Front Range Therapists LLC

“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 record review and interviews, the agency failed to ensure each patient received the home health services written in an individualized plan of care which was 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. Specifically, the agency failed to consult with the physician or allowed practitioners to approve additions or modifications to the original plan for 2 of 7 records reviewed (Patient #1 and #5). Findings Include: 1. The clinical record for Patient #1 was reviewed on 2/17/26. Plan of care orders for the certification period dated 1/6/26 to 3/6/26 revealed a start of care date of 3/12/25; diagnoses included delayed milestones in childhood. Plan of care orders included Physical Therapy (PT) one time a week to maintain therapeutic progress and prevent loss of therapeutic gains. a. The agency failed to ensure the plan of care for Patient #1 was signed by the physician of record before providing OT services. Record review revealed the current plan of care included orders for PT services only. Further review revealed a physician signature was received on 1/10/26 approving the PT orders. Record review revealed an order dated 1/19/26 was documented by OT #1 for OT services one time a week. Review of the order revealed a physician signature dated 2/2/26. The order failed to include verbal orders for the start of care for Occupational Therapy (OT) services. Review of clinician visit notes revealed an initial OT assessment visit was completed by OT #1 on 1/19/26 via Telemed. Two in person OT visits were completed on 1/20/26 and 1/27/26 by OT #1. Review of the orders found in Patient #1’s record failed to reveal a start of care order for OT services between 1/19/26 to 2/2/26 when the OT plan of care was signed by the physician of record. Review of coordination notes between 1/19/26 to 2/2/26 failed to reveal communication between the agency or OT #1 and the physician. During an interview on 2/18/26 at 2:00 p.m., OT #1 stated during the initial assessment visit, the plan of care was created and visit frequencies were scheduled. OT #1 explained the office would receive the plan of care which would then be sent to the physician for review. OT #1 revealed clinicians did not contact the physicians directly. She explained that within the Electronic Medical Record (EMR) system, visits were approved by the office staff. When asked how the clinicians knew which visits were approved, OT #1 explained that approved visits were green on their schedules or red if they were not approved by the office. During an interview on 2/19/26 at 9:51 a.m. Licensed Practical Nurse (LPN) #1 confirmed she and other office staff were in charge of ensuring the plans of care were sent to the physicians for review. LPN #1 explained staff did not always ensure the plan of care was returned signed by the physician before visits scheduled by the clinicians began. The Director of Office Operations explained the agency office would ensure the plan of care included all aspects of care and then send it to the physician for review. LPN #1 stated once the plan of care was in the patient record, the clinicians were able to make visits according to visit frequency. 2. The clinical record for Patient #5 was reviewed on 2/17/26. Plan of care orders for the certification period dated 12/29/25 to 2/26/26 revealed a start of care date of 12/29/25; diagnoses included behavior/emotion disorder. Plan of care orders included Speech Therapy (ST) one time a week to maintain therapeutic progress and prevent loss of therapeutic goals. a. The agency failed to ensure the plan of care for Patient #5 was signed by the physician of record before providing ST services. Record review for Patient #5 revealed an initial assessment visit was completed by ST #1 on 12/29/25. Review revealed a plan of care created on 12/29/25 was not signed by the physician until 1/9/26. Further review failed to reveal verbal orders to start ST services as documented in the plan of care between 12/29/25 to 1/9/26. Review of visit notes between 12/29/25 to 1/9/26 revealed an ST visit was completed in person on 1/7/26 by ST #1 at 11:43 a.m. Review of the visit documentation failed to reveal communication between the physician of record and ST #1 for Patient #5. At an interview conducted on 2/18/26 at 1:28 p.m., ST #1 verified she made the initial assessment visit and the following in person visit on 12/29/26 and 1/7/26 respectively. ST #1 revealed clinicians did not check the patient’s EMR to verify the plan of care was signed by the physician or there were verbal orders prior to starting services. Further interview with ST #1 explained the office would message clinicians when an initial assessment could be scheduled for new services. ST #1 stated all contact with the physicians was typically handled by office staff. 3. During an interview on 2/19/26, LPN #1 acknowledged failing to ensure the plan of care for Patient #1 and #5 was signed by the physician prior to the start of services. Further, LPN #1 acknowledged the agency failed to obtain verbal orders to start services for OT for Patient #1 and ST services for Patient #5. During an interview on 2/19/26 at 11:00 a.m. the Administrator and Alternate Administrator stated the agency needed to improve the process of ensuring the plan of care was signed by the physician or verbal orders from the physician were in the EMR prior to starting services. Both acknowledged there would be a change in policy and procedure to prevent this from happening in the future.”

“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 interview and record review, the agency failed to promptly alert the relevant physician to any changes in the patient’s condition or immediate needs to 3 of 7 active patients (Patient #2, #4, #6). . 1. The clinical record review of Patient #4 was reviewed on 2/17/26. Plan of Care orders for certification period dated 2/12/26 to 4/12/26 revealed a start date of care on 10/15/25; diagnosis included Unspecified disorder of psychological development, Attention-Deficit Hyperactive disorder, unspecified speech disturbance, Other specified congenital deformities of hip, and cleft hard palate. Plan of Care orders included are Physical Therapy one time a week. a) The agency failed to alert the relevant physician or allowed practitioner to missed or cancelled visits which suggested the plan of care should be altered. Review of clinical records for Patient #4 on revealed eight visits were canceled between 12/22/25 to 2/11/26. Review of coordination notes failed to reveal communication between the agency clinicians and the physician of record regarding canceled visits. Review of Patient #4’s visit schedule revealed a pattern of canceled visits every other week. An interview with Physical Therapy Assistant (PTA) #1 was completed on 2/18/26 at 2:20 p.m. PTA #1 verified cancelled visits for Patient #4 due to scheduling conflicts. PTA #1 explained clinicians would attempt to reschedule cancelled visits during the same certification period. Patient #4 did not have cancelled visits rescheduled. Additional interview revealed PTA #1 failed to notify the physician of cancelled visits. During an interview on 2/19/26 at 9:51 a.m., Licensed Practical Nurse (LPN) #1 and Director of Office Operations (DOO) stated clinicians do not contact the physician for cancelled visits. LPN #1 stated agency practice is to inform the physician of cancelled visits when a new certification plan of care was completed. During various interviews on 2/18/26 with clinical staff to include Occupational Therapist #1, Speech Therapist #1, and Occupational Therapy Assistant #2, clinicians verified the physician was not notified of cancelled visits until the next certification period. The clinical staff would put in a cancelled visit note at the time. Per ST #1, the office handled all orders and communication with the physician. During an interview on 2/19/26 at 11:00 a.m. the Administrator verified agency practice was not to notify the physician of cancelled visits promptly. When questioned further, the administrator acknowledged a need for updated agency practice to address cancelled visits when they occur. 2. Similar findings of the agency failed to notify the physician of cancelled visits promptly were found for Patient #2 and #6. During an interview conducted on 2/19/26 at 11:13 the Administrator and Alternate Administrator explained the agency relied on office staff to coordinate with the physician for changes to the plan of care. Further interview revealed the agency would be developing a new policy to have clinicians contact the physician directly for all cancelled visits. Additionally, the Administrator stated the therapists should be communicating with the family and the physician if changes in the plan of care were indicated by repeated cancelled visits.”