Every finding on record at Caretenders Vs of Boston, LLC

A Recertification survey was conducted at Caretenders, located at 330 Whitney Avenue, Suite 720, Holyoke, MA., 01040, on January 7, 2026, January 8, 2026 and January 9, 2026, for compliance with 42 CFR Part 484.102 Emergency Preparedness for Home Health Agencies. As a result of this survey, it was determined the agency was in compliance with these requirements. No deficiencies were cited.

A Recertification survey was conducted at Caretenders, located at 330 Whitney Ave., Suite 720, Holyoke, MA., 01040, on January 7, 2026, January 8, 2026 and January 9, 2026, to determine compliance with the 42 CFR Part 484 Requirements for Home Health Agencies. As a result of this survey, it was determined the agency was not in compliance with these requirements. Deficiencies were cited.

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 record review, policy review and interview, the agency failed to ensure the initial assessment visit was 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, for 2 patients (#2 and #17), out of a total sample of 17 patients. Findings include: Review of the agency's policy entitled, Patient Assessment, Initial and Reassessment, dated 12/1/25, indicated the following: *A qualified clinician performs a comprehensive assessment or reassessment visit in the following situation: Admission visit within 48 hours from referral or physician ordered start of care date. 1.Patient #2 was admitted to the agency in November 2025 with a diagnosis of Type 2 Diabetes Mellitus (condition where the body either does not produce enough insulin [hormone] or does not use insulin effectively, leading to high blood sugar) with diabetic neuropathy (nerve damage caused by prolonged high blood sugar). Review of the clinical record indicated the physician provided a referral to the agency on 11/5/25 for nursing, physical therapy and occupational therapy services. Further review of the clinical record indicated an initial skilled nursing visit was made on 11/10/25, 5 days after the referral. 2. Patient #17 was admitted to the agency in June 2025 with a diagnosis of Calcinosis Cutis (a condition where insoluble calcium deposits in the skin and underlying tissue). Review of the clinical record indicated the physician provided a referral to the agency on 5/22/25 for nursing services. Further review of the clinical record indicated an initial skilled nursing visit was made on 6/3/25, 12 days after the referral. During an interview on 1/9/25 at 11:10 A.M., after reviewing Patient #2 and #17's clinical records, the Facility Administrator said neither of the initial nursing visits occurred within 48 of the referrals as required.

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 record review, policy review and interview, the agency failed to ensure the individualized plan of care was signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration, for 3 patients (#5, #10 and #8), out of a total sample of 17 patients. Findings include: 3. Patient #8 was admitted to the agency in September 2025 with a diagnosis of encounter for fitting and adjustment of urinary device. Review of the clinical record indicated the Home Health Certification and POC for certification period 9/25/25 through 11/23/25 was signed by the physician on 11/13/25. Further review of the clinical record indicated the Home Health Certification and POC for certification period 11/24/25 through 1/22/26 had not yet been signed by the physician. During an interview on 1/8/26 at 9:15 A.M., the Administrator said the Home Health Certification and POC for certification period 9/25/25 through 11/23/25 was signed late and beyond the required 30-day timeframe. She further said the physician signature for Home Health Certification and POC for certification period 11/24/25 through 1/22/26 will be late as it has not yet been signed by the physician, as required. Review of the agency's policy entitled, Physician Orders, dated 10/1/23, indicated the following: *The Plan of Care (POC), telephone and/or verbal orders must be signed and dated by the physician or authorized practitioner within a timely manner per state regulations: Massachusetts timeliness of physician signature is 30 days. 1.Patient #5 was admitted to the agency in December 2026 with a diagnosis of osteoporosis (disease causing bones to become weak and brittle) and pathological left femur (upper leg bone) fracture. Review of the clinical record indicated a verbal order was obtained on 12/2/25 for the Home Health POC for certification period 12/2/25 through 1/30/26. Further review of the clinical record indicated the POC had not been signed by the physician within 30 days, as required. 2. Patient #10 was admitted to the agency in November 2025 with a diagnosis of age-related osteoporosis with a pathological fractured vertebra. Review of the clinical record indicated a verbal order was obtained on 11/21/25 for the Home Health POC for certification period 11/22/25 through 1/20/26. Further review of the clinical record indicated the POC had not been signed by the physician within 30 days, as required. During an interview on 1/9/26 at 9:15 A.M., the Facility Administrator said neither of the Home Health POCs had been signed by the physicians within 30 days as required.

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 observation, policy review, and interview, the agency failed to ensure gloves were doffed (removed), hand hygiene was performed and gloves were donned (putting on) and infection control guidelines were maintained during a wound dressing change observation for 1 patient (#6), out of a total sample of 7 patient home visits. Findings include: Review of the agency policy entitled, Hand Hygiene, revised 5/1/19, included the following: *Staff performs hand hygiene by handwashing with soap and water or using an alcohol-based hand sanitizer: -Before direct contact with patients. -After contact with blood, body fluids or excretions, mucous membranes, non-intact skin, wound dressings, or contaminated surfaces. -Before and after removal of personal protective equipment (PPE-gear worn to create a barrier protecting healthcare workers from infectious materials, bloodborne pathogens, and other hazards). 1. Patient #3 was admitted to the agency in May 2025 with a diagnosis of encounter for change or removal of nonsurgical wound dressing. Review of the clinical record indicated Patient #3 had a right great toe non-pressure chronic ulcer. Review of a physician order, dated 12/12/25, indicated the following: -Right great toe wound: cleanse with normal saline, pat dry with gauze, apply skin prep to intact area at medial (middle) aspect of the toe, allow to dry, apply Aquacel Ag (a sterile, silver-impregnated wound dressing that absorbs fluid, creates a get, and maintains a moist healing environment) to wound bed, cover with gauze, tuck a 2 inch by 2 inch gauze pad in between great toe and second toe to separate, secure with soft cloth surgical tape, change 3 times a week. During a home visit wound dressing change observation on 1/7/26 at 2:00 P.M., the surveyor observed Nurse #1 set up a clean field by placing wound dressing supplies on a blue barrier pad. She sanitized her hands and donned (put on) gloves. She used cleansed bandage scissors and cut into the gauze that was secured around the patient's right great toe. With the same gloves, she removed the gauze, the dressing, a piece of the Aquacel Ag that was in the wound and discarded everything. With the same gloves, she sprayed wound wash onto a gauze and washed the wound with the gauze and used another gauze to dry the wound. She then doffed (removed) her gloves and performed hand hygiene before continuing with the wound dressing procedure. During an interview on 1/7/26 at 2:30 P.M., Nurse #1 said she did not doff her gloves, perform hand hygiene and don new gloves before cleansing the wound, as required. During an interview on 1/7/26 at 3:15 P.M., the Administrator and Clinical Manager said Nurse #1 should have doffed her gloves, performed hand hygiene and donned new gloves before washing the wound to ensure infection control guidelines were maintained and she did not.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure that services were provided as ordered by the physician or allowed practitioner, as indicated in the plan of care, for 3 patients (#3, #7, and #12), out of a total sample of 17 patients. Findings include: Review of the agency policy entitled, Plan of Care (POC), revised 4/1/25, included the following: *A POC is developed for all patients and updated no less than every 60 days with the exception of some waiver patients that allow POC updates greater than 60 days. *The POC includes: Types, frequency, and duration of services required which may include virtual services..... 1. Patient #3 was admitted to the agency in May 2025 with a diagnosis of encounter for change or removal of nonsurgical wound dressing. Review of the physician ordered Home Health Certification and POC for certification period 11/25/25 and 1/23/26 indicated the following: -Skilled Nursing (SN) visits: 2 times a week for 1 week, 3 times a week for 1 week, and 2 times a week for 7 weeks. Review of the clinical record indicated 2 SN visits were provided for each week of 11/30/25 and 12/6/25, and not 3 visits, as ordered. 2. Patient #7 was admitted to the agency in December 2025 with a diagnosis of aftercare following joint surgery for right knee replacement. Review of the clinical record indicated a Physical Therapy (PT) order, dated 12/30/25, for PT visits, effective 12/28/25, 2 times a week for 3 weeks. Review of the clinical record indicated 1 PT visit was provided the week of 12/28/25, and not 2 visits, as ordered. 3. Patient #12 was admitted to the agency in November 2025 with a diagnosis of hemiplegia (paralysis affecting one side) following cerebral infarction (stroke) affecting left side. Review of the physician ordered Home Health Certification and POC for certification period 11/23/25 through 1/21/26 indicated the following: -SN visits: two times a week, 1 time a week for 7 weeks, and 2 as needed (PRN) visits. Review of the clinical record indicated 1 SN visit was provided the week of 11/30/25, and not 2 visits, as ordered. During an interview on 1/9/26 at 8:45 A.M., after reviewing the clinical records, the Administrator said the POC was not followed for Patients #3, #7 and #17 when physician ordered visits were missed and not provided, as ordered.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure staff communicated with the physician involved in the plan of care, related to the current plan of care (POC), for 3 patients (#3, #7, and #12), out of a total sample of 17 patients. Findings include: Review of the agency policy entitled, Coordination of Care, From Admit Through Discharge, revised 9/1/24, included the following: Coordination of care with physician/authorized practitioner: At admission, throughout care, and at discharge, coordination of services is promoted through routine communication with the patient's physician: a. When changes occur in the patient's condition or response to treatment. b. When changes occur in caregiver support or the environment that affect patient treatment. c. When a missed occurs altering the POC..... 1. Patient #3 was admitted to the agency in May 2025 with a diagnosis of encounter for change or removal of nonsurgical wound dressing. Review of the physician ordered Home Health Certification and POC for certification period 11/25/25 and 1/23/26 indicated the following: -Skilled Nursing (SN) visits: 2 times a week for 1 week, 3 times a week for 1 week, and 2 times a week for 7 weeks. Review of the clinical record indicated 2 SN visits were provided for each week of 11/30/25 and 12/6/25, and not 3 visits, as ordered. Further review of the clinical record did not contain any documentation that the physician had been notified of the missed SN visit for the weeks of 11/30/25 and 12/6/25. 2. Patient #7 was admitted to the agency in December 2025 with a diagnosis of aftercare following joint surgery for right knee replacement. Review of the clinical record indicated a Physical Therapy (PT) order, dated 12/30/25, for PT visits, effective 12/28/25, 2 times a week for 3 weeks Review of the clinical record indicated 1 PT visit was provided the week of 12/28/25, and not 2 visits, as ordered. Further review of the clinical record did not contain any documentation that the physician had been notified of the missed PT for the week of 12/28/25. 3. Patient #12 was admitted to the agency in November 2025 with a diagnosis of hemiplegia (paralysis affecting one side) following cerebral infarction (stroke) affecting left side. Review of the physician ordered Home Health Certification and POC for certification period 11/23/25 through 1/21/26 indicated the following: -SN visits: two times a week, 1 time a week for 7 weeks, and 2 PRN visits . Review of the clinical record indicated 1 SN visit was provided the week of 11/30/25, and not 2 visits, as ordered. Further review of the clinical record did not contain any documentation that the physician had been notified of the missed SN visit for the week of 11/30/25. During an interview on 1/9/26 at 8:45 A.M., after reviewing the clinical records for Patients #3, #7 and #12, the Administrator said the physician had not been notified of the missed physician ordered scheduled visits, as required.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure all interventions including medication administration, treatments, and services, and the responses to those interventions were documented, for 3 patients (#2, #5 and #8), out of total sample of 17 patients. Findings include: 3. Patient #8 was admitted to the agency in September 2025 with a diagnosis of encounter for fitting and adjustment of urinary device. Review of the physician ordered Home Health Certification and POC for certification period 9/25/25 through 11/23/25 indicated the following order: -SN for insertion of #16 French (a specific diameter), 10 cubic centimeters (cc-a unit of volume) balloon indwelling catheter (a thin, flexible tube inserted into the bladder for continuous urine drainage) using aseptic technique (maintaining contamination free environment); instill 10 cc of sterile water into the balloon. Change every 4 weeks and as needed (PRN) for dislodgement or blockage..... Review of a SN visit note, dated 12/11/25, contained the following: Monthly foley catheter change. Patient unable to perform catheter change due to lack of knowledge deficit and skill. The note did not indicate the foley catheter and balloon size inserted into the patient. During an interview on 1/8/26 at 9:15 A.M., the Administrator said the 12/11/25 SN visit note was incomplete as it did not contain the foley catheter and balloon size inserted into the patient, as required. Review of the agency's policy entitled, Information Management, revised 10/1/23, included the following: *Clinical notes for all services the patient has received shall be: *Turned into the agency in person or by fax, at least within 2 days from visit. For Point of Care users, synchronization will occur within 24 hours from visit.... *Signed, dated, and timed clinical notes and progress notes. Review of the agency's policy entitled, Wound Assessment, Documentation, and Photography, dated 9/1/24, included the following: *Upon initial visit and subsequently as indicated below, all wounds will be assessed with appropriate documentation within the medical record. *Wound location and description documentation is completed on all patients with wounds at the time of admit or upon development of the wound. *Document the following in the medical record: -Wound type, location and laterality, stage or thickness, wound size, and undermining and/or tunneling. 1.Patient #2 was admitted to the agency in November 2025 with a diagnosis of Type 2 Diabetes Mellitus (chronic condition where the body either does not make enough insulin [hormone] or cannot use insulin effectively leading to high blood sugar) with diabetic neuropathy (nerve damage caused by prolonged high blood sugar). Review of the physician ordered Home Health Plan of Care (POC) for certification period 11/10/25 through 01/08/26, indicated the following: *Occupational Therapy (OT) visit: once a week for 1 week, 2 times a week for 1 week, once a week times 3 weeks, then effective 12/14/25, 2 times a week for 4 weeks. On 1/7/26, surveyor and Occupational Therapist #1 completed a home visit for Patient #2. During the visit the Occupational Therapist said the agency requires visit notes to be completed on the same day as the visit or within 24 hours. The Occupational Therapist said the notes are all done on her tablet. Review of the clinical record on 1/8/26 and 1/9/26, did not indicate the visit note from 1/7/26 had been completed by the therapist. During an interview on 1/9/26 at 11:10 A.M., after reviewing Patient #2's record with the surveyor, the Facility Administrator said the OT visit note had not been completed for services provided that day, as required. 2. Patient #5 was admitted to the agency in December 2025 with a diagnosis of osteoporosis with pathological left femur (upper leg bone) fracture. Review of the physician ordered Home Health POC for certification period 12/2/25 through 1/30/26, indicated the following: *Effective 12/2/26 Skilled Nurse (SN) visit: 3 times a week times 1 week, 2 times a week times 1 week, once a week for 4 weeks, then effective 1/4/26, 3 times a week times 2 weeks, and once a week for 2 weeks. *SN to provide wound care to unstageable wound to the left buttock. SN to instruct patient/caregiver on unstageable wound to left buttock to include definition, and signs and symptoms to report. Review of the clinical record indicated the patient was seen by SN on 12/10/25. Review of the SN visit note, and the Wound Record Report indicated undocumented wound assessment information. Additionally, the patient was seen on 12/27/25 for a resumption of care visit after returning from a hospitalization. Review of the 12/27/25 SN visit note and the Wound Record Report did not include the services provided for the unstageable wound to the patient's left buttocks. During an interview on 1/8/26 at 3:15 P.M., the Facility Administrator said the SN visit notes and Wound Record Report did not include all the interventions, treatment and services provided on those 2 days noted above.

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 record review, policy review and interview, the agency failed to ensure a completed discharge summary was sent to the primary care practitioner or other health care professional responsible for providing care and services to the patient after discharge from the agency within 5 business days of the patient's discharge, for 1 patient (#14), out of a total sample of 17 patients. Findings include: Review of the agency's policy entitled, Patient Discharge/Transfer Process, dated 10/1/23, indicated the following: *A discharge summary including admission and discharge dates, reason for admission to the home health, reason for discharge , services provided to the patient, patient's discharge goals of care, patient's treatment preferences, a list of community resources or referrals made, along with a current medication list, is sent to the physician, or other healthcare professional responsible for care after discharge from the agency within 5 business days of the patient's discharge. 1.Patient #14 was admitted agency in July 2025 with a diagnosis of chronic peripheral venous insufficiency (when the leg veins become damaged and struggle to send blood back to the heart, causing blood to pool in the legs). Review of the clinical record indicated the patient was discharged from the agency on 10/27/25. Further review of the clinical record did not indicate the discharge summary was sent to the physician responsible for providing care to the patient after discharge. During an interview on 1/8/26 at 11:10 A.M., the Facility Administrator said the discharge summary was not provided to the physician as required.

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 record review, policy review, and interview, the agency failed to ensure clinical documentation was complete and appropriately authenticated and dated in accordance with currently accepted standards of practice for 8 patients (#3, #6, #9, #12, #16, #2, #5, and #17), out of a total sample of 17 patients. Findings include: 6. Patient #2 was admitted to the agency in November 2025 with a diagnosis of Type 2 Diabetes Mellitus (chronic condition where the body either does not make enough insulin [hormone] or cannot use insulin effectively leading to high blood sugar) with diabetic neuropathy (nerve damage caused by prolonged high blood sugar). Review of the physician ordered Home Health Plan of Care (POC) for certification period 11/10/25 through 1/8/26, indicated the following: *OT visit: once a week for 1 week, 2 times a week for 1 week, once a week times 3 weeks, then effective 12/14/25, 2 times a week for 4 weeks. Review of the clinical record indicated the following: *12/10/25 OT visit, note was signed and completed on 12/12/25. 7. Patient #5 was admitted to the agency in December 2025 with a diagnosis of osteoporosis with pathological left femur (upper leg bone) fracture. Review of the physician ordered Home Health POC for certification period 12/2/25 through 1/30/26, indicated the following: *Effective 12/14/26 MSW visit: once a week times 2 weeks. Review of the clinical record indicated the following: *12/15/25 MSW visit, note was signed and completed on 12/17/25. 8. Patient #17 was admitted to the agency in June 2025 with a diagnosis of Calcinosis Cutis (a condition where insoluble calcium deposits in the skin and underlying tissue). Review of the physician ordered Home Health POC for certification period 6/3/25 through 8/1/25, indicated the following: *SN visit: 2 times a week for 2 weeks, then effective 6/8/25, once a week for 8 weeks. Review of the clinical record indicated the following: *6/3/25 SN visit, note was signed and completed on 6/5/25. *6/11/25 SN visit, note was signed and completed on 6/13/25. *6/25/25 SN visit, note was signed and completed on 6/29/25. *7/11/25 SN visit, note was signed and completed on 7/15/25. *7/29/25 SN visit, note was signed and completed on 7/31/25. Review of the physician ordered Home Health POC for certification period 8/2/25 through 9/30/25, indicated the following *SN visit: once a week for 8 weeks. Review of the clinical record indicated the following: *9/3/25 SN visit, note was signed and completed on 9/6/25. During an interview on 1/10/26 at 10:45 A.M., after reviewing all the visit notes, the Facility Administrator said all the notes were not signed within 24 hours of the visits, as required. Review of the agency policy entitled, Information Management, revised 10/1/23, included the following: *Clinical notes for all services the patient has received shall be: Turned in to the agency in person or by fax, at least within 2 days from visit. For Point of Care users, synchronization will occur within 24 hours from visit.... 1. Patient #3 was admitted to the agency in May 2025 with a diagnosis of encounter for change or removal of nonsurgical wound dressing. Review of the physician ordered Home Health Certification and Plan of Care (POC) for certification period 9/26/25 through 11/24/25 indicated the following: -Skilled Nurse (SN) visits: effective 9/28/25, 2 times a week for 8 weeks, and 2 as needed (PRN) visits for medical and wound complications. Review of the clinical record indicated the following: *11/20/25 SN visit, note was signed and completed on 11/24/25. Review of the physician ordered Home Health Certification and Plan of Care (POC) for certification period 11/25/25 through 1/23/26 indicated the following: -SN visits: 2 times a week for 1 week, 3 times a week for 1 week, and 2 times a week for 7 weeks. Review of the clinical record indicated the following: *1/5/26 SN visit, note was signed and completed on 1/8/26. 2. Patient #6 was admitted to the agency in November 2025 with a diagnosis of hypertensive heart (long-term high blood pressure which weakens the heart) and Chronic Kidney Disease (CKD-slow, progressive loss of kidney function) with heart failure (heart cannot pump enough blood to meet body's need). Review of the physician ordered Home Health Certification and POC for certification period 11/16/25 through 1/14/26 indicated the following: -SN visits: 2 times a week for 1 week, 1 time a week for 8 weeks, and 2 PRN visits for cardiac/wound complications. Review of the clinical record indicated the following: *11/21/25 SN visit, note was signed and completed on 11/23/25. *12/24/25 SN visit, note was signed and completed on 12/27/25. 3. Patient #9 was admitted to the agency in December 2025 with a diagnosis of pneumonitis (inflammation of the lung tissue) due to inhalation of food and vomit. Review of the physician ordered Home Health Certification and POC for certification period 12/18/25 through 2/15/26 indicated the following: -SN visits: effective 12/21/25, 1 time a week for 8 weeks. -Physical Therapy (PT) visits: 1 time every 2 weeks times two, and 1 time a week for 8 weeks. Review of the clinical record indicated the following: *12/18/25 PT visit, note was signed and completed on 12/20/25. *12/23/25 SN visit, note was signed and completed on 12/28/25. 4. Patient #12 was admitted to the agency in November 2025 with a diagnosis of hemiplegia (paralysis affecting one side) following cerebral infarction (stroke) affecting eft side. Review of the physician ordered Home Health Certification and POC for certification period 11/23/25 through 1/21/26 indicated the following: -SN visits: two times a week, 1 time a week for 7 weeks, and 2 PRN visits . -Occupational Therapy (OT) visits: 1 time a week for 4 weeks, and 1 time every 3 weeks for 3 visits. Review of the clinical record indicated the following: *11/23/25 SN visit, note was signed and completed on 11/25/25. *12/5/25 OT visit, note was signed and completed on 12/8/25. Review of a physician order, dated 12/4/25, indicated for Medical Social Worker (MSW) visits, effective 11/30/25, 1 time a week for 5 weeks. Review of the clinical record indicated the following: *12/4/25 MSW visit, note was signed and completed on 12/9/25. *12/31/25 MSW visit, note was signed and completed on 1/5/26. 5. Patient #16 was admitted to the agency in October 2024 with a diagnosis of Parkinson Disease (a progressive neurological disorder) with dyskinesia (involuntary, erratic muscle movements that can affect the face, arms, legs or trunk). Review of the physician ordered Home Health Certification and POC for certification period 2/2/25 through 4/2/25 indicated the following: -SN visits: 1 time a week for 1 week, 1 time every 2 weeks for 8 weeks, and 2 PRN visits for cardiac complications. Review of the clinical record indicated the following: *4/2/25 SN visit, note was signed and completed on 4/4/25. Review of the physician ordered Home Health Certification and POC for certification period 4/3/25 through 6/1/25 indicated the following: -SN visits, effective 4/6/25, 1 time a week for 4 weeks, 1 time a week for 4 weeks, and 2 PRN visits for cardiac, diabetic, and respiratory complications. -PT visits, 1 time a week for 5 weeks. Review of the clinical record indicated the following: *4/23/25 Licensed Practical Nurse (LPN) visit, note was signed and completed on 4/27/25. *4/30/25 PT visit, note was signed and completed on 5/4/25. During an interview on 1/9/26 at 1:00 P.M., after reviewing all the notes, the Administrator said they were signed and completed late and not within the required 24 hour timeframe.

A Recertification survey was conducted at Caretenders Holyoke on 12/20/22 through 12/22/22 for compliance with 42 CFR Part 484.102 Emergency Preparedness for Home Health Agencies. As a result of this survey, it was determined the Agency was in compliance with these requirements. No deficiencies were cited.

A Recertification survey was conducted at Caretenders Holyoke on 12/20/22 through 12/22/22 to determine compliance with the 42 CFR Part 488 requirements for Home Health Agencies. As a result of this survey, it was determined the Agency was not in compliance with these requirements. Deficiencies were cited.

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 record review and interview, the Agency failed to ensure its staff provided an initial comprehensive assessment visit within 48 hours of a referral, for one Patient (#6), out of a total sample of 17 Patients. Findings include: Patient #6 was admitted to the Agency in November 2022 with a diagnosis to change and/or removal a surgical wound dressing. Review of the clinical record indicated a referral was received and accepted by the Agency on 11/11/22. Further review of the clinical record indicated the initial comprehensive admission assessment was not completed by a Registered Nurse (RN) until 11/17/22. During an interview on 12/22/22 at 3:35 P.M., after reviewing the clinical record, the Office Manager said that at the time the referral was made and accepted by the Agency, there was no staff available to do the initial assessement within 48 hours. She said this information was not documented in a clinical note in the record and the intial assessment was not done timely, as required.

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 and interview, the Agency failed to ensure its staff conformed with the Physician's orders for three Patients (#4, #15 and #6), out of a total sample of 17 Patients. Specifically, the Agency failed to ensure its staff provided Skilled Nursing (SN) services for Patient #4 and #6, and Occcupational Therapy (OT) services for Patient #15, as ordered. Findings include: 3. Patient #6 was admitted to the Agency in May 2022 with a diagnosis of Chronic Obstructive Pulmonary Disease-(COPD-a group of lung diseases that block airflow and make it difficult to breathe). Review of the Physician's order for certification period 7/5/22 through 9/2/22 indicated the following: SN visit, effective 7/10/22, three times a week for one week, two times a week for one week, once a week for two weeks and once every two weeks for two weeks. Review of the clinical record indicated that only two SN visits were provided for the week of 7/10/22 through 7/16/22. During an interview on 12/22/22 at 2:00 P.M., after reviewing the clinical record, the Administrator said a third visit was not provided for Patient #6 during the week of 7/10/22 through 7/16/22, as ordered. She further said there was no documentation indicating why the visit was not provided. 1. Patient #4 was admitted to the Agency in November 2022 with a diagnosis to change and/or removal of a surgical wound dressing. Reivew of the Physician's order for certification period 11/17/22 through 1/15/23 indicated the following: Skilled Nursing (SN) visit two times a week for three weeks, once a week for one week, and once a week every two weeks for two weeks. Review of the clinical record indicated that only one SN visit was provided for the week of 11/20/22 through 11/26/22. During an interview on 12/22/22 at 4:15 P.M., after reviewing the clinical record, the Administrator said a second SN visit was not provided for Patient #4 during the week of 11/20/22 through 11/26/22, as ordered. She also said there was no documentation indicating why the visit was not provided. 2. Patient #15 was admitted to the Agency in January 2022 with a diagnosis of Stage Four Pressure Ulcer (a deep wound reaching the muscles, ligaments or bones) of the right heel. Reivew the Physician's orders for certification period 11/7/22 through 1/5/23 indicated the following: effective 12/4/22, Occupational Therapy (OT) once a week for four weeks. Review of the clincial record indicated a missed OT visit on 12/21/22. A clinical note, dated 12/21/22, indicated the OT visit was not provided due a staff emergency/illness. During an interviw on 12/22/22 at 3:50 P.M., after reviewing the clinical record, the Administrator said an OT visit was not provided as ordered and had not been rescheduled.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure its staff communicated with the Physician when the care plan was not followed as ordered for Skilled Nursing Visits (SNV) for two Patients (#4 and #6), out of total sample of 17 Patients. Findings include: 2. Patient #6 was admitted to the Agency in May 2022 with a diagnosis of Chronic Obstructive Pulmonary Disease-(COPD-a group of lung diseases that block airflow and make it difficult to breathe). Review of the Physician's order for certification period 7/5/22 through 9/2/22 indicated the following: SN visit, effective 7/10/22, three times a week for one week, two times a week for one week, once a week for two weeks and once every two weeks for two weeks. Review of the clinical record indicated that only two SN visits were provided for the week of 7/10/22 through 7/16/22. Further review of the clinical record indicated there was no documentation indicating why the third SN visit was not provided or that the Physician was notified. During an interview on 12/22/22 at 2:00 P.M., after reviewing the clinical record, the Administrator said that there was no documentation by the staff indicating the Physician was notified of the missed SN visit. She further said the Physician should have been notified of the missed third SN visit for the week of 7/10/22 through 7/16/22. 1. Patient #4 was admitted to the Agency in November 2022 with a diagnosis to change/removal a surgical wound dressing. Review of the Physician's order for certification period 11/17/22 through 1/15/23 indicated the following: Skilled Nursing (SN) visit two times a week for three weeks, once a week for one week, and once a week every two weeks for two weeks. Review of the clinical record indicated that only one SN visit was provided for the week of 11/20/22 through 11/26/22. Further review of the clinical record indicated there was no documentation indicating why the SN visit was not provided or that the Physician had been notified. During an interview on 12/22/22 at 4:15 P.M., after reviewing the clinical record, the Administrator said that there was no documentation by staff indicating that they had notified the Physician of a missed SN visit for Patient #4. She said the Physician should have been notified that a second SN visit was not provided as ordered during the week of 11/20/22 through 11/26/22