Caring Point LLC

“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 record review, observation and interview, the agency failed to integrate services to ensure agency staff documented communication with PAS provider, Identifier B involved in the care for 1 (Patient #3) of 7 client records reviewed. The failure to integrate services and document coordination of care regarding personal assistance services, potentially would cause agency staff to be unaware of a duplication of care and services provided to the patient. FINDINGS INCLUDE: Patient #3: Record review revealed a POC dated 11/15/2025 to 01/13/2026 with a SOC date 09/16/2025. The POC included, “… Mental/Cognitive Status: … Anxiety, … Functional Limitations: … Legally blind… Fall risk, … Psychosocial status: … Community Resources Providing Assistance (PHC SERVICES), … .” A recertification assessment completed by RN C on 11/14/2025, included on page 4, “… SUPPORTIVE ASSISTANCE, … Community resources providing assistance: PHC SERVICES … Cg available during the day. …” During a home visit with Patient #3 on 01/02/2026, the surveyor observed a person in the kitchen washing dishes. During the visit the person joined the conversation with Patient #3 and introduced herself as the Patient’s POA and caregiver, Identifier D. The surveyor asked about care and services provided by the agency. Patient #3 stated the agency provided a SN to fill his medications and check his blood sugar. He stated Identifier D took care of him daily by fixing his meals, reminding him to take his medication and help with personal care. He stated Identifier D was “wonderful” and helped him every day. Identifier D stated she worked for the PAS provider, Identifier B and had been with the patient for many years. Review of the entire patient record revealed no documented coordination of care with Identifier B. In an interview with the Administrator on 01/06/2026 at approximately 1:00 PM, the surveyor reviewed the findings and asked if the agency had any documentation of COC with the PAS provider, Identifier B. The Administrator stated she did not know why there was no documentation of COC, that she knew to do the COC, but it was not done. Agency policy, undated, quoted in part, “Monitoring Patient/Client Care/Coordination of Care, PC. 45, Purpose: To ensure coordination of patient/client care and treatment. … Policy: II. The Agency will collaborate with other organizations providing services … to ensure appropriate coordination of care. … Procedure: I. The Agency will: … C. Integrate services, … to assure the identification of patient/client needs and factors that could affect patient/client safety and treatment effectiveness and the coordination of care provided by all disciplines. D. Coordinate care delivery to meet the patient’s/client’s needs and involve the patient/client, representative, and caregiver(s), as appropriate, in the coordination of care activities.”

“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 record reviews, observation and interviews, the agency failed to ensure skilled professionals provided services to patients as ordered by the physician and included in the plan of care. In 1 (Patient #1) of 7 patient records reviewed, the SN failed to ensure hha services were provided as ordered by the physician. This failure placed the patient at risk of not receiving interventions when needed to prevent complications and a decline in the patients’ health status due to possible personal care needs not completed. FINDINGS INCLUDE: Patient #3: Review of the record revealed a SOC comprehensive assessment competed on 12/27/2025 by RN A, page 13 included, “Bathing: Current ability to wash entire body safely. … 3- Able to participate in bathing self in shower or tub but requires presence of another person throughout the bath for assistance or supervision. …” Review of the patient record revealed a POC dated 12/27/2025 to 02/24/2026 with a SOC 12/27/2025. The POC included the diagnoses: Alcohol abuse with intoxication; Osteoarthritis (joint disease); Muscle weakness and Compression fracture vertebra (break or collapse in one of the spinal bones), routine heal. The physician ordered, “Home Health Aide to provide assistance with personal care and ADLs as indicated by limitations on functional and physical status impeding self-care. …” Review of the entire record for Patient #1 revealed no hha services were provided to the patient from 12/27/2025 to 01/02/2026 (the date the surveyor reviewed the record). In an interview with the Administrator, on 12/30/2025 at 2:30 PM, the surveyor reviewed the services provided by the agency. The Administrator stated the agency did not have hha employees and if a client needed hha services, the agency would ask an LVN to perform the personal care tasks. In an interview with the Administrator on 01/06/2026 at 1:00 PM, the surveyor was informed the Supervising Nurse was not available at the time of preliminary reviews. The surveyor reviewed the findings and asked why the POC was not followed and hha services were not provided to Patient #1. The Administrator stated she was not sure why the hha services were not provided. Agency policy, 01/01/2026, quoted in part, “Plan of Care, PC. 35, Purpose: To ensure that care provided is appropriately planned in a timely manner to meet the patient’s/client’s specific needs and problems. … Procedure: … II. An RN is responsible for coordinating the Plan of Care when multiple disciplines are involved, … III. Each patient/client must receive an individualized written Plan of Care, including any revisions or additions. …”