Hope Professional Services, Inc.

“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 interview and record review, the agency failed to electronically submit the completed Outcome and Assessment Information Set (OASIS - a standard set of data elements used by home health agencies to collect and report patient information, to tract and monitor quality of home health, used to develop individualized care plans, identify areas for quality improvement, and measures the effectiveness of home health services) to the Centers for Medicare and Medicaid Services (CMS) within 30 days of completing the assessment for 10 of 17 patients reviewed (Patients 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17). This failure had the potential to result in the delay of assessment, the development of patient’s plan of care and the delivery of the necessary care and services needed to meet patient’s individualized quality of care. Findings: On March 10, 2025, at 10 a.m., a concurrent interview and record review was conducted with the Administrator/Director of Patient Care Services (ADM/DPCS) regarding the OASIS Agency’s Final Validation report from November 30, 2023, through December 12, 2024. The OASIS report had identified 10 patients in OASIS reports with submission dates more than 30 days. The ADMIN/DPCS acknowledged the 10 patients had OASIS reports with submission dates more than 30 days. The ADM/DPCS stated the Billing Coordinator (BC) was responsible for submitting the OASIS reports. On March 12, 2025, at 2:23 p.m., a concurrent interview and record review was conducted with the BC. The BC had identified the 10 patients with late submission dates of more than 30 days as follows: 1. Patient 8 was admitted to the agency on April 18, 2023, with diagnoses which included essential hypertension (high blood pressure) and peripheral vascular disease (PVD - a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs). Patient 8’s last certification period was from October 15, 2023, to December 13, 2023. Patient 8 was discharged on November 30, 2023. The OASIS Discharge Assessment was completed on November 30, 2023. The BC stated the agency got locked out of IQIES (Internet Quality Improvement and Evaluation System - a web-based system used by CMS) OASIS submission since November 2023, to February 2024. The BC stated the agency was not able to submit any data due to a legal dispute between the two physicians. He stated the system got reactivated on March 26, 2024. He stated Patient 8’s Discharge Assessment dated November 30, 2023, was submitted on March 26, 2024. He stated the Discharge Assessment was submitted over 30 days; 2. Patient 9 was admitted to the agency on April 7, 2023, with diagnoses which included diabetes mellitus (a group of diseases that result in too much sugar in the blood) and hypertension (high blood pressure). Patient 9’s last certification was from October 4, 2023, to December 2, 2023. Patient 9 was discharged on November 24, 2023. The Discharge Oasis Assessment was completed on November 24, 2023, and was submitted on March 26, 2024. The BC stated the agency got locked out of IQIES from November 2023 to February 2024, and he was not able to submit the data to CMS. The system got reactivated on March 26. 2024. He stated the OASIS Discharge Assessment was submitted over 30 days; 3. Patient 10 was admitted to the agency on May 24, 2023, with diagnoses which included hypertension and PVD. Patient 10’s last certification was from September 21, 2023, to November 19, 2023. Patient 9 was discharged on November 19, 2023. The Oasis Discharge Assessment was completed on November 19, 2023, and was submitted on 03/26/2024. The BC stated the agency got locked out of IQIES from November 2023 to February 2024, and he was not able to submit the data to CMS. The system got reactivated on March 26, 2024. He stated the OASIS Discharge Assessment was submitted over 30 days; 4. Patient 11 was admitted to the agency on February 27, 2024, with diagnoses which included PVD. Patient 11’s first certification period was from February 27, 2024, to April 26, 2024. The OASIS Start of Care Assessment was completed on February 27, 2024, and was submitted to CMS on April 18, 2024. The BC stated he was on medical leave and the OASIS Start of Care Assessment was submitted over 30 days. Patient 11 was discharged on March 1, 2024. The OASIS Discharge Assessment was completed on March 1, 2024, and was submitted to CMS on April 18, 2024. The BC stated he was on medical leave and the OASIS Discharge Assessment was submitted over 30 days; 5. Patient 12 was admitted to the agency on February 27, 2024, with diagnoses which included PVD. Patient 12’s certification period was from February 27, 2024, to April 26, 2024. Patient 12 was discharged on March 31, 2024. The OASIS Discharge Assessment was completed on March 31, 2024, and was submitted to CMS on 05/28/2024. The BC stated he was on medical leave and the OASIS Discharge Assessment was submitted over 30 days; 6. Patient 13 was admitted to the agency on April 17, 2024, with diagnoses which included PVD and diabetes mellitus. Patient 13’s certification period was from 04/17/2024 - 06/15/2024. The OASIS Start of Care Assessment was completed on 04/17/2024, and was submitted on 06/05/2024. The BC stated he was on medical leave and the OASIS Start of Care Assessment was submitted over 30 days; 7. Patient 14 was admitted to the agency on November 7, 2024, with diagnoses which included PVD. Patient 14’s certification period was from November 7, 2024, to January 5, 2024. Patient 14 was discharged on December 5, 2024. The OASIS Discharge Assessment was completed on December 5, 2024, and was submitted to CMS on 01/10/2025. The BC stated he was on medical leave and the OASIS Discharge Assessment was submitted over 30 days; 8. Patient 15 was admitted to the agency on July 1, 2024, with diagnoses which included hypertension. Patient 5’s fourth recertification was from December 28, 2024, to February 25, 2025. The OASIS Recertification Assessment dated December 27, 2024, was completed on December 27, 2024, and was submitted to CMS on February 6, 2025. The BC stated he was on medical leave and Patient 15’s Recertification Assessment was submitted late over 30 days; 9. Patient 16 was admitted to the agency on April 10, 2024, with diagnoses which included epilepsy (a brain disorder that causes recurring, unprovoked convulsions). The first certification period was from April 10, 2024, to June 8, 2024. The OASIS Start of Care Assessment was completed on April 10, 2024, and was submitted on May 28, 2024. The BC stated he was on medical leave and the OASIS Start of Care Assessment was submitted over 30 days; and 10. Patient 17 was admitted to the agency on April 11, 2024, with diagnoses which included nodular prostate (the presence of firm, raised areas or lumps on the prostate gland). Patient 17 first certification period was from April 11, 2024, to June 11, 2024. The OASIS Start of Care Assessment was completed on April 11, 2024, and was submitted on July 1, 2024. The BC stated he was on medical leave and the OASIS Start of Care Assessment was submitted over 30 days. On March 12, 2025, at 3:19 p.m., the ADM/DPCS was interviewed. He stated on November 2023 through March 2024, the agency was not able to submit the OASIS data into the IQIES system of CMS. The agency later found out the two physicians who serviced the agency’s patients were suing each other and the agency’s name was included. He stated the owner of the agency had to hire a lawyer to clear the agency’s name and on March 2024, the OASIS Assessments were submitted when the system got reactivated. He stated the Billing Coordinator was on medical leave on April 2024, and July 2024. During a review of the agency’s policy and procedure titled, “...Data Entry/Transmission of OASIS Information, “ dated May 23, 2019, indicated, “...The Administrator must designate two (2) employees that will possess the Agency PASSWORD and knowledge to electronically transmit OASIS data to the CMS IQIES at least monthly or within 30 days of the assessment date of the beneficiary...””

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on interview and record review, the facility failed to ensure the approved visit frequencies in the patient’s Plan of Care (POC) were followed when the agency did not notify the physician of missed visits for three of 7 patients reviewed (Patients 4, 6 and 7). This failure had the potential for the Patients 4, 6 and 7, not to receive the care and services from the skilled nurse (SN) as indicated in the POC. Findings: 1. On March 12, 2025, Patient 4’s record was reviewed. Patient 4 was admitted to the agency with a SOC date of October 9, 2024, with diagnoses which included End Stage Renal Disease (ESRD – irreversible kidney failure). The POC for the certification period from February 6, 2025, to April 6, 2025, was reviewed. The POC indicated an order for skilled nurse (SN) visit for “…1W9 (one visit a week for nine weeks)…” The calendar of visits for the week of February 26, 2025, to February 29, 2025, was reviewed. The calendar indicated there was no SN visit during the week of February 23, 2025, to March 1, 2025. There was no documented evidence a communication note was made to inform the physician of the missed visit on the week of February 23, 2025, to March 1, 2025. 2. On March 12, 2025, Patient 6’s record was reviewed. Patient 6 was admitted to the agency with a Start of Care (SOC) date of November 12, 2024, with diagnoses which included peripheral vascular disease (PVD – a blood circulation disorder of the veins and arteries). The POC for the certification period from November 11, 2024, to January 10, 2025, was reviewed. The POC indicated an order for SN visit for “…Daily x3 (three days); 1W8 (one visit a week for eight weeks)…” The agency’s document titled, “POST ARTERIAL FOLLOW UP,” dated November 27, 2024, indicated, “…PLEASE SEE PATIENT FOR THE NEXT 3 (three) CONSECUTIVE DAYS: 11/27/24 – 11/29/24…” The calendar of visits for the week of November 24 – 30, 2024 was reviewed. The calendar indicated there was no SN visit on November 27, 2024, and November 29. 2024, as indicated on the post arterial follow up orders dated November 27, 2025. There was no documented evidence a communication note was made to inform the physician of missed visits on November 27, 2024, and November 29, 2024. 3. On March 13, 2025, Patient 7’s record was reviewed. Patient 7 was admitted to the agency with a SOC date of October 31, 2024, with diagnoses which included diabetes mellitus (a disorder characterized by difficulty in blood sugar control) and hypertension (high blood pressure). The POC for the certification period from October 31, 2024, to December 29, 2024, was reviewed. The POC indicated an order for SN visit for “…1W9 (one visit a week for nine weeks)…” The agency’s document titled, “POST ARTERIAL FOLLOW UP,” dated December 3, 2024, indicated, “…PLEASE SEE PATIENT FOR THE NEXT 3 CONSECUTIVE DAYS:12/03/24 – 12/05/24…” The calendar of visits for the week of November 24, 2024, to November 30, 2024, and for the week of December 1, 2024, to December 7, 2024, were reviewed. The calendar of visits indicated there were no SN visit during the week of November 24, 2024, to November 30, 2024, and there was no visit conducted on December 3, 2024, as indicated on the post arterial follow-up orders dated December 3, 2024. There was no documented evidence of missed visit notes, and the physician was not notified of the missed visits on the week of November 24, 2024, to November 30, 2024, and on December 3, 2024. On March 11, 2025, at 1:45 p.m., during an interview with Licensed Vocational Nurse (LVN) 2, she stated if the staff had a missed visit, the agency and the physician should be notified. On March 13, 2025, at 2:50 p.m., during an interview with the Administrator/Director of Patient Care Services (ADM/DPCS), he stated the procedure for missed visit was to notify the patient’s physician for the missed visit. He also stated there should also be a documentation for the reason of the missed visit. The agency’s policy and procedure titled, “Staffing Issues,” reviewed May 23, 2019, indicated, “…Whenever agency staff is unable to complete a visit…at the scheduled time…the staff member will notify the case manager and document the occurrence…If the visit cannot be rescheduled during the same…week a missed visit note will be sent to the physician explaining the occurrence…””

“Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient’s status, and must include, at a minimum, the following information: (1) The patient’s current health, psychosocial, functional, and cognitive status; This Element is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure the OASIS (Outcome and Assessment Information Set - a standardized set of data that helps measure and improve the quality of care for home health patients) Assessments were accurate and complete that included patient’s past medical history, and active health status, measurables goals and outcomes, for four of 7 patients reviewed (Patients 1, 2, 4, and 6). This failure had the potential for Patients 1, 2, 4, and 6 not to receive the patient’s centered plan of care necessary for the delivery of care and services appropriate for their current health status and discharge plans. 2. On March 10, 2025, Patient 2’s record was reviewed. Patient 2 was admitted to the agency with SOC date of February 2, 2025, with diagnoses which included bilateral osteoarthritis (a progressive disorder of the joints, caused by a gradual loss of cartilage) and hypertension. On March 11, 2025, at 11:50 a.m., a home visit was conducted with LVN 2 for Patient 2. Patient 2 was alert to time, place, person, and situation, with periods of forgetfulness. Patient 2 was observed to be by herself in the house. Patient 2 received two phone calls from her son at the beginning of the home visit. On March 11, 2025, at 12:45 p.m., during an interview with Patient 2, she stated she lived by herself since her husband passed away seven to eight years ago. She also stated her kids would call her during the day and sometimes, her son would spend a night with her. On March 11, 2025, at 1:45 p.m., LVN 2 stated she was aware Patient 2 was living alone in the house and spoke with Patient 2’s son. She stated Patient 2’s son talked about applying for In-Home Support Service (IHHS – a program that provides in-home assistance to eligible aged, blind, and disabled individuals as an alternative to out-of-home care and enables the recipients to remain safely in their own homes), or to live with his mother. On March 12, 2025, at 11:31 a.m., during a concurrent interview and record review with the ADM/DPCS, the OASIS Start of Care Assessment dated February 2, 2025, was reviewed. The OASIS assessment indicated the following: - Sensory status was not complete; - Living Arrangement, Patient lives with other person(s) in the home, around the clock; - Digestive system was not complete; and - The Patient Medication Record did not list all of Patient 2’s medications. On March 12, 2025, at 11:31 a.m., during an interview with the ADM/DPCS, he stated he was not aware Patient 2 was living alone in the house. He stated Patient 2 stated she was living with her family, and did not inform him of the medications she was taking during the initial assessment on February 4, 2025. The ADM/DPCS stated, Patient 2 did not show him her medication bottles. 3. On March 12. 2025, Patient 4’s record was reviewed. Patient 4 was admitted to the agency with SOC date of October 9, 2024, with diagnoses which included End of Stage Renal Disease (ESRD – irreversible kidney failure). The OASIS Start of Care Assessment dated February 5, 2025, for recertification period from February 6, 2025, to April 6, 2025, indicated the following: - Immunizations was not complete; - Genitourinary was not complete; - Digestive was not complete; and - Dialysis information was not complete. 4. On March 12, 2025, Patient 6’s record was reviewed. Patient 6 was admitted to the agency with a SOC date of November 12, 2024, with diagnoses which included peripheral vascular disease (PVD – a blood circulation disorder of the veins and arteries). The OASIS Start of Care Assessment dated November 12, 2024, for certification period from November 12, 2024, to January 10, 2025, included the following: - Psychosocial assessment was not complete; and - Gastrointestinal Assessment was not complete. On March 13, 2025, at 2:50 p.m., during an interview with the ADM/DPCS, he stated he was responsible for completion the OASIS Start of Care Assessment. He stated he should have completed all the required information from the OASIS Start of Care Assessment. The agency’s policy and procedure titled, “INITIAL ASSESSMENT,” reviewed May 23, 2019, indicated, “…During the initial and comprehensive patient assessment, all baseline data and other relevant information will be documented in the patient’s clinical record, including at least the following…Patient’s medical and psychosocial history and present data…An evaluation of home environment…Review of medications, including prescription and over-the counter medications…Immunizations…” 1. On March 10, 2025, Patient 1’s record was reviewed. Patient 1 was admitted to the agency with the Start of Care (SOC) date of January 24, 2025, with diagnoses which included hypertension (high blood pressure). On March 11, 2025, at 10:30 a.m., a home visit was conducted with Licensed Vocational Nurse (LVN)1 for Patient 1. Patient 1 was alert, oriented to time, place, person, situation, and able to verbalize his needs. Patient 1 was observed with bluish discoloration of both hands. Patient 1 stated he was started on blood thinner medication on August 2024. LVN1 stated she observed Patient 1’s hand discoloration on her first visit on January 21, 2025. Patient 1 was observed with pacemaker (a small device that helps regulate the heart’s beat) on his left chest. Patient 1 showed a card containing the pacemaker information. The card indicated the date of pacemaker implant (July 25, 2018), the model number, serial number, the physician’s contact information and the name of the hospital. LVN 1 stated she was not aware of Patient 1’s pacemaker information. LVN 1 visit notes dated January 21, 2025, and January 25, 2025, did not indicate Patient 1’s skin discoloration of both hands and the presence of pacemaker on his left chest. The notes did not indicate education and instructions related to the blood thinner medication and patient 1’s pacemaker. During a concurrent review of Patient 1’s medication profile with LVN 1, the medication profile indicated Patient 1 was taking Plavix 75 milligram (mg - a unit of measurement) one tablet by mouth daily. There was no documented evidence of Patient 1’s education and instructions related to the risk for bleeding and bruising at the Start of Care (SOC) comprehensive assessment. There was no documented evidence of of the pacemaker history in Patient 1’s past medical history. LVN 1 acknowledged the OASIS SOC Assessment dated January 24, 2025, did not contain the pacemaker information and skilled instruction and education of taking the blood thinner medication. On March 12, 2024, at 11:07 a.m., a concurrent interview and record review was conducted with the Administrator/Director of Patient Care Services (ADM/DPCS). The OASIS Start of Care Assessment dated January 24, 2024 indicated the following: - The pacemaker information was not entered in Patient 1’s past medical and surgical history; - The most recent and additional Immunizations were not not documented; - The respiratory status was not complete; - The Assessment/Instruction/Performance section did not contain the pacemaker education, and information related to the side effects of the Plavix. During a concurrent interview and record review of Patient 1’s medication profile and OASIS Start of Care Assessment on March 12, 2025, at 11:15 a.m., with the ADM/DPCS, he stated he missed the pacemaker assessment on Patient 1’s left chest. The ADM/DPCS stated Patient 1’s comprehensive assessment should have included patient’s past surgical and medical history, education, instructions related to his pacemaker, allergy, immunization, and respiratory status. The ADM/DPCS also acknowledged Patient 1 should have received the education about the risk and side effects of the blood thinner. He stated the OASIS SOC Assessment should be complete and accurate.”

“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 observation, interview, and record review, the agency failed to ensure the patient’s current Plan of Care (POC) and the current medication profiles were updated, accurate, and complete for two patients reviewed (Patients 1 and 2). This failure had the potential for Patient 1 and Patient 2, and their primary care givers (PCG) not to be able to identify the significant drug interactions, ineffective drug therapy and non-compliance with prescribed medications 2. On March 10, 2025, Patient 2’s record was reviewed. Patient 2 was admitted to the agency with SOC date of February 4, 2025, with diagnoses which included osteoarthritis (a progressive disorder of the joints caused by a gradual loss of cartilage), embolism (obstruction or blockage in a blood vessel) and thrombosis (a condition where a blood clot forms in the vein or artery, blocking the blood flow), and hypertension (high blood pressure). Patient 2’s medication record indicated, “…Naproxen Oral 500 MG every 12 hours with food or milk by mouth…” There were no other medications listed on Patient 2’s medication record. The OASIS (Outcome and Assessment Information Set – an assessment tool) dated February 4, 2025, indicated, “…Mental Status…Memory…Forgetful…” On March 11, 2025, at 11:50 a.m., a home visit for Patient 2 was conducted with LVN 2. Patient 2 was observed awake and alert, with periods of forgetfulness. Patient 2 took a while recalling where she kept the admission packet she received from the agency. A review of the medications currently taken by Patient 1 was conducted. The undated agency document titled, “H.O.P.E PROFESSIONAL SERVICES INC. MEDICATION REVIEW,” located in Patient 2’s admission packet was left blank. On March 11, 2025, at 12:45 p.m., a medication reconciliation was conducted with LVN 2 and Patient 2. During the medication reconciliation, Patient 2 took the following medication bottles from the cabinet and placed them on the dining table. The following medications were not listed in Patient 2’s medication profile: - Atorvastatin (medication used to lower cholesterol level) 20 mg one tablet by mouth daily at bedtime; - Janumet (used to regulate blood sugar levels) 50-500 mg one tablet by mouth 2 times a day with meals; - Valsartan-hydrochlorotiazide (used to treat high blood pressure) 160-25 mg one tablet by mouth daily; - Naproxen (anti-inflammatory to relieve symptoms of arthritis such as inflammation, swelling, stiffness, and pain) 500 mg one tablet by mouth two times a day as needed for pain with meals; - Vitamin C 1,000 mg one tablet by mouth once a day; - Advil 200 mg one tablet every four to six hours as needed for pain; and - Icy Hot (menthol 16%) apply topically to affected area not more than three to four times a day as needed. During a concurrent interview with Patient 2, she stated the Vitamin C, and the Advil were not prescribed. She stated she bought them from a pharmacy. Patient two stated she was taking Vitamin C one tablet once a day and Advil two tablets two times a day for her knee pain. On March 11. 2025, at 1:03 p.m., LVN 2 was interviewed. She stated Patient 2’s medication profile should have been completed on admission. LVN 2 stated she did not check Patient 2’s medication list. LVN 2 stated Patient 2 should have a copy of her current medication profile. On March 12, 2025, at 11:31 a.m., during a concurrent interview and record review with the ADM/DPCS, the ADM/DPCS stated he conducted the admission and initial visit for Patient 2. He stated he was not aware Patient 2 was taking other medications in addition to the Naproxen. The ADM/DPCS stated Patient 2 should have a complete list of her medications. The agency’s policy and procedure titled, “Medication Profile,” reviewed on May 23, 2019, indicated, “…Upon admission to the Agency, the admitting RN (registered nurse) or therapist is provided in the admission packet a sheet on which to record the medication(s) that the patient is taking on a routine or PRN (as needed) basis…Verbal review of medications with the patient or person responsible to ensure knowledge of medication purpose, route, amount and frequency will be compared to the written label on the medication bottle…This sheet is returned to the office along with other signed documentation for admission…Nursing staff check all medications a patient may be taking…” Findings: 1. On March 10, 2025, Patient 1’s record was reviewed. Patient 1 was admitted to the agency with the Start of Care (SOC) date of January 24, 2025, with the diagnoses which included hypertension (high blood pressure). The current Plan of Care (POC) included a high risk medication Plavix (a blood thinner) oral 75 milligram (mg - a unit of measurement) one tablet daily by mouth. On March 11, 2025, at 10:30 a.m., a home visit was conducted with the Licensed Vocational Nurse (LVN) 1, for Patient 1. Patient 1 was observed walking with steady gait, alert and oriented to time, place, person and event. Patient 1 was able to verbalize his needs. Patient 1 was observed with skin discoloration on both hands and pacemaker on his left chest. During a concurrent medication reconciliation and interview, conducted with Patient 1 and LVN 1, the following were observed: - One medication Rosuvastatin Calcium (used to lower bad cholesterol level and fats in the blood) 40 milligram one tablet twice a day by mouth was listed in Patient 1’s current POC and medication profile. The medication was not available during medication reconciliation. Patient 1 stated he ran out of medication. He stated he had not taken the medication for a month. LVN 1 stated she was not aware Patient 1 had ran out of the medication for a month. She stated she did not check if the prescription bottle was available during her visits. - Three medications were not listed in Patient 1’s medication profile and current POC. The three medications were as follows: 1. Vitamin D (vitamin used to support bone, muscle and teeth) 50,000 units one capsule per week. The date prescribed was March 3, 2024; 2. Advil (used to treat fever and pain) 200 mg Liquid Gels, one tablet as needed; and 3. Pantoprazole Sodium (used for heartburn, and acid reflux) 20 mg, one tablet daily by mouth. Patient 1 stated he started taking Vitamin D when it was prescribed by his doctor on March 3, 2024. He stated he bought the Advil over-the counter two months ago and started taking the Advil two times a day as needed for pain. He stated he had been taking the Pantoprazole Sodium one tablet a day before breakfast three months ago. LVN 1 stated she was not aware of the three medications Patient 1 were currently taking. She stated she only asked Patient 1 if he took his medications. She stated she should have checked the bottles of medications on the table. On March 12, 2025, at 11:15 a.m., a concurrent interview and record review of Patient 1’s POC and medication profile was conducted with the Administrator/Director of Patient Care Services (ADM/DPCS). The ADM/DPCS stated the Licensed Nurses who conducted patient’s first visit after the SOC should always perform another medication reconciliation. He stated Licensed Nurses should always check all prescription medications and over-the counter medications on every visit.”

“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 observation, interview, and record review, the physician’s post operative orders related to embolization (a procedure that involves blocking a blood vessel with small particles or materials to control bleeding) and angioplasty (a procedure used to open narrowed or blocked arteries) were not entered and documented in patient’s current Plan Of Care (POC) for five of seven patients reviewed (Patient 3, 5, 2, 6, and 7). This failure had the potential for Patients 3, 5, 2, 6, and 7, not to receive the necessary treatment, care, education and instructions related to the procedures they received. 3. On March 10, 2025, Patient 2’s record was reviewed. Patient 2 was admitted to the agency with SOC date of February 4, 2025, with diagnoses which included osteoarthritis (a progressive disorder of the joints caused by a gradual loss of cartilage), embolism (obstruction or blockage in a blood vessel) and thrombosis (a condition where a blood clot forms in the vein or artery, blocking the blood flow). The Face-to-Face Encounter dated February 4, 2025, indicated Patient 2 had a right genicular embolization on the right leg with the left groin access. The “Post Arterial Follow-Up,” dated February 4, 2025, indicated, “…Home health nurse to visit the patient on the day of surgery (within 2-3 hours of the patient been home) for the following…Reapply pressure dressing…To check for hematoma…Check for any bleeding, flank discoloration, flank pain…Changes in texture and firmness…Nurse to check pulse on both legs by palpation and by Doppler…If there is bleeding/hematoma or change in color of foot, let physician’s office know right away and/or call 911…Nurse to advice patient of the following…No bending from the waist…No activity for 24 hours…Ice on the groin for 24 hours…Warm blanket on the foot up to the knee on the leg the patient was operated on…Nurse to review discharge summary with patient and re-explain to patient and family…On second day, nurse to assist with ambulation without stressing the area of the groin (i.e. no bending of the waist)…Home Health Nurse to visit patient within 24 hours to remove pressure dressing (if there is no adverse outcome) and apply a light dressing (if needed)…Nurse must see patient for 3 days consecutively including day of arterial followed by once a week as needed…” The Face-to-Face Encounter dated February 18, 2025, indicated Patient 2 had a genicular embolization on the left leg with the right groin entry. The “Post Arterial Follow-Up,” dated February 18, 2025, indicated, “…Home health nurse to visit the patient on the day of surgery (within 2-3 hours of the patient been home) for the following…Reapply pressure dressing…Check for hematoma…Check for any bleeding, flan (sic) discoloration, flan (sic) pain…Changes in texture and firmness…Nurse to check pulse on both legs by palpation and by Doppler…If there is bleeding/hematoma or change in color of foot, let physician’s office know right away and/or call 911…Nurse to advice patient of the following…No bending from the waist…No activity for 24 hours…Ice on the groin for 24 hours…Warm blanket on the foot up to the knee on the leg the patient was operated on…Nurse to review discharge summary with patient and re-explain to patient and family…On second day, nurse to assist with ambulation without stressing the area of the groin (i.e. no bending of the waist)…Home Health Nurse to visit patient within 24 hours to remove pressure dressing (if there is no adverse outcome) and apply a light dressing (if needed)…Nurse must see patient for 2 days consecutively including day of arterial followed by once a week as needed…” The Plan of Care for Certification Period of February 4, 2025, to April 4, 2025, did not include the Post Arterial Follow-Up orders. 4. On March 12, 2025, Patient 6’s record was reviewed. Patient 6 was admitted to the agency with a Start of Care (SOC) date of November 12, 2024, with diagnoses which included peripheral vascular disease. The Face-to-Face Encounter dated November 12, 2024, indicated Patient 6 had an angiogram (a medical imaging procedure that uses X-rays to visualize blood vessels and blood flow) on the left leg with the right groin access. The “POST ARTERIAL FOLLOW UP,” dated November 12, 2024, indicated, “…Home health nurse to visit the patient on the day of surgery (within 2-3 hours of the patient been home) for the following…reapply pressure dressing…to check for hematoma…Check for any bleeding, flan (sic) discoloration, flan (sic) pain…Changes in texture and firmness…Nurse to check pulse on both legs by palpation and by Doppler…If there is bleeding/hematoma or change in color of foot, let physician’s office know right away and/or call 911…Nurse to advice patient of the following…No bending from the waist…No activity for 24 hours…Ice on the groin for 24 hours…Warm blanket on the foot up to the knee on the leg the patient was operated on…Nurse to review discharge summary with patient and re-explain to patient and family…On second day, nurse to assist with ambulation without stressing the area of the groin (i.e. no bending of the waist)…Home Health Nurse to visit patient within 24 hours to remove pressure dressing (if there is no adverse outcome) and apply a light dressing (if needed)…Nurse must see patient for 3 days consecutively including day of arterial followed by once a week as needed…” The Face-to-Face Encounter dated November 27, 2024, indicated Patient 6 had an angiogram on the left groin. The ”POST ARTERIAL FOLLOW-UP,” dated November 27, 2024, indicated the same orders from the first episode. The Plan of Care for Certification Period of November 12, 2024, to January 10, 2025, did not include the Post Arterial Follow-Up orders. 5. On March 13, 2025, Patient 7’s record was reviewed. Patient 7 was admitted to the agency with a SOC of October 31, 2024, with diagnoses which included PVD. The Face-to-Face Encounter dated December 3, 2024, indicated Patient 7 had an angioplasty of the right leg, with the left groin entry. The “Post Arterial Follow-Up,” dated December 3, 2024, indicated, “…Home health nurse to visit the patient on the day of surgery (within 2-3 hours of the patient been home) for the following…reapply pressure dressing…to check for hematoma…Check for any bleeding, flan (sic) discoloration, flan (sic) pain…Changes in texture and firmness…Nurse to check pulse on both legs by palpation and by Doppler…If there is bleeding/hematoma or change in color of foot, let physician’s office know right away and/or call 911…Nurse to advice patient of the following…No bending from the waist…No activity for 24 hours…Ice on the groin for 24 hours…Warm blanket on the foot up to the knee on the leg the patient was operated on…Nurse to review discharge summary with patient and re-explain to patient and family…On second day, nurse to assist with ambulation without stressing the area of the groin (i.e. no bending of the waist)…Home Health Nurse to visit patient within 24 hours to remove pressure dressing (if there is no adverse outcome) and apply a light dressing (if needed)…Nurse must see patient for 3 days consecutively including day of arterial followed by once a week as needed…” The Face-to-Face Encounter dated December 11, 2024, indicated Patient 7 had a angioplasty of the left leg with right groin entry. The ”POST ARTERIAL FOLLOW-UP,” dated December 11, 2024, indicated the same orders. The Plan of Care for Certification Period of October 31, 2024, to December 29, 2024, did not include the Post Arterial Follow-Up orders. On March 13, 2025, at 2:50 p.m., during an interview with the ADM/DPCS, he stated He stated the physician orders post angiogram should have been included in the patient’s POC. The agency’s policy and procedure titled, “CARE PLANNING PROCESS,” reviewed May 23, 2019, indicated, “…PURPOSE…To provide clinical direction to clinicians providing direct patient care…A written plan of care will be initiated within five (5) days of the start of care and updated at least every 60 days or as patient’s condition warrants…The clinical plan of care includes…interventions appropriate to each discipline…functional limitations, precautions, activities…treatments, safety measures, instructions…The plan of care will be based upon the physician’s (or other authorized licensed independent practitioner’s) orders… Findings: 1. On March 10, 2025, Patient 3’s record was reviewed. Patient 3 was admitted to the agency with the Start of Care (SOC) date of February 14, 2025, with diagnoses which included peripheral vascular disease (PVD - a circulatory condition in which narrowed vessels reduce blood flow to the limbs). Patient 3’s Face to Face Encounter (a certifying physician meet the patient that requires home health services) dated February 14, 2025, indicated Patient 3 had a left leg angioplasty (a procedure that widens blocked or narrowed arteries or veins) with right groin entry. The “POST ARTERIAL FOLLOW UP” orders dated February 14, 2025 to February 16, 2025, indicated the following: - “Home Health Nurse to visit patient the day of (within 23 hours of patient been home); - Re-apply pressure dressing; - Check for hematoma; - Check for any bleeding, flan discoloration, flan pain; - Changes in texture and firmness; - Nurse to check pulse on both legs by palpation and by Doppler; - If there is any evidence of bleeding/hematoma or change in color of foot, let physician’s office know right away and/or call 911; - Nurse to advice patient of no bending from waist, no activity for 24 hours, ice on groin for 24 hours, and warm blanket on the foot up to the knee on the leg the patient was operated on; - Nurse to review discharge summary with patient and re-explain to patient and family; - On second day, nurse to assist with ambulation without stressing the area of the groin (i.e. no bending of the waist); - Home Health Nurse to visit patient within 24 hours to remove pressure dressing(if there is no adverse outcome) and apply a light dressing (if needed); - Nurse to see patient for 3 days consecutively including the day of arterial followed by once a week as needed.” Patient 3’s Face to Face Encounter with the physician dated February 26, 2025, indicated Patient 3 had an angioplasty of the right leg, with left groin entry. Patient 3 was discharged from the clinic at 6 p.m. The physician’s orders indicated the same “POST ARTERIAL FOLLOW UP” for the second procedure. The order indicated for “...Nurse must see patient for 2 days consecutively starting 02/27/25 - 02/28/25...” Patient 3’s Face to Face Encounter with the physician dated March 11, 2025, indicated Patient 3 had “genicular embolization (a procedure that reduces knee pain caused by osteoarthritis) right knee with left groin entry...” The physician’s orders indicated the same “POST ARTERIAL FOLLOW UP” for the third procedure. The order indicated for “...Nurse must see patient for 2 days consecutively including the day of arterial followed by once a week as needed...” The physician’s orders for the three procedures were not documented in Patient 3’s Plan of Care (POC) during the certification period from February 14, 2025 to April 14, 2025. The POC did not contain Patient 3’s allergy. 2. On March 12, 2025, Patient 5’s record was reviewed. Patient 5 was admitted to the agency with the SOC date of February 18, 2025, with diagnoses which included embolism and thrombosis of other arteries. Patient 5’s Face to Face Encounter with the physician dated February 18, 2025, indicated Patient 5 had a right genicular embolization (a minimally invasive procedure used to treat chronic knee pain caused by osteoarthritis - a type of arthritis that occurs when flexible tissue at the ends of bones wear down) of the right knee with left groin entry. The “POST ARTERIAL FOLLOW UP” orders indicated, “Home Health Nurse to visit patient the day of within 23 hours of patient been home for the following...Re-apply pressure dressing...Nurse to check pulse on both legs by palpation and by Doppler...Nurse to advise patient...No bending from the waist...Nurse to review discharge summary with patient...family...Nurse to assist with ambulation...Nurse must see patient for 2 days consecutively...followed by once a week as needed...” The Post Arterial Follow Up orders were not entered and documented in Patient 5’s POC during the certification period from February 18, 2025 to March 18, 2025. The POC did not contain Patient 5’s allergy. On March 12, 2025, at 12:35 p.m., a concurrent interview and record review was conducted with the Administrator (ADM)/Director of Patient Care Services (DPCS). The ADM/DPCS acknowledged the Post Arterial Follow Up orders were not documented in Patients 3, and 5’s current POC. The ADMIN/DPCS stated the orders should have been carried out to the POC at the start of care. He stated the POC should have included the patient’s allergy.”