Americare Home Health Solutions

“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 review of the Internet Quality Improvement and Evaluation System’s (iQIES; a cloud-based application developed by the Centers for Medicare and Medicaid Services (CMS) for managing provider and patient information, and ensuring quality healthcare, specifically for Medicare and Medicaid beneficiaries) home health agency (HHA) error summary by agency report, policy review, and interview, the home health provider failed to ensure that the Outcome and Assessment Information Set (OASIS; a standardized data collection tool) was electronically transmitted to the CMS system within the required timeframe in 222 of 2442 (9.09%) of the assessments submitted. This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the iQIES report titled, “Home Health Agency (HHA) Error Summary by Agency,” for the reporting period of 02/01/2025 through 02/01/2026 showed the provider failed to ensure that the OASIS assessment was submitted to the CMS system within 30 days of completing the beneficiary’s assessment for 222 of 2442 (9.09%) assessments submitted. Review of the provider’s policy titled, “OASIS Data Transmission,” revised 4/2023, showed that all completed OASIS assessments will be electronically transmitted to the CMS system within 30 days of completing the assessment of the beneficiary. During an interview on 03/17/2026 at 2:00 PM, the home health administrator stated that there was a process error with face to face and coding issues and they were working on a new process to decrease the late OASIS submissions.”

“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 policy review, record review, observation, and interview, the home health provider failed to ensure the accuracy of documentation in one of five full records reviewed (Record/Patient #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Clinical Record Data Collection,” dated 04/2023, showed the following: -Documentation in the clinical record will be completed accurately, timely, and reflective of the care and services provided; and -Entries into the clinical record will be clear, concise, and contain specific statements of fact. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 02/02/2026 with a primary diagnosis of discitis (a rare, severe inflammation or infection of the intervertebral disc space, often causing intense back pain, stiffness, and fever). The patient lived at home with a family caregiver. Review of the plan of care dated 02/02/2026-04/02/2026 showed the following: -Diagnoses of: *Discitis, unspecified, lumbosacral region (a rare, severe inflammation or infection of the intervertebral disc space, often causing intense back pain, stiffness, and fever); *Essential (primary) hypertension (a chronic condition where blood forces against artery walls too strongly); *Retention of urine, unspecified; *Other retention of urine; *Atherosclerotic heart disease of native coronary artery without angina pectoris (a condition where plaque—fat, cholesterol, and calcium—builds up inside artery walls, restricting blood flow and oxygen to the heart); *Hyperlipidemia, unspecified (a common condition characterized by high levels of lipids (cholesterol/triglycerides) in the blood); *Other myocardial infarction type (decreased or complete cessation of blood flow to a portion of the myocardium); *Other low back pain; *Spondylosis without myelopathy or radiculopathy, lumbar region (a common age-related degeneration of the spinal discs and joints (arthritis of the spine) occurring in the neck or back); and -The patient had an expressed goal “to be able to walk with [his/her] walker again”. Review of the clinician visit notes showed: -On 02/02/2026, the registered nurse (RN) documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 02/05/2026, the occupational therapist (OT) documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 02/19/2026, the OT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 02/23/2026, the OT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 02/24/2026, the physical therapist (PT) documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 02/26/2026, the PT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 02/26/2026, the RN documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 03/02/2026, the RN documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 03/04/2026, the OT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 03/05/2026, the PT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 03/06/2026, the RN documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; -On 03/11/2026, the OT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis; and -On 03/12/2026, the PT documented an abnormal neurological finding of paralysis. The patient never had a diagnosis of paralysis. Observation on 03/17/2026, beginning at 8:00 AM, showed the patient working with the PT doing sit to stand exercises and lower extremity range of motion exercises. During an interview on 03/17/2026, at 8:45 AM, the patient stated that he/she had increased lower extremity weakness caused by back pain from a surgical site that became infected. He/she stated that, prior to the surgery, he/she was walking with a walker and he/she wished to be able to do that again with therapy. During an interview on 03/18/2026, at 10:30 AM, the home health clinical manager stated that the patient had never been diagnosed with paralysis. He/she also stated that the electronic medical record (EMR) had the option of “no abnormal findings” directly below the finding of “paralysis” in the neurological assessment section. He/she stated that it was a documentation error and that clinicians would be educated on ensuring the correct findings were documented in the EMR.”

“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 policy review, record review, observation, and interview, the home health provider failed to ensure an accurate medication review and/or update of the patient medications was completed, in two of five full records reviewed (Records/Patients #1 and #2). This deficient practice has the potential to affect all the patients served by the provider. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 02/02/2026 with a primary diagnosis of discitis (a rare, severe inflammation or infection of the intervertebral disc space, often causing intense back pain, stiffness, and fever). The patient lived at home with a family caregiver. Observation on 03/17/2026 at 8:00 AM, showed: -The provider’s medication profile showed the patient took chlorthalidone (reduces the amount of water in the body by increasing the flow of urine, which helps to lower blood pressure) 25 mg tablets, take one tablet daily. The patient did not have this medication in the home; -The provider’s medication profile showed that patient took metronidazole (used to treat bacterial infections in different areas of the body) 500 mg tablet, take one tablet twice daily. The patient did not have this medication in the home; -The provider’s medication profile showed that the patient took pantoprazole (used to treat certain conditions in which there is too much acid in the stomach) 40 mg tablet, take one tablet daily. The patient did not have this medication in the home; -The provider’s medication profile showed that the patient took rosuvastatin (used to treat cholesterol) 20 mg tablet, take one tablet daily. The patient did not have this medication in the home; -The provider’s medication profile showed that the patient took quetiapine (a second-generation antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and major depressive disorder) 25 mg, take one tablet daily. The patient took one tablet twice daily; and -The patient had ondansetron (used to prevent nausea and vomiting) 4 mg tablets, take one tablet every six hours as needed. The provider’s medication profile failed to contain this medication. During interview on 03/18/2026, beginning at 10:55 AM, the administrator stated all clinicians should ask every visit if there are any medication changes, obtain those orders for medication changes (if needed) and those clinicians would then notify the clinical managers of changes. The clinicians should make sure to update the patient’s medication list in the home. She would expect the patient’s medications and medication profiles to match. Findings included: Review of the provider’s policy titled, “Medication Profile, Reconciliation, and Review Policy and Procedure,” last reviewed on 03/17/2026, showed in part the following: -Medication reconciliation will be done at admission, when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with the addition of a new medication; -Medication profiles will be updated for each change to reflect current medications, new, and/or discontinued medications; -Compare the medication information the patient is currently taking with the medications ordered for the patient to identify and resolve discrepancies; and -Through observation during home visit and record review, a qualified clinician will confirm the medications the patient is taking against medical record documentation to verify all medications were identified, both prescription and non-prescription. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services on 10/23/2025 and recertified on 02/20/2026 with a primary diagnosis of aftercare following joint replacement surgery and pressure ulcer (skin injury caused by unrelieved pressure) of unspecified site. The patient lived with his/her adult child. Observation and interview on 03/18/2026 at 08:47 AM, showed: -The provider’s medication profile had alprazolam (used to treat anxiety) 1 milligram (mg) two to four tablets by mouth daily. The patient stated he/she takes one tablet every six hours; -The provider’s medication profile had amlodipine (used to treat high blood pressure) 5 mg by mouth daily. The patient’s medication profile in the home failed to include amlodipine; - The provider’s medication profile had lamotrigine (used to stabilize mood and treat depression) 150 mg by mouth twice daily. The patient’s medication profile in the home failed to include lamotrigine; - The provider’s medication profile had lisinopril (used to treat high blood pressure) 20 mg by mouth daily. The patient’s medication profile in the home failed to include lisinopril; - The provider’s medication profile had tamsulosin (used to treat urinary retention) 0.4 mg by mouth daily. The patient’s medication profile in the home failed to include tamsulosin; -The patient’s medication profile had topiramate (used to treat epilepsy) 50 mg four tablets by mouth in the morning and at bedtime. The provider’s medication profile failed to include topiramate; - The patient’s medication profile had prochlorperazine (used to treat nausea) 10 mg by mouth every six hours as needed. The provider’s medication profile failed to include prochlorperazine; -The patient’s medication profile had ibuprofen (anti-inflammatory) 200 mg four tablets by mouth every eight hours as needed. The provider’s medication profile failed to include ibuprofen; -The provider’s medication profile had amoxicillin 875mg-Potassium Clavulanate 125mg (antibiotic) one tablet by mouth twice daily. The patient stated he/she no longer takes this medication; -The provider’s medication profile had doxycycline hyclate (antibiotic) 100mg one tablet by mouth twice daily. The patient stated he/she no longer takes this medication; -The provider’s medication profile had Lantus U-100 insulin (long acting insulin, (injectable medication used to lower blood sugar) subcutaneous (SQ) as directed. The patient stated he/she no longer takes this medication; and -The provider’s medication profile had Tresiba flextouch U-100 (prefilled long acting insulin pen) insulin 15 units SQ at bedtime. The patient stated he/she no longer takes this medication. During an interview on 03/18/2026, beginning at 10:55 AM, the administrator stated all clinicians should ask every visit if there are any medication changes, obtain those orders for medication changes (if needed) and those clinicians would then notify the clinical managers of changes. The clinicians should make sure to update the patient’s medication list in the home. She would expect the patient’s medications and medication list to match.”

“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 policy review, record review, observation, and interview, the home health provider failed to ensure the plan of care (POC) included only pertinent diagnosis, interventions to address patient needs, and safety measures in two of five full records reviewed (Records/Patients #2, and #3). This deficient practice has the potential to affect the provision of care for all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Care Planning Policy and Procedure,” revised 04/2023, showed that an individualized POC shall be developed for each patient and is documented by the registered nurse (RN), or licensed therapist, if a therapy only admission, in coordination with the patient/family and must include: - A list of dates of onset of problems/needs based upon assessment data and physician orders; - All pertinent diagnoses; - Interventions to address the identified patient needs, including teaching and training guidelines as appropriate to the scope of practice of the individual developing and/or updating the POC consistent with relevant clinical practice guidelines; - Medications and treatments; and - Safety measures to protect against injury. RECORD/PATIENT #3: Review of the hospital admission history and physical (H & P) note, dated 02/16/2026 through 02/20/2026, showed the patient was admitted to the hospital on 02/16/2026 with a primary diagnosis of left subcapsular hematoma of the left kidney (an accumulation of blood beneath the renal capsule (a tough, fibrous connective tissue layer surrounding the kidney), often causing compression (applied pressure) of the kidney) and hemorrhage in left perirenal space (bleeding around the kidney). The H & P note contained the following additional diagnoses: - Hypoxia (an absence of enough oxygen in the tissues to sustain bodily functions); - Hypertension (HTN; elevated blood pressure)/congestive health failure (CHF; decrease in the ability of the heart to pump blood); - Hyperlipidemia (HLD; abnormally high levels of fats, specifically cholesterol and triglycerides, in the blood); - Diabetes Mellitus (DM; a chronic disease that affects how the body uses sugar for energy); - Benign Prostatic Hyperplasia (BPH; enlarged prostate gland); - Chronic Obstructive Pulmonary Disease (COPD; a group of lung diseases that block airflow and make it difficult to breathe); - Chronic Kidney Disease (CKD; a long-term condition where kidneys are damaged and cannot filter blood properly); - Gastroesophageal Reflux Disease (GERD; when stomach acid flows back up into the esophagus and causes a burning sensation in the chest); - Pulmonary embolism one year ago (PE; when a blood clot gets stuck in an artery in the lung); - Depression; - Hyperparathyroidism (condition caused by overactive parathyroid glands); and - DVT prophylaxis (preventative measures to stop deep vein thrombosis (clots in deep veins) and pulmonary embolism); and - Review of the care management note, on the H & P, showed the patient would receive therapies (physical and occupational therapy-PT/OT) at home when discharged and the anticipated date for discharge was 02/21/2026. Review of the clinical record showed the patient was admitted to home health services on 03/02/2026 with a primary diagnosis of acute kidney failure (sudden and often reversible loss of kidney function). The patient lived at home with a family caregiver. Review of the POC, dated 03/02/2026, showed: - The POC was created by the PT; - The diagnoses section contained the diagnoses listed on the H & P, including DM, and included several additional diagnoses, all had exacerbation dates (a sudden worsening or flare-up of a chronic disease’s symptoms, making them more severe than usual) of 02/24/2026, including but not limited to: -- Other instability, left knee; -- Coronavirus infection, unspecified; -- Abrasion of right forearm, initial encounter; -- Non-displaced fracture of head of right radius; -- Other fatigue; -- Hypotension; -- Precordial pain; -- Encounter for screening for malignant neoplasm of colon; -- Conductive hearing loss, bilateral; -- Aneurysm of iliac artery; -- Pneumonia, unspecified organism; -- Allergic rhinitis; -- Infrarenal abdominal aortic aneurysm without rupture; -- Rheumatic mitral valve disease; and -- Nonrheumatic tricuspid valve disease; - The section for treatment orders failed to include interventions related to assessment or monitoring of the patient’s DM; and - The section for durable medical equipment (DME) and supplies failed to include if the patient had a glucometer in the home. Observation and interview on 03/17/2026 at 11:30 AM showed the patient was able to move all extremities without pain, had no abrasion to the right forearm, and the patient stated that he/she was independent with diabetic management, and checked his/her blood sugar two times daily and recorded the results on a log. During an interview on 03/18/2026 at 11:15 AM, the home health administrator stated that: - There should be something on the plan of care about DM management, and the glucometer should be listed under DME/supply list; and - The diagnoses for patient #3 were not all exacerbated on 02/24/2026 and they will review these to correct this problem. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 02/02/2026 with a primary diagnosis of discitis (a rare, severe inflammation or infection of the intervertebral disc space, often causing intense back pain, stiffness, and fever). The patient lived at home with a family caregiver. Review of the clinical record showed the patient was prescribed clopidogrel (an antiplatelet) on 05/01/2025. Review of the plan of care, dated 02/02/2026-04/02/2026, failed to show a safety measure for bleeding precautions. During an interview on 03/18/2026 at 10:30 AM, the home health administrator stated that he/she would expect bleeding precautions to be included on the plan of care of patients who are prescribed antiplatelets.”