The New Jewish Home, Home Care (Chha)

“Homebound HHA/Hospice Inform EP Officials CFR(s): 484.102(b)(2) §418.113(b)(2), §460.84(b)(4), §484.102(b)(2) [(b) Policies and procedures. The [facilities] must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] *[For homebound Hospice at §418.113(b)(2), PACE at §460.84(b)(4), and HHAs at §484.102(b)(2):] The procedures to inform State and local emergency preparedness officials about [homebound Hospice, PACE or HHA] patients in need of evacuation from their residences at any time due to an emergency situation based on the patient’s medical and psychiatric condition and home environment. This Standard is not met as evidenced by: Based on review of the Emergency Preparedness program, and staff interviews, the agency failed to develop the emergency patient’s roster that contains all required elements. Failure to develop the emergency patient’s roster that contains all required elements, has the potential risk for negative patient outcomes. The Findings Are: The Emergency Preparedness Summary Report (Patient’s Roster) printed on 02/10/2025 lacks documented evidence of the following information: What type of life-saving equipment does the patient require? Is the life-saving equipment able to be transported? Does the patient have special needs? (electricity-dependent, communication challenges, language barriers, intellectual disabilities, special dietary needs, etc.) There is no documented evidence that the agency developed the emergency patient’s roster that contains all required elements. On 02/12/2025 at 10:30pm, The Director of Patient Services was interviewed and stated: The information regarding patient’s electricity dependence and special patient’s needs is not part of the current Emergency Preparedness Summary Report.”

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on report review, and staff interviews, the agency failed to ensure that all completed OASIS (Outcome and Assessment Information Set) assessments were transmitted to the CMS (Centers for Medicare & Medicaid Services) within thirty (30) days. This is evident for eight (8) clinical records based on review of the HHA Error Summary by Agency Report. Failure to ensure that all completed OASIS (Outcome and Assessment Information Set) assessments are transmitted to the CMS (Centers for Medicare & Medicaid Services) within thirty (30) days, has the potential for negative patient outcomes. The Findings Are: 1. The HHA Error Summary by Agency Report for the period 02/01/2025 through 02/05/2025 documents: “Error # -3330 Record Submitted Late: The submission date is more than 30 days after M0090 (Start of Care) on this new record… # of Assessments with error 8 (Eight).” There is no documented evidence that all completed OASIS (Outcome and Assessment Information Set) assessments are transmitted to the CMS (Centers for Medicare & Medicaid Services) within thirty (30) days. On 02/10/2025 at 01:30 PM, the Director of Patient Services were interviewed and did not provide an explanation for the survey 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 record reviews, and staff interviews, the agency failed to ensure that all patients receive services as documented in their individualized plan of care. This was evident for three (3) of seven (7) clinical records reviewed (Patients: #2, #3, and #4). Failure to ensure that all patients receive services as documented in their individualized plan of care has the potential for negative patient outcomes. The Findings Are: 1. Patient#2 has a Start of Care date of 02/03/2025 with Diagnoses of Venous Insufficiency, Non-Pressure Chronic Ulcer Other Part Right Lower Leg with Other Severity and Peripheral Vascular Disease documented in the “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025. The “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025 documents: “HHA (Home Health Aide) 3WK3 (three visits per week for three weeks), 1WK1 (one visit per week for one week).” The “Duty Sheet” lacks documented evidence of the home health aide services being provided, missed 1 visit for the week 02/03/2025 to 02/08/2025. There is no documented evidence that the patient received the services that are written in the individualized plan of care as ordered by the physician. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “There’s no note for the missed visit and this is the only duty sheet we have on file for the patient.”, no further explanation was provided. 2. Patient #3 has a Start of Care date of 03/27/2024 with the following diagnoses “Displaced Intertrochanteric Fracture of Left Femur, Unspecified Fracture of the Lower End of Left Radius, Type 2 Diabetes Mellitus” documented in the Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024. The Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024 documents: “Skilled nurse for instructions / reinforcement of diabetic care to include diet, skin care, administration of insulin, blood glucose testing and diabetic foot care.” The Visit Note Report dated 03/28/2024 by the physical therapist documents: “Durable Medical Equipment Available: Cane.” The plan of care lacks documented evidence of the frequency of blood glucose testing and the cane. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “The frequency of finger stick was not there, and no cane.”, no further explanation for the findings. 3. Patient # 4 has a Start of Care Date 1/17/2025 with the following diagnoses: Neuromuscular Dysfunction of Bladder Unspecified, Retention of Urine Unspecified and Hematuria Unspecified as documented on the Home Health Certification and Plan of Care for Certification Period 1/17/2025 to 3/17/2025. The Home Health Certification and Plan of Care for Certification Period 1/17/2025 to 3/17/2025 documents: “Frequency/Duration of Visits: Home Health Aide (HHA) effective 1/19/2025 3WK1 (three times a week for one week), 5WK2 (five times a week for two weeks), and 3WK2 (three times a week for two weeks).” The clinical records lack documented evidence of the home health aide services being provided on 1/27/2025 and 2/3/2025. On 2/13/2025 at 3:00PM, the Director of Patient Services was interviewed and stated: “I only have duty sheets with the home health aide going to the home four times a week not five.” The Director of Patient Services did not provide further explanation of finding. 1. Patient #2 has a Start of Care date of 02/03/2025 with Diagnoses of Venous Insufficiency, Non-Pressure Chronic Ulcer Other Part Right Lower Leg with Other Severity and Peripheral Vascular Disease documented in the “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025. The “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025 documents: “HHA (Home Health Aide) 3WK3 (three visits per week for three weeks), 1WK1 (one visit per week for one week).” The “Duty Sheet” lacks documented evidence of the home health aide services being provided, missed 1 visit for the week 02/03/2025 to 02/08/2025. There is no documented evidence that the patient received the services that are written in the individualized plan of care as ordered by the physician. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “There’s no note for the missed visit and this is the only duty sheet we have on file for the patient.”, no further explanation was provided. 2. Patient #3 has a Start of Care date of 03/27/2024 with the following diagnoses “Displaced Intertrochanteric Fracture of Left Femur, Unspecified Fracture of the Lower End of Left Radius, Type 2 Diabetes Mellitus” documented in the Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024. The Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024 documents: “Skilled nurse for instructions / reinforcement of diabetic care to include diet, skin care, administration of insulin, blood glucose testing and diabetic foot care.” The Visit Note Report dated 03/28/2024 by the physical therapist documents: “Durable Medical Equipment Available: Cane.” The plan of care lacks documented evidence of the frequency of blood glucose testing and the cane. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “The frequency of finger stick was not there, and no cane.”, no further explanation for the findings. 3. Patient # 4 has a Start of Care Date 1/17/2025 with the following diagnoses: Neuromuscular Dysfunction of Bladder Unspecified, Retention of Urine Unspecified and Hematuria Unspecified as documented on the Home Health Certification and Plan of Care for Certification Period 1/17/2025 to 3/17/2025. The Home Health Certification and Plan of Care for Certification Period 1/17/2025 to 3/17/2025 documents: “Frequency/Duration of Visits: Home Health Aide (HHA) effective 1/19/2025 3WK1 (three times a week for one week), 5WK2 (five times a week for two weeks), and 3WK2 (three times a week for two weeks).” The clinical records lack documented evidence of the home health aide services being provided on 1/27/2025 and 2/3/2025. On 2/13/2025 at 3:00PM, the Director of Patient Services was interviewed and stated: “I only have duty sheets with the home health aide going to the home four times a week not five.” The Director of Patient Services did not provide further explanation of the finding.”

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure the HHA (Home Health Aide) receive a complete paraprofessional plan of care. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #2). Failure to ensure the HHA (Home Health Aide) receive a complete paraprofessional plan of care, has potential for negative patient outcomes. The Findings Are: 1. Patient#2 has a Start of Care date of 02/03/2025 with Diagnoses of Venous Insufficiency, Non-Pressure Chronic Ulcer Other Part Right Lower Leg with Other Severity and Peripheral Vascular Disease documented in the “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025. The “Visit Note Report “dated 02/03/2025 Visit Type: RN (Registered Nurse) OASIS (Outcome and Assessment Information Set) Admission: Assessment section documents: “No incontinence or catheter (includes anuria or ostomy for urinary drainage)”. The “Aide Care Plan Report” dated 02/03/2025 documents “ADL (Activities of Daily Living) Services: Routine Catheter Care with frequency of every visit.” There is no documented evidence of accurate written patient care instructions for the home health aide prepared by the registered nurse. The patient does not have a catheter. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “The patient has no indwelling urinary catheter.”, no further explanation was provided.”

“Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient’s status, and must include, at a minimum, the following information: (1) The patient’s current health, psychosocial, functional, and cognitive status; This Element is not met as evidenced by: Based on clinical records reviews, and staff interview, the agency failed to ensure that all assessments document an accurate reflection of the patient status. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #1). Failure to ensure that all assessments document an accurate reflection of patient status, has the potential for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. The Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025 documents: “Skilled nurse to perform/teach wound care to granrenous (gangrenous) areas of hands (Rt [right] hand index finger, and 3rd finger, left hand index finger and 3rd finger gangrene tips, cleanse with NS (normal saline), pat dry, apply Povidone Iodine Solution 10% to necrotic areas topically using gauze moistened with Povidone, let dry, cover with dry protective dressing TIW (three times a week).” “Skilled nurse to perform/teach wound care to Left foot gangrene great toe tip, Rt (right) foot tip of great 2nd toes gangrene, cleanse with NS (normal saline), pat dry apply Povidone Iodine Solution 10% to necrotic areas typically using gauze moistened with Povidone, let dry, then, apply Mupirocin Oint 2% to Rt (right) great 1st and 2nd toes topically cover with dry protective dressing TIW (three times a week) using clean/aseptic technique. S/P (status post) amputation of Left 2nd and 3rd digit apply Bacitracin and Nitro Bid to demarcation line daily.” “Bacitracin Oint (ointment) 500 apply to left index finger daily.” The Visit Note Report – OASIS Admission dated 01/14/2025 documents: “#5 Mid – Sacral pressure ulcer stage II; Granulation Tissue 75-100%; Epithelialization 75-<100%.” The comprehensive assessment lacks documented evidence of the assessment for right foot great (1st) toe and 2nd toe, left index (2nd) finger, and amputation of left 2nd and 3rd toes. There is no documented evidence of an accurate assessment of the sacral pressure ulcer, stage 2 pressure ulcer with granulation. There is no documented evidence of an accurate reflection of the patient’s current status. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “The nurse will be going to patient and reassess all the wounds.”, no further explanation for the findings.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure that all medications were reviewed and accurately documented in the patient’s plan of care. This was evident for three (3) of seven (7) clinical records reviewed (Patients: #1, #3, and #5). Failure to ensure that all medications are reviewed and accurately documented in the patient’s plan of care, has the potential for negative patient outcomes. The Findings Are: 3. Patient #5 has a Start of Care (SOC) date of 01/22/2025 with the following diagnoses: “Multiple Fractures of Ribs, Right side, Acute Embolism and Thrombosis of Right Peroneal Vein, Acute Embolism and Thrombosis of Left Calf Muscular Vein, Other Pulmonary Embolism, Hypertensive Heart Decease”, documented in the Home Health Plan of Care for Certification Period 01/22/2025 to 03/22/2025. The Home Health Plan of Care dated 01/22/2025 to 03/22/2025 documents: “Medications: Diclofenac 1% topical gel; Donepezil 10 mg (milligram) tablet; Famotidine 40 mg (milligram) tablet; Gabapentin 300 mg (milligram) capsule; Irbesartan 75 mg (milligram) tablet; Macrodantin 50 mg (milligram) capsule; Oxycodone 5 mg (milligram) tablet; Polyethylene Glycole 3350 17 gram oral powder pocket; Sennoside 8.6 mg (milligram) tablet; Sertraline 25 mg (milligram) tablet; Simvastatin 20 mg (milligram) tablet; Valacyclovir 500 mg (milligram) tablet; Xarelto 10 mg (milligram) tablet.” On 02/10/2025 at 3:00 pm a home visit was conducted; the Surveyor reviewed the patient’s medication and compared them with the Clients by Medication Report (current medication list) printed on 02/10/2025 at 1:11 pm. There is no documented evidence of Oxybutynin, Celecocxib, Tramadol, Nitrofurantoin, and Eliquis on the list and the patient is currently taking the medications; and Macrodantin, Polyethylene Glycole, Sennoside, Sertraline, Valacyclovir and Xarelto are documented on list, but patient is not currently taking the medications. The RN (Registered Nurse) “Visit Note Report” dated 02/07/2025 documents: “Medication profile reviewed”. The clinical record lacks documented evidence of all the medications the patient is currently taking being reviewed. There is no documented evidence of medication reconciliation. On 02/12/2025 at 01:30 pm, the Director of Patient Services were interviewed and did not provide an explanation for the survey findings. 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. The Client Medication Report printed on 02/11/2025 documents: “Acetaminophen 500mg tablet, take 2 tablets by mouth 3 times a day; Calcium 600 + D(3) mg-5mcg (200 Unit) tablet, take 1 tablet by mouth twice a day; and Lenalidomide 15 mg capsule, take 1 tablet by mouth in the evening for 21 days.” On 02/11/2025 at 11:30AM during the home visit, the surveyor reviewed with patient and brother, patient’s medications and stated: “medications are being taken Acetaminophen as needed only, Calcium once daily, Lenalidomide have been completed, and started on 02/07/2025 Revlimid and Oxybutynin.” Also noted a bottle for Valacyclovir HCL 500 mg daily with refill date of 01/10/2025. The clinical record lacks documented evidence of the medication being reconciled. The clinical record lacks documented evidence of the review of medication. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “The nurse will be reconciling the medication on the next visit and will be calling the physician to clarify the medications.”, no further explanation for the findings. 2. Patient #3 has a Start of Care date of 03/27/2024 with the following diagnoses “Displaced Intertrochanteric Fracture of Left Femur Unspecified Fracture of the Lower End of Left Radius, Type 2 Diabetes Mellitus” documented in the Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024. The Provider Medical Discharge/Transfer Summary Note dated 03/25/2024 documents: “Discharge Medications: Lantus SoloStar Subcutaneous Solution Pen-injector 100 unit/ml Inject 8 unit subcutaneously at bedtime.” The Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024 documents: “Lantus Solostar U-100 Insulin 100 unit/ml Inject 10 units SQ (subcutaneous) at bedtime.” The Visit Note Report dated 03/29/2024 and 04/01/2024 documents: “Is the client taking insulin? NO.” The clinical record lacks documented evidence of the review of medication including the correct dosage. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “There is no documentation of the change in the amount of Lantus, and the nurse can’t remember it.”, no further 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 reviews, and staff interviews, the agency failed to ensure each patient’s individualized plan of care include all the required information. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #1, and #7). Failure to ensure individualized plan of care includes all the required information, has the potential risk for negative patient outcomes. The Findings Are: 2. Patient #7 has a Start of Care Date 7/25/2024 with the following diagnoses: Malignant Neoplasm of Unspecified Site Right Breast Female Breast, Secondary Malignant Neoplasm of Brain and Secondary Neoplasm of Unspecified Lung documented on the Home Health Certification and Plan of Care for Certification Period 7/25/2024 to 9/22/2024. The Home Care Certification Plan of Care for Certification Period 7/25/2024 to 9/22/2024 documents: Durable Medical Equipment and Supplies “wheelchair.” The Occupation Therapy Visit Report Note dated 7/25/2024 documents: “durable medical equipment available: standing walker, rolling walker, wheelchair, hospital bed and Hoyer lift” The Physical Therapy Visit Report Note dated 7/26/2024 documents “durable medical equipment available: rolling walker, wheelchair and hospital bed.” The Home Care Certification Plan of Care lacks documented evidence of a detailed individualized plan of care that lists all the required supplies and equipment. There is no documented evidence of a complete and accurate plan of care. On 2/12/2025 at 1:30PM, Director of Patient Services was interviewed and did not provide an explanation for finding. 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. The Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025 documents: “Skilled Nurse to instruct patient / caregiver in Indwelling Urinary Catheter management including care of Foley catheter, sign and symptoms of complications, perineal care, tube and bag placement.” “Medication: Lenalidomide 15 mg (milligram) capsule for chemotherapy, take 1 tablet by mouth in the evening for 21 days.” “Skilled nurse to perform/teach wound care to granrenous (gangrenous) areas of hands (Rt (right) hand index finger, and 3rd finger, left hand index finger and 3rd finger gangrene tips, cleanse with NS (normal saline), pat dry, apply Povidone Iodine solution 10% to necrotic areas topically using gauze moistened with Povidone, let Dry, Cover with Dry protective dressing TIW (three times a week).” “S/P (status post) amputation of left 2nd and 3rd digit apply Bacitracin and Nitro BIB to demarcation line daily.” Bacitracin Oint (ointment) 500 apply to left index finger daily.” The plan of care documents two different treatment orders for the left index finger. The plan of care lacks documented evidence of instruction for care of Foley catheter, the intervention and goal for chemotherapy; and no site for the amputation of left 2nd and 3rd digit – toes or fingers. There is no documented evidence of an accurate and comprehensive plan of care. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “there is no order for the foley catheter changing” “I did not see any goal or intervention for the chemotherapy”, no further explanation for the findings.”

“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 reviews, and staff interviews, the agency failed to review and/or revise the plan of care in accordance with patient needs. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #1). Failure to review and/or revise the plan of care in accordance with patient needs, has the potential risk for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. The Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025 documents: “SN (skilled nurse) 3WK (three times a week for nine weeks).” “OT (occupational therapy) 1WK1, 2WK4 (once a week for one week, twice a week for four weeks).” The Client Coordination Note Report documents: 01/22/2025 “Missed Visit Date: 1/22; Service Code: RN (registered nurse); Missed visit reason: Patient was seen yesterday 1/21 wound care was provided as ordered.” 01/27/2025 “Missed Visit Date: 1/27; Service Code: RN (registered nurse); Missed visit reason: Patient has chemotherapy treatment today.” 02/03/2025 “Missed Visit Date: 2/3; Service Code: RN (registered nurse); Missed visit reason: Schedule error patient is scheduled to be seen tomorrow instead.” 02/11/2025 “Missed Visit Date: 1/17; Service Code: RN (registered nurse); Missed visit reason: Patient was seen yesterday 1/16. Scheduler error.” The clinical record lacks documented evidence of occupational therapy being provided between 01/19/2025 to 01/25/2025, missed two visits. The clinical record lacks documented evidence of the review and revision of patient services with the physician - skilled nursing provided twice a week, order is three times a week from 01/14/2025 to 02/08/2025 and occupational therapy no visit for one week. There is no documented evidence of the review and revision of the individualized plan of care. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “there is no coordination done”, no further 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 reviews, and staff interviews, the agency failed to ensure the physician are promptly alerted to any changes in the patient’s condition or needs. This was evident for one (1) of seven (7) clinical records reviewed. (Patient #4). 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 # 4 has a Start of Care Date 1/17/2025 with the following diagnoses: Neuromuscular Dysfunction of Bladder Unspecified, Retention of Urine Unspecified and Hematuria Unspecified as documented on the Home Health Certification and Plan of Care for Certification Period 1/17/2025 to 3/17/2025. The Registered Nurse (RN) Outcome and Assessment Information Set (OASIS) dated 1/17/2025 documents: “indwelling/suprapubic catheter, within normal limits.” The Registered Nurse (RN) visit dated 1/21/2025 documents: “patient reported that her suprapubic catheter is leaking, that her pull ups are wet from urine, patient also stated that her catheter is past due for a new one. Nurse assessed port of entry, noticed that area is damp catheter remained in place but was pulling down a bit.” The Registered Nurse (RN) visit dated 1/23/2025 documents “noted leakage at the incision site. Patient also reported that her pull ups are wet with urine at times.” The clinical records lack documented evidence that Registered Nurse and Home Health Agency notified both the responsible physician or allowed practitioner, and the physician(s) associated with the relevant aspect of care of change in patient’s condition. On 2/12/2025 at 1:30PM, Director of Patient Services was interviewed and did not provide an explanation for finding.”

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure the care coordination is being provided to identify patient needs. This was evident for one (1) of seven (7) clinical records reviewed. (Patients #2). Failure to ensure the care coordination is being provided to identify patient needs, has the potential for negative patient outcomes. The Findings Are: 1. Patient#2 has a Start of Care date of 02/03/2025 with Diagnoses of Venous Insufficiency, Non-Pressure Chronic Ulcer Other Part Right Lower Leg with Other Severity and Peripheral Vascular Disease documented in the “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025. The “Home Health Certification and Plan of Care” for the Certification Period 02/03/2025 to 04/03/2025 documents: “Functional Limitations: Endurance; Ambulation; Assist to Leave Home; Assist x 1 person; Assistive Device to ambulate.” The “Visit Note Report “dated 02/03/2025 Visit Type: RN (Registered Nurse), OASIS (Outcome and Assessment Information Set) Admission: Assessment section documents: “Ambulation/Locomotion: Able to walk only with the supervision or assistance of another person at all times”. The “Visit Note Report “dated 02/04/2025 Visit Type: OT (Occupational Therapist) Add -On Evaluation: Assessment section documents: “Transfer- Independent; Mobility- Independent (But may use any aid, e.g. (example) stick.); Stairs- Independent Up and Down.” The “Visit Note Report “dated 02/05/2025 Visit Type: SN (Skilled Nursing): Assessment section documents: “Requires assistive device requires assistance of another person to leave the house safely.” The “Visit Note Report “dated 02/08/2025 Visit Type: PT Add -On Evaluation: Narrative section documents: “Patient able to transfer from the toilet, tub, bed without loss of balance without assistive device. He is able to ambulate in the community and in the building without loss of balance. He’s able to navigate four flights of stairs without any fatigue. Patient usually orders food in and is able to manage his laundry twice a month independently. Patient is able to demonstrate home exercise program provided by the physical therapist. At this time, he is functioning at his highest potential and is not a candidate for skilled Physical Therapy at home. Home Care Team was notified of the same.” The clinical record lacks documented evidence of the coordination of care provided by all disciplines, skilled nurse documents patient needs assistance with ambulation, OT and PT documents independent. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “I didn’t see any coordination note, it should have been coordinated.”, no further explanation was provided.”

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on observation, clinical record reviews, and staff interviews, the agency failed ensure that the written visit schedule is provided to the patient. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #1, and #2). Failure to ensure that the written visit schedule provided to the patient, has the potential risk for negative patient outcomes. The Findings Are: 1. Patient#2 has a Start of Care date of 02/03/2025 with Diagnoses of Venous Insufficiency, Non-Pressure Chronic Ulcer Other Part Right Lower Leg with Other Severity and Peripheral Vascular Disease documented in the Home Health Certification and Plan of Care for the Certification Period 02/03/2025 to 04/03/2025. On 02/11/2025 at 12:45PM, during the home visit, the surveyor reviewed the admission packet that was given to the patient on admission, the visit schedule including the frequency of visit by the Skilled Nurse was not included in the packet. There is no documented evidence of the written visit schedule with frequency of visits by skilled nursing was provided to the patient. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “We don’t have the calendar for the services at home.”, no further explanation was provided. 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. On 02/11/2025 at 11:30AM during the home visit, the surveyor reviewed the admission packet that was given to the patient on admission, the visit schedule including the frequency of visit by the skilled nurse, physical therapy, and occupational therapy was missing. There is no documented evidence of the written visit schedule by HHA personnel. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “We don’t have the calendar for the services at home.”, no further explanation for the findings.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to provide services that are ordered by the physician as indicated in the plan of care. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #1, and #3). Failure to provide services that are ordered by the physician as indicated in the plan of care, has the potential for negative patient outcomes. The Findings Are: 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. The Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025 documents: “OT (occupational therapy) 1WK1, 2WK4 (once a week for one week, twice a week for four weeks).” The clinical record lacks documented evidence of occupational therapy being provided between 01/19/2025 to 01/25/2025, missed two visits. There is no documented evidence that the patient received the services that are written in the plan of care as ordered by the physician. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “I could not find the visit.”, no further explanation for the findings. 2. Patient #3 has a Start of Care date of 03/27/2024 with the following diagnoses “Displaced Intertrochanteric Fracture of Left Femur, Unspecified Fracture of the Lower End of Left Radius, Type 2 Diabetes Mellitus” documented in the Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024. The Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024 documents: “SN (skilled nurse) 2WK3 (twice a week for three weeks), 1WK1 (once a week for one week); OT (occupational therapy) 1WK1 (once a week for one week).” The clinical record lacks documented evidence of the skilled nurse being provided between 03/31/2024 to 04/06/2024, missed one visit; and occupational therapy being provided between 03/27/2024 to 03/30/2024, missed one visit. There is no documented evidence that the patient received the services that are written in the plan of care as ordered by the physician. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “I did not find any visits.”, no further explanation for the findings.”

“HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient’s plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient’s condition; and (vi) Honoring patient rights. This Element is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure the Home Health Aide follows the paraprofessional plan of care for completion of assigned tasks. This was evident for one (1) of seven (7) clinical records reviewed (Patient: #2). Failure to ensure the Home Health Aide follows the paraprofessional plan of care for completion of assigned tasks, has potential for negative patient outcomes. The Findings Are: 1. Patient#2 has a Start of Care date of 02/03/2025 with Diagnoses of Venous Insufficiency (Chronic) (Peripheral), Non-Pressure Chronic Ulcer Other Part Right Lower Leg with Other Severity and Peripheral Vascular Disease documented in the Home Health Certification and Plan of Care for the Certification Period 02/03/2025 to 04/03/2025. The “Home Health Certification and Plan of Care” for Certification Period 02/03/2025 to 04/03/2025 documents: Frequency/Duration of Visits: “HHA (Home Health Aide) 3WK3 (three visits per week for three weeks), 1WK1 (one visit per week for one week. The “Aide Care Plan Report” dated 02/03/2025 documents “ADL (Activities of Daily Living) Services: Home Exercise Program, Assist to Toilet, Provide Medication Reminders, Bathing-Bed Bath, Bathing- Partial Sponge Bath, Skin Care, Perineal Care, Foot Care, Oral Care, Dressing, Prepare Meal, Prepare Snack, Offer Fluids, and Empty Urinal, with frequency of every visit.” The “Aide Duty Sheet” dated 02/05/2025 and 02/06/2025 lacks documented evidence following the patient’s plan of care for completion of the following tasks assigned to a home health aide: Home Exercise Program, Assist to Toilet, Provide Medication Reminders, Bathing- Bed Bath, Bathing- Partial Sponge Bath, Skin Care, Perineal Care, Foot Care, Oral Care, Dressing, Prepare Meal, Prepare Snack Offer Fluids, and Empty Urinal. On 02/13/2025 at 11:30AM, the Director of Patient Services was interviewed and stated, “Aides are supposed to do what needs to be done.”, no further explanation was provided.”

“Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This Element is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure the coordination of patient care with the Clinical Manager regarding missed visits to identify patient’s needs and safety. This was evident for two (2) of seven (7) clinical records reviewed (Patients: #1, and #6). Failure to ensure that patient care is coordinated with the Clinical Manager, has potential for negative patient outcomes. The Findings Are: 2. Patient #6 has a Start of Care date of 07/01/2024 with the following diagnoses “Encounter for orthopedic aftercare following surgical amputation, Acquired absence of other left toe(s), Type 2 Diabetes peripheral angiopathy w/o (without) gangrene, Lymphedema, not elsewhere classified, Morbid (severe) obesity due to excess calories” documented in the Home Health Certification and Plan of Care for the Certification Period 12/28/2024 to 02/25/2025. The Home Health Certification and Plan of Care for the Certification Period 12/28/2024 to 02/25/2025 documents: “SN (Skilled Nurse) effective 12/29/2024 3WK8 (three times a week for eight weeks), 1WK1 (once a week for one week)”. The Client Coordination Note Report documents: 01/15/2025 “Missed Visit Date: 1/1/25. Missed Visit Reason: Clinician not available.” 01/22/2025 “Missed Visit Date: 1/22/25. Missed Visit Reason: Patient was seen yesterday 1/21 wound care was provided yesterday.” 01/27/2025 “Missed Visit Date: 1/27. Missed Visit Reason: Patient has doctor’s appointment.” 01/29/2025 “Missed Visit Date: 1/29. Missed Visit Reason: Patient was seen by his vascular doctor yesterday, patient stated that his dressing was changed by his doctor, requested nurse to come on next scheduled visit.” 02/07/2025 “Call placed 212-663-4964 and message left: no RN (Registered Nurse) visit will be made today due to staffing issue. Visit will continue on Monday.” The clinical record documents only two Skilled Nursing visits every week for the period 12/29/2024 to 01/25/2025, no visits for the week 01/26/2025 to 02/01/2025, and two visits for the week 02/02/2025 to 02/08/2025. The clinical record lacks documented evidence of the coordination of patient care with the Clinical Manager regarding missed visits to identify patient’s needs and safety. On 02/12/2025 at 01:30 pm, the Director of Patient Services were interviewed and did not provide an explanation for the survey findings. 1. Patient #1 has a Start of Care date of 01/14/2025 with the following diagnoses “Gangrene, Other Disorder of Circulatory System, Adverse Effect of Peripheral Vasodilators, Multiple Myeloma, Polycystic Kidney” documented in the Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025. The Home Health Certification and Plan of Care for the Certification Period 01/14/2025 to 03/14/2025 documents: “SN (skilled nurse) 3WK (three times a week for nine weeks).” “OT (occupational therapy) 1WK1, 2WK4 (once a week for one week, twice a week for four weeks).” The Client Coordination Note Report documents: 01/22/2025 “Missed Visit Date: 1/22; Service Code: RN (registered nurse); Missed visit reason: Patient was seen yesterday 1/21 wound care was provided as ordered.” 01/27/2025 “Missed Visit Date: 1/27; Service Code: RN (registered nurse); Missed visit reason: Patient has chemotherapy treatment today.” 02/03/2025 “Missed Visit Date: 2/3; Service Code: RN (registered nurse); Missed visit reason: Schedule error patient is scheduled to be seen tomorrow instead.” 02/11/2025 “Missed Visit Date: 1/17; Service Code: RN (registered nurse); Missed visit reason: Patient was seen yesterday 1/16. Scheduler error.” The clinical record lacks documented evidence of the occupational therapy being provided between 01/19/2025 to 01/25/2025, missed two visits. The clinical record lacks documented evidence of the coordination of patient care with the Clinical Manager regarding missed visits - skilled nursing provided twice a week, the order is three times a week from 01/14/2025 to 02/08/2025 and occupational therapy no visit for one week, to identify patient’s needs and safety. On 02/13/2025 at 10:35AM, the Director of Patient Services was interviewed and stated, “there is no coordination done”, no further explanation for the findings.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure that discharge summary is sent to the primary care practitioner. This was evident for two (2) of two (2) discharge clinical records reviewed (Patients: #3, and #7). Failure to ensure that discharge summaries are sent to the primary care practitioner, has the potential risk for negative patient outcomes. The Findings Are: 2. Patient #7 has a Start of Care Date 7/25/2024 with the following diagnoses: Malignant Neoplasm of Unspecified Site Right Breast Female Breast, Secondary Malignant Neoplasm of Brain and Secondary Neoplasm of Unspecified Lung documented on the Home Health Certification and Plan of Care for Certification Period 7/25/2024 to 9/22/2024. The Discharge-Transfer Summary Report completed by Registered Nurse documents patient was discharged from Home Health Agency (The New Jewish Home) on 8/22/2024. The clinical record lacks documented evidence that discharge summary was sent to primary care physician or other health care professional who will be responsible for providing care and services to the patient after discharge from Home Health Agency. On 2/13/2025 at 3:00PM, the Director of Patient Services was interviewed and stated, “if its not written there means it wasn’t done.” The Director of Patient Services did not provide further explanation of finding. 1. Patient #3 has a Start of Care date of 03/27/2024 and a discharge date of 04/05/2024 with the following diagnoses “Displaced Intertrochanteric Fracture of Left Femur Unspecified Fracture of the Lower End of Left Radius, Type 2 Diabetes Mellitus” documented in the Home Health Certification and Plan of Care for the Certification Period 03/27/2024 to 05/25/2024. The Discharge-Transfer Summary Report dated 04/05/2024 lacks documented evidence that it was sent to the primary care practitioner. On 02/13/2025 at 12:55PM, the Director of Patient Services was interviewed and stated, “The physician has to request the discharge summary, then we send it. There was no documentation that it was sent to the physician.”, no further explanation for the findings.”