Healthview Home Health & Hospice, LLC

“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 agency policy, clinical record review, and staff interviews, the agency failed to complete the initial comprehensive physical therapy assessment within 5 days of the admission for 1 of 4 discharged patients (#2). Findings included: Patient #2 was admitted on 11/06/25 with a diagnosis of stage 5 kidney disease. The plan of care for 11/06/25-1/4/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 8 weeks with 3 PRN (as needed), and physical therapy (PT) to evaluate and treat. Review of the clinical record revealed that the PT evaluation was not conducted until 12/1/25. An interview conducted on 3/30/26 at 11:20 AM with the administrator revealed that the initial PT comprehensive assessment physician should have been completed within 5 days of admission or a new order for a delayed assessment should have been obtained from the physician.”

“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 agency policy, clinical record review, and staff interviews, the agency failed to include bleeding precautions in the plan of care for 5 of 11 patients with orders for anti-platelet and/or anticoagulant medications (used to prevent blood clots) (patient #’s 5, 6, 10, 11, & 13). Findings included: A policy, Plan of Care- CMS# 485 and Physician Orders (revised 3/2018) received on 3/31/26 at 9:33 AM from the Executive Director stated, “The individualized plan of care must include the following: … Safety measures to protect against injury…” 1. Patient #5 was admitted on 2/21/26 with diagnoses of encounter for attention to colostomy and acute embolism (blood clot that travels) and thrombosis (blood clots in veins) of deep veins. The plan of care (POC) for 2/21/26-4/21/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 4 weeks, and 2 PRN (as needed), and “Apixaban [oral blood thinner to prevent clots] 5mg take 1 tablet by mouth twice daily for blood clots.” A review of the clinical record revealed that there were no bleeding precautions included in the POC. 2. Patient #6 was admitted on 2/4/26 with diagnoses of encounter for attn (attention) to oth (other) artif (artificial) openings (opening in abdominal wall for urine drainage) and long term (current) use of aspirin (antiplatelet to prevent blood clots). The plan of care for (POC) 2/4/26-4/4/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 8 weeks, with 3 PRN (as needed) and, “Aspirin EC (enteric coated) 81 mg every day by mouth HTN [high blood pressure].” A review of the clinical record revealed that there were no bleeding precautions included in the POC. 3. Patient #10 was admitted on 6/5/25 with diagnoses of pressure ulcer of sacral region, stage 4 (full thickness wound at base of spine) and long term (current) use of aspirin (antiplatelet to prevent blood clots). The plan of care for (POC) for 1/31/26-3/31/26 included orders for skilled nurse visits 1 time a week for 8 weeks and “Aspirin (anti-platelet) 81mg take 1 tablet by mouth daily for heart health.” A review of the clinical record revealed that there were no bleeding precautions included in the POC. 4. Patient #11 was admitted on 2/7/26 with diagnoses of encounter for change or removal of surgical dressing and long term (current) use of aspirin (antiplatelet to prevent blood clots). The plan of care (POC) for 2/7/26-4/7/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 5 weeks, 3 PRN (as needed), and “Aspirin Adult Low Strength 81mg take 1 tablet by mouth daily for heart health.” A review of the clinical record revealed that there were no bleeding precautions included in the POC. 5. Patient #13 was admitted on 2/21/26 with diagnoses of other sequelae of cerebral infarction (long term neurological or physical deficits after a blockage of blood flow to the brain), long term (current) use of aspirin (antiplatelet to prevent blood clots), and long term (current) use of antithrombotic (medications to prevent blood clots). The plan of care (POC) for 2/21/26-4/21/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 8 weeks, 3 PRN (as needed), “Aspirin 81 mg oral tb [tablet] take 1 tab daily-blood thinner,” and “Clopidogrel [anti-platelet] 75 mg TAB. 1 TAB daily for HDL [high cholesterol].” A review of the clinical record revealed that there were no bleeding precautions included in the POC. An interview conducted on 4/1/26 at 8:59 AM with the Executive Director revealed that patients #6, 10, 11, and 13 should have had bleeding precautions documented under safety precautions. The Executive Director stated, “She’s [patient #5] a cash patient that specifically asked for ostomy education.” The interview revealed that the agency does not normally add precautions or additional care plans for privately paid patients.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the agency failed to include an order for wound care for an insertion site for a suprapubic catheter (device inserted through an abdominal incision into the bladder to drain urine) for 1 of 1 patient with a suprapubic catheter, (patient # 6). Findings included: Findings included: A policy, Plan of Care-CMS #485 and Physician Orders (revised 3/18) received on 3/31/26 at 9:33 AM from the Executive Director stated, “The individualized plan of care must include the following: … All medications and treatments… All patient care orders…” Patient #6 was admitted on 2/4/26 with diagnoses of encounter for attn (attention) to oth (other) artif (artificial) openings (opening in abdominal wall for urine drainage). The plan of care for 2/4/26-4/4/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 8 weeks, with 3 PRN (as needed). A review of the clinical record revealed that on 2/4/26 registered nurse (RN) #11 documented, “Red around insertion site, has not been cleaned since surgery, tubing dry and crusty, cleansed with alcohol wipes…” Further review revealed that there was no physician’s order for insertion site care. During an interview conducted on 4/1/26 at 9:30 AM RN #11 stated, “I do not see that [an order to cleanse with alcohol.” During an interview conducted on 4/1/26 at 9:50 AM the Executive Director stated, “They [nurses] should have an order.””

“Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This Element is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the agency inaccurately documented pressure injury stages (classification based on tissue damage) for 1 of 4 patients with pressure injuries, (patient #10). Findings included: A policy, Assessment/Staging of Pressure Ulcers (not dated) received on 04/01/26 at 10:02 AM from the agency administrator stated, “Stage 2: Partial thickness loss of dermis [middle layer of skin] presenting as a shallow ulcer with red pink wound bed without slough… Stage 3 : Full thickness skin loss… May include undermining [destruction of tissue under the edges of a wound] or tunneling [destruction of the facia (connective tissue) in any direction, creating passages, appearing in stage 3 or greater wounds.] … Pressure ulcers heal to a progressively shallower depth; they do not replace lost muscle, subcutaneous fat or dermis… Reverse staging does not accurately characterize what is physically occurring…” Patient #10 was admitted on 06/05/2025 with a diagnosis of pressure ulcer of sacral region (area at the base of the spine), stage 4 (full thickness loss-with exposed bone). The plan of care for 01/31/2026 included orders for skilled nurse (SN) visits 1 time a week for 8 weeks with 4 PRN (as needed) and “SN to clean sacrum with soap and water. Pat Dry, apply [name brand wound cleanser] damp gauze into undermining [erosion of wound] of wound bed, place [name brand dressing] into wound bed, cover with border foam dressing…” Review of the clinical record revealed the following documentation: On 2/5/26 licensed practical nurse (LPN) #10 documented, “Stage 2, Sacrum 4.5cm x 5.1 cm x 1 cm with 3cm tunneling. On 2/10/26 register nurse (RN) #7 documented, “Stage 2, 4.5cm x 4.3 cm x 1.3 cm undermining 3.3 cm…” On 2/26/26 RN #7 documented, “Stage 2, with tunneling.” LPN #10 was not available for an interview. RN #7 was not available for an interview. An interview conducted on 3/31/26 at 8:53 AM with the Executive Director revealed that undermining and/or tunneling cannot be present in a Stage 2 wound and if initially staged as stage 4 the wound should always be documented as stage 4.”

“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 agency policy, clinical, record review, and staff interview, the agency failed to notify the physician of a delay in a physical therapy evaluation for 1 of 9 (#2) patient with an order for physical therapy; and failed to provide an update to the physician for 1 of 1 patient with a request to contact the physician (#2); and failed to notify the physician of missed skilled nurse visits for 1 of 2 patients with missed skilled nurse visits (#6); and failed to notify the physician of a possible wound infection for 1 of 1 patient with symptoms of an infected wound (#7); and failed to document that a physician was notified of a patient fall for 1 of 2 patients with documented falls (#15). Findings included: A policy, Coordination of Patient Care (revised 03/2018) received on 3/31/26 at 9:33AM from the Executive Director stated, “The agency must: Assure communication with all physicians involved in the plan of care.” A policy Plan of Care-CMS #485 and Physician Orders (revised 03/2018) received on 3/31/26 at 9:33 AM from the Executive Director stared, “The agency alerts the physician to any changes that suggest a need to alter the plan of care. If the agency provides fewer visits than the physician’s orders, it has altered the plan of care, and the physician must be notified…” 1. Patient #2 was admitted on 11/06/25 with a diagnosis of stage 5 kidney disease. The plan of care for 11/06/25-1/4/26 included orders for skilled nurse visits 1 time a week for 1 week, 1 time a week for 8 weeks with 3 PRN (as needed), and physical therapy (PT) to evaluate and treat. Review of the clinical record revealed that the PT evaluation was not conducted until 12/1/25. Further review revealed that there was no documentation of the physician being notified of the delay. An interview conducted on 3/30/26 at 11:20 AM with the administrator revealed that the physician should have been notified if the evaluation could not be completed within 5 days of the admission and documented. Review of the clinical record revealed that during the registered nurse (RN) visit from 12/01/25 RN #7 documented, “pt [patient] has mucus in foley cath [indwelling urinary catheter] line tubing at this visit, per dtr [daughter] UTLOGIST wants a report this afternoon on pt status.” Further review revealed that there was no documentation of the urologist being given a report. RN #7 was not available for an interview. An interview conducted with the agency administrator of 4/1/26 at approximately 9:15 AM revealed that the nurse should have contacted the physician and documented the conversation. 2. Patient #6 was admitted on 2/21/26 with a diagnosis of encounter for attention to colostomy (artificial opening in the abdomen to divert stool into an external pouch). The plan of care for 2/21/26-4/21/26 included orders for skilled nurse (SN) visits 1 time a week for 1 week, 1 time a week for 4 weeks with 2 PRN (as needed) and “SN may perform colostomy appliance change and stoma care at each visit.” Review of the clinical record revealed that the SN visits of 2/28/26, 3/5/26, 3/12/26 and 3/19/26 were documented as missed visits. Further review revealed that there was no documentation that the physician was notified. An interview conducted on 4/1/26 at approximately 9:00AM with the administrator revealed that the physician should have been notified after each missed visit. 3. Patient #7 was admitted on 11/10/2025 with a diagnosis of stage 3 pressure injury of the sacrum (wound with full thickness skin loss at the base of the spine). The plan of care for 03/10/26-5/8/26 included orders for skilled nurse visits 1 time a week for 9 weeks with 3 PRN (as needed) and “Wound care orders to sacrum. Remove old dressing, clean wound with normal saline or wound cleanser, pat dry, apply moisturizer to intact skin, apply calcium alginate [absorbent dressing] into wound bed. Cover with border foam dressing or ABD [absorbent pad] and tape. Dressing to be changed daily…” Review of the clinical record revealed that on 3/11/26 RN #9 documented, “Drainage: Small<25% of DRSG [sic] is Purulent [thick, cloudy, pus-like fluid indication an infected wound].” Further review revealed that there was no documentation of the physician being notified. During an interview conducted on 4/1/26 at 9:14AM RN #9 stated, “No, I did not [call the physician] but I will.” During an interview conducted on 4/1/26 at 9:16 AM the administrator stated, “She [RN} should have call that day.” 4. Patient #15 was admitted on 3/4/26 with a diagnosis of hypertensive heart disease 9high blood pressure) with heart failure (reduced ability to pump blood). The plan of care for 3/4/26-5/2/26 included order for occupational therapy (OT) visits 1 time to evaluate and treat and 1 time a week for 8 weeks. Review of the clinical record revealed that during the OT visit on 3/19/26 OT #6 documented that the patient had a fall. Further review revealed that there was no documentation of the physician being notified. During an interview conducted on 4/1/26 at approximately 10:30 AM OT #6 stated that the physician was notified and confirmed that the notification was not documented. An interview conducted on 4/1/26 at approximately 10:35 AM with the administrator revealed that all communication with the physicians should be documented.”