Every finding on record at Hwatch of the Tx Panhandle LLC

Purpose of visit: Recertification survey Entrance date: 03/24/25 Census: L&C –77 LHH – 0 PAS - 0 Abbreviations: L&C – Licensed and Certified LHH – Licensed Home Health PAS – Personal Assistance Services RN – Registered Nurse HHA – Home Health Aide QA – Quality Assurance

Purpose of visit: Recertification survey Entrance date: 03/24/25 Census: L&C –77 LHH – 0 PAS - 0 Abbreviations: L&C – Licensed and Certified LHH – Licensed Home Health PAS – Personal Assistance Services RN – Registered Nurse HHA – Home Health Aide QA – Quality Assurance

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed ensure the registered nurse conducted an on-site visit to the patient’s home no less frequently than every 14 days to supervise services provided by the home health aide for 3 of 3 (#1, #4, and #5) patients reviewed in which home health aide services were provided for more than 2 weeks. This failure has the potential to result in the skilled nurse failing to identify and address patient concerns with the services provided by the home health aide and could result in improper or inadequate care from the home health aides. Findings include: Patient #1 - Review of the clinical record certification period from 01/26/25 to 03/26/25 included a physician’s order for HHA services 2 times a week for 8 weeks then once a week for 1 week. Review of the home health aide visit notes indicated HHA services were provided from 01/27/25 to 03/21/25. The clinical record included HHA supervisory visits dated 01/27/25 and 02/11/25 (15 days between HHA supervisory visits) and 02/26/25 (15 days between HHA supervisory visits). During an interview conducted on 03/25/25 at 9:24 a.m. with Alternate Supervising Nurse/RN C, when asked if there were additional HHA supervisory visits from 01/27/25 to 02/26/25, Alternate Supervising Nurse/RN C, stated that when she looks at the calendars the supervisory visits are scheduled every 14 days but there is centralized scheduling by the corporate office and the schedules have been changed and she was unaware of schedule changes and it made the supervisory visits late. During an interview conducted on 03/25/25 at 9:31 a.m. with Administrator/Supervising Nurse when asked to describe centralize scheduling, Administrator/Supervising Nurse stated when an RN goes out to admit /recertify a patient and the information is in the computer this office can only view the information for a few minutes and it disappears and goes to the centralized QA department and they are making scheduling changes and this office was not notified of the changes, and further stated initially this office could make changes but now if this office tries to change the visit, it disappears until it is rescheduled by the centralized scheduling department and that this started occurring several weeks ago. Patient #4 - Review of the clinical record certification period from 01/25/25 to 03/25/25 included a physician’s order for HHA services 2 times a week for 8 weeks then once a week for 1 week beginning the week of 01/26/25. Review of the home health aide visit notes indicated HHA services were provided from 01/28/25 to 03/25/25. The clinical record included HHA supervisory visits dated 03/04/25 and 03/21/25 (17 days between HHA supervisory visits) During an interview conducted on 03/26/25 at 10:47 a.m. with Administrator/Supervising Nurse when asked if there are additional HHA supervisory visits from 03/04/25 to 03/21/25, Administrator/Supervising Nurse stated she would have to check. The administrator/Supervising Nurse returned to the surveyor on 03/26/25 at 10:58 a.m. and stated there were no other HHA supervisory visits during that time and that again these were late due to the centralized scheduling changing the schedule. Patient #5 - Review of the clinical record certification period from 01/26/25 to 03/26/25 included a physician’s order for HHA services 2 times a week for 8 weeks then once a week for 1 week. Review of the home health aide visit notes indicated HHA services were provided from 01/28/25 to 03/19/25. The clinical record included HHA supervisory visits dated 02/04/25 and 02/19/25 (15 days between HHA supervisory visits) During an interview conducted on 03/26/25 at 11:19 a.m. with Administrator/Supervising Nurse when asked if there are additional HHA supervisory visits from 02/04/25 to 02/19/25, Administrator/Supervising Nurse stated she did not see any and this was late due to the centralized scheduling changing the schedule. Review of the agency’s policy titled, “Responsibilities/Supervision of Clinical Services” with a revision date of April 2021, included, “… 6… A. Home Health Aides: Skilled personnel conduct home health aide supervisory visits at least every two weeks. At the discretion of the primary care nurse or therapist, supervisory visits can be made in conjunction with the home health aide or in their absence…”