Guardian Home Health Care, LLC

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on the review of the Error Summary report and staff interview, for 993 of 3060 assessments submitted for the last 12 months, the Agency failed to submit all reports within 30 days after the assessment was completed, which resulted in a warning. Findings include: 1. The Error Summary report for 05/01/25 to 05/28/26 was reviewed on 06/01/26 at 11:30 AM. The report included error # -3330 for 993 of 3060 late submissions, 32.45% of the OASIS reports submitted, were more than 30 days after the assessment was completed. 2. During an interview with the Assistant Administrator, Director of Clinical Services, and Office Manager on 06/03/26 at 4:00 PM, it was confirmed the error occurred.”

“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, 8 of 17 (Pts. #1, 2, 8, 9, 11, 12, 15, and 17) clinical records reviewed, lacked Plans of Care that were reviewed and signed by the Patient’s Physician or allowed practitioner within 30 days of the Start of Care. 1.The clinical records for the following Pts. were reviewed between 06/01/26 and 06/04/26. The PsOC lacked a review and signature by the Patient’s Physician or allowed provider within 30 days of the SOC. Pt.#1 SOC 04/24/26 (Not Signed) Pt#2 SOC 04/27/26 (Not Signed) Pt#8 SOC 04/15/26 (Not Signed) Pt#9 SOC 04/17/26 (Not Signed) Pt#11 SOC 04/29/26 (Not Signed) Pt#12 SOC 02/25/26 (Signed “6-04-26”) Pt#15 SOC 11/21/25 (Signed “3-13”) Pt#17 SOC 12/05/25 (Signed “1-16-26”) 2. During an interview with the Director of Clinical Services, Assistant Administrator, and Office Manager on 06/03/26 from 2:30 PM-4:30 PM, the above findings were confirmed.”

“HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator’s name, business address, and business phone number in order to receive complaints. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder, observation during home visits and staff interviews, it was determined the Agency failed to provide the Pt./patient’s representative information regarding the Administrator. This was found in 17 of 17 (Pts. #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17) clinical records reviewed. Findings include: 1. The Agency’s Pt. admission folder was reviewed on 06/01/26. The folder lacked the Administrator’s name, address, and phone number to file a complaint and/or grievance. 2. On 06/01/26 and 06/02/26, home visits were conducted on the following Pts. Pt. #1. SOC 04/24/26 Pt. #2. SOC 04/27/26 Pt. #3. SOC 03/27/26 Pt. #4. SOC 05/26/26 Pt.# 5. SOC 05/27/26 Pt. #6. SOC 05/13/26 Pt. #7. SOC 05/13/26 During the home visits, the patient’s admission folder was observed and lacked the name and contact information of the Administrator. 3. The clinical records of the following Pts. were reviewed from 06/02/25 at 1:00 PM to 06/03/26 3:30 PM. Pt. #1. SOC 04/24/26 Pt. #2. SOC 04/27/26 Pt. #3. SOC 03/27/26 Pt. #4. SOC 05/26/26 Pt. #5. SOC 05/27/26 Pt. #6. SOC 05/13/26 Pt. #7. SOC 05/13/26 Pt. #8. SOC 04/15/26 Pt. #9. SOC 04/17/26 Pt. #10. SOC 05/05/26 Pt. #11. SOC 04/29/26 Pt. #12. SOC 02/25/26 Pt. #13. SOC 12/05/25 Pt. #14. SOC 12/26/25 Pt. #15. SOC 11/21/25 Pt. #16. SOC 12/16/25 Pt. #17. SOC 012/05/25 The clinical records lacked documentation that the Pt./patient’s representative was provided the name and contact of the Administrator to file a complaint or grievance. 4. During an interview with the Assistant Administrator, Director of Clinical Services and Office Manager on 06/03/26 at 3:30 PM, the administrative team confirmed the Agency failed to provide the Pt./patient’s representative with the Administrator’s name and contact information.”

“Written notice within 4 business days CFR(s): 484.50(a)(4) Provide written notice of the patient’s rights and responsibilities under this rule and the HHA’s transfer and discharge policies as set forth in paragraph (d) of this section to a patient-selected representative within 4 business days of the initial evaluation visit. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder, observation during home visits, clinical record review and staff interviews, it was determined the Agency failed to provide Pts. information regarding the Agency’s transfer and discharge policies. This was found in 17of 17 (Pts. #1, 2, 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17) clinical records reviewed. Findings include: 1.The Agency’s Pt. admission folder was reviewed on 06/01/26. The folder lacked documentation of the Agency’s transfer and discharge policies. 2. On 06/01/26 and 06/02/26, home visits were conducted on the following Pts. Pt. #1. SOC 04/24/26 Pt. #2. SOC 04/27/26 Pt. #3. SOC 03/27/26 Pt. #4. SOC 05/26/26 Pt. #5. SOC 05/27/26 Pt. #6. SOC 05/13/26 Pt. #7. SOC 05/13/26 During the home visits, the Pt. admission folders were observed, and lacked documentation of the Agency’s transfer and discharge policies. 3. The clinical records of the following Pts. were reviewed from 06/02/25 at 1:00 PM to 06/03/26 3:30 PM. Pt. #1. SOC 04/24/26 Pt. #2. SOC 04/27/26 Pt. #3. SOC 03/27/26 Pt. #4. SOC 05/26/26 Pt. #5. SOC 05/27/26 Pt. #6. SOC 05/13/26 Pt. #7. SOC 05/13/26 Pt. #8. SOC 04/15/26 Pt. #9. SOC 04/17/26 Pt. #10. SOC 05/05/26 Pt. #11. SOC 04/29/26 Pt. #12. SOC 02/25/26 Pt. #13. SOC 12/05/25 Pt. #14. SOC 12/26/25 Pt. #15. SOC 11/21/25 Pt. #16. SOC 12/16/25 Pt. #17. SOC 012/05/25 The records lacked documentation the Agency provided Pts. information, regarding the Agency’s policies pertaining to transfer and discharge. 4. During an interview with the Assistant Administrator, Director of Clinical Services and Office Manager on 06/03/26 at 3:30 PM, it was confirmed the Pt. admission folder reviewed is used for all Pts. admitted to this Agency, and that the Agency failed to provide Pts. information regarding the Agency’s transfer and discharge policies.”

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder, observation and interview during home visits, clinical record review, and staff interviews, it was determined that in 17 of 17 (Pts. # 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17) clinical records reviewed, the Agency failed to ensure the Pt./representative was informed in writing of the services to be provided and the frequency of visits. Findings include: 1. The Agency’s Pt. admission folder was reviewed on 06/01/26. The folder included the “Admission Service Agreement” form that does not included a section for the SN/PT to complete during the SOC visit and document the services to be provided and visit frequencies. 2. The clinical records of the following Pts. were reviewed from 06/02/25 at 1:00 PM to 06/03/26 at 3:30 PM. Pt. #1. SOC 04/24/26 Pt. received SN, PT and OT services. Pt. #2. SOC 04/27/26 Pt. received SN, PT and OT services. Pt. #3. SOC 03/27/26 Pt. received SN services. Pt. #4. SOC 05/26/26 Pt. received PT services. Pt. #5. SOC 05/27/26 Pt. received SN, PT and HHA services. Pt. #6. SOC 05/13/26 Pt. received SN and Pt services. Pt. #7. SOC 05/13/26 Pt. received Sn and HHA services. Pt. #8. SOC 04/15/26 Pt. received SN and MSW services. Pt. #9. SOC 04/17/26 Pt. received SN and HHA services. Pt. #10. SOC 05/05/26 Pt. received OT and PT services. Pt. #11. SOC 04/29/26 Pt. received SN and PT services. Pt. #12. SOC 02/25/26 Pt. received SN and PT services. Pt. #13. SOC 12/05/25 Pt. received Sn services. Pt. #14. SOC 12/26/25 Pt. received SN and PT services. Pt. #15. SOC 11/21/25 Pt. received SN, PT and OT services. Pt. #16. SOC 12/16/25 Pt. received SN services. Pt. #17. SOC 012/05/25 Pt. received SN services. 3. The following home visits were conducted on 06/01/26 and 06/02/26: Pt. #1. SOC 04/24/26 Pt. received SN, PT and OT services. Pt. #2. SOC 04/27/26 Pt. received PT and OT services. Pt. #3. SOC 03/27/26 Pt. received SN services. Pt. #4. SOC 05/26/26 Pt. received PT services. Pt. #5. SOC 05/27/26 Pt. received SN, PT and HHA services. Pt. #6. SOC 05/13/26 Pt. received SN and PT services. Pt. #7. SOC 05/13/26 Pt. received SN and HHA services. During the home visits of Pts. #1, 2, 3, 4, 5, 6, and 7 the patient’s admission folder was observed, and lacked documentation indicating the Pt./representative was notified of the discipline(s) to provide service, and frequency of visits in writing. 4. During an interview with the Assistant Administrator, Director of Clinical Services and Office Manager, on 06/03/26 at 3:30 PM, the administrative team confirmed the above findings.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on clinical record reviews and staff interviews, in 2 of 17 (Pts. #2 and 4) clinical records reviewed the Agency failed to ensure an RN performed the initial assessment within 48 hours of the Physician referral for Home Health Care services. Findings include: 1. Pt. #2 was admitted to Home Health Services on 04/27/26 with diagnosis of Sarcoidosis. The clinical record was reviewed on 06/02/26. The home health patient referral was signed and faxed by Physician to Agency on 04/21/26 documenting the need for the following skilled services: “Physical Therapy: PT for following care: Home safety observation, assessment and instruction, and Safety measure training, Gait training, Therapeutic exercise, Transfer training Occupational Therapy: OT for following care: Maximize independence in ADLs, home safety and home equipment recommendations.” The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 06/04/26, the record lacked documentation the Agency initiated service within the required time frame. 2. Pt. #4 was admitted to Home Health Services on 05/26/26 with diagnosis of post-procedural hypoparathyroidism. The clinical record was reviewed on 06/03/26. The home health patient referral was signed and faxed by Physician to Agency on 05/20/26 documenting the need of the following skilled services: “Physical Therapy, Assessments: Falling episodes, Muscle weakness (generalized). The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 06/04/26, the record lacked documentation the Agency initiated service within the required time frame. 3. During an interview with the Assistant Administrator, Director of Clinical Services and Office Manager, on 06/03/26 at 3:30 PM and 4:30 PM, the administrative team confirmed the initial assessment visits were conducted, after 48 hours of the referral date above findings”

“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 observations and interviews during a home visit, clinical records reviews and staff interviews, for 4 of 17 clinical records reviewed (Pts. #5, 6, 15 and 16), the Agency failed to ensure that physician orders were followed. 3. Pt.# 15 was admitted for home health services on 11/21/25 with the diagnosis of, but not limited to, pressure ulcer of left buttock stage 2. On 06/03/26 the clinical record for the certification period of 11/21/25 through 01/11/26 was reviewed. The SN Visit Note dated 12/08/25 stated, “Pt with new wound to R hallux, MD contacted and new order to start wound cared as follow: clean with wound cleanser, Hydrofera Blue to the wound bed, cover with silicone bordered foam.” The record lacked an wound order from a Physician. 4. Pt.#16 was admitted for home health services on 12/16/25 with the diagnoses of, but not limited to, Unstageable pressure ulcer affecting contiguous sites of the back, buttock, and hip, and Pressure ulcer of left ankle stage 2. On 06/03/26 the clinical record for the certification period of 12/16/25 through 02/13/26 was reviewed. The SN Visit Note dated 12/29/25 stated, “ L upper buttock new wound...redness, warm to touch. MD notified, secured with 6x 6 Foam dressing, proper positioning discussed with CG.” The record lacked an wound order from a Physician. 5. During interviews with the Director of Clinical Services, Assistant Administrator, and Office Manager from 2:30 PM to 4:30 PM, the above findings were confirmed. Findings include: 1. Pt. #5 was admitted to home health services on 05/27/26 with the diagnosis of Parkinson’s Disease. The clinical record was reviewed on 06/02/26. The record included documentation that HHA visits were provided on 05/29/26 and 06/02/26. The record lacked documentation of physician orders for HHA visits. 2. Pt. #6 was admitted to home health services on 05/13/26 with the diagnosis of Polyosteoarthritis. A home visit was conducted with the LPN on 06/02/26. During the home visit, the LPN was observed discussing the 2 medications that Pt. #6 had been taking: Medrol 4 milligrams for 6 days, and Symbicort 80/4.5 micrograms. The LPN was interviewed and stated that SN home visits were extended this week due to Pt. change in respiratory status, i.e., coughing and wheezing and new medications Pt. #6 started taking last week. The clinical record was reviewed on 06/02/26. The record included documentation of SN frequency of 1-2 times per week for 3 weeks, ending the week of 05/30/26. As the record review date of 06/02/26, the record lacked documentation of physician orders for the above-mentioned medications and lacked orders for the SN visit conducted on 06/02/26.”

“Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder and staff interviews, it was determined in 17 of 17 (Pts. #1, 2, 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17) the Agency failed to provide information regarding the Director of Clinical Services(Agency Supervisor) and their contact information. Findings include: 1. The Agency Pt. admission folder was reviewed on 06/01/26. The folder lacked information identifying the Director of Clinical Services, name and contact information. 2. On 06/01/26 and 06/02/26, home visits were conducted on the following Pts. Pt. #1. SOC 04/24/26 Pt. #2. SOC 04/27/26 Pt. #3. SOC 03/27/26 Pt. #4. SOC 05/26/26 Pt. #5. SOC 05/27/26 Pt. #6. SOC 05/13/26 Pt. #7. SOC 05/13/26 During the home visits, the Pt. admission folders were reviewed. The folders lacked the name and contact information of the Director of Clinical Services. 3. The clinical records of the following Pts. were reviewed from 06/02/25 at 1:00 PM to 06/03/26 3:30 PM. Pt. #1. SOC 04/24/26 Pt. #2. SOC 04/27/26 Pt. #3. SOC 03/27/26 Pt. #4. SOC 05/26/26 Pt. #5. SOC 05/27/26 Pt. #6. SOC 05/13/26 Pt. #7. SOC 05/13/26 Pt. #8. SOC 04/15/26 Pt. #9. SOC 04/17/26 Pt. #10. SOC 05/05/26 Pt. #11. SOC 04/29/26 Pt. #12. SOC 02/25/26 Pt. #13. SOC 12/05/25 Pt. #14. SOC 12/26/25 Pt. #15. SOC 11/21/25 Pt. #16. SOC 12/16/25 Pt. #17. SOC 012/05/25 The clinical records reviewed lacked information identifying the Director of Clinical Services, name and contact information. 4. During an interview with the Assistant Administrator, Director of Clinical Services and Office Manager, on 06/03/26 at 3:30 PM, the administrative team confirmed the Agency failed to provide the Pt./patient’s representative with the Director of Clinical Services, name and contact information.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on a review of clinical records and staff interviews, for 2 of 3 (Pts. #7 and 9) clinical records reviewed, wherein the Pt. received HHA services, the Agency failed to ensure that HHA supervisory visits were conducted every 14 days. Findings include: 1. Pt. #7 was admitted to home health services on 05/13/26 with the diagnosis of Erythema Intertrigo. The clinical record was reviewed on 06/02/26 and included documentation HHA services were provided on 05/19/26, 05/21/26, 05/26/26 and 05/28/26. The record lacked documentation that a supervisory visit was conducted every 14 days. 2. Pt. #9 was admitted to home health services on 04/17/26 with the diagnosis of Primary osteoarthritis. The clinical record was reviewed on 06/02/26 and included documentation HHA services were provided from 04/21/26 through 05/28/26. The record lacked documentation that supervisory visits were conducted every 14 days as required. 3. During an interview with the Assistant Administrator, Director of Clinical Services, and Office Manager on 06/03/26 at 2:30 PM, the above findings were confirmed.”

“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 review of clinical records, staff educational material. and staff interviews, for 9 of 17 (Pts. #6, 9, 10, 12, 13, 14, 15, 16 and 17) clinical records reviewed, the Agency failed to ensure that the clinical records were complete and accurate. 5. Pt. # 13 was admitted for home health services on 12/05/25 with the diagnosis of, but not limited to, Unspecified open wound left knee subsequent encounter. On 06/03/26 the clinical record for the certification period of 12/02/25 through 02/02/26 was reviewed. The SN Visit Notes under Skilled Intervention: Instruction/Assessment/Performance for 12/08/25, 12/16/25, 12/26/25, and 12/29/25 stated, “SN performed dressing change and wound care per MD order...Measurements updated.” The Notes under the heading Wound Care stated, “Wounds Not Addressed This Visit” and no wound measurements were recorded. The SN notes included inaccurate documentation. 6. Pt. #14 was admitted for home health services on 12/26/25 with the diagnoses of, but not limited to, Pressure ulcer of sacral region stage 3, pressure ulcer of other site unstageable, pressure ulcer of left heel unstageable, and pressure ulcer of right heel unstageable. On 06/03/26 the clinical record for the certification period of 12/26/25 through 02/23/26 was reviewed. The SN Visit Notes under Skilled Intervention: Instruction/Assessment/Performance for 12/29/25, 12/31/25, and 01/02/25 stated, “wound care was done per MD order using clean technique” The Notes under the heading Wound Care stated, “Wounds Not Addressed This Visit” and no wound measurements were recorded. The SN notes included inaccurate documentation. 7. Pt. #15 was admitted for home health services on 11/21/25 with the diagnosis of, but not limited to, Pressure ulcer of left buttock stage 2. On 06/03/26 the clinical record for the certification period of 11/21/25 through 01/11/26 was reviewed. The SN Visit Notes under Skilled Intervention: Instruction/Assessment/Performance for 11/24/25, 11/26/25, 11/28/25, 12/03/25, 12/12/25, 12/15/25, and 12/17/25 stated, “Wound care done using clean technique, pt tolerated well.” The Notes Under the heading Wound Care stated, “Wounds Not Addressed This Visit” and no wound measurements were recorded. The SN notes included inaccurate documentation. 8. Pt. #16 was admitted for home health services on 12/16/25 with the diagnoses of, but not limited to, Unstageable pressure ulcer affecting contiguous sites of the back, buttock, and hip, and Pressure ulcer of left ankle stage 2. On 06/03/26 the clinical record for the certification period of 12/16/25 through 02/13/26 was reviewed. The SN Visit Notes under Skilled Intervention: Instruction/Assessment/Performance for 12/20/25, 12/24/25, 01/02/26, 01/09/26, 01/12/26 and 01/16/26 stated, “Wound care performed ...every M - W - F by home heath nurse.” The Notes under the heading Wound Care stated, “Wounds Not Addressed This Visit” and no wound measurements were recorded. The SN notes included inaccurate documentation. 9. Pt. #17 was admitted for home health services on 12/05/25 with the diagnosis of, but not limited to, Unspecified open wound of left elbow subsequent encounter. On 06/03/26 the clinical record for the certification period of 12/05/25 through 02/02/26 was reviewed. The SN Visit Notes under Skilled Intervention: Instruction/Assessment/Performance for 12/10/25, 12/12/25, 12/15/25, 12/17, and 12/19/25 stated, “Wound care done using clean technique.” The Notes under the heading Wound Care stated, “Wounds Not Addressed This Visit” and no wound measurements were recorded. The SN notes included inaccurate documentation. 10. During an interview with the Director of Clinical Services, Assistant Administrator, and Office Manager on 06/03/26 from 2:30 PM to 4:30 PM the above findings were confirmed. Findings include: 1. Pt. # 6 was admitted to home health services on 04/17/26 with the diagnosis of Polyosteoarthritis. The clinical record was reviewed on 06/02/26. The record indicated that SN visits were provided on 05/14/26, 05/18/26, 05/22/26 and 05/25/26. As of 06/02/26, the SN visit notes were not incorporated in the clinical record. During a home visit was conducted for Pt. #6 with the LPN on 06/02/26, the LPN confirmed the above finding and stated, “I’m a little behind” on the visit notes. 2. Pt. #9 was admitted to home health services on 04/17/26 with the diagnosis of Primary Osteoarthritis. The clinical record was reviewed on 06/03/26. The record indicated that a PT treatment and supervisory visit was provided on 05/15/26. As of 06/03/26, the PT visit note was not yet incorporated in the clinical record. 3. Pt. # 10 was admitted to home health services on 05/05/26 with the diagnosis of Hemiplegia following nontraumatic intracerebral hemorrhage affecting left non-dominant side. The clinical record was reviewed on 06/03/26. The record indicated that SN visits were provided on 05/15/26, 05/22/26 and 05/29/26. As of 06/03/26, the SN visit notes were not incorporated in the clinical record. 4. On 06/03/26, the Agency presented staff orientation guidelines when they were requested to present their policy on clinical documentation. The document titled, “Timelines” was reviewed included the following documentation: “Visits. All paperwork to be in by Saturday 11 AM. Bring it in or fax it by 11 AM. The document titled, “Guidelines for Therapies” was reviewed and required, “Documentation shall be completed within 24 hours of visit. “”