Every finding on record at Livinrite Inc

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the Virginia Department of Health, Health Facility Survey and Field Operations. An unannounced on-site Recertification Survey at the above-named Home Health Agency (HHA) from 08/26/25 to 08/28/25 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.102.

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the Virginia Department of Health, Health Facility Survey and Field Operations. An unannounced on-site Recertification Survey conducted at the above-named Home Health Agency (HHA) from 08/26/25 to 08/28/25 resulted in a finding of substantial compliance respective to the applicable Condition of Participation (CoP) under 42 CFR 484, Subparts A through C with the following standard-level deficiencies listed below.

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 record review, interviews, and policy review, the Home Health Agency (HHA) failed to complete an initial assessment to determine the patients immediate care needs within 48 hours of the referral date, the inpatient discharge date, or the practitioner ordered start of care (SOC) date for two of 17 patients (Patient (P) 12, and P17). The delay in the initial assessment had the potential to affect patient safety or delay identification of signs or symptoms of health concerns which could result in rehospitalization. Findings include: Review of the agency policy titled, "Initial Assessment/Comprehensive Assessment," dated January 2024, revealed, "An Agency that is unable to complete the initial assessment within 48 hours of referral or the patient's return home, will not request a different start of care date from the ordering physician to ensure compliance with the regulation or to accommodate the convenience of the Agency." 1. Review of P12's "Patient Information Sheet" located in the electronic medical record (EMR) in the "Profile" tab revealed a referral date of 8/8/25 and a SOC date of 08/15/25. Review of P12's OASIS (Outcome and Assessment Information Set) Comprehensive Assessment dated 08/15/25 located in the EMR in the "Assessment" tab revealed services included skilled nursing (SN) for wound care. Review of a "Change Order" located in the EMR in the "Episode" tab under "Orders" revealed an order written by the Administrator on 08/08/25 and signed by a physician on 08/20/25 which showed, "Start of care for Skilled Nursing services to begin 08/15/25 secondary to pending patient financial responsibility form." 2. Review of P17's "Patient Information Sheet" located in the EMR in the "Profile" tab revealed a referral date of 07/29/25 and a SOC date of 08/08/25. Review of a referral form located in the "Episode" tab revealed a faxed date of 07/28/25 and showed, "Ambulatory referral for Home Health … SN 1 visit … PT [Physical Therapy] …recommendations for exercises, balance and mobility in the home …2w4 [two times a week for four weeks] 8 visits … Diagnoses: Ambulatory dysfunction, Alzheimer's disease, chronic obstructive pulmonary disease, chronic heart failure." Review of a "Change Order" located in the EMR in the "Episode" tab under "Orders" revealed an order written by the Director of Clinical Operations (DCO) on 07/29/25 and signed by the physician on 08/25/25 which showed, "Start of care for skilled Physical Therapy services to begin on 08/08/25 secondary to pending patient financial responsibility form." During an interview on 08/28/25 at 3:30 PM, the DCO stated the agency always completes the SOC comprehensive OASIS assessment at the initial visit. He/she stated the delay of the initial visit for P12 and P17 was due to difficulty getting approval from the insurance providers. During an interview on 08/28/25 at 3:50 PM, the Administrator stated, "We do call the patient and let them know we are a home health agency and that we are trying to get approval or they could be responsible financially if we go without approval. Patients will usually refuse if there is a chance they might have to pay."

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on document review and interviews, the Home Health Agency (HHA) failed to provide a written schedule of visit frequency consistent with the current plan of care (POC) for six of six patients (Patient (P) 11, P12, P13, P14, P15, P17) reviewed during home visit observations. This failure had the potential to lead to missed patient visit due to conflict with other appointments. Findings include: Review of the HHA's provided policies failed to identify the requirement to provide patients with a written schedule of visit frequency. Review of the HHA's admission folder provided to each patient on admission revealed it included a blank "Medication Profile" and on the bottom section of the form was a space for identifying services to be provided and the frequency of the services. 1. Review of P13's HHA admission folder on 08/26/25 at 4:00 PM revealed the section for identifying services provided and frequency of visits was blank. During an interview on 08/26/25 at 4:20 PM, Family Member (FM)1 stated, "I don't know when they are coming. He/she stated "OT has only been out one-time weeks ago and I don't know when they are coming again. The staff call the night before and give me a two-hour window of when they are coming." FM1 confirmed P13 was not provided a written schedule of services provided and frequency of visits. 2. Review of P11's HHA admission folder during a home visit observation on 08/27/25 at 10:30 AM revealed the section on the "Medication Profile" for identifying services provided and frequency of visits was blank. During an interview on 08/27/25 at 11:00 AM, FM2 confirmed that the HHA had not provided a written schedule of services and frequency of visits. 3. Review of P14's HHA Admission folder during a home visit observation on 08/27/25 at 12:00 PM revealed the section on the "Medication Profile" for identifying services provided and frequency of visits was blank. During an interview on 08/27/25 at 12:30 AM, FM4 confirmed that the HHA had not provided a written schedule of services and frequency of visits. 4. Review of P17's HHA Admission folder during a home visit observation on 08/27/25 at 1:30 PM revealed the section of the "Medication Profile" for identifying services provided and frequency of visits was blank. 5. Review of P12's HHA Admission folder during a home visit observation on 08/28/25 at 10:30 AM revealed the section on the "Medication Profile" for identifying services provided and frequency of visits was blank. During an interview on 08/28/25 at 11:00 AM, FM3 confirmed that the agency had not provided a written schedule of services and frequency of visits. FM3 stated, "The nurse will call the night before the visit." 6. Review of P15's HHA Admission folder during a home visit observation on 08/28/25 at 12:00 PM revealed the section on the "Medication Profile" for identifying services provided and frequency of visits was blank. During an interview on 08/28/25 at 12:30 PM, P15 confirmed that the agency had not provided a written schedule of services provided and frequency of visits. P15 stated, "They usually tell me when they are going to come next." During an interview on 08/28/25 at 9:15 AM, the Administrator stated, "the frequency can change frequently, that is why we do not put it in writing and instead call the patient the evening before and again prior to heading over to the patients home."

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on document review and interviews, the Home Health Agency (HHA) failed to provide the patient or caregiver with written medication list written in plain language that does not contain medical abbreviations for five of six patients (Patient (P) 11, P12, P14, P15, and P17) reviewed during home visit observations. This failure had the potential to result in medication errors. Findings include: Review of the HHA policy titled, "Patient Admission" dated March 2024, revealed, "During the initial visit, the admitting professional will: … Develop or review a medication schedule/instruction including medication name, dosage, route and frequency …" Review of the HHA's admission folder provided to each patient on admission revealed it included a blank "Medication Profile" form. 1. Review of P11's "Medication Profile" form in the HHA admission folder during a home visit observation on 08/27/25 at 10:30 AM revealed a notation written on it showing "See list." The form did not include any names of medications, purpose, dosages, or times of administration. During an interview on 08/27/25 at 11:00 AM, FM2 stated he/she had completed a written list of P11's medications. FM2 confirmed that HHA staff had not provided a written list of P11's medications. 2. Review of P14's "Medication Profile" form in the HHA Admission folder during a home visit observation on 08/27/25 at 12:00 PM revealed a notation written on it showing "Meds [medications] reviewed." The form did not include any names of medications, purpose, dosages, or times of administration. During an interview on 08/27/25 at 12:30 PM, FM4 confirmed that HHA staff had not provided a written list of P14's medications. FM4 stated they had been using the medication list provided by the facility at the time P14 was discharged. 3. Review of P17's "Medication Profile" form in the HHA Admission folder during a home visit observation on 08/27/25 at 1:30 PM revealed it was completed but the handwriting was illegible and medical abbreviations were apparent. 4. Review of P12's "Medication Profile" form in the HHA Admission folder during a home visit observation on 08/28/25 at 10:30 AM revealed a notation written on it showing "see attached" however there was no evidence of an attached medication list. During an interview on 08/28/25 at 11:00 AM, FM3 confirmed that the agency had not provided a written list of medications. FM3 stated he/she was using the medication list provided when P12 was discharged from the facility prior to the HHA admission. 5. Review of P15's "Medication Profile" form in the HHA Admission folder during a home visit observation on 08/28/25 at 12:00 PM revealed a notation written on it showing "see attached" however there was no evidence of an attached medication list. During an interview on 08/28/25 at 12:30 PM, P15 confirmed that the agency had not provided a written medication list. During an interview on 08/28/25 at 9:15 AM, the Administrator stated, "The staff always look at the medication list the patient has and reconciles it against the medications the patient has in the home. Doesn't it count that they write on the medication list form to see the medication list which references the list the patient may have if they were discharged from a facility." The Administrator did confirm that it is not the HHA practice to complete the "Medication Profile" form on admission or provide the patient with a medication schedule written in plain language.

An unannounced Home Health Agency recertification survey was conducted on February 14-16, 2022 by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Home Health Agency recertification survey was conducted on February 14-16, 2022 at the above captioned agency by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. The agency reported 2501 unduplicated admissions in the last twelve (12) months with an active census of 298 patients. The following were completed/reviewed in conjunction with the survey: Seven (7) home visits, seventeen (17) clinical records, eight (8) personnel files, review of selected policies and procedures, complaint log, emergency preparedness plan, Covid vaccination records and interviews were conducted. The agency was found to be out of compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies (HHAs).

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 observations and interviews it was determined agency staff failed to follow infection control guidelines for one (1) of seven (7) patients that were observed on home visits during the survey process (clinical record #17). Specifically, the nurse failed to follow infection control guidelines when performing a lab draw and PICC (peripherally inserted central catheter) line care. The findings were: Observations of care during home visits on 2/16/2022 at 10:30 am revealed the skilled nurse (employee #4) failed to follow infection control guidelines when drawing labs and performing PICC (peripherally inserted central catheter) line dressing care for the patient, clinical record #17. The skilled nurse obtained the labs as ordered and without changing gloves and performing hand hygiene, the nurse put the sterile gloves from the PICC line dressing kit over top of the dirty gloves used to draw blood work. The nurse proceeded to clean the area around the PICC line and apply the new dressing. An interview with the nurse at the time of the procedure revealed "I always do it that way". "I have big hands and it's a trick someone taught me to get the gloves on easier". Employee #4 broke infection control guidelines by failing to remove dirty gloves between moving from the blood draw and the PICC line dressing change. The nurse put sterile gloves on over dirty gloves. By not removing the dirty gloves and performing hand hygiene before donning the sterile gloves the nurse put the patient at potential risk of the spread of infection by touching the PICC line tubing to draw blood and touching the blood vials and then with dirty gloves moved to putting sterile gloves over top of the dirty gloves to perform PICC line dressing care. Fundamentals of Nursing Mosby, Potter and Perry, 7th Edition St. Louis Missouri, page 645 states in part: modes of transmission for infection are indirect contact-personal contact of susceptible host with contaminated inanimate object (e.g.,needles or sharp objects, dressings, environment). In this case, the gloves would have been contaminated after touching the tubing and blood vials and glove removal and hand hygiene should have occurred before proceeding. Page #655 goes on to discuss medical asepsis or clean technique procedures are used to reduce the number of organisms present and prevent the transfer of organisms. According to the Centers for Disease Control and Prevention (CDC), hand hygiene should be performed after contact with nonintact skin, after contact with wound dressings, and after removing gloves. (Guideline for Hand Hygiene in Health-Care Settings. Retrieved from https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf). The nurse placed the patient at risk for infection by not following standards of practice to prevent infection transmission and failing to perform hand hygiene at the required times. An interview with the employee #2 at approximately 12:30 PM on 2/16/2022 revealed the nurse just passed the skills check off and did not do it that way at the time. The nurse knows that is not the right way. The policy on PICC line dressing change was reviewed in the agency on 2/16/2022 at 4:30 PM. The policy stated in part: don non-sterile gloves, loosen edges of transparent dressing and carefully remove. Discard old dressing, remove non-sterile gloves and dispose of as outlined in the agency waste disposal policy. Don sterile gloves, clean exit site. The policy goes on to explain the cleaning process and application of the new dressing. The findings were reviewed with the two owners of the agency and the administrator (employee #1-3) at the exit conference on 2/16/2022.