Every finding on record at Patience Home Healthcare Service LLC The

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 05/09/25, Patience Home Health Service is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Partial Extended Recertification Survey The following deficiencies are based on the partial extended recertification survey completed 05/09/25. The Patience Home Health Services LLC is not in compliance with the requirements found at 42 CFR Part 484, Subpart B,C, Home Health Agencies.

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 Centers for Medicare & Medicaid Services (CMS) IQIES summary of Error Report and interview, the facility failed to transmit each completed OASIS assessment to the CMS system within 30 days of completing the assessment. This had the potential to affect all 73 patients of the facility. Review of the CMS IQIES Summary of Error Report revealed between 01/01/24 and 12/31/24 error number 3330 triggered. The facility had mid/late submission OASIS assessments of more than 30 days based on the information contained on question M0090. Information completed revealed 563 errors for 96.90% error rate. Interview on 05/06/25 at 12:22 P.M. with the Director of Nursing/Administrator/Owner, Staff B, verified she had late submissions last year. Staff B stated they moved to a new location last year and the OASIS information was in boxes that were not addressed timely.

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 record review and interview, the facility failed to ensure the patient and/or representative were informed of the agency's transfer and discharge policy. This affected all 73 residents of the facility. Review of the Admission packet revealed no evidence of the patient and/or representative being informed of agency's transfer and discharge policy. Interview on 05/06/25 at 12:42 P.M. with Director of Nursing/ Administrator/Owner, Staff B, verified the patients were not informed of the transfers and discharge policies.

HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator's name, business address, and business phone number in order to receive complaints. This ELEMENT is not met as evidenced by: Based on record review and interview, the facility failed to ensure the patient and/or representative were informed of the contact information for the agency administrator. This affected all 73 residents of the facility. Review of the Admission Packet revealed no evidence of the patient and/or representative being informed the Administrator's name, business address, and business phone number in order to receive complaints. Interview on 05/06/25 at 12:26 P.M. with Director of Nursing/Administrator/Agency Owner, Staff B, verified she does not include her name as the Administrator in the Admission Packet. Staff B stated she does home visits as the nurse for recertifications and start of care. She said she did not want patients knowing she was the Administrator. Staff B was concerned patients would be calling her all the time.

Contact info Federal/State-funded entities CFR(s): 484.50(c)(10)(i,ii,iii,iv,v) Be advised of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: (i) Agency on Aging (ii) Center for Independent Living (iii) Protection and Advocacy Agency, (iv) Aging and Disability Resource Center; and (v) Quality Improvement Organization. This ELEMENT is not met as evidenced by: Based on record review and interview, the facility failed to ensure the patient and/or representative were informed of the names, addresses, and telephone numbers of the Federally-funded and state-funded entities that serve the area. This affected all 73 patients of the facility. Review of the Admission packet revealed no evidence of the patient and/or representative being informed of names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area: the Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center, and Quality Improvement Organization. Interview on 05/06/25 at 12:42 P.M., the Director of Nursing/Administrator/ Agency Owner, Staff B, verified the patients were not provided the names, addresses, and telephone numbers of the Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center, and Quality Improvement Organization as required.

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on record review, interview, and policy review, the facility failed to document the details and the resolution of complaints. This had the potential to affect all 73 current patients. Review of the complaint binder with the Administrator, Staff B, revealed there were complaints typed, or hand written, on plain paper or forms. The binder contained the following: 1. A complaint dated 09/19/20 by a former aide related to a former resident's father being inappropriate had no resolution. 2. A complaint dated 10/07/24 by Staff ZZ about a missing laundry card for Patient #10. There was not a written statement by the patient or written resolution. 3. There was a statement dated 11/11/24 by an unnamed aide related to Patient #79 stating the aide never borrowed money from the patient. The staff stated they lived together and the money was for her portion of the rent. There was no corresponding patient complaint or resolution written. 4. There was an undated written statement by Staff QQQ related to Patient's #62 and Patient #32’s home and unsafe working conditions. There was no resolution written. Staff B identified the statement was written 12/18/24. 5. An undated written statement by Former Staff TTT was related to what services she provided and conversations she had with Patient #79. The statement indicated she was ill and forgot to text the patient. It stated Staff TTT found out the patient called the agency and wanted a new aide. Staff TTT stated she was not permitted to return to have the time sheet signed. There was not a corresponding complaint by Patient #79. Staff B stated the statement should have been dated 02/20/25. There was not a complaint resolution logged. 6. An undated statement was written by Staff ZZ about Patient #67 without a corresponding complaint included. Staff B identified the statement to be written 02/26/25 related to alleged missing over the counter medication that had been delivered. Patient #67 was in her home and stated she did not see Staff ZZ take anything. There was no resolution written. Review of the policy titled “Complaint Resolution,” revised 2013, revealed the agency would document both the existence and the resolution of the complaint. The complaints would be logged, tracked and trended. Interview on 05/08/26 at 3:22 P.M. with Staff B revealed she had a complaint binder and form that includes the complaint statement and resolution on one page. The binder and sheets had not been utilized since the move to the new location over a year ago. She verified the complaints were not logged, with the statements and resolutions.

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 record review, interview, observation, and policy review, the facility failed to ensure the patient's clinical record accurately identify all medications the patient was taking. This affected one (Patient #15) of three patients who had home visits conducted. Record review revealed Patient #15 had a start of care date of 08/31/15. Diagnoses included epilepsy, asthma, gastroesophageal reflux disease, anxiety disorder, transient ischemic attack and presence of a cardiac pacemaker. The certification period reviewed was 03/11/25 to 05/09/25. The 485 contained a medication list the Director of Nursing identified to be up to date. During a home visit on 05/07/25 at 11:17 A.M., Registered Nurse (RN), Staff P, had a handwritten medication profile list at the home. Review of the 485 medication list, the handwritten medication profile in the home, and the medications on hand with Staff P revealed gabapentin 300 milligrams (mg) orally three times a day was on the agency list. Patient #15 stated she quit taking this medication a while ago. Naproxen 500 mg one tablet as needed for pain was on the list. The patient stated she does not take Naproxen. Sertraline 100 mg orally one and a half tablets daily was on the 485 list, but not on the handwritten list in the home. Patient #15 stated she takes the sertraline and retrieved the bottle. Staff P stated she did not know the patient was taking the antidepressant and had not been filling her pill container with them. Tylenol Arthritis 650 mg one tablet every six hours as needed for pain was on the 485 and the patient stated she did not take them, Trazadone 100 mg one tablet nightly for sleep was on the 485, but the patient stated she had not taken them for a while. Vimpat 150 mgs one in the morning and one and a half tablets in the evening was on the 485. The prescription bottle, filled 05/01/25, had directions of one tablet in the morning and one tablet in the evening. The patient stated because she was having seizures the doctor increased the evening dose to two tablets the last time she was there. Interview on 05/09/25 at 5:31 P.M. with Staff P verified the medication list in the home did not match the medication list associated with the plan of care. Additionally, he verified he did not know what dose of Vimpat the patient was to receive based on the prescription bottle. Staff P stated what the 485 said and what the patient said she took did not match. Review of the facility policy titled “Medication Reconciliation,” revised March 2018, revealed medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication. The patient’s medication list in the home will also be updated.

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 record review and interview, the agency failed to ensure each patient received home health services as written in the individualized plan of care for four (#15, #40, #79 and #81) of seven patients reviewed. This could affect all patients receiving services from the agency. The active census was 73. 1.Record review revealed Patient #15 had a start of care date of 08/31/15. Diagnoses included epilepsy, asthma, gastroesophageal reflux disease, anxiety disorder, transient ischemic attack and presence of a cardiac pacemaker. The certification period reviewed was 03/11/25 to 05/09/25. The POC identified the patient was to receive Home Health Aide (HHA) services 13 hours week. Review of the HHA time sheets for the certification period revealed the patient was receiving nine hours of HHA services a week. Interview 05/08/25 at 1:08 P.M. with the Director of Nursing, Administrator and Owner, Staff B, revealed the POC should say nine hours of HHA services, not 13 hours. 2.Record review revealed Patient #40 had a start of care date of 09/11/24. Diagnoses included cerebral palsy. The certification period reviewed was 03/10/25-05/08/25. The POC identified skilled nurse hours were to be one time a week. The HHA was to provide 14 hours a week. Review of the HHA time sheets for the certification period revealed the patient had a missed HHA visit the week of 03/09/25. The patient received 11 hours for the week instead of 14 as care planned. There was no evidence of physician notification of missed nurse aide visit. Review of the nursing visits revealed the nurse did not do any weekly visits. There was no evidence of the physician being notified of the nurse not providing weekly visits. Interview 05/06/25 at 4:17 P.M, with Staff MM revealed the POC should say nurse visit once ever 60 days instead of weekly. Staff MM verified she did notify the physician of missed visits, stating she did not know she was supposed to call the physician about missed visits. 3. Record review revealed Patient #79 had a start of care date of 03/02/24. Diagnoses included traumatic brain injury. The certification period reviewed was 03/31/25-05/29/25. The POC stated patient would receive 30 hours a week of HHA services. Review of the HHA time sheets for the certification period revealed the patient had a missed aide visits every week of the certification period to date. The week of 03/30/25 and 04/06/25 the patient received 27 of 30 hours. The week of 04/13/25 the patient received 26 of 30 hours. The week of 04/20/25 the patient received 23 of 30 hours. The week of 04/27/25 the patient received 23 of 30 hours. Interview 05/08/25 at 4:21 P.M, with Staff MM revealed she did not know she had to notify the physician of missed visits. She indicated she notified case managers. 4. Record review revealed Former Patient #81 had a start of care date of 03/03/23. Diagnoses included Parkinson, chronic obstructive pulmonary disease, anxiety disorder, and morbid obesity. The certification period reviewed was 02/26/24-04/25/24. The skilled nurse POC included the nurse was to visit twice a week for wound care. There was no evidence of twice weekly nurse visits. The order was for skilled nurse once every 60 days. Interview on 05/06/25 at 5:40 P.M, Staff B revealed the hours were changed in December 2023 to skilled nursing every 60 days. She verified the POC included a skilled nurse visit twice a week for wound care, which wasn't done.