Every finding on record at Renaissance Home Health Care, Inc

The following reflects the findings of the California Department of Public Health during the Emergency Preparedness survey from 5/23/22 to 5/26/22. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 36471, 38630, and 39448. No deficiencies were identified from this survey.

The following reflects the findings of the California Department of Public Health during a recertification survey conducted from 5/23/22 through 5/26/22. The agency reported a patient census of 120 during the survey. The number of unduplicated admissions for the past twelve months was 584. The sample size was 13 patients with 5 home visits. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 39448, HFEN 36471, and HFEN 38630. Glossary of Terms: Aseptic - free from contamination CHHA - Certified Home Health Aide MSW - Medical Social Worker OASIS - Outcome and Assessment Information Set OM - Office Manager OT - Occupational Therapy port-a-cath - a device that is usually placed under the skin in the right side of the chest which allows easy access to a patient's veins PT - Physical Therapy SN - skilled Nurse TPN - Total Parenteral Nutrition - A special formula given through a vein that provides most of the nutrients the body needs.

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 interview and record review the agency failed to document the resolution on the grievance log for three of twenty-one complaints (1, 2, 3). As a result the outcome of the grievances was unknown. Findings: Per the agency’s Concerns Complaints, dated 2021, the following complaints did not have a documented resolution: 1 On 1/24/22 a grievance was documented related to Patient 14’s request to have a nursing visit on a specific day, which the agency did not have the staffing to accommodate. The agency’s response was “…we requested that insurance companythe patient be re-assigned to another agency…”. The outcome of Patient 14’s grievance was not documented. 2 On 2/25/22 a grievance was documented related to the agency not having enough staff to provide the ordered visits for Patient 9. The agency’s response was “…I also will call the doctor and insurance to reassign [Patient 9] to other agency that can provide all services…” The outcome of Patient 9’s grievance was not documented. 3 On 4/6/22 a grievance was documented related to Patient 15’s request to be seen by his nurse on the day of the grievance. The agency’s response was, “…[the agency] is attempting to assign another RN [Registered Nurse] at this time…”. The outcome of Patient 15’s grievance was not documented. On 5/26/22 at 9 A.M., a telephone interview was conducted with the Project Manager. The Project Manager stated, he was responsible for updating the grievance log. The Project Manager further stated, he should have documented a resolution for each grievance listed in the log. Per the agency’s policy, titled Complaint/Grievance Process, dated November 2013, “…Response to the patient regarding the complaint will occur within ten (10) days of receipt…”

Discharge Planning CFR(s): 484.58(a) Standard: Discharge planning. An HHA must develop and implement an effective discharge planning process. For patients who are transferred to another HHA or who are discharged to a SNF, IRF or LTCH, the HHA must assist patients and their caregivers in selecting a post-acute care provider by using and sharing data that includes, but is not limited to HHA, SNF, IRF, or LTCH data on quality measures and data on resource use measures. The HHA must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient's goals of care and treatment preferences. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to assist patients with discharge planning for two of four sampled patients reviewed for discharge (9, 11) As a result, there was a potential for unsafe discharge for Patients 9 and 11. Findings: 2. Per the Home Health Certification and Plan of Care, dated 10/15/21 through 12/13/21, Patient 11 was diagnosed with postsurgical malabsorption (a condition that prevents absorption of nutrients through the small intestine), under Orders For Discipline and Treatment: " Using aseptic technique, SN to teach patient/caregiver to prepare and infused a TPN therapy per port a cath..." under Discharge Plan, the agency will discharge Patient 11 when patient and caregiver demonstrate necessary skills to self-manage disease process including medication management. A record review was conducted. Per the OASIS-D1 Discharge, dated 12/13/21, SN 6 documented Patient 11 was discharged as the agency did not have adequate staff and instructed Patient 11 to call the insurance agency to assign them to another home health agency. On 5/26/22 at 9:40 A.M., an interview was conducted with SN 6. SN 6 stated Patient 11 was an unplanned discharge, and the OM told her to discharge Patient 11 because there was no other SN that could see Patient 11. SN 6 further said the OM asked her to call Patient 11 and ask Patient 11 to call the insurance company to find Patient 11 another home health agency, and so she did. Therefore, Patient 11 was discharged on 12/13/21 by the agency with no home health agency accepting Patient 11. SN 6 stated the proper discharge procedure was for the SN to discuss the discharge plan one visit before the time of discharge to ensure Patient 11's needs were met. SN 6 stated Patient 11 did not receive a proper discharge plan. On 5/26/22 at 10:15 A.M., an interview was conducted with the CM. The CM stated the agency should have followed its discharge policy and did not. Per the agency's policy and procedure, dated 11/13, titled Discharge Criteria and Process, "...The organization will verbally notify the patient of the decision to terminate or reduce services within one (1) visit prior to the time change in service is to occur (ie., prior to the last schedule visit)...For a patient requiring continuing care, assistance will be given to the patient and family/caregiver in order to manage continuing care needs..." 1. Per the Home Health Certification and Plan of Care, dated 10/13/21 through 12/11/21, Patient 9 was admitted to the agency on 10/13/21 with diagnoses to include diabetes (difficulty controlling blood sugar). On 5/24/22, Patient 9’s clinical record was reviewed. A communication note, entered by the OM, dated 2/25/22, stated the agency was no longer able to provide skilled nursing or home health aide services, and advised the family to contact their insurance company physician to reassign Patient 9 to another home health agency. The note continued to state “I [the OM] will follow up with a FAX to be sure [the physician] reassign her to another agency. There was no evidence the agency had provided resources to assist Patient 9 in selecting another home care provider, or that a follow-up message had been sent to the physician. On 5/26/22 at 9:35 A.M., the OM was interviewed. The OM stated Patient 9‘s daughter had contacted the agency asking why the SN and the HHA had not been visiting. The OM stated there was not an SN available to provide the visits. The OM stated Patient 9 wanted more HHA services than what the agency could provide.

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 interview and record review, the agency failed to ensure that staff visited patients per the plan of care for six of thirteen sampled patients (1, 3, 4, 9, 10, 13). As a result, patients did not receive the care and services ordered by their physicians. Findings: 5. Per the Home Health Certification and Plan of Care, dated 4/16/22 through 6/14/22, Patient 10 was admitted to the agency on 2/9/19 with diagnoses which included myocardial infarction (a blockage of blood flow to the heart muscle). A review of Patient 10's clinical record was conducted. Per the Physician Order, dated 4/10/21, Patient 10 had an order to be seen by the OT three times a week for four weeks. There was no documented evidence that the OT saw Patient 10. Per the Home Health Certification and Plan of Care, dated 12/17/22 through 2/14/22, Patient 10 had an order to be seen by the OT for evaluation and treatment. There was no documented evidence that the OT saw Patient 10. Per the Home Health Certification and Plan of Care, dated 2/15/22 through 4/15/22, Patient 10 had an order to be seen by the OT for evaluation and treatment. There was no documented evidence that the OT saw Patient 10. On 5/26/22 at 9:08 A.M., a joint interview and record review was conducted with SN 5. SN 5 stated Patient 10 was not seen by the OT and was unsure what happened. SN 5 said she wrote the orders, and the office should have scheduled the OT to see Patient 10. SN 5 further stated the physician should have been notified when the staff could not follow the plan of care. 6. Per the Home Health Certification and Plan of Care, dated 4/28/22 through 6/28/22, Patient 13 was admitted to the agency on 4/28/22 with diagnoses which included diabetes mellitus (abnormal blood sugar level). Per the POC, Patient 13 was to be seen by the MSW to help with housing needs. A review of Patient 13's clinical record was conducted. Per the OT Discharge note, dated 5/12/22, OT documented Patient 13 inquired about the status of the MSW order. On 5/25/22 at 11:10 A.M., during a home visit with PT 4. PT 4 told Patient 13 that Patient 13 would be discharged from the agency by the next visit. Patient 13 then asked about the MSW. On 5/26/22 at 8:30 A.M., an interview was conducted with SN 4. SN 4 stated the MSW did not see Patient 13 and should have seen them as soon as possible. On 5/26/22 at 10:15 A.M., an interview was conducted with the CM and the OM. The OM stated the agency did not have an OT assigned to Patient 10 due to a staffing issue, and The MSW did not see patient 13. The CM stated the plan of care was not followed for Patient 10 and Patient 13. The CM further said the staff should have notified the physician. Per the agency's policy and procedure, dated 11/13, titled Initial and Comprehensive Assessment, "...The initial assessment visit must be performed either within 48 hours of the referral ... or at the patient/family request…" Per the agency's policy and procedure, dated 11/13, titled Monitoring Patient's Response/Reporting to Physician, "... The patient's physician will be contacted on the same day when any of the following occur: ... When there is any problem implementing the plan of care ..." 4. Per the Home Health Certification and Plan of Care, dated 10/13/21 through 12/11/21, Patient 9 was admitted to the agency on 10/13/21 with diagnoses to include diabetes (difficulty controlling blood sugar). On 5/24/22, Patient 9’s clinical record was reviewed. Per the Physician order, dated 10/13/21, Patient 9 was to be seen by the HHA two times per week for six weeks, for a total of 12 visits, for assistance with personal care and activities of daily living. Patient 9 was seen one time weekly from 11/3/21 to 12/8/21. There was no evidence Patient 9 had been seen for the additional six ordered visits, or documentation as to why the visits had not been done. Per the Physician order, dated 12/12/21, Patient 9 was to be seen by the HHA two times per week for six weeks, for a total of 12 visits, for assistance with personal care and activities of daily living. Patient 9 was seen one time weekly from 12/15/21 to 1/17/22. There was no evidence Patient 9 had been seen for the additional six ordered visits, or documentation as to why the visits had not been done Per the Physician Order, dated 2/14/22, Patient 9 was to be seen by the SN one time per week for four weeks for monitoring and the HHA two times per week for four weeks for assistance with personal care and activities of daily living. There was no evidence the SN visits or the HHA visits had been conducted as ordered, or documentation as to why the visits had not been done. On 5/25/22 at 3:45 P.M., the OM was interviewed. The OM stated it was her responsibility to document all communications with the patient and the insurance company concerning visits. The OM stated she should have notified Patient 9’s physician about the missed visits and entered a communication note to explain why the visits were not conducted. 1a. Per the Home Health Certification and Plan of Care, dated 3/20/22 through 5/18/22, Patient 1 was admitted to the agency on 2/14/17 with diagnosis of protein malnutrition (not enough protein consumed). The plan of care did not list a visit frequency for Physical Therapist (PT) visits. On 5/25/22 at 1:30 P.M., an interview and record review was conducted with the Office Manager (OM). The OM stated, the agency provided PT visits to Patient 1 starting on 4/26/22, but she was unable to find an order for Patient 1 to have PT visits at that time. The OM further stated, PT 2 should have entered a PT visit frequency into Patient 1’s plan of care. On 5/25/22 at 3:33 P.M., a telephone interview was conducted with PT 2. PT 2 stated, he should have entered a visit frequency when he completed Patient 1’s plan of care. 1b. Per the Physician Order dated 4/8/22, Skilled Nurse (SN) to visit Patient 1 two times per week for eight weeks. On 5/25/22 at 1:30 P.M., an interview and record review was conducted with the OM. The OM stated, Patient 1 had an order on 4/8/22 for two SN visits per week for eight weeks, but was only able to find documentation of one SN visit per week on the weeks of 4/7/22 and 4/11/22. The OM stated, SN 3 should have updated the ordered visit frequency to match Patient 1’s needs. On 5/26/22 at 9:05 A.M., a telephone interview was conducted with SN 3. SN 3 stated, she should have called Patient 1’s physician to update the ordered visit frequency to match Patient 1’s needs. On 5/26/22 at 9:10 A.M., an interview was conducted with the Clinical Manager (CM). The CM stated, SN 3 should have updated the order for Patient 1 to reflect how often she needed SN visits. 2. Per the Home Health Certification and Plan of Care, dated 3/27/22 through 5/25/22, Patient 3 was admitted to the agency on 6/11/19 with diagnosis of immunodeficiency (a weakened ability to fight infection). The Plan of Care had an order for PT to visit Patient 3 one time per week for nine weeks, and did not have a listed frequency for Home Health Aide (HHA) or SN visits. On 5/25/22 at 1:08 P.M., an interview and record review was conducted with the OM. The OM stated, Patient 3 had orders for the PT to visit one time per week for 9 weeks, and was unable to find orders for HHA or SN visits for Patient 1’s certification period of 3/27/22 through 5/25/22. During the reviewed certification period, the agency provided three PT visits per week, one HHA visit per week, and one SN visit per month. The OM stated, the ordered visit frequencies changed for the PT, HHA, and SN at the beginning of the reviewed certification period, but the PT, HHA, and SN continued to visit Patient 3 at the previous certification period’s frequency. The OM further stated, the PT, HHA, and SN should have checked the ordered frequency, and notified the physician if they did not reflect the needs of the patient. 3a. Per the Home Health Certification and Plan of Care, dated 9/26/21 through 11/23/21, Patient 4 was admitted to the agency on 5/29/21 with diagnosis of hypertension (high blood pressure). The Plan of Care had an order for PT to visit Patient 4 two times per week for four weeks. On 5/25/22 at 1:52 P.M., an interview and record review was conducted with the OM. Patient 4 had an order to receive two PT visits per week for four weeks during the certification period of 9/26/21 through 11/23/21, but was only able to find documentation of one PT visit per week. On 5/25/22 at 2:38 P.M., a telephone interview was conducted with PT 1. PT 1 stated, Patient 4 refused to have more than one PT visit per week. PT 1 further stated, he should have documented a communication note of notifying the doctor that the visits were not completed, and Patient 4’s request to change the visit frequency. On 5/25/22 at 2:45 P.M., an interview was conducted with the OM. The OM stated, PT 1 should have communicated with the office and the physician to update Patient 4’s visit frequency. 3b. Per the Physician Order dated 10/18/21, HHA to visit Patient 4 two times per week for five weeks. On 5/25/22 at 1:52 P.M., an interview and record review was conducted with the OM. Patient 4 had an order on 10/18/21 to receive two HHA visits per week for five weeks, but there was only documentation of one HHA visit on the week of 10/18/22, and no HHA visits on the week of 10/25/22. The OM stated, the HHA visits were not provided as ordered because they were waiting for approval from Patient 4’s insurance provider. The OM further stated, she instructed the HHA not to complete the ordered visits, but she should have notified Patient 4’s physician that the visits were missed, and entered a communication note explaining why the visits were missed.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure standards of infection prevention for hand hygiene were followed during one of five home visits. As a result, there was an increased risk of cross-contamination between patients and staff. Findings Per the Home Health Certification and Plan of Care, dated 4/20/22 through 6/18/22, Patient 8 was admitted to the agency on 4/20/22 with diagnoses to include a skin infection on the lower right leg. On 5/24/22 at 1:30 P.M., a visit at Patient 8’s home was conducted with SN 4. SN 4 obtained Patient 8’s vital signs using gloved hands, removed the gloves, and put on clean gloves. SN 4 did not perform hand hygiene after removal of the gloves, and continued to assess Patient 8, including palpating Patient 8’s lower leg wound area. SN 4 was observed adjusting her face mask multiple times after assessing Patient 8 without removing the contaminated gloves and performing hand hygiene. On 5/24/22 at 2 P.M., SN 4 was interviewed. SN 4 stated she did not perform hand hygiene after removing the contaminated gloves. SN 4 stated she should not have readjusted her face mask using contaminated gloves, and risked transmitting infections to herself. SN 4 stated she should have removed her gloves and performed hand hygiene before readjusting her mask. SN 4 stated not performing hand hygiene increased the risk of cross-contamination to herself and other patients. On 5/25/22 at 3:30 P.M., the CM was interviewed. The CM stated the expectation was for staff to perform hand hygiene at the beginning of care and every time gloves are removed. The CM stated staff should wear face coverings that fit properly to avoid readjustment and risk cross-contamination. According to the agency’s policy, Hand Hygiene Policy No. 6-00.1, dated 11/13 “... 3. Hand decontamination using an alcohol-based hand rub should be performed: ... G. After removing gloves.”

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to develop policies and procedures to ensure all staff were vaccinated for covid-19. As a result, there was the risk of the agency not vaccinating all staff for covid-19. Findings: On 5/26/22 at 8:55 A.M., an interview was conducted with the Administrator. The Administrator stated, the agency has required all staff to be vaccinated for covid-19 since a vaccine was available. The Administrator further stated, the agency takes their guidance from the All Facility Letters (AFL state guidance to healthcare agencies). The Administrator stated, when new guidance was released which required the agency to create a policy requiring all of their staff to be vaccinated for covid-19, they did not create a policy relating to vaccination because the agency was already requiring all staff to be vaccinated for covid-19. On 5/26/22 a review was conducted of the agency's infection control binder. There was not a policy to review which required all staff to be vaccinated for covid-19. The most recent AFL in the infection control binder was from September 2021. The binder did not include QSO-22-07 (federal guidance to healthcare agencies) which required facilities to create a policy on vaccinating staff for covid-19.

The following reflects the findings of the California Department of Public Health during the investigation of two complaints. ERI/Complaint Number: CA00671310 Category: Quality of Care/Treatment ERI/Complaint Number: CA00668799 Category: Quality of Care/Treatment Representing the Department: 36708, Health Facilities Evaluator Nurse (HFEN). The inspection was limited to the complaint investigated and does not represent the findings of a full inspection of the facility. One deficiency was identified and written for complaint numbers CA00671310 and CA00668799.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians involved in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure the physician was informed of a delay in services ordered for one of 2 sampled patients (Patient 1). Patient 1's immediate need for wound evaluation and care was not completed timely. This failure had caused delay in implementing the needed care and treatment for Resident 1's newly discovered wound. Findings: Per the Home Health Certification and Plan of Care dated 10/10/19 through 12/8/19, Patient 1 was admitted to the agency on 10/10/19, with diagnoses that included presence of right artificial hip joint. Per the plan of care, the Physical Therapist (PT) was to visit Patient 1 once a week for one week, then two times a week for four weeks; a supplemental order for nursing to visit Patient 1 for wound evaluation. A review of Patient 1's clinical record, a referral form dated 12/11/19 by the physician indicated home health nurse for wound evaluation. A document titled Communication Note dated 12/23/20 indicated a call from the assisted living facility asking why there had not been a home health nurse to see Patient 1. A document titled SN (skilled nurse) skilled evaluation visit dated 12/24/19 was made by LN 1, this visit was made 13 days after the physician order was received by the agency. There was no documented evidence the physician was notified of this delay and the reason why the visit was 13 days late. Per the SN skilled evaluation visit note by LN 1, dated 12/24/20, LN 1 documented Patient 1 had a stage 3 wound (full thickness tissue loss, slough [dead tissue] may be present) on the coccyx (tailbone) that measured 2.2 cm (centimeters) in length, 1.2 cm in width, and 0.1 cm in depth; wound bed with 50 % slough. Per the supplemental order dated 12/24/20, this document indicated nursing to visit Patient 1, 3 times a week for 2 weeks and 2 times a week for 2 weeks. During a joint interview on 1/22/20 at 3:15 P.M. with the Office Manager (OM), the OM stated she was the one who assigned the visits and there was no nurse available at the time. The OM acknowledged there should have been documentation the physician was notified of the delay in sending a nurse for Patient 1's wound evaluation and treatment. During an interview on 1/22/20 at 3:40 P.M. with the Director of Patient Care Services (DPCS), the DPCS, in this case was also the licensed nurse (LN 1) who visited Patient 1 on 12/24/20. The DPCS stated she did not communicate with the physician why Patient 1 was not seen sooner as ordered and confirmed there was no evidence to show the physician was notified of the delay of service for Patient 1. The agency policy titled Care/Service Coordination dated 11/13 indicated,"...Timely and ongoing communication is the responsibility of each team member...and relevant to the care/service provided..."