Providence at Home

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on a review of clinical records and staff interviews, for 7 of 13 (Pts. #9, 12, 13, 3, 4, 10 and 11) clinical records, the Agency failed to ensure that the orders in the POC were followed. 7. Pt. 11 was admitted to home health services on 08/23/23 with diagnosis of but not limited to Laceration without Foreign Body of Left Buttock and Type 2 Diabetes Mellitus. The clinical record was reviewed on 02/24/26. The POC effective 12/15/24 to 02/12/25, required: “....Orders / Treatments:.... Contact MD for blood sugars less than 60 or greater than 400....” The Skilled Nursing Notes dated 12/23/24. 12/30/24, 01/02/25 and 01/06/25, lacked blood sugar monitoring / assessments, as ordered in the POC. 8. During staff interviews with the Administrator, Director of Quality and Clinical Supervisor on 02/24/26 at 12:45 PM and with the Administrator, Director of Quality, Clinical Supervisor and Vice President of Home and Community Based Services on 02/25/26 between 1:15 PM to 2:15 PM, the Administrative staff confirmed the above findings. 4. Pt. #3 was admitted to home health services on 02/04/26 with the diagnosis of Hypertensive chronic kidney disease with stage 1-4. The POC effective 02/04/26 required/documents under Additional Services: Vital ranges: “Notify MD with B/P greater than 160/90 or less than 100/50, Apical greater than 100 or less than 50, start date 02/04/26.” The SN note date 02/04/26 documents B/P 98/58. As of 02/25/26, there was no documentation of Physician notification of B/P falling outside range, as ordered in the POC. 5. Pt. #4 was admitted to home health services on 01/21/26 with the diagnosis of Influenza due to other identified influenza virus with other respiratory manifestations. The POC effective 01/21/26 required/documents under Additional Services: Vital ranges: “Notify MD with B/P greater than 160/90 or less than 100/50, Apical greater than 100 or less than 50, start date 01/21/26.” The SN note date 01/21/26 documents B/P = 104/42. As of 02/25/26, there was no documentation of Physician notification of B/P falling outside range, as ordered in the POC. 6. Pt. #10 was admitted to home health services on 06/20/25 with the diagnosis Pressure ulcer of sacral region stage 2. The POC effective 06/20/25 required/documents under Additional Services: Vital ranges: “Notify MD with B/P greater than 160/90 or less than 100/50, Apical greater than 100 or less than 50, start date 01/21/26.” The RN- SOC Admission visit note dated 06/20/25 documents Pulse = 106. The PT Initial Evaluation visit note dated 06/22/25 documents B/P = 124/94 and Pulse = 116. The PTA visit note dated 06/25/25documents Pulse = 108. As of 02/25/26, there was no documentation of Physician notification of B/P and Pulse falling outside range, as ordered in the POC. Findings include: 1. Pt. #9 was admitted to home health services on 01/06/26 with the diagnosis of GERD (Gastroesophageal Reflux Disease) with esophagitis without bleeding. The clinical record was reviewed on 02/24/26. The clinical record included a POC effective 01/06/26 which required, “Notify MD with BP greater than 160/90 or less than 100/50, Apical greater than 100 or less than 50…” The SN note dated 01/08/26 recorded “Blood pressure 82/60 mmHg” and on 01/12/26, “Blood pressure 97/58 mmHg.” Both SN notes also included the documentation, “Vital sign entered is outside the acceptable range for this patient… followed/documented appropriate care plan intervention.” The Physical Therapy note dated 02/02/26 and 02/13/26, included the documentation, “Pulse 110 beats per minute…” The clinical record lacked documentation the Physician was notified the vital signs were out of parameter range. 2. Pt. #12 was admitted to home health services on 04/23/25 with the diagnosis of Pressure Ulcer other site stage 2. The clinical record was reviewed on 02/24/26. The clinical record included a POC for the certification period of 04/23/25 to 06/21/25, which required, “Notify MD with BP greater than 160/90 or less than 100/50…” The SN note dated 05/23/25 recorded “Blood pressure 92/52 mmHg” and on 05/30/25, “Blood pressure 108/58 mmHg.” Both SN notes included documentation, “Vital sign entered is outside the acceptable range for this patient… followed/documented appropriate care plan intervention.” The clinical record lacked documentation the Physician was notified the vital signs were out of parameter range. 3. Pt. #13 was admitted to home health services on 04/11/25 with the diagnosis of Traumatic subdural hemorrhage without loss of consciousness. The clinical record was reviewed on 02/25/26. The clinical record included a POC for the certification period of 04/11/25 to 06/09/25 which required, “Notify MD with BP greater than 160/90 or less than 100/50, Apical greater than 100 or less than 50…” The SN note dated 04/25/25 recorded “Blood pressure 118/58 mmHg…Pulse 54” and on 05/02/25, “Blood pressure 102/58 mmHg and Pulse 58.” Both SN notes included documentation, “Vital sign entered is outside the acceptable range for this patient… followed/documented appropriate care plan intervention.” The clinical record lacked documentation the Physician was notified the vital signs were out of parameter range.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on clinical record and staff interviews, for 1 of 4 (Pt. #12) Pts. reviewed who were receiving wound care, the Agency failed to ensure that the treatment used for wound care was ordered by the Physician. Findings include: 1. Pt. #12 was admitted to home health services on 04/23/25 with the diagnoses of but not limited to Pressure ulcer of other site stage 2, Pressure ulcer of right buttock stage 2, Pressure ulcer of the left buttock stage 2. The clinical record was reviewed on 02/25/25. The following are the physician orders for the wound treatment, from 04/23/25 to 06/12/25: “Decubitus/Pressure Ulcer/Midline Buttocks Cleanse with normal saline or wound cleanser. Apply Medi honey to open area and cover with bordered foam…. Decubitus/Pressure Ulcer/Left Foot Cleanse with normal saline or wound cleanser. Apply xeroform gauze to open area and cover with bordered foam…” The SN notes included the following documentation: 04/25/25 – “Coccyx wound the, same, less erythema to peri wound. SN applied honey and hydrocolloid dressing.” 04/29/25 – “Left Foot/ Decubitus/Pressure Ulcer: Dressing/Wound Vac: Cleansed with wound cleanser, Application/Packing/Other: Medi honey.” 05/16/25 – “Midline Buttocks/Decubitus/Pressure Ulcer: Dressing/Wound Vac: Cleansed with normal saline. Application/Packing: Calcium Alginate, Other: Honey alginate rope.” Narrative: “Sacral wound…applied skin prep to peri wound, packed calcium alginate with honey into wound bed and covered with bordered foam…” 05/30/25 – “Midline Buttocks/Decubitus/Pressure Ulcer: Dressing/Wound Vac: Cleansed with wound cleanser. Application/Packing, Other: Honey alginate.” 06/03/25 - “Midline Buttocks/Decubitus/Pressure Ulcer: Dressing/Wound Vac: Cleansed with normal saline. Application/Packing, Other: Hydrocolloid, covered with Hydrocolloid gauze.” The clinical record lacked physician orders for all the above wound treatments used by the RN. 2. The policy, “Verification of Physician Orders” revised 5/11 was reviewed on 02/25/26 and required, “Orders will be obtained from a licensed physician for care and services to be provided to home health patients…” 3. During a staff interview conducted with the Administrator, Clinical Supervisor, Director of Quality and Vice President of Home and Community Based Services on 02/25/26 at 2:15 PM, the above findings were confirmed.”

“Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This Element is not met as evidenced by: Based on clinical record reviews and staff interviews, for 4 of 13 (Pts. 7, 8, 9 and 10) clinical records reviewed, the Agency failed to conduct complete assessments of patients’ Influenza and Pneumonia vaccination status. Findings include: 1.The following clinical records were reviewed from 02/23/26 to 02/25/26: Pt. #7 SOC 04/29/25, lacked Influenza vaccination assessment. Pt. #8 SOC 10/03/25, lacked Pneumonia vaccination assessment. Pt. #9 SOC 01/06/26, lacked Influenza vaccination assessment. Pt. #10 SOC 06/20/25, lacked Pneumonia vaccination assessment. The records lacked documentation that the Influenza or Pneumonia vaccination was assessed. 2. The Agency Policy titled: “Flu Plan” was reviewed on 02/25/26 and required: “....During the flu season, screen all patients for flu vaccination status and document in the comprehensive assessment. We will arrange for patients to receive the flu vaccine if they request it....” The Agency Policy titled: “Initial and Comprehensive Assessment” was reviewed on 02/25/25 and required: “.... Procedure....3. During the initial comprehensive patient assessments, all baseline data to be used in measuring the patient’s progress towards goals and other relevant information will be documented in the patient’s clinical record, including at least the following information....V. Immunizations....” 3. During staff interviews with the Administrator, Director of Quality, and Clinical Supervisor on 02/24/26 at 12:45 PM, and with the Administrator, Director of Quality, Clinical Supervisor, and Vice President of Home and Community Based Services on 02/25/26 between 1:15 PM PM to 2:15 PM, the Administrative team confirmed the above findings.”

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: Based on observation during a home visit, a review of clinical records, policy reviews, and staff interviews, for 3 of 13 clinical records reviewed (Pts. #1, 9 and 13) the Agency failed to ensure that needs and concerns identified regarding Pt. care are communicated with other staff involved in the patient’s care. Findings include: 1. Pt. #1 was admitted to home health services on 01/15/26 with the diagnosis of COVID-19. A home visit was conducted with the PTA on 02/24/26 at 9:00 AM. During the home visit, the PTA obtained the patient’s blood pressure. The blood pressure was 77/49 mmHg and out of parameter range. The PTA obtained two more blood pressures which were still out of range. It was observed that the PTA called the SN to report blood pressure reading and the SN recommended the Pt. go to urgent care and the home visit concluded. The clinical record was reviewed on 02/25/26. The record lacked documentation of coordination between care staff. During a staff interview conducted with the Administrator, Clinical Supervisor, and Director of Quality (administrative team) on 02/25/26 at 2:15 PM, it was confirmed that there was no documentation of the above-mentioned Pt. information in the clinical record, and it was stated that the administrative team was not aware of what happened, until it was brought up by the surveyor. 2. Pt, #9 was admitted to home health services on 01/06/26 with the diagnosis of GERD (Gastroesophageal Reflux Disease) with esophagitis without bleeding. The clinical record was reviewed on 02/24/26. The initial comprehensive assessment dated 01/06/26 included documentation the SN identified the need for the Pt. to be referred to MSW. The SN note dated 01/07/26 also included documentation that the SN attempted to call the physician regarding the MSW referral but was unavailable. The clinical record lacked documentation that the need for MSW services was communicated to the Clinical Supervisor and the physician. During a staff interview conducted with the administrative team on 02/25/06, the Clinical Supervisor, who coordinates MSW referral, confirmed that this information was not communicated and therefore there was no MSW referral. 3. Pt. #13 was admitted to home health services on 04/11/25 with the diagnosis of Traumatic subdural hemorrhage without loss of consciousness. The clinical record was reviewed on 02/25/26. The clinical record included documentation of an unplanned discharge from home health services effective 05/05/26. Pt. was transferred to hospice services. The record lacked documentation of coordination between staff members involved in Pt. care related to the need for hospice placement, and transfer or discharge process. 4. The policy, “Care Coordination” revised on 12/25, was reviewed on 02/25/25 and required: “To ensure the coordination of services for each patient and to minimize the potential for missed, conflicting or duplicated services...Written evidence of care coordination will be recorded during the case conference and repeated in skilled nursing visit reports in the patient’s clinical records...4. Care coordination will include, but not limited to: E. Timely documentation of coordination of care activities...H. Proper communication upon ‘hand-off’ of patient, including the opportunity for questions between the giver and receiver of patient information...7...Documentation of all communications will be included in the clinical record on a communication note, case conference summary or clinical note... Documentation will include: the date and time of the communication, individuals involved with the communication, information discussed, and the outcome of the communication...” 4. During staff interviews with the Administrator, Clinical Supervisor, Director of Quality, and Vice President of Home and Community Based Services on 02/25/26 at 2:15 PM, the above findings were confirmed.”