Every finding on record at Pinnacle Home Health Agency Inc

The following represents the findings during a complaint validation survey conducted by the California Department of Public Health on 10/17/24. Complaint number: 110210 The following Conditions of Participation were reviewed: 484.1 Basis and Scope 484.100 Comply with all Federal/State/Local laws The following Conditions of Participation were not met: 484.1 Basis and Scope 484.100 Comply with all Federal/State/Local laws See tag G325 and G848.

Basis and Scope CFR(s): §484.1 Basis and Scope (a) Basis. This part is based on: (1) Sections 1861(o) and 1891 of the Act, which establish the conditions that an HHA must meet in order to participate in the Medicare program and which, along with the additional requirements set forth in this part, are considered necessary to ensure the health and safety of patients; and (2) Section 1861(z) of the Act, which specifies the institutional planning standards that HHAs must meet. (b) Scope. The provisions of this part serve as the basis for survey activities for the purpose of determining whether an agency meets the requirements for participation in the Medicare program. This CONDITION is not met as evidenced by: Based on interview and record review, the Home Health Agency operated with a suspended and expired license. The Agency's license was suspended on 4/2/24 and expired on 7/15/24. The agency continued to accept patients and bill Medicare. Record review of the document “Barclays California Code of Regulations,” dated 2013, showed “No person, firm, partnership, association, corporation, receiver, political subdivision of the State or other governmental agency within the State shall establish, operate or maintain a home health agency or hold out, represent or advertise by any means that it operates a home health agency without first obtaining a license from the Department.” During a review of the California Electronic Licensing Management System (ELMS), ELMS indicated the Agency’s license was suspended by the Franchise Tax Board 4/2/24. During a review of the California Secretary of State’s website, the website indicated the Agency’s license was suspended on 4/2/24. During an observation on 10/17/2024 at 10:05 a.m. at the Agency’s office, the Agency’s license showed it had expired on 7/15/2024. In a concurrent interview, the Director of Nursing (DON) confirmed the agency’s license had expired on July 15, 2024. The DON stated the Agency had been accepting patients for admission since that date and continued to bill Medicare. Record review of the document "Patient Report Census," dated 10/17/2024, showed the Agency billed Medicare for patient services from April through September 2024.

Compliance with Federal, State, Local Law CFR(s): 484.100 Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients. The HHA and its staff must operate and furnish services in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients. If state or local law provides licensing of HHAs, the HHA must be licensed. This CONDITION is not met as evidenced by: Record review of the document “Barclays California Code of Regulations,” dated 2013, showed “No person, firm, partnership, association, corporation, receiver, political subdivision of the State or other governmental agency within the State shall establish, operate or maintain a home health agency or hold out, represent or advertise by any means that it operates a home health agency without first obtaining a license from the Department.” During a review of the California Electronic Licensing Management System (ELMS), ELMS indicated the Agency’s license was suspended by the Franchise Tax Board 4/2/24. During a review of the California Secretary of State’s website, the website indicated the Agency’s license was suspended on 4/2/24. During an observation on 10/17/2024 at 10:05 a.m. at the Agency’s office, the Agency’s license showed it had expired on 7/15/2024. In a concurrent interview, the Director of Nursing (DON) confirmed the agency’s license had expired on July 15, 2024. The DON stated the Agency had been accepting patients for admission since that date and continued to bill Medicare. Record review of the document "Patient Report Census," dated 10/17/2024, showed the Agency billed Medicare for patient services from April through September 2024.