Every finding on record at Intercare Home Health Services Inc

During the recertification survey conducted on 06/09/2025 to 06/11/2025 at Intercare Home Health Services Inc., Home Health Agency, Emergency Preparedness was reviewed. Intercare Home Health Services Inc is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

A recertification survey was conducted on 06/09/2025 to 06/11/2025 at Intercare Home Health Services, Inc. The Home Health Agency was in non-compliance with CFR 42 (Code of Federal Regulations) 484 Subpart A-C, Requirements for Home Health Agencies.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on observation and interview the Home Health Agency Staff B RN failed to be in accordance with current clinical practice to prevent a needle stick, by not using the scoop method on a counter surface to prevent a needle stick after giving an insulin injection with a pen needle. Findings Include: Home visit of Sample Patient (SP) #2 observed Staff B RN 06/10/2025 at 06:02pm completed giving SP #2 an insulin injection with a pen needle syringe, the nurse after used her gloved hands and unscrewed the pen needle from the syringe in open air and then put the pen needle into the sharp's container, she should have used the scoop method on a counter service to prevent a needle stick and use the cap of the pen needle to cover the needle and then remove it from the syringe. Interview with the Administrator/APRN after the incident she confirmed that this is not the standard of practice, but Staff B RN was nervous that AHCA (Agency for Health Care Administration) was watching her do her job.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the home health agency is unable to demonstrate a completed termination summary including the reason for admission to Home Health Care and the specific type of services, the frequency and duration of services at discharge for 2 out of 5 Sampled Patients (SP). SP #4 and SP #5. Findings Include: Closed record review of Sample Patient (SP) #4 and SP #5 were conducted on 06/09/2025 to 06/11/2025. The clinical record for SP #4 contained a discharge summary from the agency with a date of 03/20/2025: and SP #5 contained a discharge summary from the agency with a discharge date of 04/16/2025. The discharge summaries for SP #4 and SP#5 omitted information such as the reason for admission to home health care services and the specific type of service, frequency and duration of the services at the time of discharge. Interview conducted on 06/11/2025 with the Administrator and Office Manager at 11:15am, acknowledged the finding previously mentioned.

During the recertification survey on June 20, 2022 to June 23, 2022 at Intercare Home Health Services, Inc., a Home Health Agency, Emergency Preparedness was reviewed. Intercare Home Health Services, Inc. is not in compliance with Emergency Preparedness per Code of Federal Regulation (CFR) 42 Part 484.102, Condition of Participation for Home Health Agencies.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on record review and interviews, the Home Health Agency failed to demonstrate that an annual training on emergency preparedness was provided on 5 out of 10 Staff. Staff A, B, E, F, and J. Findings include: Reviewed Personnel files for the following Staff: Staff A hired on 12/6/2016; Staff B hired on 5/4/2020; Staff E hired on 1/23/2012; Staff F hired on 2/16/2021, and Staff J hired on 1/7/2021. The Home Health Agency was unable to demonstrate that these Staff attended the emergency preparedness training. On 6/21/2022 at 3:30 PM, the Administrator, the Director of Nursing, and the Office Manager acknowledged these findings. The Administrator acknowledged these findings again on 6/23/2022 at 11:30 AM.

A recertification survey was conducted on June 20, 2022 to June 23, 2022 at Intercare Home Health Services, Inc. The home health agency was not in compliance with 42 CFR 484 Subpart A-C, Requirements for Home Health Agencies.

Transfer and discharge CFR(s): 484.50(d) Standard: Transfer and discharge. The patient and representative (if any), have a right to be informed of the HHA's policies for transfer and discharge. The HHA may only transfer or discharge the patient from the HHA if: This STANDARD is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) was unable to demonstrate it has provided the patient and representative (if any) on the right to be informed of the HHA’s policies for transfer and discharge on 1 out of 10 sample patients. (SP # 9). Findings include: Record review of SP # 9 Service Authorization created on 3/9/3022 showed she is authorized for services type of homemaker/ companion care; start date 3/9/2022, end date 12/31/2022. Record review of the Home Health Aide Weekly record home visits showed CNA (Certified Nursing Assistant) went to provide services to the patient on 3/9/2022 and on 3/23/2022. Phone interview with SP # 9 on 6/21/2022 at 8:47 AM revealed the Aide came to her house to provide help twice.” “No, I was not transferred to another Home Health Agency.” Review of the HHA’s List of patient discharges from 1/1/2022 to 6/20/2022 revealed SP # 9 is on the discharge list. Reason for discharge blank. Review of Policy on Discharge and Transfer Showed: to establish the reason and notification of patient’s transfer or discharge from our Agency. On 6/21/2022 at 10:00 AM, the Office Coordinator was asked for any notes or documentations, she was unable to provide the surveyor any notes. Also, Office Coordinator was observed around that time notified the Case Manager of SP # 9 to send her copy of the notes. Review of the Patient contract of SP # 9 with the Insurance showed SP # 9 was discharged 4/1/2022. Reason: cancellation. This finding indicate the HHA did not demonstrate the final reason for transfer of discharge and notification of patient was documented. On 6/21/2022 at 3:30 PM, the Administrator, the Director of Nursing, and the Office Manager acknowledged these findings. The Administrator acknowledged these findings again on 6/23/2022 at 11:30 AM.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record reviews and interviews, the Home Health Agency failed to indicate what route should all the patient's medications identified be given on 1 out of 10 sample patients. SP # 10. Findings include: Clinical record review of SP # 10 showed his diagnosis as Flaccid Neuropathic Bladder; history of Parkinson’s disease. Has start of care since 2/24/2022 and is receiving skilled services. Clinical record review of SP # 10’s Medicine Schedule showed 13 (thirteen) medications were written on the list and the “route” by which the medications are to be given were omitted. Medicine Schedule showed at the top of the list what to write: the name of the medication to be given, doses, route, frequency. The Administrator stated on 6/23/2022 at 10:15 AM: “ I already told the nurse about these findings.” On 6/21/2022 at 3:30 PM, the Administrator, the Director of Nursing, and the Office Manager acknowledged these findings. The Administrator acknowledged these findings again on 6/23/2022 at 11:30 AM.

Infection control education CFR(s): 484.70(c) Standard: Education. The HHA must provide infection control education to staff, patients, and caregiver(s). This STANDARD is not met as evidenced by: Based on record reviews and interview, the Home Health Agency failed to provide infection control education to 5 out of 10 Staff. Staff A, B, D, E, and F. Findings include: Reviewed Personnel files for the following Staff: Staff A hired on 12/6/2016; Staff B hired on 5/4/2020; Staff D hired on 11/15/2021; Staff E hired on 1/23/2012; and Staff F hired on 2/16/2021. The Home Health Agency was unable to demonstrate that these Staff attended the annual Infection Control training. On 6/21/2022 at 3:30 PM, the Administrator, the Director of Nursing, and the Office Manager acknowledged these findings. The Administrator acknowledged these findings again on 6/23/2022 at 11:30 AM.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record reviews and interviews, the Home Health Agency failed to include as part of their comprehensive assessment, the route of all the identified medications for which the patient must take his or her medications on 1 out of 10 sample patients. SP # 10. Findings include: Clinical record review of SP # 10 showed his diagnosis as Flaccid Neuropathic Bladder; history of Parkinson’s disease. Has start of care since 2/24/2022 and is receiving skilled services. Clinical record review of SP # 10’s Medicine Schedule showed 13 (thirteen) medications were written on the list and the “route” by which the medications are to be given were omitted. Medicine Schedule showed at the top of the list what to write: the name of the medication to be given, doses, route, frequency. The Administrator stated on 6/23/2022 at 10:15 AM: “ I already told the nurse about these findings.” On 6/21/2022 at 3:30 PM, the Administrator, the Director of Nursing, and the Office Manager acknowledged these findings. The Administrator acknowledged these findings again on 6/23/2022 at 11:30 AM.