Every finding on record at Preferred Home Health Care & Nursing Services, Inc.

Based on the findings of an onsite unannounced Medicare recertification survey conducted March 15, 2022 through March 17, 2022, Preferred Home Health Care and Nursing Services, Inc., was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an onsite unannounced home health agency Medicare recertification survey conducted March 15, 2022, through March 17, 2022, Preferred Home Health Care and Nursing Services, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on a review of agency policy, clinical records (CR), and interview with the administrator, it was determined, that the Agency failed to follow its policy pertaining to items to be included on the plan of care for three (3) of seven (7) CR's reviewed (CR #1, 2, and 4). Findings include: A review of agency policy titled "Care Plan Management" on March 15, 2022 at approximately 1:00 pm states, "Policy: To ensure that a client's needs are being met adequately and appropriately, and services are adapted and adjusted within an individual client situation as needed, a care plan is essential. A care plan is started upon initiation of service by the registered nurse with continuing evaluation and service modifications indicated as an integral part of the ongoing provision of Agency services...The Plan of Care Addresses: 1. Tasks and schedule of care/services to be provided..." A review of CR's was conducted on March 15, 2022 from approximately 11:00 am to 3:00 pm and on March 16, 2022 from approximately 9:15 am to 2:00 pm revealed the following: CR #2, Start of Care: 8/29/2019. Home Health Certification and Plan of Care certification period reviewed 3/01/2022 through 4/20/2022. Orders state "Patient is receiving HHA (Home Health Aide) services four (4) hours per day on school days, nine (9) hours per day on non school days for parents to work and commute, and seven (7) hours per day on half school days. HHA four (4) to nine (9) hours per day five (5) days per week." Order does not include tasks/care to be provided. Findings Include: A review of agency policy titled "Care Plan Management" on March 15, 2022, at approximately 1:00 pm states, "Policy: To ensure that a client's needs are being met adequately and appropriately, and services are adapted and adjusted within an individual client situation as needed, a care plan is essential. A care plan is started upon initiation of service by the registered nurse with continuing evaluation and service modifications indicated as an integral part of the ongoing provision of Agency services...The Plan of Care Addresses: 1. Tasks and schedule of care/services to be provided..." A review of CR's was conducted on March 15, 2022, from approximately 10:30 am to 3:00 pm and on March 16, 2022, from approximately 11:15 am to 2:00 pm revealed the following: CR #1, Start of Care: 5/21/2013. Home Health Certification and Plan of Care certification period reviewed 1/16/2022 through 3/17/2022, contained orders for HHA (Home Health Aide) services nine (9) to twelve (12) hours per day times five (5) days per week (Monday through Friday), and twelve (12) hours per day (Saturday and Sunday) times sixty (60) days. Order does not include tasks/care to be provided. CR #4, Start of Care: 6/16/2014. Home Health Certification and Plan of Care certification period reviewed 12/10/2021 through 2/8/2022 and discharged on 2/8/2022, contained orders for HHA (Home Health Aide) services five (5) to seven (7) hours per day times five (5) days per week times sixty (60) days. Order does not include tasks/care to be provided. An interview with the administrator conducted March 17, 2022, at approximately 11:00 am confirmed the above findings.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on a review of agency policy, clinical record (CR) reviews, and interview with the administrator, the agency failed to provide care/physician's orders in accordance with the plan of care for six (6) of seven (7) CR's reviewed, (CR #1, 2, 3, 4 5, and 7). Findings include: A review of agency policy titled "Care Plan Management" conducted on March 15, 2022 at approximately 12:45 pm, states, "Procedure: Client Notification of Changes: 4. Pennsylvania Offices Only - Missed Shift Reporting: If the visit cannot be rescheduled, Agency staff will complete a Missed Visit Report and send a copy to the attending physician or allowed practitioner for due diligence. The Missed Visit Report will be placed in the client's chart...." A review of CR's was conducted on March 15, 2022 from approximately 10:00 am to 3:00 pm and on March 16, 2022 from approximately 9:00 am to 2:00 pm revealed the following: CR#2, Start of Care: 7/18/19. Home Health Certification and Plan of Care Certification period reviewed 1/19/2022 through 3/20/2022 contained orders for SN (Skilled Nursing) eight (8) hours per day one (1) day per week, ten (10) hours per day two (2) days per week, and eighteen (18) hours per day three (3) days per week times sixty (60) days. A verbal order written on 2/16/2022 contained orders for SN eight (8) hours per day one (1) day per week, eighteen (18) hours per day four (4) days per week, and ten (10) hours per day one (1) day per week times sixty (60) days. Visit documentation revealed: For the week of 1/19/2022 through 1/23/2022, SN visit hours were: 1/19/2022 - 19 hours 1/20/2022 - 19 hours 1/21/2022 - 19 hours 1/22/2022 - 10 hours For the week of 1/24/2022 through 1/29/2022, SN visit hours were: 1/24/2022 - 8 hours 1/25/2022 - 19 hours 1/26/2022 - 19 hours 1/27/2022 - 19 hours 1/28/2022 - 10 hours. Visit calendar indicates missed shift for 11:00 pm to 7:00 am (8 hours) without any missed shift documentation and no documentation physician was notified of missed shift. 1/29/2022 - Visit calendar indicates missed shift for 7:00 am to 5:00 pm (10 hours) without any missed shift documentation and no documentation physician was notified of missed shift. For the week of 1/31/2022 through 2/6/2022, SN visit hours were: 1/31/2022 - 8 hours 2/1/2022 - 19 hours 2/2/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation physician was notified of missed shift. 2/3/2022 - 19 hours. 2/4/2022 - 18 hours 2/5/2022 - Visit calendar indicates missed shift for 7:00 am to 5:00 pm (10 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. For week of 2/7/2022 through 2/13/2022, SN visit hours were: 2/7/2022 - 8 hours 2/8/2022 - 19 hours 2/9/2022 - 19 hours 2/10/2022 - 19 hours 2/11/2022 - 19 hours 2/12/2022 - 10 hours For the week of 2/14/2022 through 2/20/2022, SN visit were: 2/14/2022 - Visit calendar indicates missed shift for 10:00 pm to 6:00 am (8 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 2/15/2022 - 19 hours 2/16/2022 - 19 hours 2/17/2022 - 19 hours 2/18/2022 - 18 hours 2/19/2020 - 10 hours For the week of 2/21/2022 through 2/27/2022, SN visits were: 2/21/2022 - 8 hours 2/22/2022 - 19 hours 2/23/2022 - 19 hours 2/24/2022 - 19 hours 2/25/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 2/26/2022 - 10 hours. For the week of 2/28/2022 through 3/6/2022, SN visits were: 2/28/2022 - 8 hours 3/1/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/2/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/3/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/4/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/5/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. Week of 3/7/2022 through 3/13/2022, SN visits were: 3/7/2022 - 8 hours 3/8/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/9/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/10/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/11/2022 - 10 hours. Visit calendar indicates missed shift for 10:00 pm to 7:00 am (9 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/12/2022 - 10 hours. CR #5, Start of Care: 8/29/19. Home Health Certification and Plan of Care Certification period reviewed 3/1/2022 through 4/30/2022 contained orders for Home Health Aide (HHA) four (4) to nine (9) hours per day, five (5) days per week as follows: four (four) hours per day on school days; nine (9) hours per day on non school days for parents to work and commute; and seven (7) hours per day on half school days. Visit documentation revealed: For the week of 3/1/2022 through 3/6/2022, HHA visits were: 3/1/2022 - 6 hours 3/2/2022 - 6 hours 3/3/2022 - 6 hours 3/4/2022 - 2 hours For the week of 3/7/2022 through 3/13/2022, HHA visits were: 3/7/2022 - 11 hours 3/8/2022 - 6 hours 3/9/2022 - 6 hours 3/10/2022 - 6 hours 3/11/2022 - 2 hours CR#7, Start of Care: 2/14/2022. Home Health Certification and Plan of Care Certification period reviewed 2/15/2022 through 4/16/2022 contained orders for SN twenty-four (24) hours per day times two (2) weeks, then sixteen (16) hours per day thereafter. Visit documentation revealed: For the week of 2/15/2022 through 2/20/2022, SN visits were: 2/15/2022 - 22.25 hours 2/16/2022 - 20.25 hours 2/17/2022 - 24 hours 2/18/2022 - 22 hours. Visit calendar indicates missed shift for 11:00 pm to 1:00 am (2 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 2/19/2022 - 20.5 hours 2/20/22 - 12 hours For the week of 2/21/2022 through 2/27/2022, SN visits were: 2/21/2022 - 16.5 hours 2/22/2022 - 22 hours 2/23/2022 - 17 hours 2/24/2022 - 17 hours 2/25/2022 - 12 hours 2/26/2022 - 20 hours 2/27/2022 - 12 hours For the week of 2/28/2022 through 3/6/2022, SN visits were: 2/28/2022 - 6.5 hours 3/1/2022 - 8 hours. Visit calendar indicates missed shift for 7:00 am to 3:00 pm (8 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 3/2/2022 - 21 hours 3/3/2022 - 21 hours 3/4/2022 - 8 hours 3/5/2022 - 8 hours 3/6/2022 - no hours For the week of 3/7/2022 through 3/13/2022, SN visits were: 3/7/2022 - 8.5 hours 3/8/2022 - 16.5 hours 3/9/2022 - 16 hours 3/10/2022 - 21 hours 3/11/2022 - 9 hours 3/12/2022 - 16.5 hours 3/13/2022 - no hours An interview with the administrator conducted March 17, 2022 at approximately 11:00 am confirmed the above findings. Findings include: A review of agency policy titled "Care Plan Management" conducted on March 15, 2022, at approximately 12:45 pm, states, "Procedure: Client Notification of Changes: 4. Pennsylvania Offices Only - Missed Shift Reporting: If the visit cannot be rescheduled, Agency staff will complete a Missed Visit Report and send a copy to the attending physician or allowed practitioner for due diligence. The Missed Visit Report will be placed in the client's chart...." A review of CR's was conducted on March 15, 2022, from approximately 10:30 am to 3:00 pm and on March 16, 2022, from approximately 9:00 am to 2:00 pm revealed the following: CR #1, Start of Care 5/21/2013. Certification period 1/16/2022 through 3/17/2022. Contained orders for Skilled Nursing (SN): Twelve (12) hours for five (5) nights per week for sixty (60) days, and Home Health Aide (HHA): Nine (9) to twelve (12) hours per day for five (5) days per week (Monday – Friday), and twelve (12) hours per day (Saturday and Sunday) for sixty (60) days. Visit documentation revealed: For the week of 1/16/2022, SN visit hours were: 1/16/2022 – 5 hours For the week of 1/17/2022 through 1/23/2022, SN visit hours were: 1/17/2022 – 12 hours 1/18/2022 – 12 hours 1/19/2022 – 12 hours 1/20/2022 – 12 hours 1/21/2022 – 7 hours 1/23/2022 – 5 hours For the week of 1/24/2022 through 1/30/2022, SN visit hours were: 1/24/2022 – 12 hours 1/25/2022 – 12 hours 1/26/2022 – 12 hours 1/27/2022 – 12 hours 1/28/2022 – 7 hours 1/30/2022 – 5hours For the week of 1/31/2022 through 2/6/2022, SN visit hours were: 1/31/2022 – 7 hours. Visit calendar indicates missed shift for 7:00 pm to 12:00 am (5 hours) included missed shift documentation and documentation physician was notified of missed shift. 2/1/2022 – 12 hours. Visit calendar indicates missed shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours) included missed shift documentation and documentation physician was notified of missed shift. 2/2/2022 – 12 hours. Visit calendar indicates missed shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours) included missed shift documentation and documentation physician was notified of missed shift. 2/3/2022 – 12 hours. Visit calendar indicates missed shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours) without any missed shift documentation and no documentation physician was notified of missed shift. 2/4/2022 – 7 hours. Visit calendar indicates missed shifts for 12:00 am to 7:00 am (7 hours) without any missed shift documentation and no documentation physician was notified of missed shift. 2/6/2022 – 5 hours. Visit calendar indicates missed shifts for 7:00 pm to 12:00 am (5 hours) without any missed shift documentation and no documentation physician was notified of missed shift. For the week of 2/7/2022 through 2/13/2022, SN visit hours were: 2/7/2022 – 7 hours. Visit calendar indicates missed shift for 12:00 am to 7:00 am (7 hours) without any missed shift documentation and documentation physician was notified of missed shift. 2/7/2022 – Visit calendar does not indicate scheduled shift for 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shift. 2/8/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/9/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/10/2022 – Visit calendar does not indicate scheduled shift for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/11/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours). There was no missed shift documentation or documentation physician was notified of missed shift. 2/13/2022 – Visit calendar does not indicate scheduled shifts for 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shift. For the week of 2/14/2022 through 2/20/2022, SN visit hours were: 2/14/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/15/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/16/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/17/2022 – Visit calendar does not indicate scheduled shift for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/18/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours). There was no missed shift documentation or documentation physician was notified of missed shift. 2/20/2022 – Visit calendar does not indicate scheduled shifts for 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shift. For the week of 2/21/2022 through 2/27/2022, SN visit hours were: 2/21/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/22/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/23/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/24/2022 – Visit calendar does not indicate scheduled shift for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 2/25/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours). There was no missed shift documentation or documentation physician was notified of missed shift. 2/27/2022 – Visit calendar does not indicate scheduled shifts for 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shift. For the week of 2/28/2022 through 3/6/2022, SN visit hours were: 2/28/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/1/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/2/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/3/2022 – Visit calendar does not indicate scheduled shift for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/4/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours). There was no missed shift documentation or documentation physician was notified of missed shift. 3/6/2022 – Visit calendar does not indicate scheduled shifts for 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shift. For the week of 3/7/2022 through 3/13/2022, SN visit hours were: 3/7/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/8/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/9/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/10/2022 – Visit calendar does not indicate scheduled shift for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/11/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours). There was no missed shift documentation or documentation physician was notified of missed shift. 3/13/2022 – Visit calendar does not indicate scheduled shifts for 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shift. For the week of 3/14/2022 through 3/20/2022, SN visit hours were: 3/14/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/15/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. 3/16/2022 – Visit calendar does not indicate scheduled shifts for 12:00 am to 7:00 am (7 hours) and 7:00 pm to 12:00 am (5 hours). There was no missed shift documentation or documentation physician was notified of missed shifts. For the week of 1/16/2022, HHA visit hours were: 1/16/2022 – 12 hours For the week of 1/17/2022 through 1/23/2022, HHA visit hours were: 1/17/2022 – 12 hours 1/18/2022 – 12 hours 1/19/2022 – 12 hours 1/20/2022 – 12 hours 1/21/2022 – 12 hours 1/22/2022 – 12 hours 1/23/2022 – 12 hours For the week of 1/24/2022 through 1/30/2022, HHA visit hours were: 1/24/2022 – 12 hours 1/25/2022 – 12 hours 1/26/2022 – 12 hours 1/27/2022 – 12 hours 1/28/2022 – 12 hours 1/29/2022 – 12 hours 1/30/2022 – 12 hours For the week of 1/31/2022 through 2/6/2022, HHA visit hours were: 1/31/2022 – 12 hours 2/1/2022 – 12 hours 2/2/2022 – 12 hours 2/3/2022 – 12 hours 2/4/2022 – 12 hours 2/5/2022 – 12 hours 2/6/2022 – 12 hours For the week of 2/7/2022 through 2/13/2022, HHA visit hours were: 2/7/2022 – 12 hours 2/8/2022 – 12 hours 2/9/2022 – 12 hours 2/10/2022 – 12 hours 2/11/2022 – 12 hours 2/12/2022 – 12 hours 2/13/2022 – 12 hours For the week of 2/14/2022 through 2/20/2022, HHA visit hours were: 2/14/2022 – 12 hours 2/15/2022 – 12 hours 2/16/2022 – 12 hours 2/17/2022 – 12 hours 2/18/2022 – 12 hours 2/19/2022 – 12 hours 2/20/2022 – 12 hours For the week of 2/21/2022 through 2/27/2022, HHA visit hours were: 2/21/2022 – 12 hours 2/22/2022 – 12 hours 2/23/2022 – 12 hours 2/24/2022 – 12 hours 2/25/2022 – 12 hours 2/26/2022 – 12 hours 2/27/2022 – 12 hours For the week of 2/28/2022 through 3/6/2022, HHA visit hours were: 2/28/2022 – 12 hours 3/1/2022 – 12 hours 3/2/2022 – 12 hours 3/3/2022 – 12 hours 3/4/2022 – 12 hours 3/5/2022 – 12 hours. Visit calendar indicates missed shift for 7:00 am to 7:00 pm (12 hours) without any missed shift documentation and no documentation physician was notified of missed shift. 3/7/2022 – 12 hours. Visit calendar indicates missed shift for 7:00 am to 7:00 pm (12 hours) without any missed shift documentation and no documentation physician was notified of missed shift. For the week of 3/7/2022 through 3/13/2022, HHA visit hours were: 3/7/2022 – 12 hours 3/8/2022 – 12 hours 3/9/2022 – 12 hours 3/10/2022 – 12 hours 3/11/2022 – 12 hours 3/12/2022 – 12 hours 3/13/2022 – 12 hours For the week of 3/14/2022 through 3/20/2022, HHA visit hours were: 3/14/2022 – 12 hours 3/15/2022 – 12 hours 3/16/2022 – 12 hours During interview on 3/17/2022 at approximately 11:00AM, administrator stated that SN nursing visits were discontinued, and that CR #1 was only receiving HHA services. Reviewed verbal order on 3/17/2022 at approximately 11:10AM. Verbal order dated 2/21/2022, states “HHA services nine (9) to twelve (12) hours per day for five (5) days per week (Monday – Friday), and twelve (12) hours per day (Saturday and Sunday) for sixty (60) days”. There was no documentation of a verbal order to discontinue SN visits from 2/7/2022 through 2/16/2022. CR #3, Start of Care 5/11/2018. Certification period 11/14/2021 through 1/13/2022 and discharged on 1/17/2022. Contained orders for Skilled Nursing (SN): Seven (7) to nine (9) hours per day times three (3) days per week times sixty (60) days. Visit documentation revealed: For the week of 11/15/2021 through 11/21/2021, SN visit hours were: 11/15/2021 – 8 hours. There was no documentation of physician order for additional 8 hours. 11/16/2021 – 8.5 hours 11/17/2021 – 8 hours 11/18/2021 – 8.5 hours 11/19/2021 – 8 hours. There was no documentation of physician order for additional 8 hours. 11/20/2021 – 8 hours. There was no documentation of physician order for additional 8 hours. For the week of 11/22/2021 through 11/28/2021, SN visit hours were: 11/23/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 11/24/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 11/25/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. For the week of 11/29/2021 through 12/5/2021, SN visit hours were: 11/30/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. 12/1/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. 12/2/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. For the week of 12/6/2021 through 12/12/2021, SN visit hours were: 12/7/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 12/8/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 12/9/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. For the week of 12/13/2021 through 12/19/2021, SN visit hours were: 12/14/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. 12/15/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. 12/16/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. For the week of 12/20/2021 through 12/26/2021, SN visit hours were: 12/21/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 12/22/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 12/23/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. For the week of 12/27/2021 through 1/2/2022, SN visit hours were: 12/28/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. 12/29/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. 12/30/2021 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) included missed shift documentation and documentation physician was notified of missed shift. For the week of 1/3/2022 through 1/9/2022, SN visit hours were: 1/4/2022 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 1/5/2022 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. 1/6/2022 – 8.5 hours. Visit calendar indicates missed shift for 7:30 am to 4:00 pm (8.5 hours) without any missed shift documentation and no documentation the physician was notified of missed shift. For the week of 1/10/2022 through 1/16/2022, SN visit hours were: 1/13/2022 – 1 hour. Discharged CR #4, Start of Care 6/16/2014. Certification period 12/10/2021 through 2/8/2022 and discharged on 2/8/2022. Contained orders for Home Health Aide (HHA): Five (2) to seven (7) hours per day times five (5) days per week times sixty (60) days. Visit documentation revealed: For the week of 12/6/2021 through 12/12/2021, HHA visit hours were: 12/8/2021 – 5 hours 12/9/2021 – 6 hours 12/11/2021 – 9.5 hours. There was no documentation of physician order for additional 2.5 hours. 12/12/2021 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. Visit documentation also revealed only four (4) HHA visits (12/8/2021, 12/9/2021, 12/11/2021, and 12/12/2021), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 12/13/2021 through 12/19/2021, HHA visit hours were: 12/15/2021 – 6.5 hours 12/16/2021 – 12.5 hours. There was no documentation of physician order for additional 5.5 hours. 12/18/2021 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. 12/19/2021 – 10 hours. There was no documentation of physician order for additional 3 hours. Visit documentation also revealed only four (4) HHA visits (12/15/2021, 12/16/2021, 12/18/2021, and 12/19/2021), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 12/20/2021 through 12/26/2021, HHA visit hours were: 12/22/2021 – 5 hours 12/23/2021 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. 12/25/2021 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. 12/26/2021 – 10.75 hours. There was no documentation of physician order for additional 3.75 hours. Visit documentation also revealed only four (4) HHA visits (12/22/2021, 12/23/2021, 12/25/2021, and 12/26/2021), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 12/27/2021 through 1/2/2022, HHA visit hours were: 12/29/2021 – 8.75 hours. There was no documentation of physician order or additional 1.75 hours. 12/30/2021 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. 1/1/2022 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. Visit documentation also revealed only three (3) HHA visits (12/29/2021, 12/30/2021, and 1/1/2022), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 1/3/2022 through 1/9/2022, HHA visit hours were: 1/5/2022 – 5.5 hours 1/6/2022 – 5 hours 1/8/2022 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. 1/9/2022 – 8.5 hours. There was no documentation of physician order for additional 1.5 hours. Visit documentation also revealed only four (4) HHA visits (1/5/2022, 1/6/2022, 1/8/2022, and 1/9/2022), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 1/10/2022 through 1/16/2022, HHA visit hours were: 1/12/2022 – 5 hours 1/13/2022 – 6.5 hours 1/15/2022 – 11.5 hours. There was no documentation of physician order for additional 4.5 hours. 1/16/2022 – 8 hours. Visit calendar indicates missed shift for 11:30 am to 7:30 pm (8 hours) without any missed shift documentation, no documentation the physician was notified of missed shift, and no documentation of physician order for additional 1 hour. Visit documentation also revealed only four (4) HHA visits (1/12/2022, 1/13/2022, 1/15/2022, and 1/16/2022), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 1/17/2022 through 1/23/2022, HHA visit hours were: 1/19/2022 – 8 hours. Visit calendar indicates missed shift for 11:30 am to 7:30 pm (8 hours) without any missed shift documentation, no documentation the physician was notified of missed shift, and no documentation of physician order for additional 1 hour. 1/20/2022 – 8 hours. Visit calendar indicates missed shift for 11:30 am to 7:30 pm (8 hours) without any missed shift documentation, no documentation the physician was notified of missed shift, and no documentation of physician order for additional 1 hour. 1/22/2022 – 11.5 hours. There was no documentation of physician order for additional 4.5 hours. 1/23/2022 – 5 hours. Visit calendar indicates missed shift for 12:30 pm to 5:30 pm (5 hours) without any missed shift documentation, and no documentation the physician was notified of missed shift. Visit documentation also revealed only four (4) HHA visits (1/19/2022, 1/20/2022, 1/22/2022, and 1/23/2022) were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 1/24/2022 through 1/30/2022, HHA visit hours were: 1/29/2022 – 5 hours. Visit calendar indicates missed shift for 12:30 pm to 5:30 pm (5 hours) included missed shift documentation and documentation physician was notified of missed shift. 1/30/2022 – 5 hours. Visit calendar indicates missed shift for 12:30 pm to 5:30 pm (5 hours) included missed shift documentation and documentation physician was notified of missed shift. Visit documentation also revealed only two (2) HHA visits (1/29/2022 and 1/30/2022), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 1/31/2022 through 2/6/2022, HHA visit hours were: 2/5/2022 – 5 hours. Visit calendar indicates missed shift for 12:30 pm to 5:30 pm (5 hours) without any missed shift documentation, and no documentation the physician was notified of missed shift. 2/6/2022 – 5 hours. Visit calendar indicates missed shift for 12:30 pm to 5:30 pm (5 hours) without any missed shift documentation, and no documentation the physician was notified of missed shift. Visit documentation also revealed only two (2) HHA visits (2/5/2022 and 2/6/2022), were scheduled instead of five (5) days per plan of care, and no documentation of physician order to change visit frequency. For the week of 2/7/2022 through 1/13/2022, SN visit hours were: 2/8/2022 – 1 hour. Discharged An interview with the administrator conducted March 17, 2022, at approximately 11:00 am confirmed the above findings.