Every finding on record at Tehc LLC

During the Recertification survey conducted on 06/17/25 through 06/23/25 at TEHC LLC, a Home Health Agency, Emergency Preparedness was reviewed. TEHC, Inc., is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

A recertification survey was commenced on 06/17/25 and concluded on 06/23/25 at TEHC LLC. The facility was not in compliance with Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

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 Home Health Agency failed to submit OASIS assessments to the CMS system within 30 days of completion for 21.09% of 2025 first quarter (01/01/25 to 03/31/25) submissions and 17.84% of 2024 calendar year submissions. Findings include: Review of the Home Health Agency’s most recent iQIES Report “HHA Error Summary by Agency” for the first quarter of 2025 (01/01/25 to 03/13/25) reveals an error rate of 21.09% for failure to transmit a completed OASIS assessment within 30 days of completing the assessments, reflecting 58 out of 275 OASIS assessments that were not submitted within 30 days of completion. Review of the Home Health Agency’s iQIES Report “HHA Error Summary by Agency” for 2024 (01/01/24 to 12/31/25) reveals an error rate of 17.84% for failure to transmit a completed OASIS assessment within 30 days of completing the assessments, reflecting 162 out of 908 OASIS assessments that were not submitted within 30 days of completion. During an interview on 06/23/25 at 4:50 PM, the Administrator reported she believed OASIS assessments were submitted weekly after review by the Quality Assurance Nurse and denied awareness of the percentage of late submissions.

During the recertification survey conducted on 08/09/2022 to 08/10/2022 at Tehc LLC, a Home Health Agency, Emergency Preparedness was reviewed. Tehc LLC is in compliance with Emergency Preparedness per Code of Federal (CFR) 42 Part 484.102, Condition of Participation for Home Health Agencies.

A recertification survey was conducted on 08/09/2022 to 08/10/2022 at Tehc LLC. The home health agency was in non-compliance with 42 CFR 484 Subpart A-C, Requirements for Home Health Agencies.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on clinical record review and interview, the provider failed to record all patient care orders in the plan of care for 1 out of 10 Sampled Patients (SP). SP#7 Findings include: Clinical record review conducted on 08/09/22 of SP#7 contained a Plan of Care (POC) for certification period 08/08/22 to 10/06/22 that revealed the patient is receiving Skilled Nurse once a week to provide assessment of all system, instruction on medication management of intravenous administration, and peripherally inserted central catheter (PICC) line site dressing change. On 06/14/22 the patient was transferred to the hospital. On 07/21/22 the patient resumed service with the agency to continue providing skilled nursing service for intravenous medication administration via PICC line. The clinical record did not contain documentation that the physician was notified and approved a revised plan of care that reflects current medication administrator, using saline and heparin flushes as ordered on 07/15/22. On 08/10/22 between 2:13 PM and 2:21 PM a telephone interview was conducted with the Registered Nurse (RN) providing care to SP#7. The RN stated that SP#7 has a PICC line to Lt upper arm aspect, adding that the patient has been taught to self-administer the medication and use the pump but is not able to change the PICC line site dressing and no caregiver to be taught to provide the care. The RN stated that he flushes the line in use with the saline syringe and the non in use line with heparin. A telephone interview was conducted with SP#7 on 08/10/22 at 3:37 pm in presence of the Administrator. The SP#7 stated of having a PICC line to Lt upper arm. The SP#7 stated that tomorrow will be her first time independently doing the intravenouse medication bag change. It was inquired from the SP#7 to explain the process and techniques instructed by the RN to do the intravenous bag change. The SP#7 stated that she will stop the continuous ambulatory delivery device (CADD) pump, remove old bag, put new bag, change new battery, reset volume setting, prime and resume. The SP#7 was asked if she was instructed by the RN about flushing the line with Saline and Heparin, and the patient stated NO. The SP#7 added that she is afraid to do that. The SP#7 stated that the RN does the intravenous bag change and sometimes uses Saline and Heparin to flush the line. The SP#7 confirmed that the pharmacy provides the Saline and Heparin prefilled syringes.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on clinical record and interview, the home health agency (HHA) failed to ensure the clinical record included a completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer for 3 out of 10 Sampled Patient (SP). SP#2, SP#4 and SP#8 Findings include: Clinical record reviews were conducted on 08/09/22 of SP#2, SP#4 and SP#8. The clinical record for SP#2 contained a Plan of Care (POC) for certification period 07/21/22 to 09/18/22 that revealed the patient was admitted and received Skilled Nurse, Physical Therapy and Occupational services. On 08/01/22 the patient was transferred to the hospital, revealing the ordering physician was notified of the admission to the hospital. Further review revealed the provider did not send to the receiving facility a transfer summary as required. The clinical record for SP#4 contained a Plan of Care (POC) for certification period 06/11/22 to 08/09/22 that revealed the patient was admitted and received Skilled Nurse, Physical Therapy and Occupational services. On 07/22/22 the patient was transferred to the hospital, revealing the ordering physician was notified of the admission to the hospital. Further review revealed the provider did not send to the receiving facility a transfer summary as required. The clinical record for SP#8 contained a Plan of Care (POC) for certification period 06/17/22 to 08/15/22 that revealed the patient was admitted and received Skilled Nurse and Physical Therapy services. On 06/20/22 the patient was transferred to the hospital, revealing the ordering physician was notified of the admission to the hospital. Further review revealed the provider did not send to the receiving facility a transfer summary as required. Interview conducted with the Administrator and Director of Nursing on 08/10/22 at 3:50 PM confirmed the findings as stated above. The Administrator added that the patients basically return to the same facility where the referral to the home care agency occurred.

A Complaint Survey for complaint # 2021006146, was conducted on May 18, 2021 to May 19, 2021 at TEHC LLC. The Home Health Agency was in compliance with 42 CFR 484 Subpart A-C requirements for Home Health Agencies.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency failed to ensure that Staff A conducted a review of all the medications that 1 out of 3 Sampled Patients (SP) was using. SP#1 Review of SP#1’s record revealed a physician’s order dated 04/19/2021 that contained the following “Infusion Service Orders: Open-End Port (Port-a-Cath); Ceftriaxone (Rocephin) 1 gram injection every 24 hours; Dose: 2 Gm; Admin Dose: 2 Gm; inject 2 Gms total (2,000 mg) into the vein every 24 hours for 7 days; Route: Intravenous.” Further review of SP#1’ s record revealed a patient communication dated 04/24/2021 signed by the Director of Nursing that contained the following “SN to administer 2 GM of Ceftriaxone IV over 30 minutes every 24 hours. Conferenced with Staff A.” A review of the complaint log revealed the following concerning SP#1 “Medication Error (Wrong Med in addition to prescribed medication) Description of incident: Staff A went to the patient’s home on 04/24/2021 and administered the prescribed 2 GM of Ceftriaxone IV 30 minutes to the patient. When the administration of the Ceftriaxone was completed, the patient brought to the nurse’s attention that there was another medication that was delivered (Daptomycin) by the driver of _____to be administered. The nurse thought that the Daptomycin was a new medication added to the orders, and administered the medication IV to the patient. The next day, while Staff A, the nurse, was going over his orders for the patient, he realized that there were only physician’s orders for the Ceftriaxone and no order for the Daptomycin.” Review of the agency’s policy and procedure manual revealed a form titled “Medication administration” that contained “Policy: Medications and treatments are administered only as ordered by the physician.” Further record review revealed “Purpose: to ensure that physician’s orders are followed and that medications are administered safely and accurately to the correct patient.” Continued record review revealed “Procedure: 4. Agency staff must use 2 patient identifiers prior to the administration of any medication, until staff member is familiar with patient. Agency staff must verify that the medication to be administered is the correct medication based on the medication order and product label. 10. Prior to the administration of any medication by any route, the nurse will verify: Medication is the correct by comparing physician order with medication label. Medication stability by performing a visual examination for discoloration and particulates; Medication has not expired; Medication is the correct dose, strength, route and time; No contraindications exist for administration.” During an interview conducted on 05/18/2021 at 1:51 PM, the Director of Nursing (DON) acknowledged that Staff A did not conduct a review of all the medications that SP#1 was using on 04/24/2021. Furthermore, the DON also acknowledged that in addition to the Ceftriaxone, Staff A also administered another antibiotic (Daptomycin) to SP#1 which was not prescribed by the patient's physician on 04/24/2021. During an interview conducted on 05/19/2021 at 9:25 AM, Staff A acknowledged that he did not conduct a review of all the medications that SP#1 was using on 04/24/2021. Furthermore, Staff A acknowledged that in addition to the Ceftriaxone, he also administered an antibiotic (Daptomycin) which was not prescribed by SP#1’s physician, he stated “I saw the order for Ceftriaxone/Rocephin. The pharmacy sent the wrong antibiotic, I gave him the medication that was sent by error. I did not follow the 5 rights of medication administration that day.”

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 record review, policy review and interview, the Home Health Agency failed to develop an individualized Plan of Care (POC) for 1 out of 3 Sampled Patients (SP#2). Review of SP#2’s record revealed he was admitted on 05/12/2021 to receive Total Parenteral Nutrition (TPN) intravenously. Further record review revealed no documentation that the agency developed a POC for the patient. Review of the agency’s policy and procedure manual revealed a form titled “Director of Clinical Services” that contained “Responsibilities: 27. Assures that patients’ plans of care are developed, implemented and updated.” During an interview conducted on 05/18/2021 at 12:30 PM, the Director of Nursing acknowledged that SP#2’s record did not contain a POC.

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 record review and interview, the Home Health Agency failed to ensure that a registered Nurse (RN) conformed with the physician’s order for 1 out of 3 Sampled Patients (SP). SP#1 Review of SP#1’s record revealed a physician’s order dated 04/19/2021 that contained the following “Infusion Service Orders: Open-End Port (Port-a-Cath); Ceftriaxone (Rocephin) 1 gram injection every 24 hours; Dose: 2 Gm; Admin Dose: 2 Gm; inject 2 Gms total (2,000 mg) into the vein every 24 hours for 7 days; Route: Intravenous.” Further review of SP#1’ s record revealed a patient communication dated 04/24/2021 signed by the Director of Nursing that contained the following “SN to administer 2 GM of Ceftriaxone IV over 30 minutes every 24 hours. Conferenced with Staff A.” A review of the complaint log revealed the following concerning SP#1 “Medication Error (Wrong Med in addition to prescribed medication) Description of incident: Staff A went to the patient’s home on 04/24/2021 and administered the prescribed 2 GM of Ceftriaxone IV 30 minutes to the patient. When the administration of the Ceftriaxone was completed, the patient brought to the nurse’s attention that there was another medication that was delivered (Daptomycin) by the driver of _____to be administered. The nurse thought that the Daptomycin was a new medication added to the orders, and administered the medication IV to the patient. The next day, while Staff A, the nurse, was going over his orders for the patient, he realized that there were only physician’s orders for the Ceftriaxone and no order for the Daptomycin.” Review of Staff A’s personnel file revealed a form titled “Job description Registered Nurse” dated 03/07/20219 that contained the following “Responsibilities: 1. Provides services in accordance with the plan of care.” During an interview conducted on 05/18/2021 at 1:51 PM, the Director of Nursing (DON) acknowledged that Staff A did not follow SP#1’s POC on 04/24/2021. Furthermore, the DON also acknowledged that in addition to the Ceftriaxone, Staff A also administered another antibiotic (Daptomycin) to SP#1 which was not prescribed by the patient's physician on 04/24/2021. During an interview conducted on 05/19/2021 at 9:25 AM, Staff A acknowledged that he did not follow SP#1’s POC on 04/24/2021. Furthermore, Staff A acknowledged that in addition to the Ceftriaxone, he also administered an antibiotic (Daptomycin) which was not prescribed by SP#1’s physician, he stated “I saw the order for Ceftriaxone/Rocephin. The pharmacy sent the wrong antibiotic, I gave him the medication that was sent by error. I did not follow the 5 rights of medication administration that day.”

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency failed to assure that Staff A communicated/ reported that he administered an antibiotic which was not prescribed to 1 out of 3 Sampled Patients (SP)’s physician. SP#1 A review of the complaint log revealed the following concerning SP#1 “Medication Error (Wrong Med in addition to prescribed medication) Description of incident: Staff A went to the patient’s home on 04/24/2021 and administered the prescribed 2 GM of Ceftriaxone IV 30 minutes to the patient. When the administration of the Ceftriaxone was completed, the patient brought to the nurse’s attention that there was another medication that was delivered (Daptomycin) by the driver of _____to be administered. The nurse thought that the Daptomycin was a new medication added to the orders, and administered the medication IV to the patient. The next day, while Staff A, the nurse, was going over his orders for the patient, he realized that there were only physician’s orders for the Ceftriaxone and no order for the Daptomycin.” Further review of SP#1’ s record revealed a patient communication dated 04/26/2021 signed by the Director of Nursing (DON) that contained the following “Staff A admitted that he had not reported the incident to the physician, nor to the office or myself as the DON when he realized it.” Review of the agency’s policy and procedure manual revealed a form titled “Response to Adverse Drug Reactions and Medication Errors” that contained “Procedure: 9. Medication errors are to be reported immediately to the patient’s physician and Director of Clinical Services.” Review of Staff A’s personnel file revealed a form titled “Job description Registered Nurse” dated 03/07/20219 that contained the following “Responsibilities: 8. Informs personnel of changes in the condition and needs of the patient. 12. Processes orders and notifies physician of patient needs and changes in condition.” During an interview conducted on 05/18/2021 at 1:51 PM, the DON acknowledged that Staff A did not report to SP#1’s physician that in addition to the Ceftriaxone, he also administered another antibiotic (Daptomycin) to SP#1 on 04/24/2021. The DON stated “He (SP#1) was supposed to be discharged on Monday. We had order changes the whole week. He (Staff A) administered the second medication that was delivered by error. When he (Staff A) got home, he (Staff A) reviewed his notes and realized that he (Staff A) administered the wrong medication.” During an interview conducted on 05/18/2021 at 1:54 PM, the Administrator acknowledged that Staff A did not report the incident that occurred on 04/24/2021to SP#1’s physician, she stated “The proper call would have been for Staff A to notify the physician and the office.” During an interview conducted on 05/19/2021 at 9:25 AM, Staff A acknowledged that he did not report to the physician that he administered an antibiotic (Daptomycin) which was not prescribed to SP#1 on 04/24/2021. Staff A stated that he should have reported the incident to SP#1’s physician and the office when he realized it the next day, however he had to attend to another patient in the same building.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on record review, policy review and interview, the Home Health Agency failed to supervise the Skilled Nursing (RN) services provided by a Registered Nurse after he administered an intravenous antibiotic that was not prescribed to 1 out of 3 Sampled Patients (SP). Staff A A review of the complaint log revealed the following concerning SP#1 “Medication Error (Wrong Med in addition to prescribed medication) Description of incident: Staff A went to the patient’s home on 04/24/2021 and administered the prescribed 2 GM of Ceftriaxone IV 30 minutes to the patient. When the administration of the Ceftriaxone was completed, the patient brought to the nurse’s attention that there was another medication that was delivered (Daptomycin) by the driver of _____to be administered. The nurse thought that the Daptomycin was a new medication added to the orders, and administered the medication IV to the patient. The next day, while Staff A, the nurse, was going over his orders for the patient, he realized that there were only physician’s orders for the Ceftriaxone and no order for the Daptomycin.” Review of Staff A’s personnel file revealed that he was hired as a Registered Nurse (RN) on 03/07/20219. Further review of Staff A’s personnel file revealed no documentation that the Director of Nursing (DON) reevaluated/ directly observed his competency regarding medication administration while providing care to a patient after the incident that occurred with SP#1 on 04/24/2021. A review of the agency’s policy and procedure manual revealed the following “Director of Clinical Services Responsibilities: 5. Is responsible for recruiting, hiring, evaluating and terminating service personnel.” During an interview conducted on 05/19/2021 at 11:50 AM, the Director of Nursing acknowledged that Staff A’s file contained no documentation to demonstrate that she reevaluated or directly observed the employee after he administered an intravenous antibiotic which was not prescribed to SP#1 on 04/24/2021.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to provide services that are ordered by the physician or allowed practitioner as indicated in the plan of care to 1 out of 3 Sampled Patients (SP). SP#1 Review of SP#1’s record revealed a physician’s order dated 04/19/2021 that contained the following “Infusion Service Orders: Open-End Port (Port-a-Cath); Ceftriaxone (Rocephin) 1 gram injection every 24 hours; Dose: 2 Gm; Admin Dose: 2 Gm; inject 2 Gms total (2,000 mg) into the vein every 24 hours for 7 days; Route: Intravenous.” Further review of SP#1’ s record revealed a patient communication dated 04/24/2021 signed by the Director of Nursing that contained the following “SN to administer 2 GM of Ceftriaxone IV over 30 minutes every 24 hours. Conferenced with Staff A.” A review of the complaint log revealed the following concerning SP#1 “Medication Error (Wrong Med in addition to prescribed medication) Description of incident: Staff A went to the patient’s home on 04/24/2021 and administered the prescribed 2 GM of Ceftriaxone IV 30 minutes to the patient. When the administration of the Ceftriaxone was completed, the patient brought to the nurse’s attention that there was another medication that was delivered (Daptomycin) by the driver of _____to be administered. The nurse thought that the Daptomycin was a new medication added to the orders, and administered the medication IV to the patient. The next day, while Staff A, the nurse, was going over his orders for the patient, he realized that there were only physician’s orders for the Ceftriaxone and no order for the Daptomycin.” Review of Staff A’s personnel file revealed a form titled “Job description Registered Nurse” dated 03/07/20219 that contained the following “Responsibilities: 1. Provides services in accordance with the plan of care.” During an interview conducted on 05/18/2021 at 1:51 PM, the Director of Nursing (DON) acknowledged that Staff A did not follow SP#1’s POC on 04/24/2021. Furthermore, the DON also acknowledged that in addition to the Ceftriaxone, Staff A also administered another antibiotic (Daptomycin) to SP#1 which was not prescribed by the patient's physician on 04/24/2021. During an interview conducted on 05/19/2021 at 9:25 AM, Staff A acknowledged that he did not follow SP#1’s POC on 04/24/2021. Furthermore, Staff A acknowledged that in addition to the Ceftriaxone, he also administered an antibiotic (Daptomycin) which was not prescribed by SP#1’s physician, he stated “I saw the order for Ceftriaxone/Rocephin. The pharmacy sent the wrong antibiotic, I gave him the medication that was sent by error. I did not follow the 5 rights of medication administration that day.”