Every finding on record at Angel Home Health Agency Serv Corp

The Emergency Preparedness requirements were evaluated in conjunction with the recertification survey, on 11/16/23. Standard level deficiencies cited.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.542(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, REHs at §485.542, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on review of Agency’s Emergency Preparedness Plan, In-services Binder, and staff interviews, it was determined the Agency failed to conduct staff training related to the Agency’s Emergency Preparedness Plan. Findings include: 1. The Agency’s Emergency Disaster Plan and In-services Binder were reviewed on 11/14/23. The In-services Binder lacked documentation that the Agency conducted Emergency preparedness staff training in 2021 and 2022. 2. During interview with the Administrator and Nursing Supervisor on 11/15/23 at 12:00 PM, the Administrator confirmed the above findings.

Recertification survey completed. Standard Level deficiencies cited. Abbreviations: w = week # = number AM = morning SN = Skilled Nurse POC = Plan of care SOC = Start of care mg = milligram MEQ-ER= milli equivalent Extended Release BP = Blood Pressure LPN = Licensed Practical Nurse RN = Registered Nurse PM = afternoon/evening Pt./ Pts. = Patient/Patients HHA = Home Health Agency OASIS = Outcome Assessment Information Set

Written notice of patient's rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient's rights and responsibilities under this rule, and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This ELEMENT is not met as evidenced by: Based on review of the Agency's Admission Folder, and staff interviews, it was determined the Agency failed to ensure Pts. received a copy of the Agency's transfer and discharge policy. This has the potential to affect all patients admitted to the Agency. Findings include: 1. The Agency's Admission Folder provided to the patients, was reviewed on 11/13/23 at 11:00 AM. The folder lacked a copy of the Agency's transfer and discharge policy. 2. During staff interviews with the Administrator and Nursing Supervisor on 11/15/23 at 12:00 PM, the Administrator indicated the same folder is given to all Pts. and, confirmed the admission folder did not include a copy of the Agency's transfer and discharge policy.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on review of clinical records and staff interviews, it was determined the Agency failed to ensure informed consents included the frequency of visits for the services to be provided. This was found in 7 of 7 (Pts. # 1, 2, 3, 4, 5, 6 and 7) clinical records reviewed. 1. The following clinical records were reviewed beginning at 11:30 AM on 11/13/23 through 3:00 PM on 11/14/23: Pt. #1. SOC: 05/31/23. Pt. received SN service. Pt. #2. SOC: 07/03/23. Pt. received SN service. Pt. #3. SOC: 09/11/23. Pt. received SN service. Pt. #4. SOC: 09/11/23. Pt. received SN service. Pt. #5. SOC: 09/12/23. Pt. received SN service. Pt. #6 SOC: 02/13/23. Pt. received SN and Physical Therapy services. Pt. #7 SOC: 11/07/22. Pt. received SN and Home Health Aide services. The records lacked documentation that the Pt. or Pt.'s representative was notified of each discipline's frequency of visits, prior to providing Pt. care and services. 2. During staff interviews with the Administrator and Nursing Supervisor on 11/15/23 at 12:00 PM, it was confirmed the Agency failed to ensure Pts. were informed of the frequency of visits provided by each discipline.

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: Based on clinical record reviews and staff interviews, it was determined the Agency failed to ensure an RN performed the initial assessment within 48 hours of the Physician referral for Home Health Care services. This was found in 5 of 7 (Pts. #1, 2, 5, 4 and 6) clinical records reviewed. 4. Pt. #4 was admitted to Home Health Services on 9/11/23 with the primary diagnosis of Type 2 Diabetes Mellitus with diabetic neuropathy. The clinical record was reviewed on 11/14/23. The Face-to Face form signed by the Physician on 8/15/23 and faxed to the Agency on 8/31/23 required: "Skilled Nursing – resume nursing to monitor vital signs, explain disease process, assess compliance to treatment regimen and medication and educate on proper diet.” The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 11/16/23, the record lacked documentation the Agency initiated service within the required time frame. 5. Pt. #6 was admitted to Home Health Services on 2/13/23 with the primary diagnosis of Polyosteoarthritis. The clinical record was reviewed on 11/13/23. The Face-to Face form signed by the Physician on 1/31/23 and faxed to the Agency on 2/7/23 required: "Skilled Nursing Care.” The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 11/16/23, the record lacked documentation the Agency initiated service within the required time frame. Findings include: 1. Pt. #1 was admitted to Home Health Services on 5/31/23 with the primary diagnosis of Essential (primary) Hypertension. The clinical record was reviewed on 11/13/23. The Face-to Face form signed by the Physician on 4/22/23 required: "SN for observation and assessment for patient’s response to treatment." The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 11/16/23, the record lacked documentation the Agency initiated service within the required time frame. 2. Pt. #2 was admitted to Home Health Services on 7/3/23 with the primary diagnosis of Polyosteoarthritis, unspecified. The clinical record was reviewed on 11/14/23. The Face-to Face form signed by the Physician on 6/12/23 required: "SN for observation and assessment for patients’ response to treatment." The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 11/16/23, the record lacked documentation the Agency initiated service within the required time frame. 3. Pt. #5 was admitted to Home Health Services on 9/12/23 with the primary diagnosis of Type 2 Diabetes Mellitus with Diabetic Neuropathy, unspecified. The clinical record was reviewed on 11/14/23. The Face-to Face form signed by the Physician on 8/3/23 required: "Skilled Nursing Care.” The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 11/16/23, the record lacked documentation the Agency initiated service within the required time frame. 6. During an interview with the Administrator and Nursing Supervisor, on 11/15/23 at 12:00 PM, the Administrator confirmed the initial assessment visits were conducted, after 48 hours of the Face to Face or referral date.

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 a review of clinical records and staff interview, it was determined the Agency failed to follow orders by the Physician and as indicated in the POC. This was found in 3 of 7 (Pt. #7, 1 and 5) clinical records reviewed. 2. Pt. #1 was admitted to Home Health Services on 5/31/23 with the primary diagnosis of Essential (primary) Hypertension. The clinical record was reviewed on 11/13/23. The record included the POC for the certification period of 9/28/23 to 11/26/23 required, "SN Frequency: 1w9". The POC effective 9/28/23 required, "Notify Physician of: Systolic BP Greater Than (>) 160 or Less Than ( Diastolic BP Greater Than (>) 100 or Less Than ( The SN visit note dated 10/4/23 lacked documentation to Physician regarding high blood pressure. 3. Pt. #5 was admitted to Home Health Services on 9/12/23 with the primary diagnosis of Type 2 Diabetes Mellitus with Diabetic Neuropathy, unspecified. The clinical record was reviewed on 11/14/23. The record included the POC for the certification period of 9/12/23 to 11/10/23 required, "SN Frequency: 2 weeks 2, 1 week 7". The POC effective 9/28/23 required, "Notify Physician of: Systolic BP Greater Than (>) 160 or Less Than ( Diastolic BP Greater Than (>) 100 or Less Than ( The SN visit notes dated 9/20/23, 9/22/23, 9/26/23 and 10/11/23 lacked documentation to Physician regarding high blood pressure. 4. During an interview with the Administrator and the Nursing Supervisor on 11/15/23 at 12:00 PM, the Administrator confirmed the above findings Findings include: 1. Pt. #7 was admitted for skilled home health on 11/7/22 with a Primary Diagnosis of Unspecified Asthma. The clinical record which was reviewed on 10/14/23 included POC for the episode of 11/7/23 to 1/5/23 which required, “Notify Physician of: Systolic BP greater than 160 or less than 90; Diastolic BP greater than100 or less than 50.” Pt. #7’s document titled “Skilled Nursing Visit Note” dated 12/21/22 included documentation of BP 183/102 and the visit note on 1/4/23 included documentation of BP of 152/102. The clinical record lacked documentation the physician was notified of blood pressure parameters that were out of range.

Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This ELEMENT is not met as evidenced by: Based on review of clinical records, policy review and staff interviews, it was determined the Agency failed to assess the need for Pneumococcal Pneumonia vaccines for 7 of 7 (Pts. #1, 2, 3, 4, 5, 6 and 7) clinical records reviewed. Findings include: 1. The following Pts. were admitted for skilled home health services. The clinical records were reviewed beginning at 11:30 AM on 11/23/23 through 3:00 PM on 11/14/23: Pt. #1 – SOC 5/31/23 Pt. #2 – SOC 7/3/23 Pt. #3 – SOC 9/11/23 Pt. #4 – SOC 9/11/23 Pt. #5 – SOC 9/12/23 Pt. #6 – SOC 2/13/23 Pt. #7 – SOC 11/7/22 As of 11/15/23, the clinical records reviewed lacked documentation of Pneumococcal Pneumonia inquiry/assessment. 2. The policy titled, “Influenza and Pneumonia Vaccination Program” was reviewed on 11/14/23 and required, “VI. For Pneumonia vaccines, Agency staff will document in each patient’s/client’s medical record that a vaccination against pneumococcal pneumonia was offered, administered, arranged, refused or medically contraindicated or that the patient/client is not a member of a vaccination priority population. The following will be considered to be documentation approaches that meet the requirements of the Act…A. Assessment for the need of vaccination, date of offer or referral, patient response, administration, contraindication or refusal or any follow-up activities; B. Standardized check off form recording client… specific information, including the assessment for the need of the vaccination, date of offer or referral, patient response, administration, contraindication, or refusal and any follow-up activities.” 3. During an interview with the Administrator and the Nursing Supervisor on 11/15/23 from 11:00 AM – 12:00 PM, it was stated that during the start of care, the patient’s Influenza and Pneumococcal Pneumonia vaccination status is assessed, and this information is documented in the clinical record. During the same interview, the above finding was confirmed.

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: Based on observations during home visits, Agency policy review and staff interviews, it was determined the Agency failed to ensure staff provide services in accordance with the Agency' Infection Control Standards of Practice, while providing home services. This was observed in 3 of 3 (#1, #2 and #3) home visits conducted. 3. Pt. # 3 was admitted for home health services on 9/11/23 with a Primary Diagnosis of Essential Primary Hypertension. A home visit was conducted with the LPN on 11/14/23. During the home visit, the LPN used Agency- provided blood glucose monitoring machine. The LPN disinfected the machine using a hand sanitizer. The LPN also took out a red colored hazards container from the visiting bag, placed the used lancet/needle in the container, and returned the container inside the visiting bag. 4. The Agency Policy titled “Infection Control Program” was reviewed on 11/16/23 and required, “C. Prevention and Control Activities…1. The Agency will follow accepted standard precautions and as needed, transmission-based precautions with standard precautions, to prevent the transmission of infections and communicable diseases. 3. Other policies to be followed by staff to prevent, control and improve infections include Cleaning and Management of Supplies and Equipment, and Disposal of Needles and Sharps Policy.” 5. During an interview was conducted with the Administrator and the Nursing Supervisor on 11/15/23 at 11:30 AM, it was stated that Agency follows standard infection control practice for disinfecting the glucometer and disposal of sharps. During the same interview, the above findings were confirmed. 1. Pt. #1 was admitted to Home Health Services on 5/31/23 with the primary diagnosis of Essential (primary) Hypertension. A home visit was conducted with Administrator-RN on 11/13/23. During the home visit, RN checked blood glucose using a new blood glucose machine provided by HHA. The RN disposed the used lancet in a plastic bag. RN did not have a hazard container with her to dispose the needle. 2. Pt. #2 was admitted to Home Health Services on 7/3/23 with the primary diagnosis of Polyosteoarthritis, unspecified. A home visit was conducted with Nursing Supervisor-RN on 11/14/23. During the home visit, RN checked blood glucose using a new blood glucose machine provided by HHA. The RN left the lancet attached to the lancing device and placed in a plastic bag. RN did not have a hazard container with her to dispose the needle.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on a review of clinical records and staff interview, it was determined the Agency failed to ensure the Home Health Aide provided services, as directed on the Home Health Aide Care Plan. This was found in 1 of 1 (Pts. #7) clinical records reviewed, wherein the Pt. received Home Health Aide services. Findings include: 1. Pt. #7 was admitted to skilled home health with a Primary Diagnosis of Unilateral Primary Osteoarthritis, right hip. The clinical record was reviewed on 11/15/23. The record contained the "Home Health Aide Care Plan" completed by the RN which required the Home Health Aide: “Services ordered: Vital signs.” Pt. #7’s “Home Health Aide visit note” dated 11/29/22, 12/5/22, 12/12/22, 12/19/22, 12/27/22, 1/2/22 and 1/9/22, included documentation that the Home Health Aide assisted with showers for Pt. #7 during those visits. The Aide care plan did not include RN instructions for the Home Health Aide to “assist with showers." 2. During an interview with the Administrator and Nursing Supervisor on 11/15/23 at 11:30 AM, the above finding was confirmed.

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 a review of clinical records and staff interview, it was determined the Agency failed to ensure that documentation in the clinical record was accurate and complete. This was found in 6 of 7 (Pts. #1, 2, 5, 3, 4 and 6) clinical records reviewed. 4. Pt. # 3 was admitted for home health services on 9/11/23 with a Primary Diagnosis of Essential Primary Hypertension. As of the date of clinical record review on 11/15/23, the Skilled Nursing Visit notes after 10/12/23 has not been incorporated in the record. An interview was conducted with the LPN on 11/14/23 at 2:30 PM who stated that the Skilled Nursing Visit Notes are to be submitted to the Agency office weekly. 5. Pt. #4 was admitted for skilled home health services on 9/11/23 with a Primary Diagnosis of Type 2 Diabetes Mellitus with diabetic neuropathy. As of the date of clinical record review on 11/15/23, the Skilled Nursing Visit notes after 10/12/23 has not been incorporated in the record. 6. Pt. #6 was admitted for skilled home health services on 2/13/23 with a Primary Diagnosis of Polyosteoarthritis. As of the date of clinical record review on 11/15/23, the Discharge Comprehensive Assessment is incomplete. 7. The Agency Policy titled, "Timelines" was reviewed on 11/16/23 and required, "Daily Progress notes with correlating time sheets are turned in within a maximum of 7 calendar days... H. The Discharge Comprehensive Assessment is completed within 48 hours of the discharge/discharge notification prior to the submission of the OASIS data. IV. All medical record information will be incorporated into the patient's/client's medical record in a timely manner." 8. During an interview was conducted with the Administrator and the Nursing Supervisor on 11/15/23 at 12:00 PM, the Administrator confirmed that the clinical records should be accurate and complete. Findings include: Pt. #1 was admitted to Home Health Services on 5/31/23 with the primary diagnosis of Essential (primary) Hypertension. The clinical record was reviewed on 11/13/23. Pt. #1's Medication Profile and medications were reviewed with Pt. during home visit on 11/13/23. Pt. #1’s Medication Profile was not updated to include Bicalutamide, Lisinopril, Furosemide, Aspirin, Januvia, and Xarelto. Pt #1 provided a bottle of Bicalutamide 50 mg tablets, its label read “take one tablet daily by mouth,” a bottle of Lisinopril 20 mg tablets, its label read "take one tablet daily by mouth," a bottle of Furosemide 20 mg tablets, its label read “take one tablet daily by mouth,” a bottle of Januvia 100mg tablets, its label read “take one tablet daily by mouth,” and a bottle of Xarelto 10 mg tablets, its label read "take one tablet daily every morning by mouth." The record lacked any Physician orders for changes in medications. As of 11/16/23, the Medication Profile was inaccurate. The SN visit notes were missing in the clinical record after 10/11/23 to 11/16/23. 2. Pt. #2 was admitted to Home Health Services on 7/3/23 with the primary diagnosis of Polyosteoarthritis, unspecified. The clinical record was reviewed on 11/14/23. Pt. #2's Medication Profile and medications were reviewed with Pt. during home visit on 11/14/23. Pt. #2's Medication Profile was not updated to include Furosemide, Potassium Chloride and Hydralazine. Pt. #2 provided a bottle of Furosemide 20 mg tablets, its label read “take one tablet by mouth every day," a bottle of Potassium Chloride 20 MEQ ER tablets, its label read "take one tablet by mouth every day," and a bottle of Hydralazine 50 mg tablets, its label read “take one tablet by mouth twice daily.” The record lacked any Physician orders for changes in medications. As of 11/16/23, the Medication Profile was inaccurate. The SN visit notes were missing in the clinical record after 10/11/23 to 11/16/23. 3. Pt. #5 was admitted to Home Health Services on 9/12/23 with the primary diagnosis of Type 2 Diabetes Mellitus with Diabetic Neuropathy, unspecified. The clinical record was reviewed on 11/14/23. The SN visit notes were missing in the clinical record after 10/11/23 to 11/16/23.

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 review of clinical records and staff interview, it was determined the Agency failed to ensure the Physician was sent a copy of the Discharge Summary. This was found in 2 of 2 (Pts. #6 and #7) closed/discharged clinical records reviewed. Findings include: 1. Pt. #6 was admitted to Home Health Services on 2/13/23 with a Primary Diagnosis of Polyosteoarthritis, unspecified. The record contained the Discharge comprehensive assessment dated 8/11/23, indicating that Pt. #6 was discharged from the Agency. As of the date of the clinical record review on 11/14/23, the record lacked documentation that a copy of Pt. #6’s discharge summary was sent to the Physician. 2. Pt. #7 was admitted to Home Health Services on 11/7/22 with a Primary Diagnosis of Unspecified Asthma. The record contained the Discharge comprehensive assessment dated 5/5/23, indicating that Pt. #7 was discharged from the Agency. As of the date of the clinical record review on 11/14/23, the record lacked documentation that a copy of Pt. #7’s discharge summary was sent to the Physician. 3. During an interview with the Administrator and the Nursing Supervisor on 11/15/23 at 11:40 AM, the above findings were confirmed.