Magnolia Home Health

“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 interviews, the agency failed to ensure that physical therapy clinical notes were included timely in the patients clinical records, in that, 11 (Patients # 1 through # 10 and # 12) of 13 patient records reviewed the agency did not ensure that PT A included clinical notes according to the timeline of the agency’s policy. The failure caused missed visits to go undetected and placed the patients at risk of physical harm from falls or decline in physical strength if physical therapy service and treatment were not provided as ordered. Findings include: Pre-survey review of TULIP (a database utilized by the state to maintain licensing, demographic information, complaints, and self-reported incidents on home health and hospice agencies for the State of Texas), on 06/29/2026 revealed a self-reported incident, Intake 1050344 dated 11/14/2026. Review of Intake 1050344 revealed a self-reported incident with an allegation of neglect that read in part: “This is related to multiple patients with potential fraudulent documentation… Physical therapist [PT A] was behind on documentation and called into office yesterday for disciplinary action. Upon further investigation today with the GPS on car and tablet (electronic footprint), it appears that 30 out of the 44 visits charted do not support direct care treatment. The employee has been suspended pending further investigation… After this was brought to my attention, I notified[Human Resources]and compliance for guidance. Written disciplinary action was done at this time. After paperwork was completed and further evaluation of submitted visits, employee was suspended for investigation. Although we are still completing a full investigation, we do believe that there were multiple visits with documentation submitted that were not actually performed…” The incident was self-reported by former Administrator B. Patient # 1: Record review of Patient # 1’s clinical record revealed a POC with a SOC date of 08/14/2025, a certification period of 10/13/2025 to 12/11/2025, and a primary diagnosis of Paroxysmal atrial fibrillation (an irregular, rapid heart rhythm that starts and stops suddenly on its own). PT A and Former Administrator signed and dated the POC on 10/09/2025. The POC included an order for PT visits one time per week for nine weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates: 10/17/2025; 10/24/2025; 10/31/2025; and 11/08/2025. Review of the agency’s visit verification list for PT A’s patient visits revealed that on 10/17/2025 PT A was 13 plus miles away, on 10/24/2025 PT A was 6 plus miles away, and on 10/31/2025 PT A was 13 plus miles away from Patient # 1’s home. The company’s vehicle and company laptop location tracking data did not verify that PT A was at Patient # 1’s home on those dates and times of visits. Patient # 2: Record review of Patient # 2’s clinical record revealed a POC with a SOC date of 09/29/2025, a certification period of 09/29/2025 to 11/27/2025, and a primary diagnosis of Parkinson’s Disease (a nervous system disorder that primarily affects movement, the disease is progressive). RN A signed and dated the POC on 09/29/2025. The POC included an order for PT visits one time per week for one week. Continued review of Patient # 2’s record revealed a physician’s order dated 10/15/2025. Review of the physician’s order revealed a “calendar frequency” change for PT visits effective 09/29/2025 to one time per week for two weeks, two times per week for six weeks and one time per week for one week. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates: 10/04/2025; 10/11/2025; 10/15/2025; 10/24/2025; 10/25/2025; 10/30/2025; 11/08/2025; and 11/11/2025. Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 2 included the following visits: 10/11/2025; 10/18/2025; 10/25/2025; 10/28/2025; and 10/31/2025. Patient # 2’s clinical record did not include visit notes for 10/18/2025, 10/28/2025, and 10/31/2025. Patient # 3: Record review of Patient # 3’s clinical record revealed a POC with a SOC date of 01/06/2025, a certification period of 09/03/2025 to 11/01/2025, and a primary diagnosis of Hypertensive heart disease with heart failure (caused by years of unmanaged high blood pressure that forces the heart to work too hard). RN B and Former Administrator signed and dated the POC on 08/31/2025. The POC included an order for PT visits one time per week for one week effective 10/05/2025. Continued review of Patient # 3’s record revealed a physician’s order dated 10/07/2025. Review of the physician’s order revealed a “calendar frequency” change for PT visits effective 10/05/2025 to one time per week for two weeks, two times per week for two weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit date 10/07/2025. Review of the agency’s visit verification list for PT A’s patient visits revealed that on 10/14/2025 PT A’s location on 10/14/2025 was not verified in the town where the patient lived. The company’s vehicle and company laptop location tracking data did not verify that PT A was at Patient # 3’s home on the date, 10/14/2025, of visit note that he submitted . Patient # 4: Record review of Patient # 4’s clinical record revealed a POC with a SOC date of 08/05/2025, a certification period of 10/04/2025 to 12/02/2025, and a primary diagnosis of Fracture of right femur, post-surgery (a break in the thigh bone). RN A signed and dated the POC on 10/07/2025. The POC included an order for PT visits one time per week for one week effective 10/05/2025. Continued review of Patient # 4’s record revealed a physician’s order dated 10/14/2025. Review of the physician’s order revealed an order for PT visits effective 10/05/2025 for one time per week for nine weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates: 10/11/2025; 10/14/2025; 10/24/2025; 11/06/2025; and 11/22/2025. Review of the agency’s visit verification list for PT A’s patient visits revealed that on 10/11/2025 PT A did “not go to Client [Patient # 4] Home. 8+ miles away at any given point.” Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 4 included the following visit, 10/30/2025 that PT A submitted. Patient # 4’s calendar did not include visit notes for 10/30/2025. Patient # 5: Record review of Patient # 5’s clinical record revealed a POC with a SOC date of 09/20/2025, a certification period of 09/20/2025 to 11/18/2025, and a primary diagnosis of Aftercare following surgery for neoplasm (nursing and therapy care after surgical removal of a tumor). RN C and Former Administrator signed and dated the POC on 09/20/2025. The POC included an order for PT visits one time per week for one week effective 09/21/2025. Continued review of Patient # 5’s record revealed a physician’s order dated 09/26/2025. Review of the physician’s order revealed an order for PT visits effective 09/21/2025 for one time per week for one week, two time per week every two weeks, two times per week for two weeks, and one time per week for one week. Further review of the record revealed a “Client Calendar Report” for PT visits. The clinical record listed the following visit dates: 09/26/2025 and 10/09/2025. Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 5 included the following visits, 10/08/2025; 10/16/2025; 10/18/2025; 10/21/2025; 10/24/2025; and 10/28/2025 that PT A submitted. Patient # 5’s clinical record did not include visit notes for 10/08/2025; 10/16/2025; 10/18/2025; 10/21/2025; 10/24/2025; and 10/28/2025. Patient # 6: Record review of Patient # 6’s clinical record revealed a POC with a SOC date of 08/30/2025, a certification period of 08/30/2025 to 10/28/2025, and a primary diagnosis of Fracture of left wrist (a break in a bone of the wrist) . RN B and Former Administrator signed and dated the POC on 08/30/2025. The POC included an order for PT visits one time per week for one week effective 08/31/2025. Continued review of Patient # 6’s record revealed a physician’s order dated 09/05/2025. Review of the physician’s order revealed an order for PT visits effective 08/31/2025 for one time per week for one week, two times per week every three weeks, two times per week for two weeks, and one time per week for three weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates: 09/05/2025; 09/23/2025; 10/01/2025; 10/11/2025; 10/16/2025; and 10/28/2025. Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 6 included the following visits, 10/07/2025; 10/16/2025; and 10/24/2025 that PT A submitted. Patient # 6’s clinical record did not include visit notes for 10/07/2025 and 10/24/2025. Patient # 7: Record review of Patient # 7’s clinical record revealed a POC with a SOC date of 08/22/2025, a certification period of 08/22/2025 to 10/20/2025, and a primary diagnosis of Urinary tract infection (infection in the kidneys, tubes that connect the bladder to the kidneys or urinary bladder). RN B and Former Administrator signed and dated the POC on 08/22/2025. The POC included an order for PT visits one time per week for one week effective 08/24 /2025. Continued review of Patient # 7’s record revealed a physician’s order dated 08/26/2025. Review of the physician’s order revealed an order for PT visits effective 08/24/2025 for one time per week for one week, one time every two weeks times two, two times per week for two weeks, and one time per week for three weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates: 09/05/2025; 09/23/2025; 10/01/2025; 10/11/2025; 10/16/2025; and 10/28/2025. Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 7 included the following visits, 10/07/2025; 10/16/2025; and 10/24/2025 that PT A submitted. Patient # 7’s clinical record did not include visit notes for 10/07/2025 and 10/24/2025. Patient # 8: Record review of Patient # 8’s clinical record revealed a POC with a SOC date of 08/09/2025, a certification period of 10/08/2025 to 12/06/2025, and a primary diagnosis of Parkinsonism (characterized by a core set of motor symptoms: resting tremors, muscle rigidity, slowed movements, and postural instability). RN D and Former Administrator signed and dated the POC on 10/07/2025. The POC included an order for PT to evaluate. Continued review of Patient # 8’s record revealed a physician’s order dated 10/02/2025. Review of the physician’s order revealed an order for PT visits effective 09/28/2025 for one time per week for every two weeks times two. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates for PT A: 10/16/2025; 10/30/2025; 11/06/2025; and 11/08/2025. Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 8 included the following visit, 10/25/2025 that PT A submitted. Patient # 8’s clinical record did not include visit notes for 10/25/2025. Patient # 9: Record review of Patient # 9’s clinical record revealed a POC with a SOC date of 08/09/2025, a certification period of 08/28/2025 to 10/26/2025, and a primary diagnosis of Fracture upper and lower end of fibula (a break in the upper and lower part of the calf bone in the leg). RN D and Former Administrator signed and dated the POC on 08/28/2025. The POC included an order for PT to evaluate. Continued review of Client # 9’s record revealed a physician’s order dated 09/09/2025. Review of the physician’s order revealed an order for PT visits effective 08/31/2025 for one visit every two weeks times two. The order included an additional order for PT visits effective 09/07/2025 every three weeks times three. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates for PT A: 09/26/2025; 10/07/2025; and 10/17/2025. Review of the agency’s patient visit verification list for PT A’s patient visits which could not be verified for Patient # 9 included the following “Unable to locate Patient in [Electronic record system]. During email interview with Former Administrator on 10/10/2026 at 10:49 a.m. the Former Administrator stated Patient # 9 was located in the agency’s electronic records and that PT A’s 10/07/2026 visit could not be verified. Patient # 10: Record review of Patient # 10’s clinical record revealed a POC with a SOC date of 02/25/2025, a certification period of 08/24/2025 to 10/22/2025, and a primary diagnosis of Aftercare following surgery on digestive system (requires careful management of diet, incision sites, and bowel function). RN D and Former Administrator signed and dated the POC on 08/28/2025. Continued review of Patient # 10’s record revealed a physician’s order dated 09/18/2025. Review of the physician’s order revealed an order for PT visits effective 09/21/2025 for one time per week for one week. The record included an addition physician’s order dated 09/23/2025 for PT visits two times per week for one week. The record included a PT evaluation dated 09/27/2026 with PT visit frequencies of one time per week for one week, one time per week every two weeks times 2, and one time per week for two weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates for PT A: 09/27/2025 and 10/11/2025. Review of the agency’s patient visit verification list for PT A’s patient visits which could not be verified for Patient # 10 included the following “Unable to locate Patient in [Electronic record system]. During email interview with Former Administrator on 10/10/2026 at 10:49 a.m. the Former Administrator stated Patient # 10 was located in the agency’s electronic records and that PT A’s 10/11/2026 visit could not be verified. Patient # 12: Record review of Patient # 12’s clinical record revealed a POC with a SOC date of 08/27/2025, a certification period of 08/27/2025 to 10/25/2025, and a primary diagnosis of Chronic obstructive pulmonary disease with respiratory infection (a lung disease that restricts airflow a causes difficulty breathing with an infection in the lungs). RN D and Former Administrator signed and dated the POC on 08/27/2025. The POC included an order for PT visit one time per week to evaluate. Continued review of Client # 12’s record revealed a physician’s order dated 09/12/2025. Review of the physician’s order revealed an order for PT visits effective 09/07/2025 for one time every two weeks times two. The record included an additional order dated 09/18/2026 for visits effective 09/14/2025 one time per week for two weeks, two times per week for two weeks and one time per week for two weeks. Further review of the record revealed a “Client Calendar Report” for PT visits. The calendar listed the following visit dates for PT A: 09/18/2025; 09/30/2025; and 10/02/2025. Review of the agency’s patient visit list for PT A’s patient visits which could not be verified for Patient # 12 included the following visit, 10/07/2025 and 10/21/1025 that PT A submitted. Patient # 12’s clinical record did not include visit notes for 10/07/2025 and 10/21/2025. During an interview on 07/09/2026 at 12:30 p.m. with Former Administrator, the surveyor requested the agency’s investigation records. Former Administrator stated that she reported the incident because PT A had 44 visits with late documentation. She stated that when the documentation was submitted there were concerns that the visits were not correct. The agency investigated and terminated the employee for falsification of records. She stated that after investigation compliance agreed with self-reporting the incident but did not want to report to PT board until the agency knew HHSC’s findings (whether substantiated or unsubstantiated). Former Administrator stated that she would have the agency’s investigation summary provided. Review of agency’s undated “Investigation Summary Report” revealed the following: The agency opened the investigation into PT A’s alleged falsifying visit clinical notes for client physical therapy visits. The description of findings was “falsifying visit-substantiated…Corrective Action Plan…Termination. Summary of investigation: On 11/5/2025, a routine review of [PT A’s] open visit activity report in HCHB identified concerns that patient visits were not documented timely. This prompted a formal review of his visit documentation against available location-tracking data. 11/6/2025 - Fleet GPS (company vehicle) records were pulled for [PT A’s] assigned vehicle to compare against his documented visit schedule. 11/13/2025 - Following review of the Fleet GPS data, [PT A] was suspended pending the outcome of a formal investigation. During investigation – Tablet (laptop) GPS/location tracking data was obtained and reviewed. Tablet location data corroborated the Fleet GPS data, placing [PT A] at or near the same questionable locations at the times in question. A detailed comparison was conducted of documented patient visits against Fleet GPS and tablet location data. Of 44 patient visits reviewed, 30 visits could not be corroborated and may not have actually been made. 11/24/2025 – [PT A] was given the opportunity to respond. He stated that the Fleet GPS location data may not be accurate because he did not always drive the fleet vehicle, and that he did not always carry his tablet with him during visits. Determination - Because the Fleet GPS and tablet GPS data independently corroborated one another across the majority of the disputed visits, his explanation was not deemed a sufficient basis to account for the discrepancies. Termination approved. Billing for all patient visits identified as suspect was reversed/backed out following the investigation findings.” On 07/10/2026 at 7:54 a.m. surveyor attempted to call alleged perpetrator PT A with no answer, surveyor left message requesting a return phone call. On 07/10/2026 at 10:01 a.m. surveyor attempted to call PT A again with no answer and requested return call. On 07/10/2026 At 3:11 p.m. during pre-exit conference interview the surveyor requested that Former Administrator attempt to call PT A. Former Administrator stated that she texted PT A but did not receive a response. On 07/10/2026 At 7:39 p.m. post exit Former Administrator texted the surveyor and stated that PT A texted her and said he was at the lake. Former Administrator stated that she sent PT A the surveyor’s number and asked PT A to call on Monday. Former Administrator stated that PT A said he would call. No call was received for PT A. The Surveyor attempted client contact for: Patient # 1 on 07/10/2026 at 8:37 A.M. and 10:47 A.M.-left message with client’s representative with no answer and no return call. Patient # 2 on 07/10/2026 at 8:34 A.M. and 10:40 A.M.-left message with client’s representative with no answer and no return call. Patient # 3 at 8:32 A.M. and 10:38 AM-left message with client’s representative with no answer and no return call. On 07/10/2026 at 10:57 A.M. Patient # 1’s representative called back and stated that she did not remember a PT named [PT A]. She stated that there was mix up in visits because the agency was changing over to another company. She stated that with the new PT, his name was not [PT A] there had been no missed visits. Patient # 4 at 8:29 A.M. and 10:33 A.M.-left message with client’s representative with no answer and no return call. Patient # 5 at 8:26 A.M. and 10:30 A.M.-left message with client’s representative with no answer and no return call. On 7/10/2026 at 3:11 p.m. during interviews with Administrator and Former Administrator the surveyor asked what the agency’s requirements were for staff taking computer tablet to client visits. Former Administrator stated that the agency expected the staff to get the visits completed in the patient’s homes and get the patient’s signature after the visit was complete, on the tablet. She stated the agency had paper visit forms that could be used if there was a tablet malfunction. The surveyor asked what the agency’s policy was for using the company car versus the personal vehicle. The Administrator stated it was not a requirement that employees use the company vehicle. The surveyor asked what the agency’s policy was for the staff notifying the agency when a tablet malfunctioned. Former Administrator stated that the staff should notify their director for any missed visits, for being behind on anything, or any problems with completing visits. The surveyor asked who was responsible for ensuring that assigned clinicians were documenting their clinical notes for visits accurately and timely. Former Administrator stated that the director was ultimately responsible, the billing staff verified visits for a double check, and all leaders should address any trends that were identified. The surveyor asked what the agency’s policy and process were for ensuring that clinical notes for visits were accurately and timely completed in the clinical record. Former Administrator stated that every morning a report was supposed to be run by the administrative staff and schedulers. That report should be reviewed by the director. The director should follow up with employees if there were visits that had not been documented. Former Administrator stated that the Former Director “was not super proactive we had a process that was not being followed. That director Former [Director] is no longer here.” The Former Director was not available for interview. The surveyor asked why the agency was not following its process and policies. Former Administrator replied, “poor branch leadership.” The surveyor asked what should have been done differently to prevent the failure. Former Administrator replied, “[PT A] should have notified the director of why the tablet was not working or that he forgot to get a signature. After two to three days of him being behind on turning in his clinical documentation he should have been pulled from visits, we should not have allowed him to get that far behind. I will accept responsibility for that.” Review of agency policy titled, “Clinical Note” dated 2020 read in part: “POLICY: Clinical care staff will document each patient care contact in a clinical note in compliance with practice standards and regulations. PURPOSE: To have a complete, accurate, legal document recording direct contact with a patient, which reflects the patient’s most current condition and service rendered according to the ordered plan of care. PERSONNEL: All clinical personnel PROCEDURE: I. A clinical note is a required part of a patient visit and must be written on the day service is rendered…II. The note is to be written on the day service is rendered, preferably at the time the visit is made, signed, and dated by the individual making the visit. III. The description of the patient and the service rendered during the visit must be as specific and complete as possible. IV. Documentation of the services rendered shall reflect the physician/allowed practitioner’s orders in the plan of care… X. Clinical notes and documentation from unlicensed personnel are incorporated into the client record on a timely basis but no later than fourteen business days or per state regulation.” Review of agency policy titled, “Documentation Requirements” dated 2022 read in part: “POLICY: All direct patient care staff… will be oriented to the standards of documentation and be expected to document in a complete and objective manner. PURPOSE: To ensure that documentation demonstrates care provided to the patient…PERSONNEL: All clinical personnel Procedure…II. All clinical staff will be oriented to the legalities and requirements for documentation to include…A. Standards of practice…C. Medicare requirements for reimbursement and coverage; D. State licensure requirements; and E. Forms and policies of the agency III. All documentation will be completed on the day services are rendered…IV. Employees or contractors who do not submit required documentation in the manner described above will be disciplined according to policy and may be reported to the respective licensing boards...””