Horizon Home Health Care, Inc.

“EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.542(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, REHs at §485.542, OPO, “Organizations” under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility’s] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility’s] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient’s home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice’s response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice’s emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility’s] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility’s] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE’s response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE’s emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility’s emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID’s emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA’s emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO’s response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI’s and OPO’s] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI’s response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI’s emergency plan, as needed. This Standard is not met as evidenced by: Based on a review of the Agency’s Emergency Preparedness Plan and staff interview, the Agency failed to conduct testing of the Agency’s Emergency Preparedness Plan. Findings Include: 1. The Agency’s Emergency Preparedness Plan was reviewed on 12/22/25. The Emergency Preparedness Plan lacked documentation indicating that the Agency conducted any testing of the Plan since 2021. 2. During an interview with the DON, Assistant Administrator and Intake Coordinator on 12/24/25 at 9:30 AM the DON confirmed the above finding.”

“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 34 of 238 assessments submitted for the last 12 months, the Agency failed to submit all reports within 30 days after the assessment was completed resulting in a warning. Findings include: 1. The Error Summary report for 10/01/24 to 11/21/25, was reviewed on 12/22/25 at 9:30 AM. The report included error # -3330 for 34 of 238 late submissions, 14.29% of the OASIS reports submitted, were more than 30 days after the assessment was completed. 2. During an interview with the Alternate Administrator, DON and Intake Coordinator on 12/23/25 at 11:30 AM, it was confirmed that 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 clinical record review, policy review and staff interviews for 3 of 7 (Pts. #4, #5 and #7) clinical record reviews, the Agency failed to ensure that an individualized POC was developed and followed. 3. Pt. # 7 was admitted to home health services on 04/11/25 with diagnosis of Candidiasis of skin and nail. The clinical record was reviewed on 12/23/25. The clinical record included a POC for certification period 08/09/25 to 10/07/25, the POC required SN frequency of 1 time a week for 9 weeks. The clinical record lacked SN visits for weeks 2, 3 and 4 of certification period. No other physician orders were found in the record. 4. The Agency policy “Plan of Care - CMS #485 and Physician/Practitioner Orders” was reviewed on 12/23/25 and required, “Policy: The Agency will provide the patient and caregiver written instructions related to the plan of care.... Procedure: 2. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan if care must specify the care and services necessary to meet the patient specific as identified in the comprehensive assessment...20. Care and services will be provided according to physician/practitioner orders. Orders are current and updated.” 5. Findings of Agency not creating PsOC and providing services indicated in the PsOC were confirmed during interviews with the DON, Assistant Administrator and Intake Coordinator on 12/23/25 at 11:30 AM and on 12/24/25 at 9:30 AM. Findings include: 1. Pt. #4 was admitted for home health services on 11/05/25 with the diagnosis of Polyosteoarthritis. The clinical record was reviewed on 12/22/25. As of 12/23/25, the record lacked a POC for the certification period effective 11/05/25. 2. Pt. #5 was admitted for home health services on 12/03/25 with the diagnosis of Hypertensive heart disease with heart failure. The clinical record was reviewed on 12/22/25. As of 12/23/25, the record lacked a POC for the certification period effective 12/03/25.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on home visit observations SN/Pt. interview, clinical records review and staff interview in 2 of 3 home visits (Pts # 2 and 3) the Agency failed to ensure that patient medication profile included all medications that the patient is currently taking. 2. Pt. #3 was admitted to home health services on 07/03/25 with diagnoses of Hypomagnesemia and Hypokalemia. A skilled nurse home visit was conducted on 12/23/25. During the home visit, the Pt’s medications were reviewed. The clinical record of Pt #3 was reviewed on 12/23/25. The clinical record included a Medication Profile for episode period of 11/25/25 to 01/23/25 and listed the following medications: Potassium Chloride ER 20 MEQ 1 tablet daily, Magnesium Oxide 400 mg 1 tablet 2 times a day, Vitamin B1 1 tablet daily, Famotidine 20 mg 1 tablet 2 times a day. During the home visit the SN brought in a bag containing “all the medications that (Pt. #3) is currently taking...” The above-mentioned medications were not in that bag. No modification physician orders were found in the record. The medication profile also included documentation of duplicate prescription for magnesium and tamsulosin. 3. An interview was conducted with the Alternate Administrator, DON and Intake Coordinator on 12/24/25 from 9:00 AM to 10:00 AM. During the same interview, the above findings were confirmed. 1. Pt. #2 was admitted to home health services on 07/03/25 with diagnosis of Lumbago with Sciatica Right Side. A skilled nurse home visit was conducted on 12/22/25. During the home visit an interview was conducted with Pt.#2 and agency’s SN. During the interview the patient stated that for pain management she takes “tramadol and Ibuprofen”. The clinical record of Pt #2 was reviewed on 12/22/25 and on 12/23/25. The clinical record included a Medication Profile for episode period of 10/31/25 to 12/29/25 the medication profile did not include tramadol and Ibuprofen. No modification physician orders were found in the record.”

“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 home visit observations and staff interviews, in 3 of 3 (Pts. # 1, 2 and 3) home visits the Agency failed to provide the name and contact information of the Clinical Manager to the Pts. and their families on admission. Findings include: 1. The following patient home visits were conducted with an Agency staff between 12/22/25 and 12/23/25. During the home visits it was observed that the Patient Agency’s admission booklet did not include the name and contact information of the Agency’s Clinical Manager. Pt. # 1 SOC 09/11/25 - PT visit Pt. # 2 SOC 07/03/25 - SN visit Pt. # 3 SOC 06/13/25 - SN visit 2. During an interview with the DON, Assistant Administrator and Intake Coordinator on 12/24/25 at 9:30AM. the above finding was confirmed.”

“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 clinical record review and staff interview, in 1 of 1 (pt #7) clinical record reviewed with Aide services, the Agency failed to ensure the Home Health Aide was supervised by the RN every 14 days. Findings include: 1. Pt. # 7 was admitted to home health services on 04/11/25 with diagnosis of Candidiasis of skin and nail. The clinical record was reviewed on 12/23/25. The clinical record included a POC for certification period 08/09/25 to 10/07/25 that required SN frequency of 1 time a week for 9 weeks and Aide visit frequency of 2 times a week for 9 weeks. The record included completed Aide visits 2 times a week for the certification period. The clinical record lacked documentation indicating the RN supervised Aide services for the certification period. 2. Finding of the lack of Aide supervision by the RN, was confirmed during an interview with the DON, Assistant Administrator and Intake Coordinator on 12/24/25 at 9:30 AM.”