Rn4kids, Inc.

“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 policy review, record review, and interview, the home health provider failed to ensure the registered nurse (RN) completed the initial assessment within 48 hours of the patient’s referral or return home in one of five full records reviewed (Record/Patient #3). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Initial Visit,” showed the initial visit will be done within 24-48 hours upon receiving the referral unless specific [doctors] orders state otherwise. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 11/18/2025 with a primary diagnosis of premature infant of 26 weeks gestation (process of developing - born before full term gestation; 39 weeks, 0 days, through 40 weeks, 6 days) and a secondary diagnosis of bronchopulmonary dysplasia (is a chronic lung disease that primarily affects premature babies with underdeveloped lungs, causing inflammation and damage from prolonged oxygen therapy and mechanical ventilation). The patient was an infant and resided at home with his/her parents. Review of the clinical record showed the following: - A referral dated 11/11/2025; and - The patient was discharged from the hospital on 11/12/2025. Review of the initial assessment showed a start of care date of 11/18/2025, six days after the patient’s discharge to home. During an interview on 01/13/2026 at 2:45 PM, the home health administrator stated that he/she would expect the physician to be notified of the reason for the late start of care.”

“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 provider failed to ensure that the physician orders were signed in one of five full records reviewed (Record/Patient #3). This deficient practice has the potential to affect all patients served by the provider. Findings included: RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 11/18/2025 with a primary diagnosis of premature infant of 26 weeks’ gestation (process of developing - born before full term gestation; 39 weeks, 0 days, through 40 weeks, 6 days) and a secondary diagnosis of bronchopulmonary dysplasia (is a chronic lung disease that primarily affects premature babies with underdeveloped lungs, causing inflammation and damage from prolonged oxygen therapy and mechanical ventilation). The patient was an infant and resided at home with his/her parents. Review of the clinical record showed the patient was discharged from the hospital on 11/12/2025. Review of the clinical record showed a document titled, “Unable to Contact Patient or Late Start of Care,” dated 11/13/2025. The document showed the clinician was unable to contact the patient and would have to reschedule the start of care visit. The document failed to contain a physician’s signature. During an interview on 01/13/2026 at 2:45 PM, the home health administrator stated that he/she would expect the order to be faxed to the physician to be signed on the day of the order. He/she then stated that they would expect the order to be returned signed no later than 30 days after the order date.”

“Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This Element is not met as evidenced by: Based on review of the provider’s admission folder, record review, home visit observation, and interview, the provider failed to ensure the name and contact information for the clinical manager was provided to the patient’s family in two of three home visit observations conducted (Records/Patients #1 and #2). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s admission folder showed the name and contact information for the clinical manager was not included in the folder. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services on 12/22/2025 with a primary diagnosis of 33 weeks gestation (process of developing - born before full term gestation; 39 weeks, 0 days, through 40 weeks, 6 days). The patient was an infant and resided at home with his/her parents. Observation on 01/13/2026 at 8:45 AM, showed the admission folder, in the patient’s home, failed to contain the name and contact information for the clinical manager. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 12/22/2025 with a primary diagnosis of 33-week preemie (premature - an infant born before 37 weeks gestation). The patient was an infant and resided at home with his/her parents. Observation on 01/13/2026 at 9:00 AM, showed the admission folder, in the patient’s home, failed to contain the name and contact information for the clinical manager. During an interview on 01/14/2026 at 8:45 AM, the home health administrator stated that the home health admission folder failed to contain the name and contact information for the clinical manager.”