Centerwell Home Health

“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 clinical records review and staff interview, the Agency failed to ensure that patients receive services and treatments as ordered in the Plan of Care. This was evident in two (2) of seventeen (17) records reviewed (Patients #9 and #12). Failure to ensure that patients receive services and treatments as per the Plan of Care, has the potential for negative patient outcomes. The findings are: 1) Patient # 9 has a start of care date of 03/07/2024 with diagnoses of “Encounter for fitting and adjustment of urinary device, Quadriplegia, Neuromuscular dysfunction of Bladder, and Post-Polio Syndrome” as documented on the “Home Health Certification and Plan of Care” for certification period 08/29/2025 to 10/27/2025. The “Home Health Certification and Plan of Care” for certification period 08/29/2025 to 10/27/2025 document orders for “Skilled Nurse effective 9/14/25 1wk1, 1 every 4wk4, 1wk1 (one visit a week for one week, one visit every four weeks for four weeks, one visit a week for one week), Home Health Aide 1wk1, 2wk8, 1wk1 (one visit a week for one week, two visits a week for eight weeks, one visit a week for one week). Skilled Nurse to teach Indwelling catheter management such as definition, symptom monitoring and intended effects. Skilled Nurse to insert/change/maintain indwelling catheter 16 Fr, 10 milliliter balloon, inflate balloon with 10 milliliter Normal Saline, change every 4 weeks and as needed for dislodgement/stoppage using sterile technique, obtain urine specimen if ordered by Medical Doctor. Skilled Nurse to teach Urinary Tract Infection management such as definition, risk factors, and symptom monitoring. May obtain urine specimen for signs/symptoms of Urinary Tract Infection”. The “Registered Nurse Recertification with Skill” patient assessment dated 08/25/2025, documents “Genitourinary: incontinent, indwelling/suprapubic catheter, at risk for developing a Urinary Tract Infection”. The visit note lacks documented evidence of the indwelling urinary catheter size, urinary output as ordered in the Plan of Care, and catheter urinary meatus care. The “Registered Nurse subsequent visit” note dated 09/16/2025, documents “catheterization performed with no signs and symptoms of infection”. The visit note lacks documented evidence of the indwelling urinary catheter size, urinary output as ordered in the Plan of Care, and catheter urinary meatus care. The “Registered Nurse subsequent visit” note dated 10/15/2025, documents “Performed indwelling catheter insertion/change. Removed old catheter intact without complications. Performed site care using sterile technique. Inserted catheter/10 milliliter ballon using sterile technique, returned 30 milliliters urine straw color”. The visit note lacks documented evidence of the Indwelling catheter size (16 FR) that was inserted as ordered in the Plan of Care. The “Registered Nurse Recertification with Skill” assessment dated 10/27/2025, documents “Genitourinary: incontinent, indwelling/suprapubic catheter, at risk for developing a Urinary Tract Infection”. The visit note lacks documented evidence of the indwelling urinary catheter size, urinary output as ordered in the Plan of Care, and catheter urinary meatus care. Survey findings were reviewed on 12/04/2025 at 03:45 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/05/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged. 2) Patient # 12 has a start of care date of 03/20/2025 with diagnoses of “Pressure Ulcer of Sacral Region stage 3, Pressure Ulcer of Left Heel - unstageable, Pressure Ulcer of other sites - unstageable, Pressure Ulcer - other site stage 1, Pressure Ulcer - other site stage 2, and Encounter for fitting urinary device” as documented on the “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025. The “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025 document orders for “Skilled Nurse 2 wk 9 (two visits a week for nine weeks) and three (3) as needed visits for wound care. Skilled Nurse to insertion of Foley catheter maintain with 14Fr, 10 cubic centimeter balloon, change monthly. Skilled Nurse for administration of bladder irrigation (flush) with 30 milliliters sterile water or Normal Saline as needed for no urine output”. The Registered Nurse visit note report date 03/20/2025, genitourinary section documents the patient has “indwelling/suprapubic catheter, at risk for urinary tract infection, dark amber color (urine)”. The visit note lacks documentation of the catheter size and balloon size as ordered in the Plan of Care. The Registered Nurse subsequent visit note report date 03/31/2025, documents “Skilled Nurse noted Foley catheter bag hanging from tub siderail preventing flow. Skilled Nurse lowered Foley catheter bag and noted drainage. Skilled Nurse flush catheter and received over 500 cubic centimeters of output”. The genitourinary section documents the patient has “indwelling/suprapubic catheter, at risk for urinary tract infection, sediment in urine”. The visit note lacks documentation of the catheter size, balloon size, irrigation fluid type and quantity used to flush the catheter, as ordered in the Plan of Care. There is no documentation that the Foley catheter was changed on 03/31/25. The Registered Nurse subsequent visit note report date 04/29/2025, documents “Foley catheter in situ (intact) draining dark amber urine with sediments in tubing. Drainage bag was on top of the bed, informed daytime aide who corrected placement”. The genitourinary section documents the patient has “indwelling/suprapubic catheter, at risk for urinary tract infection, sediment in urine”. The visit note lacks documentation of the catheter size, balloon size as ordered in the Plan of Care. There is no documentation that the Foley catheter was changed on 04/29/25. Survey findings were reviewed on 12/02/2025 at 03:20 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/03/2025 at 10:30 AM with the Director of Patient Services/Clinical Manager. Findings were acknowledged. .”

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on clinical records review and staff interview, the Agency failed to obtain patient consents for skilled services frequency of visits. This was evident in four (4) of seventeen (17) records reviewed (Patients #9, #12, #13, and #14). Failure to consent for skilled services frequency of visits has the potential for negative patient outcomes. The findings are: 1) Patient # 9 has a start of care date of 03/07/2024 with diagnoses of “Encounter for fitting and adjustment of urinary device, Hypo-Osmolality, Hyponatremia, Neuromuscular dysfunction of Bladder, and Urinary Tract Infection as documented on the “Home Health Certification and Plan of Care” for certification period 03/07/2024 – 05/05/2024. The “Home Health Certification and Plan of Care” for certification period 03/07/2024 – 05/05/2024 document orders for Skilled Nurse 1wk2, 1 every 3wk3, 1wk1 (one visit a week for two weeks, one visit every three weeks for three weeks, one visit a week for one week), Physical Therapy 1wk5 (one visit a week for five weeks), Occupational Therapy effective 3/10/24, 1wk1, 2wk3, 1wk4 (one visit a week for one week, two visits a week for three weeks, one visit a week for four weeks). The” Home Care Consent” dated 03/07/24 lacks documented evidence of the Skilled Nurse, Physical Therapy, and Occupational Therapy frequency of visits. The “Home Care Consent” Addendum V2 dated 03/08/24 documents services will be provided for Physical Therapy and Occupational Therapy. There is no documentation of the expected frequency and duration for Physical Therapy and Occupational Therapy services. Survey findings were reviewed on 12/04/2025 at 03:45 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/05/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged. 2) Patient # 12 has a start of care date of 03/20/2025 with diagnoses of “Pressure Ulcer of Sacral Region stage 3, Pressure Ulcer of Left Heel - unstageable, Pressure Ulcer of other sites - unstageable, Pressure Ulcer - other site stage 1, Pressure Ulcer - other site stage 2, and Encounter for fitting urinary device as documented on the “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025. The “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025 document orders for Skilled Nurse 2 wk 9 (two visits a week for nine weeks) and three (3) as needed visits for wound care, Occupational Therapy 1wk5, 0wk1, 1wk1 (one visit a week for five weeks, no visit for one week, one visit a week for one week), Speech Therapy 2wk1, 1wk4 (two visits a week for one week, one visit a week for four weeks) effective 03/23/25 “. The “Home Care Consent” dated 03/20/25 lacks documented evidence of the Skilled Nurse, Occupational Therapy and Speech Therapy frequency of visits. Survey findings were reviewed on 12/02/2025 at 03:20 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/03/2025 at 10:30 AM with the Director of Patient Services/Clinical Manager. Findings were acknowledged. 3) Patient #13 has a start of care date of 10/24/2024 with diagnoses of “Nontraumatic Intracranial Hemorrhage, Hypertensive Heart and Chronic Kidney Disease, Heart Failure, and Anemia as documented on the dysfunction of Bladder, and Urinary Tract Infection as documented on the Home Health Certification and Plan of Care” for certification period 10/24/2024 to 12/22/2024. The “Home Health Certification and Plan of Care” for certification period 10/24/2024 to 12/22/2024 document orders for Skilled Nurse 1wk1, 2wk3, 1wk1 (one visit a week for one week, two visits a week for two weeks, one visit a week for one week), Physical Therapy 1wk1, 2wk3, 1wk2, 1 every 2wks2, 1wk1 (one visit a week for one week, two visits a week for three weeks, one visit a week for two weeks, one visit every two weeks for two weeks, one visit a week for one week). The” Home Care Consent” dated 10/24/24 lacks documented evidence of the Skilled Nurse and Physical Therapy frequency of visits. Survey findings were reviewed on 12/02/2025 at 03:00 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/04/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged. 4) Patient #14 has a start of care date of 06/25/2025 with diagnoses of “Alzheimer’s Disease, Dementia, Insomnia, and Overactive Bladder as documented on the Home Health Certification and Plan of Care” for certification period 06/25/2025 to 08/23/2025. The Home Health Certification and Plan of Care” for certification period 06/25/2025 to 08/23/2025 document orders for Physical Therapy 1wk2, 2wk2, 1wk3 (one visit a week for two weeks, two visit a week for two weeks, one visit a week for three weeks), Occupational Therapy 1 wk1 (one visit a week for one week) effective 6/29/25”. The” Home Care Consent” dated 06/25/25 lacks documented evidence of the Skilled Nurse and Physical Therapy frequency of visits. Survey findings were reviewed on 12/02/2025 at 03:15 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/04/2025 at 12:55 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged.”

“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 clinical records review and staff interviews, the Agency failed to establish individualized Plans of Care for all services and treatments. This was evident in two (2) of seventeen (17) records reviewed (#9 and #12). Failure to establish individualized Plans of Care, has the potential for negative patient outcomes. The findings are: 1) Patient # 9 has a start of care date of 03/07/2024 with diagnoses of “Encounter for fitting and adjustment of urinary device, Quadriplegia, Neuromuscular dysfunction of Bladder, and Post-Polio Syndrome” as documented on the “Home Health Certification and Plan of Care” for certification period 08/29/2025 to 10/27/2025. The “Home Health Certification and Plan of Care” for certification period 08/29/2025 to 10/27/2025 document orders for “Skilled Nurse effective 9/14/25 1wk1, 1 every 4wk4, 1wk1 (one visit a week for one week, one visit every four weeks for four weeks, one visit a week for one week), Home Health Aide 1wk1, 2wk8, 1wk1 (one visit a week for one week, two visits a week for eight weeks, one visit a week for one week). Skilled Nurse to insert/change/maintain indwelling catheter 16 Fr, 10 milliliter balloon, inflate balloon with 10 milliliter Normal Saline, change every 4 weeks and as needed for dislodgement/stoppage using sterile technique, obtain urine specimen if ordered by Medical Doctor. Skilled Nurse to teach Urinary Tract Infection management such as definition, risk factors, and symptom monitoring. May obtain urine specimen for signs/symptoms of Urinary Tract Infection”. The Plan of Care lack orders for Home Health Aide supervision every 14 days, urinary catheter meatus care and the frequency of urinary meatus care to be performed. It should be noted that the patient is at risk for developing Urinary Tract Infection. Survey findings were reviewed on 12/04/2025 at 03:45 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/05/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged. 2) Patient # 12 has a start of care date of 03/20/2025 with diagnoses of “Pressure Ulcer of Sacral Region stage 3, Pressure Ulcer of Left Heel - unstageable, Pressure Ulcer of other sites - unstageable, Pressure Ulcer - other site stage 1, Pressure Ulcer - other site stage 2, and Encounter for fitting urinary device” as documented on the “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025. The “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025 document orders for “Skilled Nurse 2 wk 9 (two visits a week for nine weeks) and three (3) as needed visits for wound care. Skilled Nurse to insertion of Foley catheter maintain with 14Fr, 10 cubic centimeter balloon, change monthly”. The Plan of Care lacks an order for urinary catheter meatus care and the frequency of urinary meatus care to be performed. It should be noted that the patient is at risk for developing Urinary Tract Infection. Survey findings were reviewed on 12/02/2025 at 03:20 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/03/2025 at 10:30 AM with the Director of Patient Services/Clinical Manager. Findings were acknowledged. .”

“Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient’s condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This Element is not met as evidenced by: Based on clinical record review and staff interview, the Agency failed to ensure that the Plan of Care is reviewed and revised every sixty (60) days. This was evident in one (1) of seventeen (17) records reviewed (Patient #13). Failure to review and revise the Plan of Care every sixty (60) days, has the potential for negative patient outcomes. The findings are: 1) Patient #13 has a start of care date of 10/24/2024 with diagnoses of “Nontraumatic Intracranial Hemorrhage, Hypertensive Heart and Chronic Kidney Disease, Heart Failure, and Anemia as documented on the Home Health Certification and Plan of Care” for certification period 10/24/2024 to 12/22/2024. The “Home Health Certification and Plan of Care” for certification period 10/24/2024 to 12/22/2024 document orders for “Skilled Nurse 1wk1, 2wk3, 1wk1 (one visit a week for one week, two visits a week for two weeks, one visit a week for one week), Physical Therapy 1wk1, 2wk3, 1wk2, 1 every 2wks2, 1wk1 (one visit a week for one week, two visits a week for three weeks, one visit a week for two weeks, one visit every two weeks for two weeks, one visit a week for one week).” The Registered Nurse OASIS Admission assessment is dated 10/24/2024. Physical Therapy visits are dated 10/25/24 - 11/20/24. The “Client Coordination Note Report” documents discharge 11/21/24, the patient’s son request Physical Therapy cancelled. Skilled Nurse visits are dated 10/29/24 - 12/20/24. The Registered Nurse subsequent visit dated 12/17/25 documents “Skilled Nurse provided wound care to multiple sites which patient tolerated well. Per Assisted Living Staff patient still not on Hospice”. Licensed Practical Nurse visit is dated 12/20/2024. The “Client Coordination Note Report” dated 12/23/24 documents “Interdisciplinary Team conference 12/18/24. Reviewed summary of assessment/plan for past 14 days, Discharge”. The clinical record lacks documented evidence of a discharge assessment or recertification assessment conducted prior to 12/22/24 certification end date. The patient was readmitted on 12/26/2024 with a new start of care date of 12/26/24 - 02/23/2025. The Agency did not review and revise the Plan of Care once every sixty (60) days. Survey findings were reviewed on 12/02/2025 at 03:00 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/04/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged. A second interview was conducted on 12/04/25 2025 at 01:30 PM with the Director of Patient Services/Clinical Manager who reported that patient was pending discharge to Hospice that did not occur. Agency discharged patient at end of certification period. New certification episode opened 12/26/24.”

“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 clinical records review and staff interview, the Agency failed to coordinate the patient’s wound and catheter care. This was evident in two (2) of seventeen (17) records reviewed (Patient #12 and #13). Failure to coordinate patients wound and catheter care has the potential for negative patient outcomes. The findings are: 1) Patient # 12 has a start of care date of 03/20/2025 with diagnoses of “Pressure Ulcer of Sacral Region stage 3, Pressure Ulcer of Left Heel - unstageable, Pressure Ulcer of other sites - unstageable, Pressure Ulcer - other site stage 1, Pressure Ulcer - other site stage 2, and Encounter for fitting urinary device” as documented on the “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025. The “Home Health Certification and Plan of Care” for certification period 03/20/2025 to 05/18/2025 document orders for Skilled Nurse 2 wk 9 (two visits a week for nine weeks) and three (3) as needed visits for wound care. Skilled Nurse to perform wound care treatments to Left lateral heel pressure injury, left posterior heel pressure injury, coccyx pressure injury, mid-back pressure injury, right scapula pressure injury, left medial foot. (It should be noted that there are six (6) pressure injuries listed for wound care treatments). Skilled Nurse to insertion of Foley catheter maintain with 14Fr, 10 cubic centimeter balloon, change monthly”. The Registered Nurse wound care assessment visit note dated 03/20/2025 documents the patient has a total of eight (8) wounds noted to the left heel, coccyx, mid-back, scapula, left foot lateral mid edge, left foot post edge. The genitourinary section documents the patient has “indwelling/suprapubic catheter, at risk for urinary tract infection, dark amber color (urine)”. There is no documented evidence of the foley catheter size, balloon size and date the foley catheter was changed. The Registered Nurse subsequent visit note report date 03/31/2025, documents “Skilled Nurse noted Foley catheter bag hanging from tub siderail preventing flow. Skilled Nurse lowered Foley catheter bag and noted drainage. Skilled Nurse flush catheter and received over 500 cubic centimeters of output”. The genitourinary section documents the patient has “indwelling/suprapubic catheter, at risk for urinary tract infection, sediment in urine”. There is no documented evidence of the foley catheter size, balloon size and the date the foley catheter was changed. The Registered Nurse subsequent visit notes report date 04/29/2025, documents “Foley catheter in situ (intact) draining dark amber urine with sediments in tubing. Drainage bag was on top of the bed, informed daytime aide who corrected placement”. The genitourinary section documents the patient has “indwelling/suprapubic catheter, at risk for urinary tract infection, sediment in urine”. There is no documented evidence of the foley catheter size, balloon size and the date the foley catheter was changed. The clinical record lacks documented evidence of coordination of care related to wound numbering, urinary output /sediments in urine, and Foley catheter monthly change as per the Plan of Care. Survey findings were reviewed on 12/02/2025 at 03:20 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/03/2025 at 10:30 AM with the Director of Patient Services/Clinical Manager. Findings were acknowledged. 2) Patient #13 has a start of care date of 10/24/2024 with diagnoses of “Nontraumatic Intracranial Hemorrhage, Hypertensive Heart and Chronic Kidney Disease, Heart Failure, and Anemia as documented on the Home Health Certification and Plan of Care” for certification period 10/24/2024 to 12/22/2024. The “Home Health Certification and Plan of Care” for certification period 10/24/2024 to 12/22/2024 document orders for “Skilled Nurse 1wk1, 2wk3, 1wk1 (one visit a week for one week, two visits a week for two weeks, one visit a week for one week), Physical Therapy 1wk1, 2wk3, 1wk2, 1 every 2wks2, 1wk1 (one visit a week for one week, two visits a week for three weeks, one visit a week for two weeks, one visit every two weeks for two weeks, one visit a week for one week).” The Registered Nurse subsequent visit dated 12/17/25 documents “Skilled Nurse provided wound care to multiple sites which patient tolerated well. Per Assisted Living Staff patient still not on Hospice”. The “Client Coordination Note Report” dated 12/23/24 documents “Interdisciplinary Team conference 12/18/24. Reviewed summary of assessment/plan for past 14 days, Discharge”. The clinical record lacks documented evidence of a discharge assessment. The patient was readmitted on 12/26/2024 with a new start of care date of 12/26/24 - 02/23/2025. The clinical record lacks documented evidence of coordination of patient services to ensure continuing of patient services while awaiting Hospice evaluation. Survey findings were reviewed on 12/02/2025 at 03:00 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/04/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on clinical record review and staff interview, the Agency failed to perform onsite supervision of the Home Health Aide every fourteen (14) days. This was evident in review of one (1) of two (2) records with Home Health Aide services (Patient #9). Failure to perform onsite supervision of the Home Health Aide has the potential for negative patient outcomes. The findings are: 1) Patient # 9 has a start of care date of 03/07/2024 with diagnoses of “Encounter for fitting and adjustment of urinary device, Quadriplegia, Neuromuscular dysfunction of Bladder, and Post-Polio Syndrome” as documented on the “Home Health Certification and Plan of Care” for certification period 08/29/2025 to 10/27/2025. The “Home Health Certification and Plan of Care” for certification periods 08/29/2025 - 10/27/2025 and 10/28/2025 - 12/26/2025 document orders for “Skilled Nurse effective 9/14/25 1wk1, 1 every 4wk4, 1wk1 (one visit a week for one week, one visit every four weeks for four weeks, one visit a week for one week), Home Health Aide 1wk1, 2wk8, 1wk1 (one visit a week for one week, two visits a week for eight weeks, one visit a week for one week). Home Health Aide services are dated 08/29/25, 09/01/25, 09/05/25, 09/08/25, 09/12/25, 09/15/25, 09/19/25, 09/22/25, 09/26/25, 10/03/25, 10/06/25, 10/10/25, 10/13/25, 10/17/25, 10/20/25, 10/24/25, 10/31/25, 11/03/25, 11/07/25, 11/14/25. Home Health Aide supervision is dated 08/25/25 and 10/27/25. The “Visit Note Report” dated 09/16/25, 10/15/25, and 11/24/25 lack documented evidence of Home Health Aide supervision. The clinical record lacks documented evidence of supervisory assessment of Home Health Aide services being provided no less frequently than every 14 days. Survey findings were reviewed on 12/04/2025 at 03:45 PM with the Director of Patient Services/Clinical Manager. No explanation was provided. Interview and survey findings were reviewed on 12/05/2025 at 12:35 PM with the Branch Director and Director of Patient Services/Clinical Manager. Findings were acknowledged.”