Every finding on record at Americare Specialty Homehealth Incorporated

A recertification survey was conducted on 06/17/2025. The census was 35 (Licensed and Certified). No violations were cited.

A recertification survey was conducted on 06/17/2025. The census was 35 (licensed & certified). Abbreviations: OASIS -outcome and assessment information set CMS- Center for Medicare and Medicaid Services IQIES – Internet Quality Improvement & Evaluation System M0090 – The date the OASIS assessment was completed. RN – Registered Nurse

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 record review and interview the agency failed to transmit completed OASIS (a tool used by CMS to collect certain patient information) assessment to CMS within 30 days of completing the OASIS assessment, in that: from 08/01/2024 to 06/02/2025 there were 66 assessments transmitted greater than 30 days from the assessment completion date. This failure prevented the agency's patient data from being made available to CMS for analysis to identify agency performance levels in the provision of patient care. Pre-survey review of the report titled, “OASIS Error Detail Report” on 06/16/2025 taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed 66 (patients 2, 4 and 5) assessments contained error number -3330 with the error message of, “Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record review for Patient 2: review of the agency OASIS final validation reports taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed submission identification number 65011482 submission date 05/14/2025 with 11 total record processed. Record 6 (Patient 2) gave the following error: “…Message -3330 Warning… Message: Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record 6 (Patient 2) of the OASIS Agency Final Validation report that was submitted on 05/14/2025 had a M0090 completion date of 03/26/2025. Record review for Patient 4: review of the agency OASIS final validation reports taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed submission identification number 64857453 submission date 04/15/2025 with 23 total records processed. Record 9 (Patient 4) gave the following error: “…Message -3330 Warning… Message: Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record 9 (Patient 4) of the OASIS Agency Final Validation report that was submitted on 04/15/2025 had a M0090 completion date of 03/14/2025. Record review for Patient 5: review of the agency OASIS final validation reports taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed submission identification number 65011482 submission date 05/14/2025 with 11 total records processed. Record 1 (Patient 5) gave the following error: “…Message -3330 Warning… Message: Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record 1 (Patient 5) of the OASIS Agency Final Validation report that was submitted on 05/14/2025 had a M0090 completion date of 04/12/2025. On 06/19/2025 at approximately 10:40 AM the surveyor conducted an interview with the Administrator and Office Staff D. The surveyor discussed the OASIS report titled, “OASIS Error Detail Report.” The surveyor explained that from 08/01/2024 to 06/02/2025 the agency transmitted 66 OASIS greater than 30 days from the completion date (M0090) to CMS. The surveyor asked who was responsible for transmitting the OASIS assessment to CMS. The Administrator stated, “Office Staff D is the one that make sure the OASIS is submitted on time.” The surveyor asked why the agency had 66 OASIS assessment that were transmitted past 30 days to CMS. The Administrator stated, “no, I didn’t know. In the past we did have issues but that was in 2024. I didn’t know. I guess I will have to take it over again.” The surveyor asked how submitting an OASIS late to CMS could affect the care the patient receives. The Administrator stated, “it could be a delay of services and plan of care to the patient. We could of missed services assessment to the patient.” The surveyor asked Office Staff D why the agency had 66 OASIS submitted past 30 days to CMS. Office Staff D stated, “I don’t know.” On 06/26/2025 at approximately 11:31 AM the surveyor conducted an interview the Administrator. The surveyor discussed the findings from the patient record reviews. The surveyor explained that during record review he found Patients 2, 4 and 5 had OASIS that were transmitted to CMS more than 30 days after the M0090 dates. The surveyor asked why the OASIS were transmitted past 30 days. The Administrator stated, “I don’t know, I think they were just missed” The surveyor asked what the negative outcome could be for agency clients if the agency submits OASIS past 30 days. The Administrator stated, “Delay of services and plan of care to the patient. We could of missed services assessment to the patient.” Review of Agency policy titled, “IM.10 OASIS Collecting, Encoding and Transmitting” with a revision date of 010121 read in part: “PURPOSE: To ensure the OASIS is collected, encoded and transmitted according to regulation…1. The agency must… be transmitted withing 30 days of completing the assessment…”

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 record review and interview, the agency failed to establish a written POC that included required elements for 1 of of 8 active patients (Patients #2) whose records were reviewed, in that: In 1 (Patient 2) of 1 active record reviewed where the patient had a Mediport (a small medical appliance surgically placed under the skin to provide a direct and reliable way to administer medications, chemotherapy, blood products, or blood draws) and received chemotherapy (type of treatment using drugs to kill or slow the growth of cancer cells) from her oncologist (medical doctor specializing in cancer). The POC failed to include instructions for the skilled nurse to assess the Mediport access site for: signs and symptoms of infection; pain and safety measures to include the location of the Mediport site. This failure placed the patient at risk of receiving inadequate care and could place the patient at risk of negative outcome if the Mediport site became infected due to the skilled nurse not assessing the Mediport site. Patient 2: Record review of the EMR included a POC for the certification period 03/23/2025 to 05/01/2025 electronically signed by RN H on 03/20/2025 that included a diagnosis of malignant neoplasm (a cancerous tumor) of lower lobe, left bronchus or lung. The POC did not include safety measures for the Mediport site to include the location of the Mediport and orders for the skilled nurse to assess the Mediport access site for signs and symptoms of infection. During an interview with RN H on 06/20/2025 at approximately 2:15 PM, the surveyor presented the above findings. The surveyor asked if there were any interventions or assessments that are done for Patient 2’s Mediport. RN H stated, “yes, I look at it, I check the site and make sure it is not infected, and the skin is not infected or have pain from the site. I check to make sure it doesn’t have an issue.” The surveyor asked why the POC did not include safety measures for the Mediport. RN H stated, “yes, but there is no way to put it on there from the OASIS.” The surveyor asked RN H if she included an information about the mediport in the plan of care. RN H stated, “no. I didn’t know how we should do that.” The surveyor asked what could happen if a skilled nurse was not aware of Patient 2’s Mediport and did not assess the mediport site. RN H stated, “then they could miss if there was an infection.” During an interview with the Administrator/Supervising Nurse on 06/20/2025 at approximately 2:51 PM, the surveyor presented the above findings of why the POC for Patient 2 did not include safety measures for the Mediporst site to include the location and instruction for skilled nurse to assess the site for signs and symptoms of infection and need to assess for pain from the site. The Administrator/Supervising Nurse stated, “yes, she should have put the location and any assessment information in the plan of care. I don’t know. It might be that the nurses need more training to know they can manually add something to the plan of care.” The surveyor asked what could happen to the patient due to the Mediport not being included in the plan of care. The Administrator/Supervising Nurse stated, “the nurse wouldn’t know to look for infection or to assess for pain for Patient 2.” Agency Policy titled, "TX.6 Plan of Care" undated, read in part, "Purpose To develop an individualized Plan of Care which specifies the care and services necessary to meet the patient specific needs and according to state and federal regulations… Procedure… C. The individualized Plan of Care will specify the care and services necessary to meet the patient specific needs…”

Purpose of the visit was to conduct a Re-Certification survey and investigation of 1 complaint. An entrance conference was conducted on 06/13/2022 with the agency's Administrator at 10:45 a.m. The Administrator was informed that the purpose of the survey was for a re-certification inspection with 1 complaint investigation. L & C: 53 LHH: 0 PAS: 0 Total agency census: 53 An exit conference was conducted 06/20/2022 with the administrator, at 2:30 p.m. The preliminary findings were discussed. The agency was given an opportunity to provide additional documentation. Additional documentation was not provided. Written instructions were provided for how to submit an acceptable plan of correction, within 10 days of receipt of the Statement of Violations. Abbreviations Registered Nurse (RN) Director of Nursing (DON) Licensed Vocational Nurse (LVN) Home Health Aide (hha) Quality Assessment and Performance Improvement (QAPI) Plan of Care (POC) (485) Skilled Nursing Services (SN) Emergency Preparedness Plan (EPP)

EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, OPO, "Organizations" under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE's emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI's emergency plan, as needed. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to review the EPP after each actual emergency response to evaluate its effectiveness and to update the plan as needed following the winter storm that occurred on 02/13/2021 through 02/17/2021. This failure placed the agency clients at risk of harm in the event of an emergency or disaster if the agency's emergency plan was not effective. Findings included: A review of the emergency preparedness plan binder, policies and procedures revealed no evidence of any records to establish the agency conducted an internal review after the winter storm that occurred from 2/13/2021 through 02/17/2021. In an interview on 6/20/22 with the Administrator via phone and the Alt. Admin. in person at approximately 12:45 p.m., the surveyor presented the above findings as to why the agency's emergency preparedness and response plan was not evaluated following the implementation in February of 2021. The Administrator said “we do not write anything up.” The surveyor asked the Administrator what the risks were to the agency clients by not evaluating the plan after a disaster, the Administrator said “we could not improve things for the next disaster.” The Administrator failed to organize and direct the agency’s ongoing functions related to the evaluation of the emergency preparedness plan following an actual emergency. Agency Policy: EC.8 Emergency Preparedness" read in part, "I. Emergency Management Review…3. After each actual disaster or planned exercise, a multi-disciplinary team including management and staff will evaluate (sic) effectiveness and update emergency plan as needed to improve processes.

Purpose of the visit was to conduct a Re-Certification survey and investigation of 1 complaint. An entrance conference was conducted on 06/13/2022 with the agency's Administrator at 10:45 a.m. The Administrator was informed that the purpose of the survey was for a re-certification inspection with 1 complaint investigation. L & C: 53 LHH: 0 PAS: 0 Total agency census: 53 Intake 294194-Unsubstantiated An exit conference was conducted 06/20/2022 with the administrator, at 2:30 p.m. The preliminary findings were discussed. The agency was given an opportunity to provide additional documentation. Additional documentation was not provided. Written instructions were provided for how to submit an acceptable plan of correction, within 10 days of receipt of the Statement of Violations. Abbreviations Registered Nurse (RN) Director of Nursing (DON) Licensed Vocational Nurse (LVN) Home Health Aide (hha) Quality Assessment and Performance Improvement (QAPI) Plan of Care (POC) (485) Skilled Nursing Services (SN) Emergency Preparedness Plan (EPP)

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 record review, observation and interview, the agency failed to furnish skilled nursing services in conformance with physician orders 3 (Patient 1, 2, and 3) of 4 with a diagnosis of heart failure. These failures placed Patients # 1, 2, and 3 at risk of a decline in their health condition, hospitalization due to an exacerbation of their disease processes and/or a lack of physician oversight for their skilled nursing care. Patient 1 chart: The plan of care indicated the start of care as 4/1/2021. The episode 3/27/2022 through 5/25/2022, signed and dated by RN A on 4/3/2022, with a primary diagnosis of hypertensive heart disease with heart failure. The orders included SN visits 1 time a week for 9 weeks, hha visits 1 time a week for 9 weeks, and SN to weigh the patient every week. SN notes for 3/27/2022 and 4/10/2022 failed to indicate the SN had weighed the patient. Patient 2 chart: The plan of care indicated the start of care as 4/8/2021. The episode 4/5/2022 through 6/3/2022, signed and dated by RN A on 3/3/2022, with a primary diagnosis of heart failure. The orders included SN visits 1 time a week for 8 weeks effective week of 4/10/2022 and for the SN to weigh the patient every week. SN notes for 4/17/2022 and 5/15/2022 failed to indicate the SN had weighed the patient. Patient 3 chart: The plan of care indicated the start of care as 9/9/2021. The episode 3/8/2022 through 5/6/2022, signed and dated by RN A on 3/23/2022, with a primary diagnosis of hypertensive heart disease with heart failure. The orders included SN visits 0[RG(1] [M(2] [M(3] times a week for 1 week and one time a week for 8 weeks and the SN to weigh the patient every week. SN notes for 3/13/2022, 3/23/2022, 3/27/2022, 4/3/2022, 4/10/2022, 4/18/2022 and 4/24/2022 failed to indicate the SN had weighed the patient. In an interview via phone on 6/15/2022 at approximately 3:15 p.m. with the Supervising Nurse, the surveyor reviewed the above findings. The Supervising Nurse said she didn’t know why RN 1 was not weighing the patients. In an interview via phone on 6/16/2022 at approximately 8:05 a.m. with RN 1. the surveyor reviewed the above findings. RN 1 explained that she was unable to safely weigh the patients and failed to notify the physician of not weighing as ordered. The surveyor asked RN 1 what the risks were to the patient if not weighing per orders. RN 1 said that they could have an exacerbation of heart failure. Agency policy Agency policy titled “Orders for Care PC.7” read in part:…”The agency will obtain orders and provide care in accordance with physician’s orders which are established prior to initiating patient patient/client care…” [RG(1]Just wondering if we let them know there can’t be a frequency of “0”. [M(2]No, I honestly did not but I will call the agency and let them know. [M(3]

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review and interviews, the agency failed to provide a written visit schedule including the frequency of visits by personnel acting on behalf of the agency to 3 (client’s 1, 2, and 3) of 3 clients the surveyor conducted home visits. This failure did not allow the patients the ability to anticipate care and service visits on a regular and consistent basis and placed the patients at risk of missed visits by staff when visits were not scheduled and conflicted with other appointments and the availability of the patients. Findings: Patient 1 review: The plan of care indicated the start of care as 4/1/2021. The episode 3/27/2022 through 5/25/2022, signed and dated by RN A on 4/3/2022, with a primary diagnosis of hypertensive heart disease with heart failure. The orders included SN visits 1 time a week for 9 weeks, hha visits 1 time a week for 9 weeks. The record contained no evidence a schedule of visits had been provided to the patient. During the home visit and interview with the patient on 6/16/2022 at approximately 10:10 a.m., the surveyor asked if Patient 1 had been provided with a schedule of visits for the services provided by the agency. Patient 1 stated: "No." A review of the Agency provided home folder in the home revealed no evidence of a written schedule of visits. The surveyor asked the patient if anything had been removed from the home folder. Patient 1 stated: "No." Review of Patient 2 chart revealed: The plan of care indicated the start of care as 4/8/2021. The episode 4/5/2022 through 6/3/2022, signed and dated by RN A on 3/3/2022, with a primary diagnosis of heart failure. The orders included SN visits 1 time a week for 8 weeks effective week of 4/10/2022. The record contained no evidence a schedule of visits had been provided to the patient. During the home visit and interview with the patient on 6/16/2022 at approximately 9:30 a.m., the surveyor asked if Patient 2 had been provided with a schedule of visits for the services provided by the agency. Patient 2 stated: "No." A review of the Agency provided home folder in the home revealed no evidence of a written schedule of visits. The surveyor asked the patient if anything had been removed from the home folder. Patient 2 stated: "No." Review of Patient 3 chart revealed: The plan of care indicated the start of care as 9/9/2021. The episode 3/8/2022 through 5/6/2022, signed and dated by RN A on 3/23/2022, with a primary diagnosis of hypertensive heart disease with heart failure. The orders included SN visits 0 times a week for 1 week and one time a week for 8 weeks. During the home visit and interview with the patient on 6/16/2022 at approximately 11:00 a.m., the surveyor asked if Patient 3 had been provided with a schedule of visits for the services provided by the agency. Patient 3 stated: "No." A review of the Agency provided home folder in the home revealed no evidence of a written schedule of visits. The surveyor asked the patient if anything had been removed from the home folder. Patient 3 stated: "No." An interview was conducted with the Administrator on 6/16/2022 at 2:55 p.m. The surveyor shared the results of the clinical record reviews and home visit with Patient 1, 2 and 3 and asked why there was no evidence Patient 1, 2 or 3 being provided with a schedule of the visits to be provided by the agency. The Administrator said “honestly, I don’t know what they are doing, I don’t check on them.” The surveyor asked the Administrator what the risks were to the patients if the agency failed to provide a written schedule of visits. The Administrator said they could have missed visits if they don’t remember “we are coming” and go somewhere else.