Angels Home Healthcare Services, 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 a review of the Agency’s OASIS submission report and staff interview it was determined that the Agency failed to submit OASIS assessment within the required time frame. Findings include: 1. The Agency’s OASIS submission report was reviewed on 06/11/24. The report contained information that out of the Agency’s 60 OASIS initial assessment reports, 13.33% were submitted beyond the required time frame of 30 days. 2. During an interview with the Director of Nursing on 6/13/24 at 10:30am. The Director of Nursing stated that Agency staff is not completing documentation on time causing the late submission. The Director of Nursing confirmed the Agency’s late OASIS submission.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on review of clinical records and staff interview, it was determined that in 2 of 7 (Pts. # 3 and 4) clinical records, the Agency failed to ensure the Plan of Care contained patient-specific interventions related/indicated for a pertinent Diagnosis. Findings include: 1. Pt. #3 was admitted to Home Health Services on 02/29/24 with Diagnosis Pressure Ulcer of Right Heel, Stage 4. The clinical record was reviewed on 06/12/24. The POC effective 04/28/24 to 06/27/24, included orders for discipline and treatment: “Notify Physician…. Blood sugar, Fasting….Blood Sugar, Random…” The POC included a blood sugar assessment intervention that was not indicated for Pt.#3’s diagnosis. During a home visit with Employee #3 (visiting RN) on 06/12/24 at 11:30 AM, Pt. #3 and family stated and confirmed that Pt. does not have a history or current diagnosis of Diabetes/Hyperglycemia. 2. Pt. #4 was admitted to Home Health Services on 03/16/24 with Diagnosis of Unspecified Fracture of Right Femur, subsequent encounter for closed fracture with routine healing. The clinical record was reviewed on 06/11/24. The PsOC effective 03/16/24 to 05/14/24 and 05/15/24 to 07/13/24, included orders for discipline and treatment: “Notify Physician…. Blood Sugar, Fasting….Blood Sugar, Random…” The POC included a blood sugar assessment intervention that was not indicated for Pt. #4’s diagnosis. 3. During an interview with the Director of Nursing on 06/13/24 at 11:00 AM, the Director of Nursing confirmed the above findings.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on clinical records review and staff interview it was determined the Agency failed to ensure staff provided services ordered by the physician in the plan of care. This was found in 5 of 7 (Pts # 7, 2, 3, 4, and 6) clinical records reviewed. 2. Pt. # 2 was admitted to Home Health Services on 02/19/24 with Diagnosis of Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris. The clinical record was reviewed on 06/12/24. The signed POC for certification period of 02/19/24 to 04/18/24, required to notify Physician of vital sign parameters out of range: “…. Diastolic BP: …. Less Than ( There was no documentation that Physician was notified of Diastolic BP of falling outside parameters as ordered in the POC. 3. Pt. #3 was admitted to Home Health Services on 02/29/24 with Diagnosis Pressure Ulcer of Right Heel, Stage 4. The clinical record was reviewed on 06/12/24. The POC for certification period of 04/28/24 to 06/27/24, required to notify Physician of vital sign parameters out of range: “…. Diastolic BP….Less Than( The SN visit dated 05/29/24, documented a diastolic BP of “52.” There was no documentation that Physician was notified of Diastolic BP of falling outside parameters as ordered in the POC. 4. Pt. #4 was admitted to Home Health Services on 03/16/2024 with Diagnosis of Unspecified Fracture of Right Femur, Subsequent for Closed Fracture. The clinical record was reviewed on 06/11/2024. The POC for certification period of 03/16/24 to 05/14/24, required SN frequency of 1 time a week for 9 weeks. The clinical record lack an SN visit for the week of 05/05/24 to 05/11/24. There was no modification in Physician orders or a communication indicating why no visits were done as ordered in the POC. 5. Pt. #6 was admitted to Home Health Services on 01/13/24 with Diagnosis of Lymphedema. The clinical record was reviewed on 06/11/24. The signed PT POC for certification period of 03/13/24 to 05/11/24, required PT frequency of 2 wk 6, 1 wk 1. The PT documented visits 1 time a week for on the following dates 03/16/24 (PT evaluation, week 1), 03/21/24 (week 2) and 03/26/24 (week 3). There was no modification or communication as to why PT visits were not done 2 times a week as ordered in the POC. 6. During interviews with Director of Nursing on 06/13/24 at 10:00 AM to 12:30 PM, the Director of Nursing confirmed the above findings. Findings include: 1. Pt. # 7 was admitted to Home Health Services on 01/11/24 with Diagnosis of Unspecified dementia, unspecified severity, with agitation. The clinical record was reviewed on 06/12/24. The clinical record contained a POC for certification period 03/11/24 to 05/09/24 that required PT to evaluate status and Aide services 2 times a week for 9 weeks. The record lacked PT evaluation and Aide services for certification period of 03/11/24.”