Deficiency Index

Every finding on record at Supportive Home Services, Inc.

Park Falls, Wisconsin · CCN 527194

2 findings across 1 survey, in the inspector's own words.

The inspector’s own words from form CMS-2567, unedited, including CMS’s own spacing. Names and some dates are redacted by CMS.

Survey of July 8, 2024

2 findings
G0000

An unannounced onsite complaint survey was conducted on 07/03/2024-07/08/2024 at Supportive Home Services in Park Falls, WI in response to complaint #107507 (in conjunction with Avanti Home Care complaint #107505). Supportive Home Services was found to be out of compliance with the Medicare Conditions of Participation 42 CFR 484 for Home Health Agencies. 42 CFR 484.60 Condition of Participation for Planning, Coordination of Services, and Quality of Care is NOT MET. Complaint 107505 was substantiated.

G0325

Basis and Scope CFR(s): §484.1 Basis and Scope (a) Basis. This part is based on: (1) Sections 1861(o) and 1891 of the Act, which establish the conditions that an HHA must meet in order to participate in the Medicare program and which, along with the additional requirements set forth in this part, are considered necessary to ensure the health and safety of patients; and (2) Section 1861(z) of the Act, which specifies the institutional planning standards that HHAs must meet. (b) Scope. The provisions of this part serve as the basis for survey activities for the purpose of determining whether an agency meets the requirements for participation in the Medicare program. This CONDITION is not met as evidenced by: Based on observation, record review, and interview, the agency failed to be primarily engaged in providing skilled nursing services and other therapeutic services in 1 of 1 Home Health Agency reviewed. Review of an email from Administrator A to State Agency Licensing, Certification, and CLIA Section (LCCS) Specialist B dated 06/06/2024 at 2:10 PM revealed in part, Administrator A wrote, "This written information is being provided to notify you of the current status of Supportive Home Services Home Health agency. At this time, our agency is not serving clients.” During an onsite closure verification visit on 07/03/2024 at 4:50 PM, it was observed a for sale sign out in front of the building and there were no signs the HHA was being run out of the building. According to LCCS Licensing Specialist B during a telephone call with Administrator A on 07/11/2024, Administrator A confirmed the agency would not be returning their annual report and they will be closing out their HHA license. Review of an email from Administrator A to LCCS Licensing Specialist B, on 07/24/2024 at 11:58 AM, revealed in part, “We were serving patients through Supportive Home Services through December 31, 2023. Due to that, I am assuming our official closing date would be January 1, 2024.” The facility has not been primarily engaged in providing skilled services since 12/31/2023. The facility did not notify the state agency of the effective closure date of 1/1/2024 until 7/24/2024.

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Federal survey findings only. State licensure findings for home health agencies are not shown.

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