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 65F13-H1) at the above -named Home Health Agency (HHA) on 04/29/25 to 05/01/25 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 65F13-H1) conducted at the above-named Home Health Agency (HHA) from 04/29/25 to 05/01/25 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 2 of 9 sample patients (Patients 6 & 9). 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 6 Review of Patient 6's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 11/22/23. Review of visit notes indicated a discharge visit was made by the Physical Therapist on 01/18/24. 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 01/18/24. Patient 9 Review of Patient 9's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 11/28/23. Review of visit notes indicated a discharge data collection only visit was made by the Physical Therapist on 03/06/24. 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 03/06/24. During an interview on 05/01/25 at 9:00 AM, Staff A, Administrator, confirmed the above findings of the agency not providing the Notice of Medicare Non-Coverage (NOMNC) to the patients 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 1 (Patient 9) of 9 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 9 Review of Patient 9's "Home Health Certification and Plan of Care (POC)", dated 11/28/23 indicated that the patient was admitted with a primary diagnosis of Other Frontotemporal Neurocognitive Disorder with orders for Skilled Nursing one time per week for four weeks and Physical Therapy two times per week for four weeks. Review of "Client Episode Coordination Notes Report" showed a note dated 11/24/23 which indicated that the referral received was complete. The Coordination Note dated 11/24/23 stated which physician's office was contacted and a request to start services on 11/28/23 was approved. There was no other documented reason for the delay in starting services to four days after receiving the referral. During an interview on 04/30/25 at 3:45 PM, the 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 2 of 9 sample patients reviewed ( Patients 2 & 5). The HHA also failed to send a discharge summary to the physician who would be overseeing the patient's care after discharge for 2 of 9 sample patients reviewed (Patients 6 & 9). 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: Patient 2 Review of Patient 2's clinical record showed the "Home Health Certification and Plan of Care (POC)" with a Start of Care date of 02/28/25. Review of visit notes showed a transfer to the hospital on 04/16/25. Review of the Transfer to Inpatient Facility OASIS Assessment information indicated the patient had been admitted to the hospital for inpatient surgery. However, there was no documented evidence of the transfer summary being sent to the facility where the patient was receiving health care at or near the time of transfer on 04/16/25. Patient 5 Review of Patient 5's clinical record showed the "Home Health Certification and Plan of Care (POC)" with a Start of Care date of 05/25/23. Review of visit notes showed a transfer to the hospital on 06/23/23. However, there was no documented evidence of a transfer summary being sent to the facility where the patient was receiving health care at or near the time of transfer on 06/23/23. Patient 6 Review of Patient 6's clinical record showed the "Home Health Certification and Plan of Care (POC)" with a Start of Care date of 11/22/23. Review of visit notes showed a discharge visit made by the Physical Therapist on 01/18/24. However, there was no documented evidence presented by the HHA of a discharge summary being sent to the physician at the time of discharge or within five business days after the discharge. Patient 9 Review of Patient 9's clinical record showed the "Home Health Certification and Plan of Care (POC)" with a Start of Care date of 11/28/23. Review of visit notes showed a discharge visit dated 03/06/24. Review of a document titled, "Fax Status Report" showed a "Episode Summary Report" being sent to a doctor on 05/21/24. However, there was no documented evidence of the discharge summary being sent to a physician with five business days of the discharge date of 03/06/24. During an interview on 04/30/25 at 3:15 PM, Staff A, Administrator, confirmed the agency was unable to provide evidence of the transfer and discharge summaries being sent to the receiving facility or physician.