Home Care Innovations Inc.

“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 record review and interview, the agency failed to ensure the plan of care contained patient specific education and safety measures to protect against injury for 1 of 10 patients (Patient #7) records reviewed for plans of care, in that: Patient #7’s POC did not include patient specific education and bleeding precautions as a safety measure for his use of Warfarin (a blood thinning medication used to treat blood clots). This failure could place patients at risk of not receiving proper care and education leading to complications and hospitalization. Findings included: Record review of Patient #7’s POC dated 9/11/25- 11/9/25 indicated a SOC date of 9/11/25, and indicated he was 73 years old with diagnosis including stage 2 pressure ulcer (wound caused by pressure to the skin for an extended period of time), peripheral vascular disease (a progressive disorder affecting blood vessels, often leading to reduced blood flow, particularly in the legs), embolism (obstruction or blockage in a blood vessel) and thrombosis (blood clot). The POC indicated Patient #7 was ordered SN visits twice a week for one week, three times a week for one week, and once a week for seven weeks. The POC indicated he was on Warfarin Sodium 2.5 mg daily. The POC did not include education or bleeding precautions as a safety measure for use of the blood thinning medication, Warfarin. Record review of the Medication Profile for Patient #7 dated 9/11/25- 11/9/25 indicated he had orders for Warfarin Sodium 2.5 mg daily. During an interview on 12/10/25 at 11:40 am the Alternate Administrator said the Administrator was out at a doctor’s appointment. Attempted a telephone interview on 12/10/25 at 1:10 pm with Patient #7. No answer. Voicemail left identifying surveyor and requested a call back. Attempted a telephone interview on 12/10/25 at 1:15 pm with the Alternate Supervising Nurse. The message indicated the voice mail was full and cannot accept any messages at this time. Unable to leave a message. Attempted a telephone interview on 12/10/25 at 1:18 pm with the Administrator. Message indicated the mailbox was full and cannot accept any messages at this time. Unable to leave a message. During a telephone interview on 12/10/25 at 1:34 pm the Alternate Supervising Nurse said safety measures should be included on the POC. The Alternate Supervising Nurse said for patients taking Warfarin safety measures should include bleeding precautions. The Alternate Supervising Nurse said the RN that saw the patient was responsible for completing the POC. The Alternate Supervising Nurse said bleeding precautions should absolutely be listed on Patient #7’s POC. The Alternate Supervising Nurse said bleeding precautions not being listed on Patient #7’s POC was an oversight on her part. The Alternate Supervising Nurse said if safety measures were not on the patients POC and another clinician went to see them they would not know the patient was at risk and could overlook things like using razors (preventing cuts and bruising). During an interview and record review on 12/10/25 at 2:07 pm the Supervising Nurse said safety measures should absolutely be included on the POC. The Supervising Nurse said patients taking Warfarin should have bleeding precautions as a safety measure on the POC. The Supervising Nurse said the RNs were responsible for creating the POC. The Supervising Nurse said Patient #7 was a patient from the branch office. The Supervising Nurse reviewed Patient #7’s POC dated 9/11/25-11/9/25 and confirmed the POC did not have bleeding precautions indicated as a safety measure. The Supervising Nurse said bleeding precautions should be listed as a safety measure on the POC. The Supervising Nurse said if safety measures were not included on the POC it could be bad if other clinicians were not aware of the risk and the patient started bleeding. During an interview on 12/10/25 at 2:52 pm the Alternate Administrator said safety measures should be included on the POC. The Alternate Administrator said bleeding precautions should be included as a safety measures on the POC for a patients taking Warfarin. The Alternate Administrator said the RNs were responsible for creating the POC. The Alternate Administrator said bleeding precautions should have been included as safety measure for Patient #7 since he was on Warfarin. The Alternate Administrator said safety measures not being included on the POC affect the patient if their Warfarin level dropped. Attempted a telephone interview on 12/10/25 at 3:18 pm with Patient #7. No answer. Voicemail left identifying surveyor and requested a call back. Attempted a telephone interview on 12/10/25 at 3:20 pm with the Administrator. Message indicated the mailbox was full and cannot accept any messages at this time. Unable to leave a message. Review of Warfarin side effects accessed at https://www.drugs.com/sfx/warfarin-side-effects.html on 12/12/25 indicated “... Warfarin can cause major or fatal bleeding. … Instruct patients about prevention measures to minimize risk of bleeding and to report signs and symptoms of bleeding. … This medicine may increase your chance of bleeding. Check with your doctor right away if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. Avoid picking your nose. If you need to blow your nose, blow it gently. Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done. Be careful not to cut yourself when you are using sharp objects, such as a safety razor or fingernail or toenail cutters. Avoid contact sports or other situations where bruising or injury could occur. It is recommended that you carry identification that says you are using warfarin.” Record review of a Plan of Care policy dated 05/02/24 indicated “…Policy… The Agency will use data/information gathered during patient/client assessments in the care planning process which involves the identification of patient/client goals, actions or interventions that will resolve or alleviate the patient’s/client’s problems and/or needs. … Procedure… The individualized Plan of Care must specify the care and services necessary to meet the patient/client-specific needs as identified in the comprehensive assessment … The individualized Plan of Care must also specify the patient/client and caregiver education and training. A. The individualized Plan of Care must include the following: 1. All pertinent diagnoses … 11. Safety measures to protect against injury … 12. A description of the patient’s/client’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors … 14. Patient/client-specific interventions and education…””

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the registered nurse conducted an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the home health aide for 1 of 10 patients whose records were reviewed. (Patient #7) There was no aide supervisory visit from 9/22/25 to 10/10/25 (18 days) for Patient #7. This failure has the potential of placing patients at risk of receiving ineffective and inappropriate care and services. Findings include: Record review of Patient #7’s POC dated 9/11/25- 11/9/25 indicated a SOC date of 9/11/25, and indicated he was 73 years old with diagnosis including stage 2 pressure ulcer (wound caused by pressure to the skin for an extended period of time), peripheral vascular disease (a progressive disorder affecting blood vessels, often leading to reduced blood flow, particularly the legs), embolism (obstruction or blockage in a blood vessel) and thrombosis (blood clot). The POC indicated Patient #7 was ordered SN visits twice a week for one week, three times a week for one week, and once a week for seven weeks and HHA visits twice a week for one week and three times a week for eight weeks. Record review of the HHA tab visit management calendar for Patient #7 dated 9/11/25- 11/9/25 indicated he was seen by the HHA twice a week for the first week and three times a week for the following eight weeks. Record review of the nursing tab visit management calendar for Patient #7 dated 9/11/25- 11/9/25 indicated a SNV with Aide Supervision was conducted on 9/18/25, 9/22/25, 10/10/25, 10/21/25, and 11/4/25. The visit calendar gave no indication that any RN visits for supervision of the home health aide was conducted from 9/22/25 to 10/10/25 (18 days) for Patient #7. Record review of the clinical record for Patient #7 did not include a home health aide supervisory visit from 9/22/25 to 10/10/25 (18 days). During an interview on 12/10/25 at 11:40 am the Alternate Administrator said the Administrator was out at a doctor’s appointment. Attempted a telephone interview on 12/10/25 at 1:10 pm with Patient #7. No answer. Voicemail left identifying surveyor and requested a call back. Attempted a telephone interview on 12/10/25 at 1:15 pm with the Alternate Supervising Nurse. The message indicated the voice mail was full and cannot accept any messages at this time. Unable to leave a message. Attempted a telephone interview on 12/10/25 at 1:18 pm with the Administrator. Message indicated the mailbox was full and cannot accept any messages at this time. Unable to leave a message. During a telephone interview and record review on 12/10/25 at 1:34 pm the Alternate Supervising Nurse said aide supervisory visits should be conducted every 14 days. The Alternate Supervising Nurse said aide supervisory visits should be documented. The Alternate Supervising Nurse said the RN was responsible for completing the aide supervisory visits. The Alternate Supervising Nurse reviewed the EMR and said Patient #7 had an aide supervisory visit on 9/22/25 and 10/10/25. The Alternate Supervising Nurse said there should have absolutely been an aide supervisory between 9/22/25 and 10/10/25. The Alternate Supervising Nurse said there was an aide supervisory visit scheduled on 10/6/25 and Patient #7 cancelled the visit, so she did the aide supervisory visit at the next scheduled visit on the 10/10/25. The Alternate Supervising Nurse said if aide supervisory visits were not completed every 14 days, they would not be to make sure an aide was doing a satisfactory job and doing what care plan said to do. During an interview and record review on 12/10/25 at 2:07 pm the Supervising Nurse said aide supervisory visits should be conducted every 2 weeks. The Supervising Nurse said aide supervisory visits should be documented. The Supervising Nurse said the RNs were responsible for completing the aide supervisory visits. The Supervising Nurse reviewed the EMR for Patient #7 and confirmed aide supervisory visits were completed on 9/22/25 and 10/10/25. The Supervising Nurse said there should have been an aide supervisory visit on that Monday and it was a missed visit for a doctor appointment. The Supervising Nurse said if aide supervisory visits were not completed every 14 days the agency would not know if aide was doing the right job or not. During an interview on 12/10/25 at 2:52 pm the Alternate Administrator said aide supervisory visits should be conducted every 14 days. The Alternate Administrator said the aide supervisory visits should be documented. The Alternate Administrator said the RNs were responsible for completing the aide supervisory visits. The Alternate Administrator said Patient #7 should have had an aide supervisory visit completed between 9/22/25 and 10/10/25. The Alternate Administrator said the aide supervisory visit should have been done at 14 days. The Alternate Administrator said if the aide supervisory visit was not completed every 14 days the patient’s hygiene might not be completed on time or in the right manner. Attempted a telephone interview on 12/10/25 at 3:18 pm with Patient #7. No answer. Voicemail left identifying surveyor and requested a call back. Attempted a telephone interview on 12/10/25 at 3:20 pm with the Administrator. Message indicated the mailbox is full and cannot accept any messages at this time. Unable to leave a message. Record review of an Employee Supervision policy dated 5/2/24 revealed, “… Purpose To establish employee supervision practices in accordance with applicable federal and state laws and regulations. Policy I. The Agency will assign the responsibility for employee supervision to the appropriately qualified individual. II. Supervision will be performed within the time frame defined by the policy. … Procedure I. The Agency will provide timely supervision of the following employees by qualified individuals: A. Home Health Aides 1. If home health aide services are provided to a patient/client who is receiving skilled nursing … services: a. A registered nurse (RN) or other appropriate skilled professional who is familiar with the patient/client, the patient’s/client’s care, and the written patient/client care instructions, must: (1) Make an onsite visit to the patient’s/client’s home no less frequently than every 14 days …””

“Required items in clinical record CFR(s): 484.110(a)(1) The patient’s current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the visit notes were in each patient’s clinical record within 14 days of the visit for 2 of 10 patients whose records were reviewed. (Patient #2 & #3) 1. There were no visit notes entered from SNVs on 11/10/25 and 11/17/25 for Patient #2. 2.There were no visit notes entered from SNVs on 11/10/25 and 11/17/25 for Patient #3. This failure has the potential of placing patients at risk of receiving ineffective and inappropriate care and services. Findings include: 1.Record review of Patient #2’s POC dated 11/1/25- 12/30/25 indicated a SOC date of 3/6/25, and indicated she was 80 years old with diagnosis including bipolar disorder (mental health condition characterized by extreme mood swings, including emotional highs and lows), type 2 diabetes mellitus (chronic condition characterized by insulin [a hormone produced by the body that absorbs sugar from the bloodstream] resistance and high blood sugar levels), chronic kidney disease (kidneys do not filter blood effectively, leading to a buildup of waste and excess fluid in the body), and congestive heart failure (chronic condition where the heart is unable to pump blood effectively, leading to a buildup of fluids in the lungs and other parts of the body). The POC indicated Patient #2 was ordered SN visits once a week for nine weeks. Record review of the nursing tab visit management calendar for Patient #2 dated 11/1/25- 12/30/25 indicated RN- Skilled Nursing Visit for 11/10/25 and 11/17/25 were “Not Started”. Record review of the clinical record for Patient #2 did not include SNV notes from 11/10/25 or 11/17/25. 2.Record review of Patient #3’s POC dated 10/4/25- 12/2/25 indicated a SOC date of 4/7/25, and indicated she was 102 years old with diagnosis including anxiety (group of mental health conditions characterized by excessive fear, worry, and dread that can interfere with daily activities) and hypertension (high blood pressure) The POC indicated Patient #3 was ordered SN visits once a week for eight weeks. Record review of the nursing tab visit management calendar for Patient #3 dated 10/4/25- 12/2/25 indicated RN- Skilled Nursing Visit for 11/10/25 and 11/17/25 were “Not Started”. Record review of the clinical record for Patient #3 did not include SNV notes from 11/10/25 or 11/17/25. During an interview on 12/9/25 at 9:22 am, Patient #3 said her nurse came to see her once a week. During an interview on 12/9/25 at 10:12 am, Patient #2 said her nurse came to see her once a week. During an interview on 12/10/25 at 11:40 am the Alternate Administrator said the Administrator was out at a doctor’s appointment. Attempted a telephone interview on 12/10/25 at 1:15 pm with the Alternate Supervising Nurse. The message indicated the voice mail was full and cannot accept any messages at this time. Unable to leave a message. Attempted a telephone interview on 12/10/25 at 1:18 pm with the Administrator. Message indicated the mailbox was full and cannot accept any messages at this time. Unable to leave a message. During a telephone interview on 12/10/25 at 1:34 pm the Alternate Supervising Nurse said she saw patients from the branch office. The Alternate Supervising Nurse said the goal was for visit notes to be completed within 48 hours of the visit. The Alternate Supervising Nurse said the RNs were responsible for completing the SN visit notes. The Alternate Supervising Nurse said she did not see Patient #2 or Patient #3. The Alternate Supervising Nurse said visit notes from 11/10/25 and 11/17/25 should be completed by now. The Alternate Supervising Nurse said if the visit note were not competed within 14 days if another nurse went to see the patient they wouldn’t know what has been going on and it could affect the continuity of care. During an interview and record review on 12/10/25 at 2:07 pm the Supervising Nurse said SN visit notes should be completed within 24 hours. The Supervising Nurse said the nurses were responsible for completing the SN visit notes. The Supervising Nurse reviewed the EMR for Patient #2 and confirmed the SN visit notes from 11/10/25 and 11/17/25 were not completed. The Supervising Nurse said the SN visit notes should be completed. The Supervising Nurse reviewed the EMR for Patient #3 and confirmed the SN visit notes from 11/10/25 and 11/1725 were not completed. The Supervising Nurse said the SN visit notes should be completed. The Supervising Nurse said she has not had the time to finish them. The Supervising Nurse said if someone else was seeing the patient, it could affect the patient by the staff not knowing what was going on with the patient. During an interview on 12/10/25 at 2:52 pm the Alternate Administrator said SN visit notes should be completed within 7 days so they have time to review them. The Alternate Administrator said the nurses were responsible for completing the SN visit notes. The Alternate Administrator said SN visit notes for Patient #2 from 11/10/25 and 11/17/25 should have been completed. The Alternate Administrator said SN visit notes for Patient #3 from 11/10/25 and 11/1725 should be completed. Attempted a telephone interview on 12/10/25 at 3:20 pm with the Administrator. Message indicated the mailbox is full and cannot accept any messages at this time. Unable to leave a message. Record review of a Timelines- Addendum policy dated 4/14/23 revealed, “Procedure I. In addition to the requirements defined in the Timelines policy in the Management of Information section of the Administrative Policy, the following requirements will also be met: A. All clinical and progress notes will be written the day service is rendered. B. All medical record information will be incorporated into the patient’s/client’s medical record within 14 working days. …””