Asia Home Healthcare Incorporated

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on record review and interview the agency failed to transmit completed OASIS (a tool used by CMS to collect certain patient information) assessment to CMS within 30 days of completing the OASIS assessment, in that: from 08/01/2024 to 06/02/2025 there were 66 assessments transmitted greater than 30 days from the assessment completion date. This failure prevented the agency’s patient data from being made available to CMS for analysis to identify agency performance levels in the provision of patient care. Pre-survey review of the report titled, “OASIS Error Detail Report” on 06/16/2025 taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed 66 (patients 2, 4 and 5) assessments contained error number -3330 with the error message of, “Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record review for Patient 2: review of the agency OASIS final validation reports taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed submission identification number 65011482 submission date 05/14/2025 with 11 total record processed. Record 6 (Patient 2) gave the following error: “…Message -3330 Warning… Message: Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record 6 (Patient 2) of the OASIS Agency Final Validation report that was submitted on 05/14/2025 had a M0090 completion date of 03/26/2025. Record review for Patient 4: review of the agency OASIS final validation reports taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed submission identification number 64857453 submission date 04/15/2025 with 23 total records processed. Record 9 (Patient 4) gave the following error: “…Message -3330 Warning… Message: Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record 9 (Patient 4) of the OASIS Agency Final Validation report that was submitted on 04/15/2025 had a M0090 completion date of 03/14/2025. Record review for Patient 5: review of the agency OASIS final validation reports taken from the Internet Quality Improvement & Evaluation System (IQIES) revealed submission identification number 65011482 submission date 05/14/2025 with 11 total records processed. Record 1 (Patient 5) gave the following error: “…Message -3330 Warning… Message: Record Submitted Late: The submission date is more than 30 days after M0090 on this new record.” Record 1 (Patient 5) of the OASIS Agency Final Validation report that was submitted on 05/14/2025 had a M0090 completion date of 04/12/2025. On 06/19/2025 at approximately 10:40 AM the surveyor conducted an interview with the Administrator and Office Staff D. The surveyor discussed the OASIS report titled, “OASIS Error Detail Report.” The surveyor explained that from 08/01/2024 to 06/02/2025 the agency transmitted 66 OASIS greater than 30 days from the completion date (M0090) to CMS. The surveyor asked who was responsible for transmitting the OASIS assessment to CMS. The Administrator stated, “Office Staff D is the one that make sure the OASIS is submitted on time.” The surveyor asked why the agency had 66 OASIS assessment that were transmitted past 30 days to CMS. The Administrator stated, “no, I didn’t know. In the past we did have issues but that was in 2024. I didn’t know. I guess I will have to take it over again.” The surveyor asked how submitting an OASIS late to CMS could affect the care the patient receives. The Administrator stated, “it could be a delay of services and plan of care to the patient. We could of missed services assessment to the patient.” The surveyor asked Office Staff D why the agency had 66 OASIS submitted past 30 days to CMS. Office Staff D stated, “I don’t know.” On 06/26/2025 at approximately 11:31 AM the surveyor conducted an interview the Administrator. The surveyor discussed the findings from the patient record reviews. The surveyor explained that during record review he found Patients 2, 4 and 5 had OASIS that were transmitted to CMS more than 30 days after the M0090 dates. The surveyor asked why the OASIS were transmitted past 30 days. The Administrator stated, “I don’t know, I think they were just missed” The surveyor asked what the negative outcome could be for agency clients if the agency submits OASIS past 30 days. The Administrator stated, “Delay of services and plan of care to the patient. We could of missed services assessment to the patient.” Review of Agency policy titled, “IM.10 OASIS Collecting, Encoding and Transmitting” with a revision date of 010121 read in part: “PURPOSE: To ensure the OASIS is collected, encoded and transmitted according to regulation…1. The agency must… be transmitted withing 30 days of completing the assessment…””

“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 establish a written POC that included required elements for 1 of of 8 active patients (Patients #2) whose records were reviewed, in that: In 1 (Patient 2) of 1 active record reviewed where the patient had a Mediport (a small medical appliance surgically placed under the skin to provide a direct and reliable way to administer medications, chemotherapy, blood products, or blood draws) and received chemotherapy (type of treatment using drugs to kill or slow the growth of cancer cells) from her oncologist (medical doctor specializing in cancer). The POC failed to include instructions for the skilled nurse to assess the Mediport access site for: signs and symptoms of infection; pain and safety measures to include the location of the Mediport site. This failure placed the patient at risk of receiving inadequate care and could place the patient at risk of negative outcome if the Mediport site became infected due to the skilled nurse not assessing the Mediport site. Patient 2: Record review of the EMR included a POC for the certification period 03/23/2025 to 05/01/2025 electronically signed by RN H on 03/20/2025 that included a diagnosis of malignant neoplasm (a cancerous tumor) of lower lobe, left bronchus or lung. The POC did not include safety measures for the Mediport site to include the location of the Mediport and orders for the skilled nurse to assess the Mediport access site for signs and symptoms of infection. During an interview with RN H on 06/20/2025 at approximately 2:15 PM, the surveyor presented the above findings. The surveyor asked if there were any interventions or assessments that are done for Patient 2’s Mediport. RN H stated, “yes, I look at it, I check the site and make sure it is not infected, and the skin is not infected or have pain from the site. I check to make sure it doesn’t have an issue.” The surveyor asked why the POC did not include safety measures for the Mediport. RN H stated, “yes, but there is no way to put it on there from the OASIS.” The surveyor asked RN H if she included an information about the mediport in the plan of care. RN H stated, “no. I didn’t know how we should do that.” The surveyor asked what could happen if a skilled nurse was not aware of Patient 2’s Mediport and did not assess the mediport site. RN H stated, “then they could miss if there was an infection.” During an interview with the Administrator/Supervising Nurse on 06/20/2025 at approximately 2:51 PM, the surveyor presented the above findings of why the POC for Patient 2 did not include safety measures for the Mediporst site to include the location and instruction for skilled nurse to assess the site for signs and symptoms of infection and need to assess for pain from the site. The Administrator/Supervising Nurse stated, “yes, she should have put the location and any assessment information in the plan of care. I don’t know. It might be that the nurses need more training to know they can manually add something to the plan of care.” The surveyor asked what could happen to the patient due to the Mediport not being included in the plan of care. The Administrator/Supervising Nurse stated, “the nurse wouldn’t know to look for infection or to assess for pain for Patient 2.” Agency Policy titled, “TX.6 Plan of Care” undated, read in part, “Purpose To develop an individualized Plan of Care which specifies the care and services necessary to meet the patient specific needs and according to state and federal regulations… Procedure… C. The individualized Plan of Care will specify the care and services necessary to meet the patient specific needs…””