Chicagoland Home Health Provider, Inc.

“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 review of the Error Summary report and staff interview, it was determined that in 233 of 705 reports submitted for the last 12 months, the Agency failed to submit the report within 30 days after the assessment was completed resulting in a warning. Findings include: 1. The OASIS Error Summary report for 10/01/24 to 12/19/25 was reviewed on 12/29/25. The report included a warning for the error of 233 of the 705 assessments were submitted late; 33.05% of the OASIS reports were submitted more than 30 days after the assessment was completed. 2. During staff an interview with the Director of Nursing, on 12/31/25 at 9:30 AM, the above findings were confirmed.”

“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 a review of clinical records, Agency policy, and staff interview, in 2 of 7 (Pts. #4 and 6) clinical records reviewed, the Agency failed to obtain consent for treatment prior to providing Pt. care and/or services. Findings include: 1. Pt. #4 was admitted for Home Health service on 11/25/25 with the diagnosis of, but not limited to, Hypertensive Chronic Kidney Disease with Stage 5 Chronic Kidney Disease or End Stage Renal Disease. The clinical record was reviewed on 12/30/25. The clinical record contained the SOC assessment completed by the SN and dated 11/25/25, weekly SN visit notes from 12/04/25 to 12/18/25, PT evaluation dated 12/06/25, and weekly PT visit notes from 12/13/25 to 12/21/25. As of 12/30/25, the clinical record lacked a consent for treatment. 2. Pt. #6 was admitted for Home Health service on 08/25/25 with the diagnosis of, but not limited to, Muscular Dystrophy Unspecified. The clinical record was reviewed on 12/29/25. The clinical record contained the SOC assessment form completed by the PT and dated 08/25/25; PT and/or PTA visit notes for 1 to 2 times a week from 09/03/25 to 09/17/25, and 09/26/25 to 10/21/25; PT re-assessment form dated 09/19/25, weekly Home Health Aide visit notes from 08/29/25 to 10/21/25, and the Agency’s discharge assessment form completed by the PT on 10/27/25. As of 12/29/25, the clinical record lacked a consent for treatment. 3. The Agency policy titled; “Consent” was reviewed on 12/30/25 at 12:45 PM. The policy included, “…1. All care provided by the Agency requires consent for care. 2. At time of admission, the RN or appropriate therapist will obtain consent for care…” 4. During an interview with the Director of Nursing on 12/30/25 at 12:30 PM, the Director of Nursing confirmed the Agency failed to obtain consent for treatment.”

“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 staff interview, and a review of clinical records, in 3 of 7 (Pts. #4, 7, and 3) clinical records reviewed, the Agency failed to assess the patient’s need for the Pneumonia and/or Influenza vaccines. Findings include: 1. During the entrance interview with the Director of Nursing on 12/29/25 at 9:30 AM, the Director of Nursing stated that during the SOC visit, the clinician (RN or PT) is required to assess the patient’s need for the Pneumonia and Influenza vaccines during the SOC visit. The patient/patient’s caregiver response is documented on a standardized form which is entered in the patient’s clinical record. 2. Pt. #4 was admitted for Home Health service on 11/25/25 with the diagnosis of, but not, limited to, Hypertensive Chronic Kidney Disease with Stage 5 Chronic Kidney Disease or End Stage Renal Disease. The clinical record was reviewed on 12/30/25. As of 12/30/25, the clinical record lacked documentation the admitting clinician (RN) assessed the patient’s need for the Pneumonia and Influenza vaccines. 3. Pt. #7 was admitted for Home Health service on 03/14/25 with the diagnosis of, but not, limited to, Constipation Unspecified. The closed clinical record was reviewed on 12/29/25. As of 12/29/25, the closed clinical record lacked documentation the admitting clinician (RN) assessed the patient’s need for the Pneumonia vaccine. 4. During an interview with the Director of Nursing on 12/30/25 at 12:30 PM, a request was made to review the Agency’s policy pertaining to Pneumonia and Influenza vaccinations of Pts. As of 12/30/25, the Agency was unable to provide a policy. 5. Pt. #3 was admitted for Home Health services on 08/27/25 with the diagnosis of Other Intervertebral Disc Degeneration, Lumbar Region with Discogenic Back Pain Only. The clinical record was reviewed on 12/29/25. As of 12/29/25, the clinical record lacked documentation of Pneumococcal inquiry and or the patient’s need for the Pneumonia vaccine. 6. During an interview with the Director of Nursing on 12/30/25 at 12:30 PM and 1:45 PM, the Director of Nursing confirmed the above findings. Findings include: 1. During the entrance interview with the Director of Nursing on 12/29/25 at 9:30 AM, the Director of Nursing stated that during the SOC visit, the clinician (RN or PT) is required to assess the patient’s need for the Pneumonia and Influenza vaccines during the SOC visit. The patient/patient’s caregiver response is documented on a standardized form which is entered in the patient’s clinical record. 2. Pt. #4 was admitted for Home Health service on 11/25/25 with the diagnosis of, but not limited to, Hypertensive Chronic Kidney Disease with Stage 5 Chronic Kidney Disease or End Stage Renal Disease. The clinical record was reviewed on 12/30/25. As of 12/30/25, the clinical record lacked documentation the admitting clinician (RN) assessed the patient’s need for the Pneumonia and Influenza vaccines. 3. Pt. #7 was admitted for Home Health service on 03/14/25 with the diagnosis of, but not limited to, Constipation Unspecified. The closed clinical record was reviewed on 12/29/25. As of 12/29/25, the closed clinical record lacked documentation the admitting clinician (RN) assessed the patient’s need for the Pneumonia vaccine. 4. Pt. #3 was admitted for Home Health services on 08/27/25 with the diagnosis of Other Intervertebral Disc Degeneration, Lumbar Region with Discogenic Back Pain Only. The clinical record was reviewed on 12/29/25. As of 12/29/25, the clinical record lacked documentation of Pneumococcal inquiry and or the patient’s need for the Pneumonia vaccine. 5. During an interview with the Director of Nursing on 12/30/25 at 12:30 PM, a request was made to review the Agency’s policy pertaining to Pneumonia and Influenza vaccinations of Pts. As of 12/30/25, the Agency was unable to provide a policy. 6. During an interview with the Director of Nursing on 12/30/25 at 12:30 PM and 1:45 PM, the Director of Nursing confirmed the above findings.”

“If concern identified, direct observation CFR(s): 484.80(h)(1)(ii) The supervisory assessment must be completed onsite (that is, an in person visit), or on the rare occasion by using two-way audio-video telecommunications technology that allows for real-time interaction between the registered nurse (or other appropriate skilled professional) and the patient, not to exceed 1 virtual supervisory assessment per patient in a 60-day episode. This Element is not met as evidenced by: Based on a review of clinical records and staff interview, in 1 of 1 (Pt. #6) clinical record reviewed, wherein the Pt. received Home Health Aide services, the Agency failed to ensure onsite supervision was conducted. Findings include: 1. Pt. #6 was admitted for Home Health service on 08/25/25 with the diagnosis of, but not limited to, Muscular Dystrophy Unspecified. The clinical record was reviewed on 12/29/25. The clinical record contained documentation that PT and Home Health Aide services were provided during the certification period of 8/25/25 to 10/23/25. The Home Health Aide provided service weekly from 08/29/25 to 10/21/25. The Home Health Aide supervisory visit notes completed by the PT and dated 09/12/25, 09/26/25, and 10/10/25 included documentation that there was “Telephone feedback” from the Pt. and/or family member. The clinical record lacked documentation that the PT conducted Home Health Aide supervision in-person. 2. During an interview with the Director of Nursing on 12/30/25 at 12:30 PM, the Director of Nursing confirmed the Agency failed to ensure onsite Home Health Aide supervision was conducted.”