Integrihome 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 document review and staff 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 Services (CMS) system within the required 30 days of completing the assessments of the beneficiary. Findings include: Review of the agency policy entitled, OASIS, effective 1/2021, included the following: *The agency will encode and electronically transmit all completed OASIS assessments within 30 calendar days of completion to the state agency or the CMS OASIS contractor. All validation reports will be obtained and reviewed to determine if corrections are required to the OASIS date submitted by the agency. Discrepancies will be addressed through appropriate action based on discrepancy. The action to be taken: The Clinical Manager will review reports received for discrepancies. The Clinical Manager will determine the type of discrepancy. The information will then be reviewed with the clinician that completed the OASIS. Corrections will be made and the OASIS will be resubmitted for approval to the OASIS contractor. The administrator will be notified of discrepancies and brought to the next Advisory group meeting and presented to Governing Body at next scheduled meeting. Review of the Home Health Agency (HHA) Error Summary by Agency Report indicated the agency had 31 late OASIS Assessment submissions between 12/1/25 to 4/30/26, out of a total of 86, which equaled to a 36.05% error rate. Review of the HHA Error Summary by Agency Report indicated the agency had 14 late OASIS Assessment submissions between 5/1/26 to 5/28/26, out of a total of 34, which equaled to a 41.18% error rate. During a phone interview on 5/28/26 at 8:45 A.M., the Regional Accounts Receivable Coordinator said she is responsible for transmitting OASIS submissions. She said the agency was having an issue with the previous system and a new system has been put into place a month ago and issues have been corrected. She could not provide any additional information concerning the late OASIS submissions.”

“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 after the use of medical equipment during a home visit observation, for 1 patient (#1), out of 3 patient home visits. Findings include: Review of the agency policy entitled, Bag Technique, effective 1/2021, included the following: *Spread an impervious barrier on the surface before setting the bag down.... *Do not put soiled items back in the visit bag. Review of the Centers for Disease Control and Prevention (CDC) Core Infection and Control Practices for Safe Healthcare Delivery in All Settings, dated 4/12/24, indicated the following: -Clean and reprocess (disinfect or sterilize) reusable medical equipment prior to use on another patient or when soiled. Patient #1 was admitted the agency in February 2026 with a diagnosis of influenza (a highly contagious viral infection). Review of a physician order, dated 5/19/26, indicated for Occupational Therapy visit once a week starting 5/18/26. During a home visit on 5/26/26 at 11:45 A.M., the surveyor observed the Occupational Therapist place her visit bag on a barrier pad. She placed her tablet and cell phone directly on a table. She removed her jacket, folded it, and placed it on top of her visit bag. She removed a sphygmomanometer (blood pressure cuff), stethoscope and a pulse oximeter (a small device clipped onto a finger that measures the blood oxygen level and pulse by shining a light through a fingertip). She assessed the patient’s blood pressure, placed the pulse oximeter on the patient’s finger and obtained a pulse and oxygen level. She did not cleanse the equipment after use but placed the items on top of her jacket. Upon completion of the visit, she picked up the visit bag and placed it on her shoulder. She then picked up the tablet, cell phone, stethoscope, pulse oximeter, blood pressure cuff and exited the home with the items in her hands. She did not clean any of the items in the home. She went to her vehicle, placed the items on a car seat and cleansed each item with cleansing wipes. During an interview on 5/26/26 at 12:38 P.M., the Occupational Therapist said she did not cleanse the tablet, cell phone and medical equipment after use while in the patient’s home and store it into her visit bag before exiting the home, as required. She further said she did not place a barrier on the table before she put down the cell phone and tablet, as required. During an interview on 5/26/26 at 4:00 P.M., the Branch Manager and Regional Director of Home Health both said the expectation is for staff to clean medical equipment and place the items into their visit bag after use, while in the patient’s home. They said a barrier should be placed under a tablet and phone, as well. They further said the Occupational Therapist did not follow the required infection control guidelines.”

“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 facility failed to ensure staff entries were legible, clear, complete, appropriately authenticated, dated, and timed, relative to a.) physician ordered Home Health Certification and Plan of Care (POC) for 6 patients (#1, #2, #4, #5, #6, and #7), and b.) a Physical Therapy (PT) evaluation for 1 patient (#1), out of a total sample of 7 patients. Findings included: Review of the agency policy entitled, Orders: Signed in 30 Days, effective 1/2021, included the following: *All plans of care, verbal orders and changes in orders will be signed by the certifying physician within 30 days and filed in the patient’s clinical file. Review of the agency policy entitled, Therapy Services, effective 1/2021, included the following: , *Effective 2017, Per Massachusetts Board of Allied Health: A physical therapist, physical therapy student, physical therapy assistant and physical therapist assistant student providing physical therapy intervention (s) for MA agencies, shall legibly document, date, and authenticate all care that is provided as follows: -Using their name as appearing on their professional license or legal name if student. -Professional designation. -Their license number. 1. Patient #1 was admitted the agency in February 2026 with a diagnosis of influenza (a highly contagious viral infection). a. Review of the physician ordered Home Health Certification and Plan of Care (POC) for certification period 2/9/26 through 4/9/26, indicated a physician signature, dated 4/27/26, and not within the required 30 day timeframe. Review of a physician ordered Home Health Certification and POC for certification period 4/10/26 through 6/8/26, contained no required physician signature. b. Review of a PT Re-evaluation, dated 4/7/26, contained no required discipline signature or date. 2. Patient #2 was admitted to the agency in April 2026 with a diagnosis of osteoporosis with current pathological fracture of right femur (upper leg from the hip to the knee). a. Review of the physician ordered Home Health Certification and POC for certification period 4/15/26 through 6/13/26 contained no required physician signature. 3. Patient #4 was admitted to the agency in April 2026 with a diagnosis of vascular dementia (a decline in thinking and memory skills caused by restricted blood flow to the brain). a. Review of the physician ordered Home Health Certification and POC for certification period 4/17/26 through 6/15/26, contained no required physician signature. 4. Patient #5 was admitted to the agency in April 2026 with a diagnosis of anemia (lack of red blood cells). a. Review of the physician ordered Home Certification and POC for certification period 4/6/26 through 6/4/26, indicated a physician signature, dated 5/22/26, and not within the required 30 day timeframe. 5. Patient #6 was admitted to the agency in January 2026 with a diagnosis of orthostatic hypotension (a sudden, large drop in blood pressure that occurs when standing after sitting or lying down). a. Review of the physician ordered Home Health Certification and POC for certification period 3/2/26 through 4/14/26 contained no required physician signature. 6. Patient #7 was admitted to the agency in March 2026 with a diagnosis of Type 2 diabetes mellitus (a chronic condition where the body either resists the effects of insulin or does not produce enough insulin to maintain normal glucose [sugar] levels). a. Review of the physician ordered Home Health Certification and POC for certification period 1/6/26 through 3/6/26, indicated a physician signature, dated 4/15/26, and not within the required 30 day timeframe. Review of the physician ordered Home Health Certification and POC for certification period 3/7/26 through 4/28/26, contained no required physician signature. During an interview on 5/28/26 at 1:00 P.M., after reviewing the clinical records, the Branch Manager said the Home Health Certifications and POCs were not signed within the required timeframe and the PT Re-Evaluation for Patient #1 was not signed, as required.”

“Patient’s or legal representative’s signature CFR(s): 484.50(a)(2) Obtain the patient’s or legal representative’s signature confirming that he or she has received a copy of the notice of rights and responsibilities. This Element is not met as evidenced by: Based on record review, policy review, and interview, the agency failed to obtain a patient’s or legal representative’s signature confirming a copy of the notice of rights and responsibilities had been provided upon admission to the agency for 3 patients (#2, #4 and #5), out of a total sample of 7 patients. Findings include: Review of the agency policy entitled, Admission Documentation/Patient Education, effective 1/2021, included the following: *The following forms/documents shall be reviewed by our Agency’s clinician upon the initial visit to new patients or prior to initiating services: -Welcome Letter -Patient Rights & Responsibilities in writing...... 1. Patient #2 was admitted to the agency in April 2026 with a diagnosis of osteoporosis with current pathological fracture of right femur (upper leg from the hip to the knee). Review of the clinical record did not contain any signed documentation that Patient Rights & Responsibilities had been provided to the patient or legal representative. 2. Patient #4 was admitted to the agency in April 2026 with a diagnosis of vascular dementia (a decline in thinking and memory skills caused by restricted blood flow to the brain). Review of the clinical record did not contain any signed documentation that Patient Rights & Responsibilities had been provided to the patient or legal representative. 3. Patient #5 was admitted to the agency in April 2026 with a diagnosis of anemia (lack of red blood cells). Review of the clinical record did not contain any signed documentation that Patient Rights & Responsibilities had been provided to the patient or legal representative. During an interview on 5/28/26 at 10:30 A.M., after reviewing the clinical records, the Branch Manager said there was no signed documentation to indicate a copy of the Resident Rights and Responsibilities had been provided upon admission to the patients or their legal representatives, as required.”

“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, policy review, and interview, the agency failed to ensure the comprehensive assessment was completed no later than 5 calendar days after the start of care (SOC), for 1 patient (#1), out of a total sample of 7 patients. Findings include: Review of the agency policy entitled, Admission Documentation/Patient Education, effective date 1/2021, included the following: *Once the comprehensive assessment is completed (within 5 days of initial visit) and the plan of care is approved by the responsible physician, the following written documents must be provided to the patient and/or their representative...... Patient #1 was admitted the agency in February 2026 with a diagnosis of influenza (a highly contagious viral infection). Review of the clinical record indicated a physician ordered SOC date of 2/9/26. Further review of the clinical record indicated an Oasis SOC Comprehensive Assessment was initiated on 2/9/26 and signed and completed on 4/2/26. During an interview on 5/27/26 at 3:30 P.M., the Branch Manager said the Oasis SOC Comprehensive Assessment was not completed within the required 5 day timeframe.”

“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 that services were provided as ordered by the physician or allowed practitioner, as indicated in the plan of care, for 4 patients (#1, #2, #4, #5), out of a total sample of 7 patients. Findings include: Review of the agency policy entitled, Plan of Care (POC), effective 1/2021, included the following: *Each patient will receive 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 physician. *Individualized written plan of care which would specify the care and services necessary to meet the patient’s needs, including the patient and caregiver education and training that the agency will provide, specific to the patient’s care needs. 1. Patient #1 was admitted the agency in February 2026 with a diagnosis of influenza (a highly contagious viral infection). Review of the physician ordered Home Health Certification and POC for certification period 2/9/26 through 4/9/26, indicated the following: -Physical Therapy (PT): 2/9/26 to 4/9/26, 2 visits per week for 9 weeks. Review of the clinical record indicated only 1 PT visit was provided for the weeks of 2/15/26, 2/22/26, and 4/5/26. During an interview on 5/28/26 at 1:15 P.M., the Branch Manager said the POC was not followed when the physician ordered PT visits were missed and not provided, as ordered. 2. Patient #2 was admitted to the agency in April 2026 with a diagnosis of osteoporosis with current pathological fracture of right femur (upper leg from the hip to the knee). Review of the physician ordered Home Health Certification and POC for certification period 4/15/26 through 6/13/26, indicated the following: -Skilled Nurse (SN): 4/19/26 to 4/25/26, 1 visit per week for 1 week. -PT: 4/15/26 to 4/18/26, 1 visit per week for 1 week. -PT: 4/19/26 TO 4/25/26, 1 visit per week for 1 week. -PT: 4/26/26 to 6/13/26, 2 visits per week for 7 weeks. Review of the clinical record indicated a SN visit was provided on 5/1/26, 5/8/26, and 5/20/26, with no physician order in place. Further review of the clinical record indicated the following: -1 PT visit was provided for the week of 5/10/26, and not 2, as ordered. -No PT visits were provided the week of 5/17/26, as ordered. During an interview on 5/28/26 at 1:00 P.M., the Branch Manager said the POC was not followed when SN visits were provided without a physician order. She further said the POC was not followed when a PT was missed the week of 5/10/26, and no PT visits were provided the week of 5/17/26, as ordered. 3. Patient #4 was admitted to the agency in April 2026 with a diagnosis of vascular dementia (a decline in thinking and memory skills caused by restricted blood flow to the brain). Review of a PT evaluation, dated 5/4/26, indicated for PT visit for 1 time a week for 1 week. Review of the clinical record indicated additional PT visits were provided on 5/14/26, 5/22/26, and 5/27/26. During an interview on 5/28/26 at 10:30 A.M., the Branch Manager said the POC was not followed when PT visits were provided without a physician order. 4. Patient #5 was admitted to the agency in April 2026 with a diagnosis of anemia (lack of red blood cells). Review of the physician ordered Home Certification and POC for certification period 4/6/26 through 6/4/26, indicated the following: -SN: 4/6/26 to 4/18/26, 2 visits per week for 2 weeks. -SN: 4/19/26 to 6/4/26, 1 visit per week for 7 weeks. Review of the clinical record indicated no SN visit was provided the week of 5/17/26, as ordered. During an interview on 5/28/26 at 9:45 A.M., the Branch Manager said the POC was not followed when SN visits were not provided the week of 5/17/26, as ordered.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on record review, policy review and interview, the agency failed to ensure staff communicated with the physician involved in the plan of care, related to the current plan of care (POC), for 3 patients (#1, #2, and #5), out of a total sample of 7 patients. Findings include: Review of the agency policy entitled, Interruption in Services/Missed Visit, effective 1/2021, included the following: *When an interruption occurs due to a missed visit, the following procedure should be followed: a. Complete the Missed Visit form, including an explanation why visit did not occur per the POC or must be temporarily halted (ex. Hospitalization) and anticipated length of hold, if known. b. If the Agency misses visits or services as required by the plan of care, the Agency must notify the responsible physician of the missed visit if there is any potential for clinical impact upon the patient. The physician will determine whether the patient visit may be skipped or additional intervention is required by the Agency due to the impact on the patient. c. Document all & file in the patient chart. 1. Patient #1 was admitted the agency in February 2026 with a diagnosis of influenza (a highly contagious viral infection). Review of the physician ordered Home Health Certification and POC for certification period 2/9/26 through 4/9/26, indicated the following: -Physical Therapy (PT): 2/9/26 to 4/9/26, 2 visits per week for 9 weeks. Review of the clinical record indicated only 1 PT visit was provided for the weeks of 2/15/26, 2/22/26, and 4/5/26. 2. Patient #2 was admitted to the agency in April 2026 with a diagnosis of osteoporosis with current pathological fracture of right femur (upper leg from the hip to the knee). Review of the physician ordered Home Health Certification and POC for certification period 4/15/26 through 6/13/26, indicated the following: -PT: 4/26/26 to 6/13/26, 2 visits per week for 7 weeks. Further review of the clinical record indicated the following: -1 PT visit was provided for the week of 5/10/26, and not 2, as ordered. -No PT visits were provided the week of 5/17/26. 3. Patient #5 was admitted to the agency in April 2026 with a diagnosis of anemia (lack of red blood cells). Review of the physician ordered Home Certification and POC for certification period 4/6/26 through 6/4/26, indicated the following: -SN: 4/19/26 to 6/4/26, 1 visit per week for 7 weeks. Review of the clinical record indicated no SN visit was provided the week of 5/17/26, as ordered. During an interview on 5/28/26 at 11:15 A.M., after reviewing the clinical records, the Branch Manager said the physician had not been notified of the missed physician ordered scheduled visits, as required.”

“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 record review, policy review, and interview, the agency failed to ensure a completed discharge summary was sent to the primary care practitioner or other health care professional responsible for providing care and services to the patient after discharge from the agency within 5 business days of the patient’s discharge for 2 patients (#6 and #7), out of 2 discharge records reviewed, in a total sample of 7 patients. Findings include: Review of the agency policy entitled, Discharge/Reduction in Services, effective 1/2021, included the following: *A discharge summary will be completed for all discharged patients. A discharge summary is sent to the primary care practitioner or other health professional who is responsible for providing care and services to the individual after discharge from the agency, within 5 business days of the discharge and receiving facility if patient to be transferred to another agency or facility within 2 calendar days. 1. Patient #6 was admitted to the agency in January 2026 with a diagnosis of orthostatic hypotension (a sudden, large drop in blood pressure that occurs when standing after sitting or lying down). Review of the clinical record indicated the patient was discharged from the agency on 4/14/26. Further review of the clinical record did not contain any documentation to indicate a discharge summary was sent to the physician responsible for providing care to the patient after discharge. 2. Patient #7 was admitted to the agency in March 2026 with a diagnosis of Type 2 diabetes mellitus (a chronic condition where the body either resists the effects of insulin or does not produce enough insulin to maintain normal glucose (sugar) levels). Review of the clinical record indicated the patient was discharged from the agency on 4/28/26. Further review of the clinical record did not contain any documentation to indicate a discharge summary was sent to the physician responsible for providing care to the patient after discharge. During an interview on 5/28/26 at 8:30 A.M., the Branch Manager said the agency has not been sending any discharge summaries to the physicians responsible for providing care to the discharged patients, as required.”