Every finding on record at Top Care Home Health

The following reflects the findings of the California Department of Public Health during a recertification survey conducted from 6/1/26 through 6/4/26. The agency reported a patient census of 20 during the survey. The number of unduplicated admissions for the past twelve months was 17. The sample size was 7 patients with 2 home visits. Two deficiencies were identified from this survey.

HHA Comprehensive Assessment in Disaster CFR(s): 484.102(b)(1) §484.102(b)(1) Condition for Participation: [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (1) The plans for the HHA's patients during a natural or man-made disaster. Individual plans for each patient must be included as part of the comprehensive patient assessment, which must be conducted according to the provisions at §484.55. This STANDARD is not met as evidenced by: Based on interviews and record review, the agency failed to complete the Individual Patient Emergency Preparedness Plan (IPEPP- is a written guide for unexpected events), per the agency’s policy and procedure, for 2 of 7 sampled patients (Patients 6 and 7) . This failure risks interruption of essential services during an emergency like natural disasters, power outages, or other events affecting patient care. Findings: 1. Per the Home Health Certification and Plan of Care (POC), dated 5/28/26 through 7/26/26, Patient 5 was admitted to the agency on 5/28/26 with diagnoses that included cervical disc degeneration (a condition where the discs between the neck bones gradually break down, leading to possible neck pain and stiffness). A review of Patient 5's clinical record was conducted. Per the undated IPEPP, under the questions Shelter Location, Registered for Special Needs Shelter, Registered for At Risk Registry, and the Acuity Level, were blank. 2. Per the Home Health Certification and Plan of Care (POC), dated 5/23/26 through 7/21/26, Patient 6 was admitted to the agency on 5/23/26 with diagnoses that included heart disease. A review of Patient 6's clinical record was conducted. Per the IPEPP, dated 5/23/26, the questions Shelter Location, Registered for Special Needs Shelter, Registered for At Risk Registry, and the Acuity Level were blank. On 6/3/26 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that on admission, the clinician will assess the patient's level of need and will categorize the patient. Level 1 stable patients, who do not need urgent care, Level 2, who moderately need help, and Level 3, who are the unstable patients who need help right away from the agency in case of emergency. The DPCS stated that Patients 6 and 7’s IPEPP were not completed. The DPCS further stated it was important for the IPEPP to be accurate and completed to avoid confusion amongst the staff, and to identify the patients who need the most immediate care. Per the agency’s policy and procedure, dated 11/24, titled Emergency Management Plan, “…the patient will be placed in one of three categories for triaging patient care in the event the emergency management plan (operations) is implemented…The agency maintains a hard-copy of a current patient list including contact information and categories identified for each patient in the event there is a power failure…”

EP Training and Testing CFR(s): 484.102(d) §403.748(d), §416.54(d), §418.113(d), §441.184(d), §460.84(d), §482.15(d), §483.73(d), §483.475(d), §484.102(d), §485.68(d), §485.542(d), §485.625(d), §485.727(d), §485.920(d), §486.360(d), §491.12(d), §494.62(d). *[For RNCHIs at §403.748, ASCs at §416.54, Hospice at §418.113, PRTFs at §441.184, PACE at §460.84, Hospitals at §482.15, HHAs at §484.102, CORFs at §485.68, REHs at §485.542, CAHs at §486.625, "Organizations" under 485.727, CMHCs at §485.920, OPOs at §486.360, and RHC/FHQs at §491.12:] (d) Training and testing. The [facility] must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least every 2 years. *[For LTC facilities at §483.73(d):] (d) Training and testing. The LTC facility must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually. *[For ICF/IIDs at §483.475(d):] Training and testing. The ICF/IID must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least every 2 years. The ICF/IID must meet the requirements for evacuation drills and training at §483.470(i). *[For ESRD Facilities at §494.62(d):] Training, testing, and orientation. The dialysis facility must develop and maintain an emergency preparedness training, testing and patient orientation program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training, testing and orientation program must be evaluated and updated at every 2 years. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to participate in community wide emergency preparedness drills. This failure had the potential to cause the agency to be unprepared to care for patients during a natural disaster. During an interview on 6/4/26 at 9:35 A.M. with the Director of Patient Care Services (DPCS), the DPCS stated “…we did not participate in a community drill, last year we had in-services and before that we just reviewed the policy…” The DPCS continued “…by not participating we do not know how to coordinate with the other agencies in San Diego…” During a review of the agency’s Emergency Preparedness records, there was no evidence of participation in a community wide drill for the prior three years. During a review of the agency’s policy and procedure titled Emergency Management Plan Policy No. 6-037 revised November 2024, indicated “…Testing…2. The agency participates in a full-scale exercise that is community based…every two (2) years.”

The following reflects the findings of the California Department of Public Health during a recertification survey conducted from 6/1/26 through 6/4/26. The agency reported a patient census of 20 during the survey. The number of unduplicated admissions for the past twelve months was 17. The sample size was 7 patients with 2 home visits. Four deficiencies were identified from this survey.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to complete the Start of Care (SOC) visit within 48 hours of the referral date for 1 of 7 sampled patients (Patients 7). As a result, the Home Health Agency (HHA) did not provide care and services in a timely manner for Patients 7. Per the Home Health Certification and Plan of Care (POC), dated 5/12/26 through 7/10/26, Patient 7 was admitted to the agency on 5/12/26 with diagnoses that included diabetes mellitus (abnormal blood sugar level). A review of Patient 7’s clinical record was conducted. Per the Clinic document, dated 5/7/26, Patient 7 was referred to this Home Health Agency on 5/7/26. The HHA did not start the care until 5/12/26, which indicated five days of delay in SOC. On 6/3/26 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that Patient 7’s was delayed and should not have been. The DPCS further stated the agency should conduct the SOC within 48 hours of the referral to ensure the patient's needs were addressed. Per the agency’s policy and procedure, dated 11/24, titled Intake Process, “…The initial assessment visit will be performed either 48 hours of the referral, or within 48 hours of a patient’s return home…”

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 interview and record review, the agency failed to ensure the referral order for 1 of 7 sampled patients (Patient 6) was followed when the physician ordered a Certified Home Health Aide (CHHA). As a result, Patient 6 did not receive the necessary care and services. Findings: Per the Home Health Certification and Plan of Care (POC), dated 5/23/26 through 7/21/26, Patient 6 was admitted to the agency on 5/23/26 with diagnoses that included heart disease. A review of Patient 6’s clinical record was conducted. Per the Referral Discharge Order, dated 5/18/26, Patient 6 was to be discharged on 5/22/26 with Home Health Physical Therapy, Occupational Therapy, Registered Nurse, and Home Health Aide services. Further review of Patient 6’s clinical record indicated that Patient 6 had not been seen by the CHHA. Skilled Nurse (SN) 1 was not available for an interview. On 6/3/26 at 1:45 P.M., an interview and joint record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that SN 1 missed the physician’s order for CHHA service. The DPCS stated it was important to follow the physician’s order to ensure continuity of care. Per the agency’s policy and procedure, dated 11/24, titled Intake Process, “…If service can not be provided, intake personnel will give the caller the names of other agencies that can provide the required services…” Per the agency’s policy and procedure, dated 11/24, titled Care/Service Coordination, “…To ensure the coordination of services for each patient and to minimize the potential for missed, conflicting, or duplicated services…each patient will be assigned a Case Manager upon admission…”

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 infection prevention was followed for 1 of 2 home visits conducted. This failure had the potential to expose other patients to the germs. Findings: Per the Home Health Certification and Plan of Care (POC), dated 5/23/26 through 7/21/26, Patient 6 was admitted to the agency on 5/23/26 with diagnoses that included heart disease. On 6/3/26 at 10 A.M., during the home visit, Physical Therapy (PT) 1 was observed with the blood pressure (BP) machine, thermometer, and alcohol swabs in the sealable plastic bag. PT 1 placed the BP machine on an empty chair without a protective barrier. After failing to get a reading, PT 1 placed the uncleaned BP machine on the upper left section of the clean barrier. PT 1 said, “I’m sanitizing the BP machine,” and placed the BP machine inside the sealable plastic bag. Upon further observation, there was no used alcohol swab noted on the barrier. After contact with Patient 6’s skin, PT 1 said she needed to check Patient 6’s temperature. PT 1 reached into the sealable bag without cleaning her hands. PT 1 took Patient 6’s thermometer, sanitized the equipment, but then placed the thermometer on the dirty area where the hand sanitizer and the BP machine were placed. PT 1 then placed the thermometer inside the sealable plastic bag. After the exercises, PT 1 was seen holding both the sealable plastic bag and the dirty barrier. An interview was conducted with PT 1. PT 1 stated she put the used alcohol swab in her pocket after sanitizing the BP machine because there was no trash can around. PT 1 also said that she realized that she should not have placed the dirty BP machine on the barrier, but it was already too late, and she contaminated the clean area. PT 1 further stated she had contaminated that clean side and should not have placed the cleaned thermometer on the dirty side, to prevent cross-contamination. PT 1 stated that she was holding the used barrier because there was no trash can around, and she did not want to go inside Patient 6’s house to dispose of it. PT 1 stated she will dispose of the used barrier in her car, but she could not find a plastic bag to secure the used barrier. PT 1 placed the used barrier in the passenger side floor of her vehicle. PT 1 stated that she did not follow the infection control guidelines. On 6/3/26 at 1:45 P.M., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that PT 1 called her, and they had discussed actions that PT 1 had taken during the home visits. The DPCS stated PT 1 did not follow the infection control guidelines to prevent cross-contamination. Per the agency's policy and procedure, dated 11/25, titled Bag Technique, "...Prior to administering care, alcohol-based hand rub or soap, and paper towels will be removed, and hands will be washed. These supplies will be left at the sink for hand washing at the end of the visit. Hand washing will always be completed before operating the bag...The clean area contains unused or cleaned supplies/equipment, and the dirty area is designated for contaminated materials…protective barrier for bag placement in the patient’s home, they will be discarded."

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on interviews and record review, the agency failed to ensure a patient's clinical record was accurate for 1 of 7 sampled patients (Patient 4) when Patient 4’s Individual Patient Emergency Preparedness Plan Assessment (IPEPPA- is a written guide for unexpected events), had conflicting information with the Comprehensive Assessment (a thorough evaluation of a patient’s needs to create a personalized care plan that ensures safe and effective care). This failure could lead to confusion among staff and potentially affect the care and services provided to Patient 4 during an emergency. Findings: Per the Home Health Certification and Plan of Care (POC), dated 5/15/26 through 7/13/26, Patient 4 was admitted to the agency on 5/15/26 with diagnoses that included abnormal gait (walking) and mobility (movement). A review of Patient 4's clinical record was conducted. Per the undated IPEPPA, Patient 4 requires Level 2 help in case of emergency. However, the Comprehensive Assessment dated 5/15/26 indicated that Patient 4 was placed on Level 3. On 6/3/26 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated that on admission, the clinician will assess the patient's level of need and will categorize the patient. Level 1 stable patients, who do not need urgent care, Level 2, who moderately need help, and Level 3, who are the unstable patients who need help right away from the agency in case of emergency. The DPCS further stated that Patient 4’s emergency plan had a discrepancy. The DPCS stated it’s important that the emergency assessments were accurate to avoid confusion amongst the staff who need the most immediate care, and were treated first. Per the agency’s policy and procedure, dated 11/24, titled Contents of Clinical Record, “…The clinical records will contain sufficient information to identify the patient, describe the patient’s problems and needs, justify care, accurately document care provided and results in detail…” Per the agency’s policy and procedure, dated 11/24, titled Emergency Management Plan, “…the patient will be placed in one of three categories for triaging patient care in the event the emergency management plan (operations) is implemented…”

The following reflects the findings of the California Department of Public Health during the Emergency Preparedness survey from 2/6/23 through 2/9/23. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 39448, 36471, 40615. 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 2/6/23 through 2/9/23. The agency reported a patient census of 39 during the survey. The number of unduplicated admissions for the past twelve months was 5. The sample size was 7 patients with 2 home visits. Representing the California Department of Public Health: Health Facilities Evaluator Nurses: 39448, 36471, and HFEN 40615.

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 the ordered frequency of visits were followed for 2 of 7 sampled patients (5,7). As a result, the patients did not receive the services needed as ordered by the physician. 1.Per the Home Health Certification and Plan of Care, dated 12/6/22 through 2/4/23, Patient 5 was admitted to the agency on 10/12/21 with diagnoses which included cerebral infarction (disrupted blood flow to the brain due to problems with the blood vessels that supply it). On 2/6/23 at 10:30 A.M., a review of Patient 5’s clinical record was conducted. The Home Health Certification and Plan of Care dated 12/6/22 through 2/4/23 indicated the frequency of visit for skilled nurse (SN) was once a week for the duration of nine weeks and Certified Home Health Aid (CHHA) frequency of visits was twice a week for the duration of nine weeks. Patient 5’s clinical records showed that there were no SN visits made on the weeks of 1/8/23 through 1/14/23; 1/22/23 through 1/28/23; and 1/29/23 through 2/4/23. There was no visit made by the CHHA on the week of 1/29/23 through 2/4/23. On 2/9/23 at 9 A.M., a concurrent record review and interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated there was no documentation in Patient 5’s clinical record that SN visits were made on the weeks of 1/8/23 through 1/14/23;1/22/23 through 1/28/23; and 1/29/23 through 2/4/23. The DPCS further stated, a CHHA visit was not made on the week of 1/29/23 through 2/4/23. The DPCS also stated that there were no physician orders found in Patient 5’s records for the SN and CHHA missed visits. On 2/9/23 at 9:15 A.M., an interview was conducted with the DPCS. The DPCS stated the physician should have been notified of the missed visits and staff should have obtained an order for the missed visits. 2.Per the Home Health Certification and Plan of Care, dated 11/30/22 through 1/28/23, Patient 7 was admitted to the agency on 11/30/22 with diagnoses which included diabetes mellitus (high levels of sugar in the blood) and abnormalities of gait and mobility (manner of walking). On 2/7/23 at 9:30 A.M., a review of Patient 7’s clinical record was conducted. The Home Health Certification and Plan of Care, dated 11/30/22 through 1/28/23, indicated the frequency of visits for the physical therapist (PT) was three times a week for the duration of three weeks. Patient 7’s clinical record showed that there were only two PT visits made instead of three for the week of 12/11/22 through 12/17/22. On 2/8/23 at 9 A.M., a concurrent record review and interview was conducted with the DPCS. The DPCS stated, there was a missing visit for the week of 12/11/22 through 12/17/22. The DPCS stated there was no documentation in Patient 7’s clinical record that the physician was notified of the missed visit. The DPCS stated that there should have been a physician order for missed visit and documentation in the clinical record why a visit was missed. A review of the facility’s provided document titled Missed Visits, dated November 2017, indicated “…missed visits will be communicated to the clinical supervisor and the patient’s physician… Missed visits will be recorded in the clinical record…”

High risk, high volume, or problem-prone area CFR(s): 484.65(c)(1)(i) (i) Focus on high risk, high volume, or problem-prone areas; This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to identify late document submission as a focus for quality improvement for 1 of 7 sampled patients (6). As a result, patient visit notes continued to be absent from the medical record. Findings: On 2/8/23 at 915 A.M., a concurrent interview and record review was conducted with the DPCS. The DPCS provided visit notes for Patient 6 from 7/2/22 through 2/4/23. On 2/8/23 at 9:37 A.M., an interview was conducted with Skilled Nurse (SN) 1. SN 1 stated, she was directed to turn in her visit notes within seven days of the visit, but she dropped off the last twenty-eight weeks of Patient 6’s notes on 2/8/23 because she was too busy to turn them in earlier. On 2/9/23 at 9 A.M., an interview was conducted with the DPCS. The DPCS stated, staff should have submitted their visit notes within seven days of the visit. On 2/8/23 at 9:55 A.M., an interview and document review was conducted with the DPCS. The DPCS stated, the agency’s Quality Assessment and Performance Improvement (QAPI) program most recently had a meeting on 12/4/22. The 12/4/22 QAPI notes were reviewed with the DPCS, and the notes did not mention late documentation submission as a focus for Performance Improvement. The DPCS further stated, she was not made aware of late document submission until after the QAPI meeting on 12/4/22. On 2/9/23 at 9 A.M., an interview was conducted with the DPCS. The DPCS stated, the Administrative Assistant (AA) reminded staff to turn in notes if they were not submitted within seven days, and notified the DPCS if notes continued to not be submitted. The DPCS further stated, she was notified in December 2022 of the late submission of visit notes, but she did not conduct staff retraining, document warning the staff, or document in QAPI notes that the issue was identified. On 2/9/23 at 10:20 A.M., an interview was conducted with the AA. The AA stated, she tracked which visit notes had been submitted, and would remind staff daily of all unsubmitted visit notes. The AA further stated, she had been reminding SN 1 of Patient 6’s missing visit notes every workday since July 2022. The AA stated, she notified the DPCS on a monthly basis of what notes were late, and notified her of Patient 6’s late visit notes every month since August 2022. Per the agency’s policy, titled Sample Quality Assessment and Performance Improvement (QAPI) Plan, revised November 2017, “…Summary of the QAPI Committee Duties…Identify, Correct, Address Problems or Issues…”

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 facility failed to ensure standards of infection control were followed for 2 of 2 home visits conducted (4, 5) when: (1) The Physical Therapist (PT) did not follow the manufacturer's guideline for disinfecting the used equipment, and the disinfecting wipes were expired, and (2) The Certified Home Home Aide (CHHA) did not sanitize used equipment. As a result, there was an increased risk of cross-contamination between patients and staff. Findings: 1. Per the Home Health Certification and Plan of Care, dated 1/26/23 through 3/26/23, Patient 4 was admitted to the agency on 1/26/23 with diagnoses that included osteoarthritis (a wear and tear joint disease) of the right knee. On 2/8/23 at 2:15 P.M., the PT observed to assess Patient 4's vital signs using the thermometer and a hand-held blood pressure monitor (equipment) and placed them on top of the barrier. After Patient 4's treatment session, the PT wiped the equipment with the disinfecting wipes and put them inside his back without allowing the solution to dry. A follow-up interview was conducted, and the PT showed the disinfecting wipes. The wipes had an instruction to clean and disinfect, (the equipment) should be visibly wet for 4 minutes and allowed to dry. In addition, the disinfecting wipes had an expiration date of 1/17/23. The PT stated the wipes should not be used when expired, and he should have allowed the equipment to dry to ensure the equipment was sanitized. On 2/9/23 at 9:40 A.M., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated disinfecting wipes should not be used when expired and to allow equipment to dry to kill germs. 2.Per the Home Health Certification and Plan of Care, dated 12/6/22 through 2/4/23, Patient 5 was admitted to the agency on 10/12/21 with diagnoses that included cerebral infarction (disrupted blood flow to the brain due to problems with the blood vessels that supply it). On 2/7/23 at 3:10 P.M., the Certified Home Health Aide (CHHA)7 was observed to take Patient’s 5 vital signs using a thermometer, a hand-held blood pressure monitor (device), and pulse oximeter (an electronic device that measures the oxygen level (oxygen saturation) of the blood). The CHHA did not sanitize the equipment before and after use. A follow -up interview was conducted with CHHA 7 after the home visit. CHHA 7 stated he did not disinfect the devices before and after use. CHHA 7 stated he should have disinfected the devices before and after use, but he forgot to bring disinfecting wipes. On 2/8/23 at 5:31 P.M., a phone interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated devices used for patients should be disinfected before and after use. A review of the agency’s provided policy and procedure, titled Standard Precaution, dated November 2017, indicated “…organization personnel will adhere…in infection control precautions…”

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure documentation was submitted in a timely manner for 4 of 7 sampled patients (1, 2, 3, 6). As a result, the documents were not immediately available for review, and the clinical record did not accurately represent the care provided to patients. Findings: 1. Per the Home Health Certification and Plan of Care dated 1/3/23 through 3/3/23, Patient 1 was admitted to the agency on 11/9/21 with diagnoses to include, cellulitis (skin infection). On 2/7/23 at 2:25 P.M., a concurrent interview and record review was conducted with the Director of Patient Care Services (DPCS). Patient 1 did not have any visit notes in the medical record after 12/30/22. The DPCS stated, the agency’s policy was that visit notes should be dropped off within five days of the visit. On 2/8/23 at 915 A.M., a concurrent interview and record review was conducted with the DPCS. The DPCS provided visit notes for Patient 1 from 11/29/22 through 2/5/22. The oldest note was submitted ten weeks after completion of visit. On 2/8/23 at 9:30 A.M., an interview was completed with SN 2. SN 2 stated, she was directed to turn in her documentation within three days of the visit, but she dropped off the last ten weeks of Patient 1’s notes on the day of the interview. 2. Per the Home Health Certification and Plan of Care dated 12/17/22 through 2/14/23, Patient 2 was admitted to the agency on 8/19/22 with diagnoses to include, throat cancer (uncontrolled cell growth). On 2/7/23 at 2:25 P.M., a concurrent interview and record review was conducted with the DPCS. Patient 2 did not have any visit notes in the medical record from 12/14/22 through discharge on 1/12/23. The DPCS stated, the agency’s policy was that visit notes should be dropped off within five days of the visit. On 2/8/23 at 915 A.M., a concurrent interview and record review was conducted with the DPCS. The DPCS provided visit notes for Patient 2 from 12/23/22 through 1/2/23. The oldest note was submitted seven weeks after completion of the visit. On 2/8/23 at 9:37 A.M., an interview was conducted with SN 1. SN 1 stated, she was directed to turn in her visit notes within seven days of the visit, but she dropped off the last seven weeks of Patient 2’s notes on 2/8/23 because she was too busy to turn them in earlier. 3. Per the Home Health Certification and Plan of Care, dated 12/10/22 through 2/7/23, Patient 3 was admitted to the agency on 10/11/22 with diagnoses that included chronic venous ulcer (a wound on the leg caused by damaged veins). On 2/6/23 at 8:45 A.M., an interview was conducted with SN 3. SN 3 stated the staff had to submit their notes within three to five days after the home visit. On 2/6/23 a review of Patient 3’s clinical record was conducted. The last nursing note was dated 1/15/23 and Patient 3 was an active patient. On 2/6/23 at 3:45 P.M., an interview was conducted with SN 1. SN 1 stated the skilled nurses had difficulty submitting their notes on time. On 2/8/23, the agency presented 15 nursing visits notes dated from 1/2/23 through 2/4/23 that were not in the Patient 3’s clinical record. 4. Per the Home Health Certification and Plan of Care, dated 1/28/23 through 3/28/23, Patient 6 was admitted to the agency on 8/6/21 with diagnoses which included non-pressure chronic ulcer of the right foot (a wound caused by inadequate blood flow). On 2/6/23 at 2 P.M., a review of Patient’s 6 clinical record was conducted. The last nursing note was dated 6/10/22. On 2/6/23 at 3:07 P.M., an interview was conducted with SN 1. SN 1 stated the last nursing note on the chart was dated 6/10/22. SN 1 stated that nurses were having issues with charting and submitting their notes to the agency. On 2/8/23 at 915 A.M., a concurrent interview and record review was conducted with the DPCS. The DPCS provided visit notes for Patient 6 from 7/2/22 through 2/4/23. On 2/8/23 at 9:37 A.M., an interview was conducted with SN 1. SN 1 stated, she was directed to turn in her visit notes within seven days of the visit, but she dropped off the last twenty-eight weeks of Patient 6’s notes on 2/8/23 because she was too busy to turn them in earlier. On 2/9/23 at 9 A.M., an interview was conducted with the DPCS. The DPCS stated, staff should have submitted their visit notes within seven days of the visit. Per the agency’s undated policy, titled Submission of Visit Notes, “…Clinical visit notes must be submitted to the office on the 5th day after visits.”