Wellbound

“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 review, pertinent policy review, and staff interview, the agency failed to ensure that all patients received the care that is written in the individualized Plan of Care. This was evident for thee (3) of three (3) clinical records reviewed (Patient#1, #2, and #3). Failure to ensure that all patients receive the care that is written in the individualized Plan of Care, has the potential for negative patient outcomes. The findings are: The agency’s “Missed Visits” Policy (Effective 02/21/2014) documents: “In the event that a scheduled visit to a patient cannot be made as scheduled for any reason, including the patient/patient representative’s cancellation of the visit and no rescheduling within the physician/NPP (Nonphysician Practitioner) prescribed frequency can be accomplished: The physician/NPP (Nonphysician Practitioner) must be notified by the clinician/designee that scheduled visit to the patient cannot be made as scheduled either by phone, fax, e-mail or mail.” 1. Patient #1 has a Start of Care date of 07/17/2020 with diagnoses Autistic Disorder, Developmental Disorder of Speech and Language, Congenital Hypotonia documented in the Home Health Certification and Plan of Care for Certification Period 10/19/2025 to 12/17/2025. The Home Health Certification and Plan of Care for the Certification Period 08/20/2025 to 10/18/2025 documents orders for Occupational Therapy Services: “1WK1 (one visit a week for one week), 2WK8 (two visits a week for eight weeks).” The clinical record documents one missed visit in each of the following weeks: 08/20/2025 – 08/23/2025, 08/24/2025 - 08/30/2025, 08/31/2025 – 09/06/2025, 09/07/2025 - 09/13/2025, 09/21/2025 – 09/27/2025. The Occupational Therapy Coordination Notes dated 08/22/2025, 09/02/2025, 09/09/2025, 09/16/2025, and 09/27/2025 document the following for the missed visit dates 08/22/2025, 08/29/2025, 09/05/2025, 09/13/2025, and 09/29/2025, respectively: “Case Management will be notified of missed visit for the MD (Medical Doctor) notification.” The clinical record lacks documented evidence of the physician being notified of the occupational therapy missed visits, in accordance with the agency policy. The Home Health Certification and Plan of Care for the Certification Period 10/19/2025 to 12/17/2025 documents orders for the following services: “OT (Occupational Therapy) 1WK1 (one visit a week for one week);” “ST (Speech Therapy) 1WK1 (one visit a week for one week);” and “(Home Health Aide) 4WK8 (four days a week for eight weeks), 2WK1 (two days a week for one week).” The Speech Therapy Coordination Note dated 10/22/2025 documents: “Missed Visit Notification;” “Date of Missed Visit 10/22/2025 - Start of Care for speech services;” “Physician Notified – Yes;” and “(Parent/Caregiver) has elected to discontinue services with Wellbound Home Healthcare.” The Occupational Therapy Coordination Noted dated 11/1/2025 documents: “Missed OT (Occupational Therapy) visit due to client unavailability on 10/21/2025;” “Case Management will be notified of the missed visit for the MD (Medical Doctor) notification.” The Coordination Note dated 10/22/2025 documents: “CM (Case Management) Coordination Note: As per ST (Speech Therapist), CG (caregiver) requested to discontinue services. TC (Telephone call) was made to F/U (follow-up). As per CG (caregiver), they would like to stop therapy services (Occupational Therapy/Speech Therapy) and continue with just HHA (Home Health Aide) services. CG (Caregiver) confirmed that therapy services can stop effective today 10/22/25. Scheduling department was notified.” The clinical record lacks documented evidence of the physician being notified of the caregiver request to discontinue both Occupational/Speech Therapy services and will continue with home health aide services. On 12/12/2025 at 02:05 PM, the Administrator, the Vice President of Quality and Compliance, and the Executive Director of Rehabilitation Operations were interviewed. The Executive Director of Rehabilitation Operations stated: “I don’t see” the notification to the physician. 2. Patient #2 has a Start of Care date of 07/12/2021 with diagnoses Autistic Disorder, Down Syndrome, Social Pragmatic Communication Disorder, Mixed Receptive Expressive Language Disorder documented in the Home Health Certification and Plan of Care for the Certification Period 10/19/2025 to 12/17/2025. The Home Health Certification and Plan of Care for the Certification Period 08/20/2025 to 10/18/2025 documents orders for Speech Therapy services: “2WK9 (two visits a week for nine weeks).” The clinical record documents one missed visit in each of the following weeks: 08/24/2025 - 08/30/2025, 09/21/2025 – 09/27/2025, 09/28/2025 – 10/04/2025, 10/05/2025 – 10/11/2025, and 10/12/2025 – 10/18/2025. The clinical record documents no visits (two missed visits) in each of the following weeks: 08/31/2025 – 09/06/2025, 09/07/2025 -09/13/2025, and 09/14/2025 – 09/20/2025. The clinical record lacks documented evidence of the physician being notified of the speech therapy missed visits, in accordance with the agency policy. On 12/12/2025 at 02:05 PM, the Administrator, the Vice President of Quality and Compliance, and the Executive Director of Rehabilitation Operations were interviewed. The Executive Director of Rehabilitation Operations stated: “the Speech Therapist resigned;” there was “delay in finding coverage for the patient’s service area;” and “nothing in EMR (electronic medical record” notifying the physician. 3. Patient #3 has a Start of Care date of 04/01/2025 with diagnoses Autistic Disorder, Attention Deficit Hyperactivity Disorder, Intellectual Disabilities, Developmental Disorder of Speech and Language documented in the Home Health Certification and Plan of Care for the Certification Period 11/27/2025 to 01/25/2026. The Physician Order dated 10/11/2025 documents orders for Speech Therapy services: “1WK1 (one visit a week for one week), 2WK7 (two visits a week for seven weeks).” The clinical record documents no visits (two missed visits) in each of the following weeks: 10/26/2025 – 11/01/2025 and 11/02/2025 – 11/08/2025. The clinical record lacks documented evidence of the physician being notified of the speech therapy missed visits, in accordance with the agency policy. On 12/12/2025 at 02:05 PM, the Administrator, the Vice President of Quality and Compliance, and the Executive Director of Rehabilitation Operations were interviewed. The Executive Director of Rehabilitation Operations stated: “the Occupational Therapist was going on vacation 10/30 to 11/9;’ “the family was notified and did not want another OT (Occupational Therapist) for coverage;” and notifying the physician is “not in EMR (electronic medical record.””

“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 record review, pertinent policy review, and staff interview, the agency failed to coordinate care delivery to meet the patient’s needs and involve the patient. This was evident for one (1) of three (3) clinical records reviewed (Patient: #1). Failure to coordinate care delivery to meet the patient’s needs and involve the patient, has the potential for negative patient outcomes. The finding is: The agency’s “Missed Visits” Policy (Effective 02/21/2014) documents: “In the even that a scheduled visit to a patient cannot be made as scheduled for any reason, including the patient/patient representative’s cancellation of the visit and no rescheduling within the physician/NPP (Nonphysician Practitioner) prescribed frequency can be accomplished: The clinician or paraprofessional communicates with the patient’s to apprise them of the situation and ensure that he or her needs are met and there is no jeopardy.” 1. Patient #1 has a Start of Care date of 07/17/2020 with diagnoses Autistic Disorder, Developmental Disorder of Speech and Language, Congenital Hypotonia documented on the Home Health Certification and Plan of Care for the Certification Period 10/19/2025 to 12/17/2025. The Home Health Certification and Plan of Care for the Certification Period 08/20/2025 to 10/18/2025 documents: “OT (Occupational Therapy) 1WK1 (one visit a week for one week), 2WK8 (two visits a week for eight weeks).” The Coordination Note dated 10/08/2025 documents: “Recert call was made to the CG (caregiver) on 10/8/2025. CG (Caregiver) was informed of the Recert visit for 10/14/2025 with OT (Occupational Therapist). CG (Caregiver) acknowledged. Had no questions or concerns regarding services.” The Coordination Note dated 10/16/2025 documents: “CM (Case Manager) Coordination Note: TC (Telephone call) from CG (caregiver) on 10/16. (Parent/Caregiver) requested to put OT (Occupational Therapist) on hold. (Parent/Caregiver) reported that OT (Occupational Therapist) reached out last minute today at 8 AM to schedule the recert for the same day. (Parent/Caregiver) stated that patient has a busy schedule and (parent/caregiver) needs to be notified in advance. Additionally, (parent/caregiver) requested a call from OT (Occupational Therapy) supervisor. Director of Rehab Operations was informed.” The clinical record lacks documented evidence of timely and prompt communication with the patient/caregiver regarding the change in the scheduled Recert visit for 10/14/2025. On 12/12/2025 at 02:05 PM, the Administrator, the Vice President of Quality and Compliance, and the Executive Director of Rehabilitation Operations were interviewed. The Executive Director of Rehabilitation Operations stated: “the visit should have been schedule for the Friday (10/17) a day the OT (Occupational Therapist) normally visits;” and “no communication” with caregiver is documented of the change.”

“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 complaint log review, clinical records review, and staff interviews, the agency failed to ensure all patient’s complaints are investigated. This was evident for two (2) of four (4) clinical records reviewed (Patient #2 and #3). Failure to ensure all patient’s complaints are investigated, has the potential for negative patient outcomes. The Findings Are: 1.Patient #2 has a Start of Care date of 09/28/2020 and discharge date of 09/06/2024 with the following diagnoses “Autistic Disorder, Unspecified Asthma, Developmental Disorder of Speech and Language” documented on the Home Health Certification and Plan of Care for the Certification Period 07/09/2024 to 09/06/2024. Patient #3 has a Start of Care date of 09/28/2020 and discharge date of 09/06/2024 with the following diagnoses “Autistic Disorder, Unspecified Asthma, Developmental Disorder of Speech and Language” documented on the Home Health Certification and Plan of Care for the Certification Period 07/09/2024 to 09/06/2024. The Agency’s “Patients Concerns, Complaints, Grievances” policy documents: “Any patient who feels his/her rights have been denied, or who desires to lodge a complaint will be encouraged to contact the Agency staff. Administrative Staff will review each complaint and ensure that all complaints will be investigated and that the individual making the complaint will receive a written response to all written complaints or oral complaints if requested by the individual making the complaint within 15 days of receipt of the complaint. 5.Upon receipt of a written or verbal complaint or grievance, the complainant is directed to the appropriate staff member. Staff will: a) Listen to the complaint expressed by the patient b) Record the complaint on the Complaint Form, and assist the patient in returning a written complaint to the agency c) Document the date the Complaint Form was received in the Complaint Log with a copy of the complaint /concern attached d) Notify the Agency Administrator/DPS/designee of the complaint e) Management/supervisory staff will be designated to conduct an investigation and document the findings/outcome of the investigation on the Complaint Form.” The internal email from Case Manager dated 09/13/2024 documents:” I follow up with mom earlier today and she expressed her dissatisfaction with the delivery of the service and is requesting a different person to perform the recertification. Will discuss with the Director of Case Management on further steps.” There is no documented evidence of an investigation, resolution and response to the complainant. There is no documented evidence of the complaint being documented in the complaint log. The Agency’s “Respect for Patient’s Privacy and Property” policy documents: “Visiting staff or scheduler telephones patients, or responsible other, to alert patients of the prospective arrival time of Agency personnel, time of appointment, and scheduled days of service.” The clinical record lacks documented evidence of the RN (Registered Nurse) alerting the caregiver of the prospective arrival time or time of appointment. The internal email from the caregiver to Case Manager and Director of Case Management dated 09/16/2024 documents: “... This back and forth has/is causing me major anxiety and feeling unsafe with Wellbound because no one is correcting this nurse unprofessional behavior. I’ve always asked for a date and appointment time in order to have better structure for my day and just plain respect. My request have been unheard, but the behavior of this nurse still stands and at this point, I’m uncomfortable with anyone in my home that will lie and say that I “refused” services when all of my 5-6 years of being with Wellbound, this has never been an issue. This is an ongoing issue with him and his lack of respect for the patients. I will also be making the necessary steps to find another home care agency that can respect me and not think it’s okay for their male employee to just show up to a patients home without proper notification.” There is no documented evidence of an investigation, resolution and response to the complainant. There is no documented evidence of the complaint being documented in the complaint log. On 11/13/2024 at 4:45 pm, the Administrator/Director of Patient Services and the Registered Nurse Audits and Investigation were interviewed and did not provide an explanation for the findings.”