Every finding on record at Lhcg Ccxxiv LLC

A re-certification survey of HomeCall was conducted March 26 - April 7, 2025. After reviewing the agency’s emergency preparedness program, plan, and policies and procedures, the agency was found to comply with all Conditions of Participation and related standards found at 42 CFR (Code of Federal Regulations) Part 484.102.

A re-certification survey was completed at HomeCall located in Baltimore, Maryland, on March 26 - April 7, 2025. The survey included the request for administrative records and documentation. Interviews were conducted with patients, staff, the agency's administrator, and the clinical manager. Four home visits were conducted in conjunction with the two skilled nurses, two physical therapists, and the executive director. A total of 17 clinical records were randomly selected and reviewed during the survey. This represented the scope of services as follows: Skilled Nursing Services - 14 Home Health Aide - 4 Physical Therapy Services - 15 Occupational Therapy Services – 11 Nutrition Therapy – 2 Speech Therapy – 2 Medical Social Worker – 3 The findings in this report were based on all document reviews and interviews with the administrative staff. The agency's administrative staff was kept informed of the survey findings as the survey progressed. The exit conference was conducted with the administrative staff on April 7, 2025. The following requirements of 42 CFR Part 484 Home Health Regulations were NOT met.

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 records reviewed from April 1, 2024, to March 26, 2025, the agency failed to ensure timely submission of OASIS assessments to the CMS system. The findings include: A review of the agency’s Error Report 3330 revealed that 42 OASIS assessments were submitted late, exceeding the 30-day submission requirement.

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 medical records, the agency's administration failed to ensure that an assessment of the patient by nursing or rehabilitation therapy occurs within 48 hours of referral for 9 out of 17 patients. The agency not performing assessments timely placed the patients at risk for delays in care and adverse health care outcomes. Patients: #2, #5, #7, #8, #9, #10, #11, #12, #13 Findings include: 1. On 4/7/2025, a review of a patient #2 medical record revealed the referral date as 1/8/2025. The patient's start of care (SOC) was 1/13/2025. There was no documentary evidence to support that the physician ordered the SOC. The 1/10/25 intake note indicates the physician is agreeable to 1/13/25 SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 2. On 4/7/2025, a review of a patient #13 medical record revealed the referral date as 10/8/2024. The patient's SOC was 10/14/2024. There was no documentary evidence to support that the physician ordered this SOC. The 10/11/24 intake note indicates the physician is agreeable to the 10/14/24 SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 3. On 4/7/2025, a review of patient #12's medical record revealed the referral date as 2/13/2025. The patient's SOC was 2/19/2025. There was no documentary evidence to support that the physician ordered this SOC. The 2/18/2025 coordination note indicates the patient is agreeable to the 2/19/2025 SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 4. On 4/7/2025, a review of patient #11's medical record revealed the referral date as 2/19/2025. The patient's SOC was 2/26/2025. The 2/20/25 coordination note indicates a verbal order was received from the patient's physician for a 2/21/25 SOC. 5. On 4/7/2025, a review of a patient #10 medical record revealed the referral date as 10/24/2024. The patient's SOC was 10/28/2024. The 10/25/2025 intake note indicates that the physician is agreeable to 10/28/2024 to SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 6. On 4/7/2025, a review of a patient #9 medical record revealed the referral date as 10/30/2024. The patient's SOC was 11/4/2024. The 11/1/2024 intake note indicates that the physician is agreeable to 11/4/2024 to SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 7. On 4/7/2025, a review of patient #8's medical record revealed the referral date as 9/5/2024. The patient's SOC was 9/9/2024. The 9/6/2024 intake note indicates that the physician is agreeable to 9/7/2024 but then agreeable to the 9/9/2024 SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 8. On 4/7/2025, a review of patient #7's medical record revealed the referral date as 2/3/2025. The patient's SOC was 2/8/2025. The 2/7/2025 intake note indicates that the physician is agreeable to the 2/8/2025 SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. 9. On 4/7/2025, a review of a patient #5 medical record revealed the referral date as 3/10/2025. The patient's start of care (SOC) was 3/20/2025. There was no documentary evidence to support that the physician ordered this SOC. The 3/19/25 intake note indicates the physician is agreeable to 3/20/25 SOC. There is no way to recognize if the agency requested the SOC based on the agency's availability; this should not occur. Initial assessments must occur within 48 hours of referral, a patient's return home, or the physician-ordered start of care date. An agency shall not request a change of the start of care to accommodate the agency's convenience. Delays in care are a repeat deficient practice from the agency's 2021 re-certification survey.

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 medical record reviews, the agency's staff failed to complete the patient's visit frequencies as ordered in the plan of care (POC). The missed visits were undocumented, or the patient's physician was not notified of the missed visit. This occurred for 6 out of 17 records reviewed. Missed visits and the lack of notification to the patient's physician placed patients at risk for not meeting outcome goals and risk for delays in appropriate treatments and care. Patients: #1, #3, #4, #6, #7, #13 Findings include: 1. On 4/7/2025, review of patient #1medical record revealed on 3/15/2025 and 3/21/2025 the patient had missed visits for skilled nursing services. No documentary evidence shows the patient's physician was notified of the missed visits. 2. On 4/7/2025, a review of patient #3 medical record revealed on the week of 3/16/2025 of patient's care that no skilled nursing visit occurred to follow the 1w9w ordered visit frequency. Nor is there a missed note to indicate why the visit did not occur or that the patient's physician was notified of the missed visit. 3. On 4/7/2025, a review of patient #4 medical record revealed a home health aide (HHA) visit frequency for 2wk4 effective 3/23/2025. There is no evidence to support any aide visits occurred, and no missed notes indicating why the visits did not happen. During an interview with the agency's Executive Director, it was found the agency had no full-time equivalent (FTE) aide. The current HHA works prn (as-needed basis). 4. On 4/7/2025, a review of patient #6 medical record revealed that a skilled nurse (SN) missed visits on 8/8 & 8/9/2024 for caregiver/patient refused does not show that notification to the patient's physician of the missed visits. 5. On 4/7/2025, a review of patient #7's medical record revealed HHA services ordered for 2wk3 and 1wk3 effective 2/9/2025. No HHA visit occurred during the week of 2/9/2025, and there was no missed visit note to indicate why the visit did not happen. 6. On 4/7/2025, a review of patient #13 medical record revealed SN services ordered 2wk1, 1wk5, and 2 PRN. During week 1, only one SN visit occurred with no missed note indicating why the 2nd visit did not occur. To ensure the patient's needs are still met, the physician should be notified of missed visits, and the agency should attempt to reschedule them.

Aides are members of interdisciplinary team CFR(s): 484.80(g)(4) Home health aides must be members of the interdisciplinary team, must report changes in the patient's condition to a registered nurse or other appropriate skilled professional, and must complete appropriate records in compliance with the HHA's policies and procedures. This ELEMENT is not met as evidenced by: Home health aides are members of the interdisciplinary team. They must report changes in the patient's condition to a registered nurse or other appropriate skilled professional and complete appropriate records required by the HHA. Failure to comply with regulations places patients at risk for inadequate health care. During interdisciplinary team meetings, all HHA staff involved in the patient's care must be present and, where appropriate, should contribute to any discussion regarding the patient's care. This did not occur. Findings include: 1. On 3/26/2025, a review of the agency's interdisciplinary team meeting (case conference attendance records), records for the past 2 months included meetings on 2/5, 2/12, 2/19, 2/26, 3/5, 3/12, 3/19, 3/26/2025 revealed no HHA in attendance at the meetings. 2. The agency's executive director confirmed during an interview that aides do not currently participate in the interdisciplinary team meeting.

A standard home health agency re-certification survey was conducted at Homecall, Inc in Baltimore, Maryland on May 12 - 13, 2021. The survey included the following: a review of clinical records; a review of the complaint/incident reports; a review of on-call documentation; a review of admission documentation including patient bill of rights; a review of personnel files including professional licenses and expiration dates; a review of Quality Assurance Project Plan and Reports (QAPI) & Potentially Avoidable Event Report; a review of the organizational chart; a review of the CLIA waiver, and interviews with the agency's administrative staff. The agency's emergency preparedness program and plan were reviewed. A total of fifteen randomly selected patient records were reviewed during the survey. The scope of services included the following: Skilled Nursing Services - Six Physical Therapy Services - Twelve Occupational Therapy Services - Eight Medical Social Worker - 0 Home Health Aide Services - 0 Other Services - One No home visit observations were conducted during the survey. Findings in this report were based on data present in the clinical records at the time of the reviews. The agency's administrative and clinical staff were kept informed of the survey findings as the survey progressed. The agency's staff were given the opportunity to present information relative to the findings during the course of the survey. The exit conference was conducted with agency personnel on May 13, 2021. The findings of the Medicare re-certification survey were reviewed; a patient identification key-code was provided to the agency's administrator.

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 medical records, the agency's administration failed to ensure that an assessment of the patient by nursing or rehabilitation therapy occurs within 48 hours of referral for 4 out of 15 patients. The agency not performing assessments timely placed the patients' at risk for delays in care and adverse health care outcomes. Patients: #1, #4, #8 and #15 The findings include: 1. On 5/12/2021, a review of Patient #1 medical record showed the referral date as 12/22/2020. The patient's start of care (SOC) was 12/30/2020. There was no documentary evidence to support that a physician ordered a change to the SOC. On 5/12/2021, the agency's administrative staff was allowed to provide additional information related to this finding. On 5/13/2021, during a review of the new information provided by the agency's administrative staff, the surveyor identified that an update was subsequently made to this patient's medical record on 5/12/2021. The fields showing updated were physician ordered soc/roc date and updated referral date. 2. On 5/12/2021, a review of Patient #4 medical record showed the referral date as 2/6/2021. The patient's SOC was 2/10/2021. There was no documentary evidence to support that a physician ordered a change to the SOC. On 5/12/2021, the agency's administrative staff was allowed to provide additional information related to this finding. On 5/13/2021, during a review of the new information provided by the agency's administrative staff, the surveyor identified that an update was subsequently made to this patient's medical record on 5/12/2021. The fields showing updated were physician ordered soc/roc date and updated referral date. 3. On 5/12/2021, a review of Patient #8 medical record showed the referral date as 12/10/2020. The patient's start of care (SOC) was 12/18/2020. There was no documentary evidence to support that a physician ordered a change to the SOC. On 5/12/2021, the agency's administrative staff was allowed to provide additional information related to this finding. On 5/13/2021, during a review of the new information provided by the agency's administrative staff, the surveyor identified that an update was subsequently made to this patient's medical record on 5/12/2021. The fields showing updated were physician ordered soc/roc date and updated referral date. 4. On 5/12/2021, a review of Patient #15 medical record showed the referral date as 3/11/2021. The patient's start of care (SOC) was 3/20/2021. There was no documentary evidence to support that a physician ordered a change to the SOC. On 5/12/2021, the agency's administrative staff was allowed to provide additional information related to this finding. On 5/13/2021, during a review of the new information provided by the agency's administrative staff, the surveyor identified that an update was subsequently made to this patient's medical record on 5/12/2021. The fields showing updated were physician ordered soc/roc date and updated referral date. 5. On 5/13/2021, during the exit, the surveyor discussed with the agency administrative staff that a request for additional information is to give an opportunity to provide existing information from the medical record that the surveyor may have overlooked. It is not to go back to make changes or updates. Any necessary updates or corrections should occur following the completion of the survey. Initial assessments must occur within 48 hours of referral, a patient's return home, or the physician-ordered start of care date. An agency shall not request a change of the start of care to accommodate the agency's convenience.

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 a review of medical records, the agency's staff failed to complete discharge visits/summary for 3 out of 15 of its patients. Discharge visit/summary not being completed placed the agency's patients at risk of receiving inappropriate or unnecessary continued care and, therefore, at risk for adverse health outcomes. Patients: #13, #14, and #15 The findings include: 1. On 5/12/2021, a review of the medical record for patients #13, #14, and #15 revealed no documentary evidence of discharge visit/summary. 1. On 5/12/2021 at 2 PM, during an interview, the agency's administrative staff acknowledged recently becoming aware of an issue with discharges. Discharge summaries include details about the care a patient has received from a provider. They are a helpful tool that may improve patient outcomes by providing details for continuous care, coordination of care, and transition to other providers and care settings.