Every finding on record at Caregivers America Home Health Services, LLC

Based on an unannounced, on-site Medicare recertification survey conducted March 17, 2025 through March 19, 2025, Caregivers America Home Health Services, was found not 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 an unannounced, on-site Medicare recertification survey conducted March 17, 2025 through March 19, 2025, Caregivers America Home Health Services, was found not to be in compliance with the following 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 review of agency policy, clinical records (CRs) and interview with agency administrator (EMP# 1), it was determined agency failed to follow physician orders for five (5) of seven (7) CRs reviewed. (CR# 1, CR# 2, CR# 3, CR# 4 and CR# 5) Findings included: Review of 'Physician Orders Policy Number: C-635' policy on March 18, 2025 at approximately 11:15 a.m. reads,"...Policy: Agency will ensure that all medications, services, and treatments are administered as ordered by a license physician or allowed practitioner..." Review of CRs conducted on March 18, 2025 between approximately 11:00 a.m. to 3:00 p.m. revealed the following: CR# 1, Start of Care (SOC), 7/29/2024: Certification period reviewed 1/25/2025-3/25/2025. Skilled nursing frequency order: 3/16/25: 1w1 (one visit for one week), 118 hours per week. - Week of 1/25/2025: Documentation of Total weekly hours provided: 16 hours. - Week of 1/26/2025-2/1/2025: Documentation of Total weekly hours provided: 40 hours - Week of 2/2/2025-2/8/2025: Documentation of Total weekly hours provided: 48 hours and 45 minutes - Week of 2/9/2025-2/15/2025: Documentation of Total weekly hours provided: 65 hours and 50 minutes - Week of 2/16/2025-2/22/2025: Documentation of Total weekly hours provided: 64 hours - Week of 2/23/2025-3/1/2025: Documentation of Total weekly hours provided: 64 hours - Week of 3/2/2025-3/8/2025: Documentation of Total weekly hours provided: 65 hours - Week of 3/9/2025-3/15/2025: Documentation of Total weekly hours provided: 42 hours and 45 minutes CR# 2, SOC, 1/23/2024: Certification period reviewed 1/17/2025-3/17/2025. Skilled nursing frequency order: 3/9/2025 1w1 and HHA (Home Health Aide) 9 hours per day, 7 days a week. - On 1/31/2025: Documentation of Total daily hours provided: 7 hours. CR# 3, SOC, 9/5/2024: Certification period reviewed 3/4/2025-5/2/2025. Skilled nursing frequency order: 4/27/2025 1w1 and HHA 8 hours per day, 5 days a week. - On 3/6/2025: Documentation of Total daily hours provided: 9 hours and 45 minutes CR# 4, SOC, 12/1/2023: Certification period reviewed 1/24/2025-3/24/2025. Skilled nursing frequency order: 3/16/2025 1w1 and HHA 8 hours per day, 5 days a week. - On 2/3/2025: Documentation of Total daily hours provided: 7 hours and 45 minutes On 2/17/2025: Documentation of Total daily hours provided: 7 hours and 45 minutes CR# 5, SOC, 12/8/2023: Certification period reviewed 1/31/2025-3/31/2025. Skilled nursing frequency order: 3/23/2025 1w1 and HHA 16 hours per day, 17 days a week. - On the following dates: 1/31/2025, 2/1/2025, 2/5/2025, 2/9/2025, 2/13/2025, 2/16/2025, 2/19/2025, 2/23/2025, 2/28/2025, 3/2/2025, 3/7/2025, 3/9/2025 and 3/13/20250: Documentation of Total daily hours provided: 23 hours - On the following dates: 2/1/2025, 2/3/2025, 2/8/2025, 2/11/2025, 2/15/2025, 2/18/2025, 2/22/2025, 2/26/2025, 3/1/2025, 3/3/2025, 3/8/2025, 3/11/2025 and 3/15/2025: Documentation of Total daily hours provided: 9 hours Interview with EMP # 1 on March 19, 2025 at approximately 3:30 p.m. confirmed the above policies are current and above findings.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CRs) and interview with agency administrator (EMP# 1), it was determined the agency failed to ensure the total plan of treatment is reviewed by the attending physician at least every 60 days for five (5) of seven (7) CRs reviewed. (CR# 1, CR# 2, CR# 3, CR# 5 and CR# 6) Findings included: Review of 'Home Health Policy Number: C-580' policy on March 18, 2025 at approximately 11:30 a.m. reads,"...Policy: Instructions:.. 4. The individualized plan of care must be reviewed and revised by the agency and the physician responsible for the home health plan of care as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning wit the start of care date...." Review of CRs conducted on March 18, 2025 between approximately 11:00 a.m. to 3:00 p.m. revealed the following: CR# 1, Start of Care (SOC), 7/29/2024: No documentation provided to show physician reviewed the plan of care at least every 60 days in between the following certification period timeframes: - Certification period: 9/27/2024-11/25/2024: Physician signed on 1/20/2025 (115 days between the certification periods) - Certification period: 1/25/2025-3/25/2025: Not signed. (unable to calculate the days between physician review plan of cares) CR# 2, SOC, 1/23/2024: No documentation provided to show physician reviewed the plan of care at least every 60 days in between the following certification period timeframes: - Certification period: 11/18/2024-1/16/2025: Not signed (unable to calculate the days between physician review plan of cares) - Certification period: 1/17/2025-3/17/2025: Not signed. (unable to calculate the days between physician review plan of cares) CR# 3, SOC, 9/5/2024: No documentation provided to show physician reviewed the plan of care at least every 60 days in between the following certification period timeframes: - Certification period: 11/4/2024-1/2/2025: Physician signed on 1/10/2025 (67 days between the certificaiton periods) CR# 5, SOC, 12/8/2023: No documentation provided to show physician reviewed the plan of care at least every 60 days in between the following certification period timeframes: - Certification period: 12/2/2024-1/30/2025: Not signed (unable to calculate the days between physician review plan of cares) - Certification period: 1/31/2025-3/31/2025: Not signed. (unable to calculate the days between physician review plan of cares) CR# 6, SOC, 11/14/2024: No documentation provided to show physician reviewed the plan of care at least every 60 days in between the following certification period timeframes: - Certification period: 11/14/2025-1/12/2025: Not signed (unable to calculate the days between physician review plan of cares) - Certification period: 1/13/2025-3/13/2025: Not signed. (unable to calculate the days between physician review plan of cares) Interview with EMP # 1 on March 19, 2025 at approximately 3:30 p.m. confirmed the above policies are current and above findings.

12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This STANDARD is not met as evidenced by: Based on review of agency policy, personnel records (PRs) and interview with agency administrator (EMP# 1), it was determined the agency failed to ensure 12 hours of in-service training had been completed for three (3) of seven (7) PRs reviewed. (PR# 4, PR# 6 and PR# 7) Findings included: Review of 'In-Service Education/Staff Development Policy Number: D-320' policy on March 18, 2025 at approximately 11:30 a.m. reads,"...Purpose: Special Instructions:..... Non direct care personnel have a minimum of 8 hours of on-going education per year. Direct care personnel must have a minimum of 12 hours of on-going education during each 12-month period...." Review of PRs conducted on March 18, 2025 between approximately 9:45 a.m. to 11:00 a.m. revealed the following: PR# 4, Date of Hire (DOH), 9/14/2023: No documentation in the personnel file which provided evidence the HHA completed 12 hours of in-service training in 2024. PR# 6, DOH, 8/7/2023: No documentation in the personnel file which provided evidence the HHA completed 12 hours of in-service training in 2024. PR# 7, DOH, 9/14/2023: No documentation in the personnel file which provided evidence the HHA completed 12 hours of in-service training in 2024. Interview with EMP # 1 on March 19, 2025 at approximately 3:30 p.m. confirmed the above policies are current and above findings.

Clinical manager CFR(s): 484.105(c) Standard: Clinical manager. One or more qualified individuals must provide oversight of all patient care services and personnel. Oversight must include the following-- This STANDARD is not met as evidenced by: Based on review of agency policy and interview with staff registered nurse (employee #1), it was determined the agency failed to ensure a clinical manager/supervising nurse was available and provides oversight of all patient care services and personnel at the location of one (1) of one (1) home health agency location. Findings included: Review of 'Clinical Supervisor Policy Number: C-125' policy on March 17, 2025 at approximately 11:30 a.m. reads,"...Essential Job Functions/responsibilities: 1. Acts as a Clinical Manager by providing oversight of all patient care services and personnel. Oversight includes: a. Making patient and personnel assignments. b. Coordinating patient care c. Coordinating referrals d. Assuring that patient needs are continually assessed e. Assuring the development, implementation, and updates of the individualized plan of care...6. Is available at all times during regular business hours and as needed to provide support and assure quality care delivery to home care clients...." Surveyor arrived at the home health agency on March 17, 2025 at approximately 9:30 a.m. No other home health employees were at the office. A staff registered nurse (RN) arrived at the office at approximately 10:15 a.m. No other administrative staff was in the office. Surveyor conducted survey entrance and was told by the staff RN that she does not have any access to any home health documents that were requested by the surveyor. RN staff stated, "Everything is processed by and in the Clarks Summit office." Surveyor confirmed that the Harrisburg location is not a branch location. Surveyor asked who direct the day to day operations and oversight for the Harrisburg location. The staff RN replied, "The administrator. She drives down here every 2-3 months." Surveyor did not received the client lists and personnel lists that were requested at approximately 10:30 a.m. until 12:45 p.m. Surveyor had to wait until the Clarks Summit location employees emailed all the requests lists and documents for the survey. Interview with EMP # 1 on March 19, 2025 at approximately 3:30 p.m. confirmed the above policies are current and above findings.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CRs) and interview with agency administrator (EMP# 1), it was determined agency failed to send a discharge summary 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 home health agency (HHA) (if any) within five (5) business days of the date of the order for discharge from the responsible physician, per policy, for one (1) of seven (7) CRs reviewed. (CR# 7) Findings included: Review of 'Discharge Policy, Policy Number: C-820' policy on March 18, 2025 at approximately 11:45 a.m. reads,"...Purpose: Special Instructions:...3. When a patient is discharged from the agency, the Clinical Manager and or designee, shall complete a discharge summary form within 5 days of the patient's discharge...." Review of CRs conducted on March 18, 2025 between approximately 11:00 a.m. to 3:00 p.m. revealed the following: CR# 7, Start of Care (SOC), 1/23/2024: Patient discharged from agency on 5/10/2024. Documentation provided of the Discharge Summary being sent to the physician on 6/20/2024. (29 business days) Interview with EMP # 1 on March 19, 2025 at approximately 3:30 p.m. confirmed the above policies are current and above findings.

Based on the findings of an unannounced onsite Medicare recertification survey completed March 28, 2022, Caregivers America Home Health Services, Llc. 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 Medicare recertification survey completed March 28, 2022, Caregivers America Home Health Services, Llc. was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on a review of agency policy, observations, and an interview with an agency alternate Administrator, the agency failed to ensure that everyone entering the health care facility is screened and triaged for COVID-19 for one (1) of one (1) observations (Observation #1) and failed to maintain a coordinated agency-wide program for the surveillance of communicable disease by failing to ensure all staff are screened and triaged for COVID-19 for one (1) of one (1) interviews (Interview #1). Findings: CMS-QSO-20-18-HHA (03/10/2020) 'Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs)' 'Guidance' states " ...... . Also, HHAs should be monitoring the health status of everyone (patients/residents/visitors/staff/etc.) in the homecare setting for signs or symptoms of COVID-19". "How should HHAs monitor or restrict home visits for health care staff? Health care providers (HCP) who have signs and symptoms of a respiratory infection should not report to work". Agency policy/procedures reviewed on March 28, 2022 at approximately 9:30 a.m. Policy 'COVID-19 Protocols' 'Daily Self Screening' "Screenings for overall health should be conducted daily. A 'COVID-19 Daily Screening ' questionnaire needs to be completed daily for every employee and for every visitor attempting to enter the office. ..... Office staff members are to complete and submit this form for every visitor attempting to enter the office prior to the visitor entering the office. Field staff are to complete and submit this form for themselves at the start of their work day and prior to performing patient care for the day." Observation #1: On March 25, 2022 at approximately 9:45 a.m. the state surveyor reviewed the COVID-19 symptom screening 'Caregivers America Visitor Log'. On 12/12/21 at 10:27 a.m. a visitors name and phone number was listed with (6) of (6) symptom screening sections left blank. On 02/08/22 at 9:30 a.m. a visitors name was listed with (5) of (6) symptom screening sections left blank. On 02/08/22 at 10:30 a.m. a visitors name was listed with (5) of (6) symptom screening sections left blank. On 02/10/22 at 12:15 a.m. a visitors name and phone number was listed with (6) of (6) symptom screening sections left blank. On 02/10/22 at 12:15 a.m. a visitors name was listed with (6) of (6) symptom screening sections left blank. On 03/25/22 at approximately 1:05 p.m. a (delivery company) person was observed standing in the agency office, past the agency designated COVID-19 screening area, speaking to agency staff. This person was not documented as being screened for COVID-19 on the above stated screening log. Interview #1: On March 25, 2022 at approximately 1:30 p.m. an interview was conducted with the agency alternate Administrator. The Administrator was asked if agency employees in the field, who report directly to the patients house to start their daily work shift, are self screening for COVID-19 symptoms and documenting the results. The Administrator stated "Yes, the field staff utilize a phone application prior to the start of their day." COVID-19 self screening documentation was requested of the registered nurse (employee #1) who was working outside the office with patients on 03/25/22. Employee #1 began working with a patient that day at approximately 9:16 a.m. Documentation provided of employee #1 self screening for COVID-19 late at 1:01 p.m. An interview conducted with the agency alternate Administrator on March 28, 2022 at approximately 12:45 p.m. confirmed the above findings.