Every finding on record at Nine Palms 2, LLC

*EMERGENCY PREPAREDNESS* Survey conducted on 07/29-08/01/2024 revealed the above facility meets all applicable Federal, State and local emergency preparedness requirements. No violations identified.

*GULFPORT* The Medicare Recertification survey conducted 07/29 - 08/01/2024 revealed the facility has met all Medicare Conditions of Participation for Home Health. However, Standard level deficiencies were identified as follows..... ______________

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 staff interview, policy and procedure review, and review of the facility report “HHA error summary by agency”, the facility failed to encode and electronically transmit each completed Outcome and Assessment Information Set (OASIS) assessment within 30 days of completing the assessment of the beneficiary for 777 patients in the past 12 months: 07/01/2023-07/25/2024. Findings Include: An interview with the Director of Operations and the Office Manager confirmed the agency is supposed to submit OASIS data within 30 days of completing Oasis Data Sets. Review of the facility Internet Quality Improvement and Evaluation System (IQIES) report, “The HHA Error summary report by Agency”, dated 07/25/2023 for the past 12 months revealed, Error -3330 for 777 patient assessments submitted late within 30 days of completing the assessment of the beneficiary. Review of facility’s policy, “Oasis Outcome and Information Set” revised 06/26/2023, confirmed “…OASIS data collected…is required to be transmitted within 30 days…”. During the exit conference on 08/01/2024 with the Director of Operations, Area Vice President of Clinical Operations, Area Vice President of Operations, Area Vice President of Clinical Risk, Vice President of Clinical, Vice President of Operations, Clinical Manager #1 and Clinical Manager #2, survey findings were discussed, and no further documentation was submitted for review.