Every finding on record at Unity Home Health LLC

The Oklahoma State Department of Health conducted an unannounced Emergency Preparedness Program survey at the agency on 02/24/26 to 02/25/26. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 02/24/26 to 02/25/26. An entrance conference was conducted with the Administrator. The survey process was explained. Questions were answered. The Administrator was identified as the contact person for administrative issues and the contact person for clinical issues. Findings were discussed during an informal exit with the Administrator, RN1, RN2 and the Business Manager. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: RN Registered Nurse SN Skilled Nurse POC Plan of Care SOC Start of Care PT Physical Therapist CLIA Clinical Laboratory Improvement Amendment

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 review of administrative documents and interview, the agency failed to submit OASIS assessments within 30 days as required of completing the assessment. Review of OASIS reports for the prior year showed 342 records transmitted with a 7.02% -3330 (Late Submission) error rate and the most recent month OASIS report showed 29 records transmitted with a 6.90% -3330 (Late Submission) error rate. During an interview on 02/24/26 at 2:15 PM, the Business Manager and Administrator explained the agency's OASIS submission process and were informed the Late Submission -3330 error rate exceeded the 1% threshold.

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the PT (Physical Therapist) failed to conduct the initial evaluation timely as part of the comprehensive assessment for one (#4) of seven (#1-#7) records reviewed. Patient #4 Review of Patient #4 record for SOC period 02/01/26 to 04/01/26 showed a primary diagnosis of Hypertensive Heart Disease with Heart Failure and orders for SN visits 1 time a week for 9 weeks and PT to evaluate and treat. Further review of PT documentation showed the initial PT evaluation was conducted on 02/09/26 (8 days after SOC) and no documentation was evident as to the reason the PT evaluation was delayed. On 02/25/26 at 2:15 PM, the Administrator stated the PT initial evaluation was not conducted timely and there was no documentation as to the reason for the delayed evaluation of Patient #4.

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 and interview, the agency failed to include all medications the patient was currently using on the medication profile for one (#6) of seven (#1 - #7) records review. Patient #6 Review of Patient #6 record for recertification period 12/11/25 to 02/04/26 showed a primary diagnosis of Chronic Obstructive Pulmonary Disease. The RN recertification visit note on 12/10/25 documented the patient was currently using "Oxygen at 2 liters per minute" and a fire safety assessment was completed for the home environment. Review of the Medication Profile failed to include Oxygen as a current medication. On 02/25/26 at 2:00PM, RN2 stated Oxygen was not included on the Medication Profile as ordered for Patient #6.

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 agency failed to complete interventions as ordered on the POC for five (#1 - #5) of seven (#1- #7) records reviewed. Patient #1 Review of Patient #1 record for re-certification period 02/03/26 to 04/03/26 showed a primary diagnosis of Left Ventricular Failure and orders for SN visits 1 time a week for 9 weeks and for SN to assess patient's weight log every visit. Further review of SN documentation and Vital Sign Report failed to provide evidence weights were assessed or obtained for SN visits conducted on the weeks of 02/01/26, 02/08/26 or 02/15/26. Patient #2 Review of Patient #2 record for re-certification period 12/28/26 to 02/25/26 showed a primary diagnosis of Heart Failure and orders for SN 1 time a week for 8 weeks and for "SN to instruct patient on daily weight self-monitoring...assess patient's weight log every visit". Further review of SN documentation and Vital Sign Report failed to provide evidence weights were assessed or obtained for SN visits conducted the weeks of 12/28/25, 01/04/26, 01/11/26/ 01/18/26, 01/25/26 02/08/26 or 02/15/26. Patient #3 Review of Patient #3 record for re-certification period 02/22/26 to 04/22/26 showed a primary diagnosis of Metabolic Encephalopathy and secondary diagnosis of Type II Diabetes Mellitus. The POC included orders for SN visits 1 time a week for 9 weeks and orders to "Notify physician of: Fasting Blood sugar greater than 200 or less than 70 and Random Blood sugar greater than 250 or less than 70". Further review of SN documentation and Vital Sign Report failed to provide evidence blood sugar results were assessed or obtained for SN visits conducted the weeks of 02/08/26 or 02/15/26. Patient #4 Review of Patient #4 record for SOC certification period 02/01/26 to 04/01/26 showed a primary diagnosis of Hypertensive Heart Disease with Heart Failure. The POC included orders for SN visits 1 time a week for 9 weeks with orders to "Notify physician of: Weight greater than 185 lbs. or less than 165 lbs". Further review of SN documentation and Vital Sign Report failed to provide evidence weights were assessed or obtained for the SN visit conducted the week of 02/15/26. Patient #5 Review of Patient #5 record for re-certification period 02/07/26 to 04/07/26 showed a primary diagnosis of Benign Prostatic Hyperplasia and a secondary diagnosis of Heart Disease. The POC included orders for "SN to instruct patient on daily weight self-monitoring...assess patient's weight log every visit". Further review of SN documentation and Vital Sign Report failed to provide evidence weights were assessed or obtained for SN visits conducted the weeks of 02/08/26 or 02/15/26. On 02/25/26 at 2:00PM, RN1 and RN2 stated weights and blood glucose results were not obtained as ordered for Patients #1 - #5.

Laboratory services/CLIA waivers CFR(s): 484.100(c)(1) Laboratory services. If the HHA engages in laboratory testing outside of the context of assisting an individual in self-administering a test with an appliance that has been cleared for that purpose by the Food and Drug Administration, the testing must be in compliance with all applicable requirements of part 493 of this chapter. The HHA may not substitute its equipment for a patient's equipment when assisting with self-administered tests. This STANDARD is not met as evidenced by: Based on review of administrative documents and interview, the agency failed to maintain a current CLIA (Clinical Laboratory Improvement Amendment) certificate as required to conduct laboratory testing. Review of the CLIA Certificate posted in the agency showed an expiration date of 03/27/25. During an interview on 02/24/26 at 3:00 PM, the Business Manager and Administrator confirmed the CLIA certificate was not current and stated the renewal was in process.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 02/22/23 to 02/23/23. Deficiencies were cited as a result of the Emergency Preparedness Program survey.

Plan Based on All Hazards Risk Assessment CFR(s): 484.102(a)(1)-(2) §403.748(a)(1)-(2), §416.54(a)(1)-(2), §418.113(a)(1)-(2), §441.184(a)(1)-(2), §460.84(a)(1)-(2), §482.15(a)(1)-(2), §483.73(a)(1)-(2), §483.475(a)(1)-(2), §484.102(a)(1)-(2), §485.68(a)(1)-(2), §485.542(a)(1)-(2), §485.625(a)(1)-(2), §485.727(a)(1)-(2), §485.920(a)(1)-(2), §486.360(a)(1)-(2), §491.12(a)(1)-(2), §494.62(a)(1)-(2) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following:] (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.* (2) Include strategies for addressing emergency events identified by the risk assessment. * [For Hospices at §418.113(a):] Emergency Plan. The Hospice must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach. (2) Include strategies for addressing emergency events identified by the risk assessment, including the management of the consequences of power failures, natural disasters, and other emergencies that would affect the hospice's ability to provide care. *[For LTC facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents. (2) Include strategies for addressing emergency events identified by the risk assessment. *[For ICF/IIDs at §483.475(a):] Emergency Plan. The ICF/IID must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing clients. (2) Include strategies for addressing emergency events identified by the risk assessment. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure a community-based risk assessment (All Hazards Risk Assessment) that identified the agency and a date the assessment was developed, implemented and/or was review for all patients and employees. Findings: A review of administrative records showed a community-based risk assessment which did not identify the agency and showed no date the assessment was developed, implemented and/or was review for the agency, its patient population, or its employees. On 02/23/23 at 10:45 a.m., Staff B stated the community-based risk assessment did not identify the agency or show a date an assessment was developed, implemented and/or agency review.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 02/22/23 to 02/23/23. An entrance conference was conducted with Staff A (in person) and B (by telephone). The survey process was explained. Questions were answered. Staff A was identified as the contact person for administrative and clinical issues and Staff B was identified as an additional contact person for administrative issues. Findings were discussed during an informal exit conference with Staff A, B, C and D. Standard level deficiencies were cited as a result of the survey. Glossary: CHHA certified home health aide EP Emergency Preparedness HHA Home Health Agency OT Occupational therapy PIP Performance Improvement Project PT Physical therapy POC Plan of Care QAPI Quality Assessment and Performance Improvement SN skilled nurse

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 and interview, the agency failed to ensure development of an episodic Plan of Care after a recertification OASIS assessment for one (Patients #7) of seven patients. Findings: Patient #7 A review of the clinical record showed no physician orders (episodic POC) for POC episode period of 08/03/22 to 10/01/22. Documentation showed no physician notification of the conducted a recertification OASIS assessment on 09/29/22 and documented no physician orders. On 02/23/23 at 11:40 a.m., Staff A stated patient #7 did not have a POC (physician orders) for the episode period of 08/03/22 to 10/01/22.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure an individualized patient POC included pain reporting parameters for three (Patients #1, 4 and #5) of seven patients. Findings: Patient #1 A review of a POC dated 12/31/22 to 2/28/23, showed orders for a SN visit frequency of one time every other week for nine weeks and for SN to assess the patient’s pain level and monitor effectiveness of pain medication every visit. Documentation showed no physician pain reporting parameters on the POC. Documentation showed no physician notification of the patient’s reported pain levels and no change in orders. On 02/23/23 at 11:00 a.m., Staff A stated the POC for patient #1 did not include physician pain reporting parameters. Patient #4 A review of a POC dated 1/30/23 to 3/30/23, showed orders for a SN visit frequency of one time a week for nine weeks and for SN to assess the patient’s pain level and monitor effectiveness of pain medication every visit. Documentation showed no physician pain reporting parameters on the POC. Documentation showed patient reported pain level of 4 during SN visits dated 2/22/23. Documentation showed no physician notification of the patient’s reported pain levels and no change in orders. On 02/23/23 at 11:05 p.m., Staff A stated the POC for patient #4 did not include physician pain reporting parameters. Patient #5 A review of a POC dated 12/21/22 to 02/18/23, showed orders for a SN visit frequency of one time every other week for nine weeks and for SN to assess the patient’s pain level and monitor effectiveness of pain medication every visit. Documentation showed no physician pain reporting parameters on the POC. Documentation showed patient reported pain level level of 2 during visits dated 12/30/22; 01/06/23 reported pain level of 3; 01/13/23 reported pain level of 2; 01/18/23 reported pain level of 4; 01/25/22 reported pain level of 3; 02/08/23 reported pain level of 2; and on 02/15/22 reported pain level of 4. Documentation showed no physician notification of the patient’s reported pain levels and no change in orders. On 02/23/23 at 11:30 p.m., Staff A stated the POC for patient #5 did not include physician pain reporting parameters.

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 record review and interview the agency failed to obtain physician orders for an SN visit frequency and duration for one (Patient #3) of seven patients. Findings: Patient #3 A review of a resumption of care (POC update) showed a physician order dated 02/10/23 to continue medications started while inpatient and wound site care interventions to bilateral lower extremities but showed no orders for SN treatment interventions, frequency and duration. Documentation showed no physician notification of the SN assessment, SN visit frequency and duration or physician orders for specific SN discipline interventions and goals. A review of the clinical record showed SN visits were completed on 02/10/23 and 02/15/22 (two visits conducted, no visits ordered.) On 02/23/23 at 11:10 p.m., Staff A stated SN should have documented a verbal order from the physician for the SN visit frequency and duration.

Program data CFR(s): 484.65(b)(1),(2),(3) Standard: Program data. (1) The program must utilize quality indicator data, including measures derived from OASIS, where applicable, and other relevant data, in the design of its program. (2) The HHA must use the data collected to- (i) Monitor the effectiveness and safety of services and quality of care; and (ii) Identify opportunities for improvement. (3) The frequency and detail of the data collection must be approved by the HHA's governing body. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure utilization of QAPI data to improve program effectiveness, quality of patient care and overall program improvement for all patients and employees. Findings: Administrative records of ongoing patient centered QAPI program for the agency which showed data collection, analysis and intervention activities utilized in the agency's QAPI Program for calendar years 2021 and 2022 were requested. No documentation was provided. On 02/23/23 at 10:35 a.m., Staff A stated: 1. There was no documentation of an ongoing QAPI program for calendar year 2021 and no documentation which showed QAPI activities for 2nd and 3rd quarters of calendar year 2022 and; 2. No documentation which showed utilization of data, analysis of data, and reporting of data; and no implementation of QAPI processes to identify and address problems identified by the agency to improve program effectiveness, quality of patient care and overall program improvement for calendar year 2022.

Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA's services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the initiation and review of a PIP through their QAPI Program for calendar years 2021 and 2022 for all patients and employees. Findings: Administrative records of an ongoing patient centered QAPI program for the agency which showed conduction of a QAPI program PIP for calendar years 2021 and 2022 were requested. No documentation was provided. On 02/23/23 at 10:40 a.m., Staff A stated administrative records showed no ongoing QAPI program PIPs for calendar years 2021 and 2022.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure its infection control program included surveillance monitoring and reporting and was included in QAPI program activities for all patients and staff. Findings: Administrative records which showed documentation of the agency’s infection control program and its surveillance data was included in QAPI program activities for calendar years 2021 and 2022 were requested. No documentation was provided. . On 02/23/23 at 10:40 a.m., Staff A stated administrative records showed no documentation that the agency’s infection control program and its surveillance data was included in QAPI program activities for calendar years 2021 and 2022.

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 agency failed to ensure services were provided as ordered on the POC for: 1. OT evaluation conducted for one (Patient #4) of seven patients and; 2. CHHA visit frequency for one (Patient #5) of seven. Findings: Patient #4 A review of the POC dated 01/30/23 to 03/30/23 showed orders for OT to evaluate and treat. Documentation showed no OT evaluation. Documentation showed no patient/caregiver refusal of the OT evaluation, no physician notification and no changes in orders. On 02/23/23 at 11:25 a.m., Staff A stated OT evaluations should have been conducted as ordered by the physician. Patient #5 A review of the POC dated 10/30/22 to 12/28/22 showed orders for a CHHA visit frequency of two times a week for nine weeks. Documentation showed during the week of 12/21/22 to 12/24/22 a CHHA visit was conducted on 12/23/22 (one visit conducted, two visits ordered). Documentation showed no patient/caregiver refusal of the CHHA visit, no physician notifications and no changes in orders. On 02/23/23 at 11:35 p.m., Staff A stated CHHA visits should have been conducted as ordered by the physician.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the development of a home health aide care plan for one (Patient #5) of seven. Findings: Patient #5 A review of the clinical record showed no documented of a home health aide care plan for the episode of 12/21/22 through 02/18/23. A POC showed a CHHA visit frequency of two times a week for nine weeks. Documentation showed home health aide visits were conducted on 12/23/22, 12/27/22, 12/29/22, 01/06/23, 01/10/23, 01/13/23, 01/18/23, 01/19/23, 02/03/23, 02/07/23, 02/09/23, 02/11/23 and on 02/17/23. On 02/23/23 at 11:30 a.m., Staff A stated the clinical record showed no home health aide care plan for patient #5.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure certified home health aide supervisory visits were completed every 14 days for four (Patients #1, 2, 4 and #5) of seven patients. Findings: Patient #1 A plan of care dated 12/31/22 to 02/28/23 showed a CHHA visit frequency of twice a week for eight weeks, then one a week for one week. A review of the clinical record showed CHHA visits completed 01/04/23, 01/06/23, 01/10/23, 01/12/23, 01/17/23, 01/19/23, 01/23/23, 01/27/23, 02/02/23,02/07/23, 02/09/23, 02/15/23, 02/17/23 and 02/21/23 with supervisory visits completed on 01/11/23, 01/23/23 and 02/08/23 (16 days between supervisory visits). Documentation showed no change in orders, patient refusal or physician notification. Patient #2 A plan of care dated 12/23/22 to 02/20/23 showed no CHHA visit frequency. A review of the clinical record showed CHHA visits completed 01/04/23, 01/06/23, 01/10/23, 01/13/23, 01/18/23, 01/19/23, 01/23/23, 01/27/23, 02/03/23,02/07/23, 02/08/23, 02/16/23 and 02/17/23 with supervisory visits completed on 01/24/23 (20 days from date of first CHHA visit) and on 02/08/23 (15 days between supervisory visits). Documentation showed no change in orders, patient refusal or physician notification. Patient #4 A plan of care dated 01/30/23 to 03/30/23 showed a CHHA visit frequency of twice a week for eight weeks, then one a week for one week. A review of the clinical record showed CHHA visits completed 02/03/23,02/07/23, 02/09/23, 02/16/23, 02/17/23 and 02/21/23 with supervisory visits completed on 01/30/23and 02/16/23 (16 days between supervisory visits). Documentation showed no change in orders, patient refusal or physician notification. Patient #5 A plan of care dated 12/21/22 to 02/18/23 showed a CHHA visit frequency of twice a week for nine weeks. A review of the clinical record showed CHHA visits completed 12/23/22, 12/27/22, 12/29/22, 01/06/23, 01/10/23, 01/13/23, 01/18/23, 01/19/23, 02/03/23, 02/07/23, 02/09/23, 02/11/23 and on 02/17/23 with supervisory visits completed on 12/19/23 and on 01/16/23 (27 days between supervisory visits); and 01/17/23 to 02/22/23 no supervisory visit conducted (34 days). Documentation showed no change in orders, patient refusal or physician notification. On 02/23/23 at 11:00 a.m., Staff A stated the CHHA supervisory visits for Patients #1, 2, 4 and #5 should be conducted every 14 days.

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 record reviews and interview, the agency failed to ensure a completed transfer/discharge summary was provided for two (Patients #3 and #7) of seven patients. Findings: Patient #3 A review of the clinical record documented transfer from the agency on 02/04/23 to inpatient hospital provider services. Documentation showed no transfer summary was provided to the inpatient hospital service provider. Patient #7 A review of the clinical record documented transferred from the agency on 09/12/22 to inpatient hospital provider services. Documentation showed no transfer summary was provided to the inpatient hospital service provider. On 02/23/23 at 11:40 a.m., Staff A stated no transfer summary was sent to the receiving service providers for Patients #3 and #7.