Every finding on record at Splendor Care Health Services Inc

A survey entrance conference was conducted on 05/28/2021 at approximately 11:25 a.m. with the Administrator, Employee A. The Administrator was HHS handout, "What to expect during your agency survey." L & C Census: 2 LHH Census: 0 PAS Census: 6 Agency total census: 8 An exit conference was conducted on 06/04/2021 at approximately 3:30 p.m. with the Agency Admininstrator/Alt. Supervising Nurse, Employee A, and Supervising Nurse/Alt Administrator, Employee B. The survey preliminary findings were discussed, and the agency was afforded the opportunity to provide additional information. The agency was provided with written instructions for submitting a plan of correction within ten (10) days of the receipt of the Statement of Deficiencies. Splendor Care Health Services was found to be in compliance Medicare Conditions of Participation Abbreviations: L&C - Licensed and Certified Home Health LHH - Licensed Home Health PAS - Personal Assistant Services NOMNC - Notice of Medicare Non-Coverage POC - Plan of Care SOC - Start of Care

Purpose of Visit: 36 month Re-Certification Survey 06/04/2021. A survey entrance conference was conducted on 05/28/2021 at approximately 11:25 a.m. with the Administrator, Employee A. The Administrator was HHS handout, "What to expect during your agency survey." L & C Census: 2 LHH Census: 0 PAS Census: 6 Agency total census: 8 An exit conference was conducted on 06/04/2021 at approximately 3:30 p.m. with the Agency Administrator/Alt. Supervising Nurse, Employee A, and Supervising Nurse/Alt Administrator, Employee B. The survey preliminary findings were discussed, and the agency was afforded the opportunity to provide additional information. The agency was provided with written instructions for submitting a plan of correction within ten (10) days of the receipt of the Statement of Deficiencies. Splendor Care Health Services was found to be in compliance with Medicare Conditions of Participation. Abbreviations: L&C - Licensed and Certified Home Health LHH - Licensed Home Health PAS - Personal Assistant Services NOMNC - Notice of Medicare Non-Coverage POC - Plan of Care SOC - Start of Care CMS - Centers for Medicare and Medicate Services EMR - Electronic Medical Record

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 interview, the agency failed to provide the NOMNC written notice at least two days in advance of terminating on-going care in 5 of 5 (Patient 3, 4, 5, 6, and 7) discharged records reviewed whose reason for discharge was goals met. The failure of the agency to protect the rights of the patients by informing in advance of their right to appeal the discontinuation of home health services prevented the five identified patients from exercising their right to appeal the discharge decision. Findings include: DISCHARGED PATIENT 3: Record review of the EMR contained a POC dated 01/06/2021-03/06/2021 with a SOC date of 11/07/2020. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 3/06/2021 ..." The form was signed and dated by Patient 3 on the discharge date of 03/06/2021. DISCHARGED PATIENT 4: Record review of the EMR contained a POC dated 08/09/2020-10/07/2020 with a SOC date of 06/10/2020. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 10/07/2020 ..." The form was signed and dated by Patient 4 on the discharge date of 10/07/2020. DISCHARGED PATIENT 5: Record review of the EMR contained a POC dated 03/23/2019-05/21/2019 with a SOC date of 03/28/2018. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 05/21/2019 ..." The form was signed and dated by Patient 3 on the discharge date of 05/21/2019. DISCHARGED PATIENT 6: Record review of the EMR contained a POC dated 09/22/2020-11/20/2020 with a SOC date of 07/24/2020. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 11/19/2020 ..." The form was signed and dated by Patient 6 on the discharge date of 11/19/2020. DISCHARGED PATIENT 7: Record review of the EMR contained a POC dated 01/09/2019-03/09/2019 with a SOC date of 09/11/2018. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 3/07/2019 ..." The form was signed and dated by Patient 7 on the discharge date of 03/07/2019. An interview was conducted on 06/04/2021 2:25 p.m. with the Alternate Administrator/Supervising Nurse, Employee B. The surveyor reviewed the discharge chart findings above with the Supervising Nurse of not providing the NOMNC at least 2 days prior to discharge. The Supervising Nurse said, "I misunderstood the regulation." The surveyor asked the Supervising Nurse why the NOMNC was not provided to the patients until the day of discharge. The supervising Nurse said, "When I called the patient to go see them and give them the discharge notice they would tell me to wait until I came to discharge them." The Alt. Administrator/Supervising Nurse did not dispute the findings.