Immediate Homecare and Hospice

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on review of clinical records (CR), and interview with the agency administrator, the agency failed to follow the plan of care as directed by the physician for one (1) of four (4) CRs reviewed. (CR#4). Findings include: A review of agency policy titled “Plan of Care – CMS #485 and Physician/Practitioners Orders” completed on November 17, 2025 at approximately 3:30 pm stated the following: POLICY Skilled nursing and other home health services will be in accordance with a Plan of Care based on the patient’s diagnosis and assessment of immediate and long-range needs and resources. Each Plan of Care must be signed and dated by the physician/allowed practitioner. Stamped signatures on orders, treatments or other documents that are part of the patient’s record are not accepted. The Agency will provide the patient and caregiver with written instructions related to the plan of care. Procedure: …26. Orders may authorize a specific range in the frequency of visits for each service (e.g., 2-4 visits per week) to ensure that the most appropriate level of service is provided to the patient.…. The Agency alerts the physician/practitioner to any changes that suggests a need to alter the plan of care. If the Agency provides fewer visits than the physician/practitioner orders, it has altered the plan of care and the physician/practitioner must be notified. The Agency must maintain documentation in the clinical record indicating that the physician/practitioner was notified and is aware of the missed visit. …30. The patient’s orders for treatments and services are the foundation of the plan of care. If the Agency misses a visit or a treatment or services as required by the plan of care, which results in any potential for clinical impact upon the patient, then the Agency must notify the responsible physician/practitioner of such missed treatment or service. The physician/practitioner decides whether the treatment or service may be skipped or whether additional intervention is required by the Agency due to the clinical impact on the patient. …32. The physician/practitioner will not be approached to reduce the frequency of services based solely on the availability of Agency staff. A review of CRs conducted on October 24, 2025 at approximately 10:00 am revealed the following: CR #4, Start of Care: 8/14/25; Discharged: 9/9/25. Certification period reviewed: 8/14/25 through 10/12/25; contained orders for skilled nursing services two (2) visits per week for four (4) weeks. SN orders - 8/14/2025 – 8/16/2025 -1 visit / 1 week. 8/14/25 – Start of Care Visit completed SN orders - 8/17/2025 – 9/13/2025 – 2 visits per week / 4 weeks. Week One (1) 8/19/2025 – SN Visit Completed; 8/21/2025 – SN Missed Visit; CR#4 had doctor’s appointment, as per nursing notes. No other visits were completed for this week. Week Two (2) 8/25 – SN Visit Completed ; 8/29 – SN Visit Completed Week Three (3) 9/1/2025 – SN Missed Visit – No Answer to Phone Call, as per nursing notes. 9/1/2025 – Nursing Note indicated: “No answer to phone call, Physician Notified.” Last visit made to CR#4 was made on 8/29/25, therefore, no further treatment was provided by the agency. In addition to having wound care provided at home, the patient was seen in a wound center to have the wound cared for. 9/5/25 – According to CR#4, visit was supposed to take place on 9/5/25. As per the email that was sent by CR#4 the following information was stated:”…. She confirmed I was on schedule for Friday, September 5, but could not answer any questions regarding the missed appointment on Monday, September 1. She told me a manager would call me back. After 7 days, I am still waiting for a manager to call….” No notes from agency regarding missed visit. Agency did not fulfill the visit frequency of two (2) visits per week. No further dates were scheduled by the agency to provide wound care treatment to CR#4. Last date wound care services were provided was on 8/29/25. No other visits were completed for this week Week Four (4) 9/9/2025 – SN Missed Visit – No Answer to Phone Call, as per nursing notes. No other visits were completed for this week. Discharge summary completed. An interview with the Office Director conducted on October 24, 2025, at approximately 1:45 pm confirmed the above findings.”

“Available during all operating hours CFR(s): 484.105(b)(3) The administrator or a pre-designated person is available during all operating hours. This Element is not met as evidenced by: Based on review of the agency polices/procedures and interview with the agency Office Director, the agency failed to ensure the administrator, or an alternate administrator is available during all operating hours for one (1) of four (4) Client Records reviewed. CR#4. Based upon an interview conducted with CR#4 on October 23, 2025 at approximately 9:00 am, CR4 stated that they were happy with nursing services but not satisfied with the inability of contacted a representative in the office. As per CR#4, out of the eleven (11) times they contacted the agency, only spoke to a representative from the agency one (1) time. CR#4 provided the following statement via email to the Pennsylvania Department of Health: “…August 15 – called to alert them about a change in bandage changing schedule. On hold for 45 minutes when automated system confirmed my phone number and said, “goodbye”. No call back. September 1 – nurse did not show up for appointment. I called at 8:00 a.m., 9:30 a.m.,12:00 p.m., and 2:00 p.m. to ask whether a nurse would be coming. In all cases, the automated system confirmed my number and said, “goodbye”. No call back. September 2 – called to find out about nurse not coming on September 1 and whether I was on schedule for Friday, September 5. I called at 8:10 a.m. and 9:06 a.m. Again, both calls were answered by the automated system. The company did call back at about 11a.m., but the phone only rang once. I immediately called back; the phone was answered. She confirmed I was on schedule for Friday, September 5, but could not answer any questions regarding the missed appointment on Monday, September 1. She told me a manager would call me back. After 7 days, I am still waiting for a manager to call. September 3 – called to inform them that I had a doctor’s appointment on Thursday, September 4, which may result in a change in the scheduled Friday, September 5 appointment. I asked about a better way to contact them regarding a possible change in the Friday appointment because of the difficulty in contacting them. She told me the general number was the best way to contact them. There was neither a call from a nurse regarding the Friday appointment nor a visit by a nurse. September 8 – I had a doctor’s appointment. She changed my home nursing care needs. I called the company to inform them of the change at 11:16 a.m., 2:15 p.m., and 4:00 p.m. All calls were answered by the automated system. I did not get a call back. September 9 – I called my doctor’s office to request a different home healthcare agency.” A review of the Agency’s Home Health Admission Booklet, which is presented to patient’s upon admission was conducted on October 23, 2025 at approximately 10:15 am revealed the following information: · Information regarding Office Hours/After Hours Coverage “…Office Hours: Our office hours are from 8:00 a.m. to 5:00 p.m., Monday through Friday, except holidays. You may reach us by calling… “After Hours Coverage: We have a nurse on call 24 hours a day, seven days a week to ensure that you receive necessary home care services. Your may reach the nurse by calling…After office hours and on weekends, an answering service will reach the nurse on call and he/ she will return your call to address your concerns and needs.” · Welcome to the Immediate Home Health & Hospice Family! “ …If you have any comments, suggestions or complaints, please contact us. Any concerns will be addressed promptly. A satisfactory resolution will be sought and implemented.” An interview with the Office Director conducted on October 23, 2025, at approximately 1:00 pm, indicated that the office was short staffed and there was a great possibility that calls were missed and that an extension should have been provided to the patient.”