Nightingale Visiting Nurses of Connecticut

“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 review of agency documentation, and interview with agency staff for two of eight patients (Patient #1 and #2) in the survey sample who required nursing and therapy services, the agency failed to ensure the physician ordered therapy services were provided. The findings include: Patient #1 had a start of care date of 4/02/26 and diagnoses that included acute cholecystitis, urinary tract infection and left breast cancer. The physician’s orders dated 4/02/26 included nursing services twice a week for assessments, home health aide services three times weekly for assistance with personal care and a physical therapy/PT evaluation and treatment. Review of the clinical record identified a Physical Therapy (PT) evaluation was ordered 4/2/26 by the patient’s provider, but was not conducted until 4/10/26 (eight days after the start of care). Interview and review of the clinical record on 4/15/26 at 10:40 AM with the Acting Administrator/Supervisor of Clinical Services (SCS) indicated that the PT evaluation should have been conducted within 48 hours of referral per the agency policy, but the Physical Therapist works on an “as needed basis”, so the evaluation was conducted at the PT’s convenience, on 4/10/26, and the SCS further indicated the staff failed to follow the patient’s individualized plan of care and the agency expectations. Patient #2 had a start of care date of 03/31/2026 with diagnoses that included lumbar spondylosis, Ehlers-Danlos syndrome, narcolepsy, and osteoporosis. The physician’s orders for the certification period of 03/31/2026 through 05/29/2026 included nursing services two (2) times per week for four (4) weeks for assessments. The orders also included physical and occupational therapy evaluations for pain management, functional mobility, therapeutic exercises, safe equipment use and fall prevention. Review of Patient #2’s clinical record from 03/31/2026 through 04/13/2026 identified that Patient #2 had lumbar spine decompression surgery and bilateral sacral Tarlov cysts surgery. The Patient was discharged to home 3/26/26 with documentation identifying patient had an unsteady gait, was at risk for falls, required the use of a walker and needed assistance with personal care. Further review of the clinical record identified no documentation of the completion of the physician ordered physical or occupational therapy evaluations, or communication with the Patient’s physician regarding the delay in initiating and/or inability for the agency to complete the ordered therapy service evaluations. Interview with the Acting Administrator/Supervisor of Clinical Services (SCS) on 04/16/2026 at 11:00 AM, identified that Patient #2’s physical and occupational therapy evaluations should have been completed within 48 hours of admission. The Acting Administrator/SCS stated the agency didn’t have staff members that would go to the patient’s geographical area, resulting in the agency’s inability to complete the physician ordered physical or occupational therapy evaluations for Patient #2. The clinical record did not indicate communication with the patients physician regarding the delay and/or inability in providing therapy services. Subsequently, the Patient’s responsible caregiver requested that Patient #2 be discharged to another home health agency. Review of the agency policy for Assessments and Plan of Care Development directed the initial assessment is conducted within 48 hours of the patient’s return home, unless the physician specifies a specific time to conduct the initial assessment”

“5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care. This Element is not met as evidenced by: Based on review of clinical records, agency documentation and staff interviews, for two of eight patients (Patient #1 and #2) who required nursing services and/or therapy services, the agency licensed personnel failed to follow the physician’s-certified plan of care and agency policies for therapy evaluations. The findings include: Patient #1 had a start of care date of 4/02/26 and diagnoses that included acute cholecystitis, urinary tract infection and left breast cancer. The physician’s orders dated 4/02/26 included nursing services twice a week for assessments, home health aide services three times weekly for assistance with personal care and a physical therapy/PT evaluation and treatment. Review of the clinical record identified a Physical Therapy (PT) evaluation was ordered 4/2/26 by the patient’s provider, but was not conducted until 4/10/26 (eight days after the start of care). Interview and review of the clinical record on 4/15/26 at 10:40 AM with the Acting Administrator/Supervisor of Clinical Services (SCS) indicated that the PT evaluation was ordered on 4/2/26, and was not completed until 4/10/26 (eight days later) and should have been conducted within 48 hours of the referral per the agency policy. The SCS further stated the delay was a result of the Physical Therapist working on an “as needed basis”, so the evaluation was conducted at the PT’s convenience, on 4/10/26, and further indicated the staff failed to follow agency expectations. Patient #2 had a start of care date of 03/31/2026 with diagnoses that included lumbar spondylosis, Ehlers-Danlos syndrome, narcolepsy, and osteoporosis. The physician’s orders for the certification period of 03/31/2026 through 05/29/2026 included nursing services two (2) times per week for four (4) weeks for assessments. The orders also included physical and occupational therapy evaluations for pain management, functional mobility, therapeutic exercises, safe equipment use and fall prevention. Review of Patient #2’s clinical record from 03/31/2026 through 04/13/2026 identified that Patient #2 had lumbar spine decompression surgery and bilateral sacral Tarlov cysts surgery. The Patient was discharged to home 3/26/26 with documentation identifying patient had an unsteady gait, was at risk for falls, required the use of a walker and needed assistance with personal care. Further review of the clinical record identified no documentation of the completion of the physician ordered physical or occupational therapy evaluations, or communication with the Patient’s physician regarding the delay in initiating and/or inability for the agency to complete the ordered therapy service evaluations. Interview with the Acting Administrator/Supervisor of Clinical Services (SCS) on 04/16/2026 at 11:00 AM, identified that Patient #2’s physical and occupational therapy evaluations should have been completed within 48 hours of admission. The Acting Administrator/SCS stated the agency didn’t have staff members that would go to the patient’s geographical area, resulting in the agencies inability to complete the physician ordered physical or occupational therapy evaluations for Patient #2. It was also noted that the agency did not communicate with the patients physician regarding the delay and/or inability in providing therapy services. Subsequently, the Patient’s responsible caregiver requested that Patient #2 be discharged to another home health agency. Review of the agency policy for Assessments and Plan of Care Development directed the initial assessment is conducted within 48 hours of the patient’s return home, unless the physician specifies a specific time to conduct the initial assessment”

“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 agency documentation, and interview with agency staff for two of eight patients (Patient #1 and #2) in the survey sample who required nursing and therapy services, the agency failed to ensure physician notification for a delay and/or the agencies inability to provide the ordered services. Patient #1 had a start of care date of 4/02/26 and diagnoses that included acute cholecystitis, urinary tract infection and left breast cancer. The physician’s orders dated 4/02/26 included nursing services twice a week for assessments, home health aide services three times weekly for assistance with personal care and a physical therapy/PT evaluation and treatment. Review of the clinical record identified a Physical Therapy (PT) evaluation was ordered 4/2/26 by the patient’s provider, but was not conducted until 4/10/26 (eight days after the start of care). Interview and review of the clinical record on 4/15/26 at 10:40 AM with the Acting Administrator/Supervisor of Clinical Services (SCS) identified the PT evaluation was conducted on 4/10/26, 8 days after the patients start of home care services, and should have been conducted within 48 hours of the referral per the agency policy. Review of the clinical record did not indicate communication with the patients provider related to the delay in services. Patient #2 had a start of care date of 03/31/2026 with diagnoses that included lumbar spondylosis, Ehlers-Danlos syndrome, narcolepsy, and osteoporosis. The physician’s orders for the certification period of 03/31/2026 through 05/29/2026 included nursing services two (2) times per week for four (4) weeks for assessments. The orders also included physical and occupational therapy evaluations for pain management, functional mobility, therapeutic exercises, safe equipment use and fall prevention. Review of Patient #2’s clinical record from 03/31/2026 through 04/13/2026 identified that Patient #2 had lumbar spine decompression surgery and bilateral sacral Tarlov cysts surgery. The Patient was discharged to home 3/26/26 with documentation identifying patient had an unsteady gait, was at risk for falls, required the use of a walker and needed assistance with personal care. Further review of the clinical record identified no documentation of the completion of the physician ordered physical or occupational therapy evaluations, or communication with the Patient’s physician regarding the delay in initiating and/or inability for the agency to complete the ordered therapy service evaluations. Interview with the Acting Administrator/Supervisor of Clinical Services (SCS) on 04/16/2026 at 11:00 AM, identified that Patient #2’s physical and occupational therapy evaluations should have been completed within 48 hours of admission. The Acting Administrator/SCS stated the agency didn’t have staff members that would go to the patient’s geographical area, resulting in the agencies inability to complete the physician ordered physical or occupational therapy evaluations for Patient #2. It was also noted that the agency did not communicate with the patients physician regarding the delay and/or inability in providing therapy services. Subsequently, the Patient’s responsible caregiver requested that Patient #2 be discharged to another home health agency. Review of the agency policy for Assessments and Plan of Care Development directed the initial assessment is conducted within 48 hours of the patient’s return home, unless the physician specifies a specific time to conduct the initial assessment”