Advanced Medical Home Care, LLC

“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 interview and document review, the agency failed to ensure each patient had an initial assessment visit within 48 hours of the referral date or physician ordered start of care (SOC) date for 9 of 10 patients (P1, P10, P3, P6, P4, P8, P9 P2, and P7) reviewed for initial assessment timeframes. Findings include: P1’s referral for home care services was dated 4/29/26. The scheduled SOC date section was blank. P1’s Home Health Certification and Plan of Care (HHC POC) certification period of 5/11/26 through 7/9/26, identified diagnoses of type 2 diabetes with diabetic polyneuropathy. P1 had orders for skilled nursing (SN), physical therapy (PT), speech therapy (ST) and occupational therapy (OT). The POC was signed by the medical doctor (MD) on 6/2/26. P1’s missed Visit Entry note dated 5/6/26, identified this visit was missed due to patient requesting admission date of 5/11. Agency would notify provider when home care admission occurs. Agency will non-admit if patient refuses or cancels care. There was no documentation the ordering physician was contacted to request a new SOC date. There was a difference of 12 days from the referral to the initial assessment. On 6/16/26 at 3:05 p.m., a phone interview was attempted with P1 without return call. P3’s HHC POC certification period of 3/27/26 through 5/25/26, identified diagnoses of orthopedic after care following surgical amputation. P3 had orders for SN and ST. The POC was signed by the MD 4/6/26. P3’s visit notes dated 3/24/25 through 5/25/26, lacked documentation why the initial assessment occurred 3 days after the referral and documentation the ordering physician was contacted to request a new SOC date. During an interview on 6/16/26 at 3:00 p.m., P3 stated he had to change his dressings one day due to the delayed SOC without adverse outcomes. P3 stated the SOC was delayed because the agency told him the paperwork took longer to get started. P4’s referral for home care services was dated 4/29/26. The scheduled SOC section was blank. P4’s HHC POC dated 6/1/26 through 7/30/26, identified diagnoses of chronic kidney disease, congestive heart failure and anemia. P4 had orders for SN, PT and OT. The POC was not yet signed by the MD. P4’s missed Visit Entry note dated 5/22/26, identified visit was missed due to patient being unreachable. Agency would attempt to schedule and notify provider if home care admission occurs. Agency will non-admit if patient remains unreachable. There was no documentation the ordering physician was contacted to request a new SOC date. There was a difference of 10 days from the referral to the initial assessment. P8’s referral for home care services was dated 1/22/26. The scheduled SOC date was blank. P8’s HHC POC certification period dated 1/27/26, identified diagnoses of multiple fractures and history of falling. P8 had orders for SN, PT and OT. The POC was signed by the MD on 2/13/26. P8’s missed Visit Entry note dated 1/22/26, identified the visit was missed due to patient requesting admission date of 1/27/26. Agency will notify provider if home care admission occurs. Agency will non-admit if patient refuses or cancels care. There was no documentation the ordering physician was contacted to request a new SOC date. There was a difference of 5 days from the referral to the initial assessment. P9’s referral for home care services was dated 1/8/26. The scheduled SOC date section was left blank. P9’s HHC POC dated 1/12/26 through 3/12/26, identified diagnoses of influenza and respiratory failure. P9 had orders for SN, PT and OT. The HHA POC was signed by the MD on 1/20/26. P9’s missed Visit Entry note dated 1/9/26, identified the visit was missed due to patient requesting admission date of 1/12. Agency will notify provider if home care admission occurs. Agency will non-admit if patient refuses or cancels care. There was no documentation the ordering physician was contacted to request a new SOC date. There was a difference of 4 days from the referral to the initial assessment. During an interview on 6/16/26 at 3:08 p.m., P9 denied any adverse outcome from the delayed SOC. P10’s referral for home care services was dated 11/17/25. P10’s HHC POC dated 11/22/25 through 1/20/26, identified diagnoses of acute kidney failure and lung cancer. P10 had orders for SN, PT, OT and aide services. P10’s visit notes dated 11/17/26 through 1/16/26, lacked documentation why the initial assessment occurred 5 days after the referral and documentation the ordering physician was contacted to request a new SOC date. During an interview on 6/16/26 at 2:00 p.m., the agency’s chief executive officer (CEO) stated if the initial assessment was beyond 48 hours of referral, a missed visit note would be entered into the patient’s medical record. A check mark would be present identifying the provider was notified, but there was not a way to verify of the provider received the missed visit documentation. Additionally, if delayed, the order for the new SOC date was identified on the HHC POC which was then sent to the MD for signature. The agency’s Start and Resumption of Care Timeliness Procedure dated 11/20/20, identified the following scenarios and instructions: - If patient/CG (caregiver) makes a reasonable request the HCC (health care coordinator) would document details of the situation into a Communication (Comm.) note. HCC would notify the physician of the details in an order or Missed Visit Summary. Once the SOC occurs, the referral date will be changed to equal the SOC date. - If agency could not reach the patient/representative for scheduling a SOC referral then the HCC would notify the team with the details in a PDG message and/or Comm. note. HCC would notify the physician of the details in an order or Missed Visit Summary. Once the SOC occurs, the referral date will be changed to equal the SOC date. - If a ROC (resumption of care) was needed, but agency was unaware of the inpatient discharge, then HCC would notify the team with the details in a PDG message and/or comm. Note. As soon as the Agency was made aware, the patient must be contacted in an attempt to schedule. If SOC was scheduled >2 days of when the patient discharged or became aware of the patient discharged, the agency will be late on the requirement, unless a VO is obtained from the provider to resume on a specific date within the 2-day timeline. P2’s referral for home care was 5/26/26, the start of care (SOC) date was 5/30/26. P2’s Home Health Certification and Plan of Care (HHC POC) certification period of 5/30/26 to 7/28/26 identified diagnoses of type 2 diabetes mellitus with hyperglycemia and orthopedic aftercare following an amputation. P2 had orders for physical therapy (PT) and occupational therapy (OT). P2’s missed visit entry note dated 5/26/26, identified visit missed due to patient being unreachable, agency will attempt to schedule and notify provider if home care admission occurs. Agency will non-admit if patient remains unreachable. There was no documentation the ordering medical doctor (MD) was notified of the admission or status of P2. There was a difference of 4 days from the referral to the initial assessment. P6’s referral for home care was dated 6/1/26, the start of care (SOC) date was 6/4/26. P6’sHHC POC certification period of 6/4/26 to 8/2/26 was not completed at the time of survey. P6 had a diagnosis of a diabetic foot ulcer, hypertension and status post left foot amputation. P6 had orders for skilled nursing (SN) for wound care. P6’s missed visit entry note dated 6/1/26, identified visit missed due to patient request admission date of 6/4/26. The note further indicated agency will notify provider if and when home care admission occurs, and agency will non-admit if patient refuses or cancels care. There was no documentation the ordering MD was notified of the admission or status of P6. There was a difference of 3 days from the referral to the initial assessment. P7’s referral for home care was dated 5/11/26, the SOC date was 5/14/26. P7’s HHC POC certification period of 5/14/26 through 7/12/26, identified diagnoses of fistula of stomach and duodenum, pneumonia and chronic pancreatitis. P7 had orders for SN. The POC was signed by the certified nurse practitioner (CNP) on 6/11/26. P7’s missed visit entry note dated 5/11/26, identified the visit was missed due to scheduling availability. There was no documentation the ordering CNP was contacted to request a new SOC date. There was a difference of 3 days from the referral to the initial assessment.”

“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 interview and document review, the agency failed to obtain initial start of care verbal orders by a nurse acting in accordance with state licensure requirements, or other qualified therapist (i.e., physical therapist, speech-language pathologist, occupational therapist, or medical social worker) responsible for furnishing or supervising the ordered services for 8 of 10 patients (P1, P2, P3, P4, P7, P8, P9 and P10) reviewed for verbal orders. Findings include: P1’s Home Health Certification and Plan of Care (HHC POC) certification period of 5/11/26 through 7/9/26, identified diagnoses of type 2 diabetes with diabetic polyneuropathy. P1 had orders for skilled nursing (SN), physical therapy (PT), speech therapy (ST) and occupational therapy (OT). The POC was signed by the medical doctor (MD) on 6/2/26. The agency signature was electronically signed by admin-A who was identified as a lead QA (quality assurance) specialist and physical therapy assistant (PTA) and not a nurse or qualified therapist (PT, OT, ST). P3’s HHC POC certification period of 3/27/26 through 5/25/26, identified diagnoses of orthopedic after care following surgical amputation. P3 had orders for SN and ST. The POC was signed by the MD 4/6/26. The agency signature was electronically signed by admin-B who was identified as a QA specialist and non-clinical coding and OASIS Specialist and not a nurse or qualified therapist (PT, OT, ST). P4’s HHC POC dated 6/1/26 through 7/30/26, identified diagnoses of chronic kidney disease, congestive heart failure and anemia. P4 had orders for SN, PT and OT. The POC was not yet signed by the MD. The agency signature was electronically signed by admin-A who was identified as a lead QA specialist and PTA and not a nurse or qualified therapist (PT, OT, ST). P8’s HHC POC certification period dated 1/27/26, identified diagnoses of multiple fractures and history of falling. P8 had orders for SN, PT and OT. The POC was signed by the MD on 2/13/26. The agency signature was electronically signed by admin-C who was identified as a lead QA specialist and not a nurse or qualified therapist (PT, OT, ST). P9’s HHC POC dated 1/12/26 through 3/12/26, identified diagnoses of influenza and respiratory failure. P9 had orders for SN, PT and OT. The HHA POC was signed by the MD on 1/20/26. The agency signature was electronically signed by admin-C who was not a nurse or qualified therapist (PT, OT, ST). P10’s HHC POC dated 11/22/25 through 1/20/26, identified diagnoses of acute kidney failure and lung cancer. P10 had orders for SN, PT, OT and aide services. The HHA POC was signed by the MD on 1/20/26. The agency signature was electronically signed by admin-C who was identified as a PTA and not a nurse or qualified therapist (PT, OT, ST). During an interview on 6/16/26 at 2:00 p.m., the agency’s chief executive officer (CEO) stated the staff identified as “admin” on the HHC POC’s were typically PTA, COTA or other admin staff without the required credentials. On 6/16/26 at 4:30 p.m., the assistant clinical director (ACD) and CEO were interviewed together. The CEO stated the process to enter verbal orders into the HHC POC was for the registered nurse (RN), PT, OT and ST to complete their plan of care which then pulls into the HHC POC. The ACD stated when the orders in the HHC POC were generated the “admin” staff electronically signed the document and sent it to the responsible provider. The CEO and ACD verified there were not final checks of the HHC POC by a nurse or qualified therapist before the admin staff sent it to the responsible provider. The agency’s undated Verbal Order policy for Home Care Coordinators identified home Care Coordinators (HCC’s) relay written orders verbally, on behalf of registered clinical staff (RN/PT/OT/ST), ensuring accuracy, legality, and timely implementation. A HCC may consist of CMA, RMA, HUC, LPN, PTA, &/or COTA. After proper education and training, the HCC may relay written and verbal orders for homecare registered staff and its patient’s providers. P2’s Home Health Certification and Plan of Care (HHC POC) certification period of 5/30/26 through 7/28/26, identified diagnoses of type 2 diabetes mellitus with hyperglycemia and orthopedic aftercare following an amputation. P2 had orders for physical therapy (PT) and occupational therapy (OT). The POC had not been signed by the medical doctor (MD). The agency signature was electronically signed by admin-A who was identified as a lead quality assurance (QA) specialist and physical therapy assistant (PTA), not a nurse or qualified therapist (PT, OT, ST). P7’s HHC POC certification period of 5/14/26 through 7/12/26, identified diagnoses of fistula of stomach and duodenum, pneumonia and chronic pancreatitis. P7 had orders for skilled nursing (SN). The POC was signed by the certified nurse practitioner (CNP) on 6/11/26. The agency signature was electronically signed on 6/15/26 by admin-B who was identified as QA specialist and non-clinical coding and OASIS Specialist, not a nurse or qualified therapist (PT, OT, ST).”