Choice Health at Home

“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 record review and interview, the agency failed to conduct timely initial assessments. Specifically, for 4 of 4 sample patients, the agency did not conduct visits for initial assessments within 48 hours of the patients’ referrals to the agency (Patient #1, #2, #3, and #4). Findings include: Four patient records were reviewed from 4/6/26 to 4/7/26. a) The agency failed to conduct initial assessments within 48 hours of patient referral, and did not obtain physician- or allowed practitioner- orders regarding a change in the start of care date. 1) The clinical record for Patient #1 was reviewed on 4/6/26. Plan of care orders for the certification period dated 2/8/26 to 4/8/26 revealed a start of care date of 12/10/25; diagnoses included Alzheimer’s disease with late onset and hypertensive chronic kidney disease. Plan of care orders included skilled nursing once per week for medication management and monitoring of medication effectiveness. Further review of the record revealed the agency received a physician referral for Patient #1 for home health services, dated 11/20/25. During an interview on 4/7/26 at 11:30 a.m., an intake coordinator, Employee #6, stated when Patient #1 was referred to the agency, the agency began the intake process and received a message on 11/21/25 from the insurance department notifying them the patient was possibly on service with another home health agency. Employee # 6 stated the agency left messages with the referring physician on 11/21/25 and 11/24/25 and reached out to confirm with the other home health agency the patient was not on home health services there. Employee # 6 further stated the daughter of Patient #1 requested start of care to begin on 12/3/25. Record review did not reveal documentation of physician notification of the delayed start of care or an order to change the start of care date. The skilled nursing initial visit for assessment and start of care occurred on 12/10/25, 20 days after the date the agency received the referral. 2) The clinical record for Patient #2 was reviewed on 4/6/26. Plan of care orders for the certification period dated 3/20/26 to 5/18/26 revealed a start of care date of 1/19/26; diagnoses included venous insufficiency and non-pressure chronic ulcers of lower legs limited to breakdown of skin. Plan of care orders included skilled nursing once per week to identify changes and minimize complications, and physical therapy once per week to increase functional independence. Further review of the record revealed the agency received a physician referral for Patient #2 for home health services, dated 1/15/26. On 4/7/26 at 4:47 p.m., via email, the agency administrator stated the original referral for Patient #2 lacked necessary clinical information which was not obtained until 1/17/26. Record review did not reveal documentation of physician notification of the delayed start of care or an order to change the start of care date. The skilled nursing initial visit for assessment and start of care occurred on 1/19/26, four days after the date the agency received the referral. 3) The clinical record for Patient #3 was reviewed on 4/6/26. Plan of care orders for the certification period dated 3/27/2026 to 5/25/2026 revealed a start of care date of 4/1/25; diagnoses included encounter for fitting and adjustment of urinary device and neuromuscular dysfunction of bladder. Plan of care orders included skilled nursing once per week for medication management and urinary catheter care. Further review of the record revealed the agency received a physician referral for Patient #3 for home health services, dated 3/20/25. On 4/7/26 at 4:47 p.m., via email, the agency administrator stated the delay in the start of care was due to the original referral for Patient #3 lacking necessary clinical information and due to a family request for start of care to be on 4/1/25. Record review did not reveal documentation of physician notification of the delayed start of care or an order to change the start of care date. The skilled nursing initial visit for assessment and start of care occurred on 4/1/25, 10 days after the date the agency received the referral. 4) Similar findings of the agency not conducting the initial assessment within 48 hours of patient referral, without physician orders for a different start of care date, were found for Patient #4. During an interview on 4/6/26 at 4:41 p.m., the agency administrator stated the home health admission process, from the referral of a patient to the initial assessment for a patient, is shared by the home health agency and the corporate office. She stated the corporate office frequently made decisions, or shared decisions, about whether the agency had available staff and had the ability to meet the clinical needs of the patients referred to the agency. She stated sometimes the process takes longer than 48 hours, but the delay was out of her hands. During an interview on 4/7/26 at 11:30 a.m., an intake coordinator, Employee #6, stated the out-of-state corporate office helps move patients through the referral process to the start of care visit. She stated there were several checkpoints along the way with daily meetings and messages being sent out to agency staff members. She further stated the initial assessment visit did not always occur within 48 hours because of the many moving parts involved.”

“Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure the administrator was responsible for all day-to-day operations of the home health agency. Findings include: From 4/6/26 to 4/7/26, patient records were reviewed for 4 sample patients. Additionally, personnel records were reviewed and interviews were conducted with agency staff. a) The agency failed to ensure the administrator was responsible for all day-to-day operations of the home health agency. 1) During the entrance conference interview with the agency administrator on 4/6/26 at 1:50 p.m., the administrator stated she was not sure which home health agency the survey was being conducted for because there were three different local home health agencies who all had the same out-of-state corporate owner. She stated she needed to have an employee from the out-of-state corporate office help her identify the number of current patients the agency had on service. 2) Record review revealed the administrator did not assume responsibility for assuring initial assessments were completed within 48 hours of the patients’ referrals to the agency for 4 of 4 sample patients. (see tag G514) During an interview on 4/6/26 at 4:41 p.m., the agency administrator stated the home health admission process, from the referral of a patient to the initial assessment for a patient, is shared by the home health agency and the corporate office. She stated the corporate office frequently made decisions, or shared decisions, about whether the agency had available staff and had the ability to meet the clinical needs of the patients referred to the agency. She stated sometimes the process takes longer than 48 hours, but the delay was out of her hands. 3) A list of personnel was requested on 4/6/26. The administrator provided a list of current employees. During patient record review, two employees, who had not been listed on the personnel list provided by the administrator, were documented as having provided care to patients within the previous 2 days. During an interview on 4/7/26 at 2:06 p.m., the alternate administrator stated she did not know why the personnel list was not a complete list of employees. She stated the personnel records were kept at the out-of-state corporate office and she and the administrator were trying to find a process for the local agency and the out-of-state corporate office to be able to quickly obtain accurate information.”