Americano Home Health Care, Inc.

“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 Home Health Agency (HHA, a public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to implement interventions and reassessment for pain in accordance with the plan of care for two of seven sampled patients (Patient 1 and Patient 2). This deficient practice had the potential to result in ineffective pain management. Findings: a. During a review of Patient 1’s Face Sheet (front page of the chart that contains a summary of basic information about the patient), the Face Sheet indicated a start of care (SOC) date of 4/29/2025, with diagnoses that included type 2 diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), hypertensive heart disease (hear problems arise from long-term, uncontrolled high blood pressure) and hyperlipidemia (a condition in which there are high levels of fat particles [lipids] in the blood). During a review of Patient 1’s Home Health Certification and Plan of Care (POC, a detailed, written document outlining the patient’s specific needs, including skilled nursing care, rehabilitative and supportive care provided to a patient at home) for the certification period from 4/29/2025 to 6/27/2025, the POC indicated an order for the skilled nurse (SN) to visit Patient 1 two times a week for 2 weeks, and then once a week for 7 weeks for comprehensive skilled nursing assessment, observation and evaluation of all body systems, assessment of vital signs (measures the basic functions of the body that includes body temperature, blood pressure, pulse and respiratory [breathing] rate), and to assess pain level, intensity and severity, to implement pain relief measures and evaluate their effectiveness. During a review of Patient 1’s Skilled Nursing Clinical Note, dated 5/6/2025 and 5/29/2025, the Clinical note indicated Patient 1 experienced pain 4 out of 10 (using pain rating scale of 0 to 10: 0 = no pain; 10 = unbearable pain) to her lower back, legs, knees, ankles, shoulders and arms. There was no documented evidence that pain intervention was provided, nor a follow-up pain reassessment was performed to Patient 1. b. During a review of Patient 2’s Face Sheet, the Face Sheet indicated a SOC date of 4/24/2025, with diagnoses that included hemiplegia (paralysis of one side of the body) following cerebral infarction (also known as a stroke, refers to damage to tissues in the brain due to a loss of oxygen to the area), primary osteoarthritis (degenerative joint disease where cartilage breaks down over time, leading to pain, stiffness, and reduced range of motion) and hypertensive heart disease. During a review of Patient 2’s Home Health Certification and POC for the certification period starting from 4/24/2025 to 6/22/2025, the POC indicated an order for the skilled nurse to visit Patient 2 once a week for 1 week, two times a week for 2 weeks and then once a week for 6 weeks for comprehensive skilled nursing assessment, observation and evaluation of all body systems, assessment of vital signs, and to assess pain level, intensity and severity, to implement pain relief measures and evaluate their effectiveness. The POC indicated that the goal was for Patient 2 to verbalize relief of lower back, legs, knees, shoulders and arm pain as documented by pain scale less than 2 out of 10 on the scale of 0/10 with compliance to pain relief measures and/or pain medications. During a review of Patient 2’s Skilled Nursing Clinical Note, dated 5/6/2025 and 5/15/2025, the Clinical note indicated Patient 2 experienced pain 4/10 to his lower back, legs, knees, shoulders and arms. There was no documented evidence that pain intervention was provided, nor a follow-up pain reassessment was performed to Patient 2. During a concurrent interview and record review, on 6/12/2025 at 1:00 p.m. with the Director of Patient Care Services (DPCS), the DPCS reviewed Patient 1’s Skilled Nursing Clinical Note dated 5/6/2025 and 5/29/2025, and Patient 2’s Skilled Nursing Clinical Note dated 5/6/2025 and 5/15/2025. The DPCS stated, pain assessment should include pain intervention that was implemented and the effectiveness of the intervention. The DPCS stated that for Patient 1 and Patient 2, pain intervention and assessment for effectiveness of the intervention was not performed. During a review of the HHA’s policy and procedure (P&P) titled “Pain Assessment”, undated, the P&P indicated, “All patients will receive at least an initial pain assessment. When the patient or the clinician identifies pain, the following in-depth pain assessment information will be obtained whenever possible: pain intensity using a rating scale (on a scale of 0 – 10: 0=no pain; 10=unbearable pain), pain location, quality, onset, duration, alleviating and aggravating factors, and present pain management regimen and effectiveness.””

“Written notice of patient’s rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient’s rights and responsibilities under this rule, and the HHA’s transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This Element is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA, a public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to provide the patient and/or their representatives with written notice of their rights and responsibilities in a language the patient and/or their representatives understood for one of seven sampled patients (Patient 5). This failure had the potential risk to negatively affect the overall quality of care provided to the patient and the power to exercise their rights. During a review of Patient 5’s Home Health Certification and Plan of Care for the certification episode from 5/7/2025 to 7/5/2025, the Home Health Certification and Plan of Care indicated that Patient 5 was admitted to the HHA on 5/7/2025, with a primary diagnosis of intervertebral disc degeneration (a natural process of disc breakdown that occurs with age; it is a major cause of low back pain and can also cause other issues like nerve compression and mobility limitations) at lumbosacral region (the lower part of the spine). The Home Health Certification and Plan of care indicated that Patient 5’s caregiver primary language was Armenian. During a review of Patient 5’s Comprehensive Adult Nursing Assessment, dated 5/7/2025, the Comprehensive Adult Nursing Assessment indicated that Patient 5’s preferred language was Armenian. During a telephone interview in Patient 5’s native language (Armenian) on 6/12/2025 at 8:20 a.m., Patient 5 stated the HHA provided her with a folder, which Patient 5 kept at home. Patient 5 stated the folder contained “papers”. Patient 5 stated, Patient 5 did not know what information was in the papers because it was written in English. Patient 5 stated, “I don’t understand.” Patient 5 stated that Patient 5 signed some of the papers but was not sure what type of documents Patient 5 signed. When Patient 5 was asked if there was a family member that spoke English, Patient 5 stated there was no other person at home at that time. During a concurrent interview and record review with the Director of Patient Care Services (DPCS) on 6/12/2025, at 12:05 p.m., the DPCS reviewed the following documents for Patient 5: - Client Bill of Rights and Responsibilities - Home Health Agency-Patient Arbitration Agreement - Untitled document in which the patient gave consent to computerized charting, pain management, photograph, release of medical records, and acknowledgement of rights and responsibilities. The DPCS stated those were the documents signed by Patient 5. The DPCS stated that the DPCS admitted Patient 5 and had explained the documents to the patient and her caregiver in Armenian. The DPCS stated the caregiver’s preferred language was Armenian, but the caregiver could speak English. During a review of the HHA’s undated policy and procedure, titled “Rights/Responsibilities”, the policy and procedure indicated, ‘written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities.””

“Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This Element is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA, a public or private organization that delivers skilled nursing and other therapeutic services to a patient at home) failed to ensure that Licensed Vocational Nurse 1 (LVN 1) completed required training, as part of the onboarding process, prior to providing direct patient care. This failure had the potential to negatively affect the health and safety for five of seven sampled patients (Patient 1, Patient 2, Patient 4, Patient 5, and Patient 6) from receiving substandard care. During a review of Patient 1’s Home Health Certification and Plan of Care for the certification episode from 4/29/2025 to 6/22/2025, the Home Health Certification and Plan of Care indicated that Patient 1 was admitted to the HHA on 4/29/2025, with a primary diagnosis of type 2 diabetes mellitus (a chronic condition that occurs when the body cannot use insulin correctly and glucose [sugar] builds up in the blood). The Home Health Certification and Plan of Care indicated the frequency for Skilled Nurse (SN, a licensed nurse) visit was twice a week for two weeks, then once a week for seven weeks, for a total of nine weeks. During a review of Patient 2’s Home Health Certification and Plan of Care for the certification episode from 4/24/2025 to 6/20/2025, the Home Health Certification and Plan of Care indicated that Patient 2 was admitted to the HHA on 4/24/2025, with a primary diagnosis of hemiplegia (paralysis [the loss of voluntary muscle control in one or more parts of the body, resulting from damage to the nervous system]) on one side of the body. The Home Health Certification and Plan of Care indicated the frequency for SN visit was once a week for one week, then twice a week for two weeks, then once a week for six weeks, for a total of nine weeks. During a review of Patient 4’s Home Health Certification and Plan of Care for the certification episode of 4/17/2025 to 6/15/2025, the Home Health Certification and Plan of Care indicated that Patient 4 was admitted to the HHA on 4/29/2025, with a primary diagnosis of type 2 diabetes mellitus. The Home Health Certification and Plan of Care indicated the frequency for SN visit was once a week for one week, then twice a week for two weeks, then once a week for six weeks, for a total of nine weeks. During a review of Patient 5’s Home Health Certification and Plan of Care for the certification episode of 5/7/2025 to 7/5/2025, the Home Health Certification and Plan of Care indicated that Patient 5 was admitted to the HHA on 5/7/2025, with a primary diagnosis of other intervertebral disc degeneration (a natural process of disc breakdown that occurs with age; it is a major cause of low back pain and can also cause other issues like nerve compression and mobility limitations) at lumbosacral region (the lower part of the spine). The Home Health Certification and Plan of Care indicated the frequency for SN visit was twice a week for two weeks, then once a week for seven weeks, for a total of nine weeks. During a review of Patient 6’s Home Health Certification and Plan of Care for the certification episode of 5/1/2025 to 6/29/2025, the Home Health Certification and Plan of Care indicated that Patient 6 was admitted to the HHA on 5/1/2025, with a primary diagnosis of polyarthritis (arthritis [a condition characterized by pain, stiffness, and reduced movement in the joints] that affects five or more joints). The Home Health Certification and Plan of Care indicated the frequency for SN visit was once a week for one week, then twice a week for two weeks, then once a week for six weeks, for a total of nine weeks. During a concurrent interview and record review with the Director of Patient Care Services (DPCS) on 6/12/2025, at 1:18 p.m., the DPCS reviewed the Annual Inservice/Education Log for LVN 1. The DPCS stated that all the trainings in the log must be completed before a nursing staff visited patients at home and provided care. The DPCS stated that LVN 1 was newly hired and “probably didn’t have enough time to complete all the required trainings.” The DPCS stated that LVN 1 should have completed all the trainings before she started visiting patients to ensure she would be able to provide safe and quality patient care. The DPCS stated that based on the log, LVN 1 did not complete the following trainings: - - How to handle grievances/complaints - - Infection control - -Cultural diversity - - Communication barriers - - Ethics - - Workplace and patient safety - - Compliance program - -Methods for coping with work related issues of grief, loss, and change During a review of LVN 1’s employee file, the employee file indicated LVN 1 was hired on 6/1/2025. During a review of the HHA’s policy and procedure, titled “Job Description Summary – Director of Patient Care Services (DPCS),” undated, the policy and procedure indicated, the DPCS is responsible to develop, implement, and evaluate the orientation program for new organization personnel. The DPCS is also responsible for orientation of new organization personnel, either directly or by delegating to another staff member.”