Every finding on record at Prohealth Home Health-Texas, LLC

A relicensure and recertification survey and one complaint (#43407) was conducted on 8/8/2025. The census Addison: 204 L&CHHS: 204 LHH: 0 PAS: 0 Abbreviation: IQIES – Internet Quality Improvement Evaluation System CMS – Center of Medicare and Medicaid CDC – Center of Disease Control HHA – Home Health Aide ANE – Abuse Neglect and Exploitation EMR – Employee Misconduct Registry NAR- Nurse Aide Registry L&CHHS – Licensed and Certified Home Health Services LHH – Licensed Home Health PAS – Personal Assistance Services OASIS – Outcome and Assessment Information Set PT – Physical Therapist RN - Registered Nurse No violations were cited

A relicensure and recertification survey and one complaint (#43407) and was conducted on 8/8/2025. The census Addison: 204 L&CHHS: 204 LHH: 0 PAS: 0 Abbreviation: IQIES – Internet Quality Improvement Evaluation System CMS – Center of Medicare and Medicaid CDC – Center of Disease Control HHA – Home Health Aide ANE – Abuse Neglect and Exploitation EMR – Employee Misconduct Registry NAR- Nurse Aide Registry L&CHHS – Licensed and Certified Home Health Services LHH – Licensed Home Health PAS – Personal Assistance Services OASIS – Outcome and Assessment Information Set PT – Physical Therapist RN - Registered Nurse

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 record review and interview, the Agency failed to encode and electronically transmit each completed OASIS assessment to the CMS system, within 30 days of completing the assessment of the patient for 33 of 1448 assessments processed for the time reviewed of 06/01/2024 to 12/31/2024. This failure resulted in quality data used to continuously improve the effectiveness of home healthcare failing to be reported to CMS in the required time frame. The findings included: The HHA Error Summary Report, retrieved from the iQIES website for the time of 06/01/2024 to 12/31/2024 was reviewed. Review of the HHA Error Summary Report for the time-period 06/01/2024 to 12/31/2024 identified Error #-3330. The description for Error #-3330 read in part, “Record Submitted Late: The submission date is more than 30 days after M0090 (Item M0090 specifies the date the actual assessment was completed) on this new record.” The documentation further identified the number of assessments with the error was 33 assessments and the percentage of assessments with this error was 2.28% of the total of 1448 assessments completed by the Agency. A joint interview was conducted with the Alternate Administrator and the Administrator on 8/15/2025 at 2:00 p.m. The HHA Error Summary Report was reviewed with the Alternate Administrator. The Alternate Administrator stated the Agency both acknowledged the responsibility of the late submission. The Alternate Administrator also stated that the issue was with two former employees chronically submitting the OASIS assessments late to which they no longer work at the agency as of 1/2025. During a record review of an Agency policy titled, "Timelines," dated for revision 7/1/2025, read in part, "…All completed and encoded OASIS data will be transmitted via electronic communication software that is available from CMS … It will be transmitted using electronic communications software…from the Agency or the Agency contractor to the CMS collection site within 30 days of the M0090 date…"

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review and interviews, the agency failed to administer proper written notice to 1 of 5 (Patient #12) discharged patients, in advance of the HHA termination on-going care in that: 1) The agency failed to administer Home Health Change of Care Notification to Patient #12 prior to Patient #12’s discharge. This failure could place the agency's patients at risk due to inadequate continuation of care and patient preparation prior to patient discharge. The findings included: During the entrance conference on 8/8/2025 at 1:30 p.m., with the Administrator in person. With further discussion, the agency's administrative staff were notified that a recertification and relicensure survey would be conducted, and that discharged patients will be reviewed. The surveyor requested 5 discharged patient records for review. During a record review of Patient #12 clinical records, the clinical records revealed a start of care date of 4/6/2023 with a diagnosis of chronic wounds due to leg swelling and with a certification date of 6/5/2023 to 8/3/2023. Patient #12 was receiving skilled nursing visits three times weekly. Further review of clinical records written by the Alternate Administrator, reveal Patient #12 was discharged on 6/28/2023 due to Patient #12 being transferred to another agency . Further record review revealed no evidence of the Home Health Change of Care Notification was given to Patient #12 prior to transfer. During an interview on 8/15/2025 at 3:30 p.m., with the Alternate Administrator, the Alternate Administrator was informed of the findings and acknowledged responsibility and stated that the notice could have been mailed to the Patient #12's residence. The Alternate Administrator stated that at the time she didn’t think the Home Health Change of Care Notification was needed as she made sure Patient #12 was transferred to another agency. The Alternate Administrator also stated that Patient #12 was discharged due to staff safety concerns at the time of discharge. Record review of an agency policy titled, “Advanced Beneficiary/Change of Care Notices," dated 02/01/2025, read in part, “…3. Termination - If the patient/client, or representative, wants to continue receiving care from the Agency that will not be covered by Medicare for any of the statutory reasons as listed previously and a physician orders the services, an Advanced Beneficiary Notice must be issued to the patient/client, or Representative for the Agency to charge the patient/client or secondary insurer…b. If the termination is due to an agency closure, or other reason that the agency can no longer provide services and the patient may still qualify for services, the [Home Health Change of Care Notification] is provided.”

A recertification inspection survey was conducted on 09/19/2022. The licensed and certified census was 218. No deficiencies were cited.

A recertification inspection survey was conducted on 09/19/2022. The licensed and certified census was 218. Deficiencies were cited. Abbreviations/Acronyms: Adm-Administrator Alt Adm-Alternate Administrator DON-Director of Nurses (Supervising Nurse) Alt DON-Assistant Director of Nurses (Alternate Supervising Nurse) QA Mgr.-Quality Manager RN-Registered Nurse LVN-Licensed Vocational Nurse POC/485- Plan of Care SOC- Start of Care OASIS -outcome and assessment information set SN- Skilled Nursing pt-Patient ALF-Assisted Living Facility

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure that the patient received the home health services as outlined in the individualized plan of care in one (Patient # 8) of one inactive record reviewed in which the patient had an emergency hospitalization. The failure caused the patient to not receive care and services as ordered on the POC and may have led to the patient’s emergency hospitalization for hypoglycemia. FINDINGS INCLUDED: Patient Record Review # 8: Review of Patient # 8’s clinical records revealed a POC for the certification period 05/16/2022 to 06/09/2022, signed by RN C and dated 05/23/2022. The POC had a SOC date of 05/16/2022. The POC included a primary diagnosis of Type II Diabetes. The POC included orders for SN visits two times per week for three weeks and one time per week for six weeks. Further review of the POC revealed that it included orders for “SN to perform finger stick fasting blood sugar/random blood sugar during visit if it has not been done or if patient reports signs and symptoms of hypo/hyperglycemia...” Review of SN visit note dated 05/18/2022 and signed by RN C, did not reveal that RN C performed a finger stick for blood sugar reading during this visit. The SN note also did not reveal that RN C determined if a finger stick was performed prior to her visit with Patient # 8. Review of Patient # 8’s record also revealed a transfer to inpatient facility OASIS dated 05/20/2022 that listed the “reason for emergent care” as “hypo/hyperglycemia, diabetes out of control.” The transfer OASIS was signed by DON/Alt Adm and dated 05/20/2022. Continued review of Patient # 8’s recorded revealed a physician’s order dated 05/20/2022 and signed by LVN A. The physician’s order read in part: “…Patient transferred and admitted to [hospital] on 05/20/2022 for…hypoglycemia…” Patient # 8’s record included a “Post Hospital Order [POC]” that was dated 05/23/2022 and signed by RN C. The post hospital POC included orders for SN visits one time per week for eight weeks; and for “SN to perform finger stick fasting blood sugar/random blood sugar during visit if it has not been done or if patient reports signs and symptoms of hypo/hyperglycemia...” Review of SN visit notes signed by RN C and dated 06/01/2022 and 06/08/2022, did not reveal that RN C performed a finger stick for blood sugar reading during these visits. The SN notes also did not reveal that RN C determined if the finger stick was performed prior to her visits with Patient # 8. The agency failed to ensure that Patient # 8 received blood sugar/glucose finger stick readings as outlined in the plan of care. During an interview with the DON/Alt Adm and QA Mgr., on 09/19/2022 at approximately 12:05 p.m. the surveyor discussed the above findings of why Patient # 8 did not receive the finger stick blood sugar checks as outlined in the plan of care. The QA Mgr. stated that the agency “had just rolled out a plan to help with that. I don’t know what happened.” During a follow-up telephone interview with RN C, on 09/20/2022 at 12:30 p.m., the surveyor asked why Patient # 8 did not receive the finger stick blood sugar checks as outlined in the plan of care? RN C replied, “I don’t think the facility ALF had an order to check it.” Review of agency policy titled “Plan of Care PC.8” last reviewed 010122 read in part: “V…Each patient/client must receive the home health services that are written in an individualized plan of care…”

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on record review, observation, and interview, in two (Active Patient # 2 and Inactive Patient # 8) of two records reviewed in which the clients had orders for finger stick blood sugar checks, the agency failed to Integrate services to assure the identification of patient needs and coordination of care provided by a assisted licensed facility. The failure caused the patient to not receive care and services as ordered on the POC and may have led to the patient’s emergency hospitalization for hypoglycemia. FINDINGS INCLUDED: Patient Record Review # 2: Review of Patient # 2’s clinical records revealed a POC for the certification period 07/27/2022 to 09/24/2022, signed by RN B and dated 07/26/2022. The POC had a SOC date of 03/29/2022. The POC included a primary diagnosis of Disruption of External Operation (Surgical) Wound and a secondary diagnosis of Type II Diabetes. The POC included orders for SN visits two times per week for nine weeks. Further review of the POC revealed that it included orders for “SN to perform finger stick fasting blood sugar/random blood sugar during visit if it has not been done or if patient reports signs and symptoms of hypo/hyperglycemia.” Review of skilled nurse notes signed by LVN B for the following dates, did not reveal that LVN B performed a finger stick for blood sugar reading during visits: 07/27/22, 07/29/2022 and 08/03/2022. The SN notes (07/27/22, 07/29/2022 and 08/03/2022) also did not reveal that LVN B determined if the finger sticks were performed prior to her SN visits with Patient # 2. P A SN note dated 08/05/2022 revealed that LVN B did not perform a finger stick for blood sugar reading. The 08/05/2022 SN note included a comment “Blood sugar was not taken, pt. said “I forgets [sic] to take my BS before my meals.” SN notes dated 08/11/2022, 08/17/2022, and 08/19/2022 revealed that LVN B did not perform a finger stick for blood sugar reading. SN notes (08/11/2022, 08/17/2022, and 08/19/2022) also included the comments “blood sugar was not taken, pt still cant [sic] find glucometer.” SN notes dated 08/24/2022 and 08/26/2022 revealed that LVN B did not perform a finger stick for blood sugar reading. SN Notes (08/24/2022 and 08/26/2022) also included the comment “blood sugar was not taken, “pt state [sic] I cant [sic] find my glucometer”. [sic] SN nurse notes dated 08/31/2022, 09/02/2022, 09/05/2022, and 09/07/2022 revealed that LVN B did not perform a finger stick for blood sugar reading. SN notes (08/31/2022, 09/02/2022, 09/05/2022, and 09/07/2022) included the comment “Blood Sugar is being monitored by facility staff [sic].” During a home visit with Patient # 2 and LVN C, on 09/16/2022 at approximately 10:30 a.m., the surveyor observed that Patient # 2’s finger stick was not performed by LVN C. Patient # 2 stated that he did not know where the glucometer was located. After the visit, LVN C asked the assisted living facility staff if Patient #2’s blood sugar check had been performed. The staff stated that the blood sugar had not been checked because Patient # 2 did not have a glucometer. Patient Record Review # 8: Review of Patient # 8’s clinical records revealed a POC for the certification period 05/16/2022 to 06/09/2022, signed by RN C and dated 05/23/2022. The POC had a SOC date of 05/16/2022. The POC included a primary diagnosis of Type II Diabetes. The POC included orders for SN visits two times per week for three weeks and one time per week for six weeks. Further review of the POC revealed that it included orders for “SN to perform finger stick fasting blood sugar/random blood sugar during visit if it has not been done or if patient reports signs and symptoms of hypo/hyperglycemia.” Review of SN visit note dated 05/18/2022 and signed by RN C, did not reveal that RN C performed a finger stick fasting blood sugar/random blood sugar during visit. The SN note also did not reveal that RN C determined if the finger stick was performed prior to her SN visit with Patient # 8. Review of Patient # 8’s record also revealed a transfer to inpatient facility OASIS dated O5/20/2022 that listed the “reason for emergent care” as “hypo/hyperglycemia, diabetes out of control.” The transfer OASIS was signed by the DON/Alt Adm and dated 05/20/2022. Continued review of patient # 8’s recorded revealed a physician’s order dated 05/20/2022 and signed by LVN A/RN A. The physician’s order read in part: “…Patient transferred and admitted to [hospital] on 05/20/2022 for…hypoglycemia…” Patient # 8’s record included a “Post Hospital Order [POC]” that was dated 05/23/2022 and signed by RN C. The post hospital POC included orders for SN visits one time per week for eight weeks; and for “SN to perform finger stick fasting blood sugar/random blood sugar during visit if it has not been done or if patient reports signs and symptoms of hypo/hyperglycemia...” Review of SN visit notes signed by RN C and dated 06/01/2022 and 06/08/2022, did not reveal that RN C performed a finger stick fasting blood sugar/random blood sugar during visit. The SN notes also did not reveal that RN C determined if the finger sticks were performed prior to her SN visits with Patient # 8. The agency failed to ensure that Patients # 2 and 8’s finger stick blood sugar readings were integrated and coordinated between the agency and the assisted living facility. During an interview with the DON/Alt Adm and QA Mgr., on 09/19/2022 at approximately 12:05 p.m. the surveyor discussed the above findings of why Patients # 2 and # 8 did not receive the finger stick blood sugar checks as outlined in the plan of care. For Patient # 2 the QA Mgr. stated that the agency “had just rolled out a plan to help with that (coordination with the assisted living facility). I don’t know what happened.” During a follow-up telephone interview with RN C, on 09/20/2022 at 12:30 p.m., the surveyor asked why Patient # 8 did not receive the finger stick blood sugar checks as outlined in the plan of care? RN C replied, “I don’t think the facility ALF had an order to check it.” Review of agency policy titled “…Monitoring Patient Care/Coordination of Care PC.10” revised 080120 read in part: “Purpose [:] to ensue coordination of patient/client care and treatment. Policy…II…The Agency will collaborate with a licensed facility…in which a patient/client resides…”