Merit Home Health Services Inc.

“Compliance with Federal, State, Local Law CFR(s): 484.100 Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients. The HHA and its staff must operate and furnish services in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients. If state or local law provides licensing of HHAs, the HHA must be licensed. This Condition is not met as evidenced by: The agency failed to ensure the Condition of Participation: G 848 484.100 Operate/provide services in compliance with laws/regulations was in compliance when: Based on observation, interview, and record review, the agency failed to operate in compliance with state licensure and certification requirements for two of 51 patients (Patient 1 and Patient 2) by providing Certified Home Health Aid services (CHHA services –services provided by a trained and certified healthcare worker who provides personal care and supportive services to patients in their homes under the supervision of a licensed nurse, therapist, or home health agency) that were not authorized under the services identified on the agency’s current state license. [refer to G860]. The cumulative effects of this deficient practice resulted in patients receiving CHHA services that had not been approved by the state due to lack of state oversight and approval to operate with vetted (carefully examined, evaluated, verified, or investigated to determine suitability, qualifications, accuracy, or reliability before approval or acceptance) CHHA services.”

“Organization and administration of services CFR(s): 484.105 Condition of participation: Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished. This Condition is not met as evidenced by: The agency failed to ensure the Condition of Participation: G 940 484.105 Organization and administration of services was in compliance when: Based on observation, interview, and record review, the agency’s governing body (an individual or group that has ultimate authority and responsibility for the agency’s management, operation, policies, and quality of care) failed to exercise operational oversight of the agency for two of 52 patients (Patient 1 and Patient 2) when the agency provided Certified Home Health Aid Services (CHHA services - services provided by a trained and certified healthcare worker who provides personal care and supportive services to patients in their homes) that were not authorized under the services identified on the agency’s current state license. [refer to G942]. The cumulative effects of this deficient practice resulted in the agency providing a type of service that had not undergone required state vetting (carefully examined, evaluated, verified, or investigated to determine suitability, qualifications, accuracy, or reliability before approval or acceptance), approval, or oversight for safety, scope, or regulatory suitability. This had the potential to affect the health and safety of Patient 1 and 2 receiving CHHA services from the agency.”

“Licensing CFR(s): 484.100(b) (b) Standard: Licensing. The HHA, its branches, and all persons furnishing services to patients must be licensed, certified, or registered, as applicable, in accordance with the state licensing authority as meeting those requirements. This Standard is not met as evidenced by: Based on observation, interview, and record review, the agency failed to operate in compliance with state licensure and certification requirements for two of 52 patients (Patient 1 and Patient 2) by providing Certified Home Health Aid services (CHHA services –services provided by a trained and certified healthcare worker who provides personal care and supportive services to patients in their homes under the supervision of a licensed nurse, therapist, or home health agency) that were not authorized under the services identified on the agency’s current state license. This failure had the potential to affect the health and safety of all patients receiving CHHA services, as the agency operated without state approval and oversight of CHHA services. During an interview on June 2, 2026, at 2:30 PM, with Patient 2, in Patient 2’s home, Patient 2 stated she was currently receiving CHHA services from the agency, once a week. Patient 2 further stated CHHA 1 was the staff member who would provide CHHA services for her. During a concurrent interview and record review on June 2, 2026, at 3:00 PM, with the Director of Patient Care Services (DPCS), the agency’s document titled, “Clinician List,” (undated), was reviewed. The list indicated the information of CHHA (CHHA 1) and included but was not limited to: name, hire date of September 25, 2025, and discipline as “CHHA.” The DPCS stated CHHA 1 was currently the agency’s only active CHHA staff and CHHA 1 was assigned to provide services to Patient 1 and 2. During an interview on June 3, 2026, at 9:55 AM, with CHHA 1, CHHA 1 stated she had been working at the agency for nine months as a home health aide and was currently assigned to Patient 1 and Patient 2. During an interview on June 3, 2026, at 10:25 AM, with Patient 1, Patient 1 stated she had been receiving CHHA services by CHHA 1 for approximately nine months now and received services three times a week. During an interview on June 3, 2026, at 2:40 PM, with the DPCS and the Administrator (ADMIN), the ADMIN stated she thought the agency had CHHA services indicated on their state license from the California Department of Public Health (CDPH) but in 2023 the agency identified that their license did not include CHHA services and they had been working with their accrediting organization to determine why CHHA services were not included on their license and to have CHHA services added. The DPCS and the ADMIN both acknowledge the facility has been offering CHHA services to patients despite the agency not having it as an approved service on their state license. During an observation on June 4, 2026, at 10:59 AM, a framed license was displayed on the wall in the facility’s lobby and indicated, “State of California Department of Public Health…License: 550003217, Effective: 06/29/2025 [June 29, 2025], Expires: 06/28/2026 [June 28, 2026] … In accordance with applicable provisions of the Health and Safety Code of California and its rules and regulations, the Department of Public Health hereby issues this License to [name of facility] to operate and maintain the following Home Health Agency [name and address of facility]. In addition to skilled nursing, the following additional services have been approved: Diet Counseling/Nutrition, Medical Social Services, Occupational Therapy, Physical Therapy, Speech Therapy.” There was no mention or listing of Certified Home Health Aide (CHHA) services. During a review of Patient 1’s “Home Health Certification and Plan of Care” (document that outline a patient’s in home medical treatment), with a certification period from May 3, 2026, through July 1, 2026, the plan of care included a physician’s order which indicated Patient 1 was to receive CHHA services three times a week for eight weeks, then two times a week for one week starting May 3, 2026. During a review of Patient 2’s “Home Health Certification and Plan of Care,” with a certification period from May 8, 2026, through July 6, 2026, the plan of care included a physician’s order which indicated Patient 2 was to receive CHHA services once a week for eight weeks starting May 8, 2026. During a review of CHHA 1’s “Employment Application,” dated September 25, 2025, the application was signed by CHHA 1 and indicated, “position applying for: HHA [home health aide.]” During a review of CHHA 1’s job description titled, “Home Health Aide,” (undated), the job description indicated CHHA 1’s written name and included CHHA 1’s signature and was dated September 25, 2025. During a review of CHHA 1’s “Wage and Benefit Agreement,” (undated), the document included CHHA 1’s name and indicated, “date of hire: 9/25/25 [September 25, 2025].” During a review of CHHA 1’s work schedule titled, “Clinician Monthly Schedule,” for the month of June 2026, the schedule indicated CHHA 1 was scheduled to perform 19 CHHA home visits from June 1 through July 1, 2026. 14 of the scheduled visits were for Patient 1 and five [5] of the visits were for Patient 2. During a review of the facility’s policy and procedure (P&P) titled, “Compliance with Federal, State, and Local Law,” dated January 2026, the P&P indicated, “Responsibility of Agency: The agency and its staff must operate, and furnish services, in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients. 1. If state, or local, law provides licensing of agencies, the agency must be licensed…Licensing: The agency, its branches, and all persons furnishing services to patients must be licensed, certified, or registered, as applicable, in accordance with the state licensing authority as meeting those requirements….Agency must be in compliance with all laws and regulations including, but not limited to: 1. Local and state licensure…7. Medicare/Medicaid regulations…””

“Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency’s overall management and operation, the provision of all home health services, fiscal operations, review of the agency’s budget and its operational plans, and its quality assessment and performance improvement program. This Standard is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure its governing body (an individual or group that has ultimate authority and responsibility for the agency’s management, operation, policies, and quality of care) exercised operational oversight of the agency for two of 52 patients (Patient 1 and Patient 2) when Certified Home Health Aid Services (CHHA services - services provided by a trained and certified healthcare worker who provides personal care and supportive services to patients in their homes) were provided when the agency was not authorized under the services identified on the agency’s current state license. This failure resulted in Patient 1 and 2 receiving CHHA services, as the agency operated without state approval and oversight of CHHA services and placed Patient 1 and 2’s health and safety at risk. During an interview on June 2, 2026, at 2:30 PM, with Patient 2, in Patient 2’s home, Patient 2 stated she currently was receiving CHHA services from the agency once a week. Patient 2 further stated CHHA 1 was the staff member who would provide CHHA services for her. During a concurrent interview and record review on June 2, 2026, at 3:00 PM, with the Director of Patient Care Services (DPCS), the agency’s document titled, “Clinician List,” (undated), was reviewed. The list indicated the information of CHHA (CHHA 1) including but was not limited to: name, hire date of September 25, 2025, and discipline as “CHHA.” The DPCS stated CHHA 1 was currently the agency’s only active CHHA staff and CHHA 1 was assigned to provide services to Patient 1 and 2. During an interview on June 3, 2026, at 9:55 AM, with CHHA 1, CHHA 1 stated she had been working at the agency for nine months as a home health aide and was currently assigned to Patient 1 and Patient 2. During an interview on June 3, 2026, at 10:25 AM, with Patient 1, Patient 1 stated she had been receiving CHHA services by CHHA 1 for approximately nine months now and received services three times a week. During an interview on June 3, 2026, at 2:40 PM, with the DPCS and the Administrator (ADMIN), the ADMIN stated she thought the agency had CHHA services indicated on their state license from the California Department of Public Health (CDPH) but in 2023 the agency identified that their license did not include CHHA services and they had been working with their accrediting organization (a private, independent organization that evaluates home health agencies to ensure they meet the standards for patient care, safety, and operational quality) to determine why CHHA services were not included on their license and to have CHHA services added. The DPCS and the ADMIN both acknowledged the facility has been offering CHHA services to Patient 1 and 2 despite the agency not having it as an approved service on their state license. During an observation on June 4, 2026, at 10:59 AM, a framed license was displayed on the wall in the facility’s lobby. The framed license indicated, “State of California Department of Public Health…License: 550003217, Effective: 06/29/2025 [June 29, 2025], Expires: 06/28/2026 [June 28, 2026] … In accordance with applicable provisions of the Health and Safety Code of California and its rules and regulations, the Department of Public Health hereby issues this License to [name of facility] to operate and maintain the following Home Health Agency [name and address of facility]. In addition to skilled nursing, the following additional services have been approved: Diet Counseling/Nutrition, Medical Social Services (help patients and families with support and resources during illness or care) , Occupational Therapy (helps people learn or regain the skills they need for everyday activities so they can live as independently as possible), Physical Therapy (helps people improve movement and reduce pain so they can function better), Speech Therapy (helps people improve their speech, language, and communication skills).” There was no mention or listing of Certified Home Health Aide (CHHA) services. During a review of Patient 1’s “Home Health Certification and Plan of Care” (document that outline a patient’s in home medical treatment), with a certification period from May 3, 2026, through July 1, 2026, the plan of care included a physician’s order which indicated Patient 1 was to receive CHHA services three times a week for eight weeks, then two times a week for one week starting May 3, 2026. During a review of Patient 2’s “Home Health Certification and Plan of Care,” with a certification period from May 8, 2026, through July 6, 2026, the plan of care included a physician’s order which indicated Patient 2 was to receive CHHA services once a week for eight weeks starting May 8, 2026. During a review of CHHA 1’s “Employment Application,” dated September 25, 2025, the application was signed by CHHA 1 and indicated, “position applying for: HHA [home health aide]” During a review of CHHA 1’s job description titled, “Home Health Aide,” (undated), the job description indicated CHHA 1’s written name and included CHHA 1’s signature and was dated September 25, 2025. During a review of CHHA 1’s “Wage and Benefit Agreement,” (undated), the document included CHHA 1’s name and indicated, “date of hire: 9/25/25 [September 25, 2025].” During a review of CHHA 1’s work schedule titled, “Clinician Monthly Schedule,” dated for the month of June 2026, the schedule indicated CHHA 1 was scheduled to perform 19 CHHA home visits from June 1 through July 1, 2026. Fourteen of the scheduled visits were for Patient 1 and five [5] of the visits were for Patient 2. During a review of the governing body meeting minutes titled, “Home Health Agency Governing Body Meeting Minutes” (meeting minutes), dated August 24, 2023, the meeting minutes indicated, “Attendees – Administrator [name of ADMIN]…DPCS [name of DPCS]…MD [medical director]… Agenda Item: Omission of Certified Home Health Aides (CHHAs) from state license… The administrator informed the governing body that during a recent review of the agency’s licensure documents, it was discovered that certified home health aide (CHHA) services were not listed on the agency’s California State Home Health Agency License… Discussion… 4. Immediate action is necessary to ensure state licensure accurately reflects the services approved through accreditation and intended to be provided by the agency… Governing Body Actions… After discussion, the Governing Body directed the administrator to:… Request amendment or correction of the state license to include CHHA services… maintain documentation of all communications with [name of accrediting organization] Report progress and final resolution to the Governing Body at the next scheduled meeting…Follow up – The Administrator will provide monthly status updates until the matter is resolved and the corrected license is received.” During an interview on June 4, 2026, at 3:15 PM, with the DPCS, the DPCS was asked to provide documentation regarding governing body follow up as indicated in meeting minutes, documentation of communication to [name of accrediting organization] for resolution of CHHA on state license, and documentation for administrator monthly status updates as indicated in “follow up” notes for governing body. The DPCS stated she would attempt to obtain evidence as requested but stated a lot of the discussions and conversations were done over the phone which may not have been documented. During an interview on June 4, 2026, at 4:26 PM, with the DPCS, the DPCS stated agency was unable to provide additional documentation regarding governing body follow up during subsequent governing body meetings and could not provide monthly status updates by the Administrator as indicated in the governing body meeting minutes. The DPCS further stated their accrediting organization was still working on trying to get information regarding why the CHHA services were not included on their state license. During a review of the facility’s policy and procedure (P&P) titled, “Compliance with Federal, State, and Local Law,” dated January 2026, the P&P indicated, “Responsibility of Agency: The agency and its staff must operate, and furnish services, in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients. 1. If state, or local, law provides licensing of agencies, the agency must be licensed…Licensing: The agency, its branches, and all persons furnishing services to patients must be licensed, certified, or registered, as applicable, in accordance with the state licensing authority as meeting those requirements….Agency must be in compliance with all laws and regulations including, but not limited to: 1. Local and state licensure…7. Medicare/Medicaid regulations…” During a review of the facility’s P&P titled, “Governing Body,” dated February 20, 2026, the P&P indicated, “Policy: The agency’s policy is that the governing body/owner (or designated persons functioning) assumes full legal authority, responsibility and accountability for the organization’s overall management and operation, the provision of services, fiscal operations, review of the organization’s budget and its operational plans, and its continuous quality improvement program…””