Every finding on record at Intrinsic, Inc

Based on the findings of an onsite unannounced Medicare recertification survey completed June 4, 2025, Intrinsic, Inc. 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 onsite unannounced Medicare recertification survey completed June 4, 2025, Intrinsic, Inc. 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.

Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA's services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This STANDARD is not met as evidenced by: Based on review of agency policy, documentation, and staff (EMP) interview, the agency failed to conduct distinct performance improvement projects annually that reflected the scope, complexity, and past performance of the HHA's services and operations, and failed to document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects for the years 2022, 2023, and 2024. Review of agency policy on June 4, 2025, at 10 a.m. showed, "QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PLAN (QAPI) Intrinsic, Inc. shall establish a Quality Assurance and Performance Improvement plan to continuously measure, assess, and improve the performance of clinical and other processes. This plan will be based on the organization's mission and goals and designed to improve client outcomes and the perceptions of clients/families about the quality and value of services. ... PURPOSE ... To identify areas for improvement in the quality of care, treatment and services. To improve client and agency outcomes through a coordinated collaborative approach to assessing and improving organizational performance. To evaluate all areas of concern and implement plans to resolve the issues. OBJECTIVE OF THE PROGRAM To assess and evaluate the quality and appropriateness of client care services provided, and satisfaction of clients and families. ... To identify deviations from agency and professional standards and pursue improvement opportunities by assessment, planning and evaluation. To identify, address, track and resolve problems in client care services and satisfaction to insure resolution and/or improvement. ... To support the organization's process improvement through data collection and outcome measurement in compliance with OASIS Data Collection required by CMS. To reduce factors that may contribute to unanticipated adverse events and/or outcomes ... 1. The development of a performance improvement plan will be guided by the mission, vision and strategic goals of the organization. Additional activities for performance improvement will be prioritized by the agency's management team. Program will reflect participation by all services and levels of staff; and will Subscribe to compliance with internal and external standards including the Medicare Conditions of Participation and JCAHO/CHAP/ACHC performance improvement standards. 2. Data will be collected to allow the agency to monitor its performance. Data collection will be prioritized based on the organization's mission, care services provided, and populations served. Data that may be used for data collection include the following: a) Staff perception of risks to individuals and suggestions for improving safety for clients. b) Utilization of services. c) Staff opinion and needs. d) Adverse events/outcomes of processes or services, e) Infection control surveillance and reporting. f) The needs, expectations and satisfaction of individuals and organizations served. g) Perceptions of care, treatment and services including: How well the agency meets these needs and expectations. How the organization can enhance client safety and improve outcomes. Effectiveness of programs in responding to specific concerns such as pain management and medication management. i) Client diagnosis and demographics. j) Environmental conditions of the organization or clients. 3. The activities will meet the needs of clients, Staff and others and will unite new and existing improvement activities into the agency's system wide approach. 4. Data will be systematically collected to measure process and outcome. 5. Data will be assessed to: a) Identify current level of performance. b) Evaluate the stability of the processes. c) Identify effectiveness of communication systems. d) Identify areas to be improved. e) Identify strategies to stabilize or improve processes. f) Evaluate whether outcomes were achieved. 6. This process will encourage the following behaviors/activities: a) Recognizing and acknowledging the risks and anticipated adverse events/outcomes. b) Initiating actions to reduce risks and outcome. c) Reporting internally on risk reduction initiatives and their effectiveness. d) Minimizing blame or retribution for involvement in an unanticipated adverse event/outcome. e) Investigating factors that contribute to unanticipated adverse events. f) Sharing knowledge within the organization and with other organizations. 7. Intensive assessment will be completed when undesirable patterns or trends in performance are detected or important sentinel events are identified. 8. The plan will target the performance of existing processes and outcomes and identify/design new processes based on priorities, standards and resources. ... 11. Information is communicated to all departments when they are impacted by Performance Improvement activities or findings that may affect the agency and its goal of providing quality care in an efficient and effective manner. 12. Performance improvement activities, minutes, reports, correspondence are considered to be confidential and privileged. Some information may be disseminated on a "need to know" basis as required to meet regulatory requirements and other review organizations. This would be approved by the Administrator/Governing Body. 13. The QAPI Plan is evaluated at least annually and is incorporated into the annual agency evaluation required by CMS." Review of agency documentation with EMP1 (administrator) on June 4, 2025, at 11 a.m. revealed "INTRINSIC, INC QUARTERLY CLINICAL RECORD REVIEW AND QUALITY ASSURANCE REVIEW" for 2024, 2023, and 2022. The statistical data showed agency had identified problems with clinical and agency quality indicators to include patient falls, infections, a decrease in referrals, staffing issues, and a chronically low census. Specifically, the agency recorded patient falls for the 1st, 2nd, and 3rd quarters of 2024; UTIs (urinary tract infections) for the 1st, 2nd, 3rd quarters and five (5) falls during the 4th quarter of 2023; UTIs for the 1st, and 2nd (13 this quarter alone) quarters of 2022; and falls for the 1st (9 falls), 2nd (3 falls), 3rd (13 falls), and 4th (8 falls) quarters of 2022. Further review of agency documentation on June 4, 2025, at 12 p.m. did not show agency developed distinct performance improvement projects concerning problems identified during quarterly meetings to include falls, infections, low census, low referrals, and staffing. An interview with EMP1 at the time of review confirmed above findings.

Based on the findings of an onsite unannounced Medicare recertification survey completed May 16, 2022, Intrinsic, Inc. 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.

800x600 Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 st1\:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman",serif;} Based on the findings of an onsite unannounced Medicare recertification survey completed May 16, 2022, Intrinsic, Inc. 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.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on observation, review of agency policy and procedure, clinical records (CR), and staff (EMP) interview, the agency failed to promptly notify the physician to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered for two (2) of five (5) active clinical records reviewed (CR2 & CR5). Findings included: Review of agency policy on May 22, 2022, at 11 a.m. showed: "PLAN OF CARE ... SPECIAL INSTRUCTIONS ... 8. The total plan of care shall be reviewed by the attending physician and agency personnel as often as the severity of the client's condition requires, ... 9. Professional staff shall promptly alert the physician to any changes that suggest a need to alter the plan of care. MEDICAL SUPERVISION ... 4. Physician will be contacted when any of the following occurs: a. Condition changes. ... e. Any changes in client condition ... 12. Agency responsibilities include: a. prompt reporting of a change in client condition." Review of CR2 on May 10, 2022, at 1:30 p.m. showed a home health plan of care with a start of care date of 5/23/2021 and a recertification period of 3/19/2022 to 5/17/2022. Diagnoses included atrial fibrillation, and heart failure. During a home visit on 5/11/2022 at 10:05 a.m. the patient (CR2) noted that she fell the previous day. Review of occupational therapy visit note from the 5/11/2022 visit showed, "PATIENT STATES SHE FELL YESTERDAY MORNING AT END OF BED. STAFF VERIFIED." Review of fall log on May 12, 2022, at 10:30 a.m. at agency office showed CR2 suffered another fall earlier in the month, "FALLS ... 5/6 [2022] [CR2] 0 [no] injury." Interview with EMP1 on May 12, 2022, at 10:52 a.m. confirmed agency did not notify CR2's attending physician concerning the above falls. EMP1 noted that the personal care home informed agency about 5/6/2022 fall. Interview with EMP2 (OT) on May 12, 2022, at 11 a.m. confirmed he/she did not notify CR2's attending physician about the 5/11/2022 fall, "the [personal care] home does it." Review of CR3 on May 10, 2022, at 1:30 p.m. and again on May 12, 2022, at 10:06 a.m. with EMP1, showed a home health plan of care with a start of care date of 4/29/2022 for an initial certification period ending 6/27/2022. Review of skilled nursing note from 5/6/2022 showed, "JOINT VISIT WITH P.T. [physical therapist] MADE DUE TO [CR3] HAVING EPISODE OF DIZZINESS AND SYNCOPE [fainting or passing out] DURING O.T. VISIT YESTERDAY." Review of OT visit from "YESTERDAY" 5/6/2022 revealed "attempted truck transfer, ... patient experienced quick onset of dizziness, difficulty breathing and light headedness requiring us to get him a chair and instructed on slow deep breaths. 'i feel like I am going to pass out' ... SN/PT notified of episode following treatment. patient has appt with orthopedic dr [doctor] on monday." Review of physical therapy note for CR3 from 5/10/2022 showed, "Upon finishing standing [exercises], pt stated that he was lightheaded. ... PT phoned RN [EMP1] about findings and it was decided that the pt should go to the ER. Pt asked if he could try to make appt with his cardiologist tomorrow but PT insisted that he go to the ER. The pt and wife agreed, and PT assisted the pt and his wife in getting him into the car." Interview with EMP1 on May 12, 2022, at 10:09 a.m. confirmed pt went to ER on 5/10/2022, and that attending physician was not notified of above changes in the patient's condition or ER visit.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CR), and staff (EMP) interviews, skilled professional services failed to assume responsibility of the patient and conduct ongoing an assessment of the patient for four (4) of five (5) clinical records reviewed receiving occupational therapy (OT) service (CR2, CR3, CR5, & CR7). The occupational therapist performed initial evaluations and treated patients without completing a full assessment of the patient to include a blood pressure when a patient was symptomatic. Findings included: Review of agency policy on May 12, 2022, at 11 a.m. showed: "POSITION: OCCUPATIONAL THERAPIST ... ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY ... 1. Performs occupational therapy assessments, diagnostic test, skilled treatments, and ongoing evaluation of clients who are receiving services under a medically approved plan of care. ... PURPOSE ... To identify needs to modify the plan of care. To evaluate the adequacy of treatment and the effect of services provided. COORDINATION OF PATIENT SERVICES POLICY ... All personnel furnishing services shall maintain liaison to assure that their efforts are coordinated effectively and support the objectives outlined in the plan of care. This may be done through formal care conferences; maintaining complete, current plans of care; and written and verbal intertercation. ... To provide the attending physician with an ongoing assessment of the client and identify the patient's response to services provided." Review of CR2 on May 10, 2022, at 1:30 p.m. showed a home health plan of care with a start of care date of 5/23/2021 and a recertification period of 3/19/2022 to 5/17/2022. Diagnoses included atrial fibrillation, and heart failure. The occupational therapist performed an initial evaluation and treatment of the patient on 4/18/2022 and treated the patient during subsequent visits on 4/20, 4/25, 4/27, 5/2, and 5/4/2022. The OT failed to obtain the patient's blood pressure during the entire episode. Review of CR3 on May 10, 2022, at 1:30 p.m. showed a home health plan of care with a start of care date of 4/29/2022 for an initial certification period ending 6/27/2022. The occupational therapist performed an initial evaluation and treatment of the patient on 5/2/2022 but failed to obtain the patient's blood pressure. Review of skilled nursing note from 5/6/2022 showed, "JOINT VISIT WITH P.T. [physical therapist] MADE DUE TO [CR3] HAVING EPISODE OF DIZZINESS AND SYNCOPE [fainting or passing out] DURING O.T. VISIT YESTERDAY." Review of OT visit from "YESTERDAY" 5/6/2022 revealed the OT failed to obtain the patient's blood pressure but the OT did document, "attempted truck transfer, ... patient experienced quick onset of dizziness, difficulty breathing and light headedness requiring us to get him a chair and instructed on slow deep breaths. 'i feel like I am going to pass out' ... SN/PT notified of episode following treatment. patient has appt with orthopedic dr on monday." Review of CR5 on May 10, 2022, at 2:45 p.m. showed a home health plan of care with a start of care date of 2/1/2022 with a recertification period of 4/2/2022 to 5/31/2022. Diagnosis included atrial fibrillation. CR5 only received occupational therapy services during the episode with SN completing the initial comprehensive assessment on 2/1/2022. The occupational therapist treated the patient on the following days without obtaining the patient's blood pressure: 3/14, 3/17, 3/21, 3/23, 3/30, 4/6, 4/7, 4/11, 4/13, 4/18, 4/20, 4/26, 4/27, 5/4, and 5/5/2022. The OT also completed a "Re-Evaluation" of the patient on 5/4/2022 but failed to obtain the patient's blood pressure. Review of CR7 on May 11, 2022, at 3:30 p.m. showed a home health plan of care with a start of care date of 2/17/2022 with an initial certification period ending 4/17/2022. Diagnosis included heart failure. The occupational therapist treated the patient on the following days without obtaining the patient's blood pressure: 2/28, 3/16, 4/7, and 4/11/2022. Interview with EMP1 on May 12, 2022, at 12 p.m. confirmed above findings.

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 review of policy, observations during home visits and staff (EMP) interview, the agency failed to ensure skilled professionals followed accepted standards of practice for two (2) of three (3) home visits (HV1 & HV2). Findings include: Review of "Bag Technique Procedure" on May 12, 2022, at 10:03 a.m., "Objectives ... Prevent contamination of the healthcare bag. Protect patients, family members, and healthcare workers from the spread of infection. ... 10. Remove any items needed for patient care, ... 11. Close bag before performing patient care. 12. Wash hands again if you need to re-enter the bag for additional supplies during patient care." Review of "HAND WASHING/HAND HYGIENE" policy on May 12, 2022, at 10:05 a.m. showed, "3. Indications for hand washing and hand antisepsis: ... f. after removing gloves." Observation during home visit with EMP2 (occupational therapist) on May 11, 2022, at 10:05 a.m. revealed EMP2 open supply bag and remove equipment. EMP2 used thermometer and pulse oximeter on patient and wiped with disinfectant wipe when finished. EMP2 then used blood pressure cuff and stethoscope on patient, completed his/her assessment, and placed equipment down when finished. EMP2 donned gloves and touched patient during treatment. When finished with treatment, EMP2 removed gloves and wiped hands with disinfectant wipe. EMP2 then wiped equipment and placed back inside open supply bag one at a time, without allowing items to dry, and without performing hand hygiene. Supply bag remained open during entire visit. Review of disinfectant wipe used by EMP2 to wipe his/her hands showed, "Sani-Cloth ... NOT A SKIN WIPE FOR USE ON HANDS NON POROUS SURFACES ONLY. ... Directions for use ... Allow treated surfaces to remain wet for a full two (2) minutes." Interview with EMP2 on May 11, 2022, at 10:37 a.m. confirmed above findings. Observation during home visit with EMP1 (registered nurse) on May 11, 2022, at 11:45 a.m. revealed EMP1 open supply bag and remove equipment needed for patient care but the bag remained open for the entire visit. While providing patient care, EMP1 donned gloves and assessed the patient. Once finished, EMP1 removed gloves, did not perform hand hygiene, and wrote in notebook with pen. EMP1 donned another set of gloves and continued assessing the patient using his/her stethoscope. When done with remaining assessment, EMP1 wiped his/her stethoscope with a disinfectant wipe, placed down, removed his/her gloves, and without performing hand hygiene returned equipment to his/her open bag, and then continued writing in notebook as he/she talked to the patient. Interview with EMP1 on May 11, 2022, at 12:15 p.m. confirmed he/she failed to close his/her bag during patient care but disagreed with surveyor findings concerning hand hygiene after glove removal.