Every finding on record at Health at Home Seattle Metro LLC

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 Part 484 conducted this health and safety survey. Examination number: X2025-705 Dates Onsite: 08/11/25, 08/12/25, & 08/13/25 This survey was conducted by: Surveyor #1 DOH staff found the facility in substantial compliance with all Conditions of Participation except those standard-level deficiencies listed below. DOH recommends recertification based on an acceptable plan of correction. .

Strengths, goals, and care preferences CFR(s): 484.55(c)(2) The patient's strengths, goals, and care preferences, including information that may be used to demonstrate the patient's progress toward achievement of the goals identified by the patient and the measurable outcomes identified by the HHA; This ELEMENT is not met as evidenced by: Based on document review, record review, and interview the agency failed to establish patient-specific goals for each discipline that may be used to demonstrate the patient's progress toward achieving their discipline specific goals for 6 of 10 patients (Patient #102, Patient #103, Patient #104, Patient #105, Patient #108, and Patient #110). Failure to establish patient-specific goals prevents patients from achieving their individualized home health goals. Findings included: 1. Document review of the agency's policy titled, "Patient Assessment, Initial and Reassessment," (Policy No. 2.1.002 Revised Date: 09/01/24) showed upon admission and reassessment, the clinicians collect the patients' goals which is used to demonstrate the patient's progress toward achievement of goals identified by the patient and as identified by the agency. 2. Record review of patient records for Patient #102, Patient #103, Patient #104, Patient #105, Patient #108, and Patient #110 showed: a. Patient #102 was admitted on 07/10/25 with the primary diagnosis of Spinal Stenosis. The comprehensive initial assessment was completed by the Registered Nurse (RN) and showed patient-specific goals for nursing was to move up and down without pain. There was no documentation to show patient-specific goals for Physical Therapy (PT) and Occupational Therapy (OT). b. Patient #103 was admitted on 07/25/25 with the primary diagnosis of Cerebral Infarction. The comprehensive initial assessment was completed by the Registered Nurse (RN) and showed patient-specific goals for nursing was to get stronger. There was no documentation to show patient-specific goals for PT and OT. c. Patient #104 was admitted on 10/01/24 with the primary diagnosis of Abscess to the Right Lower Extremity. The comprehensive initial assessment was completed by the Registered Nurse (RN) and showed patient-specific goals for nursing was to heal wounds. There was no documentation to show patient-specific goals for PT and OT. d. Patient #105 was admitted on 06/26/25 with the primary diagnosis of Esophageal Injury. The comprehensive initial assessment was completed by the Registered Nurse (RN) and showed patient-specific goals for nursing was to be able to walk. There was no documentation to show patient-specific goals for PT and OT. e. Patient #108 was admitted on 08/13/24 with the primary diagnosis of Laceration on the head. The comprehensive initial assessment was completed by the Registered Nurse (RN) and showed patient-specific goals for nursing was to heal wounds and be comfortable. There was no documentation to show patient-specific goals for PT and OT. f. Patient #110 was admitted on 02/24/25 with the primary diagnosis of Diabetes Mellitus. The comprehensive initial assessment was completed by the Registered Nurse (RN) and showed patient-specific goals for nursing was to find a place to live. There was no documentation to show patient-specific goals for PT and OT. 3. On 08/13/25 at 11:00 AM, Surveyor #1 interviewed the agency’s Area Administrator (Staff #110) regarding the lack of patient-specific goals for the other disciplines that care for the patient. Staff #110 acknowledged the findings and stated that the clinicians established their clinical goals for the patients but was unable to provide documentation of patient-specific goals for each PT and OT services.

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 CFR 484, conducted this health and safety survey. Onsite dates: 10/17/22-10/20/22 Examination number: X2022-881 The survey was conducted by: Surveyor #1 DOH recommends recertification based on an acceptable plan of correction. .

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide a safe and appropriate transfer to other care entities when the agency discharged the patient due to the patient’s needs exceeded the agency’s capabilities to care for the patient for 1 of 1 patient (Patient #108). Failure to provide safe and appropriate transfer care of the patient may have a clinical impact on the patient’s wellbeing and safety. Findings included: 1. Document review of agency’s document titled, “Patient Discharge/Transfer Process Policy # 2.1.004,” (Dated 01/01/22) showed that if a patient is discharged because the agency can no longer meet their needs the agency will assist the patient or their representative in choosing other care providers that can meet the patient’s needs. 2. Record review of patient records for Patients #108 showed that the patient was admitted on 03/07/22 and that the patient had a primary diagnoses of Unspecified Severe Protein-Calorie Malnutrition, Chronic Obstructive Pulmonary Disease, Major Depressive Disorder, and History of falls. a. The physician ordered Skilled Nursing (SN) visits for 1 time a week for 9 weeks with visits completed on 03/07/22, on 03/16/22, and last visit completed on 03/30/22, Occupational Therapy visit for 1 time a week for 1 week and visit completed on 03/17/22, and Social Worker services visits for 2 times a week for 1 week with first visit completed on 03/10/22. b. The Social Worker visit dated 03/10/22 showed services ordered to assist in placement for higher level of care. There was no documentation to show that the social worker provided assistance in placement for higher level of care for the patient prior to discharge. c. Coordination notes dated 03/24/22 showed a case conference with the team discussed patient concerns. The team determined that home health discharge is the most appropriate as the patient required a higher level of care. d. A skilled nursing visit dated 03/30/22 showed patient discharge from the agency. Record review showed the patient discharge to home for self-care and noted the patient's condition was unstable. There was no documentation to show that the agency provided a safe and appropriate transfer to other care entities to provide a higher level of care to the patient. 3. On 10/19/22 at 1:00 PM, the Surveyor interviewed the agency’s area administrator (Staff #110) on Patient #108’s discharge issues. Staff #110 acknowledged the issues and stated that they were unable to provide documentation of the patient’s safe and appropriate transfer to another care entity. .

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the plan of care was followed as ordered by the physician for 2 of 10 patients (Patient #107 and Patient #108). Failure to follow the plan of care, as ordered by the physician, puts the patient at risk of worsening symptoms of existing diagnoses. Findings included: 1. Document review of agency’s document titled, “Missed Visits,” (Dated April 2022) showed that if a visit is missed and not rescheduled, the clinician will notify the patient’s physician. 2. Record review of patient records for Patient #107 and Patient #108 showed: a. Patient #107 was admitted on 08/24/22 with diagnoses of Left Femur Fracture, Chronic Kidney Disease, Anemia, Hypertension, and Dialysis (three times a week)–not a complete list. On 09/04/22, the physician ordered Skilled Nursing (SN) services 1 time a week for 2 weeks and 2 times a week for 5 weeks. The week of 09/18/22, the patient received 1 of the 2 SN ordered visits. The week of 09/25/22, the patient received 0 of the 2 SN ordered visits. There was no documentation to explain the missed visits, and no evidence the agency notified the patient's physician. b. Patient #108 was admitted on 03/07/22 with diagnoses of Unspecified Severe Protein-Calorie Malnutrition, Chronic Obstructive Pulmonary Disease, Major Depressive Disorder, and History of Falling. On 03/07/22, the physician ordered Social Worker (SW) services 2 time a week for 1. The week of 03/07/22, the patient received 1 of the 2 SW ordered visits. There was no documentation to explain the missed visits, and no evidence the agency notified the patient's physician. 3. On 10/19/22 at 1:00 PM, the Surveyor interviewed the agency’s area administrator (Staff #110) of the lack of documentation on the missed visits. Staff #110 acknowledged the findings and stated that they were unable to find any documentation on the missed visits. .

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to follow state requirements to conduct a Tuberculosis (TB) screening using a TB risk assessment form provided or approved by the department. Failure to screen staff for TB places staff and patients at risk from TB exposure. Reference: WAC 246-335-525 Personnel, contractor, and volunteer policies. The applicant or licensee must develop and operationalize personnel, contractor, and volunteer policies and procedures that describe: (15) Infection control practices, communicable disease testing, and vaccinations. Policies and procedures must include, at minimum: (a) Standard precautions such as hand hygiene, respiratory hygiene and cough etiquette, and personal protective equipment; (b) Availability of personal protective equipment and other equipment necessary to implement client plans of care; (c) Tuberculosis (TB) infection control program. Key elements include, but are not limited to: (i) Conducting a TB risk assessment for all new employees upon hire. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine the agency's responsibility to conduct TB testing of new employees. If TB testing is required, follow the department's tuberculosis risk assessment form testing recommendations. (ii) Conducting an annual assessment of new TB risk factors for all employees. Agencies must use a tuberculosis risk assessment form provided by the department. Based on risk assessment results, determine agency's responsibility to conduct TB testing of employees. Retesting should only be done for persons who previously tested negative and have new risk factors since the last assessment. Findings included: 1. Document review of the agency’s policy titled, "Staff Screening, New Hire and Annual Policy #6.002," (Dated: 07/01/22) showed the agency's TB screening requirements of staff on-hire and annually. There is no documentation that a TB risk assessment form is used on-hired and annually that comply with the department TB requirements. 2. Record review of personnel records for 9 of 9 staff (Staff #101, #102, #103, #104, #105, #106, #107, #108, and #109). The review showed: a. Staff #101 was hired on 09/13/20. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. b. Staff #102 was hired on 01/15/18. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. c. Staff #103 was hired on 07/29/19. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. d. Staff #104 was hired on 01/10/22. The record failed to contain a completed [DOH]-approved initial TB risk assessment. e. Staff #105 was hired on 03/23/22. The record failed to contain a completed [DOH]-approved initial TB risk assessment. f. Staff #106 was hired on 03/08/16. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. g. Staff #107 was hired on 10/07/16. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. h. Staff #108 was hired on 02/26/15. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. i. Staff #109 was hired on 12/20/15. The record failed to contain a completed [DOH]-approved initial or annual TB risk assessment. 3. On 10/19/22 at 1:00 PM, the Surveyor interviewed the agency’s area administrator (Staff #110) about the agency's policy and TB screening process. Staff #110 acknowledged the findings and stated that they were not aware of the department-approved TB risk assessment form, and also stated that they are currently working to update the agency’s TB screening process.