Every finding on record at Day by Day Staff Relief, LLC

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey (iQIES 65F12-H1) at the above -named Home Health Agency (HHA) on 04/22/25 to 04/25/25 resulted in compliance with the Emergency Preparedness Program Condition of Participation (CoP) under 42 CFR 484.102.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site (Recertification) survey (iQIES 65F12-H1) conducted at the above-named Home Health Agency (HHA) from 04/22/25 to 04/25/25 resulted in a findings of substantial compliance respective to applicable Condition of Participation (CoP) under 42 CFR 484, Subpart C through E with the following standard level deficiencies cited.

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review, and staff interview, the home health agency failed to provide the patient with the Notice of Medicare Non-Coverage (NOMNC) at least two calendar days prior to covered services ending for 1 of 13 sample patients (Patient 13). This deficient practice failed to ensure the patient had been made aware of their right to the expedited determination process and the ability to dispute the termination of services. Findings Include: Patient 13 Review of Patient 13's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 11/23/24. Review of visit notes indicated a discharge visit was made by the Registered Nurse (RN) on 01/20/25. There was no documented evidence in the record of a NOMNC given to the patient or caregiver at any time prior to the discharge visit on 01/20/25. During an interview on 04/25/25 at 9:15 AM, Staff A, Administrator, confirmed the above findings of the agency not providing the Notice of Medicare Non-Coverage (NOMNC) to the patient prior to discharge within the required timeframe.

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 staff interview, it was determined that the home health agency (HHA) failed to conduct an initial assessment visit within 48 hours after receiving a referral to provide services for 3 (Patients 5, 6, & 12) of 13 patients reviewed. This failure had the potential for the patient not to receive needed assessments and home care services that could have negatively impacted patient outcomes. Findings Include: Patient 5 Review of Patient 5's "Home Health Certification and Plan of Care (POC)", dated 08/12/24 indicated that the patient was admitted with a primary diagnosis of Parkinson with orders for Physical Therapy one time per week for nine weeks. Review of "Client Episode Coordination Notes Report" showed a note dated 08/07/24 which indicated that the referral received was complete except from Physician to follow for care. The Coordination Note dated 08/08/24 stated which physician would follow the patient while on services. The note also stated "verbal okay to perform SOC (Start of Care) on Monday 08/12/24. There was no other documented reason for the delay in starting services to four days after receiving the referral. Patient 6 Review of Patient 6's "Home Health Certification and Plan of Care (POC)" dated 01/08/24 indicated that the patient was admitted with a primary diagnosis of Cellulitis of right upper limb. Review of "Client Episode Coordination Notes Report: showed a note dated 01/03/24 which indicated that a complete referral for services had been received. The Coordination Note dated 01/04/24 stated the RN with physician office gave VSOC (Verbal Start of Care) approval for Monday the 8th (01/08/24). There was no other documented reason for the delay in starting services to four days after receiving the referral. Patient 12 Review of Patient 12's "Home Health Certification and Plan of Care (POC)" dated 08/29/24 indicated that the patient was admitted with a primary diagnosis of Open Wound to Left Lower Limb with orders for wound care to be provided by Skilled Nurse. Review of "Client Episode Coordination Notes Report showed a note dated 08/26/24 stating all items needed were included in the referral and there was nothing the agency was waiting to receive. The note also stated "planning SOC Thursday 08/29/24. There was no other documented reason for the delay in starting services to three days after receiving the referral. During an interview on 04/24/25 at 3:30 PM, Staff A, Administrator confirmed that the agency had not admitted the patient within the 48-hour time frame.

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 and interview, it was determined the Home Health Agency (HHA) failed to send a transfer summary to the facility were the patient was receiving in-patient health care services for 1 of 13 sample patients reviewed ( Patient 11). The deficient practice had the potential to affect patient safety and to place the patients at risk for adverse outcomes related to the lack of care coordination with other health care services. Findings Include: Review of Patient 11's clinical record showed the "Home Health Certification and Plan of Care (POC)" with a Start of Care date of 02/07/25. Review of visit notes showed a transfer to the hospital on 02/28/25. Review of document titled, "Episode Summary Report" showed a section titled, "Discharge Reason" which stated that the patient had been transferred to "short-term hospital for inpatient care". Review of a document titled, "Fax Status Report" showed that the Episode Summary Report had been faxed to the patient's physician on 04/08/25. However, there was no documented evidence of the transfer summary being sent to the facility where the patient was receiving health care at the time of transfer on 02/28/25. During an interview on 04/24/25 at 3:15 PM, Staff A, Administrator, confirmed the agency was unable to provide evidence of the transfer summary being sent to the receiving facility.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey #38456-H1 at the above-named Home Health Agency (HHA) from 02/28/22 to 03/04/22 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.22.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification survey #38456-H1 conducted at the above-named Home Health Agency (HHA) from 02/28/22 to 03/04/22 resulted in a finding of substantial compliance respective to applicable Conditions of Participation (CoPs) under 42 CFR 484, Subpart A through C with the following standard-level deficiencies cited.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on interviews, record reviews, and policy review, it was determined that the agency failed to include a diagnosis for two of 17 patients (Patients 1 and 8) on the patients’ Plans of Care (POC - an individualized and comprehensive plan that includes diagnoses, medications, and interventions that guides the staff in providing patient care). These failures had the potential for Patients 1 and 8 to not receive staff education and services related to management of their health issues. Findings Include: A review of an agency policy titled, “Service Delivery Physician’s Role,” created on 01/2000 and revised 03/01/19, showed that every patient’s POC should include all pertinent diagnoses. 1. A review of Patient 1’s clinical record, “Home Health Certification and Plan of Care (POC),” dated 01/19/22, showed the agency admitted Patient 1 on 03/25/21, with diagnoses that included anemia (lower amounts of red blood cells in the blood stream), type 2 diabetes mellitus with diabetic polyneuropathy (high levels of sugar in the blood that damages the nerves), and muscle weakness. Further review showed that Patient 1 was taking levothyroxine (a medication used to treat thyroid issues) one time per day. Further review of the record did not show any diagnoses related to thyroid issues. A review of Patient 1’s clinical record, “Assessment Report,” dated 01/29/22, showed that Patient 1 was hospitalized at a local hospital from 01/27/22 through 01/30/22 and was referred back to the agency on 01/29/22 from the local hospital. Further review of the record showed that Patient 1 had a diagnosis of thyroid disease. 2. A review of Patient 8’s clinical record, “Home Health Certification and Plan of Care (POC),” dated 01/22/22, showed the agency admitted Patient 8 on 11/22/21, with diagnoses that included Parkinson’s disease (a chronic and progressive movement disorder that initially causes tremor in one hand, stiffness or slowing of movement), type 2 diabetes mellitus (high levels of sugar in the blood), and muscle weakness. Further review showed that Patient 8 was taking omeprazole (a medication used to treat gastroesophageal reflux disease [GERD-a chronic stomach disease]), one time per day. Further review of the record did not show any diagnoses related to GERD. A review of Patient 8’s clinical record, “D/C (Discharge) Orders,” dated 11/19/21, showed that a local care agency referred Patient 8 to the agency on 11/19/22. Further review showed that Patient 8 had a diagnosis of GERD. During an interview conducted on 03/04/22 at 12:20 PM with the Administrator (ADMIN), the ADMIN confirmed that Patient 1’s “POC” dated 01/19/22 did not show any diagnoses related to thyroid problems. The ADMIN stated that Patient 1’s POC should have included a diagnosis related to thyroid issues and acknowledged that the agency had not followed their policy. The ADMIN also confirmed that Patient 8’s POC did not show a diagnosis of GERD and stated that Patient 8’s POC should have included a GERD diagnosis. The ADMIN acknowledged that the agency was not following its policy.