Every finding on record at Dynamic Home Health Care Inc.

Based on the findings of an unannounced, onsite Medicare complaint investigation survey completed May 1, 2026, Dynamic Home Health Care, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of policies/procedures, personnel files, and interview with agency administrator, the agency failed to ensure staff-maintained certification in life support techniques specific to pediatrics for three (3) of three (3) files reviewed. PF #1-3; failed to ensure competencies included pediatric specific topics for three (3) of three (3) files reviewed. PF #1-3. Findings include: Review of policies May 1, 2026 completed between approximately 3:00 PM and 3:30 PM showed: policy 4.29 Skills competency evaluations; section: Responsibility of Agency: "Skills competency evaluations are required for all Field Staff, on hire, before a field staff member can visit a patient in their home"... 6. "Skills competency evaluations are carried out by professional who have appropriate supervisory experience: b. Registered nurses (to include DON) will conduct skills competency evaluations for LPNs. c. Registered nurses (to include DON) will conduct skills competency evaluations for other registered nurses...Methods of Determining Competence and Skill Level 1. Clinical skills must be observed by a manager or designee,... 2. Skills testing is to be done a live patient. Staff will not use mannequins...4. A skill that is cognitive can be evaluated through written exam and oral presentation...Competencies Not Met 1. If a field staff is observed and evaluated not to be proficient or competent in a skill, an action plan with defined time parameters, and a schedule set for re-observation will be implemented". There is no mention of pediatric specific competency. Review of Personnel files completed April 29, 2026, between approximately 11:30 AM and 1:30 PM showed: PF#1, date of hire (DOH):11/24/25, contained certification of basic life support techniques but no other documentation to show any other certification in life support techniques specific to pediatrics. No documentation to show any competency testing information included pediatric specific topics. PF#2, (DOH): 5/30/25, contained certification of basic life support techniques but no other documentation to show any other certification in life support techniques specific to pediatrics. No documentation to show any competency testing information included pediatric specific topics. PF#3, (DOH): 6/9/25, contained certification of basic life support techniques but no other documentation to show any other certification in life support techniques specific to pediatrics. No documentation to show any competency testing information included pediatric specific topics. Interview with the agency administrator completed April 29, 2026, at approximately 2:30 PM confirmed the above findings. “Nurses and aides are to be certified in basic life support”.

Based on the findings of an onsite complaint investigation conducted on October 12, 2022, and off-site on October 14, 2022, and October 17, 2022, Dynamic Home Health Care, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of clinical records (CR), and interview with the Vice President, it was determined that the agency failed to ensure SN services were provided per physician’s orders, for two (2) of three (3) clinical records (CR) reviewed. (CR1 and CR2). Findings include: Review of clinical records (CR), was conducted on 10/12/2022 from approximately 9:43AM until approximately 2:00PM revealed: CR1 - (Start of Care): 10/26/2021 – Certification Period: 8/16/2022 through 10/14/2022 and discharged on 9/7/2022 – Contained orders for Skilled Nursing (SN): Up to fifty-two (52) hours per week – Monday, Tuesday, and Wednesday (2:00PM – 9:00PM); and Saturday and Sunday (3:00PM – 9:00PM) – Assistance with medication administration per physician order; and SN for supervisory visit every sixty (60) days. Visit documentation revealed: For the week of 8/15/2022 through 8/21/2022, SN visit hours were: 8/20/2022 – Visit calendar does not indicate scheduled visit for six (6) hours, and there was no missed visit documentation. 8/21/2022 – Visit calendar does not indicate scheduled visit for six (6) hours, and there was no missed visit documentation. For the week of 8/22/2022 through 8/28/2022, SN visit hours were: 8/24/2022 – Visit calendar does not indicate scheduled visit for seven (7) hours, and there was no missed visit documentation. 8/27/2022 – Visit calendar does not indicate scheduled visit for six (6) hours, and there was no missed visit documentation. 8/28/2022 – Visit calendar does not indicate scheduled visit for six (6) hours, and there was no missed visit documentation. For the week of 8/29/2022 through 9/4/2022, SN visit hours were: 8/31/2022 – SN missed visit for seven (7) hours due to no staffing available - Missed visit documentation noted. 9/3/2022 – SN missed visit for six (6) hours due to no staffing available - Missed visit documentation noted. 9/4/2022 – SN missed visit for six (6) hours due to no staffing available - Missed visit documentation noted. For the week of 9/5/2022 through 9/11/2022, SN visit hours were: 9/5/2022 – Visit calendar does not indicate scheduled visit for seven (7) hours, and there was no missed visit documentation. During interview with the Vice President on 9/12/2022 at approximately 9:45AM the Vice President indicated that CR1 “receives additional SN services from another agency” (not identified) and that at times, they “cover each other’s shifts” when needed. On 10/17/2022 at approximately 4:06PM, the Vice President sent this surveyor an email stating that CR1 has not received any SN visits after 8/30/2022. There was no documentation for the above six (6) missed visits, and there was no documentation that the other agency provided coverage for the above missed visits CR2 - (Start of Care): 7/22/2022 – Certification Period: 7/22/2022 through 9/19/2022 and discharged on 9/20/2022 (Pediatric Waiver) – Contained orders for Skilled Nursing (SN): Twenty-four (24) hours per day for seven (7) days per week for sixty (60) days; SN one (1) to two (2) times per month for sixty (60) days, for supervision and recertification, and any changes in plan of care; SN case shared with other agencies (not identified). Visit documentation revealed: For the week of 7/25/2022 through 7/31/2022, SN visit hours were: 7/25/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 7/26/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. For the week of 8/1/2022 through 8/7/2022, SN visit hours were: 8/1/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 8/2/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. For the week of 8/8/2022 through 8/14/2022, SN visit hours were: 8/8/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 8/9/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 8/12/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. For the week of 8/15/2022 through 8/21/2022, SN visit hours were: 8/15/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 8/16/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. For the week of 8/22/2022 through 8/28/2022, SN visit hours were: 8/22/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 8/23/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. For the week of 8/29/2022 through 9/4/2022, SN visit hours were: 8/29/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 8/30/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. 9/1/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. For the week of 9/5/2022 through 9/11/2022, SN visit hours were: 9/5/2022 – Visit calendar does not indicate scheduled visit for twelve (12) hours, and there was no missed visit documentation. This surveyor sent an email on 10/17/2022 at 11:37AM requesting agency to provide explanations for the missed SN visits above. The Vice President sent a response email on 10/17/2022 at 4:06PM, indicating that CR2 has not received any SN visits after 9/4/2022. She also stated, “SN case shared with other agencies. Since this was shared case with another agency, we only covered days requested by insurance company”. The plan of care did not include the total hours of SN that each agency would provide individually. There was no documentation that indicated specific dates authorized by the insurance company. There was no documentation for the above fifteen (15) missed visits, and there was no documentation that the other agency provided coverage for the above missed visits. Further review of clinical records (CR), and interview with the Vice President, it was determined that the agency failed to ensure SN documentation included daily recording of vital signs per physician’s orders, for one (1) of three (3) clinical records (CR) reviewed. (CR2) Findings include: Review of clinical records (CR), was conducted on 10/12/2022 from approximately 9:43AM until approximately 2:00PM revealed: CR2 - (Start of Care): 7/22/2022 – Certification Period: 7/22/2022 through 9/19/2022 (Pediatric Waiver) – Contained orders for Skilled Nursing (SN): Twenty-four (24) hours per day for seven (7) days per week for sixty (60) days; SN one (1) to two (2) times per month for sixty (60) days, for supervision and recertification, and any changes in plan of care; SN case shared with other agencies (not identified); SN to assess vital signs. Reviewed clinical record flowsheets (paper documentation to record daily vital signs and SN narrative) for CR2 on 10/12/202 at approximately 1:10PM. Flowsheets revealed the following recorded vital signs: 7/22/2022 through 7/31/2022: Vital signs (temperature, pulse rate, respirations, and oxygen status on room air) and blood glucose were not recorded each day. 8/4/2022 through 8/7/2022: Temperature and pulse rate were recorded each day. However, respirations, oxygen saturation (room air), and blood glucose were not recorded either day. SN narrative note stated, “patient continuously monitored for respiratory and behavior issues”. 8/10/2022 through 9/4/2022: Temperature, pulse rate, respirations, oxygen saturation (room air), and blood glucose were recorded for each day. Interview with the Vice President, on 9/12/2022 at approximately 3:25PM confirmed the above findings.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on review of clinical records (CR), SN visit documentation, agency’s policy, and interview with the Vice President, it was determined that the agency failed to follow its policy to ensure that a thirty (30) day or sixty (60) day reassessment of care plan was conducted, for one (1) of three (3) clinical records (CR) reviewed. (CR3) Findings Include: Reviewed agency policy titled “Reassessment/Recertification of Patients” on 10/26/2022 9:13AM. Policy states, “…1. Reassessments are completed by the primary RN or therapist. The comprehensive assessment is updated and revised as frequently as the patient’s condition warrants it due to a major decline or improvement in the patient’s health status, but no less frequently than: (a) The last five (5) days of every sixty (60) days beginning with the start of care date…(4) In accepting a patient for treatment, Dynamic Home Health Care, Inc. maintains liaison with the attending physician with regard to the progress of the patient and ensures that the required plan of treatment is periodically reviewed by the physician. This includes: (a) securing from the physician the required recertifications of the medical necessity for home health care according to the Medicare Conditions of Participation. (b) Obtaining the physician’s review, and signature on the total Plan of Care which is updated at least every sixty (60) days or as needed…” During an interview with the Vice President on 10/12/2022 at approximately 9:25AM the Vice President stated that care plans are reviewed during the intake process, changes to an order, and during the thirty (30) day supervisory visit and care plan review for pediatric patients, and sixty (60) day supervisory visit and care plan review for non-pediatric patients. Review of clinical records (CR), was conducted on 10/12/2022 from approximately 9:43AM until approximately 2:00PM and review of supervisory visits on 10/12/2022 at approximately 3:10PM revealed: CR3 - (Start of Care): 1/31/2022 – Certification Period: 7/26/2022 through 9/23/2022 (Pediatric Waiver). Clinical record did not contain documentation that care plan was reassessed at thirty (30) days or sixty (60) days. Interview with the Vice President, on 9/12/2022 at approximately 3:25PM confirmed the above findings.