Metrowest Homecare and Hospice, An Amedisys Company

“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 document review and interview, the agency failed to electronically transmit completed Outcome and Assessment Information Set (OASIS-a group of standard data elements developed to enable systemic comparative measurements of home health care patient outcomes) assessments to the Centers for Medicare and Medicaid (CMS) system within the required 30 days of completing the assessments of the beneficiary. Finding include: Review of the agency policy titled, OASIS Outcome and Information Set, dated as last reviewed 6/9/25, included but was not limited to the following: *The agency will collect, encode, and electronically transmit OASIS data as stated in the CMS Federal Conditions of Participation. *The agency complies with OASIS data collection and submission requirements as outlined in the Conditions of Participation, electronically submitting OASIS data within 30 days of completing the OASIS assessment. Review of the Home Health Agency (HHA) Error Summary by Agency Report indicated the agency had 479 late OASIS Assessment submissions between 3/17/25 through 3/17/26, out of a total of 7097 assessments, which equaled a 6.75% error rate. During an interview on 3/20/26 at 1:34 P.M., the Administrator and surveyor reviewed the Error Summary by Agency Report. The Administrator said the revenue recovery team was responsible for overseeing the report. She said she had not been notified of any issues and had received no communication with regards to the late OASIS submission.”

“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, policy review, and interview, the agency failed to ensure infection control guidelines were maintained and the tablet computer (a portable, touchscreen device) used to document patient visits was sanitized after use during a home visit observation for 1 patient (#6), out of a total sample of 7 patient home visits. Findings include: Review of the agency policy entitled, Decontamination of Re-usable Equipment, reviewed 8/8/25, indicated the following: *Care of the agency-issued laptop or tablet includes surface cleaning and disinfection along with proper hand hygiene with laptop/tablet use. Patient #6 was admitted to the agency in December 2025 with a diagnosis of hypertensive heart disease and chronic kidney failure with heart failure (chronic high blood pressure causes both heart muscle changes and kidney damage). During a home visit on 3/18/26 at 1:30 P.M., the surveyor observed Nurse #1 complete her visit documentation on a tablet and handed the tablet to the patient. The patient signed the tablet digitally and handed the tablet to the nurse. Nurse #1 did not cleanse the tablet and exited the home. During an interview on 3/18/26 at 2:10 P.M., Nurse #1 said she did not cleanse the tablet after the home visit, as required.”

“Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This Standard is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure the individualized plan of care was signed timely by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration, for 5 patients (#1, #3, #4, #6 and #10), out of a total sample of 17 patients. Findings include: Review of the agency policy entitled, Plan of Care (POC) Planning Process, reviewed 2/9/26, indicated the following: *The Plan of Care will be forwarded to the physician/allowed practitioner for his/her review and should be received with dated signature within thirty (30) days. 1. Patient #1 was admitted to the agency in February 2026 with a diagnosis of cerebrovascular accident (CVA-stroke) with hemiplegia (partial or total loss of motor function on one side of the body). Review of the clinical record indicated a verbal order was obtained on 2/19/26 for the Home Health Certification and Plan of Care (POC) for certification period 2/19/26 through 4/19/26. Further review of the clinical record indicated the POC had not been signed by the physician. 2. Patient #3 was admitted to the agency in February 2026 with a diagnosis of complications of amputation (surgical removal of all or part of a limb) stump (remaining part of a limb). Review of the clinical record indicated a verbal order was obtained on 2/11/26 for the Home Health Certification and POC for certification period 2/11/26 through 4/11/26. Further review of the clinical record indicated the POC had not been signed by the physician. 3. Patient #4 was admitted to the agency in February 2026 with a diagnosis of encounter for orthopedic aftercare. Review of the clinical record indicated a verbal order for was obtained on 2/5/26 for the Home Health Certification and POC for certification period 2/5/26 through 4/5/26. Further review of the clinical indicted the POC had not been signed by the physician. 4. Patient #6 was admitted to the agency in December 2025 with a diagnosis of hypertensive heart disease and chronic kidney failure with heart failure (chronic high blood pressure causes both heart muscle changes and kidney damage). Review of the clinical record indicated a verbal order was obtained on 1/30/26 for the Home Health Certification and POC for certification period 2/4/26 through 4/4/26. Further review of the clinical record indicated the POC was signed by the physician on 3/19/26. 5. Patient #10 was admitted to the agency in January 2026 with a diagnosis of first lumbar (lower back) fracture. Review of the clinical record indicated a verbal order was obtained on 1/24/26 for the Home Health Certification and POC for certification period 1/24/26 through 3/24/26. Further review of the clinical record indicated the POC was signed by the physician on 3/22/26. During an interview on 3/20/26 at 4:00 P.M., after reviewing the clinical records for Patients #1, #3, #4, #6 and #10, the Administrator said the Home Health Certifications and POC’s had not been signed within 30 days of admission, as required.”

“Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This Element is not met as evidenced by: Based on record review, policy review, and interview, the agency failed to ensure the Notice of Medicare Non-Coverage (NOMNC-an official Centers for Medicare and Medicaid Services {CMS} form that informs beneficiaries when their Medicare-covered skilled services, home health or outpatient rehabilitation services are ending and explains the right to appeal the decision) was provided prior to discharge for 3 patients (#15, #17 and #16), out of a total sample of 17 patients. Findings include: 3. Patient # 16 was admitted to the agency in January 2026 with a diagnosis of pulmonary embolism and required skilled care. Review of the clinical record indicated Patient #16 was discharged from the agency on 3/12/26. Further review of the clinical record indicated the NOMNC was issued on 3/12/26. The record did not indicate the patient/caregiver was provided information 2 days prior to the anticipated discharge. During an interview on 3/20/26 at 12:45 P.M., the Administrator said the NOMNC was provided on the day of discharge and not 2 days prior to discharge, as required, for Patients #15, #16 and #17. Review of the agency policy entitled, Medicare Notice of Non-Coverage, reviewed 2/5/26, included the following: *The agency will issue the “Notice of Medicare Non-Coverage” to all Medicare beneficiaries (Traditional Fee for Service and Medicare Advantage) no later than 2 days before the end of covered services or the second to last day of service if care is not being provided daily. (The two-day advantage requirement is NOT a 48-hour requirement.) 1. Patient #15 was admitted to the agency in October 2025 with a diagnosis of lumbago (acute lower back pain) with sciatica (pain radiating along the sciatic nerve from the lower back through the hips and down the leg). Review of the clinical record indicated the patient was discharged from the agency on 11/25/25. Further review of the clinical record indicated the NOMNC was issued on 11/25/25. The record did not indicate that the patient/caregiver was provided information 2 days prior to the anticipated discharge. 2. Patient #17 was admitted to the agency in January 2026 with a diagnosis of pneumonia. Review of the clinical record indicated the patient was discharged from the agency on 2/12/26. Further review of the clinical record indicated the NOMNC was issued on 2/12/26. The record did not indicate that the patient/caregiver was provided information 2 days prior to the anticipated discharge.”

“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 record review, policy review, and interview, the agency failed to ensure the Plan of Care (POC) was followed relative to oxygen use for 1 patient (#6) during a home visit observation, out of a total of 7 home visits. Findings include: Review of the agency policy entitled, POC, reviewed 2/9/26, included the following: *A POC will be developed through a care planning process, which is designed to provide care, treatment, and services that are appropriate to the patient’s individual needs, as well as patient’s choice. Review of the agency policy entitled, Administration of Oxygen, reviewed 10/14/25, included the following: *Review orders/treatment plan from the patient’s treating provider for: a. Type of oxygen therapy. b. Administration device and liter flow rate or concentration. c. Oxygen saturation parameters, as applicable in guiding oxygen therapy. Patient #6 was admitted to the agency in December 202 5 with diagnosis of hypertensive heart disease and chronic kidney failure with heart failure (chronic high blood pressure causes both heart muscle changes and kidney damage). Review of a physician ordered Home Health Certification and POC for certification period 2/4/26 through 4/4/26 indicated the following: -Oxygen Therapy: Registered Nurse (RN)/Licensed Vocational Nurse (LVN) to instruct on oxygen management including administration at 2.5 liters to 3.5 liter per minute (measure of the flow rate of supplemental oxygen delivered to the patient). During a home visit on 3/18/26 at 1:30 P.M., the surveyor observed Patient #6 receiving supplemental oxygen via a nasal cannula (a flexible, lightweight tube used to deliver supplemental oxygen) that was connected to an extension tube connected to a concentrator (a medical device that filters nitrogen out of the surrounding air to to deliver a steady stream of oxygen), out of vision, located in the patient’s bedroom. Nurse #1 assessed the patient’s oxygen level via an oxygen oximeter (a non-invasive clip-like device placed on a finger that measures blood oxygen saturation) while the patient was sitting in the living room. Nurse #1 did not assess the oxygen liter flow on the concentrator to ensure the correct setting during the home visit. During an interview on 3/18/26 at 2:10 P.M., Nurse #1 said she did not assess the oxygen concentrator for correct oxygen liter flow, as per the POC. During an interview on 3/18/26 at 3:30 P.M., the Administrator said Nurse #1 did not follow the POC relative to ensuring the patient was receiving the correct oxygen liter flow, as required.”