Faith Home Health Care

“Condition of Participation: Patient rights. CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient’s rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This Condition is not met as evidenced by: Based on clinical record review, review of “Discharge/Transfer/Referral of Patients” policy, staff interviews, patient interviews, the home health agency failed to: 1. provide sufficient notice of its cessation of business 2. facilitate the safe transfer of its patients to other home health agencies 3. Follow their policy to protect and promote patient rights. Failure to follow their policy for patient care resulted in the following: a. prevented the patient/family from participating in their discharge planning and selecting an alternate entity b. the patient and alternate home health agency did not receive a written copy of their discharge paperwork c. the alternate home health agency did not receive pertinent patient care information from the agency within 24 hours d. the patient, physician and alternate agency received inadequate notice from the agency before discharge Review of the agency’s governing body meeting minutes, dated 3/1/24, identified the closing/relocating office. “Board has reviewed financials and logistics of current Mount Pleasant office. Final decision has been made to move forward with closing the Mount Pleasant office and relocating to Des Moines as of 3/19/24.” The home health agency’s undated policy, titled “Discharge/Transfer/Referral of Patients”, identified at agency dissolution/closure the agency will maintain an agreement with an alternate agency to transfer the patients, the patients/families will be informed of their right to choose an alternate agency. The patient, physician and alternate agency will be notified in writing of patient discharge and imminent transfer and the alternate care agency will receive pertinent patient care information from the agency within 24 hours of notification of intent to transfer the patient. During an interview on 6/5/24 at 9:05 AM Staff D, Owner stated, “the agency couldn’t let the patient know ahead of time or the staff would also know of the closure of the Mount Pleasant office.” Staff D, Owner stated, “the employees and the patients were informed of the closure on the same day (3/19/24).” Staff D, Owner identified two alternate home health agencies agreed to take patients. On 3/19/24, Staff D, Owner, provided the employees with a letter, dated 3/19/24, that stated “it is with a heavy heart that we must inform you that Faith Home Health has made the difficult decision to close its Mount Pleasant operations. Despite our best efforts, the operations in Mount Pleasant have not been sustainable due to lack of profitability, noncompliance with Medicare guidelines and excessive payroll. Any company supplies in your possession will need to be surrendered immediately. This includes tablets, nursing and therapy supplies, company scrubs and any company purchased items.” On 6/6/24 at 9:14 AM, during an interview, Staff J, Physical Therapist (PT), reported being told on 3/19/24 there was a mandatory staff meeting at 2:00 PM. During the meeting, staff were informed the agency was closing effective 3/19/24 at 5:00 PM and everything needed turned in immediately. On 6/4/24 at 5:43 PM, during an interview, Staff C, Registered Nurse (RN), reported she found out the agency was closing during a staff meeting on 3/19/24 at 2:00 PM. Staff C, RN shared neither staff nor patients were given notice of the agency closure. Staff C, RN expressed her understanding was patients did not receive notice of the closure in writing, the patients were not referred to other agencies, and the patients were not given copies of their discharge summaries. Patients were only notified of the closure of the agency by telephone. Clinical record review indicated 3 patients were discharged by phone without receiving written or advance notification prior to the home health agency closing on 3/19/24 at 5:00 PM and 9 patients were discharged in the same manner the day after on 3/20/24. All of these patients lived within the agency’s approved geographical service area. Interview with 9 of 9 patients during the onsite investigation confirmed all the patients were not informed of the office closure and did not have a right to choose an alternate agency to provide their home health care prior to the Mount Pleasant office closed. Interview with 2 of 2 alternate home health agencies confirmed the agencies did not receive pertinent patient care information from the home health agency prior to their closure. The cumulative effects of these systemic practices resulted in the inadequate notice and in the failure to ensure patients were able to select an alternate provider and have the home health agency facilitate the safe transfer of care to those providers.”

“Comprehensive Assessment of Patients CFR(s): 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient’s eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. This Condition is not met as evidenced by: Based on clinical record review, review of the “Patient Comprehensive Assessment” policy, staff interviews, patient interviews, the home health agency failed to: 1. ensure comprehensive assessments were updated at discharge by assessing the patient directly in the patient’s home prior to their cessation of business on 3/19/24. 2. ensure comprehensive assessments were updated at discharge by the last qualified clinician who assessed the patient directly in the case of an unexpected discharge when the nurse cannot visit the patient During an interview on 6/4/24Staff E, Registered Nurse (RN), reported that she failed to complete the update to the comprehensive assessment at discharge in the patient’s home. The home health agency’s policy, “Patient Comprehensive Assessment”, dated 1/1/2020, assessments should be performed by a Registered Nurse or qualified therapist at discharge. The comprehensive assessment is updated and revised including the administration of the OASIS at the time of discharge. The Outcome and Assessment Information Set (OASIS) is a group of standard data elements home health agencies (HHA) integrate into their comprehensive assessment, to collect and report quality data to the Centers for Medicare & Medicaid Services (CMS). Review of the agency’s governing body meeting minutes, dated 3/1/24, identified the closing/relocating office. “Board has reviewed financials and logistics of current Mount Pleasant office. Final decision has been made to move forward with closing the Mount Pleasant office and relocating to Des Moines as of 3/19/24.” During an interview on 6/5/24 at 9:05 AM Staff D, Owner stated,” the agency couldn’t let the patient know ahead of time or the staff would also know of the closure of the Mount Pleasant office. Staff D, Owner stated, the employees and the patients were informed of the closure on the same day (3/19/24).” During an interview on 6/4/24 at 4:09 PM, Staff E, RN, stated she had been clinical liaison for the agency. In that role, she did not do home visits and provide any nursing services for the patients. She stated she was the nurse who actually contacted all of the patients that had services on 3/19/24, and found out if the patient’s still needed home health services and still had a skilled need. If the patient still needed the home health services, she called their primary care physician. She also stated she sent the provider a discharge summary and the provider sent an order to another agency to begin home health services. Staff E stated “she did not go out to the patient’s home and do a discharge assessment visit. She completed the discharge comprehensive assessment OASIS on all the patients. She stated she was pretty familiar with a lot of the patients as she had met with them during the referral process. She stated she completed the comprehensive assessment by talking with patients on the phone and her knowledge about the patients and the disease process.” Clinical record review indicated 3 patients were discharged by phone without receiving written or advance notification prior to the home health agency closing on 3/19/24 at 5:00 PM and 9 patients were discharged in the same manner the day after on 3/20/24. Interview with 9 of 9 patients during the onsite investigation confirmed all the patients were not informed of the office closure and did not have a right to choose an alternate agency to provide their home health care prior to the Mount Pleasant office closure. The cumulative effects of these systemic practices resulted in the failure to ensure the organizational framework of the agency promoted and protected the rights of the agency’s patients.”

“Discharge Planning CFR(s): 484.58 Condition of Participation: Discharge planning. This Condition is not met as evidenced by: Based on clinical record review, review of “Discharge/Transfer/Referral of Patients” policy, staff interviews, patient interviews, provider interview, the home health agency (HHA) failed to: 1. develop and implement an effective discharge planning process 2. follow their policy to protect and promote patient rights. Failure to follow their policy for patient care resulted in the following: a. the patient/family did not have a right to choose an alternate agency b. the patient, physician and alternate agency did not receive in writing of the patient discharge c. the alternate home health care agency did not receive pertinent patient care information from the agency d. the patient, physician and alternate home health agency received inadequate notice from the agency before discharge Review of the agency’s governing body meeting minutes, dated 3/1/24, identified the closing/relocating office. “Board has reviewed financials and logistics of current Mount Pleasant office. Final decision has been made to move forward with closing the Mount Pleasant office and relocating to Des Moines as of 3/19/24.” The home health agency’s undated policy, titled “Discharge/Transfer/Referral of Patients”, identified at agency dissolution/closure the agency will maintain an agreement with an alternate agency to transfer the patients, the patients/families will be informed of their right to choose an alternate agency. The patient, physician and alternate agency will be notified in writing of patient discharge and imminent transfer and the alternate care agency will receive pertinent patient care information from the agency within 24 hours of notification of intent to transfer the patient. During an interview on 6/5/24 at 9:05 AM Staff D, Owner stated, “the agency couldn’t let the patient know ahead of time or the staff would also know of the closure of the Mount Pleasant office. Staff D, Owner stated, the employees and the patients were informed of the closure on the same day (3/19/24).” Staff D, Owner identified two alternate home health agencies agreed to take patients. On 3/19/24, Staff D, Owner, provided the employees with a letter, dated 3/19/24, that stated “it is with a heavy heart that we must inform you that Faith Home Health has made the difficult decision to close its Mount Pleasant operations. Despite our best efforts, the operations in Mount Pleasant have not been sustainable due to lack of profitability, noncompliance with Medicare guidelines and excessive payroll. Any company supplies in your possession will need to be surrendered immediately. This includes tablets, nursing and therapy supplies, company scrubs and any company purchased items.” On 6/6/24 at 9:14 AM, during an interview, Staff J, Physical Therapist (PT), reported being told on 3/19/24 there was a mandatory staff meeting at 2:00 PM. During the meeting, staff were informed the agency was closing effective 3/19/24 at 5:00 PM and everything needed turned in immediately. On 6/4/24 at 5:43 PM, during an interview, Staff C, Registered Nurse (RN), reported she found out the agency was closing during a staff meeting on 3/19/24 at 2:00 PM. Staff C, RN shared neither staff nor patients were given notice of the agency closure. Staff C, RN expressed her understanding was patients did not receive notice of the closure in writing, the patients were not referred to other agencies, and the patients were not given copies of their discharge summaries. Patients were only notified of the closure of the agency by telephone. Clinical record review indicated 3 patients were discharged by phone without receiving written or advance notification prior to the home health agency closing on 3/19/24 at 5:00 PM and 9 patients were discharged in the same manner the day after on 3/20/24. All of these patients lived within the agency’s approved geographical service area. On 3/22/24 the Iowa Department of Inspections, Appeals and Licensing received a letter from the home health agency in regards to their planned relocation that included: “to relocate our home health office in Mount Pleasant, Iowa to Des Moines, Iowa.” Interview with 9 of 9 patients during the onsite investigation confirmed all the patients were not informed of their discharge prior to their day of discharge and did not have a right to choose an alternate agency to provide their home health care prior to the day of discharge. On 6/5/24 at 9:22 AM, during an interview, Staff B, LVPN, Director of Quality, identified the names of the two alternate agencies that agreed to take some of the patients being discharged at the time of the agency closure. The home health agencies were alternate agency #1 and alternate agency #2. Interview with 2 of 2 home health agencies (identified by Staff B, LVPN, Director of Quality, as the alternate home health agencies) confirmed the home health agencies did not receive pertinent patient care information prior to the patient’s being discharged from the agency. The cumulative effects of these systemic practices resulted in the failure of the agency to assure patients received ongoing, necessary care to avoid preventable health complications and/or hospitalizations.”

“Organization and administration of services CFR(s): 484.105 Condition of participation: Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished. This Condition is not met as evidenced by: Based on provider interview, policy review and record review the home health agency failed to: ensure the governing body assumed full legal authority and responsibility for the agency’s overall management and operation. (G942) The cumulative effects of these systemic practices resulted in the failure to ensure the organizational framework of the agency promoted and protected the rights of the agency’s patients.”

“Clinical records CFR(s): 484.110 Condition of participation: Clinical records. The HHA must maintain a clinical record containing past and current information for every patient accepted by the HHA and receiving home health services. Information contained in the clinical record must be accurate, adhere to current clinical record documentation standards of practice, and be available to the physician(s) or allowed practitioner(s) issuing orders for the home health plan of care, and appropriate HHA staff. This information may be maintained electronically. This Condition is not met as evidenced by: Based on clinical record review, review of agency policy, staff interviews, the home health agency failed to: 1. Complete clinical notes for services provided and 2. Maintain a clinical record containing current documentation for home visit 3. Failure to follow their policy for patient care resulted in the following: Ensure protected patient health information was maintained According to the agency policy titled “Patient Visits-Scheduling”, dated 9/1/22, service notes to be completed per company policy, oasis 48 hours, all other visit types 24 hours. The Director of Nursing/Clinical supervisor to monitor, if clinician is outside of this policy disciplinary action will take place, and could result in termination. During an interview on 6/5/24 at 1:44 PM, Staff I, Licensed Practical Nurse (LPN) stated the agency closed during a mandatory staff meeting on 3/19/24 at 2:00 PM. She stated she identified she had open skilled nurse visits to document on. Staff I, LPN further stated she did not have the opportunity to finish the documentation and the agency Administration stated it was her fault the documentation was not completed. Clinical record review identified missing documentation for Patients #7, #9 and #13 on 3/18/24. Clinical record review identified missing documentation for Patient #13 on 3/19/24. During an interview on 6/6/24 at 9:14 AM, Staff J, Physical Therapist (PT) stated she was notified during a mandatory meeting the afternoon on 3/19/24 the agency was closing. The letter provided stated the agency closed effective at 5:00 PM that day and staff needed to turn in everything. Staff J, PT stated she could not finish her documentation and had partial notes done that day but did not complete the narrative notes (A narrative note is a detailed narrative that describes the patient’s current condition/complaint, function, activity level and symptoms). Clinical record review identified missing documentation for Patient #9 on 3/19/24. The cumulative effects of these systemic practices resulted in the failure of the agency to assure protected patient health information is maintained in a manner to ensure confidentiality, accuracy and the integrity of clinical records for its patients.”

“Discharge Planning CFR(s): 484.58(a) Standard: Discharge planning. An HHA must develop and implement an effective discharge planning process. For patients who are transferred to another HHA or who are discharged to a SNF, IRF or LTCH, the HHA must assist patients and their caregivers in selecting a post-acute care provider by using and sharing data that includes, but is not limited to HHA, SNF, IRF, or LTCH data on quality measures and data on resource use measures. The HHA must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences. This Standard is not met as evidenced by: Based on staff interviews, clinical record reviews and agency policy reviews, the agency failed to implement an effective discharge planning process for 2 of 3 sampled patients (Patient #4 and #15) discharged on 3/19/24 and 7 of 9 sampled patients (Patients #3, #5, #7, #10, #11, #12 and #13) discharged on 3/20/24. Failure to implement an effective discharge planning process that secured ongoing, necessary care for patients increased the risk for patients to experience preventable health complications and/or hospitalizations. Findings include: On 6/4/24 at 1:30 PM, during an interview, Staff B, Licensed Practical Vocational Nurse (LPVN) ,Director of Quality, reported alternate home health agency #2 was contacted about taking referrals and alternate home health agency #2 stated they could not take a patient referral from the closing agency and needed to have a referral from the doctor. Alternate home health agency #2 said they needed to have their own orders to provide services and they could not use the closing agency orders. On 6/4/24 at 4:09 PM, during an interview, Staff E, Registered Nurse (RN) stated she learned in February 2024 the Mount Pleasant office would be closing. Staff E, RN reported contacting all the patients that were on service at the time of the closure to see if they still needed home health services and to see if they still had a skilled need. Staff E, RN notified the patient’s primary care physician if services were still needed and discharge summaries were sent to all primary care physicians. Staff E, RN reported she made phone calls to the patients at the time of the discharges and home visits were not made to the patient’s home to do a discharge assessment. On 6/4/24 at 4:20 PM, during an interview, Alternate home health agency #2 Home Health Supervisor, denied receiving a call from the home health agency for any referrals of the patients. She reported they did get calls from physician offices regarding referrals and accepted four of the referred patients after the Mount Pleasant office closed. On 6/5/24 at 9:05 AM, during an interview, Staff D, Owner, reported the nurses called the patients the day of the staff meeting (3/19/24) to inform the patients of the closure and doctors were contacted and asked to get orders to the new home health agencies. Staff D, owner identified two agencies agreed to take patients. On 6/5/24 at 9:22 AM, during an interview, Staff B, LVPN, Director of Quality, identified the names of the two alternate agencies that agreed to take some of the patients being discharged at the time of the agency closure. The home health agencies were alternate agency #1 and alternate agency #2. On 6/5/24 at 10:26 AM, during an interview, alternate agency #1 office Manager, denied receiving any referrals or communication from the Mount Pleasant office. She received calls from patients requesting services and accepted two of the Mount Pleasant patients. Agency #1’s office Manager stated Staff J, Physical Therapist (PT) from the home health agency notified her of the closure. 1. Clinical record review identified Patient #15 had a start of care date of 2/13/24. Staff C, RN, was Patient #15’s Clinical Manager (provides oversight of all the patient care; this includes coordinating the patient care, coordinating referrals, assuring the patient needs are continually assessed and assuring the development, implementation and updates of the patient individualized plan of care). During an interview on 6/4/24 at 4:51 PM, Patient #15 stated the home health agency called at 2:42 PM and told him/her they were done with services that day (3/19/24) and they closed at 5:00 PM. The patient stated he/she called another home health agency. The other agency could not come until the following Tuesday. The other agency did provide services at that time. He/she went to the wound clinic for wound care which included a wound vac dressing change. The patient stated his/her spouse drove him/her to the wound clinic and he/she required a wheelchair due to weakness and the need to carry the wound vac. a. The Plan of Care (POC), dated 2/13/24 to 4/12/24, included physician orders for skilled nursing and physical therapy services. Physician orders for skilled nursing included wound vac (negative pressure wound therapy used to remove excess exudate and promote healing in wounds) change dressing as ordered twice a week, assess pain, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. b. The agency identified the last skilled visit prior to discharge, dated 3/14/24. The skilled nurse visit note, dated 3/14/24, Staff C, RN provided wound care, completed patient assessment, and educated patient on signs and symptoms of healing/infection and disease processes. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:49 PM. The discharge summary identified Patient #15 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #15 had a discharge date of 3/19/24. 2. Clinical record review identified Patient #4 had a start of care date of 3/1/24. Staff C, RN, was Patient #4’s Clinical Manager. On 6/4/24 at 3:48 PM, during an interview, Patient #4 reported he/she was informed of the agency closing but could not recall when the notification occurred. a. The POC, dated 3/1/24 to 4/29/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for occupational therapy included adaptive training, balance and safety training at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/15/24. The skilled nurse visit note, dated 3/15/24, Staff C, RN, completed pain and skin assessment and provided education on skin care, the importance of off loading to prevent pressure ulcers and assessed medication regimen understanding. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:26 PM. The discharge summary identified Patient #4 was notified and “patient will require a new referral to be sent to another home health agency for continued wound car” (care). Clinical record review indicated Patient #4 had a discharge date of 3/19/24. 3. Clinical record review identified Patient #10 had a start of care date of 6/8/23. Staff C, RN, was Patient #10’s Clinical Manager. On 6/5/24 at 10:58 AM during an interview, Patient # 10 and their spouse reported they contacted the agency to find out why the patient’s home health aide did not show up and that is when they were notified of the agency closure. They did not receive a phone call from the agency and they did not receive anything in writing referencing the closure of the home health agency. The patient and their spouse shared they had to contact another home health agency themselves; nobody assisted them with a referral. a. The Plan of Care (POC), dated 2/3/24 to 4/2/24, included physician orders for skilled nursing and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess urinary status, change catheter as needed and monthly, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/5/24. The skilled nurse visit note, dated 3/5/24, Staff P, RN, completed the patient’s skilled assessment, assessed pain and skin integrity, provided education on epilepsy, hypertension and Parkinson’s disease and assessed medication regimen/understanding. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:46 AM. The discharge summary identified Patient # 10 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #10 had a discharge date of 3/20/24. 4. Clinical record review identified Patient #12 had a start of care date of 6/23/23. Staff P, RN, was Patient #12’s Clinical Manager. On 6/6/24 at 11:49 AM, during an interview, Patient #12’s daughter/durable power of attorney (DPOA) for healthcare, reported she did not receive any communication from the agency regarding their closure. The DPOA identified the Assisted Living Facility (ALF) was notified of the closure on 3/19/24. The HHA closure happened around the same time as when the patient’s foley catheter (a flexible tube that is inserted into the bladder to drain urine into a bag outside the body) change was scheduled. The ALF reached out to another HHA to assist with meeting the patient’s needs. DPOA reported calling patient’s primary care physician and urologist to inform them the home health agency was “no longer providing services due to closure”. Due to the lack of notice, it took approximately one week to get new home health services set up. The catheter was changed around 3/29/24; one week later than the every four weeks like it was originally ordered. On 6/6/24 at 12:37 PM, during an interview, Registered Nurse (RN) at ALF reported she received a phone call from closing agency on 3/19/24 and they weren’t given any assistance in coordinating services with another agency. She had contacted another home health agency and that agency communicated with the patient’s primary care physician and urologist to get necessary orders to initiate home health services. a. The POC, dated 2/18/24 to 4/17/24, included physician orders for skilled nursing services. Physician orders for skilled nursing included assess pain, change Foley catheter every four weeks or as needed if not functioning properly, instill 60 milliliters of Gentamicin (antibiotic) via Foley catheter once weekly, assess and instruct on pressure ulcer techniques, medication regime knowledge and knowledge of disease process at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/15/24. The skilled nurse visit note, dated 3/15/24, Staff P, RN, completed a patient assessment, performed catheter flush, provided education on signs and symptoms of a urinary tract infection, and assessed pain and skin integrity. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:53 AM. The discharge summary identified Patient # 12 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #12 had a discharge date of 3/20/24. 5. Clinical record review identified Patient #3 had a start of care date of 11/3/23. Staff P, RN, was Patient #3’s Clinical Manager. During an interview on 6/3/24 at 4:05 PM, Patient #3 stated he/she had no advanced notice of being discharged. The agency called him/her and notified of the closure the same day the agency stopped services on 3/19/24. a. The POC, dated 3/2/24 to 4/30/24, included physician orders for skilled nursing and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/14/24. The skilled nurse visit note, dated 3/14/24, Staff P, RN, documented patient assessment, provided education regarding active arrhythmias and the importance of monitoring edema (patient seen in emergency room on 3/7/24 for elevated B-type natriuretic peptide [a hormone produced by the heart that helps regulate blood circulation and protect the heart from stress]) and reviewed medications. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:26 AM. The discharge summary identified Patient #3 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #3 had a discharge date of 3/20/24. 6. Clinical record review identified Patient #5 had a start of care date of 2/1/24. Staff C, RN, was Patient #5’s Clinical Manager. During an interview on 6/3/24 at 4:05 PM, Patient #5’s Power of Attorney (POA) stated neither the patient or him/her received notification from the agency of the closure. The POA stated he/she attempted to call the HHA, the day after it “closed” and the phone was already disconnected. The patient did not receive a referral for another home health agency and the patient’s daughter stayed with the patient and assisted with care. a. The POC, dated 2/1/24 to 3/31/24, included physician orders for skilled nursing and physical therapy services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, obtain INR (international normalized ratio to test blood clotting times) as ordered, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. b. The agency identified the last skilled visit prior to discharge, dated 3/12/24. The skilled nurse visit note, dated 3/12/24, Staff I, Licensed Practical Nurse (LPN), completed patient assessment, instructed on pressure ulcer techniques, provided anticoagulant therapy education, and educated patient on taking medications as ordered. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:30 AM. The discharge summary identified Patient #5 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #5 had a discharge date of 3/20/24. 7. Clinical record review identified Patient #7 had a start of care date of 10/25/23. Staff C, RN, was Patient #7’s Clinical Manager. During an interview on 6/4/24 at 3:55 PM, Patient #7 stated the agency called and told him/her they were closing 2 hours before they closed on 3/19/24. The patient stated he/she called the wound clinic right away and the wound clinic assisted to put him/her on their hospital’s home health agency services. a. The POCs, dated 12/24/23 to 2/21/24 and 2/22/24 to 4/21/24, included physician orders for skilled nursing and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess, perform and complete wound care as ordered, assess, perform and instruct on diabetic foot and nail care, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/12/24. The skilled nurse visit note, dated 3/12/24, Staff I, LPN, completed the patient’s skilled assessment (addressed pain), performed wound care, assessed medication management, provided education to the patient on diabetes management, fall prevention, and repositioning to avoid skin breakdown. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:33 AM. The discharge summary identified Patient #7 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #7 had a discharge date of 3/20/24. 8. Clinical record review identified Patient #11 had a start of care date of 2/3/23. Staff F, RN, was Patient #11’s Clinical Manager. During an interview on 6/4/24 at 4:05 PM, Patient #11 stated he/she had no notice of being discharged from the office. The home health aide had been a good friend and told him/her the agency closed. Home health services were provided by another agency but not quite sure who made the referral to them. a. The POC, dated 1/29/24 to 3/28/24, included physician orders for skilled nursing, physical therapy and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess, perform and instruct on moist wound healing for pressure ulcers receiving hydrating treatments, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/14/24. The skilled nurse visit note, dated 3/14/24, Staff I, LPN, completed the patient’s skilled assessment, assessed pain and medication management, and provided education on hospital risks and pain management. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:48 AM. The discharge summary identified Patient #11 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #11 had a discharge date of 3/20/24. 9. Clinical record review identified Patient #13 had a start of care date of 5/5/23. Staff F, RN, was Patient #13’s Clinical Manager. During an interview on 6/4/24 at 3:24 PM, Patient #13 stated he/she had a call from someone in the office and they told him/her they were done with services. “The doctor’s office nor any other agency called me to get home health services started.” a. The POC, dated 2/29/24 to 4/28/24, included physician orders for skilled nursing services. Physician orders for skilled nursing included check INR (international normalized ratio to test blood clotting times) as ordered, assess pain, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/11/24. The skilled nurse visit note, dated 3/11/24, Staff I, LPN, performed INR check and communicated with physician regarding results, completed patient assessment, provided medication education, completed a pulmonary assessment and assessed pain. The visit note lacked a plan to discharge. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. c. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:54 AM. The discharge summary identified Patient #13 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #13 had a discharge date of 3/20/24. The agency failed to implement an effective discharge planning process prior to discharging the patients.”

“Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency’s overall management and operation, the provision of all home health services, fiscal operations, review of the agency’s budget and its operational plans, and its quality assessment and performance improvement program. This Standard is not met as evidenced by: Based on review of the agency’s governing body meeting minutes, the agency failed to involve the governing body in the overall management and operation of the organization resulting in the governing body not being aware the agency was operating out of compliance with several condition level regulations. Failure to include the governing body in the overall management and operation of the agency, placed agency patients at risk for inadequate and unsafe care. Findings include: According to the agency policy titled “Leadership Board of Directors”, dated 1/1/2020, the board of directors responsibilities include: assuming full legal authority for the operation of the organization, establishing the organization’s mission, vision and goals, approving the organization’s long-range, strategic and operational plans, providing budget oversight, appointing a qualified Administrator for the agency and evaluating senior management. Monitoring and evaluating the effectiveness of the agency’s performance on an annual basis to ensure that the organization’s mission is consistently sustained over time, authorizing and supporting adequate resources to establish and maintain an effective organization-wide performance improvement program and reviewing, recommending and approving policies related to patient care, treatment and/or service delivery. The home health agency’s policy, titled “Discharge/Transfer/Referral of Patients”, identified at agency dissolution/closure the agency will maintain an agreement with an alternate agency to transfer the patients, the patients/families will be informed of their right to choose an alternate agency. The patient, physician and alternate agency will be notified in writing of patient discharge and imminent transfer and the alternate care agency will receive pertinent patient care information from the agency within 24 hours of notification of intent to transfer the patient. Review of the agency’s governing body meeting minutes, dated 3/1/24, identified the closing/relocating office. “Board has reviewed financials and logistics of current Mount Pleasant office. Final decision has been made to move forward with closing the Mount Pleasant office and relocating to Des Moines as of 3/19/24.” During an interview on 6/5/24 at 9:05 AM the Staff D, Owner stated the agency made the decision in the corporate office. The HHA called for a staff meeting on 3/19/24. Nurses were calling patients the day of the meeting (3/19/24) and let the patients know of the agency closure and help coordinate their care. Staff D, Owner stated, the agency couldn’t let the patient know ahead of time or the staff would also know. He stated staff called the patient’s Doctor office. He stated the agency made sure the patients received the services they needed. He further stated the agency had stopped taking admissions 30 days prior to 3/19/24 and wanted to minimize disruption to patients to the best of their ability. The employees and the patients were informed at the same time on 3/19/24. Staff D, owner identified two agencies agreed to take patients. On 3/19/24, Staff D, Owner, provided the employees with a letter, dated 3/19/24, that stated “it is with a heavy heart that we must inform you that Faith Home Health has made the difficult decision to close its Mount Pleasant operations. Despite our best efforts, the operations in Mount Pleasant have not been sustainable due to lack of profitability, noncompliance with Medicare guidelines and excessive payroll. Any company supplies in your possession will need to be surrendered immediately. This includes tablets, nursing and therapy supplies, company scrubs and any company purchased items.” See G474, G550, G562 and G1012 The governing body failed to assume full legal authority and responsibility for the agency’s overall management and operation for the provision of all home health services.”

“HHA ceases to operate CFR(s): 484.50(d)(7) The HHA ceases to operate. This Element is not met as evidenced by: Based on staff interviews, patient interviews, provider interview and clinical record reviews, the home health agency (HHA) failed to provide sufficient notice of its cessation of business to 3 of 3 sampled patients (Patients #4, #8 and #15) discharged by phone without receiving written or advance notification prior to the home health agency closing on 3/19/24 at 5:00 PM and 9 of 9 sampled patients (Patients #3, #5, #7, #9, #10, #11, #12, #13 and #14) discharged in the same manner the day after on 3/20/24. Failure to ensure patients were given sufficient notice to select an alternate provider and have the home health agency facilitate the safe transfer of care to those providers increased the risk of patients going without treatments and services necessary to maintain or restore their health status. Findings include: 7. Patient #3 had a start of care date of 11/3/23 and discharge date of 3/20/24. a. The POCs, dated 1/2/24 to 3/1/24 and 3/2/24 to 4/30/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service. c. During an interview on 6/3/24 at 4:05 PM, the patient stated he/she had no advanced notice of being discharged. The agency called him/her and notified of the closure the same day they stopped services. He/she stated another agency came to his home right after the discharge and provided services and had no break in services. 8. Patient #5 had a start of care date of 2/1/24 and discharge date of 3/20/24. a. The POCs, dated 2/1/24 to 3/31/24, included physician orders for skilled nursing, physical therapy and occupational therapy services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service . c. During an interview on 6/3/24 at 4:05 PM, the patient’s Power of Attorney stated neither the patient or him/her received notification from the agency of the closure. The POA stated he/she attempted to call the agency the next day after and the phone had already been disconnected. The patient did not receive a referral for another home health agency and the patient’s daughter staid with the patient and assisted with care. 9. Patient #7 had a start of care date of 10/25/23 and a discharge date of 3/20/24. a. The POCs, dated 12/24/23 to 2/21/24 and 2/22/24 to 4/21/24, included physician orders for skilled nursing and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service . c. During an interview on 6/4/24 at 3:55 PM, the patient stated the agency called and told him/her they were closing 2 hours before they closed. The patient stated he/she called the wound clinic right away and they assisted to put him/her on their hospital’s home health agency. He/she stated it was a bad situation. 10. Patient #3 had a start of care date of 2/23/24 and discharge date of 3/20/24. a. The POCs, dated 2/23/24 to 4/22/24, included physician orders for skilled nursing, physical therapy and occupational therapy services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service . 11. Patient #11 had a start of care date of 2/3/23 and discharge date of 3/20/24. a. The POCs, dated 1/3/24 to 3/28/24, included physician orders for skilled nursing, physical therapy and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service. c. During an interview on 6/4/24 at 4:05 PM, the patient stated he/she had no notice of being discharged from the office. The home health aide had been a good friend and told him/her the agency closed. Home health services were provided by another agency but not quite sure who made the referral to them. He/she stated they are doing better now and have been discharged from home health services. 12. Patient #13 had a start of care date of 5/5/23 and discharge date of 3/20/24. a. The POCs, dated 1/3/24 to 3/28/24, included physician orders for skilled nursing, physical therapy and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service. c. During an interview on 6/4/24 at 3:24 PM, the patient stated he/she had a call from someone in the office and they told him/her they were done with services. No one from the Doctors office or another home health agency contacted him/her for services. The patient stated he/she is doing better now and the personal care provider set up a machine to check the INR (International normalized ratio to test blood clotting time) and call the results into the Doctor’s office. 13. Patient #15 had a start of care date of 2/13/24 and discharge date of 3/20/24. a. The POC, dated 2/13/24 to 4/12/24, included physician orders for skilled nursing and physical therapy services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer. c. During an interview on 6/4/24 at 4:51 PM, the patient stated the home health agency called at 2:42 PM and told him/her they were done with services that day and they closed at 5:00 PM. The patient stated he/she called another agency. The other agency could not come until the following Tuesday. The other agency did provide services at that time. He/she went to the wound clinic for wound care which included a wound vac dressing change. The patient stated his/her spouse drove him/her to the wound clinic and he/she required a wheelchair due to weakness and the need to carry the wound vac. The agency failed to provide the patients/families with information to choose an alternate agency, failed to notify the patient in writing of patient discharge and imminent transfer and provide the alternate care agency with pertinent patient care information from the agency within 24 hours of notification of intent to transfer the patient. The home health agency’s undated policy, titled Discharge/Transfer/Referral of Patients, identified at agency dissolution/closure the agency will maintain an agreement with an alternate agency to transfer the patients, the patients/families will be informed of their right to choose an alternate agency, the patient, physician and alternate agency will be notified in writing of patient discharge and imminent transfer and the alternate care agency will receive pertinent patient care information from the agency within 24 hours of notification of intent to transfer the patient. On 3/19/24, the home health agency terminated 1 Director of Nursing, 3 Registered Nurses, 1 Licensed Practical Nurse, 2 Physical Therapists, 1 Physical Therapy Assistant, 1 Occupational Therapist and 1 Home Health Aide. On 3/22/24 the Department of Inspections, Appeals and Licensing received a letter of intent from the home health agency in regards to their planned relocation that included: this is a change of information and not a termination of the provider number. This relocation is part of our strategic plan to better serve our clients and solve our recruiting issues. On 6/4/24 at 1:30 PM, during an interview, Staff B, Director of Quality, identified that Staff E, Registered Nurse (RN), called and interviewed all the patients, notified the physician of the discharge, and a discharge summary was faxed to each patient’s primary care physician. Staff B reported the alternate agency #2 was contacted about taking referrals and alternate Agency #2 stated they could not take a patient referral from the closing agency and needed to have a referral from the doctor. Alternate Agency #2 said they needed to have their own orders to provide services and they could not use the closing agency orders. On 6/4/24 at 4:09 PM, during an interview, Staff E, RN identified she learned in February of 2024 the agency would be closing. Staff E, RN noted the agency quit taking new referrals about a month prior to closure; however, a specific closure date had not been set. Staff E, RN reported contacting all the patients that were on service at the time of the closure (3/19/24) to see if they still needed home health services and to see if they still had a skilled need. Staff E, RN notified the patient’s primary care physician if services were still needed and discharge summaries were sent to all primary care physicians. Staff E confirmed she made phone calls to the patients at the time of the discharges; home visits were not made to the patient’s home. On 6/4/24 at 4:20 PM, during an interview, Alternate agency #2 Home Health Supervisor, denied receiving a call from the closing agency for any referrals of their patients. She reported they did get calls from physician offices regarding referrals and accepted four of the referred patients. On 6/4/24 at 5:14 PM, during an interview, Staff F, RN, stated she was told on 3/19/24 to report to the office for a mandatory meeting at 2:00 PM. Staff F, RN reported she was told in the meeting she was done and needed to leave the agency. Staff F, RN noted she did not have time to complete her documentation for visits done on Monday and Tuesday (3/18/24 and 3/19/24). Staff F, RN denied having any prior notice regarding the closure of the office and no opportunity to complete her documentation for work completed on 3/18/24 and 3/19/24. On 6/4/24 at 5:43 PM, during an interview, Staff C, RN, reported she found out the agency was closing during a staff meeting on 3/19/24 at 2:00 PM. Staff C, RN shared neither staff nor patients were given notice of the agency closure. Staff C,RN expressed her understanding was patients did not receive notice of the closure in writing, the patients were not referred to other agencies, and the patients were not given copies of their discharge summaries. Patients were only notified of the closure of the agency by telephone. On 6/5/24 at 9:05 AM, during an interview, Staff D, Owner, reported On 3/19/24, a staff meeting was called and staff were notified the agency was closing on this date (3/19/24). Staff D, owner noted the nurses called the patients the day of the closure to inform the patients of the closure and doctors were contacted and asked to get orders to the new home health agencies. Staff D, owner identified two agencies agreed to take patients; however, Staff D could not recall the names of the two agencies. On 6/5/24 at 9:22 AM, during an interview, Staff B, Director of Quality, identified the names of the two alternate agencies that agreed to take some of the patients being discharged at the time of the agency closure. The home health agencies were Alternate agency #1 and Alternate agency #2. On 6/5/24 at 10:26 AM, during an interview, alternate agency #1 office Manager, denied receiving any referrals or communication from the agency closing. She received calls from patients requesting services and accepted two of the patients. She learned of the agency closure by Staff J, Physical Therapist, after Staff J was informed of the closure by the agency closing. On 6/5/24 at 1:44 PM, during an interview, Staff I, Licensed Practical Nurse (LPN), reported receiving an email on 3/19/24 from the Director Of Nursing stating there was an emergency mandatory meeting. Staff I, LPN was given a letter at the office discussing the closure. Staff I, LPN expressed she was surprised by the news and she was upset for her patients. Staff I, LPN reported telling management she had open visits to complete and she was told that it was her fault and the visits should have been done. Staff I, LPN was not given the chance to complete her visits. On 6/6/24 at 9:14 AM, during an interview, Staff J, Physical Therapist (PT), reported being told on 3/19/24 there was a mandatory staff meeting at 2:00 PM. During the meeting, staff were informed the agency was closing effective 3/19/24 at 5:00 PM and everything needed turned in immediately. Staff J, PT identified other staff members questioned what would happen to all of the active patients and Staff D, Owner reported phone calls were being made to patients’ primary care physicians and the agency would transfer patients to different agencies. Staff J, PT reported seeing patients on 3/19/24 and that her documentation lacked the narrative portion. Staff J, PT reported she was unable able to complete her documentation as management wanted devices turned in immediately and didn’t allow staff to finish their notes. 3. Patient #10 had a start of care date of 6/8/23 and a discharge date of 3/20/24. a. The POC, dated 2/3/24 to 4/2/24, included physician orders for skilled nursing and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient was notified and would need referrals sent out to new home health agencies due to current home health no longer in service. c. On 6/5/24 at 10:58 AM during an interview, the patient and patient’s spouse reported they contacted the agency to find out why the patient’s home health aide did not show up and that is when they were notified of the agency closure. They did not receive a phone call from the agency and they did not receive anything in writing referencing the closure of the home health agency. The patient and patient’s spouse shared they had to contact another home health agency themselves; nobody assisted them with a referral. They were successful in securing services through another agency. 4. Patient #12 had a start of care date of 6/23/23 and a discharge date of 3/20/24. a. The POC, dated 2/18/24 to 4/17/24, included physician orders for skilled nursing and home care aide services. b. The discharge summary, dated 3/20/24, identified the administrator of the assist living facility (ALF) was notified and the patient would need referrals sent out to new home health agencies due to current home health no longer in service. c. On 6/6/24 at 11:49 AM, during an interview, the patient’s daughter/durable power of attorney (DPOA) for healthcare, reported she did not receive any communication from agency regarding their closure. The DPOA identified the ALF was notified of the closure on the date of the closure. The closure happened about the time of month when patient’s catheter tubing needed changed. The ALF reached out to another agency to assist with meeting the patient’s needs. DPOA reported calling patient’s primary care physician and urologist to inform them the home health agency was no longer providing services due to closure. Due to the lack of notice, it took approximately one week to get new services set up. The catheter was changed around 3/29/24; one week later than the every four weeks like it was originally ordered. The DPOA reported no problems occurred with the catheter being changed a week later. d. On 6/6/24 at 12:37 PM, during an interview, Registered Nurse (RN) at ALF reported she received a phone call from closing agency on the date of closure and they weren’t given any assistance in coordinating services with another agency. She had contacted another home health agency and that agency communicated with the patients primary care physician and urologist to get necessary orders to initiate services. She reported no problems occurred with the catheter being changed a week later. 5. Patient #14 had a start of care date of 2/8/24 and a discharge date of 3/20/24. a. The POC, dated 2/8/24 to 4/7/24, included physician orders for skilled nursing, physical therapy, occupational therapy, and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient had been notified and the patient needed referrals sent out to new home health agencies due to current home health no longer in service. c. On 6/4/24 at 4:23 PM, during an interview, the patient’s primary caregiver reported she and the patient were notified of the immediate closure of the agency and within a couple of days a new home health agency was set up to provide services. At the time of this call, the primary caregiver reported patient no longer had a need for home health care services. 6. Patient #3 had a start of care date of 11/3/23 and discharge date of 3/20/24. a. The POCs, dated 1/2/24 to 3/1/24 and 3/2/24 to 4/30/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service. c. During an interview on 6/3/24 at 4:05 PM, the patient stated he/she had no advanced notice of being discharged. The agency called him/her and notified of the closure the same day they stopped services. He/she stated another agency came to his home right after the discharge and provided services and he/she had no break in services. 7. Patient #5 had a start of care date of 2/1/24 and discharge date of 3/20/24. a. The POCs, dated 2/1/24 to 3/31/24, included physician orders for skilled nursing, physical therapy and occupational therapy services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service . c. During an interview on 6/3/24 at 4:05 PM, the patient’s Power of Attorney stated neither the patient or him/her received notification from the agency of the closure. The POA stated he/she attempted to call the agency, the next day after (3/20/24) and the phone had already been disconnected. The patient did not receive a referral for another home health agency and the patient’s daughter stayed with the patient and assisted with care. At the time of this call, the POA reported the patient no longer had a need for home health care services. 8. Patient #7 had a start of care date of 10/25/23 and a discharge date of 3/20/24. a. The POCs, dated 12/24/23 to 2/21/24 and 2/22/24 to 4/21/24, included physician orders for skilled nursing and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service . c. During an interview on 6/4/24 at 3:55 PM, the patient stated the agency called and told him/her they were closing 2 hours before they closed. The patient stated he/she called the wound clinic right away and the wound clinic assisted to put him/her on their hospital’s home health agency services. 9. Patient #11 had a start of care date of 2/3/23 and discharge date of 3/20/24. a. The POCs, dated 1/3/24 to 3/28/24, included physician orders for skilled nursing, physical therapy and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service. c. During an interview on 6/4/24 at 4:05 PM, the patient stated he/she had no notice of being discharged from the office. The home health aide had been a good friend and told him/her the agency closed. Home health services were provided by another agency but not quite sure who made the referral to them. He/she stated they are doing better now and have been discharged from home health services. 10. Patient #13 had a start of care date of 5/5/23 and discharge date of 3/20/24. a. The POCs, dated 1/3/24 to 3/28/24, included physician orders for skilled nursing, physical therapy and home care aide services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service. c. During an interview on 6/4/24 at 3:24 PM, the patient stated he/she had a call from someone in the office and they told him/her they were done with services. No one from the Doctors office or another home health agency contacted him/her for services. The patient stated he/she is doing better now and the personal care provider set up a machine to check the INR (International normalized ratio to test blood clotting time) and call the results into the Doctor’s office. 11. Patient #15 had a start of care date of 2/13/24 and discharge date of 3/20/24. a. The POC, dated 2/13/24 to 4/12/24, included physician orders for skilled nursing and physical therapy services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer. c. During an interview on 6/4/24 at 4:51 PM, the patient stated the home health agency called at 2:42 PM and told him/her they were done with services that day and they closed at 5:00 PM. The patient stated he/she called another agency. The other agency could not come until the following Tuesday. The other agency did provide services at that time. He/she went to the wound clinic for wound care which included a wound vac dressing change. The patient stated his/her spouse drove him/her to the wound clinic and he/she required a wheelchair due to weakness and the need to carry the wound vac. The patient reported his/her wound continued to heal without problems and he/she had no missed appointments for wound cares until the new home health agency could start services. 12. Patient #8 had a start of care date of 3/8/21 and a discharge date of 3/19/24. a. The POC, dated 2/21/24 to 4/8/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. b. The discharge summary, dated 3/19/24, identified the patient needed referral to a new home health agency due to home health agency no longer in service. 11. Patient #9 had a start of care date of 2/23/24 and discharge date of 3/20/24. a. The POCs, dated 2/23/24 to 4/22/24, included physician orders for skilled nursing, physical therapy and occupational therapy services. b. The discharge summary, dated 3/20/24, identified the patient discharged from the agency and the patient will need referrals sent out to new home health agencies due to agency no longer in service . 12.Patient #4 had a start of care date of 3/1/24 and a discharge date of 3/19/24. a. The Plan of Care (POC), dated 3/1/24 to 4/29/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. b. The discharge summary, dated 3/19/24, identified the patient was notified of the discharge from the agency and the patient will need referrals sent out to a new home health agency for continued wound care. c. On 6/4/24 at 3:48 PM, during an interview, the patient reported he/she was informed of the agency closing but could not recall when the notification occurred. The patient’s son confirmed they were notified of agency closing and there was not a lapse in service as patient was privately paying for services through another agency while receiving skilled services through the closing agency. 13. Patient #6 had a start of care date of 2/9/24 and a discharge date of 3/20/24. a. The POC, dated 2/9/24 to 4/8/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. b. The patient was admitted to a skilled nursing facility (SNF) on 3/11/24 for therapy to get stronger and remained there at the time of the agency closure. c. The discharge summary, dated 3/20/24, identified a social worker at the SNF was notified of the agency closure and the patient needed referrals sent out to a new home health agency due to agency no longer in service. The agency failed to provide sufficient notice of its planned cessation of business to enable the patients to select an alternative service provider and to enable the agency to facilitate the safe transfer of its patients to other agencies. 1. Clinical record review indicated Patient #15 had a start of care date of 2/13/24. During an interview on 6/4/24 at 4:51 PM, Patient #15 stated the home health agency called at 2:42 PM and told him/her they were done with services that day (3/19/24) and they closed at 5:00 PM. The patient stated he/she called another home health agency. The other agency could not come until the following Tuesday. The other agency did provide services at that time. He/she went to the wound clinic for wound care which included a wound vac (negative pressure wound therapy used to remove excess exudate and promote healing in wounds) dressing change. The patient stated his/her spouse drove him/her to the wound clinic and he/she required a wheelchair due to weakness and the need to carry the wound vac. a. The Plan of Care (POC), dated 2/13/24 to 4/12/24, included diagnosis malignant neoplasm and encounter for surgical aftercare. The POC also included physician orders for skilled nursing and physical therapy services. Interview on 6/4/24 at 4:09 PM, with Staff E, Register Nurse (RN), revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, Licensed Practical Vocational Nurse (LPVN), Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:49 PM. The discharge summary identified Patient #15 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #15 had a discharge date of 3/19/24. 2. Clinical record review indicated Patient #4 had a start of care date of 3/1/24. On 6/4/24 at 3:48 PM, during an interview, Patient #4 reported he/she was informed of the agency closing but could not recall when the notification occurred. a. The POC, dated 3/1/24 to 4/29/24, included diagnosis Covid-19 and Repeated Falls. The POC also included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:26 PM. The discharge summary identified Patient #4 was notified and would need referrals sent out to new home health agency for continued wound care. Clinical record review indicated Patient #4 had a discharge date of 3/19/24. 3. Clinical record review indicated Patient #8 had a start of care date of 3/8/21. a. The POC, dated 2/21/24 to 4/20/24, included diagnosis of neuromuscular dysfunction and cardiac murmur. The POC also included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:35 PM. The discharge summary identified Patient #8 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #8 had a discharge date of 3/19/24. 4. Clinical record review indicated Patient #10 had a start of care date of 6/8/23. On 6/5/24 at 10:58 AM during an interview, Patient # 10 and their spouse reported they contacted the agency to find out why the patient’s home health aide did not show up and that is when they were notified of the agency closure. They did not receive a phone call from the agency and they did not receive anything in writing referencing the closure of the home health agency. The patient and their spouse shared they had to contact another home health agency themselves; nobody from the agency assisted them with a referral. a. The Plan of Care (POC), dated 2/3/24 to 4/2/24, included diagnosis Parkinson’s Disease and Dementia. The POC also included physician orders for skilled nursing and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:46 AM. The discharge summary identified Patient # 10 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #10 had a discharge date of 3/20/24. 5. Clinical record review indicated Patient #12 had a start of care date of 6/23/23. On 6/6/24 at 11:49 AM, during an interview, Patient #12’s daughter/durable power of attorney (DPOA) for healthcare, reported she did not receive any communication from the agency regarding their closure. The DPOA identified the Assisted Living Facility (ALF) was notified of the closure on 3/19/24. The HHA closure happened around the same time as when the patient’s foley catheter (a flexible tube that is inserted into the bladder to drain urine into a bag outside the body) change was scheduled. The ALF reached out to another HHA to assist with meeting the patient’s needs. DPOA reported calling patient’s primary care physician and urologist to inform them the home health agency was “no longer providing services due to closure”. Due to the lack of notice, it took approximately one week to get new home health services set up. The catheter was changed around 3/29/24; one week later than the every four weeks like it was originally ordered. On 6/6/24 at 12:37 PM, during an interview, Registered Nurse (RN) at ALF reported she received a phone call from closing agency on 3/19/24 and they weren’t given any assistance in coordinating services with another agency. She had contacted another home health agency and that agency communicated with the patient’s primary care physician and urologist to get necessary orders to initiate home health services. a. The POC, dated 2/18/24 to 4/17/24, included diagnosis chronic kidney disease and neoplasm. The POC also included physician orders for skilled nursing services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:53 AM. The discharge summary identified Patient # 12 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #12 had a discharge date of 3/20/24. 6. Clinical record review indicated Patient #3 had a start of care date of 11/3/23. During an interview on 6/3/24 at 4:05 PM, Patient #3 stated he/she had no advanced notice of being discharged. The agency called him/her and notified of the closure the same day the agency stopped services on 3/19/24. a. The POCs, dated 1/2/24 to 3/1/24 and 3/2/24 to 4/30/24, included diagnosis Hemiplegia and Osteomyelitis of vertebrae. The POC also included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:26 AM. The discharge summary identified Patient #3 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #3 had a discharge date of 3/20/24. 7. Clinical record review indicated Patient #5 had a start of care date of 2/1/24. During an interview on 6/3/24 at 4:05 PM, Patient #5’s Power of Attorney (POA) stated neither the patient or him/her received notification from the agency of the closure. The POA stated he/she attempted to call the HHA, the day after it “closed” and the phone was already disconnected. The patient did not receive a referral for another home health agency and the patient’s daughter stayed with the patient and assisted with care. a. The POC, dated 2/1/24 to 3/31/24, included diagnosis Chronic Obstructive Pulmonary Disease (COPD) and Pneumonia. The POC also included physician orders for skilled nursing, physical therapy and occupational therapy services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:30 AM. The discharge summary identified Patient #5 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #5 had a discharge date of 3/20/24. 8. Clinical record review indicated Patient #7 had a start of care date of 10/25/23. During an interview on 6/4/24 at 3:55 PM, Patient #7 stated the agency called and told him/her they were closing 2 hours before they closed on 3/19/24. The patient stated he/she called the wound clinic right away and the wound clinic assisted to put him/her on their hospital’s home health agency services. a. The POCs, dated 12/24/23 to 2/21/24 and 2/22/24 to 4/21/24, included diagnosis muscle weakness, non pressure chronic ulcer and dependence on wheelchair. The POC also included physician orders for skilled nursing and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:33 AM. The discharge summary identified Patient #7 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #7 had a discharge date of 3/20/24. 9. Clinical record review indicated Patient #11 had a start of care date of 2/3/23. During an interview on 6/4/24 at 4:05 PM, Patient #11 stated he/she had no notice of being discharged from the office. The home health aide had been a good friend and told him/her the agency closed. Home health services were provided by another agency but not quite sure who made the referral to them. a. The POC, dated 1/29/24 to 3/28/24, included diagnosis Chronic pain syndrome and Osteoarthritis. The POC also included physician orders for skilled nursing, physical therapy and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:48 AM. The discharge summary identified Patient #11 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #11 had a discharge date of 3/20/24. 10. Clinical record review indicated Patient #13 had a start of care date of 5/5/23. During an interview on 6/4/24 at 3:24 PM, Patient #13 stated he/she had a call from someone in the office and they told him/her they were done with services. “The doctor’s office nor any other agency called me to get home health services started.” a. The POC, dated 2/29/24 to 4/28/24, included diagnosis Chronic Obstructive Pulmonary Disease (COPD) and Chronic Respiratory Failure. The POC also included physician orders for skilled nursing services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:54 AM. The discharge summary identified Patient #13 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #13 had a discharge date of 3/20/24. 11. Clinical record review indicated Patient #9 had a start of care date of 2/23/24. a. The POC, dated 2/23/24 to 4/22/24, included diagnosis Displaced subtrochanteric fracture of the right femur (bone from hip to knee) and Non pressure chronic ulcer. The POC also included physician orders for skilled nursing, physical therapy and occupational therapy services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:42 AM. The discharge summary identified Patient #9 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #9 had a discharge date of 3/20/24. 12. Clinical record review indicated Patient #14 had a start of care date of 2/8/24. a. The POC, dated 2/8/24 to 4/7/24, included diagnosis Fracture of left femur and Diabetes Mellitus. The POC also included physician orders for skilled nursing, physical therapy, occupational therapy, and home care aide services. Interview on 6/4/24 at 4:09 PM, with Staff E, RN, revealed no home visit was completed for a discharge assessment. The discharge assessment was completed by phone. b. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:57 AM. The discharge summary identified Patient # 14 was notified and would need referrals sent out to new home health agencies due to the “current home health no longer in service.” Clinical record review indicated Patient #14 had a discharge date of 3/20/24. During an interview on 6/5/24 at 9:05 AM, Staff D, Owner stated the agency made the decision in the corporate office. The HHA called for a staff meeting on 3/19/24. Nurses were calling patients the day of the meeting (3/19/24) and let the patients know of the agency closure and help coordinate their care. Staff D, Owner stated, the agency couldn’t let the patient know ahead of time or the staff would also know. He stated staff called the patient’s Doctor office. He stated the agency made sure the patients got the services they needed. He further stated the agency had stopped taking admissions 30 days prior to 3/19/24 and wanted to minimize disruption to patients to the best of their ability. The employees and the patients were informed of the closure on the same day (3/19/24). Staff D, Owner identified two agencies agreed to take patients; however, Staff D could not recall the names of the two agencies. On 6/4/24 at 1:30 PM, during an interview, Staff B, Director of Quality, stated alternate home health agency #2 was contacted about taking referrals and alternate home health agency #2 stated they could not take a patient referral from the closing agency and needed to have a referral from the doctor. Alternate home health agency #2 said they needed to have their own orders to provide services and they could not use the closing agency orders. On 6/4/24 at 4:09 PM, during an interview, Staff E, RN stated she learned in February 2024 the agency would be closing. Staff E, RN noted the agency quit taking new referrals about a month prior to closure; however, a specific closure date had not been set. Staff E, RN reported contacting all the patients that were on service at the time of the closure to see if they still needed home health services and to see if they still had a skilled need. Staff E, RN notified the patient’s primary care physician if services were still needed and discharge summaries were sent to all primary care physicians. Staff E confirmed she made phone calls to the patients at the time of the discharges and home visits were not made to the patient’s home to do a discharge assessment. On 6/4/24 at 4:20 PM, during an interview, Alternate home health agency #2 Home Health Supervisor, denied receiving a call from the Mount Pleasant office for any referrals of their patients. She reported they did get calls from physician offices regarding referrals and accepted four of the referred patients after the Mount Pleasant office closed. On 6/5/24 at 9:22 AM, during an interview, Staff B, Director of Quality, identified the names of the two alternate agencies that agreed to take some of the patients being discharged at the time of the agency closure. The home health agencies were Alternate agency #1 and Alternate agency #2. On 6/5/24 at 10:26 AM, during an interview, alternate agency #1 office Manager, denied receiving any referrals or communication from the home health agency. She received calls from patients requesting services and accepted two of the Mount Pleasant patients. Agency #1’s office Manager stated Staff J, Physical Therapist (PT) from the home health agency notified her of the closure. On 6/5/24 at 1:44 PM, during an interview, Staff I, Licensed Practical Nurse (LPN), reported receiving an email on 3/19/24 from the Director Of Nursing stating there was an emergency mandatory meeting. Staff I, LPN was given a letter at the office discussing the Mount Pleasant office closure. Staff I, LPN expressed she was surprised by the news and she was upset for her patients. Staff I, LPN reported telling management she had open visits to complete and she was told that it was her fault and the visits should have been done. Staff I, LPN was not given the chance to complete her visits. Clinical record review identified missing documentation for Patients #7, #9 and #13 on 3/18/24. Clinical record review identified missing documentation for Patient #13 on 3/19/24. On 6/6/24 at 9:14 AM, during an interview, Staff J, Physical Therapist (PT), identified other staff members questioned what would happen to all of the patients receiving services and StaffD, Owner reported phone calls were being made to patients’ primary care physicians and the agency would transfer patients to different agencies. Staff J, PT reported seeing patients on 3/19/24 and her documentation lacked the narrative portion (The narrative note is a detailed narrative that describes the patient’s current condition/complaint, function, activity level and symptoms). Staff J, PT reported she was unable to complete her documentation as management wanted devices turned in immediately and didn’t allow staff to finish their notes. Staff J, PT could not recall which patient she had not completed her documentation on. Clinical record review identified missing documentation for Patient #9 on 3/19/24. On 6/4/24 at 5:14 PM, during an interview, Staff F, RN, stated she was told on 3/19/24 to report to the office for a mandatory meeting at 2:00 PM. Staff F, RN reported she was told in the meeting she was done and needed to leave the agency. Staff F, RN noted she did not have time to complete her documentation for visits done on Monday and Tuesday (3/18/24 and 3/19/24). Staff F, RN denied having any prior notice regarding the closure of the office and no opportunity to complete her documentation for work completed on 3/18/24 and 3/19/24. Staff F could not recall what patients she had not completed her documentation on. On 3/19/24, the home health agency had 11 employees. On 3/19/24, the agency had a mandatory meeting and 10 employees were removed from payroll that included: Staff A ,Director of Nursing, Staff C, Registered Nurse (RN), Staff F, RN, Staff P, RN, Staff I, Licensed Practical Nurse, Staff Q, Physical Therapist, Staff J, Physical Therapist, Staff R, Physical Therapy Assistant, Staff G, Occupational Therapist and Staff H, Home Health Aide. The home health agency retained Staff E, Registered Nurse. The agency failed to provide sufficient notice of its cessation of business to enable the patients to select an alternative service provider and to enable the agency to facilitate the safe transfer of its patients to other agencies.”

“At discharge CFR(s): 484.55(d)(3) At discharge. This Element is not met as evidenced by: Based on agency policy review, clinical record review and agency staff interview, the agency failed to ensure completion of the update to the comprehensive assessment by a Registered Nurse or in therapy only cases, a qualified therapist, who last visualized the patient or made a home visit at discharge for 12 of 12 sampled patients requiring a comprehensive assessment at discharge (Patients #3, #4, #5, #7, #8, #9, #10, #11, #12, #13, #14 and #15). Failure to complete a discharge comprehensive assessment in a timely manner (prior to cessation of business on 3/19/24) increased the potential that patients might not receive services in a manner to meet individualized patient needs. Findings include: 1. Clinical record review identified Patient #3 had a start of care date of 11/3/23. Staff P, Registered Nurse (RN), was Patient #3’s Clinical Manager (provides oversight of all the patient care; this includes coordinating the patient care, coordinating referrals, assuring the patient needs are continually assessed and assuring the development, implementation and updates of the patient individualized plan of care). a. The Plans of Care (POCs), dated 1/2/24 to 3/1/24 and 3/2/24 to 4/30/24, included physician orders for skilled nursing and home health aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/14/24. The skilled nurse visit note, dated 3/14/24, Staff P, RN, documented patient assessment, provided education regarding active arrhythmias and the importance of monitoring edema (patient seen in emergency room on 3/7/24 for elevated B-type natriuretic peptide [a hormone produced by the heart that helps regulate blood circulation and protect the heart from stress]) and reviewed medications. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #3’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, Licensed Vocational Practical Nurse (LPVN), Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:26 AM. The discharge summary identified Patient #3 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #3 had a discharge date of 3/20/24. 2. Clinical record review identified Patient #4 had a start of care date of 3/1/24. Staff F, RN, was Patient #4’s Clinical Manager. a. The POC, dated 3/1/24 to 4/29/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for occupational therapy included adaptive training, balance and safety training at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/15/24. The skilled nurse visit note, dated 3/15/24, Staff C, RN, completed pain and skin assessment and provided education on skin care, the importance of off loading to prevent pressure ulcers and assessed medication regimen understanding. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #4’s discharge comprehensive assessment on 3/19/24, the day the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:26 PM. The discharge summary identified Patient #4 was notified and “patient will require a new referral to be sent to another home health agency for continued wound car” (care). Clinical record review indicated Patient #4 had a discharge date of 3/19/24. 3. Clinical record review identified Patient #5 had a start of care date of 2/1/24 and discharge date of 3/20/24. Staff C, RN, was Patient #5’s Clinical Manager. a. The POCs, dated 2/1/24 to 3/31/24, included physician orders for skilled nursing and physical therapy. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, obtain INR (international normalized ratio to test blood clotting times) as ordered, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. b. The agency identified the last skilled visit prior to discharge, dated 3/12/24. The skilled nurse visit note, dated 3/12/24, Staff I, Licensed Practical Nurse (LPN), completed patient assessment, instructed on pressure ulcer techniques, provided anticoagulant therapy education, and educated patient on taking medications as ordered. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #5’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:30 AM. The discharge summary identified Patient #5 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #5 had a discharge date of 3/20/24. 4. Clinical record review identified Patient #7 had a start of care date of 10/25/23. Staff C, RN, was Patient #7’s Clinical Manager. a. The POCs, dated 12/24/23 to 2/21/24 and 2/22/24 to 4/21/24, included physician orders for skilled nursing and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess, perform and complete wound care as ordered, assess, perform and instruct on diabetic foot and nail care, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/12/24. The skilled nurse visit note, dated 3/12/24, Staff I, LPN, completed the patient’s skilled assessment (addressed pain), performed wound care, assessed medication management, provided education to the patient on diabetes management, fall prevention, and repositioning to avoid skin breakdown. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #7’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:33 AM. The discharge summary identified Patient #7 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #7 had a discharge date of 3/20/24. 5. Clinical record review identified Patient #8 had a start of care date of 3/8/21. Staff C, RN, was Patient #8’s Clinical Manager. a. The POC, dated 2/21/24 to 4/20/24, included physician orders for skilled nursing, physical therapy, occupational therapy and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, change foley catheter every two weeks and as needed, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for occupational therapy included adaptive training, balance and safety training at each visit. Establish a home exercise program given to patient by discharge. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/12/24. The skilled nurse visit note, dated 3/12/24, Staff I, LPN, completed the patient’s assessment, provided education related to catheter care, urinary tract infection prevention, and the importance of taking medications as prescribed. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #8’s discharge comprehensive assessment on 3/19/24, the day the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:35 PM. The discharge summary identified Patient #8 was notified and “ patient would need referrals to new home health agency. Home health no longer in service.” Clinical record review indicated Patient #8 had a discharge date of 3/19/24. 6. Clinical record review identified Patient #9 had a start of care date of 2/23/24. Staff C, RN, was Patient #9’s Clinical Manager. a. The POCs, dated 2/23/24 to 4/22/24, included physician orders for skilled nursing, physical therapy and occupational therapy services. Physician orders for skilled nursing included assess pain, perform INR (international normalized ratio to test blood clotting times) checks as ordered, assess and instruct on pressure ulcer techniques, provide wound care, assess, perform and instruct on diabetic foot and nail care, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for occupational therapy included adaptive training, balance and safety training at each visit. Establish a home exercise program given to patient by discharge. b. The agency identified the last skilled visit prior to discharge, dated 3/12/24. The skilled nurse visit note, dated 3/12/24, Staff I, Licensed Practical Nurse (LPN), completed the patient’s skilled assessment (addressed pain), provided wound care, completed INR check, provided medication management assessment and education on diabetes management. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #9’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:42 AM. The discharge summary identified Patient #9 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #9 had a discharge date of 3/20/24. 7. Clinical record review identified Patient #10 had a start of care date of 6/8/23. Staff C, RN, was Patient #10’s Clinical Manager. a. The POC, dated 2/3/24 to 4/2/24, included physician orders for skilled nursing and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess urinary status, change catheter as needed and monthly, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/5/24. The skilled nurse visit note, dated 3/5/24, Staff P, RN, completed the patient’s skilled assessment, assessed pain and skin integrity, provided education on epilepsy, hypertension and Parkinson’s disease and assessed medication regimen/understanding. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #10’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:46 AM. The discharge summary identified Patient # 10 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #10 had a discharge date of 3/20/24. 8. Clinical record review identified Patient #11 had a start of care date of 2/3/23. Staff F, RN, was Patient #11’s Clinical Manager. a. The POC, dated 1/29/24 to 3/28/24, included physician orders for skilled nursing, physical therapy and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess and instruct on moist wound healing for pressure ulcers receiving hydrating treatments, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/14/24. The skilled nurse visit note, dated 3/14/24, Staff I, LPN, completed the patient’s skilled assessment, assessed pain and medication management, and provided education on hospital risks and pain management. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #11’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:48 AM. The discharge summary identified Patient #11 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #11 had a discharge date of 3/20/24. 9. Clinical record review identified Patient #12 had a start of care date of 6/23/23. Staff P, RN, was Patient #12’s Clinical Manager. a. The POC, dated 2/18/24 to 4/17/24, included physician orders for skilled nursing services. Physician orders for skilled nursing included assess pain, change foley catheter every four weeks or as needed if not functioning properly, instill 60 milliliters of Gentamicin (antibiotic) via foley catheter once weekly, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/15/24. The skilled nurse visit note, dated 3/15/24, Staff P, RN, completed a patient assessment, performed catheter flush, provided education on signs and symptoms of a urinary tract infection, and assessed pain and skin integrity. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #12’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:53 AM. The discharge summary identified Patient # 12 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #12 had a discharge date of 3/20/24. 10. Clinical record review identified Patient #13 had a start of care date of 5/5/23. Staff F, RN, was Patient #13’s Clinical Manager. a. The POC, dated 2/29/24 to 4/28/24, included physician orders for skilled nursing services. Physician orders for skilled nursing included check INR (international normalized ratio to test blood clotting times) as ordered, assess pain, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/11/24. The skilled nurse visit note, dated 3/11/24, Staff I, LPN, performed INR check and communicated with physician regarding results, completed patient assessment, provided medication education, completed a pulmonary assessment and assessed pain. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #13’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:54 AM. The discharge summary identified Patient #13 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #13 had a discharge date of 3/20/24. 11. Clinical record review identified Patient #14 had a start of care date of 2/8/24. Staff C, RN, was Patient #14’s Clinical Manager. a. The POC, dated 2/8/24 to 4/7/24, included physician orders for skilled nursing, physical therapy, occupational therapy, and home care aide services. Physician orders for skilled nursing included assess pain, assess and instruct on pressure ulcer techniques, assess and instruct on diabetic foot and nail care, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. Physician orders for occupational therapy included adaptive training, balance and safety training at each visit. Establish a home exercise program given to patient by discharge. Physician orders for home health aide included assist with cares at each visit. b. The agency identified the last skilled visit prior to discharge, dated 3/19/24. The skilled nurse visit note, dated 3/19/24, Staff P, RN, provided patient assessment, assessed pain, provided education on falls/safety, bleeding precautions, hypertension, diabetes, signs and symptoms of infection, medication management, and skin issues. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #14’s discharge comprehensive assessment on 3/20/24, 1 day after the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/20/24 at 9:00 AM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/20/24 at 10:57 AM. The discharge summary identified Patient # 14 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #14 had a discharge date of 3/20/24. 12. Clinical record review identified Patient #15 had a start of care date of 2/13/24. Staff C, RN, was Patient #15’s Clinical Manager. a. The POC, dated 2/13/24 to 4/12/24, included physician orders for skilled nursing and physical therapy services. Physician orders for skilled nursing included change dressing, wound vac as ordered twice a week, assess pain, assess and instruct on pressure ulcer techniques, assess medication regimen knowledge and knowledge of the disease process at each visit. Physician orders for physical therapy included establish a home exercise program with written home exercise program by discharge. b. The agency identified the last skilled visit prior to discharge, dated 3/14/24. The skilled nurse visit note, dated 3/14/24, Staff C, RN provided wound care, completed patient assessment, and educated patient on signs and symptoms of healing/infection and disease processes. The visit note lacked a plan to discharge. c. Staff E, RN, completed and documented Patient #15’s discharge comprehensive assessment on 3/19/24, the day the HHA ceased business. d. The discharge summary indicated, Staff B, LPVN, Director of Quality, received a verbal order on 3/19/24 at 2:00 PM. Another entry indicated Staff B, LPVN signed the discharge summary on 3/19/24 at 3:49 PM. The discharge summary identified Patient #15 was notified and “patient will need referrals sent out to new home health agencies due to current home health no longe” (no longer in service). Clinical record review indicated Patient #15 had a discharge date of 3/19/24. The agency failed to include an accurate update of the comprehensive assessment of the patient at discharge.”

“Required items in clinical record CFR(s): 484.110(a)(1) The patient’s current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This Element is not met as evidenced by: Based on staff interviews, clinical record reviews and agency policy review, the agency failed to ensure the clinical record included the patient’s current documentation and a complete chart for 3 of 8 sampled patients (Patients #7, #9 and #13). Failure of the agency to ensure the clinical record included current documentation placed agency patients at risk to receive care or not receive care meeting the needs of the patient. Findings include: During an interview on 6/5/24 at 9:05 AM the Staff D, Owner stated he home health agency called for a staff meeting on 3/19/24. Nurses were calling patients the day of the meeting (3/19/24) and let the patients know of the agency closure and help coordinate their care. Staff D, Owner stated, the employees and the patients were informed of the closure on the same day (3/19/24). During an interview on 6/4/24 at 1:30 PM Staff B, Director of Quality stated some staff had not completed their documentation at the time they were notified the Mount Pleasant office closing (3/19/24). The staff were not willing to stay on employment and complete their documentation. During an interview on 6/4/24 at 5:14 PM, Staff F, Registered Nurse (RN) stated they were notified to attend a mandatory staff meeting on 3/19/24 at 2:00 PM. The agency identified the agency was closing and took all staff equipment and locked staff out of the computer system on 3/19/24. Staff F, RN stated she did not have time to complete all of her charting for skilled nurse visits on 3/18/24 or 3/19/24. 1. Clinical record review indicated Patient #13 had a start of care date of 5/5/23. a. The Plan of Care (POC), dated 2/29/24 to 4/28/24, included orders for skilled nursing services 1 time a week to check INR (international normalized ratio to test blood clotting times) as ordered by the physician. b. Clinical record review revealed no skilled nursing visit documentation for 3/18/24 or 3/19/24. c. An interim physician’s order, dated 3/18/24, identified the patient’s INR at 3.4. (For patients who are on anticoagulant therapy, the therapeutic INR ranges between 2.0 to 3.0). The order included to hold coumadin dose today and recheck the INR on 3/19/24. During an interview on 6/4/24 at 3:45 PM, Physician office RN, identified Patient #13 had an INR completed on the 3/19/24 and the INR results were called to the Physician by Staff I, Licensed Practical Nurse (LPN). During an interview on 6/5/24 at 9:30 AM, Staff B, Director of Quality stated Staff I, LPN was scheduled and to her knowledge Staff I, LPN, completed the skilled nurse visit on 3/18/24 and 3/19/24. She further stated no documentation was available for the skilled nurse visit on 3/18/24 and 3/19/24. Clinical record review indicated Patient #13 had a discharge date of 3/20/24. 2. Clinical record review indicated Patient #7 had a start of care date of 10/25/23. a. The POC, dated 2/22/24 to 4/21/24, included orders for skilled nursing services 3 times a week and home health aide services 1 time a week. b. Clinical record review revealed no skilled nursing visit documentation for 3/18/24. During an interview on 6/5/24 at 10:05 AM, Staff B, Director of Quality stated the visit for Staff I, LPN was scheduled and to her knowledge Staff I, LPN, completed the skilled nurse visit on 3/18/24. She further stated no documentation was available for the skilled nurse visit on 3/18/24. Clinical record review indicated Patient #7 had a discharge date of 3/20/24. 3. Clinical record review indicated Patient #9 had a start of care date of 2/23/24. a. The POC, dated 2/23/24 to 4/22/24, included orders for skilled nursing services 1 time a week, physical therapy services 1 time a week and home care aide services 1 time a week. b. Clinical record review revealed no skilled nursing visit documentation for 3/18/24. c. Clinical record review included a physical therapy visit, dated 3/19/24 completed by Staff J, Physical Therapist (PT). The physical therapy note failed to include documentation of the narrative note (The narrative note is a detailed narrative that describes the patient’s current condition/complaint, function, activity level and symptoms) completed by Staff J, PT. During an interview on 6/5/24 at 9:40 AM, Staff B, Director of Quality stated the visit for Staff I, LPN was scheduled and to her knowledge Staff I, LPN completed the skilled nurse visit on 3/18/24. She further stated no documentation was available for the skilled nurse visit on 3/18/24. Clinical record review indicated Patient #9 had a discharge date of 3/20/24. The agency failed to follow agency policy of including all completed documentation in the patient’s electronic medical record.”