Every finding on record at Wellbound II, LLC

The following statement of deficiencies represents the results of a partial extended recertification survey of Wellbound II, LLC, Provider #337211, located at 7424 13th Avenue, Brooklyn, NY, 11228 conducted on 09/22/2025 through 09/26/2025. A standard re - certification survey was initiated on 09/22/2025. Deficient practices were identified within level 1 Standards in 484.60 Care Planning Coordination, Quality of Care resulting in a partial extended survey. The survey consisted of a review of seven (7) clinical records (identified as Patient #1, #2, #3, #4, #5, #6, and #7) including two (2) discharge records, three (3) observational home visits, and eight (8) personnel records (identified as Employee #1, #2, #3, #4, #5, #6, #7, and #8). The survey included a review of pertinent policies and procedures, Quality Improvement Meeting Minutes for past 12 months, PIP (Performance Improvement Project), Admission Packet, Emergency Preparedness Plan, Complaint Log, one (1) contract, and the agency's Infection Control and Flu policy and procedure. Pre-survey activities consisted of review on 09/18/2025 of the agency's Health Commerce System account, Home Care Worker Registry, Internet Quality Improvement and Evaluation System reports (iQIES) for the period 07/2024 through 06/2025, The HHA Error Summary by Agency Report for the period 07/01/2025 through 09/19/2025, and compliance with statistical report submission. The active patient census is 95. Interviews were conducted throughout the survey with the Administrator, and the Director of Patient Services. Findings were reviewed at the exit conference on 09/26/2025. The following deficiencies were identified as a result of the survey: G0372 – Accuracy of encoded OASIS data G0434 – Participate in care G0514 – RN performs assessment G0572 – Plan of Care G0574 – Plan of Care must include the following G0580 – Only as ordered by a physician G0584 – Verbal orders G0590 – Promptly alert relevant physician of changes G0592 – Revised plan of care G0598 – Discharge plans communication G0716 – Preparing clinical notes G0982 – Skilled services furnished G1012 – Required items in clinical record G1014 – Interventions and patient response J1244 – Governing authority J1304 – Contracts J1328 – Contracts J1444- Personnel J1504 – Records and reports J1512 – Records and reports

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 a review of the Home Health Agency (HHA) Error Summary Report for the period 07/01/2025 through 09/19/2025 and staff interviewed, the agency failed to ensure that all completed OASIS (Outcome and Assessment Information Set) assessments were transmitted to the CMS (Centers for Medicare & Medicaid Services) within thirty (30) days. This is evident for twenty-six (26) clinical records documented in the HHA Error Summary by Agency Report. Failure to ensure that all completed OASIS (Outcome and Assessment Information Set) assessments are transmitted to the CMS (Centers for Medicare & Medicaid Services) within thirty (30) days, has the potential for negative patient outcomes. The Findings Are: The HHA Error Summary by Agency Report for the period 07/01/2025 through 09/19/2025 documents: “Error # -3330 Record Submitted Late: The submission date is more than 30 days after M0090 (Start of Care) on this new record… # of Assessments with error twenty-six (26). There is no documented evidence that all completed OASIS (Outcome and Assessment Information Set) assessments are transmitted to the CMS (Centers for Medicare & Medicaid Services) within thirty (30) days. On 09/26/2025 at 12:30 PM, the Administrator and the Directors of Patient Services were interviewed and did not provide an explanation for the findings.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on clinical record review, and staff interview, the governing authority failed to inform patients of changes in frequency of services. This was evident for one (1) of seven (7) clinical records reviewed. (Patient: #6). Failure to ensure that patients are informed of changes in frequency of services, has the potential for negative patient outcomes. The Findings Are: 1. Patient #6 has a Start of Care date of 08/13/2025 with diagnoses of Type 2 Diabetes Mellitus Without Complications, Epilepsy, Unspecified, Not Intractable, Without Status Epilepticus, and Parkinson’s Disease Without Dyskinesia, Without Mention of Fluctuations documented on the Home Health Certification and Plan of Care with a Certification Period from 08/13/2025 to 10/11/2025. The “Wellbound II Patient Consent” form signed by the patient on 08/13/2025 documents, “The proposed services to be provided, visit frequency/hours of service and charges, if any that the patient will be responsible for, are below. Skilled Nursing, Please specify below: Skilled Nursing Hours/Frequency of Service/Duration.” The “Skilled Nursing Hours/Frequency of Service/Duration” was not completed. There is no documented evidence of the patient being informed of the “Skilled Nursing Hours/Frequency of Service/Duration.” On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings.

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 record reviews, and staff interviews, the agency failed to ensure that all initial assessments were conducted within the required time frames for all patients. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #5). Failure to ensure that all initial assessments are conducted within the required time frames for all patients, has the potential for negative patient outcomes. The Findings Are: 1. Patient #5 has a Start of Care Date of 04/17/2025, Discharge Date of 06/11/2025 with diagnoses Multiple Sclerosis, Primary Generalized Osteoarthritis, Age-related Osteoporosis with Current Pathological Fracture, History of Falling documented in the Home Health Certification and Plan of Care for Certification Period 04/17/2025 to 06/15/2025. The Clinical Intake note dated 04/14/2025 documents: “Verbal order received from NP (Nurse Practitioner) for home care services from (a subacute rehab and skilled nursing facility);” “Patient is resident of (assisted living facility);” “Received rehab services, cleared for discharge 4/10/25 to the (assisted living facility); “ “this resident remains homebound and requires skilled services – SN (Skilled Nurse), PT (Physical Therapy), OT (occupational Therapy).” The Clinical Intake note lacks documentation of the physician specifying a start of care date. The “Initial Comprehensive Assessment” Policy (Revised 12/31/2024) documents: “A RN (Registered Nurse), PT (physical Therapist) or SLP (Speech Language Pathologist) must conduct the initial assessment visit within 48 hours of referral, within 48 hours of the patient’s return from home, or on the physician/NPP (Nonphysician Practitioner) ordered start of care date.” “In the absence of a physician/NPP (Nonphysician Practitioner) specified start of care date, the initial assessment visit is conducted within 48 hours of the referral. If the physician/NPP (Nonphysician Practitioner) specified a start of care date, this supersedes the 48-hour time frame.” The RN (Registered Nurse) Admission assessment visit dated 04/17/2025 documents a start of care assessment visit was conducted on 04/17/2025, more than 48 hours of the referral intake. There is no documented evidence of the agency conducting an initial assessment visit to determine the immediate care and support needs of the patient within the required timeframe, as per agency policy. On 09/25/2025 at 10:30AM, the Director of Patient Services was interviewed and did not provide further documents or explanation of the survey finding.

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 clinical records review and staff interview the agency failed to ensure that all patients receive services as documented in their individualized plan of care. This was evident for four (4) of seven (7) clinical records reviewed (Patients: #1, #5, #6, and #7). Failure to ensure that all patients receive services as documented in their individualized plan of care has the potential for negative patient outcomes. The Findings Are: 3. Patient #6 has a Start of Care date of 08/13/2025 with diagnoses of Type 2 Diabetes Mellitus Without Complications, Epilepsy, Unspecified, Not Intractable, Without Status Epilepticus, and Parkinson’s Disease Without Dyskinesia, Without Mention of Fluctuations documented on the Home Health Certification and Plan of Care with a Certification Period from 08/13/2025 to 10/11/2025. The Home Health Certification and Plan of Care with a Certification Period from 08/13/2025 to 10/11/2025 documents the following insulin orders: 1. Humalog Kwipen (U-100) insulin 100 unit/milliliter, subcutaneous, inject 7 units, three times a day with meals. 2. Lantus Solostar (U-100) insulin 100 unit/milliliter (3 milliliters) subcutaneous pen, inject 30 units, subcutaneous in AM. 3. Mounjaro 2.5 milligrams/0.5 milliliters subcutaneous, pen injector, inject 2.5 milligrams once weekly on Tuesday. There is no documented evidence of the patient receiving Mounjaro, 2.5 milligram/0.5 milliliters once weekly on Tuesday as ordered. The “Visit Note Report” dated 08/14/2025 documents, “Enter Time of Visit: 07:05 (AM)” and “Name of First Insulin/Injection: Lantus, Dose of First Insulin/Injection: 22 (units).” There is no documented evidence of the patient receiving 30 units of Lantus as ordered. The “Visit Note Report” dated 08/25/2025 documents in the Endocrine section, “Enter Time of Visit: 16:15 (4:15 PM)” and “Name of First Insulin/Injection: Humalog, Dose of First Insulin/Injection: 2 units.” In the Interventions Provided section, the “Visit Note Report” documents, “Details/Comments . . . . 7 units Humalog administered subcutaneous left arm before dinner.” There is no documented evidence of the patient receiving only 7 units of Humalog as ordered. The “Visit Note Report” dated 09/07/2025 documents in the Endocrine section, “Enter Time of Visit: 16:20 (4:20 PM)” and “Name of First Insulin/Injection: Humalog, Dose of First Insulin/Injection: 10 units.” In the Interventions Provided section, the “Visit Note Report” documents, “Details/Comments . . . . Administered 7 units Humalog subcutaneous to abdomen.” There is no documented evidence of the patient receiving only 7 units of Humalog as ordered. On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. A medical order dated 09/09/2025 documents, “PT Effective 09/07/2025 3 WK 1, 4 WK 3, 2 WK 1 (Physical Therapy Effective 09/07/2025, 3 times a week for 1 week, then 4 times a week for 3 weeks, and then 2 times a week for 1 week). The clinical record documents the patient received two (2) Physical Therapy visits the week of 09/07/2025 and not a total of three (3) as ordered. The clinical record documents the patient received two (2) Physical Therapy visits the following week of 09/14/2025 and not a total of four (4) visits as ordered. On 09/25/2025 at 3:35 PM, the Director of Patient Services and Executive Director of Rehabilitation Operations were interviewed. The Executive Director of Rehabilitation Operations stated the order (PT Effective 09/07/2025 3 WK 1, 4 WK 3, 2 WK 1) was a “technical error” (a problem with the software program of the electronic health record) and the order should be “two (2) times a week for nine (9) weeks.” 4. Patient #7 has a Start of Care Date of 08/09/2024, a discharge date of 09/20/2024 with diagnoses of Type II Diabetes Mellitus Without Complications, Disorder Involving the Immune Mechanism, Unspecified, and Hypertensive Heart Disease with Heart Failure documented on the Home Health Certification and Plan of Care with Certification Period from 08/09/2024 to 10/07/2024. The Home Health Certification and Plan of Care (medical orders) with a Certification Period from 08/09/2024 to 10/07/2024 documents the following nursing orders: Skilled Nurse to Perform Blood Sugar Analysis 3 x daily (3 times daily). Skilled Nurse to Administer SQ (subcutaneous) insulin 3 x daily (3 times daily). The clinical record documents one Skilled Nursing visit on 08/28/2024 at 8:40 AM. There is no documented evidence of a total of three Skilled Nursing visits on 08/28/2024. The clinical record documents two Skilled Nursing visits on 08/30/2024 at 7:00 AM and 11:10 AM. There is no documented evidence of a total of three Skilled Nursing visits on 08/30/2024. On 09/25/2025 at 4:20 PM, the Director of Patient Services was interviewed and stated the coordination notes for 09/02/2024 and 09/03/2024 should have documented the missed visits (on 08/28/2024 and 08/30/2024). Patient #5 has a Start of Care Date of 04/17/2025, Discharge Date of 06/11/2025 with diagnoses Multiple Sclerosis, Primary Generalized Osteoarthritis, Age-related Osteoporosis with Current Pathological Fracture, History of Falling documented in the Home Health Certification and Plan of Care for Certification Period 04/17/2025 to 06/15/2025. The physician order dated 05/14/2025 documents the following for Physical Therapy service: “Effective (week of) 05/04/2025 1WK2 (one visit a week for two weeks), 2WK1 (two visits a week for one week), 1WK1 (one visit a week for one week).” The clinical record lacks documentation that a Physical Therapy visit was made during the week beginning 05/11/2025. The Physical Therapy “Missed Visit Notification” note dated 05/13/2025 documents: “Patient not feeling well.” The “Missed Visits” Policy (Effective 07/18/2022) documents: “if a scheduled visit cannot be rescheduled and is not made, the clinician will:” “be responsible for immediately notifying the agency;” “must notify the physician/NPP (Nonphysician Practitioner) about the missed visit reason;” and “document all pertinent details in a communication or missed visit note.” The clinical record lacks documented evidence of the physical therapist notifying the physician about the missed visit, as per agency policy. The physician order dated 05/09/2025 documents orders for Occupational Therapy Evaluation visit: “Effective (week of) 05/11/2025 1WK1 (one visit a week for one week).” The Occupational Therapy “Missed Visit Notification” note dated 05/16/2025 documents: patient “asked to be started on Monday (05/19/2025).” The clinical record lacks documented evidence of the Occupational Therapist notifying the physician about the missed evaluation visit, as per agency policy. The physician order dated 05/19/2025 documents the following orders for Occupational Therapy service: “Effective (week of )05/18/2025 2WK4 (two visits a week for four weeks - total eight visits)” “to establish home exercise program and provide therapeutic exercises.” The clinical record documents one occupational therapy visit was made during the week beginning 06/08/2025 (week four). The Occupational Therapy Visit Note dated 06/09/2025 (Visit number 7) documents: patient “continues to benefit from ongoing occupational therapy services;” “no changes in frequency/duration;” and treatment plan for next visit is to continue plan of care. The clinical record lacks documented evidence a second visit during the week of 06/08/2025, as ordered by the physician. The clinical record lacks documented evidence of the occupation therapist notifying the agency and the physician about a missed visit, as per agency policy. The Occupational Therapist visit notes dated 05/19/2025, 05/30/2025, 06/04/2025, 06/06/2025, and 06/09/2025 document: “Interventions not provided: Written home exercise program given to the patient/caregiver with return demonstration and understanding. Exception code: Not applicable to current visit;” and “Goals not met: Home Exercise Program established, and patient/caregiver verbalizes understanding and motivation in program. Exception code: not applicable to current visit.” The Occupational Therapist documents that the patient was not given a written home exercise program. The physician order dated 06/11/2025 documents: “MD (Medical Doctor) notification/Agency Discharge: Patient had Occupational Therapy evaluation completed on 05/19/2025. Patient was seen by Occupational Therapist for 7 additional visits (total 8 visits). As per Occupational Therapist, upon discharge patient achieved goals with maximum rehab potential reached.” “Plan to continue with home exercise program as tolerated. Last visit with discharge completed on 06/11/2025.” The clinical record documents that the last skilled service visit was the occupational visit on 06/09/2025 (visit number 7). The clinical record lacks documented evidence of the Occupational Therapist providing services as ordered by the physician. Specifically, there is no documented evidence of the following as indicated the discharge order: last visit with discharge on 06/11/2025, home exercise program given to the patient, and goals being achieved with maximum rehab potential reached. On 09/25/2025 at 10:30AM, the Director of Patient Services was interviewed about the survey findings. On 09/26/2025 at 12:30PM, the DPS stated there was “no” notification to physician for the missed visits and “no” explanation for the occupational therapy not making a second visit during the week of 05/08/2025. 1. Patient #1 has a Start of Care (SOC) date of 07/29/2025 with the following diagnoses "Type 2 Diabetes Mellitus, Chronic Kidney Disease Stage 4, Osteoarthritis" documented in the Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025. The Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025 documents: Skilled nurse to report blood glucose levels greater than 400 mg/dl or less than 60 mg/dl (milligram per deciliter). The Visit Note Report documents fingerstick results on: 08/06/2025 noon = 486, 09/05/2025 morning = 400, 09/16/2025 noon = 422, 09/19/2025 morning = 464, afternoon = 552, 09/20/2025 morning = 439, noon = 450, and 09/21/2025 afternoon = 423. The clinical record lacks documented evidence of the physician being notified of fingerstick that was greater than 400. There is no documented evidence that the written individualized plan of care is being followed. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings.

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 clinical records review, and staff interview, the agency failed to establish an individualized plan of care that include all the required information. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #4, and #6). Failure to ensure individualized plan of care includes all the required information, has the potential risk for negative patient outcomes. The Findings Are: 2. Patient #6 has a Start of Care date of 08/13/2025 with diagnoses of Type 2 Diabetes Mellitus Without Complications, Epilepsy, Unspecified, Not Intractable, Without Status Epilepticus, and Parkinson’s Disease Without Dyskinesia, Without Mention of Fluctuations documented on the Home Health Certification and Plan of Care with a Certification Period from 08/13/2025 to 10/11/2025. The Home Health Certification and Plan of Care (medical orders) with a Certification Period from 08/13/2025 to 10/11/2025 documents the following orders: “Skilled Nurse to perform blood glucose analysis TID (three times a day).” “DME and Supplies (Durable Medical Equipment and Supplies): alcohol; diabetic lancets, diabetic supplies; diabetic test strips; DME-Glucometer; DME-Walker; Syring/Needle.” The “Visit Note Report” dated 08/16/2025 documents, “Enter Time of Visit: 07:38 AM” and “Site of Fingerstick: Resident uses Freestyle Libre Sensor.” The “Visit Note Report” dated 08/16/2025 documents, “Interventions provided, Details/Comments: BS (Blood Sugar) collected via Freestyle Libre Sensor . . .” The Freestyle Libre Sensor is a medical device that an individual wears on their back upper left or right arm. The device can monitor an individual's blood sugar level without having to prick an individual’s fingertip with a lancet (a type of needle) and placing a sample of blood in a glucometer device. The “Visit Note Report” dated 08/22/2025 documents, “Enter Time of Visit: 07:05 (AM)” and “Site of Fingerstick: Resident uses Freestyle Libre Sensor.” The “Visit Note Report” dated 08/22/2025 documents, “Interventions provided, Details/Comments: BS (Blood Sugar) collected via Freestyle Libre Sensor . . .” The “Visit Note Report” dated 08/25/2025 documents, “Enter Time of Visit: 07:05 (AM)” and “Site of Fingerstick: Resident uses Freestyle Libre Sensor.” The “Visit Note Report” dated 08/25/2025 documents, “Interventions provided, Details/Comments: BS (Blood Sugar) collected via Freestyle Libre Sensor . . .” There is no documented evidence of the plan of care including for the patient to use a blood glucose sensor medical device to monitor the patient’s blood glucose levels. On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. 1. Patient #4 has a Start of Care Date of 09/11/2023 with diagnoses Schizophrenia, Essential Hypertension, Type 2 Diabetes Mellitus Without Complications, Long-Term (Current) Use of Oral Hypoglycemic Drugs documented in the Home Health Certification and Plan of Care for Certification Period 08/31/2025 to 10/29/2025. The Registered Nurse Recertification assessment dated 06/26/2025 documents in the endocrine section: “Is the client taking Insulin?” No;” “How frequent are blood sugars checked? During routine checkups.” The Registered Nurse Recertification assessment dated 08/28/2025 documents in the endocrine section: “Is the client taking Insulin?” No;” “How frequent are blood sugars checked? Never.” The recertification assessments document the patient’s does not take insulin or checks blood sugar level frequently to manage diabetes. The Home Health Certification and Plan(s) of Care for Certification Period 07/02/2025 to 8/30/2025 and 08/31/2025 to 10/29/2025 document the following orders: “Skilled Nurse for instruction/reinforcement of diabetic care to include diet, skin care, administration of insulin, blood glucose testing and diabetic foot care.” The Plans of Care document the patient takes an oral hypoglycemic drug. The Plan(s) of Care lack documented evidence of specifying who is responsible for managing and checking the patient’s blood glucose and includes orders for the nurse provide instructions on administration of insulin, not taken by patient. The “Plan of Care – Physician/NPP (Nonphysician Practitioner) Orders – 485” Policy (Effective 7/15/2022) documents: “The individualized plan of care must specify the care and services necessary to meet the patient specific needs as identified in the comprehensive assessment.” There is no documented evidence of the plan(s) of care specifying the diabetic care necessary to meet the patient specific needs as identified in the comprehensive assessment dated 06/26/2025 and 08/28/2025, as per agency policy. On 09/25/2025 at 10:30AM, the Director of Patient Services was interviewed and did not provide further documents or explanation of the survey finding.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on clinical record reviews, and staff interview, the agency failed to ensure that treatments are administered in accordance with physician orders. This was evident for three (3) of seven (7) clinical records reviewed (Patients: #1, #2, and #3). Failure to ensure that treatments are administered in accordance with physician orders, has the potential for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care (SOC) date of 07/29/2025 with the following diagnoses "Type 2 Diabetes Mellitus, Chronic Kidney Disease Stage 4, Osteoarthritis" documented in the Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025. The Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025 documents: Lantus Solostar 45 units every PM. The Visit Note Report documents Lantus 40 units were administered on: 08/05/2025, 08/06,2025, 08/11/2025 to 0814/2025, 08/17/2025, and 08/20/2025. The clinical record lacks documented evidence of the medication, Lantus 45 units being administered as ordered. The Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025 documents: Humalog Kwik pen if BGL (blood glucose level) 151- 200 = 2 units; 201- 250 = 4 units; 251- 300 = 6 units; 301- 350 = 8 units; 351- 400 = 10 units; 401- 450 = 12 units and call MD. The Visit Note Report documents: On 08/23/2025 for a fingerstick result of 207- 2 units of insulin was given, (order is 4 units). On 09/18/2025 for a fingerstick result of 309- 10 units of insulin was given, (order is 8 units). The clinical record lacks documented evidence of the administration of the correct dosage of insulin per sliding scale. There is no documented evidence that the insulin is administered as ordered by the physician. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings. 2. Patient #2 has a Start of Care (SOC) date of 09/02/2024 with the following diagnoses "Type 2 Diabetes Mellitus with Diabetic Peripheral Angiopathy, Schizophrenia " documented in the Home Health Certification and Plan of Care for the Certification Period 08/28/2025 to 10/26/2025. The Home Health Certification and Plan of Care for the Certification Period 08/28/2025 to 10/26/2025 documents: Lantus Solostar 40 units every PM. The Visit Note Report dated 09/14/2025 documents: Lantus 20 units was administered (order is 40 units). The clinical record lacks documented evidence of the Lantus 40 units being administered on 08/30/2025 and 08/31/2025. The clinical record lacks documented evidence of Lantus being administered as ordered. The Home Health Certification and Plan of Care for the Certification Period 08/28/2025 to 10/26/2025 documents: Insulin Aspart Administer per sliding scale protocol TID (three times a day): 151-200 =2 units; 201-250 = 4 units; 251-300 = 6 units; 301-350 = 8 units; 351-400 = 10 units; if BG (blood glucose above 400 mg/dl (milligram per deciliter) or less than 70 mg/dl - call MD. The Visit Note Report documents: On 08/29/2025 Lispro 4 units was administered, (order is Insulin Aspart). On 09/03/2025 for the fingerstick result of 275, 2 units of insulin was given, (order is 6 units). On 09/10/2025 for the fingerstick result of 225, 5 units of insulin was given, (order is 4 units). The clinical record lacks documented evidence of the administration of the correct dosage of insulin per the sliding scale. There is no documented evidence of the medications being administered as ordered by the physician. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings. 3. Patient #3 has a Start of Care (SOC) date of 02/26/2025 with the following diagnoses "Type 2 Diabetes Mellitus with Diabetic Neuropathy, Bipolar Disorder" documented in the Home Health Certification and Plan of Care for the Certification Period 08/25/2025 to 10/23/2025. The Home Health Certification and Plan of Care for the Certification Period 08/25/2025 to 10/23/2025 documents: Lantus Solostar 8 units every AM. The clinical record lacks documented evidence of Lantus being administered as ordered on 09/04/2025. There is no documented evidence of the medication being administered as ordered by the physician. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on clinical records review and staff interview, the agency failed to ensure all verbal orders are put in writing and authenticated by the physician. This was evident for three (3) of seven (7) clinical records reviewed (Patients: #1, #2, and #3). Failure to ensure that all verbal orders are put in writing and authenticated by the physician, has the potential for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care (SOC) date of 07/29/2025 with the following diagnoses "Type 2 Diabetes Mellitus, Chronic Kidney Disease stage 4, Osteoarthritis" documented in the Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025. The Visit Note Report documents: Site of Fingerstick: Sensor or Libre on the following dates: 08/02/2025 to 08/06/2025, 08/11/2025 to 08/13/2025, 08/16/2025 to 08/19/2025, 08/25/2025, 08/26/2025, 08/30/2025 to 09/03/2025, 09/08/2025 to 09/10/2025, 09/13/2025, and 09/14/2025. The clinical record lacks documented evidence of a verbal order including who is responsible of applying/changing the device and frequency. The Home Health Certification and Plan of Care for the Certification Period 07/29/2025 to 09/26/2025 documents: Humalog Kwikpen if BGL (blood glucose level) 151-200 =2 units; 201-250 = 4 units; 251-300 = 6 units; 301-350 = 8 units; 351-400 = 10 units; 401-450 = 12 units and call MD. The Visit Note Report documents: 08/06/2025 fingerstick result of 486, given 10 units of insulin (no coverage). 09/18/2025 morning fingerstick result of 464, given 10 units of insulin and afternoon 552, given 10 units (no coverage for both). 09/22/2025 fingerstick 541, given 10 units (no coverage). The clinical record lacks documented evidence of a verbal order to give insulin coverage of 10 units on 08/06/2025, 09/18/2025, and 09/22/2025. The Visit Note Report dated 0922/2025 documents: NP (nurse practitioner name) notified. Patient given 10 units of Humalog. 10 units of Lantus will be added to AM regime. The clinical record lacks documented evidence of the verbal order for Lantus 10 units to given on 09/23/2025 in the morning and documentation that it was administered to the patient. There is no documented evidence of the verbal orders being documented in the patient’s clinical record. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings. 2. Patient #2 has a Start of Care (SOC) date of 09/02/2024 with the following diagnoses "Type 2 Diabetes Mellitus with Diabetic Peripheral Angiopathy, Schizophrenia " documented in the Home Health Certification and Plan of Care for the Certification Period 08/28/2025 to 10/26/2025. The Visit Note Report documents: Site of Fingerstick: Sensor or Libre on the following dates: 08/30/2025 to 09/03/2025, 09/08/2025, 09/09/2025, 09/13/2025 to 09/16/2025, 09/19/2025, and 09/22/2025. The clinical record lacks documented evidence of the verbal order including who is responsible of applying/changing the device and frequency. There is no documented evidence that the verbal orders were documented in the patient’s clinical record. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings. 3. Patient #3 has a Start of Care (SOC) date of 02/26/2025 with the following diagnoses "Type 2 Diabetes Mellitus with Diabetic Neuropathy, Bipolar Disorder" documented in the Home Health Certification and Plan of Care for the Certification Period 08/25/2025 to 10/23/2025. The Visit Note Report documents :Site of Fingerstick: Sensor or Libre on the following dates: 08/252025, 08/26/2025, 08/30/2025 to 09/03/2025, 09/08/2025 to 09/10/2025, 09/13/2025 to 09/16/2025, 09/19/2025, and 09/22/2025. The clinical record lacks documented evidence of the verbal order including who is responsible of applying/changing the device and frequency. There is no documented evidence of the verbal orders being documented in the patient’s clinical record. On 09/25/2025 at 10:30 AM, the Directors of Patient Services was interviewed and did not provide an explanation for the findings.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure the physician are promptly alerted to any changes in the patient's condition or needs. This was evident for one (1) of seven (7) clinical records reviewed (Patient #7). Failure to ensure the physician are promptly alerted to any changes in the patient's condition or needs, has the potential for negative patient outcomes. The Findings Are: 1. Patient #7 has a Start of Care Date of 08/09/2024, a discharge date of 09/20/2024 with diagnoses of Type II Diabetes Mellitus Without Complications, Disorder Involving the Immune Mechanism, Unspecified, and Hypertensive Heart Disease with Heart Failure documented on the Home Health Certification and Plan of Care with a Certification Period from 08/09/2024 to 10/07/2024. The Home Health Certification and Plan of Care (medical orders) with a Certification Period from 08/09/2024 to 10/07/2024 documents, “Skilled Nurse to report blood glucose levels of greater than 400 mg/dl (milligrams per deciliter) or less than 60 mg/dl.” The “Visit Note Report” dated 08/25/2024 documents the patient’s blood glucose level was 478 mg/dl at the 7:00 AM visit. The “Visit Note Report” dated 09/03/2024 documents the patient’s blood glucose level was 425 mg/dl at the 7:10 AM visit. The “Visit Note Report” dated 09/12/2024 documents the patient’s blood glucose level was 460 mg/dl at the 11:00 AM visit. There is no documented evidence of the physician being notified of the patient's blood glucose levels being over 400 mg/dl on 08/25/2024, 09/03/2024 and 09/12/2024. The Home Health Certification and Plan of Care (medical orders) with a Certification Period from 08/09/2024 to 10/07/2024 documents the following insulin order: Humalog Kwikpen (U-100) insulin 100 unit/milliliter subcutaneous, 20 units, 3 times daily. Hold for blood glucose less than 100 milligrams per deciliter. The patient resides in an Assisted Living Facility. The Assisted Living Facility medical record documents the patient refused the noon insulin dose on 09/13/2024. The Assisted Living Facility medical record documents the patient refused the noon insulin dose on 09/15/2024. There is no documented evidence of the physician being notified that the patient refused the noon doses of insulin on 09/13/2024 and 09/15/2024. On 09/25/2025 at 4:20 PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure the physician is promptly alerted to any changes in the patient's condition or needs. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #7). Failure to ensure the physician is promptly alerted to any changes in the patient's condition or needs, has the potential for negative patient outcomes. The Findings Are: 1. Patient #7 has a Start of Care Date of 08/09/2024 and a discharge date of 09/20/2024 with diagnoses of Type II Diabetes Mellitus Without Complications, Disorder Involving the Immune Mechanism, Unspecified, and Hypertensive Heart Disease with Heart Failure documented on the Home Health Certification and Plan of Care with a Certification Period from 08/09/2024 to 10/07/2024. The Home Health Certification and Plan of Care with Certification Period from 08/09/2024 to 10/07/2024 documents the following order: “Skilled Nurse to report blood glucose levels of greater than 400 mg/dl (milligrams per deciliter) or less than 60 mg/dl.” The “Visit Note Report” dated 09/10/2024 documents the patient’s blood glucose level was 332 mg/dl at the 7:00 AM visit and “NP (Nurse Practitioner) aware of elevation.” The “Visit Note Report” dated 09/12/2024 documents the patient’s blood glucose level was 304 mg/dl at the 7 AM visit and “NP aware of elevation.” There is no documented evidence of the Home Health Certification and Plan of Care being revised to notify the patient’s authorized practitioner when blood glucose levels are above 300 mg/dl. On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings.

Discharge plans communication CFR(s): 484.60(c)(3)(ii) (ii) Any revisions related to plans for the patient's discharge must be communicated to the patient, representative, caregiver, all physicians or allowed practitioner's issuing orders for the HHA plan of care, and the patient's 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). This ELEMENT is not met as evidenced by: Based on clinical record reviews, and staff interview, the agency failed to communicate with the physician regarding the patient's discharge. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #5). Failure to communicate with the physician regarding the patient's discharge has the potential for negative patient outcomes. The Findings Are: 1. Patient #5 has a Start of Care Date of 04/17/2025 and a Discharge Date of 06/11/2025 with diagnoses Multiple Sclerosis, Primary Generalized Osteoarthritis, Age-related Osteoporosis with Current Pathological Fracture, History of Falling documented in the Home Health Certification and Plan of Care for Certification Period 04/17/2025 to 06/15/2025. The physician order dated 05/19/2025 documents the following orders for Occupational Therapy service: “Effective (week of) 05/18/2025 2WK4 (two visits a week for four weeks - total eight visits)” to establish home exercise program and provide therapeutic exercises.” The Occupational Therapy Visit Note dated 06/09/2025 (Visit number 7) documents: patient “continues to benefit from ongoing occupational therapy services;” “no changes in frequency/duration;” care communication with the patient, registered nurse, and facility staff; treatment plan for next visit is to continue plan of care. The clinical record documents the last skilled service visit was the occupational visit on 06/09/2025 (visit number 7). The physician order dated 06/11/2025 documents: “MD (Medical Doctor) notification/Agency Discharge.” The Discharge Transfer Summary Report dated 06/11/2025 documents: “last visit dated 6/9/2025;” “discharge to home or self-care.” The clinical record lacks documented evidence of the agency discussing with the physician and the patient or patient representative the change in providing occupational visits as ordered and the agency discharge planning in advance. On 09/25/2025 at 10:30AM, the Director of Patient Services was interviewed about the survey finding. On 09/26/2025 at 12:30PM, the DPS stated the agency has “no” explanation for the occupational therapist not continuing the plan of care and visit frequency as ordered.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to prepare and document clinical notes in timely manner. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #4, #7). Failure to prepare clinical notes in timely manner, has the potential for negative patient outcomes. The Findings Are: ***Patient #7 has a Start of Care Date of 08/09/2024, a discharge date of 09/20/2024 with diagnoses of Type II Diabetes Mellitus Without Complications, Disorder Involving the Immune Mechanism, Unspecified, and Hypertensive Heart Disease with Heart Failure documented on the Home Health Certification and Plan of Care with a Certification Period from 08/09/2024 to 10/07/2024. The agency "Clinical Record, Policy VII-1" with a revised date of 12/31/2024 documents, "The record will be complete, and all documentation filed in the record within 14 days of the home visit or patient contact." 1. The 7:00 AM "Visit Note Report" dated 09/12/2024 documents the Licensed Practical Nurse (LPN) signed and completed the visit note on 12/15/2024. 2. The 11:00 AM “Visit Note Report dated 09/12/2024 documents the LPN signed and completed the visit note on 12/15/2024. 3. The 7:50 AM “Visit Note Report” dated 09/13/2024 documents the LPN signed and completed the visit note on 12/15/2024. 4. The 3:40 PM “Visit Note Report” dated 09/13/2024 documents the LPN signed and completed the visit note on 12/15/2024. 5. The 8:20 AM “Visit Note Report” dated 09/15/2024 documents the LPN signed and completed the visit note on 02/25/2025. 6. The 3:20 PM “Visit Note Report” dated 09/15/2024 documents the LPN signed and completed the visit note on 02/24/2025. There is no documented evidence of the “Visit Note Reports” for 09/12/2024, 09/13/2024, and 09/15/2024 being completed with 14 days of patient contact. On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. Patient #4 has a Start of Care Date of 09/11/2023 with diagnoses Schizophrenia, Essential Hypertension, Type 2 Diabetes Mellitus Without Complications, Long-Term (Current) Use of Oral Hypoglycemic Drugs documented in the Home Health Certification and Plan of Care for Certification Period 08/31/2025 to 10/29/2025. The Home Health Certification and Plan of Care for Certification Period 07/02/2025 to 8/30/2025 documents order for Skilled Nurse visits: “For administration of IM (intramuscular) injection once a month (Q6th (Every 6th)),” “to observe and assess patient with Schizophrenia;” “for instructions/reinforcement of diabetic care.” The “Client Calendar Report” printed 09/22/2025 documents a scheduled Skilled Nurse visit date of 08/06/2025. The clinical record/electronic health record lacks documentation to a completed Skilled Nurse visit note for 08/06/2025. On 09/25/2025 at 10:30AM, the Director of Patient Services was interviewed about lack of documentation for a visit on 08/06/2025. On 09/26/2025 at 12:30PM, the Director of Patient Services stated the visit note was in the patient’s electronic health record. The Skilled Nurse “Visit Note Reported” dated 08/06/2025 documents: Documentation Time “Completed: 09/25/2025 06:30PM,” fifty (50) days after the visit. The “Clinical Record” Policy (Revised 12/31/2024) documents: “The record will be complete, and all documentation filed in the record within 14 days of the home visit or patient contact.” The Skilled Nurse visit note lacks documented evidence of the nurse completing the note within the 14-day timeframe, as per agency policy. On 09/26/2025 at 12:30PM the Director of Patient Services was interviewed and stated “yes” the visit note completion is over 14 days.

Skilled services furnished CFR(s): 484.105(f) Standard: Services furnished. Skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are made available on a visiting basis, in a place of residence used as a patient's home. An HHA must provide at least one of the services described in this subsection directly, but may provide the second service and additional services under arrangement with another agency or organization. This STANDARD is not met as evidenced by: Based on review of the Contract, Employee Roster, Organizational Chart, and interviews with the Administrator, it was determined that the agency failed to ensure that at least one qualifying service was provided directly through agency's employees. Failure to provide one service directly has the potential for negative patient outcomes. The Findings Are: On 09/22/2025 at 11:15 AM, during the Entrance Conference, the Administrator and the Director of Patient Services were interviewed and stated we provide SN services directly and PT, OT services through contract. 09/22/25 at 01:40 PM, the agency submitted clinical employee roster total of one hundred sixteen employees without identifying if the employee is direct or contract hire. On 09/22/25 at 04:00 PM, the Administrator was interviewed and stated: “We have contract (Contract A) with another CHHA (Certified Home Health Agency) and we use their employees.” On 09/22/2025, the Surveyor reviewed The Employee Roster and Contract A and determined that no services were provided directly by agency staff. On 09/25/2025 at 10:30 AM, the Administrator was interviewed and stated: “I am directly hired by the agency, we hired Director of Patient Services in July of 2025, and we hired one Registered Nurse in April of 2025. The Registered Nurse performs supervisory visit and patient’s visits. Majority of SN Services, PT, and OT Services are provided through (Contract A) with another CHHA (Certified Home Health Agency).”

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 clinical record reviews, and staff interviews, the agency failed to ensure that all required items are in the clinical record. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #6, #7). Failure ensure that all required items are in the clinical record, has the potential for negative patient outcomes. The Findings Are: 1. Patient #6 has a Start of Care date of 08/13/2025 with diagnoses of Type 2 Diabetes Mellitus Without Complications, Epilepsy, Unspecified, Not Intractable, Without Status Epilepticus, and Parkinson’s Disease Without Dyskinesia, Without Mention of Fluctuations documented on the Home Health Certification and Plan of Care with a Certification Period from 08/13/2025 to 10/11/2025. The Home Health Certification and Plan of Care with a Certification Period from 08/13/2025 to 10/11/2025 documents the following medication order: Abilify 960 milligrams/3.2 milliliters suspension, extended release, intramuscular syringe, inject at 8 AM IM (intramuscular) every 57 days. A physician’s prescription documents, “Resident received Abilify 3.2 ml (milliliters) IM to right deltoid. Resident with no c/o (complaints of) pain or discomfort and tolerated well on 09/18/2025. Resident’s next dose 11/04/2025.” There is no documented evidence of a clinical note in the Wellbound II clinical record documenting when the administration of Abilify was due to be given and the administration of Abilify on 09/18/2025. On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. 2. Patient #7 has a Start of Care Date of 08/09/2024, a discharge date of 09/20/2024 with diagnoses of Type II Diabetes Mellitus Without Complications, Disorder Involving the Immune Mechanism, Unspecified, and Hypertensive Heart Disease with Heart Failure documented on the Home Health Certification and Plan of Care with a Certification Period from 08/09/2024 to 10/07/2024. The Home Health Certification and Plan of Care (medical orders) with a Certification Period from 08/09/2024 to 10/07/2024 documents the following orders: Skilled Nurse to Perform Blood Sugar Analysis 3 x daily (3 times daily). Humalog Kwikpen (U-100) insulin 100 unit/milliliter subcutaneous, 20 units, 3 times daily. Hold for blood glucose less than 100 milligrams per deciliter. The patient resides in an Assisted Living Facility. The Wellbound II clinical record “Visit Note Reports” for 08/24/2024 documents the patient had a blood glucose level of 118 mg/dl and at 8:10 AM and a blood glucose level of 202 at 6:00 PM on 08/24/2024. The Assisted Living Facility medical record documents the patient had a blood glucose level of 94 mg/dl at 11:00 AM on 08/24/2024. There is no documented evidence of a clinical note in the Wellbound II clinical record that the patient’s blood glucose level was of 94 mg/dl at 11:00 AM on 08/24/2024, and the Humalog insulin dose was held for a blood glucose level of less than 100 mg/dl. The Wellbound II clinical record “Visit Note Reports” for 09/13/2024 documents the patient received the first Humalog dose at 7:50 AM and third dose at 3:40 PM on 09/13/2024. The Assisted Living Facility medical record documents the patient refused the noon insulin dose on 09/13/2024. The Wellbound II clinical record “Visit Note Reports” for 09/15/2024 documents the patient received the first Humalog dose at 8:20 AM and the third dose at 3:20 PM on 09/15/2024. The Assisted Living Facility medical record documents the patient refused the noon insulin dose on 09/15/2024. There is no documented evidence of a clinical note in the Wellbound II clinical record that the patient refused the noon doses of insulin on 09/13/2024 and 09/15/2024. On 09/25/2025 at 11:00 AM, the Director of Patient Services was interviewed and did not provide an explanation for the findings.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure clinical records documents all interventions and the responses to those interventions. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #7). Failure to ensure clinical records documents all interventions and responses to those interventions, has the potential for negative patient outcomes. The Findings Are: 1. Patient #7 has a Start of Care Date of 08/09/2024, a discharge date of 09/20/2024 with diagnoses of Type II Diabetes Mellitus Without Complications, Disorder Involving the Immune Mechanism, Unspecified, and Hypertensive Heart Disease with Heart Failure documented on the Home Health Certification and Plan of Care with a Certification Period from 08/09/2024 to 10/07/2024. The Home Health Certification and Plan of Care with a Certification Period from 08/09/2024 to 10/07/2024 documents the following order: “Skilled Nurse to report blood glucose levels of greater than 400 mg/dl (milligrams per deciliter) or less than 60 mg/dl.” The patient resides in an Assisted Living Facility. The Assisted Living Facility medical record documents on 09/20/2024 at 7:00 AM the patient’s blood sugar was “high” (indicates a blood glucose that is very high that the blood glucose meter cannot give an exact number). There is no documented evidence in the Wellbound II clinical record of what interventions were provided, the insulin administered, and the patient’s response to the interventions. On 09/26/2025 at 11:15 AM, the Director of Patient Services was interviewed and stated 20 units of Lantus was administered and once the patient transfers to the hospital (name of electronic medical record system) wipes out the visit information.