Parkview Health at Home 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 record review and interview, the agency failed to submit OASIS assessments within 30 days for 47 of 5741 assessments completed in calendar year 2025. Findings include: Review of the Internet Quality Improvement and Evaluation System HHA Error Summary by Agency evidenced 47 of 5741 assessments submitted more than 30 days after the date of assessment. During an interview on 03/30/2026 during the entrance conference, the Administrator indicated the agency had some assessments that were not submitted on time.”

“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 record review and interview, the agency failed to ensure the POC was based on the patient’s assessed needs for 1 of 6 patients with a home visit observation who received a skilled service in addition to skilled nursing (Patient #2). Findings include: 1.Patient #2’s clinical record evidenced a SOC of 03/14/2026. The POC for certification dates 03/14/2026 – 05/12/2026 evidenced an order for PT visits for 7 weeks, effective 03/15/2026. The POC also included goals for the PT visits. The POC included an order for OT visits for 5 weeks, effective 03/15/2026. The POC also included goals for the OT visits. The clinical record evidenced an OT evaluation completed on 03/16/2026 and a PT evaluation completed 03/17/2026. The PT and OT developed POC goals prior to assessing Patient #2’s needs. The agency failed to ensure the POC was developed based on the results of the comprehensive assessment. During an interview on 04/07/2026 beginning at 11:23 AM, the Administrator could not explain how the goals were on the POC when the evaluations were after the development of the POC. 410 IAC 17-13-1(a)”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observation and interview, the agency failed to ensure hand hygiene was performed after the aide touched a contaminated surface and before providing direct patient care, for 1 of 1 observation of an aide providing care (HHA 1). Findings include: 1.A home visit observation of HHA 1 and Patient #6 occurred on 04/01/2026 beginning at 10:10 AM. During the visit, HHA 1 prepared to provide personal care to Patient #6. HHA completed hand hygiene and donned gloves. Prior to beginning care, HHA 1 moved a trash can closer to her work area. HHA 1 provided care without performing hand hygiene and donning new gloves. During an interview at the end of the home visit, HHA 1 confirmed they did not perform hand hygiene after she touched a contaminated surface. HHA 1 indicated she knew she should have performed hand hygiene. 410 IAC 17-12-1(m)”

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure patients received all services ordered in the plan of care for 2 of 18 active patients reviewed (Patients #4 and 18). Findings include: 1. Patient #4’s clinical record evidenced an order for an OT evaluation effective 03/16/2026. The OT completed the evaluation on 03/26/2026. The OT failed to ensure Patient #4 received the services as ordered by the physician. During an interview on 04/09/2026 beginning at 02:37 PM, the Administrator indicated an evaluation with an effective date should be done during that calendar week. 2. Patient #18’s clinical record evidenced a POC for certification period 02/05/2026 – 04/05/2026. The POC included an order for SN visits once every other week. The record evidenced a SN visit on 02/04/2026 to complete the recertification assessment. The next SN visit occurred on 02/18/2026, with the next visit on 03/18/2026. The nurse failed to provide a visit every other week. During an interview on 04/09/2026 beginning at 02:37 PM, the Clinical Supervisor indicated Patient #18 should only receive SN visits once per month. The Clinical Supervisor failed to provide a physician order for SN once per month.”

“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 record review and interview, the home health agency failed to ensure the initial assessment was completed within 48 hours of discharge for 1 of 9 active patients with home visits observations (Patient #5). Findings include: 1. Review of the Comprehensive Patient Assessment policy, revised 9/15/25, indicated “… The initial assessment visit must be conducted within 48 hours of referral, or within 48 hour of the patient’s return home, or on the physician/ allowed practitioner-ordered Start of Care (SOC) date…” 2. Review of Patient #5’s clinical record included a referral form dated 3/16/26 for SN, PT, and OT with a facility discharge date of 3/17/26. The record also included a coordination note by Corporate Sales Team Member 1 dated 3/19/26 which indicated the first call was attempted to Patient #9. The clinical record also included an initial comprehensive assessment by RN 8 dated 3/20/26. The record failed to evidence the initial assessment was conducted within 48 hours of the referral. 3. During an interview on 4/08/26 at 11:07 AM, Corporate Sales Team Member 1 relayed she attempted the first call to Patient #5 to schedule the initial assessment on 3/19/26 at 11:09 AM because he was discharged on 3/17/26, but the agency had to get an order for SOC on 3/20/26 due to the agency could not see Patient #5 prior to that due to staffing availability. 4. During an interview on 4/8/26 at 12:11 PM, the Clinical Supervisor relayed Patient #9 had a physician-ordered SOC date. 5. During an interview on 4/8/26 at 12:13 PM, the Administrator relayed if the sales team knows the agency doesn’t have staffing they will notify the physician they can refer elsewhere or provide an order for the SOC date. 410 IAC 17-14-1(a)(1)(A)”

“5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care. This Element is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure a complete comprehensive assessment including all ordered disciplines was completed within 5 days of SOC for 2 of 16 active patient records reviewed of patients admitted in 2024 or later (Patient #12 and 14). 3. Patient #14’s clinical record indicated a SOC of 02/05/2026. A physical therapy evaluation occurred on 02/11/2026, six days after the SOC. An MSW evaluation occurred on 02/12/2026, seven days after the start of care. The agency failed to ensure the PT and MSW completed their evaluations within 5 days of the SOC. During an interview on 04/09/2026 beginning at 02:37 PM, the Administrator indicated the PT and MSW evaluations were not completed within the 5 days of the SOC. Findings include: 1. Review of the Comprehensive Patient Assessment policy, revised 9/15/25, indicated “… The comprehensive assessment must be completed within five (5) calendar days after the Start of Care (SOC). This completion must be consistent with the patient’s immediate needs…” 2. Review of Patient #12’s clinical record included a PT SOC date of 3/09/26. The record included a verbal order received on 3/13/26 at 9:18 AM for OT to evaluate the week of 3/16/26. The order failed to indicate a reason for the delay past the five day assessment window. The clinical record failed to evidence a reason for the OT evaluation being more than five days after the PT SOC assessment. During an interview on 4/09/26 at 4:02 PM, OT 2 relayed she believed Patient #12’s OT evaluation was not completed within five days of the SOC because the Patient had a weird phone system and OT 2 having trouble contacting the Patient. OT 2 indicated that information was not documented in the clinical record. During an interview on 4/09/26 at 4:25 PM, the Clinical Supervisor relayed she could see OT 2 had requested orders to move Patient #12’s OT evaluation to the following week but did not see why.”

“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 observation, record review, and interview, the home health agency failed to ensure the patient’s medications were accurately assessed for 2 of 9 patients with home visit observations (Patient #3 and 9). Findings include: 1. Review of the Comprehensive Patient Assessment policy, revised 9/15/25, indicated “… The comprehensive assessment will accurately reflect the patient’s status across multiple domains and will include, at a minimum, the following information… A review of all current medications to identify potential adverse effects, drug reactions, ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and non-compliance…” 2. Review of the Medication Profile policy, revised 1/21/25, indicated “… The assessment review will identify current medications taken… The current medication regimen will be recorded on the patient medication profile…” 4. A home visit observation of RN 6 providing care for Patient #9 was conducted on 4/02/26 at 1:56 PM. During the visit, Patient #9 relayed they received infusions of Keytruda (a medication used to treat multiple types of cancers) at the infusion clinic every three weeks. Patient #9 also showed their bottle of pregabalin (a medication used to treat nerve pain, fibromyalgia, and seizures) 75 milligrams capsules. Patient #9 relayed they had been taking pregabalin for three years and were still taking it. Patient #9 also relayed they had never taken hydroxyzine, that it had been prescribed in the nursing home but never administered. Patient #9 relayed they did not have hydroxyzine in the home. Review of Patient #9’s clinical record included a medication profile. The medication profile failed to include Keytruda and failed to include pregabalin as an active medication. The medication profile also failed to exclude the hydroxyzine Patient #9 was not taking. During an interview on 4/07/26 at 2:56 PM, RN 7 relayed she completed Patient #9’s SOC assessment on 3/07/26. RN 7 indicated she could not answer why hydroxyzine was included on Patient #9’s medication profile. RN 7 also relayed she did not recall why pregabalin was removed from the Patient’s active medication profile. RN 7 also indicated she was not aware Patient #9 was receiving Keytruda. During an interview on 4/08/26 at 1:31 PM, Patient #9 relayed they had been receiving Keytruda infusions since November of 2025. 410 IAC 17-141(a)(1)(B) 4. A home visit observation with RN 1 and Patient #3 occurred on 03/31/2026 beginning at 11:28 AM. During the visit, RN 1 asked Patient #3 if they were still receiving infusions. Patient #3 confirmed they were receiving infusions. A review of the medication profile provided for the visit failed to include any infusion therapy. During an interview on 04/08/2026 beginning at 10:56 AM, RN 1 stated that Patient #3 received an infusion of fluids. When asked, RN 1 was unsure whether the infusion was required to be listed on the medication profile. Findings include: 1. Review of the Comprehensive Patient Assessment policy, revised 9/15/25, indicated “… The comprehensive assessment will accurately reflect the patient’s status across multiple domains and will include, at a minimum, the following information… A review of all current medications to identify potential adverse effects, drug reactions, ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and non-compliance…” 2. Review of the Medication Profile policy, revised 1/21/25, indicated “… The assessment review will identify current medications taken… The current medication regimen will be recorded on the patient medication profile…” 3. A home visit observation of RN 6 providing care for Patient #9 was conducted on 4/02/26 at 1:56 PM. During the visit, Patient #9 relayed they received infusions of Keytruda (a medication used to treat multiple types of cancers) at the infusion clinic every three weeks. Patient #9 also showed their bottle of pregabalin (a medication used to treat nerve pain, fibromyalgia, and seizures) 75 milligrams capsules. Patient #9 relayed they had been taking pregabalin for three years and were still taking it. Patient #9 also relayed they had never taken hydroxyzine, that it had been prescribed in the nursing home but never administered. Patient #9 relayed they did not have hydroxyzine in the home. Review of Patient #9’s clinical record included a medication profile. The medication profile failed to include Keytruda and failed to include pregabalin as an active medication. The medication profile also failed to exclude the hydroxyzine Patient #9 was not taking. During an interview on 4/07/26 at 2:56 PM, RN 7 relayed she completed Patient #9’s SOC assessment on 3/07/26. RN 7 indicated she could not answer why hydroxyzine was included on Patient #9’s medication profile. RN 7 also relayed she did not recall why pregabalin was removed from the Patient’s active medication profile. RN 7 also indicated she was not aware Patient #9 was receiving Keytruda. During an interview on 4/08/26 at 1:31 PM, Patient #9 relayed they had been receiving Keytruda infusions since November of 2025. 4. A home visit observation with RN 1 and Patient #3 occurred on 03/31/2026 beginning at 11:28 AM. During the visit, RN 1 asked Patient #3 if they were still receiving infusions. Patient #3 confirmed they were receiving infusions. A review of the medication profile provided for the visit failed to include any infusion therapy. During an interview on 04/08/2026 beginning at 10:56 AM, RN 1 stated that Patient #3 received an infusion of fluids. When asked, RN 1 was unsure whether the infusion was required to be listed on the medication profile. 410 IAC 17-141(a)(1)(B)”

“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, record review, and interview, the home health agency failed to ensure all equipment and supplies used by the patient were included in the POC for 1 of 9 patient records reviewed with home visit observations (Patient #8). Findings include: 1. Review of the Plan of Care and Physician and Allowed Practitioner Orders policy, revised 3/05/24, indicated “… The POC must include… Types of supplies… Types of equipment…” A home visit observation of the ST providing care for Patient #8 was conducted on 4/02/26 at 12:32 PM. Observed Patient #8 wearing eyeglasses and bilateral hearing aids. Review of Patient #8’s clinical record included a POC for certification period 2/25/26 to 4/25/26. The POC failed to include eyeglasses or hearing aids. The POC also included Plavix (an antiplatelet medication used to prevent blood clots) 75 milligrams daily. The POC failed to include antiplatelet or bleeding safety precautions. During an interview on 4/08/26 at 11:44 AM, RN 5 relayed she completed Patient #8’s recertification assessment and POC. RN 5 also relayed eyeglasses and hearing aids should be included in the POC but indicated she did not see them listed in Patient #8’s POC. RN 5 indicated Plavix was not a new medication so there were no safety measures specific to it on the current POC. 410 IAC 17-13-1(C)(ii) and (x)”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the SN updated wound care orders for 1 of 2 patients with wounds who had home visit observations (Patient #3). Findings include: 1.Patient #3’s clinical record included a ROC assessment completed by RN 1 on 02/27/2026. RN 1 documented the wound care she did included the use of normal saline to cleanse and pack the wound. An order dated 03/05/2026 indicated RN 1 entered the wrong wound care order on the ROC. The order should have included the use of Vashe (a brand of wound cleanser) instead of normal saline. During an interview on 04/08/2026 beginning at 10:57 AM, RN 1 stated she had used the new order from the hospital discharge instructions when she performed wound care on 02/27/2026. RN 1 acknowledged that she failed to update the wound care orders in the system, which resulted in the note not populating the new order into the “wound care provided” section. 410 IAC 17-13-1(a)(1)(B)(4)”

“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 record review and interview, the home health agency failed to ensure provider orders were received prior to providing services for 1 of 18 active patient records reviewed (Patient #9). Findings include: 1. Review of the Plan of Care and Physician and Allowed Practitioner Orders policy, revised 3/05/24, indicated “… All care and services provided are according to current physician or allowed practitioner orders…” 2. Review of Patient #9’s clinical record included a POC for certification period 3/07/26 to 5/05/26 which was returned signed by the physician on 3/16/26 and included but was not limited to orders effective 3/08/26 for PT one visit per week for one week. A separate physician order form completed by PT 3 on 3/09/26 was returned signed by the physician on 3/16/26 at 3:58 PM with orders for PT effective 3/08/26 for one visit per week for one week then two visits per week for three weeks then one visit per week for four weeks. The record included a coordination note completed by PT 3 on 3/13/26 which indicated PT 3 received a verbal order from the physician on 3/13/26 at 9:13 AM for PT two times per week for three weeks then one time per week for four weeks. The clinical record failed to evidence a valid verbal order was obtained for PT services for Patient #9. The record included a PT visit note completed by PT 3 for a visit on 3/16/26 which began at 2:07 PM, prior to the agency receiving the signed written order for PT services from the physician. During an interview on 4/09/26 at 3:07 PM, PT 3 relayed she did not get the verbal order for the PT frequency for Patient #9. PT 3 relayed a phone nurse had obtained the verbal order, but PT 3 entered the verbal order into the coordination note. During an interview on 4/09/26 at 4:23 PM, the Clinical Supervisor relayed whoever actually spoke to the provider should be the one to put the verbal order into the clinical record.”

“Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA’s internal policies. (4) When services are provided on the basis of a physician or allowed practitioner’s verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA’s policies, must document the orders in the patient’s clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA’s internal policies. This Element is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure verbal orders were authenticated by the physician for 4 of 18 active patient records reviewed (Patient #5, 9, 10, and 12). Findings include: 1. Review of the Plan of Care and Physician and Allowed Practitioner Orders policy, revised 3/05/24, indicated “… All verbal orders are verified by a ‘read back’ of the complete order by the person receiving the order… All signed physicians’ and allowed practitioners’ POCs and verbal orders received back to the Organization contain the order time and date…” 2. Review of Patient #5’s clinical record included a POC for certification period 3/20/26 to 5/18/26 which included but was not limited to orders for SN one visit per week for five weeks then one visit every two weeks for four weeks and three as needed visits. The POC also included but was not limited to orders effective 3/22/26 for PT one visit per week for four weeks. The POC was signed by the provider and returned to the agency on 3/30/26. The POC included a verbal date and time of 3/23/26 at 9:00 AM. The record also included a coordination note completed by RN 8 which indicated the RN received a verbal order directly from the physician on 3/23/26 at 7:35 AM for SN one time per week for four weeks and then every two weeks for four weeks for neurological checks, hypertension education, genitourinary education, fall risk education, pain assessments, medication education, and skin assessments. The record failed to evidence the verbal order was read back and verified and failed to evidence the order sent to the physician for signature included the time the verbal order was received. A separate physician order form was completed by PT 1 on 3/25/26 with orders for PT effective 3/22/26 for one visit per week for four weeks which indicated it was not to be sent to the physician. The record included a coordination note completed by PT 1 on 3/30/26 which indicated PT 1 received a verbal order through secure electronic messaging directly from the physician on 3/26/26 at 10:35 AM for PT one time per week for three weeks for therapeutic exercise, neuromuscular education, gait training, and therapeutic activity. The clinical record failed to evidence the order sent to the physician for signature included the date and time the verbal order was received. During an interview on 4/06/26 at 3:26 PM, PT 1 relayed she had documented the physician’s orders for Patient #5’s PT services in a coordination note. PT 1 also relayed the verbal order date and time on the separate PT order was the date the verbal order was requested, not the date the verbal order was received. During an interview on 4/09/26 at 4:10 PM, the Clinical Supervisor relayed the verbal order time of 7:35 AM for SN services for Patient #5 was not included in the POC sent to the physician for signature. 3. Review of Patient #9’s clinical record included a POC for certification period 3/07/26 to 5/05/26 which included but was not limited to orders for SN one visit per week for nine weeks and three as needed visits. The POC also included but was not limited to orders effective 3/08/26 for PT one visit per week for one week. The POC was signed by the provider and returned to the agency on 3/16/26. The POC included a verbal date and time of 3/09/26 at 9:00 AM. The record also included a coordination note completed by RN 7 which indicated the RN received a verbal order from the physician’s nurse on 3/09/26 at 11:05 AM for SN one time per week for nine weeks and for PT and OT to evaluate the patient. The record failed to evidence the verbal order was read back and verified and failed to evidence the order sent to the physician for signature included the verbal order time. During an interview on 4/07/26 at 2:56 PM, RN 7 relayed the date and time she received the verbal order for Patient #9’s SN frequency was on 3/09/26 at 11:05 AM and relayed she documented the verbal order in a coordination note. During an interview on 4/09/26 at 3:09 PM, the Clinical Supervisor indicated an order with the time the verbal order was received for Patient #9’s SN frequency was not sent to the physician for signature and indicated the coordination note documenting the verbal order did not specify the verbal order was read back and verified. 4. Review of Patient #10’s clinical record included a POC for certification period 3/20/26 to 5/18/26 which included but was not limited to orders for PT, one visit per week for one week then two visits per week for two weeks then one visit per week for four weeks. The POC was signed by the provider and returned to the agency on 3/20/26. The POC included a verbal date and time of 3/09/26 at 11:58 AM. The record also included a coordination note completed by PT 3 which indicated the PT received a verbal order from the physician’s nurse through secure electronic messaging on 3/23/26 at 8:24 AM for PT frequency and skills to be performed. The record failed to evidence the order sent to the physician for signature included the verbal order time. During an interview on 4/09/26 at 3:13 PM, PT 3 relayed she received the verbal order for Patient #10’s PT frequency on 3/23/26 at 8:24 AM through a secure electronic message and relayed she documented the verbal order in a communication note. 5. Review of Patient #12’s clinical record included a POC for certification period 3/09/26 to 5/07/26 which included but was not limited to orders for PT one visit per week for one week then two visits per week for three weeks then one visit per week for four weeks. The POC was signed by the provider and returned to the agency on 3/27/26. The POC included a verbal date and time of 3/09/26 at 12:00 PM. The record also included a coordination note completed by PT 4 which indicated the PT received a verbal order from the physician’s medical assistant on 3/09/26 at 1:21 PM for PT frequency and skills to be performed. The record failed to evidence the order was read back and verified and failed to evidence the order sent to the physician for signature included the verbal order time. During an interview on 4/09/26 at 4:25 PM, the Clinical Supervisor indicated the verbal time on the POC for Patient #12 was 12:00 PM and relayed the verbal order was documented as received at 1:21 PM in the coordination note. 6. During an interview on 4/07/26 at 4:07 PM, the Administrator relayed the date the verbal order was received should be documented on the order that was sent to the provider for signature. 7. During an interview on 4/09/26 at 4:20 PM, the Clinical Supervisor relayed the verbal date and time on the POC was the date and time the clinician requested the verbal order.”

“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 record review and interview, the home health agency failed to ensure HHAs were supervised by an RN at least every 14 days for 4 of 7 active patient records reviewed of patients receiving HHA services (Patient #7, 13, 15, and 16). 2. Patient #7’s clinical record evidenced a POC for the certification period 01/11/2026 – 03/11/2026, which indicated Patient #7 should receive HHA visits twice a week for 8 weeks. The record included supervisory visits on 02/17/2026 and 03/10/2026. The record indicated Patient #7 received HHA visits on 03/05/2026 and 03/09/2026. The HHA performed these visits without RN supervision. During an interview on 04/08/2026 beginning at 10:01 AM, RN 2 indicated supervisory visits were due every other week and there was a missing supervisory visit between 02/17/2026 and 03/10/2026. During an interview on 04/09/2026 beginning at 02:37 PM, the Clinical Supervisor indicated there was no supervisory visit between 02/17/2026 and 03/01/2026. Findings include: 1. Review of the Supervision of Home Health Aides policy, revised 3/10/26, indicated “… If the patient receives skilled nursing care, the Registered Nurse (RN), or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days…” 3. Review of Patient #13’s clinical record included HHA visit notes dated 2/25/26, 3/06/26, and 3/18/26. The clinical record failed to include any HHA supervisory visits. During an interview on 4/09/26 at 4:21 PM, the Clinical Supervisor relayed there were no HHA supervisory visits conducted for Patient #13. 4. Review of Patient #15’s clinical record included HHA visit notes on 2/03/26, 2/10/26, and 2/13/26. The record also included a SN visit note dated 1/26/26 which included HHA supervisory visit documentation. The record included an RN recertification with SN note dated 2/23/26, 28 days later, which included HHA supervisory visit documentation. The clinical record failed to include an HHA supervisory visit at least every 14 days. During an interview on 4/08/26 at 10:12 AM, RN 2 relayed she could not look back in the EMR to the previous certification period to see whether an HHA supervisory visit was conducted for Patient #15 between 1/26/26 and 2/16/26. During an interview on 4/08/26 at 12:20 PM, the Clinical Supervisor relayed the type of supervisory note in the EMR for Patient #15 on 2/02/26 did not give the ability to document the HHA’s name or the supervisory questions. 5. Review of Patient #16’s clinical record included HHA visit notes dated 2/18/26, 2/25/26, 3/11/26, 3/19/26, 3/27/26, and 4/02/26. The clinical record included a SN visit note dated 2/17/26 which included HHA supervisory visit documentation. The record failed to include any further HHA supervisory visits as of 4/08/26, 50 days later. During an interview on 4/08/26 at 2:17 PM, RN 4 relayed she conducted HHA supervisory visits at least every 30 days including for patients receiving skilled services. RN 4 also relayed Patient #16 had not received an HHA supervisory visit after the one conducted on 2/17/26. RN 4 further indicated the supervisory visit on the 3/17/26 SN visit note should have been for the HHA but was conducted for a nurse trainee. During an interview on 4/08/26 at 2:58 PM, the Clinical Supervisor relayed there were no HHA supervisory visits conducted for Patient #16 after the one on 2/17/26. 6. During an interview on 4/08/26 at 12:11 PM, the Clinical Supervisor relayed HHA supervisory visits should be conducted every 14 days.”