effective Date Coverage of Your Current Home Health Services Will End” was blank. Pt. #2. SOC: 07/03/25 - The section, “The Effective Date Coverage of Your Current Home Health Services Will End” was blank. Pt. #3. SOC: 08/18/25 – The section, “The Effective Date Coverage of Your Current Home Health Services Will End” was blank. Pt. #4. SOC: 07/02/25 – The section, “The Effective Date Coverage of Your Current Home Health Services Will End” was blank. Pt. #5. SOC: 07/03/25 – The section, “The Effective Date Coverage of Your Current Home Health Services Will End” was blank. 2. During an interview with the Agency Supervisor on 09/23/25 at 1:45 PM, it was stated that the form is to be filled out once the Agency has determined the effective date Medicare will not pay for the services, and not to be filled out at the SOC. During the same interviews, the above findings were confirmed.

Names and Contact Information CFR(s): 484.102(c)(1) §403.748(c)(1), §416.54(c)(1), §418.113(c)(1), §441.184(c)(1), §460.84(c)(1), §482.15(c)(1), §483.73(c)(1), §483.475(c)(1), §484.102(c)(1), §485.68(c)(1), §485.625(c)(1), §485.727(c)(1), §485.920(c)(1), §486.360(c)(1), §491.12(c)(1), §494.62(c)(1). [(c) The [facility must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following:] (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [facilities]. (v) Volunteers. *[For Hospitals at §482.15(c) and CAHs at §485.625(c)] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [hospitals and CAHs]. (v) Volunteers. *[For RNHCIs at §403.748(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Next of kin, guardian, or custodian. (iv) Other RNHCIs. (v) Volunteers. *[For ASCs at §416.45(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For Hospices at §418.113(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Hospice employees. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Other hospices. *[For HHAs at §484.102(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For OPOs at §486.360(c):] The communication plan must include all of the following: (2) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Volunteers. (iv) Other OPOs. (v) Transplant and donor hospitals in the OPO's Donation Service Area (DSA). This STANDARD is not met as evidenced by: A. Based on review of the Agency's Emergency Preparedness Plan and staff interview, it was determined the Agency failed to ensure the communication plan included all the required elements. This has the potential to affect all services provided by the Agency. Findings include: 1. The Agency's Emergency Preparedness plan last updated in 2022 was reviewed on 8/23/22 at 10:50 AM. The plan lacked the names of the direct staff and contract staff/companies, and their contact information. 2. During an interview with the Administrator and the Director of Nursing on 8/24/22 at 11:15 AM, the Director of Nursing confirmed the Agency's Emergency Preparedness communication plan lacked all the required elements.

Recertification survey completed. Standard Level deficiencies cited. Abbreviations: RN = Registered Nurse SN = Skilled Nurse EMS=Electrical Muscle Stimulator POC= Plan of care PsOC = Plans of care OT = Occupational Therapy/Therapist Pt./Pts. = Patient/patients SOC = Start of care AM = morning PM = afternoon/evening RBS= Random Blood Sugar

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: A. Based on a review of clinical records and staff interview, it was determined the Agency failed to ensure the initial assessment visit was done within 48 hours of the referral date. This was found in 5 of 10 (Pts. #3, 4, 5, 2 and 6) clinical records reviewed. 4. Pt. #2. SOC8/3/22. Principal Diagnosis: Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris. The clinical record was reviewed on 8/23/22/ at 9:15 AM. The record included a Physician referral for home health services dated 7/29/22. The record also contained the initial SOC assessment, dated 8/3/22, 5 days after the Physician referral. The agency failed to initiate service within 48 hours after receipt of the referral. 5. Pt. #6 SOC 6/9/22. Principal Diagnosis: Malignant Neoplasm of Unspecified site of Right Female Breast. The clinical record was reviewed on 8/23/22 at 1:30 PM. The record included a Physician referral for home health services dated 6/3/22. The record also contained the initial SOC assesment, dated 6/9/22, 6 days after the Physician referral. The Agency failed to initiate services witin 48 hours after receipt of the referral. 6. During an interview with the Administrator and Director of Nursing on 8/24/22 from 10:00 AM to 12:30 PM. The Administrative team confirmed the Agency failed to ensure services were initiated within 48 hours of the referral date. Findings include: 1. Pt. #3. SOC 7/13/22. Primary Diagnosis: Hypertensive Chronic Kidney Disease in Stage 1 to 4 / Unspecified Chronic Kidney Failure. The clinical record was reviewed 8/22/22 at 12:30 PM. The record contained the consent for treatment signed by the Pt. and RN on 7/13/22, and the initial POC with a SOC date of 7/13/22. The referral ("Face-to-Face Encounter Form") included documentation the Agency received the referral on 6/23/22. The SOC visit was conducted 20 days after the Agency received the referral. 2. Pt. #4. SOC 8/3/22. Diagnoses: Hemiplegia Following Cerebral Infarction Affecting Dominant Side, Type 2 Diabetes Mellitus without Complications, and Long term (current) use of insulin. The clinical record was reviewed on 8/22/22 at 2:15 PM. The record contained the consent for treatment signed by the Pt. and RN on 8/3/22, and the initial POC with a SOC date of 8/3/22. The referral ("Face-to-Face Encounter Form") included documentation the Agency received the referral on 7/28/22. The SOC visit was conducted 7 days after the Agency received the referral. 3. Pt. #5. SOC 1/17/21. Primary Diagnosis: Multiple Sclerosis. The clinical record was reviewed on 8/22/22 at 1:30 PM. The record contained the consent for treatment signed by the Pt. and RN on 1/17/21, and the initial POC with a SOC date of 1/17/21. The referral ("Encounter Form") included documentation the Agency received the referral on 1/18/21 which was 1 day after the SOC visit . During an interview with the Administrator and the Director of Nursing on 8/24/22 at 10:00 AM. The Director of Nursing stated, "We (the Agency) must have received a referral or order on the 17th, but I don't see it in the record." It cannot be determined when the Agency received the initial referral to start services for Pt. #5.

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: A. Based on observation and interview during a home visit, clinical record review and staff interview, it was determined the Agency failed to ensure staff obtain Physician orders for treatments. This was found in 1 of 6 (Pt. #4) clinical records reviewed, wherein therapy services were provided. Findings include: 1. Pt. #4. SOC 8/3/22. Diagnoses: Hemiplegia Following Cerebral Infarction Affecting Dominant Side, Type 2 Diabetes Mellitus with Complications, and Long term (current) use of insulin. A home visit was conducted on 8/23/22 at 3:30 PM with Employee #1. During the home visit, observed Employee #1 remove a black box from the therapy bag. During an interview, Employee #1 identified the item as an "EMS" that is used to give electrical impulses to the patient's right arm/hand. Pt. #4 also confirmed that she has received EMS therapy from Employee #1. The clinical record was reviewed on 8/22/22 at 2:15 PM and contained the OT evaluation and care plan dated 8/10/22, which lacked the use of an "EMS" 2. The Agency policy titled, "Care Plan" was reviewed on 8/25/22 at 10:25 AM. The policy required: "...Procedures... 3. No changes to the POC are made withiut obtaining physician approval and authorization. Modified physician orders shall be developed, sent, reviewed, and approved... 12... interventions necessary to meet those goals for each sixty-day period..." 3. During an interview with the Administrator and the Director of Nursing on 8/24/22 at 10:00 AM, the Administrator confirmed staff failed to obtain Physician orders for the EMS treatment provided to Pt. #4.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: A. Based on clinical record review, interview during a home visit and staff interview, it was determined the Agency failed to ensure care coordinatinon was conducted in a timely manner to meet the needs of the Pt. This was found in 1 of 10 (Pt. #4) clinical records reviewed. Findings include: 1. Pt. #4. SOC 8/3/22. Diagnoses: Hemiplegia Following Cerebral Infarction Affecting Dominant Side, Type 2 Diabetes Mellitus with Complications, and Long term (current) use of insulin. The clinical record was reviewed on 8/22/22 at 2:15 PM. The record contained a form titled "Medication Profile" and dated 8/3/22 which included: "Novolin 70/30 46 units every morning subcutaneous, Novolin 70/30 40 units every evening subcutaneous". The SOC comprehensive assessment dated 8/3/22 included a RBS result of 168 mg/dl. The SN visit note dated 8/10/22 included a RBS result of 220 mg/dl. The SN visit note dated 8/15/22 included a RBS result of 290 mg/dl. A home visit was conducted on 8/23/22 at 3:30 PM with Employee #1. During the home visit, an interview was conducted with the Pt. that stated, she had not taken any insulin within the past 3 weeks, because she did not have any needles/syringes for the insulin, and that the nurse was aware. The record lacked documentation that the SN had notified the Agency or the Physician regarding the above findings until 8/23/22. 2. The Agency policy titled, "Care Coordination" reviewed on 8/25/22 at 10:20 AM. The policy required: "...3. Assure communication with physician involved in the plan of caare...6. Coordinate care delivery to meet the patient's needs...8. Written evidence of care coordination will be found in the Multi-Discipline Care Plan and Case Conference Summary forms in the patient's medical records..." 3. During an interview with the Administrator and the Director of Nursing on 8/24/22 at 10:00 AM, both confirmed the SN failed to ensure care coordination was conducted in a timely manner to meet the needs of the Pt.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: A. Based on observation during a home visit, Agency policy review and staff interview, it was determined the Agency failed to ensure staff comply with its bag technique policy. This was found in 1 of 4 (Pt. #4) home visits conducted. Findings include: 1. Pt. #4. SOC 8/3/22. Diagnoses: Hemiplegia Following Cerebral Infarction Affecting Dominant Side, Type 2 Diabetes Mellitus with Complications, and Long term (current) use of insulin. The clinical record was reviewed on 8/22/22 at 2:15 PM. A home visit was conducted on 8/23/22 at 3:30 PM with Employee #1. During the home visit, observed Employee #1 remove equipment and supplies from the therapy bag and place them on a barrier, then place the bag on the floor. Employee #1 failed to comply with the Agency's bag technique, by placing the therapy bag directly on the floor. 2. The Agency's policy titled, "Nursing Bag Technique" was reviewed on 8/24/22 at 11:00 AM. The policy required: "...Procedures: 1. Upon entrance to patient's home, the nursing bag is placed on a clean area on a solid surface. The bag is never placed on...floor... If this is not possible, a barrier such as newspaper or paper towels should be placed under the bag..." 3. During an interview with the Administrator and the Director of Nursing on 8/24/22 at 10:00 AM, both confirmed staff failed to comply with the Agency's Nursing Bag Technique. During an interview with the Administrator on 8/25/22 at 9:30 AM, the Administrator stated the "Nursing Bag Techique" policy is applicable to all staff that provide direct Pt. care and/or services.

Substantial Allegation Survey conducted for complaint # 62357, Tracking ID # 2282048/ IL 62357/222323. Standard level deficiencies cited. Abbreviations : SN = Skilled Nurse Pt./Pts. = Patient/Patients POC = Plan of Care SOC = Start of Care

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: A. Based on the clinical record review and Staff interview, it was determined the Agency Staff did not conform to the Physician’s order for the visit frequency. This was found in 2 of 4 (Pts. #1 and 2) records reviewed. Findings include: 1. Pt. #1 SOC 02/16/22. Diagnoses: Essential (Primary) Hypertension and History of Falls. The clinical record was reviewed on 03/25/22 at 10:15 AM. The Plan of Care dated 02/16/22 included orders for the SN with visit frequency of 1 time a week for 9 weeks. The SN duties included taking vital signs each visit and to notify the physician of significant changes. The record lacked the SN visits notes for the week of 02/27/22 (week #3), no vital signs were taken for more than 17 days and for the week of 3/20/22 (week #5), no vital signs taken since last 11 days and the plan of care not modified by the Physician. The same POC required the Physical Therapy frequency of: 1 time a week for 6 weeks. The record lacked a Physical Therapy visit for the week of 03/03/22 and the plan of care was not modified by the Physician. 2. Pt. #2 SOC 12/07/21. Diagnosis: Hypertensive Chronic Kidney Disease. The clinical record was reviewed on 03/25/22 at 11:00 AM. The Plan of Care dated 02/05/22 included physician orders for the Aide services: 1 time a week for 9 weeks. The Aide missed a visit during the week of 02/27/22 (week 5). No vital signs were taken by the Aide for 16 days, the Physician was not notified and the POC was not modified by the Physician. 3. The above findings related to the Staff not conforming to the Physician’s order for the visit frequencies were confirmed with the Agency Supervisor and Administrator on 03/25/22 at 3:00 PM.