Every finding on record at Platinum Home Health Care, Inc

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 04/16/26. Standard level deficiencies cited. Pts. = Patients

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 review of the Agency's Emergency Preparedness Plan and staff interview, it was determined the Agency failed to review and update its Emergency Plan and policies biennially. This has the potential to affect all Pts. who receive services from the Agency. Findings include: 1. The Agency's Emergency Preparedness Plan was reviewed on 04/15/26 at 10:00 AM. The Plan was last reviewed and updated by the Agency on 11/17/22. The Agency failed to review and update the Plan every two years. 2. During an interview conducted with the Administrator, Agency Supervisor and Nursing Supervisor on 04/15/26 at 10:30 AM, the above finding was confirmed.

Plan Based on All Hazards Risk Assessment CFR(s): 484.102(a)(1)-(2) §403.748(a)(1)-(2), §416.54(a)(1)-(2), §418.113(a)(1)-(2), §441.184(a)(1)-(2), §460.84(a)(1)-(2), §482.15(a)(1)-(2), §483.73(a)(1)-(2), §483.475(a)(1)-(2), §484.102(a)(1)-(2), §485.68(a)(1)-(2), §485.542(a)(1)-(2), §485.625(a)(1)-(2), §485.727(a)(1)-(2), §485.920(a)(1)-(2), §486.360(a)(1)-(2), §491.12(a)(1)-(2), §494.62(a)(1)-(2) [(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 the following:] (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.* (2) Include strategies for addressing emergency events identified by the risk assessment. * [For Hospices at §418.113(a):] Emergency Plan. The Hospice must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach. (2) Include strategies for addressing emergency events identified by the risk assessment, including the management of the consequences of power failures, natural disasters, and other emergencies that would affect the hospice's ability to provide care. *[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. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents. (2) Include strategies for addressing emergency events identified by the risk assessment. *[For ICF/IIDs at §483.475(a):] Emergency Plan. The ICF/IID must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing clients. (2) Include strategies for addressing emergency events identified by the risk assessment. This STANDARD is not met as evidenced by: Based on review of the Agency's Emergency Preparedness Plan and staff interview, the Agency failed to ensure the Emergency Preparedness Plan was based on a facility and community risk assessment, utilizing an all-hazards approach. This has the potential to affect all Pts. served by the Agency. Findings include: 1. The Agency's Emergency Preparedness Plan was reviewed on 04/15/26 at 10:00 AM. The plan lacked an all-hazards facility and community-based risk assessment for the years 2023, 2024 and 2025. 2. During an interview with the Administrator, Agency Supervisor and Nursing Supervisor on 04/15/26 at 10:30 AM, the above finding was confirmed.

Names and Contact Information CFR(s): 484.102(c)(1) §403.748(c)(1), §416.54(c)(1), §418.113(c)(1), §441.184(c)(1), §460.84(c)(1), §482.15(c)(1), §483.73(c)(1), §483.475(c)(1), §484.102(c)(1), §485.68(c)(1), §485.542(c)(1), §485.625(c)(1), §485.727(c)(1), §485.920(c)(1), §486.360(c)(1), §491.12(c)(1), §494.62(c)(1). [(c) The [facility must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following:] (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [facilities]. (v) Volunteers. *[For Hospitals at §482.15(c) and CAHs at §485.625(c)] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [hospitals and CAHs]. (v) Volunteers. *[For RNHCIs at §403.748(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Next of kin, guardian, or custodian. (iv) Other RNHCIs. (v) Volunteers. *[For ASCs at §416.45(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For Hospices at §418.113(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Hospice employees. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Other hospices. *[For HHAs at §484.102(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For OPOs at §486.360(c):] The communication plan must include all of the following: (2) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Volunteers. (iv) Other OPOs. (v) Transplant and donor hospitals in the OPO's Donation Service Area (DSA). This STANDARD is not met as evidenced by: Based on the review of the Agency's Emergency Preparedness Plan, policy review and staff interview, the Agency failed to include an updated list of the required names and contact information in the communication plan. This has the potential to affect all Pts. who receive services from the Agency. Findings include: 1.The Agency's Emergency Preparedness Plan was reviewed on 04/15/26. The plan lacked a communication plan that meets the following requirements: Updated names and contact information for all staff members and entities providing services under arrangement. 2. The policy, "Communication Plan and Policy for Emergency Operations Plan" revised 2018, required, "The communication plan is reviewed and updated at least annually...The communication plan includes the following: Names and contact information for the following: staff, entities providing services under arrangement or contract, patients' physicians..." 3. During an interview with the Administrator, Agency Supervisor and Nursing Supervisor on 04/16/26 at 10:30 AM, the above finding was confirmed.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 04/16/26. Standard level deficiencies were cited. Abbreviations: Pt./Pts. = Patient/Patients PT = Physical Therapy SOC = Start of Care AM = Morning PM = Afternoon # = number mg = milligram mcg = microgram

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on observation and interviews during a home visit, clinical record review and staff interview, for 2 of 7 (Pts. #1 and 2) clinical records reviewed, the Agency failed to ensure the information contained in the clinical records were complete and accurate. Findings include: 1. Pt. #1 was admitted to home health on 03/27/26 with the diagnosis of Nondisplaced Fracture of the head of the left radius. A home visit was conducted on 04/13/26 at 1:00 PM with E#1 (Physical Therapist). During the home visit, Pt#1's medications were reviewed. During the home visit, Pt. #1 stated that she had an updated list of medications and that came from the nurse at the facility and will bring the same list to orthopedic doctor appointment on 04/16/26. The following medication was listed: 04/02/26 - Hydralazine 10 mg, 1 tablet every 8 hours as needed for Systolic Blood Pressure greater than 160. The clinical record was reviewed on 04/14/26 and included the form “Medication Profile” printed on 04/13/26. The profile lacked documentation of the above-mentioned medication. 2. Pt. #2 was admitted to home health on 01/23/26 with the diagnosis of Cerebral Infarction, unspecified. A home visit was conducted on 04/14/26 at 9:40 AM with E#2 (Physical Therapist). During the home visit, Pt. #2’s medications were reviewed. Pt. #2 brought the medication containers and stated, “I take 8 pills” The following medications were found at Pt. #2’s home: Levothyroxine 75 mcg, 1 tablet daily (date filled 03/17/26) and Cyclobenzaprine 5 mg, 1 tablet 3 times a day (date filled 12/04/25). The clinical record was reviewed on 04/14/26 and included the form “Patient Medication Profile” printed on 04/13/26. The profile included documentation, “Levothyroxine sodium (Levothyroxine 88 mcg tablet) 88 mcg 1 tablet daily once a day oral.” The profile did not list the medication cyclobenzaprine. The medication profile was inaccurate. 3. During an interview conducted with the Administrator, Agency Supervisor and Nursing Supervisor on 04/15/26 at 10:30 AM, the above findings were confirmed.

Recertification survey completed. Standard Level deficiencies cited. Abbreviations: Pt./Pts. = Patient/Patients SOC = Start of Care AM = Morning PM = Afternoon/Evening

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: A. Based on a review of the Agency's Pt. admission folder, observation during home visits, and staff interviews, it was determined the Agency failed to ensure complete information regarding the State Hotline was provided to Pts. This was found in 7 of 7 (Pts. #1, 2, 3, 4, 5, 6 and 7) clinical records reviewed. Findings include: 1. The patient's admission folder was reviewed on 1/17/23 at 10:35 AM. The folder contained a document titled, "Complaints Hotlines," with information pertaining to the State's Complaint Hotline. This section lacked the address to forward a written complaint to the Illinois Department of Public Health. 2. The following clinical records were reviewed from 1/17/23 at 11:25 AM to 1/18/23 at 12:45 PM, and lacked the address to forward a written complaint to the Illinois Department of Public Health: Pt. #1. SOC 10/5/22. Pt. #2. SOC 11/10/22. Pt. #3. SOC 2/3/22. Pt. #4. SOC 12/12/22. Pt. #5. SOC 12/22/22. Pt. #6. SOC 7/12/22. Pt. #7. SOC 6/22/22. 3. The following home visits were conducted on 1/17/23 at 3:00 PM to 1/18/23 at 10:00 AM: Pt. #1. SOC 10/5/22. Pt. #2. SOC 11/10/22. Pt. #3. SOC 2/3/22. During the home visits, the Pt. admission folders were observed, and lacked an address for which the Pt./patient's representative may submit a complaint to the State Complaint Hotline in writing. 4. During interviews with the Administrator, Agency Supervisor, and the Nursing Supervisor on 1/18/23 at 11:25 AM and 2:00 PM, the Administrator and Agency Supervisor confirmed the Agency failed to ensure Pts. were informed of the address for the State's Complaint Hotline to forward a written complaint.

Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This ELEMENT is not met as evidenced by: A. Based on a review of the Agency's Pt. admission folder, observation and interview during a home visit, clinical record review, and staff interviews, it was determined the Agency failed to provide information regarding the Agency Supervisor. This was found in 7 of 7 (Pts. #1, 2, 3, 4, 6 and 7) clinical records reviewed. Findings include: 1. The patient's admission folder was reviewed on 1/17/23 at 10:35 AM. The folder lacked the name and contact information of the Agency Supervisor (Clinical Manager). 2. The following home visits were conducted on 1/17/23 at 3:00 PM to 1/18/23 at 10:00 AM: Pt. #1. SOC 10/5/22. Pt. #2. SOC 11/10/22. Pt. #3. SOC 2/3/22. During the home visits, the patient's admission folder was observed, and lacked the name and contact information of the Agency Supervisor. A home visit was conducted at the residence of Pt. #3 with Employee #1. During an interview with the primary caregiver of Pt. #3, the caregiver was not aware of the Agency Supervisor's name. 3. The following clinical records were reviewed from 1/17/23 at 11:25 AM to 1/18/23 at 12:45 PM, and lacked the name and contact information of the Agency Supervisor. Pt. #1. SOC 10/5/22. Pt. #2. SOC 11/10/22. Pt. #3. SOC 2/3/22. Pt. #4. SOC 12/12/22. Pt. #5. SOC 12/22/22. Pt. #6. SOC 7/12/22. Pt. #7. SOC 6/22/22. 4. During an interview with the Administrator, Agency Supervisor, and the Nursing Supervisor on 1/18/23 at 11:25 AM and 2:00 PM, the Administrator and Agency Supervisor confirmed the Agency failed to provide Pts. with the Agency Supervisor's name and contact information.