Every finding on record at Grace Home Health Inc

Purpose: A self-report investigation (1066352) was entered on 4/2/2026. Census: Total 370 L&C-250 LHHS-52 PAS-120 Abbreviations: ADL- Activities of Daily Living Alt. Admin- Alternate Administrator ANE- Abuse, Neglect, Exploitation HHSC- Health and Human Services Commission L&C—Licensed and Certified LHHS—Licensed Home Health Services PAS- Personal Assistance Services

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to report an allegation of neglect by an agency employee to HHSC within 24 hours of being made aware of the complaint in 1 of 2 patients (Patient #1) reviewed. This failure could place the agency's clients at risk of alleged acts of abuse, neglect, or exploitation (ANE) by agency employees. The findings included: During the entrance conference for a self report incident on 4/2/2026 at 10:00 a.m., with the Alt. Administrator, the surveyor requested the agency's list of Personal Attendants employed by the agency and a list of active patients for 2026. Record review of the agency’s Provider Investigative Report revealed the initial complaint was received via voice mail on 1/28/2026. The agency followed up with the patient’s family and interviewed PROV A. The investigative report revealed that PROV A was suspended and an in-service was conducted. The agency made a self report on 1/30/2026. Record review of Patient #1’s PAS care plan revealed a care plan for incontinent care and assistance with ADL’s. Further record review revealed that Patient #1 received daily personal attendant services from agency staff, PROV A. Further record review revealed that the patient was receiving meal delivery daily as well as assistance with bathing. Record review of PROV A personnel record reveal PROV A hire date was 2/13/25 with competency evaluation completed on 2/13/25 During an interview on 4/2/2026 at 11:30., with the Alt Administrator, Administrator and Alt Administrator were given the opportunity to review the above findings. The Administrator verbalized responsibility for not notifying HHSC within 24 hours from where there was cause to believe there was suspected neglect of Patient #1 when PROV A failed to ensure patient was awake to receive her meal. Alt Administrator also stated she was aware that the requirement of reporting Record review of agency policy titled, “TX.3 Abuse, Neglect, and Exploitation” (no date) read in part… “information will be reported immediately, meaning within 24 hours, upon witnessing the act or upon receipt of the allegation through the HHSC Complaint and Incident Intake reporting…”