Hackensack Meridian at Home Monmouth County

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Based on medical record review, staff interviews, and review of facility documents, it was determined that the facility failed to ensure 1) all patients receive skilled services according to physician orders (G0572); and 2) that patients receive the prescribed visits for all disciplines involved, to meet the patient’s needs (G0608). Cross Reference: §484.60(a) Standard: Plan of care §484.60(d)(4) Coordination of Care”

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the 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 doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on medical record review, staff interviews, and review of facility documents, it was determined the facility failed to ensure all patients receive skilled services according to the established plan of care and physician orders. Findings include: Facility policy titled, “Rights/Responsibilities” dated 06/2025, stated, “… Procedure: 1. The patient will be informed verbally and in writing during the initial evaluation visit, in advance of furnishing care to the patient, of the following: … L. … The organization shall ensure that the patient receives all services outlined in the plan of care. M. The establishment and revision of the plan of care, including the disciplines that will furnish the care and the frequency of visits as well as any changes in the care to be furnished.” Facility policy titled, “Staffing and Scheduling” dated 03/2022, stated, “… Procedure: 1. The Clinical Care Coordinator (CCC) in conjunction with the Manager of Clinical Practice (MCP) will review the patient census and staffing levels on a daily basis and will make patient assignments … 4. Clinicians will communicate with the office to report any planned visits for the day that were not made, to report availability for visits the next day, and to receive admission assignment or changes for the next day’s schedule.” Facility policy titled, “Verification of Physician Orders” dated 03/2022, stated, “…NOTICES TO THE PHYSICIAN: 1. The office will notify the physician if the patient refuses service or treatment ordered and will document that refusal in the clinical record. 2. If fewer visits are provided during the week than ordered, the physician will be notified with documentation in the clinical record that the physician is aware of the missed visit unless the physician has authorized missed visits under specific circumstances (for example the plan of care indicates that the office may skip nursing visits on the day of physician visits or that home health aide visits may be skipped when the patient’s daughter is in the home to provide personal care) …” On 07/22/26 at 11:15 AM, a review of P1’s medical record, conducted in the presence of Staff (S)1 and S5, revealed the following: A physician’s “Referral” note dated 06/29/26 stated, “… Home Care Disciplines/Needs: Skilled Nursing evaluation for SOC [start of care] assessment for disease and medication management, comprehensive assessment, and education. Monitor and educate on signs and symptoms of infection, reporting abnormal finding to MD [medical doctor]. Assess and educate on fall precautions and home safety. Educate on emergency medical management and activation of EMS [Emergency Medical Services]. SN [Skilled Nurse] assess for other disciplines. Home care Diagnosis/Focus of Care: Ascites/pancreatic mass …” P1 was admitted on 06/30/26. P1’s “Skilled Nursing Care Plan” revealed that P1 was ordered to receive SN visits once a week for 2 weeks from 06/30/26 to 07/11/26. P1’s “Patient Calendar” indicated that P1 received an initial SN visit completed by S14 on 06/30/26 at 12:15 PM, where S14 recommended a Physical therapy (PT) evaluation for the patient and obtained an order. An “Inconvenience Visit” note completed by S7 on 07/06/26 at 2:23 PM stated, “… Patient was leaving for Doctor appointment as nurse was arriving. Discipline discharge rescheduled for Wednesday. Patient still waiting for therapy eval visit …” Upon interview, S1 stated that an “inconvenience visit” note is documented when a clinician arrives for a scheduled visit, but the patient is not available for appointment. A review of P1’s “Skilled Nursing Care Plan” revealed that P1 was ordered to receive SN visit, one visit per week for one week, from 07/06/26 to 07/11/26. S1 stated the additional SN visit order string was entered so the SN could reschedule the visit that was missed when P1 had a doctor’s appointment. P1’s medical record lacked evidence of a rescheduled SN visit or SN discipline discharge. P1’s “Ancillary Services Care Plan” revealed that P1 was ordered to receive one PT visit every six days for six days from 06/30/26 to 07/05/26. P1’s medical record lacked evidence of a PT evaluation during the week of 06/30/26 to 07/05/26. P1’s “Ancillary Services Care Plan” revealed that P1 was ordered to receive one PT visit every six days, for six days, from 07/06/26 to 07/11/26. P1’s medical record lacked evidence of a PT evaluation during the week of 07/06/26 to 07/11/26. On 07/22/26 at 11:58 AM, during an interview, S1 and S5 confirmed that P1 only received the initial SN visit on 06/30/26 and did not receive follow-up SN visits or an initial PT visit. S1 confirmed the medical record lacked evidence of communication with the physician regarding the delay in the PT evaluation. S1 and S5 confirmed that P1 was still an active patient, but the ordered SN and PT order strings had expired. At 2:21 PM, during a telephone interview, S7 stated that another SN performed the initial intake and assessment for P1. S7 stated, he/she was assigned as the case manager for P1. S7 stated, he/she went to P1’s home once for a visit, but P1 was leaving the home for an appointment, and was unable to conduct the SN visit as scheduled. When asked why P1 did not currently have any orders for nursing or therapy, S7 stated that he/she forgot about P1. S7 stated, he/she was supposed to transfer service from SN to PT for P1. S7 stated, he/she must have forgotten to reschedule a visit to go out to see P1. S7 stated that he/she would definitely call to schedule a visit to see P1 now that surveyors brought this to their attention. On 07/23/26 at 10:13 AM, during an interview, S10 stated, he/she was responsible for managing the PT, OT (Occupational Therapy), and SLP (Speech Language Pathologist) disciplines at the facility. When asked about the process for a PT evaluation, S10 stated, the SN puts in for an evaluation, and a case communication note is sent to the scheduler. S10 stated, he/she triages the evaluation requests and assigns them to a therapist based on acuity and need. S10 stated, he/she keeps a running tally of patients who are still pending an evaluation for therapy. S10 stated, even if a PT evaluation order expires, the patient still remains on the running tally list and is a part of their daily conversations. S10 stated, if the visit frequency order expired, then they would need to obtain a new order from the physician. S10 stated, if there was a delay in care, he/she would call the physician and document a note in the electronic medical record (EMR). At 10:49 AM, during a telephone interview, P1 stated that the SN came out once since their discharge from the hospital. P1 stated, he/she only received an admission visit from the SN and has had no other visits. P1 stated, the facility contacted him/her at night on 07/22/26 and scheduled visits with the RN and PT for 07/24/26. P1 stated that he/she talked about a PT eval with the SN during the admission visit but hadn’t heard anything more about it until he/she was contacted by the facility on 07/22/26 and was not sure what the facility was doing to help him/her. P1 stated, he/she was weak from dialysis and was preparing for chemotherapy, however, had not experienced any falls or adverse events since his/her admission visit. P1 stated, he/she did not attempt to contact the facility when they did not receive visits. P1 stated, he/she was so busy with dialysis and chemotherapy that they forgot about the visits from the facility. At 1:37 PM, an interview was conducted with S3. S3 explained that the case manager assumes patient care after the admission is completed. S3 stated, the case manager should be managing all of the visits and overseeing all the other disciplines involved in the patient’s care. S3 stated P1’s case manager should have gone out to reassess P1 and/or communicated with PT regarding the missed PT evaluations. S3 further explained that if there was an issue, he/she should escalate to a nursing or PT leader.”

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on medical record review, staff interview, and review of facility documents, it was determined the facility failed to coordinate delivery of care to ensure that patients receive the prescribed visits for all disciplines involved, to meet the patient’s needs. Findings include: Facility policy titled, “Staffing and Scheduling” dated 03/2022, stated, “… Procedure: 1. The Clinical Care Coordinator (CCC) in conjunction with the Manager of Clinical Practice (MCP) will review the patient census and staffing levels on a daily basis and will make patient assignments … 4. Clinicians will communicate with the office to report any planned visits for the day that were not made, to report availability for visits the next day, and to receive admission assignment or changes for the next day’s schedule.” A review of P1’s medical record conducted in the presence of Staff (S)1 and S5, revealed the following: A physician’s “Referral” note dated 06/29/26 stated, “… Home Care Disciplines/Needs: Skilled Nursing evaluation for SOC [start of care] assessment for disease and medication management, comprehensive assessment, and education. Monitor and educate on signs and symptoms of infection, reporting abnormal findings to MD [medical doctor]. Assess and educate on fall precautions and home safety. Educate on emergency medical management and activation of EMS [Emergency Medical Services]. SN [Skilled Nurse] assess for other disciplines ...” P1’s “Ancillary Services Care Plan” revealed that P1 was ordered to receive one PT visit every six days for six days from 06/30/26 to 07/05/26 for “evaluation and treat for HEP [home exercise program], transfer, and mobility training.” P1’s medical record lacked evidence of a PT evaluation during the week of 06/30/26 to 07/05/26. P1’s “Ancillary Services Care Plan” revealed that another order was received for, one PT visit every six days, for six days, from 07/06/26 to 07/11/26, for “evaluation and treat for HEP, transfer, and mobility training.” P1’s medical record lacked evidence of a PT evaluation during the week of 07/06/26 - 07/11/26. On 07/22/26 at 11:58 PM, S1 and S5 confirmed that P1 did not receive an initial PT visit. S1 confirmed the medical record lacked evidence of communication with the physician regarding the delay in the PT evaluation. S1 and S5 confirmed that P1 is still an active patient, but his/her PT order strings have expired. On 07/23/26 at 9:47 AM, during an interview, S9 stated that patients are triaged by the manager and assigned to a clinician based on diagnosis, location of patient’s home, and availability of clinicians. S9 stated that they handle a high volume of patients and work to schedule them as best as possible. S9 stated that he/she meets with the therapy and nursing manager several times per day to discuss visit frequencies. According to S9, if a visit frequency order was approaching an expiration date, then he/she would alert the manager to obtain a new order. S9 stated that he/she would not be alerted to a missed visit after an order expired, thus would not have known about the patient. S9 stated that the manager would contact the patient’s physician to obtain a new order. At 10:13 AM, during an interview, S10 stated that they were responsible for managing the PT, OT (Occupational Therapy), and SLP (Speech Language Pathologist) disciplines at the facility. When asked about the process for a PT evaluation, S10 stated, the SN enters an evaluation in the electronic medical record (EMR), and a case communication note is sent to the scheduler. S10 stated, he/she triages the evaluation requests and assigns them to a therapist based on acuity and need. S10 stated, he/she keeps a running tally of patients who are still pending an evaluation for therapy. S10 stated, even if a PT evaluation order expires, the patient still remains on the running tally list and is a part of our daily conversations. S10 stated, if the visit frequency order expired, then he/she would need to obtain a new order from the physician. S10 stated, if there was a delay in care, he/she would call the physician and document a note in the EMR. Upon request, S10 was unable to provide documentation of the “running tally list” from June 30 until July 22, 2026 (first day of survey). At 1:37 PM, an interview was conducted with S3. S3 stated that the case manager assumes patient care after the admission is completed. S3 stated, the case manager should be managing all of the visits and overseeing all of the other disciplines involved in the patient’s care. S3 stated P1’s case manager should have gone out to reassess P1 and/or communicated with PT regarding the missed PT evaluations. S3 stated that if there was an issue, he/she should escalate it to a nursing or PT leader. When asked about the lack of documentation regarding the PT evaluation delay, S3 stated the CCC normally documents the communication in the chart. During the medical review, there was no documented evidence by the CCC concerning the delayed or missed visit.”

“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 observations, staff interview, and a review of facility policies, it was determined the facility failed to follow the facility policy to prevent the transmission of infections and communicable diseases, in four of seven home visit patients (Patient (P)1, P3, P4, and P6). Findings include: On 4/30/25 at 9:19 AM, during a home visit with Patient (P) 4, in the presence of Staff (S)10 (Licensed Practical Nurse) and S11 (Manager of Clinical Practice), S10 was observed setting up his/her laptop computer on a clean barrier on the patient’s table. At 9:25 AM, while speaking with the patient, S10 was then observed walking around the table, touching and adjusting the backs of the chairs, prior to using the laptop computer. S10 was not observed performing hand hygiene before using the laptop computer. The computer was not disinfected after use. At 1:46 PM, during an interview with S4 (Director of Quality), he/she provided documentation of their procedure for cleaning the laptop computers. Review of facility document titled “Procedure for Care, Cleaning, and Infection Prevention Practices for the Computer and Other Electronic Devices” revealed the following: “.Purpose: ...Electronic devices include, but are limited to, computers, tablets, and mobile phones. ..Care and Cleansing of the Computer/Electronic Device:. All electronic devices should be disinfected daily when visibly soiled or contaminated. ...Special instructions: Always remove gloves and perform hand hygiene before touching all electronic devices, including the computer, screen, keyboard, stylus, and mouse. ...” S4 confirmed that the laptops are cleaned at the end of each day, and that staff are to perform hand hygiene prior to using the laptop computer. At 2:01 PM, S4 confirmed that when S10 touched the chairs in P4’s home, the expectation was that S10 would perform hand hygiene prior to using the laptop. Findings include: Facility policy titled “Hand Washing and Hand Hygiene”, last revised on 07/2024, stated, “Policy: … hand hygiene will be performed in accordance with the CDC guidelines … cleaning your hands by using either handwashing with soap and water or antiseptic hand rub with alcohol-based hand sanitizer … Procedure: Hands are a common transfer mechanism for potential pathogens from one patient to another, from a contaminated article from the patient or patient’s environment or from healthcare personnel to the patient … C. Hand Washing/Hand Hygiene Indications: … Before and after contact with patient or environment …” Facility undated policy titled “Cleaning & Disinfecting Guidelines for Patient Care Equipment, stated, “Policy: … has been established to prevent the transmission of pathologic organisms between patients and caregivers … Procedure: 1. Thermometer, stethoscope (bell) and pulse oximeter: Cleaned between each patient use … 2. … non-critical items, including, but not limited to, blood pressure cuffs … must be cleaned/disinfected after use on patient … 3. Separation must be maintained between clean and soiled equipment to prevent cross-contamination …” Facility policy titled “Bag Technique”, last revised on 03/2022, stated, “… 5. Remove supplies from clean area … and place on the clean barrier … 12. Clean equipment per policy prior to returning it to the clinician bag …” Facility undated policy titled “Procedure for Care, Cleaning, and Infection Prevention Practices for the Computer & Other Electronic Devices”, stated, “Care and Cleansing of the Computer/Electronic Device: All electronic devices should be disinfected daily and when … contaminated … Special Instructions: Always remove gloves and perform hand hygiene before touching all electronic devices, including the computer …” On 04/29/25 at 11:35 AM, in the presence of Staff (S)8 (Therapy Supervisor), S12, an Occupational Therapist (OT) was observed providing care for P6. At 11:14 AM, while completing a medication reconciliation with P6’s spouse, S12 touched medication bottles and then proceeded to touch his/her computer without washing and/or sanitizing his/her hands multiple times. At 11:51 AM, S12 touched P6’s arm and then proceeded to touch his/her computer without washing and/or sanitizing his/her hands. At 12:07 PM, S12 completed vital signs on P6. During this process, S12 touched P6 multiple times and then proceeded to touch his/her computer without washing and/or sanitizing his/her hands. At 12:14 PM, S12 closed and picked up his/her computer, without cleaning the computer, and proceeded to exit the home. On 04/30/25 at 12:15 PM, in the presence of S8, S15, a Physical Therapist (PT) was observed providing care for P1. At 11:18 AM, S15 placed three barrier pads on P1’s dresser for patient care. S15’s laptop and paperwork were placed on the left barrier pad. At 11:20 AM, while completing a medication reconciliation with P1’s private aide, the private aide handed S15 a plastic bin filled with medications. S15 placed the medications on center barrier pad. While S15 was reviewing the medications with his/her computer, P1’s private aid placed papers on the right barrier pad. At 11:22 AM, S15 completed a set of vital signs for P1 utilizing the following equipment: blood pressure cuff, pulse oximeter, thermometer, and stethoscope. S15 placed dirty equipment on the center barrier pad. At 11:25 AM, S15 utilized disinfectant wipes to clean the equipment (blood pressure cuff, pulse oximeter, thermometer, and stethoscope). S15 placed clean equipment on the right barrier pad to dry. At 11:58 AM, S15 set up P1’s next appointments for physical therapy and updated a dry erase board calendar. At 12:01 PM, P1’s private aid placed the updated dry erase board calendar on top of the clean equipment on the right barrier pad. At 12:05 PM, S15 placed the equipment back in the nursing bag without re-cleaning the equipment. At 12:06 PM, S15 closed and picked up his/her computer, without cleaning the computer, and proceeded to exit the home. On 05/01/25 at 12:02 PM, an interview was conducted with S19 (Staff Development). When questioned about infection control related to bag technique, S19 explained that during orientation, new staff are trained on infection control, which includes bag technique. S19 further explained that all staff members review bag technique on a yearly basis. S19 stated that if an item that is considered dirty is placed on the clean barrier with already cleaned supplies, then the supplies would be required to be re-cleaned. When questioned about infection control related to staff computers, S19 stated, “We tell staff to think of your computer as always clean because you wash your hands before you touch it.” S19 explained that computers are not cleaned during every visit since they are only touched with cleaned hands; instead, they are cleaned at the end of every week. S19 revealed that staff are trained on the “Procedure for Care, Cleaning, and Infection Prevention Practices for the Computer & Other Electronic Devices” policy during orientation and then every three years. Cross reference: NJAC 8:42-12.2(b) On 04/30/25 at 9:32 AM, in the presences of Staff (S) 6 (Manager of Clinical Practice), S5, Registered Nurse (RN) was observed providing care for P3. At 9:35 AM, S5 spoke with P3’s spouse regarding P3’s medications, glucose (sugar) levels, diet, balance, pain, and upcoming schedule for the week. At 10:02 AM, S5 placed a barrier pad on P3’s table and placed the nursing bag on the barrier pad. S5 performed hand hygiene and placed a second barrier down on the table. S5 removed “Super Sani Cloth” (germicidal wipes) and placed the wipes and the hand sanitizer on the second barrier. At 10:06 AM, S5 began vital sign assessment on P3. At 10:12 AM, S5 finished taking P3’s vital signs and began cleaning the equipment with a “Super Sani Cloth.” After using the disinfectant wipes on the vital sign equipment (stethoscope, pulse oximeter, and blood pressure cuff), S5 placed the clean equipment onto the barrier where the hand sanitizer and “Super Sani Cloth” were located. At 10:14 AM, S5 began to drain P3’s pleurx catheter (a tube placed into the body to drain excess fluid) and when finished draining, S5 changed P3’s dressing. At 10:28 AM, S5 performed hand sanitized and repeated P3’s vital signs. at 10:36 AM, S5 cleaned the equipment with a “Super Sani Cloth” and placed the clean equipment onto the second barrier on top of the “Super Sani Cloth” package. On 04/30/25 at 10:16 AM, S6 stated that “Super Sani Cloths” are contained within the “dirty” section of the nursing bag. On 05/01/25 at 12:03 PM, the observed nursing procedure during P3’s home visit was described to S19 (Staff Development). S19 explained that clean vital signs equipment should not have been placed on the barrier with the hand sanitizer and the “Super Sani Cloth” and he/she stated, “oh no, you need a whole separate barrier, at least 5-6 per visit.” When asked if the “Super Sani Cloth” were considered “dirty” S 19 stated that they are clean and kept in the “clean” section of the nursing bag. Facility policy, titled, “Bag Technique,” last revised 03/2022, states, “...Bag Setup...Small Side Zipper Area (A): The “dirty” section. Meridian provided soap, Epiclenz gel, paper towels, alcohol swabs, Sani-Wipes, Gluco-chlor wipes, Barriers....Main Zipper Area (B): The “Clean Section.” All dressing supplies, foleys, blood tubing, clean gloves, suture removal kits, single use thermometers, OSHA bag, spill kit, and any clean supplies needed for patient care...””

“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 medical record review, interviews with staff, and review of facility documents, it was determined the facility failed to follow facility policy to conduct initial assessments with 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician-ordered start of care date in three of five medical records reviewed (Patient (P)6, 11, and 14). Findings include: Facility policy titled “Initial and Comprehensive Assessments” last revised 03/2022 states “Purpose: To provide guidelines for the initial assessments of patients admitted to service… Policy: … The initial assessment visit must be performed either within 48 hours of the referral, within 48 hours of patient’s discharge from inpatient, on the start of care date ordered by the physician (or other licensed practitioner), at the patient/family request with the approval of the physician (or other licensed practitioner) or within 48 hours of the organization receiving notification of patient’s return home on resumption of care. …” On 5/1/25 at 9:30 AM, a review of P6’s medical record was conducted with Staff (S)6 (Registered Nurse (RN) / Manager of Clinical Practice) and S18 (Clinical Director of Ocean County) and revealed the following: On 3/20/25, P6 received a referral from a physician for home health care. On 4/5/25, P6 was discharged to home from the hospital. On 4/8/25 at 11:20 AM, telephone communication from S6 to P6’s caregiver stated that P6 was “home ok” and agreeable to SOC (start of care). On 4/10/25 at 12:22 PM, RN conducted initial assessment of P6. On 5/1/25 at 10:09 AM, a review of P11’s medical record was conducted with S6 and S18 and revealed the following: On 3/17/25, P11 received a referral from a physician for home health care. On 3/17/25, P11 was discharged to home from the hospital. On 3/18/25 at 4:30 PM, a telephone communication to the patient stated the facility “LVM (left voicemail) to set up HC (home care) svcs (services).” On 3/20/25 at 11:57 AM, a telephone communication to the patient stated “home and agreeable to SOC. All information verified.” On 3/27/25 at 11:07 AM, RN conducted an initial assessment of P11. On 5/1/25 at 10:25 AM, S6 and S18 confirmed that there were no additional communication notes between 3/20/25 and 3/27/25 to explain the delay in the initial assessment. On 5/1/25 at 10:28 AM, a review of P14’s medical record was conducted with S6 and S18 and revealed the following: On 11/5/24, P14’s referral from a physician for home health care was initiated. On 11/6/24, P14 was discharged to home from the hospital. On 11/7/24, physician signed the referral for P14. On 11/8/24 at 11:40 AM, a telephone communication to P14’s daughter stated that P14 was home and “agreeable to SOC.” On 11/10/24 at 12:06 PM, RN conducted an initial assessment of P14. On 5/1/25 at 10:34 AM, when questioned about when P14 should have received an initial assessment per facility policy, S6 stated that “P14 should have been seen on 11/9/24.” S6 and S18 confirmed that there were no additional notes to explain the delay in receiving the initial assessment. Cross Reference: NJAC 8:42-6.1(a)3 - Plan of Care”

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on medical record review, staff interview, and review of facility policies, it was determined the facility failed to ensure communication with the physician is documented when a delay in services, due to staffing, occurrs, in one of five medical records reviewed (Patient (P)2). Findings include: Facility policy titled “Verification of Physician Orders”, last revised on 03/2022, states, “Notices To The Physician: ... 2. If fewer visits are provided during the week than ordered, the physician will be notified with documentation in the clinical record that the physician is aware of the missed visit unless the physician has authorized missed visits under specific circumstances …” On 04/30/25 at 2:29 PM, a review of P2’s medical record was conducted with Staff (S)6 (Registered Nurse/Manager Clinical Practice) and S18 (Clinical Director Ocean County) and revealed the following: A review of P2’s “Home Health Plan of Care” document, for the certification period beginning 3/10/25, showed visit orders for the Home Health Aide (HHA) as “… Aide (HHA) 2 visits every week for 1 week from 3/10/25 to 3/15/25.” During the week of 03/10/25 to 03/15/25, P2 was only visited once by the HHA on 03/12/25. On 03/13/2025, a Home Health Aide (HHA) note documented a missed visit for P2. The note explained that P2’s spouse cancelled the appointment after he/she arrived at the home. There was no documented method of notification to the physician (verbal or fax) for the missed visit in the medical record. On 04/30/25 at 2:42 PM, the findings were confirmed by S6 and S18. When questioned regarding the missed visit, S18 stated, “The doctor is always notified regardless of reason for the missed visit.” Cross reference: NJAC 8:42-6.1(a)3 - Care Plans”

“Must have a written agreement CFR(s): 484.105(e)(2)(i-iv) An HHA must have a written agreement with another agency, with an organization, or with an individual when that entity or individual furnishes services under arrangement to the HHA’s patients. The HHA must maintain overall responsibility for the services provided under arrangement, as well as the manner in which they are furnished. The agency, organization, or individual providing services under arrangement may not have been: (i) Denied Medicare or Medicaid enrollment; (ii) Been excluded or terminated from any federal health care program or Medicaid; (iii) Had its Medicare or Medicaid billing privileges revoked; or (iv) Been debarred from participating in any government program. This Element is not met as evidenced by: Based on staff interview and review of facility documents, it was determined the facility failed to ensure a written agreement is in place for social work services provided by a separately certified Home Health Agency (HHA). Findings Include: On 4/29/25 on 9:49 AM, during a review of services offered by the Home Care, Staff (S) 2 (Director of Home Care) reported that the facility did not utilize any contracted services. On 5/1/25 at 9:30 AM, the medical record revealed that Patient (P)6 was seen by social worker on 4/12/25. On 5/1/25 at 9:53 AM, during medical record review, S20 (Clinical Director), in the presence of S19 (Staff Development), reported that the facility’s only social worker was on medical leave. On 5/1/25 at 12:15 PM, a review of the facility’s staff list revealed only one social worker is employed by the HHA. On 5/1/25 at 12:39 PM, an interview was conducted with S2 and S3 (Vice President of Home Care). S2 explained that the HHA employs one social worker, and he/she is currently on a medical leave. According to S2, the Social Worker began medical leave in mid-March. S2 explained that the Ocean County HHA is providing social work coverage. According to S2, when a patient has a social work referral, the scheduling department contacts the director of Ocean County HHA to confirm social work availability before placing the patient on the Ocean County social worker’s caseload. S2 reported that if the consult is urgent, this is communicated during scheduling. S3 explained that the social worker job description, electronic medical record, and training, at both HHAs is the same. S2 reported there are currently 17 patients being followed by social work. Upon request, the facility failed to provide a written agreement between the two HHAs. On 5/1/25 at 1:30 PM, S22 (Senior Vice President) confirmed the facility does not have a written agreement regarding the use of social work services from the Ocean County HHA. Cross Reference: NJAC 8:42-3.7(a) - Written Agreements”