Every finding on record at Clark County Home Health Agency

The Emergency Preparedness regulations were reviewed as part of the Medicare recertification survey completed on 04/30/2025. During the survey it was determined the home health provider is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Providers.

A partial extended survey for Medicare recertification for the home health provider was completed on 04/30/2025. The provider had 48 current patients.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on policy review, record review, home visit observation, and interview, the home health provider failed to ensure staff performed a complete medication review in one of five full records reviewed (Record/Patient #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Policy for Use of Medication and Treatment Profile,” showed in part the following: - All drugs will be entered into the medication profile of the electronic health information; - The medication profile shall be updated whenever any changes in medications occur; - Medications and treatments will be reviewed by a skilled nurse at every home visit for any changes; - Nurses will update the medication profile as needed, and medications that are discontinued or added will be added to the profile upon completion of every visit; and - Patients/Caregivers/Responsible parties will have a medication profile in the home, and this will be reviewed and updated as needed with each skilled nursing and therapy visit. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 4/13/2025 after an inpatient hospital stay for primary diagnosis of acute kidney failure (sudden decrease in kidney function that develops within seven days) and the patient resided at home with his/her spouse, and family and neighbors checked on him/her. The patient received skilled nursing and home health aide services. Observation on 4/29/2025 at 9:08 AM, showed the following: - The skilled nurse (SN) asked the patient if there had been any medication changes. The patient verbalized there had been no changes; - The state agent (SA) compared the provider's medication profile to the patient's medications and a medication list the patient had in their home. The following discrepancies were noted; * Humalog (fast-acting insulin) 100 unit/milliliters (ml) per sliding scale (S/S) subcutaneously (SQ- given under the skin) nightly: * The provider's medication profile showed if the blood sugar (BS) was 150-199 = 2 (two) units. The medication list in the patient's home showed 150-199 = 0 (zero) units; * The provider's medication profile showed if BS was 200-249 = 4 (four) units. The medication list in the patient's home showed 200-249 = 2 units. The patient stated that he/she was taking the insulin according to the sliding scale written on the medication list he/she had in their home; and * The provider's medication profile showed melatonin (a hormone supplement used to aid sleep) disintegrating tablet 3 milligrams (mg) two by mouth daily at bedtime. The patient stated that he/she was taking one at bedtime and had been for approximately six months. During an interview on 04/30/2025 at 2:22 PM, the administrator stated that he/she expected the staff to reconcile the patient’s hospital list with what was in the patient’s home and any discrepancies were to be reported to the physician.

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 policy review, record review, and interview, the provider failed to provide physical therapy (PT) services at the frequency ordered in two of five full records reviewed (Records/Patients #1 and #4). This deficient practice has the potential to adversely affect all the patients served by the provider. Findings included: Review of the provider's policy titled, "Role Of The Skilled Nurse In The Agency," revised 02/2016, showed in part the following: - The provider shall provide skilled nursing care to patients in the agency per written plan of care of the attending physician; - The registered professional nurse will coordinate services as the needs arises (i.e.: physical therapy, speech therapy, occupational therapy, home health aide); and - The registered professional nurse will keep the physician and other personnel informed of changes in the patient's condition and needs. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services with a primary diagnosis of chronic obstructive pulmonary disease (COPD; a group of lung diseases that block airflow and make it difficult to breathe). Review of the patient referral form dated 04/11/2025, showed the following: - Skilled nurse (SN): vital signs, general assessment, medication management and teaching; and - PT/Occupational therapy (OT): evaluate and treat. Review of the plan of care (POC) dated 04/14/2025 to 06/12/2025, showed PT to see the patient for an initial evaluation and to establish the POC. Review of the PT POC dated 04/15/2025 to 06/12/2025, showed PT visits were ordered two times a week for four weeks. Further review of the clinical record showed: - There failed to be two PT visits the week of 04/20/2025 to 04/26/2025; - There was a PT note documented in the electronic medical record (EMR) that showed the patient cancelled due to illness; and - There failed to be any communication by the SN with the physician regarding the PT failure to follow the visit frequency for the week of 04/20/2025 to 04/26/2025. (The record failed to show documentation that the PT tried to make up the missed visit during that week) RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to home health services on 04/10/2025 with a primary diagnosis of multiple fractures (sternum, ribs, thoracic) from a motor vehicle accident. Review of the patient referral form dated 04/09/2025, showed the following: - Skilled nurse: vital signs, general assessment, medication management and teaching, disease process teaching; and - PT/OT: evaluate and treat. Review of the POC dated 04/10/2025 to 06/08/2025, showed PT to see the patient for initial evaluation and to establish the POC. Review of the PT POC dated 04/11/2025 to 06/08/2025, showed PT visits were ordered one time a week for one week, then two times a week for three weeks. Further review of the clinical record showed: - There failed to be two PT visits the week of 04/20/2025 to 04/26/2025; and - There failed to be any communication by the SN with the physician regarding the PT failure to follow the visit frequency the week of 04/20/2025 to 04/26/2025. (The record failed to show documentation that the PT tried to make up the missed visit during that week) During an interview on 04/30/2025 at 1:38 PM, the administrator stated that: - Staff were to make up the visit, if they could, that week; - If unable to make up the visit, staff were to notify the physician and write an order; and - There was no documentation the physician was notified of the missed visits.

The Emergency Preparedness regulations were reviewed as part of the Medicare recertification survey completed on 05/12/2022. During the survey it was determined the home health provider is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Agencies.

A partial extended survey for Medicare recertification for the home health provider was completed on 05/12/2022. The agency had 47 current patients.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on policy review, review of the agency’s current patient rights information, and interview, the agency failed to ensure staff provided the written notice of the updated state toll free home health telephone hotline hours of operation (7:00 AM to 8:00 PM, seven days a week) in the preprinted admission booklet. This deficient practice has the potential to adversely affect the patient’s knowledge and comprehension of the rights and responsibilities of all the agency’s patients. Findings included: Review of the agency’s undated policy titled, “Home Health Client’s Privacy & Rights and Responsibilities," showed: - All home health clients will review the Home Health Conditions of Participation: Patient Rights (regulation 484.50) form during the initial evaluation visit, in advance of providing care to the patient, and will sign the client authorization form in the agency admissions booklet, acknowledging receipt and review of this form. Review of the preprinted home health admission booklet and patient rights information showed: - Page 10 listed the state’s home care hotline number and listed the hours as 7:00 AM to 12:00 AM, seven days a week; - Page 13 advised of the state toll-free home health telephone hotline and listed the Missouri hotline number and listed the hours as 7:00 AM to 12:00 AM, seven days a week; During a review of the findings and interview conducted with the clinical manager and administrator on 05/12/2022 at 9:48 AM, the administrator stated that the patient should be notified of the change in the hotline hours.

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 policy review, record review and interview, the agency failed to ensure an initial assessment visit was conducted to determine the immediate care and support needs of the patient within 48 hours of referral in one (Record/Patient #3) of 5 full records reviewed. This deficient practice has the potential to adversely affect identification of immediate care needs for all the agency’s patients. Findings included: Review of the agency’s policy titled, “ROLE OF THE SKILLED NURSE IN THE AGENCY,” dated most recently revised 02/2016, showed an initial assessment shall be made by the Registered Professional Nurse within 48 hours of referral and 48 hours of patient’s return home from in-patient stay or on the physician’s ordered start of care date, and will reevaluate the needs of the patient on a regular basis. RECORD/PATIENT #3 Review of the clinical record showed the home health agency received a referral for home health services on0 4/14/2022. The initial assessment/SOC assessment took place on 04/18/2022. During an interview on 05/12/2022 at 10:23 AM, the clinical manager stated that he/she spoke to the family and asked if they wanted them (the agency) to come out tomorrow (04/15/2022) or Monday (04/18/2022), and that Saturday (04/16/2022) or Sunday (04/17/2022) probably wasn’t offered. The family then picked Monday (04/18/2022). Per interview conducted during a home observation visit, three family members stated that they were unaware why they waited and started on 04/18/2022. Further review of the clinical record failed to show any communication with the physician regarding the delayed initial assessment.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on agency policy, clinical record review, and interview, the agency failed to review all medications the patient was currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy in two (Records/Patients #1 and #3) of five full records reviewed. This deficient practice has the potential to affect the medication management for all of the agency’s patients. Findings included: Review of the agency’s undated policy titled, “Policy for Use of Medication and Treatment Profile,” showed: - Medications and treatments will be reviewed by a skilled nurse at home visits for any changes; - Nurses will update the medication profile as needed, and medications that are discontinued or added will be added to the profile upon completion of every visit; and - Patients/caregivers/responsible parties will have a medication profile in the home, and this will be reviewed and updated as needed with each skilled nursing and therapy visit. RECORD/PATIENT #1 Review of the clinical record showed the patient was admitted to home health services on 03/25/2022 with, in part, diagnoses of fracture of right foot, syncope and collapse (sudden temporary loss of consciousness and fall), and paroxysmal atrial fibrillation (rapid erratic heart rate that begins suddenly and then stops on its own). Observation on 05/11/2022 at 09:45 AM, during the patient's home visit with registered nurse (RN) B, showed the review of the updated medication profile supplied by the agency in comparison to the current clinical medication profile in the home, showed no discrepancies, yet after medication reconciliation with the patient, performed by the surveyor, the following discrepancies were noted: - Warfarin Sodium 5 mg (milligram) 1 tablet daily on Tuesday, Thursday, Saturday and Sunday (blood thinner): Patient is taking ½ tablet (A physician order dated 03/31/2022 showed a clarification of this order to be ½ tablet yet the medication profile in the home failed to be updated; - Fluticasone 50 MCG (microgram) 2 sprays in each nostril inhalation daily (for seasonal allergies); Patient did not use and has never had it; - Vitamin C 1,000mg 1 tablet daily (vitamin supplement): Patient took 500mg daily; and - The patient takes probiotic (healthy bacteria for your digestive system) every 2-3 days which failed to be listed on any medication profile. RECORD/PATIENT #3 Review of the clinical record showed the patient was admitted to home health services on 04/18/2022 with, in part, fracture of unspecified part of neck of right femur (right hip fracture), and age related osteoporosis (condition in which the bones become weak and brittle). Observation on 05/11/2022 at 08:00 AM, during the patient's home visit with the physical therapist, showed review of the updated medication profile supplied by the agency in comparison to the current clinical medication profile in the home, showed no discrepancies, yet after medication reconciliation with the responsible party as well as with the family member responsible for filling the pill planner, performed by the surveyor, the following discrepancies were noted: - Omeprazole 20 mg 1 capsule daily (used to treat heartburn): Patient did not take; - Alendronic acid 70 mg 1 tab daily (used to treat osteoporosis): Patient took 1 tab weekly; - Cholecalciferol vitamin 1250 mcg 1 capsule daily (vitamin D supplement): Patient did not take; - Aspirin 81 mg 1 tablet daily (for heart health): Patient took aspirin 81mg delayed release 1 tablet daily; - Ibuprofen 200 mg two tablets three times a day as need for pain: Patient took as needed without limit of three times daily; - Sertraline 50mg 1 tablet daily (used to treat depression): Medication bottle showed sertraline 50 mg 1 and ½ tablet daily: Patient currently using a punch card with sertraline 50 mg 1 tablet daily (no clarification of dosage noted in clinical record); - Gabapentin 300mg 1 capsule three times a day (used to treat nerve pain and seizures): Medication bottle showed gabapentin 300 mg every eight hours: Patient taking Gabapentin 300 mg two times daily (no clarification of dosage noted in clinical record); - Patient was taking pantoprazole sodium (used to treat heartburn) 40 mg delayed release tablet one twice a day 30 minutes before breakfast and dinner which failed to be listed on any med profile; - Patient was taking pravastatin sodium (used to help lower cholesterol) 20 mg one daily at bedtime which failed to be listed on any med profile; - Patient was taking tramadol 50 mg 1 tablet twice a day as needed for pain which failed to be listed on any med profile; - Patient was taking docusate sodium 100 mg one daily as needed for constipation which failed to be listed on any med profile; and - Patient was taking lorazepam 0.5 mg one every 8 hours as needed for anxiety which failed to be listed on any med profile. During an interview on 05/12/2022 at 9:48 AM with the administrator and clinical manager, the administrator stated that: - Medications should be reconciled anytime there was a change; - He/she would expect the medications to be reviewed or the patient be asked if there have been any medication changes at visits; and - Therapists do not reconcile medications, but should communicate changes if they are the only discipline in the home providing services.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the agency failed to notify/communicate with the physician regarding patient care changes in one (Record/Patient #4) of five full records reviewed. This deficient practice has the potential to adversely affect the care of all patients served by the agency. Findings Included: Review of the agency’s policy titled, “ROLE OF THE SKILLED NURSE IN THE AGENCY,” dated most recently revised 02/2016, showed: - The registered professional nurse will keep the physician and other personnel informed of changes in the patient’s condition and needs; and - In addition the registered professional nurse will counsel the patient and family members in meeting the nurse and related needs. RECORD/PATIENT #4 Review of the POC (plan of care) dated 04/09/2022 through 06/07/2022 showed: - Diagnoses of DM II (diabetes mellitus type II: A chronic condition that affects the way the body processes blood sugar (glucose)), atrial fibrillation (an irregular and often very rapid heart rhythm that can lead to blood clots in the heart), COPD (chronic obstructive pulmonary disease- a group of lung disease that block airflow and make it difficult to breathe); - Patient to use supplemental oxygen at 3L/min (liters per minute) with CPAP (continuous positive airway pressure- a machine that uses mild air pressure to keep breathing airways open while you sleep) 20 cmH2O (the setting for the CPAP machine) at hs (bedtime) and may wear supplemental oxygen via nasal cannula throughout the day prn (as needed) shortness of breath; and - Agency parameters to notify physician included glucose less than 60 or more than 250 mg/dl (milligrams per deciliter). Review of the SN (skilled nurse) visit note dated 04/14/2022 showed: - SPO2 (oxygen saturation) 97% at 2L/NC (oxygen at 2 liters per nasal cannula); - RBS (random blood sugar) 320 mg/dl, had frosted cornflakes for breakfast; - Visit note failed to show physician notification of blood sugar out of parameters; and - Visit note failed to show counsel of patient regarding utilizing O2 (oxygen) at incorrect flow liter or physician notification of not following oxygen flow liter order. During an interview on 05/12/2022 at 9:35 AM with the administrator and clinical manager, the administrator agreed that the staff should notify the physician of out of parameter blood sugars and educate the patient of correct oxygen flow liter to wear and/or contact the physician regarding the patient wearing the oxygen at the incorrect flow liter.

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 home visit observation, and interview, the agency failed to provide the patient/caregiver with a copy of written instructions outlining the visit schedule, including frequency of visits in two (Records/Patients #1, and #3) of three home visit observations. This deficient practice has the potential to adversely affect the patient’s knowledge of self-care and agency expectations in all patients served by the agency. Findings included: RECORD/PATIENT #1 Review of the POC (plan of care) dated 03/25/2022 through 05/23/2022 showed SN (skilled nurse) one time weekly for eight weeks, PT (physical therapy) for evaluation on 3/28/2022 and aide services one time weekly for eight weeks ordered. Review of a physician’s ordered dated 03/28/2022 showed PT beginning with initial evaluation on March 28th, 2022, see patient two times weekly for four weeks. Observation on 05/11/2022 at 09:45 AM, during the patient's home visit with registered nurse (RN) B, the surveyor observed the patient’s home folder which showed: - The agency failed to document frequency of visits for the skilled nurse or the nurse aide (physical therapy had completed their visit duration). RECORD/PATIENT #3 Review of the POC (plan of care) dated 04/18/2022 through 06/16/2022 showed: - SN (skilled nurse) See patient today (04/18/2022) for SOC then one time weekly for eight weeks; - Home health aide: see patient two times weekly for eight weeks, then one time weekly for one week. Review of the Physical therapy reassessment dated 04/21/2022 showed: - Frequency: one time a week for one week, two times a week for three weeks, then, one time a week for one week. Observation on 05/11/2022 at 08:00 AM, during the patient's home visit with the PT, the surveyor observed the patient’s home folder which showed: - PT frequency was left blank. During an interview on 05/12/2022 at 9:48 AM with the administrator and clinical manager, the administrator stated that the frequency of visits should be completed either in the admission booklet on the preprinted calendar or on the patient’s wall calendar.

Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This ELEMENT is not met as evidenced by: Based on review of the preprinted home health admission booklet, home visit observation, and interview, the agency failed to provide in writing the name and contact information of the clinical manager in three (Records/Patients #1, #2, and #3) of three home visit observations. This deficient practice has the potential to adversely affect all patients served by the agency. Findings included: Review of the preprinted home health admission booklet showed the back page had printed Clinical Manager: with lines to fill in for clinical manager’s name, phone number and email if patient prefers. RECORD/PATIENT #1 Observation on 05/11/2022 at 09:45 AM, during the patient's home visit with registered nurse (RN) B, the surveyor observed the patient’s home folder which showed: - The agency failed to include the name and contact information of the clinical manager; and - The lines were left blank on the back of the preprinted home health admission booklet to fill in the clinical manager name and contact information. RECORD/PATIENT #2 Observation on 05/11/2022 at 11:00 AM, during the patient's home visit with RN A, the surveyor observed the patient’s home folder which showed: - The agency failed to include the name and contact information of the clinical manager; and - The lines were left blank on the back of the preprinted home health admission booklet to fill in the clinical manager name and contact information. RECORD/PATIENT #3 Observation on 05/11/2022 at 08:00 AM, during the patient's home visit with the physical therapist, the surveyor observed the patient’s home folder which showed: - The agency failed to include the name and contact information of the clinical manager; and - The lines were left blank on the back of the preprinted home health admission booklet to fill in the clinical manager name and contact information. During an interview on 05/12/2022 at 9:48 AM with the administrator and clinical manager, the administrator stated that the clinical manager name and contact information should be listed.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the agency failed to provide services in accordance with current clinical practice guidelines and accepted professional standards of practice when they failed to follow their established policy regarding written clinical and progress notes in three (Records/Patients #1, #2, and #4) of five full records reviewed. This deficient practice has the potential to adversely affect all the patients on service with the agency. Findings included: Review of the agency’s policy titled, “ROLE OF THE SKILLED NURSE IN THE AGENCY,” dated most recently revised 02/2016, showed clinical and progress notes will be written within ten (10) business days and filed in the patient’s clinical record. RECORD/PATIENT #1 Review of the SN (skilled nurse) visit note dated 04/11/2022 showed an electronic nurse signature of registered nurse (RN) B, dated and timed 05/04/2022 03:06 PM (seventeen business days later). Review of the SN visit note dated 04/20/2022 showed an electronic nurse signature of RN B, dated and timed 05/09/2022 03:16 PM (thirteen business days later). RECORD/PATIENT #2 Review of the SN visit note dated 04/08/2022 showed an electronic nurse signature of RN A, dated and timed 05/04/2022 02:52 PM (eighteen business days later). Review of the SN visit note dated 04/15/2022 showed an electronic nurse signature of RN A, dated and timed 05/09/2022 05:13 PM (sixteen business days later). Review of the SN visit note dated 04/20/2022 showed an electronic nurse signature of RN A, dated and timed 05/09/2022 06:42 PM (thirteen business days later). RECORD/PATIENT #4 Review of the SN visit note dated 04/14/2022 showed an electronic nurse signature of RN A, dated and timed 05/09/2022 07:57 PM (seventeen business days later). During an interview on 05/12/2022 at 9:53 AM the administrator stated that he/she would expect the clinical and progress notes be completed within in 10 business days and in the medical record and that the electronic signature meant that the nurse had finished his/her documentation.

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 policy review, record review and interview, the agency failed to ensure a completed comprehensive discharge summary was sent to the primary care physician or other professional who would be responsible for providing care and services to the patient after discharge from the agency/services within five business days of the patient’s discharge in two (Records/Patients #5 and #6) of two discharge records reviewed. This deficient practice has the potential to adversely affect the post-discharge care of all patients served by the agency. Findings included: Review of the agency’s policy titled, “Discharge, Transfer and Referral Policy,” dated January 13, 2018 showed: - Discharge summaries will be completed by RN (Registered Nurse) and therapists; and - Discharge summaries will be sent to the primary care practitioner or other healthcare professionals who will be responsible for providing care and services to the patient after discharge from the home health agency within five business days of the patient’s discharge. RECORD/PATIENT #5: Review of the patient’s POC (plan of care) dated 04/08/2022 through 06/06/2022 showed: - SOC (start of care) date 04/08/2022; - Diagnoses included, but not limited to, aftercare following joint replacement surgery; and - SN (skilled nursing) services only. Review of the discharge summary showed a discharge date of 04/22/2022. Review of a fax confirmation form dated May 3rd, 2022 showed the discharge summary was sent to the primary care physician nine business days following discharge. RECORD/PATIENT #6: Review of the patient’s POC (plan of care) dated 03/18/2022 through 05/16/2022 showed: - SOC (start of care) date 03/18/2022; - Diagnoses included, but not limited to, aftercare following joint replacement surgery; and - SN (skilled nursing) and PT (physical therapy) services. Review of the physical therapy discharge summary showed a discharge date of 03/31/2022. Review of the clinical record failed to show the physical therapy discharge summary was sent to the primary care physician or other professional who would be responsible for providing care and services to the patient after discharge from the agency/services. Review of the skilled nursing discharge summary showed a discharge date of 03/31/2022. Review of a fax confirmation form dated April 11th, 2022 showed the discharge summary was sent to the primary care physician seven business days following discharge. During an interview on 05/12/2022 at 9:35 AM the administrator stated that he/she would expect the discharge summary to be faxed within five business days to the primary care physician or other professional who would be responsible for providing care and services to the patient after discharge from the agency/services.