Every finding on record at M D Home Health LLC

During the Health Recertification survey was commenced on 07/15/2025 and concluded on 07/16/2025 at M D Home Health, LLC, Home Health Agency provider, Emergency Preparedness was reviewed. M D Home Health, LLC was in compliance with Emergency Preparedness per Title 42, Code of Federal Regulations (CFR) Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was commenced on 07/15/2025 and concluded on 07/16/2025 at M D Home Health, LLC, Home Health Agency provider. The provider was not in compliance with Title 42 Code Of Federal Regulations (CFR) Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

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 the Home Health Agency (HHA)'s Policy, observation, and interview, the Home Health Agency (HHA)'s staff failed to adhere to the HHA's Policy for 2 of 3 sampled patients as evidenced by the failure to follow the HHA's policy for Nursing Bag Technique during and between patient visit (Patients #1 and #3). The findings included: 1) Review of the HHA's Policy titled, Nursing Bag Technique”, dated January 1, 2025, documented," To minimize the risk of cross-contamination and infection between patients through the proper use and handling of the nursing bag during home visits. This policy applies to all licensed clinical staff who carry and utilize a nursing bag when performing home visits on behalf of M D Home Health, LLC. The nursing bag is considered a mobile extension of the clinical environment. It must be maintained in a clean, organized, and contamination-free condition. The bag technique is to be strictly followed before, during, and after each patient visit to prevent the spread of infections. The procedure upon arrival at patient’s home – place bag on barrier – never place the bag on the floor, couch, or patient surfaces. Use a disposable barrier (underpad or paper towel)." Observation, on 07/16/25 at 11:25 AM, during a home visit conducted for Patient #1 to observe the administration of an intravenous infusion revealed Staff A, a Licensed Practical Nurse (LPN), placed their Nursing Bag directly on the patient's high counter chair without benefit of a protective barrier and failed to carry out the HHA's Nursing Bag Technique after providing care and services to Patient #1 and proceeding to the next patient. 2) Observation on 07/16/25 at 12:25 PM, during a home visit conducted for Patient #3 to observe a teaching session revealed Staff A placed their Nursing Bag directly on the patient's couch without benefit of a protective barrier and failed to carry out the HHA's Nursing Bag Technique after providing care and services to Patient #3 and proceeding to the next patient. During an interview, on 07/16/25 at 2:41 PM, the Administrator acknowledged the findings.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on review of the Home Health Agency (HHA)'s Policy, observation, interview, and record review, the Home Health Agency (HHA) failed to follow the physician's orders, in the Plan of Care (POC) for the intravenous infusion for 1 of 1 sampled patients (Patient #1) observed during an intravenous infusion administration; failed to follow the physician's order in the Plan of Care for wound care treatment for 1 of 7 sampled patients (Patient #6) and failed to follow the physician's order frequency in the Plan of Care for Physical Therapy services for 2 of 7 sampled patients (Patient #5 and #7). The findings included: 1) Review of the HHA's Policy titled, "Wound Care Evaluation and Management.” Dated January 1, 2025, documented, "To ensure safe, evidence-based wound care services are provided in compliance with Centers for Medicaid (CMS) Conditions of Participation (COPs) and Florida Agency for Health Care Administration (AHCA) regulations. This policy provides direction for wound evaluation, documentation, treatment, and follow-up care in the home health setting. This policy applies to all clinical personnel providing wound care services to patients of M.D Home Health, LLC, including Registered Nurse (RN)s, Licensed Practical Nurse (LPN)s, therapists, and Medical Directors. All wound care services must be performed recording to the patient’s individualized POC, updated regularly, and documented to meet CMS COPs and Local Coverage Determinations (LCD) guidelines. Home Health clinicians must assess, manage, and document wound care interventions and patient response during every skilled nursing or therapy visit." Review of the HHA's Policy titled, "Frequency and Duration of Ordered Skilled Nursing and Physical Therapy Visits,” dated January 1, 2025, documented, "To establish a standardized, CMS – and AHCA – compliant policy regarding the frequency and duration of skilled nursing (SN) and physical therapy (PT) visits, ensuring medically necessary services are provided according to individualized care needs and physician orders. This policy applies to all clinical personnel responsible for creating, reviewing, and implementing skilled nursing and therapy visit frequencies for patients receiving home health services." Record review revealed that Patient #1 was admitted to the Home Health Agency's services on 07/04/2025 for Skilled Nursing Services. Review of the POC for the certification period from 07/04/2025 through 09/01/2025 documented that a Skilled Nurse was to administer 2 grams of Intravenous (IV) Ceftriaxone (antibiotic) via IV push over five minutes every 24 hours through a midline catheter in the right upper arm. Further documentation revealed that the patient or caregiver was to flush the IV lumen(s) with 3–5 milliliters (ml.) of Heparin (anticoagulant) solution (100 units/ml.) upon completion of each infusion therapy. Observation, on 07/16/2025 at 11:14 AM, during a home visit with the HHA's Registered Nurse Administrator and Staff A, a Licensed Practical Nurse (LPN), to oversee IV infusion care revealed Staff A took a pre-filled syringe of Ceftriaxone from the refrigerator, wiped the IV line’s lumen, flushed it with 10 cubic centimeter (cc)s of Normal Saline (NS), and then administered the medication for five minutes, followed by another flush of 10 ml. of NS. However, despite the POC's instructions to flush the IV line with Heparin after every infusion, Staff A did not follow this step. On 07/16/2025 at 11:14 AM, during an interview, the Registered Nurse Administrator, when questioned about the absence of Heparin, stated that the pharmacy may have removed the (Heparin) order or failed to send it and stated his intention to call the pharmacy for clarification. On 07/16/2025 at 11:58 AM, the Registered Nurse Administrator contacted the HHA's office, requesting a representative contact the pharmacy to verify the Heparin order. During an interview on 07/16/2025 at 2:39 PM the HHA's Administrator provided further clarification regarding the Heparin order and stated, “The pharmacy had originally delivered the first dose of the antibiotic to the wrong address. When they redelivered it, it did not include the Heparin either.” The administrator acknowledged that the HHA should have followed up with the pharmacy about the Heparin and alerted the physician regarding the undelivered medication. 2) Record review revealed that Patient #6 was admitted to the Home Health Agency (HHA) on 05/08/2025 to receive skilled nursing services. The plan of care (POC) for the certification period from 05/08/2025 through 05/23/2025 specified that the skilled nurse would assess the integumentary status and provide wound care for the left upper extremity (LUE) and left lower extremity (LLE) three times a week. This included cleansing the wounds with normal saline, applying Mupirocin ointment to the wound bed, and covering the area with a non-adherent dressing secured with tape at each visit until healed. The nurse was also instructed to assess the wounds for size, drainage, odor, and tissue condition during each visit and to document these findings thoroughly. However, the record for Patient #6 revealed no evidence of documented wound assessments following the Skilled Nurse's visits on May 12, 2025, May 17, 2025, and May 20, 2025, and a lack of documentation regarding the visits, or any assessments conducted, the visit records were "blank." On 07/16/2025 at 2:33 PM, the HHA's Administrator was interviewed, a detailed review of Patient #6’s record was performed together and he acknowledged the findings. 3) Record review revealed Patient #5 was re-admitted to the Home Health Agency’s services on 05/26/2025, for physician ordered Physical Therapy services two times a week for four weeks. Further review revealed that during the second week of services, from 06/01/25 to 06/07/25, only one Physical Therapy visit occurred, rather than the two visits that had been physician ordered. Review of the third week of services, from 06/08/25 to 06/14/25, revealed evidence of documentation of only one Physical Therapy visit conducted instead of the physician ordered two visits. On 07/16/2025 at 2:30 PM, an interview was conducted with the HHA's Administrator, who acknowledged the findings. 4) Record review revealed that Patient #7 was re-admitted to the Home Health Agency's services on 05/08/25, for physician ordered Physical Therapy services at a frequency of two times per week for four weeks. Further review revealed that during week five, from 06/01/25 through 06/07/25, only one Physical Therapy visit was provided instead of the physician ordered two visits. On 07/16/25 at 2:44 PM, during a side- by-side record review and interview, conducted with the HHA's Administrator regarding the missed physical therapy visits, he acknowledged the findings.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to timely notify the Agency for Health Administration (AHCA) of the change of the Alternate Administrator. Review of the HHA's most recent "Renewal Licensure Application dated 06/15/2024 revealed the name of an Alternate Administrator. 07/16/2025 at 1:21 PM, during an interview with the HHA's Administrator, when asked, the name of the Alternate Administrator and if this person had been in their role since the HHA applied for its most recent 'Renewal License," the Administrator responded that another Alternate Administrator was hired in January 2025, but he has not informed the Agency for Health Care Administration (AHCA) Home Care unit about this change.

An unannounced Complaint Survey, #2022008907 was commenced on 08/29/2022 and concluded on 09/09/2022 at M D Home Health LLC, Home Health Agency provider. The provider was not in compliance with 42 CFR, Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on review of the Home Health Agency's Policy and Procedure, record review and interview, the Home Health Agency's Administrator, who was providing the Skiiled Nurse services, failed to assure the coordination of care by failing to completely document who the Administrator spoke to at the patient's insurance care coordination company to assure that an Insulin Dependent Diabetic requiring a Skilled Nurse to administer Insulin injections five days a week, would be receiving Home Health Agency services after discharge for 1 of 3 sampled patients (Patient #1). The findings included: Review of the Home Health Agency's policy titled, "Clinical Documentation" reveals "Telephone or other communication with clients, physicians, families, or other members of the health care team will be documented in clinical progress notes or other interagency communication form." Further review reveals Patient #1 was admitted to the Home Health Agency's services on 07/22/2000; was an Insulin Dependant Diabetic for which a Skilled Nurse was making visits 5 days a week, Monday through Friday, to obtain Blood Sugar levels and give an Insulin injection. On 05/03/22, the Registered Nurse (RN) who is also the Administrator arrived at the patient's home for the visit; the patient's spouse was told that day that the Home Health Agency could not longer provide services to Patient #1 and will be discharging the patient on Friday, 05/06/22. During an interview, on 09/08/22 at 10:00 AM via telephone, the Administrator stated that he called the patient's referring physician's office on 05/06/22 to inform them that the Home Health Agency would no longer provide service as of Friday, 05/06/22; a letter was sent to the patient and a letter was sent to the referring physician regarding the patient's discharge; the Administrator further stated that he called the patient's insurance "Care Coordination" company so they could find another Home Health Agency for Patient #1. A review of the Discharge Outcome and Assessment Information Set (OASIS) dated 05/06/22 does not document the Home Health Agency Patient #1 was referred to or to whom the Administrator spoke to at the patient's insurance "Care Coordination" company; further review reveals documentation, "Replacement Home Health company to start on (Monday) 05/09/22" and the Administrator was unable to verbalize how he was sure that a Home Health Agency would be starting care on Monday, 05/09/22 or who told him that.

During the Recertification survey conducted on 02/14/2022 through 02/16/2022 at M D Home Health, LLC, a Home Health Agency, Emergency Preparedness was reviewed. M D Home Health, LLC is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was commenced on 02/14/2022 and concluded on 02/16/2022 at M D Home Health LLC, a Home Health Agency provider located at 580 Village Blvd, West Palm Beach, Florida. The Home Health Agency was not in compliance with 42 CFR Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Incorporate OASIS items CFR(s): 484.55(c)(8) Incorporation of the current version of the Outcome and Assessment Information Set (OASIS) items, using the language and groupings of the OASIS items, as specified by the Secretary. The OASIS data items determined by the Secretary must include: clinical record items, demographics and patient history, living arrangements, supportive assistance, sensory status, integumentary status, respiratory status, elimination status, neuro/emotional/behavioral status, activities of daily living, medications, equipment management, emergent care, and data items collected at inpatient facility admission or discharge only. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to incorporate the start of care and current recertification assessments into the Outcome and Assessment Information Set (OASIS) items for 3 of 7 sampled patients (Patients #2, #3 and #4). The findings included: 1) Review of the record revealed Patient #2 was admitted to the HHA on 01/20/22 for the provision of services to include skilled nursing. Review of the current certification period from 01/20/22 through 03/30/22 revealed an incomplete start of care OASIS. During an interview with the Director of nursing (DON) on 02/14/22 at 3:01 PM, an inquiry was made regarding the incomplete OASIS; he DON explained she had completed the comprehensive assessment on paper, but had not put the information into the computer system to incorporate the OASIS data. 2) Review of the record revealed Patient #3 was admitted to the HHA on 04/20/21 for the provision of services to include skilled nursing. Review of the certification period from 12/16/21 through 02/13/22 revealed an incomplete recertification OASIS. During an interview with DON on 02/14/22 at 3:36 PM, the DON again stated the recertification assessment was completed on paper, but had not been put into the computer system to incorporate the OASIS data. 3) Review of the record revealed Patient #4 was admitted to the HHA on 07/30/21 for the provision of services to include skilled nursing. Review of the current certification period from 01/26/22 through 03/26/22 revealed an incomplete recertification OASIS. Further review of the record revealed an incomplete recertification OASIS for the certification period of 09/28/21 through 11/26/21. During an interview on 02/15/22 at 11:00 AM, the Administrator explained that he had completed the recertification assessments on paper, but had not incorporated the assessments into the OASIS on the computer.

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 review of the Home Health Agency (HHA)'s policy, record review and interview, the HHA failed to ensure a written plan of care for 5 of 7 sampled patients (Patient #1, #2, #3, #4 and #5). The findings included: 1) Review of the HHA's policy titled “Care Plans” not dated, documented each client (patient) will have a care plan on file that addresses their identified needs and the agency’s plan to respond to those needs; the policy further documented the following purposes: To assure continuity and consistency between the disciplines providing care under the current plan; to focus the interventions and frequency and duration based on the effectiveness of interventions and progress towards goals; to provide updated, coordinated document that reflects the current home care services and the policy instructed a care plan shall be developed following the initial assessment and with each episode of care. Review of the record revealed Patient #1 was admitted to the HHA on 02/12/20 for the provision of services to include skilled nursing and physical therapy. Review of the record lacked a written plan of care for the following certification periods: Episode #12 with a certification period of 12/03/21 through 01/31/22 and Episode #13 with a certification period of 02/01/22 through 04/01/22. During an interview on 02/14/22 at 12:20 PM, the Administrator was asked to locate and provide the plans of care for episodes #12 and #13. The Administrator confirmed the lack of the plans of care for these two episodes. 2) Review of the record revealed Patient #2 was admitted to the HHA on 01/20/22 for the provision of services to include skilled nursing. Review of the record lacked a written plan of care the current certification period of 01/20/22 through 03/30/22. During an interview on 02/14/22 at 3:01 PM, the Director of Nursing (DON), who was the person who completed the initial comprehensive assessment, was asked about the lack of the written plan of care for Patient #2 and the DON stated the plan of care was not completed for this episode. 3) Review of the record revealed Patient #3 was admitted to the HHA on 04/20/21 for the provision of services to include skilled nursing. Review of the record lacked a written of plan of care the certification period of 12/16/21 through 02/13/22. During an interview on 02/14/22 at 3:36 PM, the DON confirmed the lack of a written plan of care. 4) Review of the record revealed Patient #4 was admitted to the HHA on 07/30/21 for the provision of services to include skilled nursing. Review of the record lacked a written plan of care for the following certification periods: Episode #2 with a certification period of 09/28/21 through 11/26/21; Episode #3 with a certification period of 11/27/21 through 01/25/22 and Episode #4 with a certification period of 01/26/22 through 03/26/22. During an interview on 02/15/22 at 11:00 AM, the Administrator confirmed there was no written plans of care for these three certification periods. 5) Review of the record revealed Patient #5 was admitted to the HHA on 12/10/21 for the provision of services to include skilled nursing, physical therapy, occupational therapy, and a home health aide. Review of the records lacked evidence of a written plan of care for the certification period 12/10/21 through 02/07/22. During an interview and side-by-side review of the record on 02/15/22 at 12:35 PM, the Administrator confirmed there was no written plan of care for this certification period.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to follow physician's orders for wound care for 1 of 7 sampled patients (Patient #4). The findings included: Review of the record revealed Patient #4 was admitted to the HHA on 07/30/21 for the provision of skilled nursing services for wound care. Review of the physician's order, dated 01/07/22 documented the use of Polymem (a specific wound dressing) every other day and did not include the use of Drawtex (another specific wound care dressing). Review of the skilled nursing visit note by Staff B, a Licensed Practical Nurse (LPN), dated 02/06/22 documented conflicting interventions including the use of Polymem every forth day, the use of Drawtex every other day and the use of a wet to dry gauze dressing daily. Review of the skilled nursing visit note by Staff B, the same LPN, dated 02/08/22 documented the identical conflicting interventions as the previous skilled nursing visit note of 02/06/21. Further review of the record revealed another physician's order dated 02/10/22 that documented the use of Xeroform (specific wound care dressing) to the wound bed every other day and this order did not include the use of an antibiotic ointment. During a telephone interview on 02/15/22 at 10:13 AM, Staff B, the LPN, was asked the current wound care being provided to Patient #4. Staff B explained she cleansed the wound with a Dakin’s solution (antiseptic solution), then applied Gentamycin cream (an antibiotic) and Xeroform to the wound. On 02/15/22 at 10:45 AM, a subsequent interview was held with Staff B via speaker telephone, with the Administrator present; Staff B confirmed that she has been applying Gentamycin to the wound; Staff B explained the patient's family member provides the wound care orders to the nurses after each wound care physician visit and the use of the Gentamycin was the most recent physician order. During a side-by-side record review on 02/15/22 at approximately 11:00 AM, the Administrator confirmed the contradiction with the documented interventions provided to Patient #4 and the lack of a documented physician's order that included the Gentamycin; the Administrator stated he would speak further with Staff B to see if she had documented that physician's order or could get it from the patient's home. During a subsequent interview on 02/15/22 at 11:12 AM, the Administrator stated they were unable to locate any current physician's order for the use of the Gentamycin ointment, as described by Staff B.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on policy review, record review and interview, the Home Health Agency (HHA) failed to develop written patient care instructions for a Home Health Aide for 1 of 7 sampled patients (Patient #5). The findings included: Review of the policy “Home Health Aide Care Plan” (not dated) documented, "A complete and appropriate Care Plan, identifying duties to be performed by the Home Health Aide, shall be developed by a Registered Nurse or Therapist. All home health aide staff will follow the identified plan. The Care Plan will be available to all persons involved in client care, including contracted providers." Review of the record revealed Patient #5 was admitted to the HHA on 12/10/21 for the provision of services to include a Home Health Aide. Review of the record lacked evidence of written patient care instructions for a Home Health Aide, for the certification period of 12/10/21 through 02/07/21. During an interview and side-by-side review of the record on 02/15/22 at 12:45 PM, the Administrator confirmed the lack of written patient care instructions for a Home Health Aide for Patient #5, referred to as a Home Health Aide Care Plan, by the HHA's policy.

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 policy review, record review and interview, the Home Health Agency (HHA) failed to ensure a complete and accurate clinical record for 3 of 7 sampled patients (Patients #2, #3 and #4). The findings included: 1) Review of the policy, “Clinical Documentation” (not dated) documented, "The agency will document each direct contact with the client. This documentation will be completed by the direct caregivers and monitored by the skilled professional responsible for managing the client’s care." This policy further explained the documentation of services provided will be incorporated into the clinical record within seven days after the care has been provided. Review of the record revealed Patient #2 was admitted to the HHA on 01/20/22 for the provision of services to include skilled nursing. Review of the records revealed incomplete skilled nursing visit notes to include the following dates: 01/24/22, 01/25/22, 01/27/22, 01/31/22, 02/07/22. During an interview the Director of Nursing (DON) on 02/14/22 at 3:01 PM confirmed the findings. 2) Review of the record revealed Patient #3 was admitted to the HHA on 04/20/21 for the provision of services to include skilled nursing. Review of the certification period of 12/16/21 through 02/13/22 revealed incomplete skilled nursing visit notes to include the following dates: 12/26/21, 01/19/22, 01/22/22, 01/23/22, 01/24/22, and 01/26/22. During an interview on 02/14/22 at 3:36 PM, the DON confirmed the findings. 3) Review of the record revealed Patient #4 was admitted to the HHA on 07/30/21 for the provision services to include skilled nursing. Review of the certification period of 01/26/22 through 03/26/22 revealed an incomplete skilled nursing visit note on 01/29/22. During an interview on 02/15/22 at 11:00 AM, the Administrator, he confirmed the findings.