Every finding on record at Omega Home Health Agency, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey . Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 85 Active Patients - 25 Sample Size - 7 Home Visits- 3

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.542(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the emergency preparedness plan and training for staff was done on an annual basis. This failure had the potential to result in the staff having a lack of knowledge to respond effectively during an emergency situation. During a review of the emergency preparedness plan of the HHA on 5/7/2023, at 12:30 p.m., the Home Health agency (HHA) did not have a documented evidence of an Emergency Preparedness training/disaster drill for all staffs and did not have an evidence of an emergency plan annual review. During an interview with Director of Patient Care Services (DPCS) on 5/7/2023, at 1 p.m., the DPCS stated she had not received Emergency Preparedness/Disaster training plan from the HHA. There was no documented evidence the governing body reviewed the policy annually for Emergency Preparedness/Disaster The HHA's undated policy and procedure titled "Emergency/Disaster Plan" indicated the purpose was to outline a planned, coordinated strategy to promote the safety and continuation of care and/or services to agency patients in the event of a disaster.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Unduplicated Admissions - 85 Active Patients - 25 Sample Size - 7 Home Visits- 3

Written notice of patient's rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient's rights and responsibilities under this rule, and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to provide written notice of patients’ rights that the two of 7 sampled patients, ( Patient 5 and 6) understood. This failure resulted for Patients 5 and 6 not to have written notice of patient’s rights available in their patient handbook available that they can understand. A review of Patient 5’s Face sheet indicated that a Start of Care (SOC) date of 2/28/23 with the certification period reviewed on 4/29/23 to 6/27/23 with a diagnosis of hypertensive heart disease (refers to heart problems that occur because of high blood pressure that is present over a long time) and spinal stenosis lumbar region (a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs). Skilled nursing (SN) visit frequency of twice a week for two weeks and once a week for six weeks. SN to perform each visit vital signs every visit, scale pain (0-10) implement pain relieving measures and evaluate its effectiveness. SN to assess/monitor for medication effectiveness, possible adverse effects and duplication. SN to instruct/validate patient/caregiver(CG) on medications/high risk medications as to dosage, route, frequency and side effects. signs and symptoms of bleeding, bleeding precautions related to aspirin intake and other non-drug methods to control the disease. SN to report to MD(medical doctor) ineffectiveness of current medications. Ancillaries as ordered by MD. Notify agency of significant clinical findings, negative outcomes, medication/service/treatment/personal changes, CG status and other relevant matters. A review of Patient 6’s Face sheet indicated that a Start of Care (SOC) date of 2/28/23 with the certification period reviewed on 4/29/23 to 6/27/23 with a diagnosis of type 2 diabetes (means that your body doesn't use insulin properly and while some people can control their blood glucose (blood sugar) levels with healthy eating and exercise, others may need medication or insulin to manage it) and bilateral primary osteoarthritis (Degenerative condition that can reduce mobility). SN visit frequency of twice a week for two weeks and once a week for six weeks. SN to perform each visit vital signs every visit, scale pain (0-10) implement pain relieving measures and evaluate its effectiveness. SN to assess/monitor for medication effectiveness, possible adverse effects and duplication. SN to instruct/validate patient/CG on medications/high risk medications as to dosage, route, frequency and side effects. signs and symptoms of bleeding, bleeding precautions related to aspirin intake and other non-drug methods to control the disease. SN to report to MD ineffectiveness of current medications. Ancillaries as ordered by MD. Notify agency of significant clinical findings, negative outcomes, medication/service/treatment/personal changes, CG status and other relevant matters. During the joint home visit with Licensed Vocational Nurse 1 (LVN1) on 5/6/23 at 11:00 a.m., noted that Patients 5 and 6 speaks mostly Russian. LVN 1 initiated her home visit. During an observation of the home visit at the same date and time, Patient 5 was observed ambulating slowly with a cane, alert and oriented, complaints of 3-4 out of 10 pain on lower back while sitting, walking and standing. On concurrent interview, Patient 5 stated that the CG comes in different hours during the day. Patient 5 stated she understands a bit of English, when asked if she understands the patient handbook in written English, stated she does not understand or read written English. During an observation with Patient 6, Patient 6 ambulates slowly with four wheel walker, appeared weak and anxious, denied pain and no respiratory distress. Patient 6 speaks mostly Russian. During an interview with LVN 1 stated that there is a CG that comes everyday intermittently for the patients. LVN 1 stated she met the CG on her last visit. On concurrent review of the patients handbook, noted there was no patients’ rights in Russian noted inside the patients handbook. LVN 1 also stated she does not know the number of the patients caregiver and does not know the patients physician's phone numbers. LVN 1 also stated that usually the registered nurse (RN) who conducts the admission leaves the handbook. LVN 1 stated she will ask the office for the copy of the Patient’s Rights in Russian and will give it to the patient on the next visit. During an interview with the Director of Nursing (DON) on 5/7/23 at 11:30 a.m., DON stated that the admitting nurses should have left the appropriate written notice with the proper translation inside the patient’s handbook upon admission to the service. DON stated that 90% of their patients are Armenian and some Russian. DON further stated that it is important that patients know their rights and understands it in their own language. On concurrent review with the sample admission packet with the DON, revealed that the handbook is only translated on Armenian and not in Russian. A review of the HHA’s policy titled "Rights and Responsibilities" dated 4/2018 indicated the admitting clinician will document that the patient have received a copy of the "Patient rights and responsibilities handbook". If the patient is unable to understand his/her rights and responsibilities , documentation in the clinical note will be made. In the event a communication barrier exists, if possible, special devices or interpreters will be made available. Written information will be provided in the predominant languages of the population served.

Continuing need for home care CFR(s): 484.55(c)(3) The patient's continuing need for home care; This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to assess the patient's continuing need for skilled nursing services for one of seven patients. (Patient 1). This deficient practice resulted in unnecessary continuous home health services. A review of Patient 1's clinical record indicated a start of care (SOC) date of 2/3/23, with diagnosis that included hypertensive heart disease (changes in the left ventricle, left atrium and coronary arteries as a result of chronic blood pressure elevation). A review of Patient 1's plan of care (POC) from 2/3/23 to 4/3/23, included an order for the skilled nurse (SN) to visit of once a week for one week, twice a week for two weeks, once a week for six weeks, to assess all body systems, vital signs (measure the basic functions of your body that includes your body temperature, blood pressure, pulse and respiratory [breathing] rate), pain level, severe shortness of breath, blood sugar check(measures the level of glucose in your blood), medication and diet compliance, and safety on every visit. The goal included patient’s blood sugar will be maintained within the range 60-250 milligrams per deciliter (mg/dl), patient will have no skin breakdown, blood pressure levels maintained within normal parameters, no signs and symptoms of shortness of breath and respiratory distress, and patient will remain safe at home without incidents of fall, injury or hospitalization throughout the certification period. Discharge planning indicated to discharge when medical condition is stable, and when patient is no longer in need of skilled services. On 5/6/2023, at 1 p.m., a joint home visit was conducted at Patient 1's residence with LVN 1 (license vocational nurse). Patient 1 was observed sitting up in chair, alert and oriented, and ambulatory using a cane. On 5/6/2023 at 1:15 p.m., during an interview with Patient 1, she stated she takes her medications daily as scheduled with the help of her daughter who prepares her medications every morning. She also stated that her daughter checks her blood pressure readings every morning and cooks for her. She further stated that she have no wounds, no falls, and no hospitalization for the past 12 months. A review of Patient 1's SN Visit Notes from 2/3/2023 to 4/3/2023 indicated Patient 1’s blood sugar ranging from 115 to 137, blood pressure ranging from 132-145 systolic (first number) and 65-88 diastolic (second number). The rest of the patient's vital signs (temperature, pulse rate and respiratory rate) were within a normal range. There were no admissions to the hospital, no pain, no episodes of falls, no wound care performed, and any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continuous skilled nursing services. On 5/7/2023 at 1:40 p.m., during an interview with the DPCS (director of patient care services), when asked why Patient 1 was recertified for another 60 days, she stated that Patient 1 was a fragile, older lady and she needs to be monitored for safety purposes. She also stated that Patient 1 needed more patient teaching with her medication regimen. A review of the agency’s policy and procedure titled, "Discharge Criteria and Process", revised November 2022, indicated the purpose of the policy is to outline the process for discharging a patient from service. Services will be terminated when the patient meets one of the following discharge criteria: if appropriate, the physician (or other authorized licensed independent practitioner) and the organization agree that the goals of home health have been attained or are no longer attainable.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to monitor and maintain an accurate, and current medication profiles for 2 of 7 patients (Patients 5, and 6). This failure has the potential to result in placing the patient at risk for medication errors and adverse drug reactions. A joint home visit was conducted on 5/6/23 at 11:00 a.m., at Patient 5 and 6’s residence with licensed vocational nurse 1 (LVN 1). A review of Patient 5’s Face sheet indicated that a Start of Care (SOC) date of 2/28/23 with the certification period reviewed on 4/29/23 to 6/27/23 with a diagnosis of hypertensive heart disease (refers to heart problems that occur because of high blood pressure that is present over a long time) and spinal stenosis lumbar region (is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older) Skilled nursing (SN) visit frequency of twice a week for two weeks and once a week for six weeks. SN to perform each visit vital signs every visit, scale pain (0-10) implement pain relieving measures and evaluate its effectiveness. SN to assess/monitor for medication effectiveness, possible adverse effects and duplication. SN to instruct/validate patient/caregiver(CG) on medications/high risk medications as to dosage, route, frequency and side effects. signs and symptoms of bleeding, bleeding precautions related to aspirin intake and other non-drug methods to control the disease. SN to report to MD(medical doctor) ineffectiveness of current medications. Ancillaries as ordered by MD. Notify agency of significant clinical findings, negative outcomes, medication/service/treatment/personal changes, CG status and other relevant matters. A review of Patient 6’s Face sheet indicated that a Start of Care (SOC) date of 2/28/23 with the certification period reviewed on 4/29/23 to 6/27/23 with a diagnosis of type 2 diabetes (means that your body doesn't use insulin properly and while some people can control their blood glucose (blood sugar) levels with healthy eating and exercise, others may need medication or insulin to manage it) and bilateral primary osteoarthritis (occurs when both knees are affected with OA. OA is a painful, degenerative condition that can reduce your mobility and make daily tasks difficult to manage. Early diagnosis and treatment may decrease joint damage and improve your overall quality of life). SN visit frequency of twice a week for two weeks and once a week for six weeks. SN to perform each visit vital signs every visit, scale pain (0-10) implement pain relieving measures and evaluate its effectiveness. SN to assess/monitor for medication effectiveness, possible adverse effects and duplication. SN to instruct/validate patient/CG on medications/high risk medications as to dosage, route, frequency and side effects. signs and symptoms of bleeding, bleeding precautions related to aspirin intake and other non-drug methods to control the disease. SN to report to MD ineffectiveness of current medications. Ancillaries as ordered by MD. Notify agency of significant clinical findings, negative outcomes, medication/service/treatment/personal changes, CG status and other relevant matters. During the joint home visit with Licensed Vocational Nurse 1 (LVN1) on 5/6/23 at 11:00 a.m., noted that Patient's 5 and 6 speaks mostly Russian. LVN initiated her home visit. During a review of medications for Patient 5, revealed Synthroid 25 mcg 1 tablet three times a week on medication profile but on bottle label it was written as four times week. On concurrent interview with Patient 5 stated she had blood work done a month and a half ago and it was changed to three times a week per her physician. During a review of medications with LVN 1 for patient 6, observed the following medication discrepancies: Lantus 100 units (the concentration of insulin) per milliliter (a unit of liquid measurement) insulin administer 49 units at bedtime but on supply box it is labeled at 44 units at bedtime. Lyrica 75 milligrams(mg-unit of solid measurement) 1 capsule daily bottle was missing on the medication box. Patient 6 verbally stated that the CG keeps all the medications and prepares them in a small pill box that she leaves with the patient. Glucometer was missing. Patient 6 stated he does not know where his glucometer is being kept. Patient 6 stated that the CG comes three intermittently three times a day to check his blood sugar and writes it in a paper. Amlodipine Besylate 5 mg 1 tablet once a day on patient medication profile but on patient's bottle indicated twice a day. During an interview with LVN 1 on the same date and time, LVN 1 stated it should be updated to not confuse the patient and CG when preparing patients medications. LVN 1 stated she met the CG once but was not able to get her phone number. LVN 1 stated she will get it on her next visit. During an interview with the Director of Nursing (DON) on 5/7/23 at 11:15 a.m., DON stated that both patients were just recertified for this current certification period. DON further stated that medication labels should be updated as ordered. A review of the HHA's policy titled " Medication Profile" dated 4/2018, indicated patients receiving medications will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications. For accuracy and to completely reconcile medications across the continuum of care, the admitting organization will obtain and document a complete list of the patients current medications upon the patient's entry to the organization. A comparison of the medications ordered for the patient while under the organization's care will be made to those on the list. A review of the HHA's policy titled "Identification of medication for Administration" dated 4/2018 indicated medications will be properly labeled with the patient's name, and additional patient identifier, name of drug, dosage, diluent, date of preparation, expiration date, initials of the preparer and any special instructions, as applicable.

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 interview and record review, the home health agency failed to ensure the written plan of care for one of seven sampled patients, (Patient 1) was followed. For Patient 1, the skilled nurse failed to assess the patient's pain as indicated in the plan of care. This deficient practice placed the patient at risk for ineffective pain management. A review of Patient 1's clinical record indicated a start of care (SOC) date of 2/3/23, with diagnosis that included hypertensive heart disease (changes in the left ventricle, left atrium and coronary arteries as a result of chronic blood pressure elevation). A review of Patient 1's plan of care (POC) from 2/3/23 to 4/3/23, included an order for the skilled nurse (SN) to visit of once a week for one week, twice a week for two weeks, once a week for six weeks, to assess all body systems, vital signs (measure the basic functions of your body that includes your body temperature, blood pressure, pulse and respiratory [breathing] rate), pain level, severe shortness of breath, blood sugar check(measures the level of glucose in your blood), medication and diet compliance, and safety on every visit. Skilled nursing to evaluate the pain level every visit and the effectiveness of pain management. Report to the physician if pain levels above 8/10 (severe) and or greater not relieve by prescribed medication/rest. On 5/6/2023, at 1 p.m., a joint home visit was conducted at Patient 1's residence with LVN 1 (license vocational nurse). Patient 1 was observed sitting up in chair, alert and oriented, and ambulatory using a cane. On 5/6/2023 at 1:15 p.m., during an interview with Patient 1, she stated she has lower back pain with a pain scale of 3 out 10 but her pain gets relieved by taking her prescribed pain medication when needed. A review of Patient 1's Skilled Visit Notes dated 2/3/23 through 4/3/23, indicated Patient 1 was assessed to have an intermittent dull pain level of 2-4/10 (mild to moderate pain - 0 as no pain and 10 as the worst pain) on her lower back. The intervention was rest and medication with Tylenol extra strength 500 mg 1 to 2 tabs every 8 hours as needed for pain. However, there was no documentation if the intervention to relieve pain was effective and no post pain assessment was done. On 5/7/23, at 1 p.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse should do a post pain assessment and response to treatment if pain was relieved. A review of the agency's undated policy and procedure titled "Pain Assessment/Management", indicated the nurse/therapist includes all to assess the patient's pain, location, duration, severity (rating scale), alleviating factors, current treatment and response to treatment. The follow-up assessment will address effectiveness of the pain management program and identify if there is a need for referral for additional or alternative therapy. A review of Patient 7's clinical record indicated a start of care date of 1/11/23, with diagnosis that included hypertensive heart disease and heart failure(A chronic condition in which the heart doesn't pump blood as well as it should). A review of Patient 7's plan of care from 3/12/23 to 5/10/23, included an order for the skilled nurse to visit of twice a week for one week, once a week for seven weeks, to assess all body systems, vital signs (measure the basic functions of your body that includes your body temperature, blood pressure, pulse and respiratory [breathing] rate), pain level, severe shortness of breath, blood sugar check(measures the level of glucose in your blood), medication and diet compliance, and safety on every visit. Skilled nursing to evaluate the pain level every visit and the effectiveness of pain management. Patient desired goals: reduce pain from 4/10 to 1-2/10, increase activity tolerance, no falls/hospitalizations. Discharge when optimal function attained with family/caregiver assist, when all goals are met. A review of Patient 7's Skilled Visit Notes dated 4/4/23 through 4/30/23, indicated Patient 7 was assessed to have an intermittent dull pain level of 3/10 (mild to moderate pain - 0 as no pain and 10 as the worst pain) on her lower back and both lower extremities. The intervention was rest and medication with Tylenol extra strength 500 mg 1 tab every 6 hours as needed for pain. However, there was no documentation for post pain assessment was done. On 5/7/23, at 1 p.m., during an interview with the DPCS (director of patient care services), she stated the visiting nurse should do a post pain assessment and response to treatment if pain was relieved. A review of the agency's policy and procedure titled "Ongoing Assessments", dated 4/2018 indicated during each home visit, the clinician and other discipline will re-evaluate the patient according to the problems identified during the initial and subsequent visits. Using the standards of care identified by the organization, the clinician will reassess the patient as appropriate for: blood pressure , pulse, respirations, temperature, pain status when applicable.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to provide patient and caregiver education as indicated in the plan of care (POC) for 2 of 7 sampled patients, (Patients 5 and 6). This failure had the potential to result in the HHA's inability to ensure needed services and high quality healthcare were provided to the patients under their care. A joint home visit was conducted on 5/6/23 at 11:00 a.m., at Patient 5 and Patient 6’s residence with licensed vocational nurse 1 (LVN 1). Patient 5 and 6 are husband and wife admitted to the home health agency. A review of Patient 5’s Face sheet indicated that a Start of Care (SOC) date of 2/28/23 with the certification period reviewed on 2/28/23 to 4/28/23 with a diagnosis of hypertensive heart disease (refers to heart problems that occur because of high blood pressure that is present over a long time) and spinal stenosis lumbar region (is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older) Skilled nursing (SN) visit frequency of twice a week for two weeks and once a week for seven weeks. Physical Therapy (PT) for evaluation and treatment. SN to perform each visit vital signs every visit, scale pain (0-10) implement pain relieving measures and evaluate its effectiveness. SN to assess/monitor for medication effectiveness, possible adverse effects and duplication. SN to instruct/validate patient/caregiver(CG) on medications/high risk medications as to dosage, route, frequency and side effects. signs and symptoms of bleeding, bleeding precautions related to aspirin intake and other non-drug methods to control the disease. SN to report to MD(medical doctor) ineffectiveness of current medications. Ancillaries as ordered by MD. Notify agency of significant clinical findings, negative outcomes, medication/service/treatment/personal changes, CG status and other relevant matters. A review of Patient 6’s Face sheet indicated that a Start of Care (SOC) date of 2/28/23 with the certification period reviewed on 2/28/23 to 4/28/23 with a diagnosis of type 2 diabetes (means that your body doesn't use insulin properly and while some people can control their blood glucose (blood sugar) levels with healthy eating and exercise, others may need medication or insulin to manage it) and bilateral primary osteoarthritis (occurs when both knees are affected with OA. OA is a painful, degenerative condition that can reduce your mobility and make daily tasks difficult to manage. Early diagnosis and treatment may decrease joint damage and improve your overall quality of life). SN visit frequency of twice a week for two weeks and once a week for seven weeks. PT for evaluation and treatment. SN to perform each visit vital signs every visit, scale pain (0-10) implement pain relieving measures and evaluate its effectiveness. SN to assess/monitor for medication effectiveness, possible adverse effects and duplication. SN to instruct/validate patient/CG on medications/high risk medications as to dosage, route, frequency and side effects. signs and symptoms of bleeding, bleeding precautions related to aspirin intake and other non-drug methods to control the disease. SN to report to MD ineffectiveness of current medications. Ancillaries as ordered by MD. Notify agency of significant clinical findings, negative outcomes, medication/service/treatment/personal changes, CG status and other relevant matters. During the joint home visit on 5/6/23 at 11:00 a.m., with Patient 5 complained that she has constant pain on her lower back when sitting, standing or walking for long periods of time. Patient 5 stated that her pain level was usually an 8/10( pain scale measures a patient's pain intensity from 0 being the lowest and 10 being the highest pain intensity) before medications and one hour after medication it was about 3-4 out of 10. Patient stated she refused physical therapy services because of her history of contracting Covid-19 and the fear of contracting the disease again. Patient 5 stated they were both vaccinated with Covid-19. Patient 5 stated there was no instructions on what PT services would provide for her condition. Patient 5 stated she would like to try PT services. During an interview with LVN 1 at the same date and time, LVN 1 stated that she will inform the office and the caregiver on the importance of following the physician's order for rehabilitation as part of pain management. LVN 1 stated it is the goal of home health to continuously educate patients every home visits of home health services. During an interview with the Director of Nursing (DON) on 5/7/23 at 11:15 a.m., DON stated they refused PT services before and will send PT services to evaluate patient as ordered and the importance of continuous patient education every home visit. A review of the HHA's policy titled " Ongoing Assessments" dated 4/2018, indicated that during each home visit, the clinician or other disciplines will re-evaluate the patient according to the problems identified during the initial and subsequent visits. A review of the HHA's policy titled "Nursing Services" indicated nursing care should be provided in accordance with the patient's plan of care. The policy indicated professional nursing services should include those requiring substantial and specialized skilled services educating the patient and family regarding the disease process, self-care techniques and prevention strategies.