Attain Health Home Health, Inc.

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to meet the Condition of Participation (refer to the requirements that healthcare organizations must meet to participate in federal healthcare programs) for Care Planning, Coordination of Services and Quality of Care as follows: 1. The HHA failed to ensure the Plan of Care (POC) was followed for two of seven sampled patients (Patient 1 and Patient 2 ). This failure placed patients at risk for health status decline by not providing the services as indicated in the POC (Refer to G572). 2. The HHA failed to review, document and include all the medications, treatments required in the Plan of Care (POC) three of seven sampled patients (Patient 1, Patient 4 and Patient 5). This deficient practice had the potential to result in patients not receiving the identified needs and services, and have a decline in health status, that could affect their quality of care and well-being. (Refer to G574). 3. The HHA failed to communicate and coordinate with all physicians regarding glucometer (a portable medical device used to measure the approximate concentration of glucose [sugar] in a persons blood) replacement for one of seven sampled patients (Patient 1). This deficient practice resulted in Patient 1 not receiving a new glucometer to monitor blood glucose levels. (Refer to G602). 4. The HHA failed to provide written information regarding the Plan of Care (POC) for two of seven sampled patients (Patient 4 and Patient 5). This deficient practice resulted in patients and their representatives not being able to be active participants in their care. (Refer to G612). The cumulative effect of these systemic practices resulted in the failure of the HHA to deliver statutorily (written law) mandated compliance with the Federal regulations for Care planning, Coordination of services, and Quality of care to ensure home health benefits and services were furnished to certified home health patients.”

“Infection prevention and control CFR(s): 484.70 Condition of Participation: Infection prevention and control. The HHA must maintain and document an infection control program which has as its goal the prevention and control of infections and communicable diseases. This Condition is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics services to a patient at home) failed to ensure the Condition of Participation (refer to the requirements that healthcare organizations must meet to participate in federal healthcare programs) regarding Infection Prevention and Control was met as follows: The HHA failed to ensure proper infection control practices were implemented by clinicians for two of nine sampled patients (Patient 1 and Patient 4). The deficient practice had the potential to result in cross contamination and jeopardize the health and safety of the patients. (Refer G682). The cumulative effect of this systemic practice resulted in the failure of the HHA to deliver statutorily mandated (written law) compliance with Federal Regulations for Infection Prevention and Control to ensure highest quality health care is provided to patients assessed to receive home health services.”

“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 observation, interview and record review the Home Health Agency (HHA) failed to ensure the Plan of Care (POC) was followed for two of seven sampled patients (Patient 1 and Patient 2 ). This failure placed patients at risk for health status decline by not providing the services as indicated in the POC. a. During a record review on 5/27/2026 of Patient 1’s “Home Health Certification and Plan of Care” for the certification period of 4/19/2026 to 6/17/2026, the “Home Health Certification and Plan of Care” indicated Patient 1 had a start of care date of 10/21/2025 with a primary diagnosis of type 2 diabetes mellitus (disease in which blood sugar levels are too high) with diabetic polyneuropathy (a type of nerve damage caused by diabetes). The “Home Health Certification and Plan of Care” indicated that Skilled Nurse (SN) to assess diabetic status, identify any signs and symptoms of impaired diabetic function and report significant changes to physician. The “Home Health Certification and Plan of Care” further indicated that SN to instruct self-management program to include blood sugar monitoring and that SN may obtain blood sugar levels via fingerstick as needed for signs and symptoms of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). The “Home Health Certification and Plan of Care” indicated to notify the physician if fasting blood sugar is greater than 250 mg/dl (milligrams per deciliter - it is the unit of measurement) or less than 70 mg/dl or random blood sugar is greater that 300 mg/dl or less than 70 mg/dl. The “Home Health Certification and Plan of Care” further indicated that Patient 1 with unstable endocrine (the body’s glands and tissues that create and release hormones directly into your bloodstream) status as evidenced by episodes of hypoglycemia/hyperglycemia and poorly controlled blood sugar. During a joint home visit, on 5/28/2026 at 10 a.m., with the Director of Patient Care Services (DPCS) at Patient 1’s residence. Patient 1 was observed sitting on a wheelchair alert and oriented to self, place and time. DPCS was observed checking Patient 1’s blood sugar level using a glucometer (a portable medical device used to measure the approximate concentration of glucose [sugar] in a person’s blood) that was from the DPCS bag. Patient 1 stated that she did not have her own glucometer and she has not had one for several months. During a record review on 5/28/2026 of Patient 1’s “Skilled Nurse Visit” dated 4/28/2026, 5/1/2026, 5/5/2026, 5/11/2026, 5/13/2026, 5/19/2026 and 5/21/2026 indicated, that there was no documentation that the SN was checking Patient 1’s blood sugar levels and there was no documentation regarding patient’s unstable endocrine status and poorly controlled blood sugar. During a record review on 5/29/2026 of Patient 1’s “Communication Note” dated 11/10/2025, indicated that mobile MD (a mobile physician, house-call doctor, or mobile medical clinic) was contacted regarding patient’s need for a glucometer prescription. b. During a record review on 5/28/2026 of Patient 2’s “Home Health Certification and Plan of Care” for the certification period of 4/27/2026 to 6/25/2026, the “Home Health Certification and Plan of Care” indicated Patient 2 had a start of care date of 3/8/2024 with a primary diagnosis of type 2 diabetes mellitus with other specified complications. The “Home Health Certification and Plan of Care” indicated that Skilled Nurse (SN) to assess diabetic status, identify any signs and symptoms of impaired diabetic function and report significant changes to physician. The “Home Health Certification and Plan of Care” further indicated that SN to instruct self-management program to include blood sugar monitoring and that SN may obtain blood sugar levels via fingerstick as needed for signs and symptoms of hyperglycemia or hypoglycemia. The “Home Health Certification and Plan of Care” indicated to notify the physician if fasting blood sugar is greater than 250 mg/dl or less than 70 mg/dl or random blood sugar is greater that 300 mg/dl or less than 70 mg/dl. The “Home Health Certification and Plan of Care” further indicated that the goal for Patient 2 included control of blood sugar. During a record review on 5/29/2026 of Patient 2’s “Skilled Nurse Visit” dated 4/30/2026, 5/4/2026, 5/19/2026 and 5/26/2026 indicated, there was no documentation from the SN regarding Patient 2’s blood sugar levels during visits. During a concurrent interview and record review on 5/29/2026 at 11:12 a.m., and 12:06 p.m., with Director of Patient Care Services (DPCS), the DPCS stated Patient 1 has not had a glucometer since December 2025. DPCS stated that Patient 1’s nursing visit notes dated 4/28/2026, 5/1/2026, 5/5/2026, 5/11/2026, 5/13/2026, 5/19/2026 and 5/21/2026 and Patient 2’s nursing visit notes dated 4/30/2026, 5/4/2026, 5/19/2026 and 5/26/2026 did not have blood sugar levels documented. DPCS stated that it is important to document patient’s blood sugar levels because if the blood sugars levels are out of range, levels should be reported to the physician and also important to document blood sugar levels to monitor if patient’s goals are being met or not. DPCS stated that it is important to follow the plan of care because the plan of care is based on the physician’s orders. During a record review of the agency’s policy and procedure, titled “Care Planning Process” revised 4/2021, the policy and procedure indicated that the purpose of the policy and procedure is to provide clinical direction to the clinicians providing direct patient care.”

“Written instructions to patient include: CFR(s): 484.60(e) Standard: Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: This Standard is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to provide written information regarding the plan of care and medication list for two of seven patients (Patient 4 and Patient 5). This deficient practice resulted in patients and their representatives not knowing their care team or their treatment course. a. During a record review of Patient 4’s Patient Profile sheet indicated a start of care date of 4/17/2026, with diagnoses including biliary acute pancreatitis without necrosis or infection (a sudden inflammation of pancreas caused by a gallstone temporarily blocked the pancreatic duct). During a concurrent observation and interview on 5/28/2026 at 10:40 a.m. with Care Giver 1 (CG 1) at Patient 4’s residence, there was no plan of care or medication list observed at the patient’s residence. The caregiver stated, “we were never provided a medication list or a care plan we only have this booklet.” b. During a record review of Patient 5’s Patient Profile sheet indicated a start of care date of 1/06/2025, with diagnoses including essential hypertension (a condition resulting in high blood pressure of the heart). During a concurrent observation and interview on 5/28/2026 at 11:25 a.m., with Care Giver 2 (CG 2) at Patient 5’s residence, there was no plan of care or medication list observed at the patient’s residence. The caregiver stated, “we were never provided a medication list or a care plan we only have this booklet.” During an interview on 5/29/2026 at 1:25 p.m., with the DPCS, DPCS stated all patient need to have a copy of the Plan of Care in the patient’s residence because the patient has the right to know what care they are receiving. The nurses need to leave med recon and plan of care in the patient’s home. And the LVN is supposed to follow up on the other visits and make sure the plan of care and medication reconciliation is available in the folder. During a record review of the HHA’s undated document titled, Care Planning Process, revised April 2021, indicated, “The organization shall provide the patient and caregiver with a copy of written instructions outlining: A. Visit schedule, including frequency of visits…Patient medication schedule/instructions, including medication name…””

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observation, interview and record review the Home Health Agency (HHA) failed to ensure proper infection control practices were implemented by clinicians for two of nine sampled patients (Patient 1 and Patient 4). The deficient practice had the potential to result in cross contamination and jeopardize the health and safety of the patients. b.During a record review of Patient 4’s Patient Profile sheet indicated a start of care date of 4/17/2026, with diagnoses including biliary acute pancreatitis without necrosis or infection (a sudden inflammation of pancreas caused by a gallstone temporarily blocked the pancreatic duct). During a record review of Patient 4’s “Plan of Care” dated 4/17/2026 to 6/15/2026, indicated addendum…patient with draining tubes from right flank area (a draining device from the gallbladder inserted by MD during surgery in the right side of the torso). MD order for drain tube care: SN to flush both drains with 10cc normal saline every 12 hours. There was no care plan in the plan of care and what to monitor regarding the care, dressing chance, and signs and symptoms to monitor for infection regarding the biliary tubes. During an observation on 5/28/2026 at 10:20 a.m. in Patient 4’s residence, LVN 1 was observed setting up an aseptic field to flush Patient 4’s biliary drain. LVN 1 was observed setting up with empty, used, prefilled normal saline 10ml syringe to draw up normal saline from a vial in order to flush the biliary drain. The LVN 1 then proceeded to do a dressing change by removing the old dressing, cleansing the drain site with normal saline and gauze, then applying a new dressing . The LVN 1 did not change the gloves after removing the old dressing, and applying the new dressing. The syringes used during the procedure had an expiration date of 2022. During an interview on 5/28/2026 at 10:30 a.m. with LVN 1, she stated, “I used this syringe the last time with Patient 4 and I was reusing it.” When asked if she is supposed to use an expired syringe that was prefilled and reuse the same syringe twice, she stated no the syringe indicates discard left over portion, and its expired so she should have used a new syringe. LVN 1 stated this is important because this can cause an infection and the patient might need hospitalization. During an interview on 5/28/2026 at 10:35 a.m. with LVN 1, she stated, “our plan of care does not have dressing change orders, I know we are supposed to have orders for a dressing change.” When asked, when are you supposed to change gloves during dressing change, the LVN stated, “when you take off the old dressing you are suppose to sanitize and put on new gloves before applying the new dressing. I’m sorry I forgot to do this. This is important to do to prevent infection.” During an interview and record review on 5/29/2026 at 1:35 p.m. of Patient 4’s Electronic Medical Record (EMR) with DPCS there was no physician orders for in the EMR for biliary drain dressing change. The DPCS stated, it is important to have dressing change orders so the nurse can know what to follow and to prevent infection. During an interview on 5/29/2026 at 1:40 p.m. with DPCS, DPCS stated per home health agency policy biliary flushing the field needs to be sterile if this was not followed than there is a risk of infection to the site, the nurse is supposed to change gloved after sterile technique is done, and after they remove an old dressing the nurse is supposed to remove gloves, sanitize hands, then put new gloves in order to put new dressing to prevent infection. The nurse is supposed to use prefilled sterile syringes to flush the biliary flushing. They are not allowed to reuse syringes, or use expired syringes due to risk of infection. During a record review of the HHA’s policy and procedure, titled, “Biliary Drain Dressing Change”, undated, the policy and procedure indicated, “pre procedure, 1. Verify physician orders, Clinician shall verify, dressing change frequency, cleansing solution, flush orders if applicable, drain type and instructions”. The policy further stated, “ Apply clean gloves, remove old dressing carefully while stabilizing drain tubing. 2. Assess existing dressing, observe for drainage amount color, bile leakage, blood, odor, dressing saturation, dispose of dressing per infection control policy. 3. Inspect drain site, assess and document: redness, swelling, warmth, tenderness, skin breakdown, drain migration, presence of sutures stabilization device, signs of infection. Immediately report abnormal findings to supervising RN physician as indicated. 4. Remove gloves and perform hand hygiene. Apply sterile gloves. 5. Cleanse site, using sterile technique: cleanse insertion site with sterile saline or prescribed cleanser, clean from insertion site outward and circular motion, use a new sterile applicator gauze for each pass. Allow area to air dry completely. 6. Apply skin barrier, apply skin prep barrier film if indicated to protect surrounding skin. 7. Apply sterile dressing, place sterile split drain sponge around catheter, cover with sterile gauze or transparent dressing, secure dressing without tension or tubing….” Findings: a. During a record review on 5/27/2026 of Patient 1’s “Home Health Certification and Plan of Care” for the certification period of 4/19/2026 to 6/17/2026, the “Home Health Certification and Plan of Care” indicated Patient 1 had a start of care date of 10/21/2025 with a primary diagnosis of type 2 diabetes mellitus (disease in which blood sugar levels are too high) with diabetic polyneuropathy (a type of nerve damage caused by diabetes). The “Home Health Certification and Plan of Care” indicated that Skilled Nurse (SN) to assess diabetic status, identify any signs and symptoms of impaired diabetic function and report significant changes to physician. The “Home Health Certification and Plan of Care” further indicated that SN to instruct self-management program to include blood sugar monitoring and that SN may obtain blood sugar levels via fingerstick as needed for signs and symptoms of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). During a joint home visit, on 5/28/2026 at 10:00 a.m. with the Director of Patient Care Services (DPCS) at Patient 1’s residence. Patient 1 was observed sitting down on a wheelchair alert and oriented to self, place and time. DPCS was observed checking Patient 1’s blood sugar level using a glucometer (a portable medical device used to measure the approximate concentration of glucose [sugar] in a persons blood) that was from the DPCS bag. Patient 1 stated that she did not have her own glucometer and she has not had one for several months and during home visits the nurses bring their own glucometer. During a record review on 5/29/2026 of Patient 1’s “Communication Note” dated 11/10/2025, indicated that mobile MD (a mobile physician, house-call doctor, or mobile medical clinic) was contacted regarding patient’s need for a glucometer prescription. During an interview on 5/29/2026 at 11:12 a.m. and 2:07 p.m., with Director of Patient Care Services (DPCS), the DPCS stated that the glucometer that was used for Patient 1 during the home visit was a glucometer that is used on other patients during home visits. DPCS stated that skilled nurses also use their own glucometer to check Patient 1’s blood sugar during home visits since Patient 1 does not have one at the home. DPCS stated that Patient 1 has not had a glucometer since December 2025. DPCS stated that he was not aware if the glucometers being used by the HHA nurses are for single patient use or multi patient use and that he has never heard that glucometers cannot be used for multiple patients. DPCS stated that it is important to check that glucometers are for single or multi patient use to prevent and avoid cross contamination. During a record review of the agency’s policy and procedure, titled “Home Glucose Monitoring” revised 4/2021, the policy and procedure indicated that the purpose of the policy and procedure is to provide guidelines for the safe use of home glucose monitoring devices. The policy and procedure indicated that nurses will utilize home glucose monitoring devices in accordance with manufacturer’s guidelines in order to ensure the quality and accuracy of blood glucose values. The policy and procedure further stated that the nurse shall not substitute the organization’s equipment when assisting with patient self-administration tests, except for short duration when the patient has not yet obtained their own testing equipment.”

“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 observation, interview and record review the Home Health Agency (HHA) failed to review, document and include all the medications, and treatments required in the Plan of Care (POC) three of seven sampled patients (Patient 1, Patient 4 and Patient 5). This deficient practice had the potential to result in patients not receiving the identified needs and services, and have a decline in health status, that could affect their quality of care and well-being. b.During a record review of Patient 4’s Patient Profile sheet indicated a start of care date of 4/17/2026, with diagnoses including biliary acute pancreatitis without necrosis or infection (a sudden inflammation of pancreas caused by a gallstone temporarily blocked the pancreatic duct). During a record review of Patient 4’s “Plan of Care” dated 4/17/2026 to 6/15/2026, indicated addendum…patient with draining tubes from right flank area (a draining device from the gallbladder inserted by MD during surgery in the right side of the torso). MD order for drain tube care: SN to flush both drains with 10cc normal saline every 12 hours. There was no care plan in the plan of care and what to monitor regarding the care, dressing chance, and signs and symptoms to monitor for infection regarding the biliary tubes. During an interview with on 5/29/2026 at 1:28 p.m. the DPCS, the DPCS stated, for Patient 4 there was no dressing change order and no care plan for monitoring for signs and symptoms of infection for the biliary drain in the plan of care. The DPCS stated the plan of care should specify both dressing change order, assessment and monitoring for signs and symptoms of infection at the drain site. This is important because that guides the nurses care, and there is a risk for infection and this could be missed and not reported to the MD. c. During a record review of Patient 5’s Patient Profile sheet indicated a start of care date of 1/06/2025, with diagnoses including essential hypertension (a condition resulting in high blood pressure of the heart). During a review of Patient 5’s “Plan of Care (POC, a mandatory, written, and patient-specific document that outlines necessary medical, rehabilitative, and supportive services to treat an injury or illness at home)”, dated 5/1/2026 to 6/29/2026, the POC indicated SN (Skilled Nurse) to preform medication review each skilled nursing visit and reconcile medications as indicated. During a concurrent interview and record review on 5/28/2026 at 11:15 a.m. with LVN 1, in Patient 5’s residence, the medication Naproxen (medication used for pain management) did not have dose, indication, frequency listed on the bottle. LVN 1 stated this was missed, nurses are supposed to do medication reconciliation on every visit. The RN does the initial one and the LVN’s do the follow up checks to make sure the patient has the correct medications. Every medication should have the dose, frequency, and indication. During an interview and record review on 5/29/2026 at 1:59 p.m. of Patient 5’s medication list with DPCS, there was no frequency, reason, or dosage for Naproxen. The DPCS stated this medication should have had the dosage, frequency and indication so the patient can know when and how much to take it. The risk is that she can take too little or too much without this information. During a record review of the agency’s policy and procedure, titled “Care Planning Process” undated, the policy and procedure indicated, “ The patient-specific clinical plan of care includes all pertinent diagnoses, mental status, types of services/equipment, frequency of visits, goals and interventions appropriate to each discipline, prognosis, rehabilitation potential, functional limitations, precautions, activities, nutritional requirements, food/drug allergies, medications, treatments, safety measures, instructions, discharge plan...” the policy and procedure further indicated, “Based on the assessment and conclusions, the plan of care will include, but not be limited to: A. Patient specific interventions and education B. All patient care orders from all physicians involved in the plan of care, including verbal orders C. Identified patient problems and needs, including functional limitations, activities permitted, nutritional requirements D. Reasonable, measurable, and individualized goals and outcomes identified by the organization and the patient anticipated to occur as a result of implementing and coordinating the plan of care E. Specific services and treatments to be provided, including services furnished via telecommunication systems (if appropriate) F. Actions to be taken to meet the patient goals G. Type, including identifying the responsible discipline(s), frequency, and duration of above actions... 6. The plan of care will be based upon the physician’s (or allowed practitioner’s) orders and will encompass the equipment, supplies, and services required to meet the patient’s needs.” Findings: a. During a record review on 5/27/2026 of Patient 1’s “Home Health Certification and Plan of Care” for the certification period of 4/19/2026 to 6/17/2026, the “Home Health Certification and Plan of Care” indicated Patient 1 had a start of care date of 10/21/2025 with a primary diagnosis of type 2 diabetes mellitus (disease in which blood sugar levels are too high) with diabetic polyneuropathy (a type of nerve damage caused by diabetes). The “Home Health Certification and Plan of Care” indicated that Skilled Nurse (SN) to perform medication review each skilled nursing visit and reconcile medications (process of comparing a patient’s medication orders to all of the medications that the patient has been taking) as indicated. hormones directly into your bloodstream) status as evidenced by episodes of hypoglycemia/hyperglycemia and poorly controlled blood sugar. During a joint home visit, on 5/28/2026 at 10:00 a.m. with the Director of Patient Care Services (DPCS) at Patient 1’s residence. Patient 1 was observed sitting down on a wheelchair alert and oriented to self, place and time. During a review of Patient 1’s current medication, on 5/28/2026 at 10:30 a.m. with the DPCS, the following medications were not available in Patient 1’s residence but were listed in Patient 1’s medication profile and plan of care provided by the HHA: Diltiazem HCL Extended Release (ER) (treat high blood pressureand prevent chronic chest pain), 180 milligram (mg – unit of measurement) capsule – one daily by mouthDuring a review of Patient 1’s current medication, on 5/28/2026 at 10:30 a.m. with the DPCS, the following medications were available at Patient 1’s residence but not listed in Patient 1’s medication profile or plan of care provided by the HHA: Diltiazem HCL Extended Release (ER) 240 mg - frequency not listed on the bottleGabapentin (used to control seizures, to treat nerve pain) 300 mg capsule – take 1 capsule by mouth four times a dayCitalopram (used to treat depression [serious mood disorder characterized by persistent feelings of sadness, emptiness, and a loss of interest in activities]) 20 mg tablet – take one tablet by mouth every morningVitamin B-12 (used to prevent and treat vitamin B12 deficiency and its resulting complications) 500 microgram tablet (mcg – unit of measurement) – take one tablet by mount every dayDocusate Sodium (used to treat and prevent occasional constipation) 100 mg soft gel – take one capsule by mouth twice a dayDuring an interview on 5/29/2026 at 11:12 a.m., with Director of Patient Care Services (DPCS), the DPCS stated that medication reconciliation is done every visit by the Licensed Vocational Nurse (LVN) and during recertification by the Registered Nurse (RN). DPCS stated that it is important to do medication reconciliation and check the patient’s medications because there can be issues medication side effects and nurses have to monitor the effectiveness of the medications. During a record review of the agency’s policy and procedure, titled “Care Planning Process” revised 4/2021, the policy and procedure indicated that the purpose of the policy and procedure is to provide clinical direction to the clinicians providing direct patient care. During a record review of the agency’s policy and procedure, titled “Medication Profile” revised 4/2021, the policy and procedure indicated, patient receiving medications administered by the organization will have a current, accurate medication profile in the clinical record and medication profile will be updated for each change to reflect medications, new, and/or discontinued medications.”

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on observation, interview and record review the Home Health Agency (HHA) failed to communicate and coordinate with the physician regarding replacement of a glucometer (a portable medical device used to measure the approximate concentration of glucose [sugar] in a person’s blood) for one of seven sampled patients (Patient 1). This deficient practice resulted in Patient 1 not receiving a new glucometer to monitor blood glucose levels. During a record review on 5/27/2026 of Patient 1’s “Home Health Certification and Plan of Care” for the certification period of 4/19/2026 to 6/17/2026, the “Home Health Certification and Plan of Care” indicated Patient 1 had a start of care date of 10/21/2025 with a primary diagnosis of type 2 diabetes mellitus (disease in which blood sugar levels are too high) with diabetic polyneuropathy (a type of nerve damage caused by diabetes). The “Home Health Certification and Plan of Care” indicated that Skilled Nurse (SN) to assess diabetic status, identify any signs and symptoms of impaired diabetic function and report significant changes to physician. The “Home Health Certification and Plan of Care” further indicated that SN to instruct self-management program to include blood sugar monitoring and that SN may obtain blood sugar levels via fingerstick as needed for signs and symptoms of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). The “Home Health Certification and Plan of Care” indicated to notify the physician if fasting blood sugar is greater than 250 mg/dl (milligrams per deciliter - it is the unit of measurement) or less than 70 mg/dl or random blood sugar is greater that 300 mg/dl or less than 70 mg/dl. The “Home Health Certification and Plan of Care” further indicated that Patient 1 with unstable endocrine (the body’s glands and tissues that create and release hormones directly into your bloodstream) status as evidenced by episodes of hypoglycemia/hyperglycemia and poorly controlled blood sugar. During a joint home visit, on 5/28/2026 at 10 a.m., with the Director of Patient Care Services (DPCS) at Patient 1’s residence. Patient 1 was observed sitting on a wheelchair alert and oriented to self, place and time. DPCS was observed checking Patient 1’s blood sugar level using a glucometer (a portable medical device used to measure the approximate concentration of glucose [sugar] in a persons blood) that was from the DPCS bag. Patient 1 stated that she did not have her own glucometer and she has not had one for several months. Patient 1 further stated that she used to have a continuous glucose monitoring device, but the device broke four months ago. During a record review on 5/29/2026 of Patient 1’s “Communication Note” dated 11/10/2025, indicated that mobile MD (a mobile physician, house-call doctor, or mobile medical clinic) was contacted regarding patient’s need for a glucometer prescription. During a review on 5/29/2026 of Patient 1’s “Communication Note” dated 2/27/2026, indicated that report was made to the physician regarding patient needing a new prescription for continuous glucose monitoring (CGM) device. During a review on 5/29/2026 of Patient 1’s “Communication Note” dated 3/13/2026, indicated that follow-up was made to the physician’s office regarding patient’s CGM device. During an interview on 5/29/2026 at 11:12 a.m., and 2:07 p.m., with Director of Patient Care Services (DPCS), the DPCS stated Patient 1 has not had a glucometer since December 2025. DPCS stated that they have reached out to the mobile doctor regarding Patient 1’ s need for a glucometer and prescriptions have been written but there have been issues with insurance. DPCS stated that the HHA has not reached out and notified her primary care physician (PCP) and have only notified the mobile doctor regarding Patient 1’s need for a glucometer. DPCS stated that the primary care physician oversees the patient’s care. DPCS stated that coordination of care is important so that all doctors involved in the patient’s care are aware regarding a patient’s situation. During a record review of the agency’s policy and procedure, titled “Coordination of Services with other Providers” revised 4/2021, the policy and procedure indicated that the purpose of the policy and procedure is to ensure the coordination of services provided by the organization and by other service provided. The policy and procedure further indicated that the Case Manager will act as a liaison with other organizations or individuals also providing care to the patient to assure effective coordination of related services.”