Every finding on record at Cleveland Health Care LLC

Development and evaluation of plan of care CFR(s): 484.75(b)(2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s); This ELEMENT is not met as evidenced by: Based on interview, and record review, the agency failed to ensure skilled professionals were available to assume responsibility for development and evaluation of the plan of care in partnership with the patient, representative (if any), caregiver (s) and other functions accordance with 42 §484.75(b), This deficient practice had the potential to affect future patients served by the agency at risk of receiving inadequate care and services and could place the patients at risk for negative outcomes. The Findings Included: During pre-survey preparation on 06/23/26, review of Texas Unified Licensure Information (TULIP), (a database utilized by the state to maintain licensing, demographic information, complaints, and self-reported incidents on home health agencies for the State of Texas) revealed the agency listed the following: an administrator, alternate administrator, supervising nurse and an alternate supervising nurse. TULIP also listed an agency address as Address #1 and operating hours of Monday through Friday from 9:00 am-5:00 pm. TULIP listed the agency’s telephone number as 956-668-XXXX. TULIP did not document any changes to the location, telephone number, or agency closure. The agency’s license categories were listed as L&C, LHH, and PAS. The Surveyor arrived at the location listed on TULIP, Address #1 on 06/24/26 at 10:30 a.m. Upon arrival it was noted that the business name on the glass door was identified as “Business C”, located at Address #1. Business C offered licensed investigative services and expertise along with surveillance and security equipment. The storefront has a large window and door graphics with a detective style logo (hat and silhouette) and a shield logo. The hours of operation were listed on the glass door as Monday-Friday 9:00 a.m. to 5:00 p.m., and closed Saturday and Sunday. A telephone number was also displayed on the locked glass door as follows: (956)937-XXXX. The surveyor went to neighboring suites, however they were closed and had locked doors. The Surveyor was able to speak with Identifier 50 at Business H on 06/24/26 at 10:40 a.m. As per Identifier 50 had been at Business H for 5 years and stated that personnel from this Agency were rarely there and didn’t speak with them. No other information was provided. It was noted that there were no signs in the plaza for this Agency. The surveyor photographed Address #1’s front glass door and large glass window. On 06/24/26 at 10:47 a.m., the Surveyor contacted the agency number, it rang and then went to an automated system stating, “your call can not be completed as dialed please check the number and dial again, Message 2:US01LV”. The surveyor was unable to leave a message. On 06/24/26 at 10:54 a.m., the Surveyor called Adm Tech J to inquire about any other address or telephone number listed for this Agency. No updated address or telephone number was noted on TULIP. On 06/24/26 at 11:05 a.m. the Surveyor informed PM K of not being to get a hold of the Adm. As per PM K, the Surveyor was informed to have Adm Tech J send an email to the emails listed in TULIP. On 06/24/26 at 11:10 a.m. the Surveyor spoke with Adm Tech J to send an email to all the emails in TULIP that the surveyor was at the said location to conduct a survey. On 06/24/26 at 11:13 a.m. the Surveyor contacted the agency number for a second time, it rang and then went to an automated system stating, “your call can not be completed as dialed please check the number and dial again, Message 2:US01LV”. The surveyor was unable to leave a message On 06/24/26 at 11:15 a.m. an email was sent by Adm Tech J to all emails listed in TULIP. The surveyor was pending a response from this Agency. On 06/24/26 at 11:20 a.m. an email was received as follows, “your message couldn’t be delivered.” On 06/24/26 at 11:36 a.m. a call was placed to (956) 607-XXXX, Adm’s cellphone number. The call was forwarded to voicemail. A message was left to call the surveyor back. On 06/24/26 at 11:38 a.m. a call was placed to (956) 607-XXXX Alt Adm’s cell phone number. The surveyor identified herself and explained reason for call. Alt Adm stated, “I am the Alt Adm. We are not operating anymore. I’m out of town.” Alt Adm stated that she would be contacting the Adm to call the Surveyor back due to him being able to provide the surveyor with further information. During the call with the Alt Adm the Surveyor received a call back from the Adm and the call with Alt Adm was concluded. On 06/24/26 at 11:40 a.m. the Surveyor received a call from the Adm, and an introduction was made and the reason for the call was explained. The Adm acknowledged that he was Adm and then stated, “I have 0 pt’s. I received the POC. It was too much and I was not able to find a location. I have not had any patient’s since 2025.” As per the Adm he refused the survey due to making the decision of giving up the agency’s license. The Adm was asked if he would like to proceed with interview view questions regarding this agency. The Adm confirmed that this location was not currently open. The Surveyor asked to explain his understanding of the agency’s responsibility regarding participation in state recertification and re-licensure surveys. The Adm stated that he was not sure. The Surveyor asked the Adm to describe how failure to cooperate with survey process could affect the agency’s ability to identify and correct issues impacting patient care. The Adm stated, “Currently we have no patients and there was no disruption in care or that can impact care.” The Surveyor then asked, what risks would current and patients be at if the Surveyor was unable to verify the agency’s compliance with regulatory requirements. The Adm stated that there were no risks due to not having any patients. The Adm acknowledged that there was no Supervising Nurse nor Alt Supervising Nurse due to not having any patients. During the interview with the Adm, the Adm stated that the agency’s policy was to have a supervising nurse or alternate supervising nurse for L&C and LHH. The Adm confirmed that he was not a licensed skilled professional and they used LHH for telemonitoring services. The Surveyor asked why the agency had no current skilled staff at the agency. The Adm stated that since they didn’t have any patients in a long time there was no need for them (nursing staff). The Surveyor asked if the agency had notified HHSC or CMS of the permeant closure, relocation, or voluntary suspension of operations. The Adm stated, “No, I didn’t, I just recently decided on giving up my license.” The surveyor departed from this Agency at Address #1 listed in TULIP on 06/24/26 at 12:30 p.m. without conducting a recertification, re-licensure, and follow-up to survey dated 05/20/26. On 06/26/26 at 3:33 p.m. the Surveyor emailed IM 23-01 Inability to Access Records or Perform a Federal/State Survey by Texas Health and Human Services (HHS) to the Adm. The agency did not dispute the survey findings and did not provide this surveyor with any additional documents.

Purpose of Survey – To conduct a Re-certification and follow-up to survey dated 07/19/23. On 05/20/26 the surveyor conducted an unannounced visit. Census- L&CHHS-unknown LHHS-unknown PAS-unknown L&CHHS-Licensed and certified home health services LHHS-Licensed home health PAS-Personal assistance services

Purpose of Survey – To conduct a Re-certification and follow-up to survey dated 07/19/23. On 05/20/26 the surveyor conducted an unannounced visit. Census- L&CHHS-unknown Abbreviations: LHHS-Licensed Home Health Services PAS-Personal Assistant Services L&CHHS-Licensed and certified Home Health Services HHSC-Texas Health and Human Services Commission CFR-Code of Regulations HHA-Home Health Agencies TULIP-Texas Unified Licensure Information Adm-Administrator Alt Adm-Alternate Administrator CMS-Center for Medicare Services HHS- Texas Health and Human Services IM-Internal Memo SN-Skilled Nursing HHA-Home Health Agency

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: Based on observation, record review and interviews the agency failed to meet the following Conditions of Participation: Condition of Participation 484.75 Skilled Professional Services. Based on interview and record review, the agency failed to ensure skilled professionals services were available to provide services either directly or under arrangement to assume responsibility for patient assessment, coordination of care, and other required professional functions in accordance with 42 CFR §484.75(b), Responsibilities of Skilled Professionals. Based on interview and record review, the agency failed to ensure skilled professionals were available to assume responsibility for patient assessment, coordination of care, and other required professional functions in accordance with 42 CFR §484.75(b), Responsibilities of Skilled Professionals. This deficient practice had the potential to affect all patients served by the agency by limiting the agency’s ability to provide ongoing clinical oversight, interdisciplinary assessment, and timely implementation of skilled services necessary to meet patient needs. Refer to G704. These Conditions of Participation: Condition of Participation 484.75 Skilled Professional Services were out of compliance. Refer to G704.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to ensure skilled professionals were available to assume responsibility for patient assessment, coordination of care, and other required professional functions in accordance with 42 CFR §484.75(b), Responsibilities of Skilled Professionals. This deficient practice had the potential to affect all patients served by the agency by limiting the agency’s ability to provide ongoing clinical oversight, interdisciplinary assessment, and timely implementation of skilled services necessary to meet patient needs. The findings included: During pre-survey preparation on 05/19/26, review of Texas Unified Licensure Information (TULIP), a database utilized by the state to maintain licensing, demographic information, complaints, and self-reported incidents on home health agencies for the State of Texas revealed the agency listed that they had an administrator, alternate administrator, supervising nurse and an alternate supervising nurse. TULIP also listed an agency address as Address #1 and operating hours of 9:00 am-5:00 pm, Monday through Friday. TULIP listed the agency’s telephone number as 956-668-XXXX. The TULIP system did not document any changes of location, telephone number, or agency closure. The agency’s categories were listed as L&CHHS, LHHS, and PAS. The surveyor arrived at the location listed on TULIP, Address #1 on 05/20/26 at 9:00 am. The business appears to be “Business A”, located in Address #1 offering licensed investigative services and expertise along with surveillance /security products under “Title C”. The storefront has a large window and door graphics with a detective style logo (hat and silhouette) and a shield logo for Title C. Hours of operation were listed as Monday-Friday 9:00 am to 5:00 pm, Saturday and Sunday closed. A telephone number of 956-937-XXXX. Door locked. The surveyor went to neighboring suites however they were closed and had locked doors. There were no signs in the plaza for “Agency B”. The surveyor photographed Address #1’s front door and the large window. During an interview with the Administrator on 05/20/26 at 10:22 am, the surveyor asked the Adm to describe his responsibilities as a skilled professional, the Administrator stated, “I am not a skilled professional.” Further interview revealed the agency did not maintain skilled personnel. When asked whether the agency currently skilled staff for nursing, therapy, or telemonitoring services had, the Administrator stated, “No, because we haven’t had patients in a long time. So, there was no need for them at this time.” When asked whether the agency had clinical staff available should an admission occur, the Administrator stated, “No, I don’t. We don’t have a census.” The Administrator additionally acknowledged the agency currently had no staff other than the Administrator by stating, “No, just myself.” These findings demonstrated that the agency failed to ensure qualified skilled professionals were available to assume responsibility for required patient care functions and ongoing clinical responsibilities. Failure to maintain skilled professionals had the potential to delay patient assessment, compromise coordination and oversight of care, and adversely affect the delivery of safe and appropriate home health services. The surveyor departed from Agency B at Address #1 listed in TULIP on 05/20/26 at 11:15 am without conducting a recertification, re-licensure, and follow-up to survey dated 07/19/23 and as a result, the Surveyor was unable to determine when the Home Health Agency last had skilled professional staff to assume responsibility for required patient care functions. An interview was conducted on 05/20/26 at 11:25 am with the leasing Manager G of the property for Address #1, he confirmed that Agency B vacated the property in January of 2026 due to financial issues. The surveyor emailed IM 23-01 Inability to Access Records or Perform a Federal Survey by Texas Health and Human Services (HHS) to the Adm on 05/20/26 at 2:00 pm. The agency did not dispute the survey findings and did not provide this surveyor with any additional documents.

Organization and administration of services CFR(s): 484.105 Condition of participation: Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient's plan of care, for each patient's medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished. This CONDITION is not met as evidenced by: Based on observation, record review and interviews the agency failed to meet the following Conditions of Participation: 484.105 Organization and Administration of Services. Based on observation, record review, and interview the Administrator failed to be responsible for all day-to-day operations of the home health agency in that: 1.The agency's Administrator failed to provide entry to the State Surveyor after the Surveyor's arrival to the agency to conduct a recertification, re-licensure, and a follow-up to survey dated 07/19/23. 2.The Administrator failed to be available to surveyor when calls were made to the agency's telephone number. 3.The agency’s Administrator failed to notify HHSC of the agency’s relocation. 4.There were no provisions in place for all the home health services provided by the agency, the Administrator was the only staff member for the agency. The agency had the categories of services of L&CHHS, LHHS and PAS and provided the following services SN directly for telemonitoring. The agency had one employee and no current nursing or professional employees. Refer to G0948. Based on interview the agency failed to ensure skilled nursing services and at least one additional therapeutic service were available on a visiting basis, in a place of residence used as a patient’s home as required under 42 CFR §484.105(f), which requires an HHA to provide skilled nursing services and additional therapeutic services either directly or through arrangement. This deficient practice had the potential to affect all patients served by the agency by limiting the agency’s ability to provide required home health services, coordinate timely care, and ensure continuity and availability of skilled interventions. Refer to G0982. These Conditions of Participation: 484.105 Organization and Administration of Services were out of compliance. Refer to G0948 & G0982

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on observation, record review, and interview the Administrator failed to be responsible for all day-to-day operations of the home health agency in that: 1.The agency's Administrator failed to provide entry to the State Surveyor after the Surveyor's arrival to the agency to conduct a recertification, re-licensure, and a follow-up to survey dated 07/19/23. 2.The Administrator failed to be available to surveyor when calls were made to the agency's telephone number. 3.The agency’s Administrator failed to notify HHSC of the agency’s relocation. 4.There were no provisions in place for all the home health services provided by the agency, the Administrator was the only staff member for the agency. The agency had the categories of services of L&CHHS, LHHS and PAS and provided the following services directly SN for telemonitoring. The agency had one employee and no current nursing or professional employees. The Administrator failed to manage the daily operations of the agency by failing to cooperate with required survey activities, maintain availability, ensure accurate agency information, and provide operational oversight of licensed services. These failures had the potential to impede regulatory oversight and delay the identification and correction of deficient practices, resulting in potential risks to client health and safety, interruptions in continuity of care, compromised quality of services, delayed interventions, and an inability to ensure compliance with Federal and State requirements intended to protect current and future clients receiving services. Findings include: During pre-survey preparation on 05/19/26, review of Texas Unified Licensure Information (TULIP), a database utilized by the state to maintain licensing, demographic information, complaints, and self-reported incidents on home health agencies for the State of Texas revealed the agency listed that they had an administrator, alternate administrator, supervising nurse and an alternate supervising nurse. TULIP also listed an agency address as Address #1 and operating hours of 9:00 am-5:00 pm, Monday through Friday. TULIP listed the agency’s telephone number as 956-668-XXXX. The TULIP system did not document any changes of location, telephone number, or agency closure. The agency’s categories were listed as L&CHHS, LHHS, and PAS. The surveyor arrived at the location listed on TULIP, Address #1 on 05/20/26 at 9:00 am. The business appears to be “Business A”, located in Address #1 offering licensed investigative services and expertise along with surveillance /security products under “Title C”. The storefront has a large window and door graphics with a detective style logo (hat and silhouette) and a shield logo for Title C. Hours of operation were listed as Monday-Friday 9:00 am to 5:00 pm, Saturday and Sunday closed. A telephone number of 956-937-XXXX. Door locked. The surveyor went to neighboring suites however they were closed and had locked doors. There were no signs in the plaza for “Agency B”. The surveyor photographed Address #1’s front door and the large window. On 05/202/6 at 9:10 am, the surveyor contacted the agency number, it rang and then went to an automated system stating, “The mailbox is full and you cannot leave a message”. The surveyor was unable to leave a voicemail. On 05/20/26 at 9:30 am, the surveyor informed Tech D and PM E. Tech D sent out emails listed in TULIP for further information on this agency. On 05/20/26 at 9:37 am the surveyor contacted the agency number for a second time, it rang and then went to an automated system stating, “The mailbox is full and you cannot leave a message”. The surveyor was unable to leave a voicemail. On 05/20/26 at 10:03 am an email was sent by Tech D to all emails listed in TULIP, pending response from agency vital connections. On 05/20/2026 at 10:14 am an remail was received documenting “Your message couldn’t be delivered to multiple recipients. The recipients weren’t found at Email F” Couldn’t deliver to the following recipients. The surveyor attempted to contact Adm on 05/20/26 at 10:18 am no answer. The surveyor left a voicemail. The surveyor contacted Alt Adm on 05/20/26 at 10:20 am, confirmed she will call the Adm and have him call me back regarding agency B. On 05/20/26 at 10:22 am Adm contacted this surveyor and was interviewed. The surveyor identified herself and explained contact was being made due to a recertification, re-licensure, and a follow-up to survey dated 07/19/23 needed to be conducted and the surveyor was currently at the address listed in TULIP. The Adm confirmed he was not prepared to do a survey and refused the survey and was is no longer at Address #1 as of May 01, 2026, however, was not sure on the exact date. Furthermore, he confirmed that this location was not currently open and fully operational. The surveyor asked to explain his understanding of the agency’s responsibility regarding participation in state recertification and re-licensure surveys. The Adm stated, “I’m not sure at this moment.” Adm confirmed he was the Administrator of Agency B and oversees Agency B. The surveyor further asked did you refuse, delay, or limit surveyor access to the agency, records, staff, or patients. If yes, explain. The Adm stated, “Yes I refused, I am not prepared for a survey.” The surveyor explained you stated you’re not prepared at this time for survey. What was the reason for not being prepared for the recertification/re-licensure survey. The Adm confirmed he was trying to sell Agency B and was just not prepared with staffing for a survey. Furthermore, the Adm confirmed he was not sure of the agency’s policy for cooperating with the survey process but did know the agency should cooperate with surveyor within 2 hours of arrival and provide any documentation requested. The surveyor asked to describe how failure to cooperate with survey activities could affect the agency’s ability to identify and correct issues impacting client care. The Adm stated, “Currently we have no patients and there is no disruption in care or that can impact care.” The surveyor further asked, what risks do you believe may exist for current or future patients if surveyors are unable to verify the agency’s compliance with regulatory requirements. Adm stated, “No risks since there are no patients.” Further interview with the Adm, identified the agency’s policy that the agency’s policy was to have a Supervising Nurse or Alternate Supervising Nurse for L&CHHS and LHHS. Adm further confirmed they were using LHHS for telemonitoring services and there was no current census at the agency at this time. The Adm additionally confirmed that he was not a licensed skilled professional. The surveyor asked why the agency had no current skilled staff at the agency. The Adm stated, “Because we haven’t had patients in a long time. So, there is no need for them at this time.” Furthermore, they have not used the L&CHHS for Medicare patients. Additionally, the Adm confirmed policies on the process of relocation, closure, and notifying HHSC and CMS for the agency. The surveyor asked if the agency notified HHSC or CMS of status changes to this agency such as permeant closure, relocation, or voluntary suspension of operations. The Adm stated, “No, I didn’t I was trying to sell my business and it’s been 3 weeks, and they were supposed to have a new location for the agency. However, that has not gone through. I hadn’t submitted closure or relocation, or any changes due to trying to sell the business.” The surveyor departed from Agency B at Address #1 listed in TULIP on 05/20/26 at 11:15 am without conducting a recertification, re-licensure, and follow-up to survey dated 07/19/23. An interview was conducted on 05/20/26 at 11:25 am with the leasing Manager G of the property for Address #1, he confirmed that Agency B vacated the property in January of 2026 due to financial issues. The surveyor emailed IM 23-01 Inability to Access Records or Perform a Federal Survey by Texas Health and Human Services (HHS) to the Adm on 05/20/26 at 2:00 pm. The agency did not dispute the survey findings and did not provide this surveyor with any additional documents.

Skilled services furnished CFR(s): 484.105(f) Standard: Services furnished. Skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are made available on a visiting basis, in a place of residence used as a patient's home. An HHA must provide at least one of the services described in this subsection directly, but may provide the second service and additional services under arrangement with another agency or organization. This STANDARD is not met as evidenced by: Based on interview the agency failed to ensure skilled nursing services and at least one additional therapeutic service were available on a visiting basis, in a place of residence used as a patient’s home as required under 42 CFR §484.105(f), which requires an HHA to provide skilled nursing services and additional therapeutic services either directly or through arrangement. This deficient practice had the potential to affect all patients served by the agency by limiting the agency’s ability to provide required home health services, coordinate timely care, and ensure continuity and availability of skilled interventions. The findings included: During pre-survey preparation on 05/19/26, review of Texas Unified Licensure Information (TULIP), a database utilized by the state to maintain licensing, demographic information, complaints, and self-reported incidents on home health agencies for the State of Texas revealed the agency listed that they had an administrator, alternate administrator, supervising nurse and an alternate supervising nurse. TULIP also listed an agency address as Address #1 and operating hours of 9:00 am-5:00 pm, Monday through Friday. TULIP listed the agency’s telephone number as 956-668-XXXX. The TULIP system did not document any changes of location, telephone number, or agency closure. The agency’s categories were listed as L&CHHS, LHHS, and PAS. The surveyor arrived at the location listed on TULIP, Address #1 on 05/20/26 at 9:00 am. The business appears to be “Business A”, located in Address #1 offering licensed investigative services and expertise along with surveillance /security products under “Title C”. The storefront has a large window and door graphics with a detective style logo (hat and silhouette) and a shield logo for Title C. Hours of operation were listed as Monday-Friday 9:00 am to 5:00 pm, Saturday and Sunday closed. A telephone number of 956-937-XXXX. Door locked. The surveyor went to neighboring suites however they were closed and had locked doors. There were no signs in the plaza for “Agency B”. The surveyor photographed Address #1’s front door and the large window. During an interview with the Adm on 05/20/26 at 10:22 am, the Adm confirmed he is not a licensed skilled professional and further confirmed the agency did not currently employ skilled staff for nursing, therapy, or telemonitoring services because the agency had not had patients in a long time and currently has no census of patients. The surveyor asked, how the lack of skilled staff could affect patient care, the Adm stated, “We are not currently taking admissions so it wouldn’t affect quality of care.” Additionally, the Adm further confirmed there was no non-clinical staff currently working with the agency other than the Administrator. These interview findings demonstrated that the agency did not maintain the personnel and service availability necessary to provide skilled nursing services and an additional therapeutic service as required under federal regulations, which had the potential to delay admissions, impede provision of necessary skilled interventions, and negatively affect patient access to safe and appropriate home health services. The surveyor departed from Agency B at Address #1 listed in TULIP on 05/20/26 at 11:15 am without conducting a recertification, re-licensure, and follow-up to survey dated 07/19/23 and as a result, the Surveyor was unable to conduct a survey to determine when the last time skilled services, along with one other therapeutic service was provided on a visiting basis by the Home Health Agency. An interview was conducted on 05/20/26 at 11:25 am with the leasing Manager G of the property for Address #1, he confirmed that Agency B vacated the property in January of 2026 due to financial issues. The surveyor emailed IM 23-01 Inability to Access Records or Perform a Federal Survey by Texas Health and Human Services (HHS) to the Adm on 05/20/26 at 2:00 pm. The agency did not dispute the survey findings and did not provide this surveyor with any additional documents.