M D Home Health LLC

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on review of the Home Health Agency (HHA)’s Policy, observation, and interview, the Home Health Agency (HHA)’s staff failed to adhere to the HHA’s Policy for 2 of 3 sampled patients as evidenced by the failure to follow the HHA’s policy for Nursing Bag Technique during and between patient visit (Patients #1 and #3). The findings included: 1) Review of the HHA’s Policy titled, Nursing Bag Technique”, dated January 1, 2025, documented,” To minimize the risk of cross-contamination and infection between patients through the proper use and handling of the nursing bag during home visits. This policy applies to all licensed clinical staff who carry and utilize a nursing bag when performing home visits on behalf of M D Home Health, LLC. The nursing bag is considered a mobile extension of the clinical environment. It must be maintained in a clean, organized, and contamination-free condition. The bag technique is to be strictly followed before, during, and after each patient visit to prevent the spread of infections. The procedure upon arrival at patient’s home – place bag on barrier – never place the bag on the floor, couch, or patient surfaces. Use a disposable barrier (underpad or paper towel).” Observation, on 07/16/25 at 11:25 AM, during a home visit conducted for Patient #1 to observe the administration of an intravenous infusion revealed Staff A, a Licensed Practical Nurse (LPN), placed their Nursing Bag directly on the patient’s high counter chair without benefit of a protective barrier and failed to carry out the HHA’s Nursing Bag Technique after providing care and services to Patient #1 and proceeding to the next patient. 2) Observation on 07/16/25 at 12:25 PM, during a home visit conducted for Patient #3 to observe a teaching session revealed Staff A placed their Nursing Bag directly on the patient’s couch without benefit of a protective barrier and failed to carry out the HHA’s Nursing Bag Technique after providing care and services to Patient #3 and proceeding to the next patient. During an interview, on 07/16/25 at 2:41 PM, the Administrator acknowledged the findings.”

“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 review of the Home Health Agency (HHA)’s Policy, observation, interview, and record review, the Home Health Agency (HHA) failed to follow the physician’s orders, in the Plan of Care (POC) for the intravenous infusion for 1 of 1 sampled patients (Patient #1) observed during an intravenous infusion administration; failed to follow the physician’s order in the Plan of Care for wound care treatment for 1 of 7 sampled patients (Patient #6) and failed to follow the physician’s order frequency in the Plan of Care for Physical Therapy services for 2 of 7 sampled patients (Patient #5 and #7). The findings included: 1) Review of the HHA’s Policy titled, “Wound Care Evaluation and Management.” Dated January 1, 2025, documented, “To ensure safe, evidence-based wound care services are provided in compliance with Centers for Medicaid (CMS) Conditions of Participation (COPs) and Florida Agency for Health Care Administration (AHCA) regulations. This policy provides direction for wound evaluation, documentation, treatment, and follow-up care in the home health setting. This policy applies to all clinical personnel providing wound care services to patients of M.D Home Health, LLC, including Registered Nurse (RN)s, Licensed Practical Nurse (LPN)s, therapists, and Medical Directors. All wound care services must be performed recording to the patient’s individualized POC, updated regularly, and documented to meet CMS COPs and Local Coverage Determinations (LCD) guidelines. Home Health clinicians must assess, manage, and document wound care interventions and patient response during every skilled nursing or therapy visit.” Review of the HHA’s Policy titled, “Frequency and Duration of Ordered Skilled Nursing and Physical Therapy Visits,” dated January 1, 2025, documented, “To establish a standardized, CMS – and AHCA – compliant policy regarding the frequency and duration of skilled nursing (SN) and physical therapy (PT) visits, ensuring medically necessary services are provided according to individualized care needs and physician orders. This policy applies to all clinical personnel responsible for creating, reviewing, and implementing skilled nursing and therapy visit frequencies for patients receiving home health services.” Record review revealed that Patient #1 was admitted to the Home Health Agency’s services on 07/04/2025 for Skilled Nursing Services. Review of the POC for the certification period from 07/04/2025 through 09/01/2025 documented that a Skilled Nurse was to administer 2 grams of Intravenous (IV) Ceftriaxone (antibiotic) via IV push over five minutes every 24 hours through a midline catheter in the right upper arm. Further documentation revealed that the patient or caregiver was to flush the IV lumen(s) with 3–5 milliliters (ml.) of Heparin (anticoagulant) solution (100 units/ml.) upon completion of each infusion therapy. Observation, on 07/16/2025 at 11:14 AM, during a home visit with the HHA’s Registered Nurse Administrator and Staff A, a Licensed Practical Nurse (LPN), to oversee IV infusion care revealed Staff A took a pre-filled syringe of Ceftriaxone from the refrigerator, wiped the IV line’s lumen, flushed it with 10 cubic centimeter (cc)s of Normal Saline (NS), and then administered the medication for five minutes, followed by another flush of 10 ml. of NS. However, despite the POC’s instructions to flush the IV line with Heparin after every infusion, Staff A did not follow this step. On 07/16/2025 at 11:14 AM, during an interview, the Registered Nurse Administrator, when questioned about the absence of Heparin, stated that the pharmacy may have removed the (Heparin) order or failed to send it and stated his intention to call the pharmacy for clarification. On 07/16/2025 at 11:58 AM, the Registered Nurse Administrator contacted the HHA’s office, requesting a representative contact the pharmacy to verify the Heparin order. During an interview on 07/16/2025 at 2:39 PM the HHA’s Administrator provided further clarification regarding the Heparin order and stated, “The pharmacy had originally delivered the first dose of the antibiotic to the wrong address. When they redelivered it, it did not include the Heparin either.” The administrator acknowledged that the HHA should have followed up with the pharmacy about the Heparin and alerted the physician regarding the undelivered medication. 2) Record review revealed that Patient #6 was admitted to the Home Health Agency (HHA) on 05/08/2025 to receive skilled nursing services. The plan of care (POC) for the certification period from 05/08/2025 through 05/23/2025 specified that the skilled nurse would assess the integumentary status and provide wound care for the left upper extremity (LUE) and left lower extremity (LLE) three times a week. This included cleansing the wounds with normal saline, applying Mupirocin ointment to the wound bed, and covering the area with a non-adherent dressing secured with tape at each visit until healed. The nurse was also instructed to assess the wounds for size, drainage, odor, and tissue condition during each visit and to document these findings thoroughly. However, the record for Patient #6 revealed no evidence of documented wound assessments following the Skilled Nurse’s visits on May 12, 2025, May 17, 2025, and May 20, 2025, and a lack of documentation regarding the visits, or any assessments conducted, the visit records were “blank.” On 07/16/2025 at 2:33 PM, the HHA’s Administrator was interviewed, a detailed review of Patient #6’s record was performed together and he acknowledged the findings. 3) Record review revealed Patient #5 was re-admitted to the Home Health Agency’s services on 05/26/2025, for physician ordered Physical Therapy services two times a week for four weeks. Further review revealed that during the second week of services, from 06/01/25 to 06/07/25, only one Physical Therapy visit occurred, rather than the two visits that had been physician ordered. Review of the third week of services, from 06/08/25 to 06/14/25, revealed evidence of documentation of only one Physical Therapy visit conducted instead of the physician ordered two visits. On 07/16/2025 at 2:30 PM, an interview was conducted with the HHA’s Administrator, who acknowledged the findings. 4) Record review revealed that Patient #7 was re-admitted to the Home Health Agency’s services on 05/08/25, for physician ordered Physical Therapy services at a frequency of two times per week for four weeks. Further review revealed that during week five, from 06/01/25 through 06/07/25, only one Physical Therapy visit was provided instead of the physician ordered two visits. On 07/16/25 at 2:44 PM, during a side- by-side record review and interview, conducted with the HHA’s Administrator regarding the missed physical therapy visits, he acknowledged the findings.”

“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 record review and interview, the Home Health Agency (HHA) failed to timely notify the Agency for Health Administration (AHCA) of the change of the Alternate Administrator. Review of the HHA’s most recent “Renewal Licensure Application dated 06/15/2024 revealed the name of an Alternate Administrator. 07/16/2025 at 1:21 PM, during an interview with the HHA’s Administrator, when asked, the name of the Alternate Administrator and if this person had been in their role since the HHA applied for its most recent ‘Renewal License,” the Administrator responded that another Alternate Administrator was hired in January 2025, but he has not informed the Agency for Health Care Administration (AHCA) Home Care unit about this change.”