Revival Home Health Care

“Investigate complaints made by patient CFR(s): 484.50(e)(1)(i) The HHA must— (i) Investigate complaints made by a patient, the patient’s representative (if any), and the patient’s caregivers and family, including, but not limited to, the following topics: (A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; (B) Mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and/or misappropriation of patient property by anyone furnishing services on behalf of the HHA. This Element is not met as evidenced by: Based on clinical record review, and staff interviews, the agency failed to investigate all complaints made by a patient. This was evident for one (1) of three (3) clinical records reviewed (Patient #1). Failure to ensure all complaints are investigated, has the potential risk for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 03/20/2025 with diagnoses: Disruption of External Operation (Surgical) Wound, Malignant Neoplasm Colon, Anemia in Neoplastic Disease, Encounter for Attention to Colostomy documented in the Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025. The Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025 documents an order for “SN (Skilled Nursing) 1WK2 (one visits a week for two weeks), 2WK1 (two visit a week for one week), 1WK5 (one visits a week for five weeks).” The Clinical Coordination Note dated 04/04/25 documents: “PT (patient) reports not wanting anymore nursing visits because she feels it did not help her at all and the only things she needs right now are PT (Physical Therapy), Wound Specialist, and additional supplies.” The clinical record lacks documented evidence of a complaint investigation addressing the patient’s unsatisfaction with Skilled Nurse services. On 05/27/2025 at 3:45 PM, the Administrator, and the Director of Quality and Compliance were interviewed and did not provide an explanation for the findings.”

“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 record review, and staff interviews, the agency failed to establish an individualized plan of care that includes all the required information. This was evident for one (1) of three (3) clinical records reviewed (Patient #1). Failure to ensure individualized plan of care includes all the required information, has the potential risk for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 03/20/2025 with diagnoses Disruption of External Operation (Surgical) Wound, Malignant Neoplasm Colon, Anemia in Neoplastic Disease, Encounter for Attention to Colostomy documented in the Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025. The Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025 documents an order for “SN (Skilled Nursing) 1WK2 (one visits a week for two weeks), 2WK1 (two visit a week for one week), 1WK5 (one visits a week for five weeks).” The Complaint Investigation dated 04/03/25 documents: “The patient reported that she had not received any ostomy supplies and had assumed that the visiting nurse would bring them.” The Physician Order dated 04/03/25 documents: “Ostomy supplies, Coloplast Brand: REF #120700 HCPCS AA4362 – 20/box-order: 1 Box, REF #120115 HCPCS A4456 – 30/Box – order: 1 Box, REF #16716 HCPCS A5057 10/box -order: 2 Boxes.” The clinical record lacks documented evidence of the Registered Nurse assessing the patient’s need for ostomy supplies from 03/20/25- 04/03/2025. The Home Health Certification and Plan of Care lacks documented evidence of a physician order for ostomy supplies from 03/20/25- 04/03/202, and a physician order for ostomy care/treatment. The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/20/25: Observed patient’s abdominal incision to be nearly closed w(with)/no drainage or signs/symptoms of infection. RN (Registered Nurse) cleansed w(with)/normal saline and covered with dry dressing.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/25/25: wound care was provided to the patient’s abdominal incision cite. The site was cleansed with normal saline, patted dry, and covered with a dry sterile dressing.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 04/02/25: Performed wound care to the patient’s abdominal incision site. Area was gently cleaned with normal saline and dried. A clean, dry dressing was applied, the incision appeared to be healing appropriately, with no signs of infection, drainage, or dehiscence observed.” The Home Health Certification and Plan of Care lacks documented evidence of the physician order for abdominal incision site treatment. There is no documented evidence that the agency established an individualized plan of care. On 05/27/2025 at 3:45 PM, the Administrator, and the Director of Quality and Compliance were interviewed and did not have an explanation for the findings.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on clinical record review and staff interviews, the agency failed to ensure that all treatments are administered in accordance with physician orders. This was evident for one (1) of three (3) clinical records reviewed (Patient #1). Failure to ensure that all treatments are administered in accordance with physician orders, has the potential for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 03/20/2025 with diagnoses: Disruption of External Operation (Surgical) Wound, Malignant Neoplasm Colon, Anemia in Neoplastic Disease, Encounter for Attention to Colostomy documented in the Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025. The Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025 documents an order for “SN (Skilled Nursing) 1WK2 (one visits a week for two weeks), 2WK1 (two visit a week for one week), 1WK5 (one visits a week for five weeks).” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/20/25: The ostomy site was noted to be red and irritated. Patient reported difficulty with the appliance, stating it would not stay in place and that she was unable to control her bowel movements. She stated that stool was coming out continuously in a liquid form, causing the appliance to leak. RN cleanse the area with Normal Saline and applied Ostomy Powder. RN contacted Case Manager (name) during the visit and discussed the ongoing Ostomy Issues. Clinical Manager recommended trial of a different ostomy appliance to improve adherence and reduce leakage.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/25/25: Ostomy Site was assessed. Peristomal skin appeared red and mildly irritated. Patient reported frequent leakage due to loose stools and difficulty keeping the appliance in place. The area was cleaned with Normal Saline and Ostomy Powder applied. A new ostomy bag was applied, and the patient tolerated the change well. Appliance maintained good adherence with no immediate leakage noted.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 04/02/25: Ostomy site evaluated surrounding skin was noted to be reddened and slightly irritated. Patient expressed concern over continuous leakage due to loose stool and poor appliance adherence. The stoma area was cleaned with normal saline ostomy powder applied, and a new ostomy appliance was fitted patient tolerated the procedure without discomfort. Seal was secured at time of visit with no leakage noted.” The Home Health Certification and Plan of Care lacks documented evidence of a physician order for ostomy care/treatment. The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/20/25: Observed patient’s abdominal incision to be nearly closed w(with)/no drainage or signs/symptoms of infection. RN (Registered Nurse) cleansed w(with)/normal saline and covered with dry dressing.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/25/25: wound care was provided to the patient’s abdominal incision cite. The site was cleansed with normal saline, patted dry, and covered with a dry sterile dressing.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 04/02/25: Performed wound care to the patient’s abdominal incision site. Area was gently cleaned with normal saline and dried. A clean, dry dressing was applied, The incision appeared to be healing appropriately, with no signs of infection, drainage, or dehiscence observed.” The Home Health Certification and Plan of Care lacks documented evidence of an order for abdominal incision site treatment. There is no documented evidence of the treatments being administered in accordance with physician orders. On 05/27/2025 at 3:45 PM, the Administrator, and the Director of Quality and Compliance were interviewed and did not have an explanation for the findings.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on clinical record review, and staff interviews, the agency failed to ensure that the physician is promptly alerted to any changes in the patient’s condition or needs. This was evident for one (1) of three (3) clinical records reviewed (Patient #1). Failure to ensure the physician are promptly alerted to any changes in the patient’s condition or needs, has the potential for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 03/20/2025 with diagnoses: Disruption of External Operation (Surgical) Wound, Malignant Neoplasm Colon, Anemia in Neoplastic Disease, Encounter for Attention to Colostomy documented in the Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025. The Home Health Certification and Plan of Care for the Certification Period 03/20/2025 to 05/18/2025 documents an order for “SN (Skilled Nursing) 1WK2 (one visits a week for two weeks), 2WK1 (two visit a week for one week), 1WK5 (one visits a week for five weeks).” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/20/25: The ostomy site was noted to be red and irritated. Patient reported difficulty with the appliance, stating it would not stay in place and that she was unable to control her bowel movements. She stated that stool was coming out continuously in a liquid form, causing the appliance to leak. RN cleanse the area with Normal Saline and applied Ostomy Powder. RN contacted Case Manager (name) during the visit and discussed the ongoing Ostomy Issues. Clinical Manager recommended trial of a different ostomy appliance to improve adherence and reduce leakage.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 03/25/25: Ostomy Site was assessed. Peristomal skin appeared red and mildly irritated. Patient reported frequent leakage due to loose stools and difficulty keeping the appliance in place. The area was cleaned with Normal Saline and Ostomy Powder applied. A new ostomy bag was applied, and the patient tolerated the change well. Appliance maintained good adherence with no immediate leakage noted.” The Clinical Coordination Note dated 04/29/25 documents: “Addendum to SOC (Start of Care) visit note from 04/02/25: Ostomy site evaluated surrounding skin was noted to be reddened and slightly irritated. Patient expressed concern over continuous leakage due to loose stool and poor appliance adherence. The stoma area was cleaned with normal saline ostomy powder applied, and a new ostomy appliance was fitted patient tolerated the procedure without discomfort. Seal was secured at time of visit with no leakage noted.” There is no documented evidence of the physician being promptly notified of the changes in the ostomy assessment and the need to alter the plan of care to reflect the current status of the patient. On 05/27/2025 at 3:45 PM, the Administrator, and the Director of Quality and Compliance were interviewed and did not provide an explanation for the findings.”

“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 record reviews, and staff interview the agency failed to ensure coordination and involvement of the patient and the patient representative/caregiver in the changes in the plan of care for home health aide services. This was evident for one (1) of three (3) clinical records reviewed (Patients #2). Failure to ensure that all clinicians involve the patient in the coordination and delivery of care has the potential for negative patient outcome. The findings are: Patient #2 has a Start of Care date of 10/31/2024 with the diagnoses Pressure Ulcer Right Buttock Stage 2, Muscle Wasting and Atrophy, Primary Generalized Osteoarthritis documented in the Home Health Certification and Plan of Care for the Certification Period 12/30/2024 to 02/27/2025. The Home Health Certification and Plan of Care for the Certification Period 10/31/2024 to 12/29/2024 documents the following orders for home health aide services: “1 Day x 4 Hours x 1 Week (one visit a week for four hours a visit for one week), 4 Days x 4 Hours x 1 Week (four visits a week for four hours a visit for one week), 3 Days x 4 Hours x 3 Weeks (three visits a week for four hours a visit for three weeks).” The following Physician Orders document multiple changes and updates to home health aide services and visit frequency: 11/12/2024 – “Administrative order for MD (Medical Doctor) notification auth (health insurance authorization) approved for (home health aide) 23 visits @ 4 hours each;” “(home health aide) Effective week of 11/10/2024 4WK1 (four visits for week), (then) 7WK1 (seven visits a week for one week), (then) 6WK1 (six visits a week for one week), (then) 1WK1 (one visit a week for one week) @ 4 hours each visit.” 12/05/2024 – “Additional (home health aide) visit are pending auth. (authorization) eff. (effective) week of 12/1/24 2 days x 4 hours x 1 week, then 5 days x 4 hours x 1 week, then 4 days x 4 hours x 1 week.” 12/15/2024 – “Order to notify MD (Medical Doctor) of update to patients POC (plan of care) missed (home health aide) visit (on) 12/7, 12/9, and 12/16 to make up 12/20-12/23 Friday, Saturday and Monday;” “(home health aide) effective 12/15/2024 5WK1 (five visits a week for one week), (then) 1WK1 (one visit a week for one week).” 12/19/2024 - “(home health aide) Effective week of 12/22/2024 4WK1 (four visits a week for one week) @ 4 hours each visit.” The MSW (Master of Social Work) Evaluation visit note dated 12/06/2024 documents: “Pt (Patient) and caregiver report they have been notified by (health insurance) that aide services has been approved. Aide service will resume on Monday 12/9. Pt (Patient) and caregiver unsure as to the frequency or duration of aide services. Caregiver reports (caregiver) was told aide services will end either 12/19 or Jan. 2025. Pt (Patient) needs ongoing aide services as caregiver burnout is possible.” The clinical record lacks documented evidence of the patient and/or the patient representative/caregiver being notified of the changes in home health aide services and the visit frequencies/schedule during the Certification Period 10/31/2024 to 12/29/2024. On 01/09/2025 at 3:35 PM, the Administrator, Vice President of Clinical Operations/ Director of Patient Services, and the Director of Quality Management were interviewed, and did not provide an explanation for the findings.”

“Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This Element is not met as evidenced by: Based on review records and staff interview, the agency failed to ensure the Physical Therapist provides patients with appropriate education regarding discharge planning, rehab potential and goals for the services identified in the plan of care for the patient. This was evident for one (1) of three (3) clinical records reviewed (Patients #2). Failure to provide appropriate education has the potential to result in the patient receiving inadequate care and could result in a negative patient outcome. The findings are: Patient #2 has a Start of Care date of 10/31/2024 with the diagnoses Pressure Ulcer Right Buttock Stage 2, Muscle Wasting and Atrophy, Primary Generalized Osteoarthritis documented in the Home Health Certification and Plan of Care for the Certification Period 12/30/2024 to 02/27/2025. The Registered Nurse Start of Care Assessment visit note dated 10/31/2024 documents: the patient has “significant memory loss;” is “chairfast – ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair;” and a referral made for “PT (Physical Therapy).” The Home Health Certification and Plan of Care for the Certification Period 10/31/2024 to 12/29/2024 documents orders for Physical Therapist evaluation. The Physical Therapy Evaluation dated 11/01/2024 documents the patient’s family/caregiver was present and is involved in the patient’s care. The Physical Therapy Evaluation documents: Physical Therapy to “continue for fall prevention, therapeutic exercise, HEP (Home Exercise Program) instruction, transfer training, gait training, and patient/caregiver education.” The Physician Order dated 11/01/2024 documents an order for the continuation of Physical Therapy “1WK4 (one visit a week for four weeks).” The Physical Therapy visit notes dated 11/13/2024 and 11/20/2024 document the patient “refused to walk” and that gait goal was revised. The Physical Therapy visit note dated 11/20/2024 documents the following therapy plan for the next visit treatment (on 11/25/2024): “HEP (Home Exercise Program), ROM (Range of Motion), strengthening exercise, transfer training.” The Physical Therapy Discharge of Services visit note dated 11/25/2024 documents: Functional “deficits identified - No further rehab potential” for transfer ability and ambulation; “Patient functioning at max level of potential;” and revised goals for transfer and gait were met. The Client Coordination Note Report dated 11/25/2024 documents the following communication to the patient’s allowed practitioner: “Discipline D/C (discharge) 11/25/24;” “Patient has met the goals. Patient functioning at max level of potential.” The MSW (Master of Social Work) Evaluation visit note dated 12/06/2024 documents: “Pt (Patient) and caregiver request more PT (Physical Therapy) services” to help patient “move more and prevent sores(bedsores) from worsening.” The Physical Therapy visit notes dated 11/20/2024 and 11/25/2024 lack documented evidence of the physical therapist provding ongoing education to the patient and the patient’s representative/caregiver regarding the patient’s rehab potential, goals, and discharge planning for physical therapy services. On 01/09/2025 at 3:35 PM, the Administrator, Vice President of Clinical Operations/ Director of Patient Services, and the Director of Quality Management were interviewed, and did not provide an explanation for the findings.”

“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 each patient receive the services that are written in an individualized plan of care. This was evident for two (2) of three (3) patient care records reviewed (Patient’s #1 and #2). Failure to ensure that each patient must receive the services that are written in an individualized plan of care, has the potential for negative patient outcomes. The findings are: 1. Patient #1 has a Start of Care date of 07/22/2024 with the following diagnoses “Pressure Ulcer of Sacral Region, Stage 2; Pressure Ulcer of Right Buttock, Stage 2” documented in the Home Health Certification and Plan of Care for Certification Period 07/22/2024 to 09/19/2024. The Physician Order dated 08/09/2024 documents: “Order Description: MD (medical doctor) notification of updated POC (plan of care) regarding home health aide service for assistance with personal care and ADL’s (activity of daily living) secondary to functional limitations, which prevent self-care. 3daysx4hoursx 2 weeks (three days times four hours for two weeks).” “Calendar Frequency: hha (home health aide) effective 08/11/2024 3WK2 (three times a week for two weeks).” The clinical record lacks documented evidence of the aide providing services for the week of 08/11/2024 to 08/17/2024, missing three visits. There is no documented evidence of the patient receiving aide services as ordered. On 09/17/2024 at 3:30pm, the Director of Patient Services and the Director of Quality Measures were interviewed and did not provide an explanation for the findings. 2. Patient #2 has a Start of Care date of 04/15/2024 with the following diagnoses “Pressure Ulcer of Sacral Region, Stage 4; Pressure Ulcer of Right Hip, Stage 3” documented in the Home Health Certification and Plan of Care for the certification period 06/14/2024 to 08/12/2024. The Physician Order dated 07/29/2024 documents: hha (home health aide) effective 07/28/2024 5WK2, 1WK1 (five times a week for two weeks, once a week for one week). The Duty Sheet documents aide services being provided on 08/05/2024 and 08/07/2024 The clinical record lacks documented evidence of the aide providing services for the week of 08/04/2024 to 08/10/2024, missing two visits. There is no documented evidence of the patient receiving aide services as ordered. On 09/18/2024 at 1:30pm, The Administrator, the Director of Patient Services and the Director of Quality Measures were interviewed and did not provide an explanation for the findings.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(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 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 §484.80(g), must make an onsite visit to the patient’s home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This Element is not met as evidenced by: Based on clinical records review and staff interview the agency failed to ensure a supervisory assessment of the aide services being provided no less frequently than every 14 days. This was evident for two (2) of three (3) patient care records reviewed (Patient’s #1 and #2). Failure to ensure a supervisory assessment of the aide services being provided no less frequently than every 14 days, has the potential for negative patient outcomes. The findings are: 1. Patient #1 has a Start of Care date of 07/22/2024 with the following diagnoses “Pressure Ulcer of Sacral Region, Stage 2; Pressure Ulcer of Right Buttock, Stage 2” documented in the Home Health Certification and Plan of Care for Certification Period 07/22/2024 to 09/19/2024. The Home Health Certification and Plan of Care for the certification period 07/22/2024 to 09/19/2024 documents: “hha (home health aide) effective week of 07/28/2024 3 days x 4 hours x 2 weeks.” The Order dated 08/09/2024 documents: “Order Description: MD (medical doctor) notification of updated POC (plan of care) regarding home health aide service for assistance with personal care and ADL’s (activity of daily living) secondary to functional limitations, which prevent self-care. 3daysx4hoursx 2 weeks. Calendar Frequency: hha (home health aide) effective 08/11/2024 3WK2 (three times a week for two weeks). The Duty Sheet documents aide services being provided on: 07/29/2024, 07/31/2024, 08/02/2024, 08/05/2024, 08/07/2024, and 08/09/2024. The clinical records documents aide supervision on 08/21/2024. The clinical record lacks documented evidence of aide supervision every 14 days. On 09/17/2024 at 3:30pm, the Director of Patient Services and the Director of Quality Measures were interviewed and did not provide an explanation for the findings. 2. Patient #2 has a Start of Care date of 04/15/2024 with the following diagnoses “Pressure Ulcer of Sacral Region, Stage 4; Pressure Ulcer of Right Hip, Stage 3” documented in the Home Health Certification and Plan of Care for the Certification Period 06/14/2024 to 08/12/2024. The Physician Order documents: 07/05/2024 hha (home health aide) effective 07/07/2024 3WK5 (three times a week for five weeks) and 07/29/2024 hha (home health aide) effective 07/28/2024 5WK2, 1WK1 (five times a week for two weeks, once a week for one week). The Duty Sheet documents aide services being provided on: 07/09/2024, 07/11/2024, 07/12/2024, 07/19/2024, 07/22/2024, 07/24/2024, 07/30/2024, 07/31/2024, 08/01/2024, 08/02/2024, 08/05/2024, 08/07/2024, 08/09/204, and 08/12/2024 to 08/16/2024. The clinical record documents aide supervision conducted on 07/10/2024. The clinical record lacks documented evidence of an aide supervision every 14 days. On 09/18/2024 at 1:30pm, The Administrator, the Director of Patient Services and the Director of Quality Measures were interviewed and did not provide an explanation for the findings.”