Every finding on record at Machris Home Health Services Inc

An Emergency Preparedness recertification survey was initiated on 02/04/2026. Census: Licensed and Certified: 6 Licensed Home Health: 0 Personal Assistance Services: 2 The agency was in compliance with the Medicare Conditions of Participation for Emergency Preparedness and no deficiencies were cited.

A recertification survey was initiated on 02/04/2026. Census: Licensed and Certified: 6 Licensed Home Health: 0 Personal Assistance Services: 2 Acronyms: TULIP- Texas Unified Licensure Information Portal DON- Director of Nursing AA/ADON- Alternate Administrator/Alternate Director of Nurses ADR- Additional documentation request FAX- facsimile HHS- Health and Human Services SN- skilled nurse POC- Plan of care SOC- Start of care OASIS- outcome and assessment information set IQIES- internet quality improvement and evaluation system CMS- Centers for Medicare and Medicaid Services EHR- Electronic Health Records

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 record review and interview, the agency failed to transmit completed OASIS assessments (a tool used by CMS to collect certain patient information to measure patient service needs and measure care quality) to the CMS, within 30 days of completing the OASIS assessment of the beneficiaries (patients) for 6 (Patients #1, 2, 3, 4, 5 and 6) of 6 active patient records reviewed. From 01/01/2025 thru 01/01/2026, 109 OASIS assessments were transmitted greater than 30 days from the assessment date. This Failure prevented the agency's patient data from being made available to CMS for analysis to identify agency performance levels in the provision of patient care. FINDINGS INCLUDE: Pre-survey review of the report titled, “OASIS Error Detail Report” taken from the IQIES (A CMS data based system for patient analysis and care trends) revealed 109 assessments contained error number -3330 with the error message of, “Record Submitted Late: The submission date is more than 30 days after M0090 (the date the assessment is finished) on this new record.” Patient #1: Review of the record showed an OASIS assessment was completed by the Administrator/DON on 09/06/2025 for the certification period 09/07/2025-11/05/2025. The OASIS assessment had not been submitted to IQIES. Patient #2: Review of the record showed an OASIS assessment was completed by the Administrator/DON on 12/04/2025 for the certification period 12/05/2025-02/02/2026. The OASIS assessment had not been submitted to IQIES. Patient #3: Review of the record showed an OASIS assessment was completed by the Administrator/DON on 12/24/2025 for the certification period 12/25/2025-02/22/2026. The OASIS assessment had not been submitted to IQIES. Patient #4: Review of the record showed an OASIS assessment was completed by the Administrator/DON on 11/21/2025 for the certification period 11/22/2025-01/20/2026. The OASIS assessment had not been submitted to IQIES. Patient #5: Review of the record showed an OASIS assessment was completed by the Administrator/DON on 10/22/2025 for the certification period 10/23/2025-12/21/2025. The OASIS assessment had not been submitted to IQIES. Patient #6: Review of the record showed an OASIS assessment was completed by the Administrator/DON on 11/28/2025 for the certification period 12/01/2025-01/29/2026. The OASIS assessment had not been submitted to IQIES. On 02/09/2026 at 2:45 PM, the surveyor reviewed the findings with the Administrator/DON and asked who was responsible in the agency to submit the OASIS assessments to the IQIES portal for CMS. The Administrator/DON stated she was the only one who submitted OASIS assessments. The surveyor asked why the OASIS assessments for Patients #1-6 were not submitted. The Administrator/DON stated, “There was a time I couldn’t submit, I called CMS, they got it fixed, it’s been a while. And then I had issues with the EHR, Identifier J, I was having money issues, they wouldn’t give me permission to submit. I think they will let me submit now. I need to try it again.”

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on records review and interview, the agency failed to ensure individual plans of care were reviewed and signed by the physician or nurse practitioner for 6 (Patients 1, 2, 3, 4, 5, and 6) of 6 active patients who received SN services. This failure potentially placed patients at risk of harm due to lack of physician or practitioner oversight and direction for treatments of the patient’s healthcare needs. FINDINGS INCLUDE: On 02/04/2026 at 2:20 PM, the Administrator/DON provided a current active list of patients who received SN services. There were 6 active patients listed. Patient 1: Review of the record revealed a POC with a SOC date 11/13/2024 included a Certification period 09/07/2025 to 11/05/2025. The POC included a verbal SOC date 09/06/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Physician, H by 10/06/2025. The POC was not signed by the physician. A POC with a SOC date 11/13/2024 included a Certification period 11/06/2025 to 01/04/2026. The POC included a verbal SOC date 11/05/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Physician H by 12/05/2025. The POC was not signed by the physician. Patient #2: Review of the record revealed a POC with a SOC date 02/08/2025 included a Certification period 08/07/2025 to 10/05/2025. The POC included a verbal SOC date 08/06/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 09/05/2025. The POC was not signed by the Nurse Practitioner. A POC with a SOC date 02/08/2025 included a Certification period 12/05/2025 to 02/02/2026. The POC included a verbal SOC date 12/04/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 01/03/2026. The POC was not signed by the Nurse Practitioner. Patient #3: Review of the record revealed a POC with a SOC date 12/30/2024 included a Certification period 08/27/2025 to 10/25/2025. The POC included a verbal SOC date 08/26/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 09/26/2025. The POC was not signed by the Nurse Practitioner. A POC with a SOC date 12/30/2024 included a Certification period 10/26/2025 to 12/24/2025. The POC included a verbal SOC date 10/24/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 11/24/2025. The POC was not signed by the Nurse Practitioner. Patient #4: Review of the record revealed a POC with a SOC date 02/01/2024 included a Certification period 09/23/2025 to 11/21/2025. The POC included a verbal SOC date 09/22/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 10/22/2025. The POC was not signed by the Nurse Practitioner. A POC with a SOC date 02/01/2024 included a Certification period 11/22/2025 to 01/20/2025. The POC included a verbal SOC date 11/21/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner I, by 12/21/2025. The POC was not signed by the Nurse Practitioner. Patient #5: Review of the record revealed a POC with a SOC date 01/02/2024 included a Certification period 10/23/2025 to 12/21/2025. The POC included a verbal SOC date 10/22/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 11/21/2025. The POC was not signed by the Nurse Practitioner. A POC with a SOC date 01/02/2024 included a Certification period 12/22/2025 to 02/19/2026. The POC included a verbal SOC date 12/20/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 01/19/2026. The POC was not signed by the Nurse Practitioner. Patient #6: Review of the record revealed a POC with a SOC date 02/15/2023 included a Certification period 08/03/2025 to 10/01/2025. The POC included a verbal SOC date 07/31/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 08/30/2025. The POC was not signed by the Nurse Practitioner. A POC with a SOC date 02/15/2023 included a Certification period 12/01/2025 to 01/29/2026. The POC included a verbal SOC date 11/28/2025 and was electronically signed by the Administrator/DON. The POC was due to be signed by Nurse Practitioner, I, by 12/28/2025. The POC was not signed by the Nurse Practitioner. On 02/09/2026 at approximately 3:15 PM, the surveyor reviewed the findings with the Administrator/DON. The Administrator/DON stated, “I’ve been trying to get the POC’s signed today, I’ve sent them to the Nurse Practitioner (Identifier I) and they said they would get them signed, but they haven’t yet.” The surveyor asked what the agency’s policy required for POC’s signature. The Administrator/DON stated, “it’s 30 or 60 days.” The surveyor asked why the POC’s reviewed did not include physician or nurse practitioner signatures. The Administrator/DON stated, “I’m trying to get them, they just don’t send them back to us when they’re supposed to.” The surveyor asked who was responsible for ensuring the POC’s were signed by the physician or nurse practitioner. The Administrator/DON stated, “I am, there is no one else to help.” The surveyor asked how POC’s not signed by the physician or nurse practitioner could affect patient care. The Administrator/DON stated, “we cannot bill.” Agency Policy, revised date 01/01/2006, quoted in part, “ORDERS FOR CARE TX.5, PURPOSE: To ensure patient care is provided in accordance with physician’s orders and federal and state laws and regulations. … PROCEDURE: … 11. Physician signatures are obtained on 485s (plans of care) and supplemental verbal orders within 30 days ….” Agency Policy, revised date 04/17/2006, quoted in part, “PLAN OF CARE TX.6, PURPOSE: To ensure that care provided is appropriately planned in a timely manner to meet the patient’s specific needs and problems. … PROCEDURE: … 4. Verbal orders will be signed and dated by the physician within 30 days …”