Every finding on record at Immediate Homecare LLC

Based on the findings of an unannounced onsite complaint investigation, conducted October 23, 2025 and concluded November 17, 2025, Immediate Homecare and Hospice, was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on review of clinical records (CR), and interview with the agency administrator, the agency failed to follow the plan of care as directed by the physician for one (1) of four (4) CRs reviewed. (CR#4). Findings include: A review of agency policy titled "Plan of Care – CMS #485 and Physician/Practitioners Orders" completed on November 17, 2025 at approximately 3:30 pm stated the following: POLICY Skilled nursing and other home health services will be in accordance with a Plan of Care based on the patient’s diagnosis and assessment of immediate and long-range needs and resources. Each Plan of Care must be signed and dated by the physician/allowed practitioner. Stamped signatures on orders, treatments or other documents that are part of the patient’s record are not accepted. The Agency will provide the patient and caregiver with written instructions related to the plan of care. Procedure: …26. Orders may authorize a specific range in the frequency of visits for each service (e.g., 2-4 visits per week) to ensure that the most appropriate level of service is provided to the patient.…. The Agency alerts the physician/practitioner to any changes that suggests a need to alter the plan of care. If the Agency provides fewer visits than the physician/practitioner orders, it has altered the plan of care and the physician/practitioner must be notified. The Agency must maintain documentation in the clinical record indicating that the physician/practitioner was notified and is aware of the missed visit. …30. The patient’s orders for treatments and services are the foundation of the plan of care. If the Agency misses a visit or a treatment or services as required by the plan of care, which results in any potential for clinical impact upon the patient, then the Agency must notify the responsible physician/practitioner of such missed treatment or service. The physician/practitioner decides whether the treatment or service may be skipped or whether additional intervention is required by the Agency due to the clinical impact on the patient. …32. The physician/practitioner will not be approached to reduce the frequency of services based solely on the availability of Agency staff. A review of CRs conducted on October 24, 2025 at approximately 10:00 am revealed the following: CR #4, Start of Care: 8/14/25; Discharged: 9/9/25. Certification period reviewed: 8/14/25 through 10/12/25; contained orders for skilled nursing services two (2) visits per week for four (4) weeks. SN orders - 8/14/2025 – 8/16/2025 -1 visit / 1 week. 8/14/25 – Start of Care Visit completed SN orders - 8/17/2025 – 9/13/2025 – 2 visits per week / 4 weeks. Week One (1) 8/19/2025 – SN Visit Completed; 8/21/2025 – SN Missed Visit; CR#4 had doctor’s appointment, as per nursing notes. No other visits were completed for this week. Week Two (2) 8/25 – SN Visit Completed ; 8/29 – SN Visit Completed Week Three (3) 9/1/2025 – SN Missed Visit – No Answer to Phone Call, as per nursing notes. 9/1/2025 – Nursing Note indicated: “No answer to phone call, Physician Notified.” Last visit made to CR#4 was made on 8/29/25, therefore, no further treatment was provided by the agency. In addition to having wound care provided at home, the patient was seen in a wound center to have the wound cared for. 9/5/25 – According to CR#4, visit was supposed to take place on 9/5/25. As per the email that was sent by CR#4 the following information was stated:”…. She confirmed I was on schedule for Friday, September 5, but could not answer any questions regarding the missed appointment on Monday, September 1. She told me a manager would call me back. After 7 days, I am still waiting for a manager to call….” No notes from agency regarding missed visit. Agency did not fulfill the visit frequency of two (2) visits per week. No further dates were scheduled by the agency to provide wound care treatment to CR#4. Last date wound care services were provided was on 8/29/25. No other visits were completed for this week Week Four (4) 9/9/2025 – SN Missed Visit – No Answer to Phone Call, as per nursing notes. No other visits were completed for this week. Discharge summary completed. An interview with the Office Director conducted on October 24, 2025, at approximately 1:45 pm confirmed the above findings.

Available during all operating hours CFR(s): 484.105(b)(3) The administrator or a pre-designated person is available during all operating hours. This ELEMENT is not met as evidenced by: Based on review of the agency polices/procedures and interview with the agency Office Director, the agency failed to ensure the administrator, or an alternate administrator is available during all operating hours for one (1) of four (4) Client Records reviewed. CR#4. Based upon an interview conducted with CR#4 on October 23, 2025 at approximately 9:00 am, CR4 stated that they were happy with nursing services but not satisfied with the inability of contacted a representative in the office. As per CR#4, out of the eleven (11) times they contacted the agency, only spoke to a representative from the agency one (1) time. CR#4 provided the following statement via email to the Pennsylvania Department of Health: “…August 15 – called to alert them about a change in bandage changing schedule. On hold for 45 minutes when automated system confirmed my phone number and said, “goodbye”. No call back. September 1 – nurse did not show up for appointment. I called at 8:00 a.m., 9:30 a.m.,12:00 p.m., and 2:00 p.m. to ask whether a nurse would be coming. In all cases, the automated system confirmed my number and said, “goodbye”. No call back. September 2 – called to find out about nurse not coming on September 1 and whether I was on schedule for Friday, September 5. I called at 8:10 a.m. and 9:06 a.m. Again, both calls were answered by the automated system. The company did call back at about 11a.m., but the phone only rang once. I immediately called back; the phone was answered. She confirmed I was on schedule for Friday, September 5, but could not answer any questions regarding the missed appointment on Monday, September 1. She told me a manager would call me back. After 7 days, I am still waiting for a manager to call. September 3 – called to inform them that I had a doctor’s appointment on Thursday, September 4, which may result in a change in the scheduled Friday, September 5 appointment. I asked about a better way to contact them regarding a possible change in the Friday appointment because of the difficulty in contacting them. She told me the general number was the best way to contact them. There was neither a call from a nurse regarding the Friday appointment nor a visit by a nurse. September 8 – I had a doctor’s appointment. She changed my home nursing care needs. I called the company to inform them of the change at 11:16 a.m., 2:15 p.m., and 4:00 p.m. All calls were answered by the automated system. I did not get a call back. September 9 – I called my doctor’s office to request a different home healthcare agency.” A review of the Agency’s Home Health Admission Booklet, which is presented to patient’s upon admission was conducted on October 23, 2025 at approximately 10:15 am revealed the following information: · Information regarding Office Hours/After Hours Coverage “…Office Hours: Our office hours are from 8:00 a.m. to 5:00 p.m., Monday through Friday, except holidays. You may reach us by calling… “After Hours Coverage: We have a nurse on call 24 hours a day, seven days a week to ensure that you receive necessary home care services. Your may reach the nurse by calling…After office hours and on weekends, an answering service will reach the nurse on call and he/ she will return your call to address your concerns and needs.” · Welcome to the Immediate Home Health & Hospice Family! “ …If you have any comments, suggestions or complaints, please contact us. Any concerns will be addressed promptly. A satisfactory resolution will be sought and implemented.” An interview with the Office Director conducted on October 23, 2025, at approximately 1:00 pm, indicated that the office was short staffed and there was a great possibility that calls were missed and that an extension should have been provided to the patient.

Based on the findings of an unannounced onsite Medicare recertification survey conducted February 8 through February 10, 2022, Immediate Home Care was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare recertification survey conducted February 8 through February 10, 2022, Immediate Home Care was found not to be in compliance with the following requirement of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Treatment or care CFR(s): 484.50(e)(1)(i)(A) (i)(A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; and This ELEMENT is not met as evidenced by: Based on a review of patient files (PF) and an interview with the alternate administrator/supervising registered nurse, the home health agency (HHA) failed to furnish treatment or care on a consistent basis for one (1) of seventeen (17) patient files that were reviewed: PF #15. Findings include: A review of patient files was conducted on February 10, 2022 at approximately 12:00 PM. The start of care (SOC) is indicated below: PF#15 SOC 12/17/2021 contained a Home Health Certification and Plan of Care (HHCPC) for the certification period 12/17/2021 to 02/14/2022. The HHCPC contained orders as follows: "Assess, evaluate, implementation of standard precautions/infection control;" "Assess, evaluate gastrostomy tube as follows: "Percutaneous endoscopic gastrostomy (PEG) tube" (a tube placed through the abdominal wall into the stomach)" attached to drain bag pending conversion to Gastrostomy-Jejunostomy (GJ) Tube" (a tube placed through the abdominal wall into the stomach and positioned into the small intestine. A review of the skilled nursing notes on 12/18/2021 and 12/20/2021 did not contain documentation regarding the presence of a PEG tube under either the Integumentary nor the Gastrointestinal Sections of the nursing note. A narrative nursing note stated "PEG tube not in use but is attached to drain bag for drain purposes." There was no documentation concerning assessment of and care to the PEG tube site, nor was there any documentation as to the description or presence/amount of drainage from the PEG tube. Skilled nursing notes on 12/22/2021 and 01/13/2022 noted the location of the PEG tube under the Integumentary system section of the note. There was no documentation concerning assessment of and care to the PEG tube site, nor was the presence, amount and/or description of drainage documented. Skilled nursing notes on 12/27/2021 and 01/10/2022 did not contain any documentation regarding the presence of a PEG tube. A skilled nursing note on 01/03/2022 did not contain documentation of the presence of a PEG tube under the Integumentary or Gastrointestinal sections of the nursing note. A narrative nursing note stated, "G" (gastrostomy) "tube used for gastric drainage." There was no documentation concerning assessment of and care to the PEG tube site, nor was there any documentation as to the description or presence/amount of drainage from the PEG tube. A skilled nursing note on 01/06/2022 documented the presence of a PEG tube under the Integumentary section of the nursing note. The narrative nursing note stated, "Patient still have PEG tube in place and is pending procedure to replace PEG tube to another side of her abdomen." There was no documentation regarding the PEG tube site nor PEG tube drainage. A skilled nursing note on 01/17/2022 contained documentation of the location of the PEG tube and a narrative note stated that a new PEG tube was placed for feeding purposes. There was no documentation concerning assessment of and care to the old or new PEG tube sites. A skilled nursing note on 01/20/2022 noted, under the Integumentary Section of the note that "wound cleansed with normal saline," and the narrative section of the note stated," assess the jejunostomy clean with normal saline and applied a split gauze to protect the skin from irritation of drainage fluid from the site." There was no mention of assessment, care or treatment to the old PEG tube site. A skilled nursing note on 01/26/2022 noted that "PEG tube care done by caregiver," and "jejunal tube to left upper abdomen." There was no documentation of an assessment of the current PEG tube site nor the former site. During eleven (11) home health visits, assessment, care and/or treatment to the PEG tube site(s) was either absent or inconsistent. An interview conducted on February 10, 2022 at approximately 2:15 PM with the administrator, alternate administrator, supervising registered nurse and alternate supervising registered nurse confirmed the above findings.

Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency's overall management and operation, the provision of all home health services, fiscal operations, review of the agency's budget and its operational plans, and its quality assessment and performance improvement program. This STANDARD is not met as evidenced by: Based on a review of the Pennsylvania Department of Health Event Reporting System, and an interview with the Vice President/Supervising Registered Nurse, the Governing Body failed to assume full responsibility for the agency's overall management and operation. The requirements were not met as it relates to sixteen (16) patients. Findings include: Per the Pennsylvania Department of Health Event Reporting System Manual, "...Purpose: To provide a system to enter events per 28 PA Code - 51.3 that is readily available to all appropriate PA-DOH [Pennsylvania Department of Health] facilities, a simple process to insure consistent data entry and submission, and a source for quick and meaningful feedback on event notification submissions...All facilities are required to submit notification of events as defined in 28 Pa Code Chapter 51 to the Department of Health within 24 hours of occurrence or discovery. The Electronic Event Reporting System [ERS] is the mechanism the Department will use to meet this regulatory requirement..." A review of the PA Department of Health Event Reporting System on February 7, 2022 at 1:00 PM, encompassing the time frame of February 1, 2021 to February 7, 2022, contained no evidence that the home health agency submitted reports to the Department of Health Event Reporting System regarding patients who tested positive for the Coronavirus (COVID-19 virus). A review of Home Health Agency’s Program Evaluation for 2021 took place on February 8, 2022 at approximately 12:30 PM. Page 9 of the Program Evaluation noted that there were “16 COVID-19 Infections,” and Page 10 noted that “Sixteen patients tested positive for COVID-19 under our care.” In an interview with the Home Health Agency’s Vice President/Supervising Registered Nurse conducted on February 10, 2022 at approximately 1:00 PM, she noted that the agency was not aware of the requirement to report COVID-19 positive patients, and she confirmed that no reports were entered into the PA Department of Health’s Event Reporting System for the sixteen patients who developed and tested positive for COVID-19 in 2021 while under the care of the Home Health Agency (HHA). The HHA began to enter the reports into the Event Reporting System on February 10, 2022 for the sixteen patients who developed and tested positive for COVID-19 in 2021 while under the care of the HHA. An interview conducted on February 10, 2022 at approximately 2:15 PM with the administrator, alternate administrator, supervising registered nurse and alternate supervising registered nurse confirmed the above findings.