Every finding on record at Inspired Homecare of Maryland, LLC

A recertification survey of Inspired Homecare was conducted on April 29 - May 2, 2025. After the review of the agency's emergency preparedness program, the agency was found to be in compliance with Conditions of Participation found at 42 CFR (Code of Federal Regulations) Part 484.102.

A recertification survey was completed at Inspired HomeCare of Maryland, located in Baltimore, Maryland, on April 29 - May 2, 2025, to determine if the agency was in compliance with federal requirements for home health agencies. The survey included a review of administrative records and patient documentation. Interviews were conducted with the agency's administrator. One home visit was conducted with the Registered Nurse. A total of 7 clinical records were reviewed during the survey. This represented the scope of services as follows: Skilled Nursing Services - 5 Home Health Aide - 0 Physical Therapy Services - 3 Occupational Therapy Services - 1 Social Work - 0 Speech Therapist - 0 The following requirements of 42 CFR Part 484 were not met. Note: Due to Federal Government Shutdown that lasted from 10/01/2025 to 11/12/2025, the exit date of survey was adjusted on this document pursuant to guidance provided by Centers for Medicare and Medicaid Services in QSO-26-02-ALL.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on review of the administrative records, it was determined that the agency failed to ensure the timely submission of OASIS assessments to the CMS system. This failure may affect the accuracy of patient data, impact regulatory compliance, and compromise the effectiveness of patient care planning for all agency patients. The findings include: A review of administrative records on 4/29/2025 revealed the agency’s Error Report 3330 from 01/01/2024 to 12/31/2024 documented that 8 OASIS assessments were submitted late, failing to meet the required 30-day submission deadline.

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 a review of clinical documentation, the agency did not initiate home health services within 48 hours of referral or on the physician-ordered start date, as required, for 3 out of 7 patients reviewed. Failure to ensure timely start of care has the potential of negatively impacting patient outcomes. Patients impacted: Patient #1, 5, 7 The findings include: A review of medical records on 5/2/25 revealed that multiple patients had a start of care exceeding 48 hours from the referral date or physician-ordered start date, as outlined below. a) Patient #1: Referral date 02/26/25, start of care 03/24/25 b) Patient #5: Referral date 02/21/2023, start of care 03/14/2023 c) Patient #7: Referral date 11/16/2023, start of care 11/22/2023 There was no documentation explaining the reason for the delays or any communication with the referring provider to justify changes in the start of care date.

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 the review of 7 clinical records, it was determined that the agency failed to ensure that services were provided in accordance with the physician-ordered plan of care for 4 out of 7 patients reviewed. Patients # 3, 4, 5, and 7 experienced missed therapy and nursing visits, failure to notify the physician when pain levels exceeded ordered parameters, and lack of required wound measurements to evaluate wound healing. These deficiencies placed patients at risk for unmanaged symptoms, lack of clinical oversight, and interrupted or ineffective treatment. Patient # 3 The findings include: 1) A review of clinical records revealed that the plan of care included the instruction: “A licensed professional to report vital signs falling outside the following established parameters where pain is listed as greater than 3 to be reported to the physician.” Pain scores were documented as follows: July 15 (4), July 17 (4), July 19 (5), July 22 (6), July 24 (6), July 26 (5), July 30 (6), August 2 (7), August 5 (5), and August 10 (7). There was no documentation that the physician was notified of the elevated and persistent pain levels as outlined in the plan of care. Upon discharge on 09/06/2024, the patient was noted to have bilateral knee pain described as sharp and rated 8/10, along with consistent right ankle pain also rated at 8/10. Patient #4 1) A review of clinical records on 05/02/2025 revealed that the plan of care included the goal: “Patient will demonstrate improved decubitus ulcer status as evidenced by decrease in size/drainage of wound, absence of infection, and decreased pain as a result of skilled interventions by 09/05/2024.” However, documentation from skilled nursing visits did not include any wound measurements during care, as required to monitor the goal’s progress. Patient #5 1) A review of clinical documentation from 03/29/2023 revealed that the physician ordered physical therapy at a frequency of three times per week for five weeks. During the week of 03/30/2023, only one physical therapy assistant (PTA) visit was conducted; two visits were missed.During the week of 04/06/2023, one PTA visit was conducted; two visits were missed.During the week of 04/13/2023, two PTA visits were conducted; one visit was missed.Patient #7 The findings include: 1) A physician order for skilled nursing services at a frequency of one visit every three weeks for a duration of three weeks (1q3w3) was not implemented. No skilled nursing visits were documented during this period. 2) A review of the plan of care dated 11/26/2023 revealed that physical therapy was ordered in the following sequence: one visit for one week (1w1), two visits for one week (2w1), and one visit per week for five weeks (1w5). A PTA visit was missed during the week of 11/26/2023.A PTA visit was missed for the weeks of 01/01/2024 and 01/08/2024 during the 1w5 frequency phase.3) Occupational therapy was ordered on 12/24/2023 at a frequency of one visit per week for one week. A missed OT visit was documented for the week of 01/15/2024.

Infection prevention and control CFR(s): 484.70 Condition of Participation: Infection prevention and control. The HHA must maintain and document an infection control program which has as its goal the prevention and control of infections and communicable diseases. This CONDITION is not met as evidenced by: Based on review of the agency's policies and procedures, personnel files, and other pertinent documentation, and observations of care, it was determined that the agency failed to establish and implement a comprehensive infection control program to identify, prevent, control, and investigate infections and communicable diseases. This failure resulted in inadequate infection prevention staff practices and placed all agency patients and staff at increased risk of healthcare-associated infections. The absence of these critical components indicates non-compliance with the requirements for a comprehensive infection control program and resulted in a finding of the agency being out of compliance with the Condition of Participation for Infection Control. The findings include: A review of administrative records on 4/30/2025 revealed that the HHA did not have documented procedures for the surveillance and identification of infectious and communicable disease problems. Additionally, there was no evidence of preventative measures or control protocols being implemented. Cross -reference to tag G-0684.Observations of care determined that HHA nursing staff did not follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. Cross-reference to tag G-0682.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on review of personnel files, it was determined that 1) the agency failed to maintain current documentation related to hepatitis B vaccination status or declinations as part of its infection control program for 3 out of 4 personnel reviewed; and 2) the agency failed to ensure that its staff adhered to accepted standards of practice related to infection control when providing care to Patient #1. This failure limited the agency’s ability to assess and mitigate communicable disease risks, potentially compromising patient and staff safety, and increased the risk of health care associated infections to patients and staff. Staff impacted: Home Health Aide #1, RN #2, and RN #3. The findings include: 1) A review of personnel records on 04/30/2025 revealed the following deficiencies: Home Health Aide #1 did not have a completed hepatitis B declination form on file since 2014. RN #2 did not have a completed hepatitis B declination form on file since 2022. RN #3 did not have a completed hepatitis B declination form on file since 2023. 2) During a home visit observation on 4/30/2025 with Patient #1, the registered nurse placed vital sign equipment on newspapers covering the patient’s chair without using a designated clean or dirty field. After completing the assessment, RN #1 placed the used equipment on top of her home health bag, wiped each item with alcohol wipes, and set them on the side of the bag. The equipment was then pushed inside the bag, making contact with the top surface that had been previously contaminated by the dirty equipment, resulting in recontamination and failure to maintain separation between clean and dirty supplies.

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 the review of the agency's administrative records, it was determined that the agency failed to develop, implement and maintain a comprehensive infection control program, which includes coordinated surveillance, identification, prevention, and control measures for infectious and communicable diseases as part of the HHA’s QAPI program. This deficiency results in inadequate infection control practices and an increased risk of infectious disease spread for the agency's patients and staff. The findings include: A review of administrative records on 4/30/2025 revealed that the HHA did not have a method for identifying infectious and communicable disease problems. There were no documented procedures for surveillance, identification, prevention, control, or investigation of infectious diseases. The absence of these critical components indicates non-compliance with the requirements for a comprehensive infection control program as part of the HHA’s QAPI program.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on review of 4 personnel records, it was determined that the agency failed to ensure that a registered nurse (RN #3) completed an annual skills evaluation to verify continued competency. The lack of a documented evaluation limits the agency’s ability to ensure the nurse maintains the necessary skills to deliver safe and effective care. The findings include: A review of personnel records on 04/30/2025 revealed that RN #3 did not have documentation of a completed skills evaluation for calendar year 2024.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on observations of care on 04/30/25, it was determined that the agency failed to ensure that a registered nurse followed proper infection control protocols during the handling and storage of patient care equipment, which created a risk of cross-contamination and compromised patient safety for Patient #1. The findings include: During a home visit observation on 4/30/2025 with Patient #1, the registered nurse placed vital sign equipment on newspapers covering the patient’s chair without using a designated clean or dirty field. After completing the assessment, RN #1 placed the used equipment on top of her home health bag, wiped each item with alcohol wipes, and set them on the side of the bag. The equipment was then pushed inside the bag, making contact with the top surface that had been previously contaminated by the dirty equipment, resulting in recontamination and failure to maintain separation between clean and dirty supplies.