Valley View Healthcare Services LLC

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on interview, and record review, the agency failed to ensure two of 10 sampled patients (Patient 1 and Patient 4), were assessed by a Registered Nurse (RN) within 48 hours of their referral for home health care services and notify the physician when there was a delayed start of care (admission to agency). This failure could result in changes to care without physician knowledge or approval, and a lack of adequate physician oversight leading to negative clinical outcomes including re-hospitalization. Findings: During a review of the agency’s policy and procedure (P&P) titled, “Initial and Comprehensive Assessment,” revised 11/2021, the P&P indicated, to provide guidelines for the initial assessment of patients admitted to service and for completing the plan of care (POC). An initial patient assessment will be performed and documented in the patient’s clinical record by a registered nurse (RN), physical therapist (PT), or speech therapist (ST). The initial assessment visit must be performed either within 48 hours of the referral, within 48 hours of the return of the patient home, or on the start of care (SOC) date ordered by a physician, or at the request of the patient/family request with the approval of the physician or other licensed independent practitioner. During a record review of Patient 1’s clinical record, a document titled, “Referral,” dated 3/2/26 from a local hospital indicated the physician ordered RN, PT, Occupational Therapy (OT), and Home health aide (HHA) for discharge scheduled 3/3/26 for a broken right femur (thigh) bone. Patient 1’s clinical record was reviewed. Patient 1 was admitted for home health services on 3/6/26, with diagnoses that included displaced fracture of shaft of right femur (broken thigh bone and the bones have shifted out of place), vitamin B12 deficiency anemia (a condition when lack of the vitamin B12 causes the body to produce too few blood or large, dysfunctional blood cells needed to carry oxygen in the blood), high blood pressure, anxiety (persistent feelings of worry, restlessness, and unease), erythema intertrigo (skin fold or chafing rash with redness and itching), and history of falls. During an interview on 4/14/26 at 12:30 pm, the Director of Patient Care Services (DPCS) confirmed the Initial and Comprehensive Assessment or SOC was completed by the Registered Nurse three days after the referral and was one day late per their policy and federal regulations, and the physician had not been updated of this delay in services ordered. During a record review of Patient 4’s clinical record, a document titled, “Referral,” dated 2/12/26 from a local hospital indicated the physician ordered Skilled Nurse (SN) and PT. The RN did not complete the Initial and Comprehensive assessment or SOC until 2/17/26, five (5) days after receiving the referral for services ordered. Patient 4’s clinical record was reviewed. Patient 4 was admitted for home health services on 2/17/26 with diagnoses that included acute respiratory failure (a sudden loss of lung function causing shortness of breath), influenza (commonly known as the flu, a viral respiratory illness with a fast onset, severe aches, fever and intense fatigue), pneumonia (a contagious respiratory infection, inflammatory condition of the lungs), supraventricular tachycardia (very fast irregular heart beat), congestive heart failure (long lasting condition when the heart does not pump enough blood to meet the body’s needs), chronic kidney disease (loss of kidney function that cannot filter wastes from the blood as they should), pulmonary hypertension (high blood pressure in the arteries of the lungs), peripheral vascular disease (PVD, slow, progressive condition called poor circulation), and dependence on supplemental oxygen (lungs are unable to take in enough oxygen from the air for the body’s need to breathe adequately). During an interview on 4/14/26 at 4:22 pm, the DPCS confirmed Patient 4 had a late SOC, 5 days after the referral and the physician had not been updated for this delay in services. DPCS stated, “I confirm [Patient 4] should have been opened before 5 days, and the physician should have been updated.””

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on interview, and record review, the agency failed to identify and update the physician of a significant change in condition for two of seven sampled patients (Patients 1 and 6) when: 1. Patient 1 was missing multiple medications in the home ordered by the physician when discharged by a local hospital during the initial assessment that was not immediately reported to the physician. 2. Patient 6 did not have required lab orders during the Resumption of Care (ROC) for a new medication Warfarin (a blood thinner) ordered during a hospitalization, and there was a delay reporting this new medication to the physician. These failures did result in medication errors and had the had the potential for medical complications and hospitalizations. Findings: 1. During a review of the agency’s policy and procedure (P&P) titled, “Medication Profile,” revised 11/2021, the P&P indicated, “Patient receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. Medications will be updated for each change to reflect current medications, new, and/or discontinued medications. A drug regimen will be performed at the time of admission, when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with the addition of a new medication. During subsequent home visits, the medication profile will be used as care planning and teaching guide to ensure that the patient and family/caregiver as well as other clinicians understand the medication regimen. Deviations from taking medications as ordered will be documented in the clinical notes, and the physician will be notified.” Patient 1’s clinical record was reviewed. Patient 1 was admitted for home health services on 3/6/26, with diagnoses that included displaced fracture of shaft of right femur (broken thigh bone and the bones have shifted out of place), vitamin B12 deficiency anemia (a condition when lack of the vitamin B12 causes the body to produce too few blood or large, dysfunctional blood cells needed to carry oxygen in the blood), high blood pressure, anxiety (persistent feelings of worry, restlessness, and unease), erythema intertrigo (skin fold or chafing rash with redness and itching), and history of falls. During a record review of Patient 1’s clinical record, a document titled, “Outcome and Assessment Information Set (OASIS)-E1 Start of Care,” dated 3/6/26, indicated, “The patient’s medications could not be fully reconciled due to multiple medications on her medication list were still at the pharmacy needing to be picked up. The patient states her friend will pick them up later in the day. Collaborated with a follow up nurse to reconcile medication list fully on next home visit.” During a concurrent interview and record review on 4/14/26 at 1:20 pm, the Director of Patient Care Services (DPCS) confirmed the medications for Patient 1 were not reconciled until the next Skilled Nursing (SN) visit on 3/11/26, 5 days later from the time of admission to the agency, and the physician had not been updated all ordered medications were not in the home following a hospitalization. DPCS stated, “I confirm this is a safety issue and the physician should have been updated about missing medications in the home, and we should have called or gone back to follow up before the next scheduled visit for [Patient 1].” 2. During a review of the agency’s policy and procedure (P&P) titled, “Monitoring Patient’s Response/Reporting to the Physician,” revised 11/2021, the P&P indicated, “To provide guidelines for monitoring the patients’ response to care, and for reporting to the patient’s physician. Clinicians will monitor, document, and report patient’s response to care and treatment provided on each home visit. Clinicians will establish and maintain ongoing communication with the physician to ensure safe and appropriate care for the patient. The physician will be contacted the same day if any of the following occur: Significant change in condition, patient’s psychosocial status, family/care giver support, home environment. Inability to achieve goals within the expected time frame, changes in the patient’s expected response to treatments or medications, changes that have occurred regarding diagnosis, prognosis, or treatment including procedures, medications, precautions, and limitations.” Patient 6’s clinical record was reviewed. Patient 6 was admitted for home health services on 10/29/25 with diagnoses that included dehydration (lack of fluids or losing more fluids than taking in), Alzheimer’s disease (the most common form of dementia, a progressive, irreversible brain disease causing memory loss, thinking problems, behavioral changes and eventually loss of activities of daily life), diabetes (too much sugar in the blood), chronic kidney disease (loss of kidney function that cannot filter wastes from the blood as they should), adult failure to thrive (frailty and mental and physical decline in the elderly), benign prostatic hyperplasia (non-cancerous enlargement of the prostate gland), and depression (persistent feelings of sadness, emptiness and loss of activities). During a record review of Patient 6’s clinical record, a document titled “OASIS-E1 Resumption of Care,” dated 1/6/26, indicated “Clinically significant medication issues were present. Patient identified to be a high risk for falls.” During a concurrent interview and record review on 4/14/26 at 3:28 pm, the DPCS confirmed no education was provided for a new medication Warfarin (a blood thinner), the danger of falls with the new medication ordered, and the importance of labs needed were not included to the care giver. DPCS also confirmed the physician was not updated of a new medication that requires laboratory values for safety and appointments were not arranged for these labs to be completed at the physician office or coordinated with home health nurses until one month later.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure the plan of care (a personalized, doctor approved roadmap outlining the specific medical services, goals, and treatments a patient receives at home) was followed for one of seven sampled patients (Patient 4) when: Patient 4 did not receive Physical Therapy (PT, health care professional that uses various techniques to help pain, mobility, balance and function to restore overall wellness) as ordered by the physician. This failure had the potential to cause a delay in needed services, which could lead to negative clinical outcomes. Findings: During a review of the agency’s policy and procedure (P&P) titled, “Missed Visits,” revised 9/2021, the P&P indicated, “To ensure that missed visits are documented and does not affect the quality of patient care. Missed visits will be communicated to the clinical supervisor and the patients’ physician. Missed visits will be documented in the clinical record. If a patient is routinely refusing visits, the clinician should evaluate the appropriateness of the plan of care and make adjustments to the plan of care with input from the patient and physician.” Patient 4’s clinical record was reviewed. Patient 4 was admitted for home health services on 2/17/26 with diagnoses that included acute respiratory failure (a sudden loss of lung function causing shortness of breath), influenza (commonly known as the flu, a viral respiratory illness with a fast onset, severe aches, fever and intense fatigue), pneumonia (a contagious respiratory infection, inflammatory condition of the lungs), supraventricular tachycardia (very fast irregular heart beat), congestive heart failure (long lasting condition when the heart does not pump enough blood to meet the body’s needs), chronic kidney disease (loss of kidney function that cannot filter wastes from the blood as they should), pulmonary hypertension (high blood pressure in the arteries of the lungs), peripheral vascular disease (PVD, slow, progressive condition called poor circulation), and dependence on supplemental oxygen (lungs are unable to take in enough oxygen from the air for the body’s need to breathe adequately). During a concurrent interview and record review on 4/14/26 at 2:55 pm, the Director of Patient Care Services (DPCS) confirmed the Physical Therapy order for Patient 4 was never completed per physician orders and the physician was not updated. DPCS confirmed the first attempt to schedule a PT evaluation was on 2/23/26, six days after the Start of Care (SOC), and the patient refused. DPCS stated, “I confirm we missed the PT order, and this is a missed visit. The doctor should have been notified and attempts by the therapist should have been made to reschedule. I confirm [Patient 4] never received PT.””