Every finding on record at Advantage Home Health Services, East, LLC

Based on the findings of an onsite unannounced home health agency Medicare and state licensure complaint survey conducted on 4/23/25 Advantage Home Health and Hospice, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 a review of admission book, policies and procedures, medical records (MR) and staff interview the agency failed to ensure that services were provided as ordered by a physician for two (2) of five (5) MR's reviewed (MR#3 & MR#4) Review of admission handbook on 4/23/25 at 10:00 AM states, “Admission to Advantage Home Health Services, LLC can only be made under the direction of physician or other allowed practitioner…” Review of policies and procedures on 4/23/25 at 10:30 AM reveled the following: Plan of Care Policy states, “Each plan of care must be signed and dated by the physician/allowed practitioner…Each patient must receive home health services that re written in an individualized plan of care…signed by a physician or authorized practitioner …care and services provided will be provided according to physician/practitioner orders. Orders are current and updated…all clinical services are implemented only in accordance with a plan of care established by aa physicians/practitioners written order. The Agency: accepts orders on referral communicated verbally by n institution’s discharge planner, nurse practitioner, physician’s assistant or other authorized staff member followed by written, signed and date physician orders, in order to begin services as soon as possible…” A review of medical records (MR) on 4/23/25 at 12:00 PM revealed the following: MR#3 Start of Care 4/8/25 A referral order was obtained on 4/8/25. A Physical therapy (PT) evaluation was completed on 4/8/25. The plan of care was pending with no orders for services. A PT visit had been completed on 4/22/25. MR#4 Start of Care 3/14/25. On 4/1/25 documentation from Hamilton Health Center states, “See notes from PCP. She’s declining to sign orders. She did not give these orders. Our records show she ordered OPPT (out patient physical therapy) with Achieva Rehab.” A patient care order with an order date of 3/30/25 written by the Occupational Therapist (OT) states, “Discontinue: effective 3/31/25 12:01 AM-Occupational Therapy 1 wk 3 wk read back and confirmed (ordered on 3/18/25 1:26 PM). A signed handwritten note on this document by the nurse practitioner stated, “I did not give verbal orders for these services. I ordered outpatient therapy for patient with Achieva.” Physical therapy visits had been conducted on 3/14, 3/18, 3/21, 3/25, 3/28 and 4/1/25 with no orders. Interview on 4/23/25 at approximately 12:45 PM with the clinical director and VP of quality assurance confirmed the above findings

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on a review of admission book, policies and procedures, medical records (MR) and staff interview the agency failed to ensure that services were provided as ordered by a physician for two (2) of five (5) MR's reviewed (MR#3 & MR#4) Review of admission handbook on 4/23/25 at 10:00 AM states, “Admission to Advantage Home Health Services, LLC can only be made under the direction of physician or other allowed practitioner…” Review of policies and procedures on 4/23/25 at 10:30 AM reveled the following: Plan of Care Policy states, “Each plan of care must be signed and dated by the physician/allowed practitioner…Each patient must receive home health services that re written in an individualized plan of care…signed by a physician or authorized practitioner …care and services provided will be provided according to physician/practitioner orders. Orders are current and updated…all clinical services are implemented only in accordance with a plan of care established by a physicians/practitioners written order. The Agency: accepts orders on referral communicated verbally by an institution’s discharge planner, nurse practitioner, physician’s assistant or other authorized staff member followed by written, signed and date physician orders, in order to begin services as soon as possible…” A review of medical records (MR) on 4/23/25 at 12:00 PM revealed the following: MR#3 Start of Care 4/8/25 A referral order was obtained on 4/8/25. A Physical therapy (PT) evaluation was completed on 4/8/25. The plan of care was pending with no orders for services. A PT visit had been completed on 4/22/25. MR#4 Start of Care 3/14/25. On 4/1/25 documentation from Hamilton Health Center states, “See notes from PCP. She’s declining to sign orders. She did not give these orders. Our records show she ordered OPPT (out patient physical therapy) with Achieva Rehab.” A patient care order with an order date of 3/30/25 written by the Occupational Therapist (OT) states, “Discontinue: effective 3/31/25 12:01 AM-Occupational Therapy 1 wk 3 wk read back and confirmed (ordered on 3/18/25 1:26 PM). A signed handwritten note on this document by the nurse practitioner stated, “I did not give verbal orders for these services. I ordered outpatient therapy for patient with Achieva.” Physical therapy visits had been conducted on 3/14, 3/18, 3/21, 3/25, 3/28 and 4/1/25 with no orders. Interview on 4/23/25 at approximately 12:45 PM with the clinical director and VP of quality assurance confirmed the above findings

Based on the findings of an unannounced onsite home health agency Medicare recertification survey completed on December 14, 2022, Advantage Home Health and Hospice, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite home health agency Medicare recertification survey completed on December 14, 2022, Advantage Home Health and Hospice, was found to not be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on review of policy and procedure, clinical record review, and an interview with the Vice President of Compliance, it was determined the agency failed to ensure weekly wound measurements, for two (2) out of four (4) clinical records reviewed, of patients receiving skilled nursing wound care services from the agency (CR#11 and CR #17). Review of agency policy "Wound Measurement Policy" on 12/14/2022 at approximately 2:30 PM states " ...wounds will be measured weekly and documented in patient's chart". Review of CR#11 (Start of Care (SOC): 10/22/2022) on 12/14/2022 at approximately 9:00 AM revealed the following: A "Home Health Certification and Plan of Care" for the certification period 10/22/2022-12/20/2022 with the following wound care order: Right posterior Foot Plantar Area R great toe remove old dressing, double bag, place in trash. Cleanse ulcer with mild soap and water, pat dry, apply Betadine, cover with gauze wrap secure with tape daily and PRN detachment or increased drainage". Review of skilled nursing visits revealed wound measurements to not be recorded in the clinical record for the visit week of 11/20/2022-11/26/2022, with a skilled nursing visit conducted on 11/23/2022. Review of CR#17(SOC: 10/26/2022) on 12/14/2022 at approximately 12:00 PM revealed the following: A "Home Health Certification and Plan of Care" for the certification period 10/26/2022-12/24/2022 with the following wound care order: "Puncture/ Left outer Foot Arch 2 pinpoint holes, cleanse area with NSS, pat dry, apply calcium alginate and cover with DSD daily. Review of skilled nursing visits revealed wound measurements to not be recorded in the clinical record for the following visit weeks, nor was the wound assessment documented as non-measurable: 10/23/2022-10/29/2022, with a skilled nursing visit conducted on 10/26/2022 10/30/2022-11/05/2022, with a skilled nursing visit conducted on 10/31/2022 11/13/2022-11/19/2022, with a skilled nursing visit conducted on 11/16/2022 11/27/2022-12/03/2022, with a skilled nursing visit conducted on 11/30/2022 An interview with the agency Vice President of Compliance on 12/14/2022 at approximately 2:00 PM confirmed the above findings.