Healthy Health Home Health, Inc.

“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, in 7 of 7(Pts. #1, 2, 3, 4, 5, 6 and 7) clinical records reviewed, the Agency failed to provide Pts. information regarding the Agency’s transfer and discharge policies. Findings include: 1.The Agency’s Pt. admission folder was reviewed on 04/06/26. The folder lacked documentation of the Agency’s transfer and discharge policies. 2. The following home visits were conducted on 04/06/26 and 04/07/26. Pt. #1. SOC 01/17/26. Pt. #2. SOC 03/21/26. Pt. #3. SOC 02/09/26. During the home visits, the Pt. admission folders were observed, and lacked documentation of the Agency’s transfer and discharge policies. 3. The following clinical records were reviewed on 04/06/26 and 04/07/26: Pt. #1. SOC 01/17/26. Pt. #2. SOC 03/21/26. Pt. #3. SOC 02/09/26. Pt. #4. SOC 03/15/26. Pt. #5. SOC 03/16/26. Pt. #6. SOC 10/16/25. Pt. #7. SOC 12/08/25. The records lacked documentation the Agency provided Pts. information, regarding the Agency’s policies pertaining to transfer and discharge. 4. During the interview with the Agency Supervisor, on 04/09/26 at 9:45 AM, it was confirmed the Pt. Admission folder reviewed was used for all Pts. admitted to this Agency, and the Agency failed to provide Pts. information regarding the Agency’s transfer and discharge policies.”

“State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This Element is not met as evidenced by: Based on review of the Patient’s Admission Folder, clinical record review, and staff interview, the Agency failed to ensure Pts. were provided with the correct information to file a concern or complaint with the Illinois Department of Public Health. This was found in 7 of 7 clinical records reviewed (Pts. #1, 2, 3, 4, 5, 6, and 7). Findings include: 1. The Patient’s Admission folder was reviewed on 04/06/26 at 11:00 AM. The folder included a document with the following information regarding filing a complaint. “You have the right to complain to us and to the United States Secretary of Health and Human Services if you believe we have violated your privacy rights. There is no risk in filing a complaint. To file a complaint with us contact us by mail at: Our Designee: Nursing Supervisor, RN. 4747 Lincoln Mall Drive Suite 260, Telephone No (708) 283-0202.” “To file a complaint with the United States Secretary of Health and Human Services. Send your complaint to the Secretary at: Office of Civil Rights, U.S. Department of Health and Human Services: 200 Independence Ave SW. Washington, DC 20201.” The above address is inaccurate. The Agency failed to provide the Pts. and/or the patients’ representatives the State of Illinois’ toll free home health telephone hot line purpose and its contact information. 2. During an interview with the Agency Supervisor on 04/09/26 at 9:45 AM, the above findings were confirmed.”

“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 observation and interviews during home visits, clinical record review and staff interviews, for 3 of 7 Pts (Pts. #1, 6 and 7), the Agency failed to ensure that the PsOC included all the requirements. Findings include: 2. Pt. #6 was admitted to home health services on 10/16/25 with the diagnosis of Type 2 Diabetes Mellitus with hyperglycemia. The clinical record was reviewed on 04/08/26 and included a POC for the certification period of 12/15/25 to 02/12/26. The POC required, “SN assess patient on diabetic status…identify any signs and symptoms of hyper/hypoglycemia and report significant changes to physician…” The POC lacked documentation of blood glucose monitoring parameters to be reported to the physician. 3. Pt. #7 was admitted to home health services on 12/08/25 with the diagnoses of but not limited to Atherosclerosis of native arteries of the left leg with ulceration of other part of foot, Type 2 Diabetes Mellitus with hypoglycemia without coma and End Stage Renal Disease. The clinical record was reviewed on 04/09/26 and included a POC for the certification period of 12/08/25 to 02/05/26. The POC required “(Blood glucose checks) three times daily before meal…” The POC lacked documentation of blood glucose monitoring parameters to be reported to the physician. During an interview with the Agency Supervisor on 04/09/26 at 10:30 AM, it was confirmed the Pt. had dialysis treatments 3 times a week and that the dialysis access site should be inspected. The POC lacked documentation of the care of the dialysis access site and supplies used. 4. During an interview with the Agency Supervisor on 04/09/26 from 10:00 Am to 11:00 AM, the above findings were confirmed. 1. Pt. #1 was admitted to Home Health services on 01/17/26 with the diagnosis of Non pressure chronic ulcer of an unspecified part of the lower leg with unspecified severity. The clinical record was reviewed on 04/06/26. The POC for period of 03/18/26 to 05/16/6 has an order to apply negative pressure wound vac twice weekly on Mondays, then Thursdays by wound clinic. The order lacked a description of the directions for the application of the wound vac, a description of equipment used, and instructions to Pt. or caregiver regarding care and application of wound vac therapy. The SN notes dated, 02/09/26, 02/16/26, 02/23/26, 03/02/26 03/09/26, 03/23/26 and 03/30/26 documents the same entry “negative pressure wound vac was applied” during every visit where treatment was completed by SN.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on review of clinical records and staff interview, it was determined the Agency failed to ensure the Physician was sent a copy of the Transfer Summary. This was found in 1 of 2 (Pt. # 6) discharged clinical records reviewed. 1. Pt. #6 was admitted for home health services on 10/16/25 with the diagnosis of Type 2 Diabetes Mellitus with hyperglycemia. The record included a transfer assessment, indicating that Pt. #6 was transferred to an in-patient facility on 12/24/25. As of the date of the clinical record review on 04/08/26, the record lacked documentation that a complete copy of the transfer summary was sent to the physician and the hospital. 2. During an interview with the Director of Nursing on 04/09/26 at 11:00 AM, the above findings were confirmed.”