Med Plus Home Healthcare Inc.

“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 encode and electronically transmit each completed OASIS assessment to the CMS system, within 30 days of completing the assessment of the patient, for 5 (Patient 1, 2, 4, 5 and 7) of 7 active patient records reviewed whose assessments were processed for the time reviewed from 10/01/2024 to 12/17/2025. This failure resulted in pertinent data required to continuously improve the quality and effectiveness of home healthcare being neglected to be reported to CMS in the required time frame. Findings included: The home health agency (HHA) Error Summary Report, retrieved from the IQIES website for the time of 10/01/2024 to 12/17/2025 was reviewed. Review of the HHA Error Summary Report identified Error -3330. The description for Error -3330 read in part, “Record Submitted Late: The submission date is more than 30 days after M0090 (Item M0090 specifies the date the actual assessment was completed) on this new record.” The documentation identified the number of assessments with the error was 85 assessments processed with 39 (Error-3330) assessments reported late. The percentage of assessments with this error was listed as 45.88% of the assessments completed by the Agency were late. An interview was conducted with the Alternate Administrator on 12/18/2025 at 10:45 AM. The results were discussed regarding the late submissions of the assessments reported. The HHA Error Summary Report was reviewed with the Alternate Administrator. The Alternate Administrator acknowledged the responsibility of the late submission and said she had been in discussion with the Administrator on the timeliness of the submissions. The Alternate Administrator also stated she would be taking over the submission of the assessments and make sure they were completed as required. Agency Policy: HCL, Section 8: Outcome and Assessment Information Set (OASIS), (not dated) “The Agency is required to submit all OASIS assessments to the national database specified by CMS within 30 days of the MOO90 date”.”

“Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide’s performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure that a performance evaluation of tasks listed at 484.80(b)(3)(i), (iii), (ix), (x) and (xi) was evaluated and observed by an RN for 1 home health aide (HHA A) employed by the agency whose record was reviewed, of 1 home health aide employed by the agency. There was no evidence found that HHA skills were observed, and competencies completed by a RN for HHA A. This failure led to services being provided by a HHA who had not been observed competent by an RN that may have led to harm from care that did not meet the patients’ needs. FINDINGS INCLUDE: According to the federal regulations for home health agencies: [§484.80c) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section.] “484.80(c)(1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing a aide’s performance of the task with a patient or pseudo-patient…. (i) Communication skills, including the ability to read, write, and verbally report clinical information to patients, representatives, and caregivers, as well as to other HHA staff. (iii) Reading and recording temperature, pulse, and respiration. (ix) Appropriate and safe techniques in performing personal hygiene and grooming tasks that include— (A) Bed bath; (B) Sponge, tub, and shower bath; (C) Hair shampooing in sink, tub, and bed; (D) Nail and skin care; (E) Oral hygiene; (F) Toileting and elimination; (x) Safe transfer techniques and ambulation; (xi) Normal range of motion and positioning; …” An active employee list provided by the Alternate Administrator on 12/18/2025 indicated the agency had 1 HHA (HHA A) employed. The list included the date of hire for HHA A as 09/25/2025. Review of the personnel record for HHA A revealed a signed job description for “Home Health Aide” signed by HHA A and dated 09/25/2025. The record included an application signed by HHA A on 9/25/25 and included a certified nurse assistant (CNA) number that indicated it was issued by Texas Health and Safety Code. Review of HHA A’s entire personnel record did not include any evidence that an observation of the required HHA skills competency evaluation was conducted and observed by a RN per regulatory requirement. Review of Patient #7’s clinical record indicated Patient 7 received HHA services from HHA A. The record included a POC dated 09-15-25 to 11-13-25 with a SOC of 05/23/2024. The POC included physician’s orders for skilled nursing to be provided once a week for nine weeks and HHA services to be provided two times a week for nine weeks. Review of Patient 7’s clinical record included HHA services were provided by HHA A, on 9/23/2025, 9/27/2025, 9/30/2025, 10/2/2025, 10/7/2025, 10/11/2025, and 10/14/2025. A phone interview was conducted with Patient 7 on 12/23/2025 at 9:03 am. Patient 7 stated she had a HHA for a couple weeks and said the HHA got sick and couldn’t keep working. Patient 7 said the agency told her they were looking for another HHA until HHA A could return. Patient 7 said she hoped HHA A could come back. The surveyor reviewed the findings with the Alternate Administrator on 12/23/2025 at 3:00 PM. The DON was also included via telephone. The surveyor asked the DON if HHA A had provided HHA services to Patient 7. The DON said she thought she had. The surveyor asked the DON if HHA A was evaluated for skills competency of the required HHA tasks. The DON said she wasn’t sure. The surveyor said there was no evidence of a skills check off in HHA A’s personnel record. The DON said she had not done the skills competency evaluation for HHA A. She stated she had forgotten to make sure this was done but would make sure she completed it in the future. The Alternate Administrator stated she should have made sure the skills check-off was done. Agency Policy: Home Health Aide Competency Evaluation HR.45, (not dated) Read as follows: “The Agency will ensure that each home health aide successfully completes a home health aide competency evaluation in accordance with federal and state laws and regulations prior to performing care independently”. Procedure: “The competency evaluation will be administered by a Registered Nurse, in consultation with other skilled professionals as appropriate, and as scheduled during the orientation period”. Subjects Addressed in the Competency Evaluation: “The following subject areas must be evaluated by observing a home health aide’s performance of the task with a patient/client or pseudo-patient/client”. 1.“Communication skills, including the ability to read, write, and verbally report clinical information to patient’s/client’s, representatives, and caregivers, as well as to other agency staff”. 2.” Reading and recording temperature, pulse, and respiration”. 3. “Appropriate and safe techniques in performing personal hygiene and grooming tasks that include: bed bath, sponge, tub, and shower bath, hair shampooing in sink, tub, and bed, nail and skin care, oral hygiene, toileting and elimination, normal range of motion and positioning.”

“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 review and interview the Director of Nursing failed to ensure that care was provided according to a patient’s plan of care as written for 2 (Patient #1 and 2) of 3 active patients with a diagnosis of Type 2 Diabetes (chronic condition when a body can’t use insulin correctly and sugar builds up in the blood) in that: LVN R failed to perform a FSBS (test to measure the level of sugar in a person’s blood) during every assigned skilled nursing visit as ordered for Patients 1 and 2. This failure placed the patients at risk of increased blood sugars that can cause damage to vital organs and low blood sugars that can cause confusion and left untreated could lead to coma even death. Findings include: Review of Patient 1’s clinical record included a POC dated 11-23-2025 to 01-21-2026 with a SOC date of 05/27/2025. The POC included a diagnosis of Type 2 Diabetes and a physician’s order for skilled nursing to provide skilled visits once a week for 9 weeks. The POC also included physician’s orders for skilled nursing to perform fasting blood sugar and report the following results to the physician: “Fasting blood sugar greater than (>) 250 or less than () 300 or less than () 250 or less than () 300 or less than (<0 60….” Review of Patient 2’s clinical record included signed skilled notes by LVN R for the following dates: 11/25/2025, 11/27/25, 12/2/25, 12/4/25, 12/9/25, and 12/11/25. Review of the skilled notes and entire clinical record, there was no documentation that indicated FSBS were performed. A phone interview was conducted on 12/19/205 at 3:53 PM with Patient 2 and Patient 2’s family member, Identifier Z. Patient 2 and Family Member Z reported Patient 2 is paralyzed and required total care. Family Member Z reported that LVN R comes 2 times a week to see Patient 2. Family Member Z said LVN R checks the patient’s vital sign, changes the patient’s urinary catheter when needed, checks the patient’s feeding tube and the patient’s skin. He said he is not comfortable doing the FSBS and Patient 2 is not able to do it, so he leaves that to the nurse when she comes. A home visit was arranged to be conducted by another surveyor, Surveyor K, on 12/23/25 at 11:36 AM. Surveyor K reported she spoke with Family Member Z during the home visit. Surveyor K reported she observed Patient 2 was bedbound, paralyzed and required total care. Survey K reported Family Member Z said he provided all Patient 2’s care. Surveyor K reported that Family Member Z said LVN R comes twice weekly to check on Patient 2 and checked vital signs, skin and the urinary catheter. Surveyor K reported Family Member Z said he did not feel comfortable doing the FSBS checks, and said Patient 2 cannot do them so he leaves that to the nurse. During the exit interview with the DON and the Alternate Administrator on 12/23/2025 at 3:00 PM, the surveyor asked the DON why she did not make sure LVN R was doing the FSBS checks as ordered for Patient 1 and Patient 2. The DON said LVN R should have known to do the FSBS. The Alternate Administrator reviewed the findings and agreed the FSBS was not on the LVN R’s visit notes. The DON said she thought Family Member Z was doing the FSBS and said she did not know why LVN R was not doing the FSBS or documenting the results of the FSBS. The surveyor requested an interview with LVN R but the Alternate Administrator said LVN R was not available at this time. Agency Policy: Responsibilities of the Clinical Manager LD.30 (not dated), Read as follows: “The Clinical Manager, appointed by the Administrator, is responsible for the oversight of all patient/client care services and personnel, and participates in activities relevant to the professional services furnished”. Addendum to Agency Policy: Responsibilities of the Clinical Manager LD.30 (not dated) was attached and Read as follows: LD.30TX (not dated), “Ensuring that a patient’s/client’s Plan of Care is executed as written.””

“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 did not ensure an onsite supervisory visit of the HHA (home health aide) services was conducted no less frequent than every 14 days by an agency RN, or other appropriate skilled professional. This failure to supervise the HHA services could result in substandard care, that could result in harm from inadequate services being provided to agency patients. Findings include: Patient 7: Review of Patient 7’s clinical record included a POC dated 09-15-25 to 11-13-25 with a SOC of 05/23/2024. The POC included physician’s orders for skilled nursing to be provided once a week for nine weeks and HHA services to be provided two times a week for nine weeks. Review of Patient 7’s clinical record included HHA services provided by HHA A, on 9/23/2025, 9/27/25, 9/30/25, 10/02/25, 10/7/25, 10/11/25, and 10/14/2025. An onsite RN supervisory visit for the HHA services should have been completed by 10/07/2025. A phone interview was conducted with Patient 7 on 12/23/2025 at 9:03 AM. The surveyor asked if the patient would allow a surveyor to do a home visit. She said she would. The surveyor asked Patient 7 what services the agency provided. Patient 7 said she loved the nurse that came but would like to have HHA services again. She said the previous HHA (HHA A) had become ill and couldn’t work anymore. She said the HHA came a couple times a week for a few weeks. During the exit interview with the Alternate Administrator on 12/23/2025 at approximately 3:00 PM, with the DON via telephone, the surveyor reviewed the findings. The Alternate Administrator stated the agency only had one HHA (HHA A) that provided services for a few weeks but became sick and couldn’t continue working. She said it was DON’s responsibility to do the HHA supervisory visits. The surveyor asked the DON why the RN supervisory visits had not been done. The DON said HHA A only provided services for a little while and she didn’t realize she had missed doing the supervisory visits. She said she had not done the HHA supervisory visits for the home health aide services provided by HHA to Patient 7 but would make sure she did them in the future. Agency Policy: Employee Supervision HR.60, (not dated) reads as follows: “The Agency will assign the responsibility for employee supervision to the appropriately qualified individual”. “The Agency will provide timely supervision of the following employees by qualified individuals: HHA, make an onsite visit to the patient’s/client’s home no less than every 14 days”. 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.”