Pruitthealth @ Home- Griffin

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on the policy titled “OASIS Data,” the Centers for Medicare & Medicaid Services (CMS) Home Health Agency (HHA) Error Summary by agency report, and staff interview, it was determined that the agency failed to electronically transmit monthly Outcome and Assessment Information Set (OASIS) data collected to the CMS system every 30 days. Findings include: Review of the policy titled “OASIS Data,” revised 02/08/2023, revealed the following: Procedure: The HHA will encode and electronically transmit each completed OASIS assessment to the CMS OASIS contractor regarding each beneficiary, with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. Review of CMS report titled “HHA Error Summary by Agency,” with report period of 05/01/2024-05/01/2025 and run date of 05/27/2025, revealed the agency failed to transmit OASIS data to CMS system within 30 days. On 06/23/2025 at approximately 11:00 a.m., during an in-office interview, the Administrator revealed that she was unaware that the 30-day OASIS submission timeframe requirements were not met during the time frame of 05/01/2024 through 05/01/2025. The Administrator explained that the Business Office Manager is responsible for submitting and tracking OASIS, and the late OASIS submissions may have been a result of the computer program system transition the agency was undergoing at that time.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on record reviews, staff interviews, and agency policy “Plan of Care (POC),” it was determined the agency failed to include goals, and interventions with a diagnosis of end stage renal disease (a medical condition in which a person’s kidneys are no longer able to function adequately on their own and requires dialysis or kidney transplant to maintain life) for three patients (P) (P#1, P#6, P#8) of 11 sampled patients. Findings include: Review of the policy titled “Plan of Care (POC) (Version: 3),” revised 11/06/2018, reveals the following: Policy Statement: It is the policy of PruittHealth Home Health, in accordance with Program Regulations that the agency develops and implement an individualized plan of care for each patient admitted for care/services. The individual plan of care will specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care will also specify the patient and caregiver education and training that the HHA will provide, specific to the patient’s care needs, and will be furnished in accordance with accepted standards of practice Procedure: 1. Upon admission to the agency, each patient has an initial comprehensive assessment. • If a physician refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician is consulted to approve additions or modifications to the original plan. 2. As determined by the comprehensive assessment, identified patient needs, and physician orders, a patient specific goal-directed plan of care is initiated with measurable outcomes and goals. • The plan of care establishes a means of recording the patient’s plan of care, which reflects the current problems, planned interventions and expected outcomes of those interventions relating to the care and services which have been ordered. 1. Review of the plan of care (POC) for P#1 (certification period (start of care) of 5/26/2025 to 7/24/2025) revealed P#1 was admitted to the Home Health agency on 5/26/2025, with a diagnosis of end stage renal disease. The agency failed to address goals, and interventions on the POC to assess and monitor permanent catheter (connection that a surgeon makes between an artery and a vein to make it possible for you to receive hemodialysis) on right chest catheter site for dialysis for bleeding and signs of infection. 2. Review of the plan of care (POC) for P#6 (certification period (start of care) of 6/11/2025 to 8/9/2025) revealed P#6 was admitted to the Home Health agency on 2/11/2025, with a diagnosis of end stage renal disease. The agency failed to address goals, and interventions on the POC to assess and monitor the fistula (connection that a surgeon makes between an artery and a vein to make it possible for you to receive hemodialysis) on left lower arm site for dialysis for bleeding and signs of infection. 3. Review of the plan of care (POC) for P#8 (certification period (start of care) of 5/1/2025 to 6/29/2025) revealed P#8 was admitted to the Home Health agency on 5/1/2025, with a diagnosis of end stage renal disease. The agency failed to address goals, and interventions, on the POC to assess and monitor the fistula (connection that a surgeon makes between an artery and a vein to make it possible for you to receive hemodialysis) on left upper arm site for dialysis for bleeding and signs of infection. During an interview on phone with Registered Nurse (RN) AA on 6/24/2025 at 1:45 p.m., RN AA confirmed that the agency failed to address interventions on diagnosis of end stage renal disease on P#1, P#6, P#8, POC, because she was not aware that she had to obtain order to assess and monitor for bleeding and infection at fistula site. During an interview on phone with RN BB on 6/24/2025 at 2:18 p.m., RN BB confirmed that the agency failed to address interventions on diagnosis of end stage renal disease on P#1, P#6, P#8, POC, because she was not aware that she had to include it (intervention). On 6/24/2025 at 2:45 p.m., an interview conducted with the RN CC, who acknowledged that she failed to include interventions for the diagnosis of end stage renal disease for P#1, P#6, P#8.”