Interim Healthcare of Hartford, Inc.

“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 clinical record review, review of agency policies and interview with agency personnel, for two of seventeen patients (Patient’s #7 & #14) in the survey sample, the agency licensed personnel failed to conduct the initial assessment within 48 hours. The findings include: a. Patient #7 had a start of care date of 5/28/25 and diagnoses that included hypertensive emergency, acute on chronic congestive heart failure and type II diabetes mellitus. The physician’s orders dated 5/28/25 included nursing services for assessments and weight monitoring and a physical therapy evaluation. Review of the hospital referral document dated 5/23/25 (Friday) identified the need for nursing and physical therapy services. Review of the clinical record identified the patient’s home care admission date of 5/28/25 (Wednesday) initiated by Registered Nurse/RN #1 (5 days later). Interview and review of the clinical record and communication notes dated 5/27/25 with the Administrator on 6/03/25 at 1:30 PM identified that the referral came in on a Friday, Monday was a holiday, the family was called on 5/27/25 (Tuesday) and was willing for services to start on 5/28/25, but failed to identify the start of care was completed within 48 hours of referral according to agency policy. b. Patient #14 had a start of care date of 8/18/23 and diagnoses that included type I diabetes mellitus, lymphedema and major depressive disorder. The physician’s orders dated 8/18/23 included nursing services for assessments. Review of the hospital referral dated 8/18/23 (Friday) identified the need for nursing and physical therapy services. Review of the clinical record identified the home care admission date of 8/21/23 (Monday) initiated by Registered Nurse/RN #1 (72 hours later). Interview and review of the clinical record dated 8/21/23 with the Administrator on 6/04/25 at 11:30 AM identified that the referral came in on a Friday, and the patient may have refused the weekend admission, although, there was no evidence of documentation to substantiate a patient request, and the admission was conducted on Monday, 8/21/23, but failed to identify admission within 48 hours of referral according to agency policy. Review of the agency Admission policy directed an initial evaluation for patient admission shall occur within 48 hours of receiving a referral unless a reason is documented which includes notification to the referral source and physician.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on review of the clinical record, review of agency policies and interview with agency personnel for one of seventeen patients (Patient #16) in the survey sample, the agency licensed personnel failed to notify the physician of an alteration in the care plan. The findings include: Patient #16 had a start of care date of 2/27/25 and diagnoses that included non-pressure chronic ulcer of the left ankle and right lower leg, chronic kidney disease stage IV and chronic venous insufficiency. The physician’s orders dated 2/27/25 included nursing services three times a week for assessments and wound care to the bilateral lower extremities, physical therapy/PT, occupational therapy/OT and medical social worker/MSW evaluations. Review of the clinical record identified completion of the MSW evaluation on 3/17/25 (seventeen days after the start of care) and the OT evaluation on 3/18/25 (eighteen days after the start of care) and the subsequent nursing note dated 3/01/25 of the patient’s refusal of PT services. Interview and review of the clinical record from 2/27/25 to 4/02/25 with the Administrator on 6/04/25 at 11:40 AM identified that the OT and MSW were having difficulty scheduling the initial evaluations due to the patient requesting to reschedule the visits, but failed to identify communication with the physician for the delay in MSW and OT services and the refusal of PT services in accordance with the plan of care. Review of agency policy for Coordination of Care/Services directed the designated employee contacts the physician when the patient’s condition changes, documents changes in the plan of care, communicates significant information promptly to all healthcare team members and monitors timely implementation of physician’s orders.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on clinical record reviews and an interview with agency personnel, for one of seventeen (Patient #11) who received home health aide and skilled services, an agency professional failed to provide documentation of home health aide supervisions and on-site supervisory visits at a minimum every two weeks. The findings include: Patient #11 had a start of care date of 02/03/2025 and diagnoses that included spondylosis, spinal stenosis, and chronic obstructive pulmonary disease. The physician’s orders for the recertification period of 04/09/2025 to 06/02/2025 included physical therapy one time per week for nine weeks and home health aide services three times per week for eight weeks for assistance with personal care. Review of Patient #11’s clinical record for the period of 04/09/2025 to 06/02/2025 identified the Patient had eight physical therapy visits and nineteen home health aide visits. Interview with the Administrator on 06/04/2025 at 1:00 PM, identified fifty-five days had passed without a home health aide supervisory visit for Patient #11, and was not completed no less frequently than every 14 days (two weeks).”