Every finding on record at HHC, Inc./Housecall Supportive Services, Inc.

An Emergency Preparedness survey was conducted on 7/14/2025 through 7/16/2025 with the recertification survey. The facility meets all requirements reviewed for Emergency Preparedness.

A recertification survey was conducted along with an Emergency Preparedness survey conducted on 7/14/2025 through 7/16/2025. An entrance conference was held with the Director of Operations. An exit conference was held on 7/16/2025 with the Director of Operations, Area Vice President, Physical Therapist/Area Vice President, Vice President Clinical, Area Vice President of Operations and Clinical Manager.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on policy review, medical record review, observation, and interview, the agency failed to follow the Plan of Care as ordered by the physician for 3 of 7 (Patient #2, #3, and #4) of patients reviewed during home visits. The findings included: 1. Review of the agency’s “Coordination of Care,” policy dated 7/10/2025, revealed, “…To ensure consistent documentation, communication, coordination, and retrieval of significant administrative and patient…information…Ensure each patient…receive ongoing education and training…regarding the care and services identified in the plan of care…” 2. Review of the medical record revealed Patient #2 was admitted with a start of care date 6/6/2025 with diagnoses of Diabetes, Chronic Pain, and Anxiety. Review of the “HOME HEALTH CERTIFICATION AND PLAN OF CARE,” dated 6/6/2025 to 8/4/2025, revealed “…PTA [Physical Therapy Assistant] TO OBSERVE AND MONITOR, PROVIDE SKILLED THERAPUTIC INTERVENTION, ACTIVITY, EDUCATION AND TRAINING TO ADRESS…MONITOR AND EDUCATE ON OXYGEN SATURATION DURING ADLS [Activities of Daily Living]…NOTIFY PHYSICIAN…AND CLINICAL MANAGER …IF O2 [Oxygen] SATS [Saturation] BELOW PHYSICIAN ORDERED PARAMETERS AFTER 10 MIN [Minutes] OF REST…RECORD PATIENT REPORTED BLOOD SUGAR LEVELS AND NOTIFY PHYSICIAN…CLINICAL MANAGER…NOTIFICATION IF BLOOD SUGAR LEVELS ARE OUTSIDE ORDERED PARAMETERS. TEACH PATIENT/[and]CAREGIVER ON DAILY FOOT INSPECTIONS…” Patient #2 had no orders for oxygen parameters. Observations in Patient #2’s home on 7/14/2025 at 2:15 PM, revealed the Physical Therapy Assistant (PTA) failed to record patient reported blood sugars, conduct routine foot inspections, teach daily foot inspections, or monitor and educate on oxygen saturation. During an interview on 7/14/2025 at 3:00 PM, the PTA confirmed blood sugars were not monitored, foot inspections and teaching were not done, and oxygen saturations were not performed after 10 minutes of rest. 3. Review of the medical record revealed Patient #3 was admitted with a start of care date 4/3/2025 with diagnoses of Right Femur Fracture, Hypertension, and Altered Mental Status. Review of the “HOME HEALTH CERTIFICATION AND PLAN OF CARE,” dated 6/2/2025 to 7/31/2025, revealed “…OT [Occupational Therapy]…TO MONITOR AND EDUCATE ON OXYGEN SATURATION DURING ADLS…NOTIFY PHYSICIAN…CLINICAL MANAGER FOR PHYSICIAN NOITFICATION IF O2 SATS BELOW 90% AFTER 10 MIN OF REST…” Observations in Patient #3’s home on 7/15/2025 at 9:10 AM, revealed the OT failed to perform oxygen saturations after finishing the visit. During an interview on 7/15/2025 at 9:45 AM, the OT confirmed no oxygen saturations were checked after the therapy visit. 4. Review of the medical record revealed Patient #4 was admitted with a start of care date 4/24/2025 with diagnoses of Cerebral Infarction, Hypertension, and Dementia. Review of the “HOME HEALTH CERTIFICATION AND PLAN OF CARE,” dated 6/23/2025 to 8/21/2025, revealed “…PT [Physical Therapy]…TO MONITOR AND EDUCATE ON OXYGEN SATURATION DURING ADLS… NOTIFY PHYSICIAN…AND CLINICAL MANAGER …IF O2 SATS BELOW PHYSICIAN ORDERED PARAMETERS AFTER 10 MIN OF REST…” Patient #4 had no orders for oxygen parameters. Observations in Resident #4's home on 7/15/2025 at 12:26 PM, revealed the PT checked Resident #4's O2 sat during the visit, but there were no parameters for Resident #4's O2 sat to designate when the therapist should notify the physician. During an interview on 7/16/2025 at 1:15 PM, the Director of Operations (DOO) confirmed the agency failed to follow the Plan of Care for Patient #2, #3, and #4. .

An Emergency Preparedness survey was conducted from 3/8/2022 to 3/10/2022 at Amedisys Home Health Care. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

A recertification survey was conducted at Amedisys Home Health Care on 3/8/2022 to 3/10/2022. Condition and standard level deficiencies were cited under CFR Part 484, Requirements for Home Care Organizations Providing Home Health Care.

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 policy review, medical record review and interview, the agency failed to perform the initial assessment within 48 hours of the physician’s referral for 3 patients (#2, #11 and #13) of 17 patients reviewed. The findings include: Review of the agency’s policy on “Patient Assessment/Reassessment revised 9/13/2021 revealed “...Initial Assessment Visit...The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home...” Medical record review of Patient #2’s referral revealed the physician ordered home health services on 1/7/2022. Medical record review revealed Patient #2’s initial assessment was completed on 1/11/2022 and not within the 48 hours of the referral. Medical record review of Patient #11’s referral revealed the physician ordered home health services on 12/17/2021. Medical record review revealed Patient #11’s initial assessment was completed on 12/20/2021 and not within the 48 hours of the referral. Medical record review of Patient #13’s referral revealed the physician ordered home health services on 1/15/2021. Medical record review revealed Patient #13’s initial assessment was completed on 1/19/2021 and not within the 48 hours of the referral. Interview with the Area Vice President of Operations on 3/9/2022 at 1:30PM confirmed the agency failed to initiate the initial assessment within 48 hours of the physician's referrals for patients #2, #11 and #13.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on review of policies, medical record review and interview, it was determined that the home health agency failed to conform with physician's orders (G578). The home health agency failed to ensure treatments were administered only as ordered by the physician (G580). The home health agency failed to ensure patient or caregivers received ongoing education and training (G610). The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' needs would be met. Refer to G578, G580 and G610.

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 medical record review and interview, the agency failed to conform with physician’s orders to provide instructions and assessment of blood glucose levels for 1 patient (#14) of 17 patients reviewed. The findings include: Medical record review revealed Patient #14 was admitted to the agency on 7/7/2021 with diagnoses including Alzheimer’s Disease and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care dated 7/7/2021 to 9/4/2021 revealed a physician’s order for Diabetes Management. Further review revealed “...Skilled nurse for instruction of diabetic care to include diet, skin care, signs/symptoms of hypo/hyperglycemia, proper administration of diabetic medications. Skilled nurse to instruct on diabetic foot care and monitor skin for skin lesions on lower extremities. Blood glucose testing...skilled nurse to assess patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician. Skilled nurse may perform blood glucose test as needed. Skilled nurse to report to physician blood glucose readings greater than 400 or less than 70...” Medical record review of the initial assessment dated 7/7/2021 revealed the patient was discharged from a Psychiatric hospital or unit with Diabetes, Hypertension, Dementia and Depression on 7/7/2021. Further review revealed the patient lived in a congregate home (not a medically licensed facility). Continued review revealed the patient was taking oral anti-diabetic medications and her blood glucose readings were between 300 and 400. Further review revealed the patient required assistance of another person to administered medications. Continued review revealed the plan of care was discussed with the patient and two family members. Further review revealed the patient was oriented to “person” only. No documentation found to indicate the patient or family members were educated on diabetic management. No documentation a base line blood glucose level was obtained by the skilled nurse. Medical record review of a skilled nurse visit note dated 7/9/2021 revealed the no documentation was found to indicate the patient, staff or family members were educated on diabetic management. No documentation blood glucose levels were assessed by the skilled nurse or obtained from the facility staff or family. Medical record review of a skilled nurse’s note dated 7/13/2021 revealed no documentation blood glucose levels were assessed by the skilled nurse or obtained from the facility staff or family. No documentation found to indicate the patient, staff or family members were educated on diabetic management. Medical record review of a skilled nurse telephone call (telehealth) on 7/15/2021 revealed the facility staff assisted with the telehealth call. Further review revealed the facility staff does not consider themselves the patient’s caregivers. No documentation was noted regarding diabetic management instruction or assessment of blood glucose levels. Medical record review of a skilled nurse telephone call (telehealth) on 7/16/2021 revealed the facility staff assisted with the telehealth call. No documentation was noted regarding diabetic management instruction or assessment of blood glucose levels. Medical record review of a Transfer Summary Report dated 7/19/2021 revealed the patient was transferred to the hospital due to Hypoglycemia and Fall. All home health services were placed on hold. Medical record review of a “No Visit Made – Data Collection Only” note dated 7/23/2021 revealed the patient was transferred to an inpatient facility due to Hypo/Hyperglycemia, Diabetes Out of Control. Medical record review of a physician's order dated 7/23/2021 revealed "...Placed all home health services on hold as of 7/19/2021 due to patient being admitted to...Hospital for Hypoglycemia or Fall..." Interview with the Area Vice President of Operations on 3/9/2022 at 3:00 PM confirmed the agency did not conform with the physician's orders in regards to diabetic management instructions or assessment of blood glucose levels as ordered by the physician.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to obtain wound care frequency orders for 1 patient (#10) of 17 patients reviewed. The findings include: Medical record review revealed Patient #10 was admitted to the agency on 2/23/2022 with diagnoses including Change or Removal of Nonsurgical Wound Dressing and Peripheral Vascular Disease. Medical record review of the Home Health Certification and Plan of Care dated 2/23/2022 to 4/23/2022 revealed a physician’s order for “...Left Statis Ulcer Mallelous (bony prominence on side of ankle) and 2nd toe: Apply Acticoat (antimicrobial barrier dressing) to wound bed, apply Silver Alginate (absorbs drainage) to wound bed, apply Vaseline (lubricating gel) to dry skin over left leg, wrap with gauze (dressing) and cover with Tubigrip (support for management of swelling)...” Further review revealed the frequency of the wound care was not obtained from the physician. Medical record review of skilled nurse notes dated 2/23/2022 to 3/1/2022 revealed the skilled nurse was providing the wound care 2 days a week. Further review revealed clarification of wound care frequency was not obtained from the physician. Medical record review of a physician’s order dated 3/1/2023 revealed “...Cleanse wound with wound cleanser and pat dry with gauze. Apply Calcium Alginate and cover with dry dressing, wrap with Kerlix (rolled dressing)...” Further review revealed wound care frequency was not obtained by the agency. Medical record review of the skilled nurse’s notes dated 3/1/2022 to 3/4/2022 revealed the skilled nurse provided the wound care 2 times a week. Continued review revealed clarification of wound care frequency was not obtained from the physician. Interview with the Area Vice President of Operations on 3/9/2022 confirmed the agency did not obtain wound care frequency orders for the wound care ordered on 2/23/2022 or 3/1/2022.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on policy review, medical record review and interview, the agency failed to provide diabetic management instructions for 1 patient (#14) of 17 patients reviewed. The findings include: Review of the agency's policy on "Services Provided" revised on 6/24/2021 revealed "...Responsibilities of skilled professionals...Patient and caregiver education..." Medical record review revealed Patient #14 was admitted to the agency on 7/7/2021 with diagnoses including Alzheimer’s Disease and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care dated 7/7/2021 to 9/4/2021 revealed a physician’s order for Diabetes Management. Further review revealed “...Skilled nurse for instruction of diabetic care to include diet, skin care, signs/symptoms of hypo/hyperglycemia, proper administration of diabetic medications. Skilled nurse to instruct on diabetic foot care and monitor skin for skin lesions on lower extremities. Blood glucose testing...skilled nurse to assess patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician. Skilled nurse may perform blood glucose test as needed. Skilled nurse to report to physician blood glucose readings greater than 400 or less than 70...” Medical record review of the initial assessment dated 7/7/2021 revealed the patient was discharged from a Psychiatric hospital or unit with Diabetes, Hypertension, Dementia and Depression on 7/7/2021. Further review revealed the patient lived in a congregate home (not medically licensed facility). Continued review revealed the patient was taking oral anti-diabetic medications and her blood glucose readings were between 300 and 400. Further review revealed the patient was oriented to “person” only. No documentation found to indicate the patient, family members or facility staff were educated on diabetic management or blood glucose monitoring. Medical record review of a skilled nurse visit note dated 7/9/2021 revealed no documentation to indicate the patient, facility staff or family members were educated on diabetic management or glucose monitoring. Further review revealed no documentation the patient/caregivers were monitoring blood glucose levels. Medical record review of a skilled nurse visit note dated 7/13/2021 revealed no documentation to indicate the patient, facility staff or family members were educated on diabetic management or glucose monitoring. Further review revealed no documentation the patient/caregivers were monitoring blood glucose levels. Medical record review of a skilled nurse telephone call (telehealth) on 7/15/2021 revealed the facility staff assisted with the telehealth call. Further review revealed the facility staff does not consider themselves the patient’s caregivers. No documentation noted regarding diabetic management instruction or assessment of blood glucose levels. Medical record review of a skilled nurse telephone call (telehealth) on 7/16/2021 revealed the facility staff assisted with the telehealth call. No documentation noted regarding diabetic management instruction or assessment of blood glucose levels. Medical record review of a Transfer Summary Report dated 7/19/2021 revealed the patient was transferred to the hospital due to Hypoglycemia and Fall. All services were placed on hold. Medical record review of a “No Visit Made – Data Collection Only” note dated 7/23/2021 revealed the patient was transferred to an inpatient facility due to Hypo/Hyperglycemia, Diabetes Out of Control. Medical record review of a physician's order dated 7/23/2021 revealed "...Placed all home health services on hold as of 7/19/2021 due to patient being admitted to...Hospital for Hypoglycemia or Fall..." Interview with the Area Vice President of Operations on 3/9/2022 at 3:00 PM confirmed the agency did not provide education to the patient, facility staff or family members regarding diabetic management instructions or blood glucose monitoring.

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: Based on review of policies, medical record review and interview, it was determined that the Home Health Agency failed to ensure skilled nurses provided services ordered by the physician in the plan of care (G710). The Home Health Agency failed to ensure skilled nurses provided education and instructions to the patient and/or caregivers (G714). The Home Health Agency failed to ensure skilled nurses communicated with the physician (G718). The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' nursing needs would be met. Refer to G710, G714 and G718.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the skilled nurses failed to provide wound care as ordered by the physician for 1 patient (#10) and failed to provide diabetic assessment, education and glucose monitoring for 1 patient (#14) as ordered by the physician out of 17 patients reviewed. The findings include: Medical record review revealed Patient #10 was admitted to the agency on 2/23/2022 with diagnoses including Change or Removal of Nonsurgical Wound Dressing and Peripheral Vascular Disease. Medical record review of the Home Health Certification and Plan of Care dated 2/23/2022 to 4/23/2022 revealed a physician’s order for “...Left Statis Ulcer Mallelous (bony prominence on side of ankle) and 2nd toe: Apply Acticoat (antimicrobial barrier dressing) to wound bed, apply Silver Alginate (absorbs drainage) to wound bed, apply Vaseline (lubricating gel) to dry skin over left leg, wrap with gauze (dressing) and cover with Tubigrip (support for management of swelling)...” Further review revealed the frequency of the wound care was not obtained from the physician. Medical record review of skilled nurse notes dated 2/23/2022 to 3/1/2022 revealed the skilled nurse was providing the wound care 2 days a week. Further review revealed clarification of wound care frequency was not obtained from the physician. Medical record review of a physician’s order dated 3/1/2023 revealed “...Cleanse wound with wound cleanser and pat dry with gauze. Apply Calcium Alginate and cover with dry dressing, wrap with Kerlix (rolled dressing)...” Further review revealed wound care frequency was not obtained by the agency. Medical record review of the skilled nurse’s notes dated 3/1/2022 to 3/4/2022 revealed the skilled nurse provided the wound care 2 times a week. Continued review revealed clarification of wound care frequency was not obtained from the physician. Interview with the Area Vice President of Operations on 3/9/2022 confirmed the skilled professional did not obtain wound care frequency orders for the wound care ordered on 2/23/2022 or 3/1/2022. Medical record review revealed Patient #14 was admitted to the agency on 7/7/2021 with diagnoses including Alzheimer’s Disease and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care dated 7/7/2021 to 9/4/2021 revealed a physician’s order for Diabetes Management. Further review revealed “...Skilled nurse for instruction of diabetic care to include diet, skin care, signs/symptoms of hypo/hyperglycemia, proper administration of diabetic medications. Skilled nurse to instruct on diabetic foot care and monitor skin for skin lesions on lower extremities. Blood glucose testing...skilled nurse to assess patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician. Skilled nurse may perform blood glucose test as needed. Skilled nurse to report to physician blood glucose readings greater than 400 or less than 70...” Medical record review of the initial assessment dated 7/7/2021 revealed the patient was discharged from a Psychiatric hospital or unit with Diabetes, Hypertension, Dementia and Depression on 7/7/2021. Further review revealed the patient lived in a congregate facility (not a medically licensed facility). Continued review revealed the patient was taking oral anti-diabetic medications and her blood glucose readings were between 300 and 400. Continued review revealed the plan of care was discussed with the patient and two family members. Further review revealed the patient was oriented to “person” only. No documentation found to indicate the patient or family members were educated on diabetic management. No documentation a base line blood glucose level was obtained by the skilled nurse. Medical record review of a skilled nurse visit note dated 7/9/2021 revealed no documentation found to indicate the patient, facility staff or family members were educated on diabetic management or blood glucose monitoring. No documentation blood glucose levels were assessed by the skilled nurse or obtained from the facility staff or family. Medical record review of a skilled nurse’s note dated 7/13/2021 revealed no documentation blood glucose levels were assessed by the skilled nurse or obtained from the facility staff or family. No documentation found to indicate the patient, staff or family members were educated on diabetic management or blood glucose monitoring. Medical record review of a skilled nurse telephone call (telehealth) on 7/15/2021 revealed the facility staff assisted with the telehealth call. Further review revealed the facility staff does not consider themselves the patient’s caregivers. No documentation noted regarding diabetic management instruction or assessment of blood glucose levels. Medical record review of a skilled nurse telephone call (telehealth) on 7/16/2021 revealed the facility staff assisted with the telehealth call. No documentation noted regarding diabetic management instruction or assessment of blood glucose levels. Medical record review of a Transfer Summary Report dated 7/19/2021 revealed the patient was transferred to the hospital due to Hypoglycemia and Fall. All services were placed on hold. Medical record review of a “No Visit Made – Data Collection Only” note dated 7/23/2021 revealed the patient was transferred to an inpatient facility due to Hypo/Hyperglycemia, Diabetes Out of Control. Medical record review of a physician's order dated 7/23/2021 revealed "...Placed all home health services on hold as of 7/19/2021 due to patient being admitted to...Hospital for Hypoglycemia and Fall..." Interview with the Area Vice President of Operations on 3/9/2022 at 3:00 PM confirmed the skilled nurse did not provide assessment or education regarding diabetic management as ordered by the physician. Further review confirmed the skilled nurse did not obtain any blood glucose levels.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on policy review, medical record review and interview, the skilled nurses failed to provide education to the patient/family/caregivers regarding diabetic management and blood glucose monitoring for 1 patient (#14) of 17 patients reviewed. The findings include: Review of the agency's policy on "Services Provided" revised on 6/24/2021 revealed "...Responsibilities of skilled professionals...Patient and caregiver education..." Medical record review revealed Patient #14 was admitted to the agency on 7/7/2021 with diagnoses including Alzheimer’s Disease and Type 2 Diabetes Mellitus. Medical record review of the Home Health Certification and Plan of Care dated 7/7/2021 to 9/4/2021 revealed a physician’s order for Diabetes Management. Further review revealed “...Skilled nurse for instruction of diabetic care to include diet, skin care, signs/symptoms of hypo/hyperglycemia, proper administration of diabetic medications. Skilled nurse to instruct on diabetic foot care and monitor skin for skin lesions on lower extremities. Blood glucose testing...skilled nurse to assess patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician. Skilled nurse may perform blood glucose test as needed. Skilled nurse to report to physician blood glucose readings greater than 400 or less than 70...” Medical record review of the initial assessment dated 7/7/2021 revealed the patient was discharged from a Psychiatric Hospital or unit with Diabetes, Hypertension, Dementia and Depression on 7/7/2021. Further review revealed the patient lived in a congregate home (not a medically licensed facility). Continued review revealed the patient was taking oral anti-diabetic medications and her blood glucose readings were between 300 and 400. Further review revealed the patient was oriented to “person” only. No documentation found to indicate the patient or family members were educated on diabetic management or blood glucose monitoring. Medical record review of a skilled nurse visit note dated 7/9/2021 revealed no documentation to indicate the patient, facility staff or family members were educated on diabetic management or glucose monitoring. Further review revealed no documentation the patient/caregivers were monitoring blood glucose levels. Medical record review of a skilled nurse visit note dated 7/13/2021 revealed no documentation to indicate the patient, facility staff or family members were educated on diabetic management or glucose monitoring. Further review revealed no documentation the patient/caregivers were monitoring blood glucose levels. Medical record review of a skilled nurse telephone call (telehealth) on 7/15/2021 revealed the facility staff assisted with the telehealth call. Further review revealed the facility staff does not consider themselves the patient’s caregivers. No documentation noted regarding diabetic management instruction or blood glucose monitoring. Medical record review of a skilled nurse telephone call (telehealth) on 7/16/2021 revealed the facility staff assisted with the telehealth call. No documentation noted regarding diabetic management instruction or blood glucose monitoring. Medical record review of a Transfer Summary Report dated 7/19/2021 revealed the patient was transferred to the hospital due to Hypoglycemia and Fall. All services were placed on hold. Medical record review of a “No Visit Made – Data Collection Only” note dated 7/23/2021 revealed the patient was transferred to an inpatient facility due to Hypo/Hyperglycemia, Diabetes Out of Control. Medical record review of a physician's order dated 7/23/2021 revealed "...Placed all home health services on hold as of 7/19/2021 due to patient being admitted to...Hospital for Hypoglycemia and Fall..."s Interview with the Area Vice President of Operations on 3/9/2022 at 3:00 PM confirmed the skilled nurses did not provide education to the patient, facility staff or family members regarding diabetic management instructions or blood glucose monitoring.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the skilled nurse failed to obtain wound care frequency from the physician for 1 patient (#10) of 17 patients reviewed. The findings include: Medical record review revealed Patient #10 was admitted to the agency on 2/23/2022 with diagnoses including Change or Removal of Nonsurgical Wound Dressing and Peripheral Vascular Disease. Medical record review of the Home Health Certification and Plan of Care dated 2/23/2022 to 4/23/2022 revealed a physician’s order for “...Left Statis Ulcer Mallelous (bony prominence on side of ankle) and 2nd toe: Apply Acticoat (antimicrobial barrier dressing) to wound bed, apply Silver Alginate (absorbs drainage) to wound bed, apply Vaseline (lubricating gel) to dry skin over left leg, wrap with gauze (dressing) and cover with Tubigrip (support for management of swelling)...” Further review revealed the frequency of the wound care was not obtained from the physician. Medical record review of skilled nurse notes dated 2/23/2022 to 3/1/2022 revealed the skilled nurse failed to contact the physician for clarification of wound care frequency. Medical record review of a physician’s order dated 3/1/2023 revealed “...Cleanse wound with wound cleanser and pat dry with gauze. Apply Calcium Alginate and cover with dry dressing, wrap with Kerlix (rolled dressing)...” Further review revealed wound care frequency was not obtained from the physician. Medical record review of the skilled nurse’s notes dated 3/1/2022 to 3/4/2022 revealed the skilled nurse provided the wound care 2 times a week. Continued review revealed clarification of wound care frequency was not obtained from the physician. Interview with the Area Vice President of Operations on 3/9/2022 at 3:00 PM confirmed the skilled nurses did not obtain wound care frequency orders for the wound care ordered on 2/23/2022 or 3/1/2022.