Intuitive Care Home Health Agency, LLC

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on record review and interview, the Agency failed to ensure that each patient received the home health services that were written in an individualized plan of care, in that, physician orders on the POC were not followed for 4 of 8 patient records reviewed (Patients 1, 2, 3 and 4). This failure placed patients at risk for inconsistent and insufficient care and failed to meet the health needs of patients. Findings included: Review of Patient 1’s medical chart revealed a SOC date of 9/17/2024 and the diagnoses of Type II Diabetes (a chronic condition where the body resists insulin or does not make enough of it, causing sugar to build up in the blood), Kidney Disease (when kidneys are damaged and can no longer filter waste, extra water, and toxins from the blood the way they should), and a chronic ulcer (an open sore on the skin or a mucous membrane that fails to heal within a normal timeframe, usually lasting longer than six weeks) on both feet. Record review of the care episode dated 11/16/2024 – 1/14/2025 revealed a POC with the following order: Notify physician of vital sign parameters out of range…pulse less than 55 or greater than 110. The following SN visit notes did not follow the physician’s order regarding reporting vital signs that were outside of parameters: - A SN visit note dated 11/30/2024 recorded Patient 1’s pulse as 50, there was no evidence of the physician being notified. - A SN visit note dated 12/07/2024 recorded Patient 1’s pulse as 50, there was no evidence of the physician being notified. - SN visit note dated 12/17/2024 recorded Patient 1’s pulse as 50, there was no evidence of the physician being notified. - SN visit note dated 12/19/2024 recorded Patient 1’s pulse as 51, there was no evidence of the physician being notified. Review of Patient 2’s medical chart revealed a SOC date of 2/11/2025 with the diagnoses of Neoplasm of the Right Adrenal Gland (an abnormal growth on the hormonal gland located above your right kidney) and Kidney Disease. Record review of the care episode dated 4/7/2026 – 6/5/2026 revealed a POC with the following order: SN to weigh patient every visit and report to the doctor if weight gain greater than 3 pounds in five days or greater than 5 pounds in seven days. Patient 2’s SN visit notes demonstrated that for five out of eight SN visits (visits dated 4/8/26, 5/5/26, 5/12/26, 5/19/26, and 5/26/26), Patient 2 did not have her weight assessed by the SN. Review of Patient 3’s medical chart revealed a SOC date of 10/2/2025 with the diagnoses of Stage 1 Sacral Pressure Ulcer (an area of intact, non-blanching red or discolored skin over the lower back and tailbone caused by prolonged pressure), and Urine Retention (the inability to completely empty the bladder). Record review of the care episode dated 12/1/2025 – 1/29/2026 revealed a POC with the following order: SN to weigh patient every visit and report to the doctor if weight gain greater than 3 pounds in five days or greater than 5 pounds in seven days. According to SN visit notes, Patient 3 was not weighed per physician orders during five out of nine SN visits reviewed (visits dated 12/31/25, 1/7/26, 1/14/26, 1/21/26, and 1/26/26). Review of Patient 4’s medical chart revealed a SOC date of 6/16/2026 and the diagnoses of Lymphedema (chronic swelling caused by a buildup of protein-rich lymph fluid in the body’s tissues when lymphatic vessels are damaged or blocked), Cellulitis in both legs (a bacterial skin infection that affects the deeper layers of the skin and subcutaneous tissues), and Congestive Heart Failure (a chronic condition where the heart muscle cannot pump blood efficiently, causing fluid to back up and build up in the lungs and body tissues). Record review of the care episode dated 6/16/2026 – 8/14/2026 reflected a POC with the following order: SN to weigh patient every visit and report to the doctor if weight gain greater than 3 pounds in five days or greater than 5 pounds in seven days. Patient 4’s SN visit notes revealed Patient 4 was not weighed per physician orders on SN visits dated 8/12/2026 and 8/14/2026. During the entrance conference with the Adm/ADON and the Alt Adm/DON on 9/15/2026 at 09:45 AM, the Surveyor asked who at the Agency was responsible for ensuring the POC was followed. The DON/Alt Adm responded that it was her responsibility to ensure the POC was followed according to physician orders. During an interview with the Adm/ADON and the Alt Adm/DON on 9/18/2026 at 12:12 PM, the Surveyor asked why the SN did not report Patient 1’s pulse readings of less than 55 to the physician according to the orders on the POC. The Alt Adm/DON responded that she also did not see any communication with the physician and was unsure why the physician was not notified of the pulse being outside of perimeters. The Surveyor asked why weight was not taken for Patient 2 as ordered on the POC, and the Alt Adm/DON replied that Patient 2 often refused to have her weight taken. The Alt Adm/DON acknowledged that the refusal should have been documented in the SN visit note. The Surveyor asked why weight was not assessed for Patient 3 as ordered on the POC, and the Alt Adm/DON replied that Patient 3 often got agitated and that could be the reason weight was not assessed but again acknowledged that a refusal should have been documented. The Surveyor asked why weight was not assessed for Patient 4 as ordered on the POC, and the Alt Adm/DON replied that the weights should have been recorded, especially on the recertification. The Surveyor asked why Agency policies and regulations were not followed to which the Alt Adm/DON responded that she did not know why and stated that nurses should know to document and follow the POC. Agency policy 5.6, under Care, Treatment, Service and Continuum of Care, titled “Orders for Care”, revised 1/29/2020, read in part …”The Agency will obtain orders and provide care in accordance with physician’s…orders…””

“Participate in the HHA’s QAPI program; CFR(s): 484.75(b)(8) Participation in the HHA’s QAPI program; and This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure that all skilled professional staff provided input into and participated in the Agency’s QAPI program, in that, there was no evidence that other skilled professionals gave input according to the Agency’s policy for 5 of 5 QAPI committee meetings reviewed. This failure placed agency patients at risk by limiting the agency’s ability to effectively evaluate, monitor, and improve the quality and safety of all services provided. Findings included: Review of the Agency’s QAPI committee meeting records revealed a committee signature page dated July 31, 2024. This document contained signatures from the Adm/ADON, the Alt Adm/DON, and RN A; there was no evidence of participation from individuals representing each scope of service provided by the agency such at PT, OT, ST, MSW, or an HHA. Review of the Agency’s QAPI committee meeting records revealed a committee signature page dated January 31, 2025. This document contained signatures from the Adm/ADON, the Alt Adm/DON, and RN A; there was no evidence of participation from individuals representing each scope of service provided by the agency such at PT, OT, ST, MSW, or an HHA. Review of the Agency’s QAPI committee meeting records revealed a committee signature page dated July 31, 2025. This document contained signatures from the Adm/ADON, the Alt Adm/DON, and RN A; there was no evidence of participation from individuals representing each scope of service provided by the agency such at PT, OT, ST, MSW, or an HHA. Review of the Agency’s QAPI committee meeting records revealed a committee signature page dated January 31, 2026. This document contained signatures from the Adm/ADON and the Alt Adm/DON; there was no evidence of participation from individuals representing each scope of service provided by the agency such at PT, OT, ST, MSW, or an HHA. Review of the Agency’s QAPI committee meeting records revealed a committee signature page dated July 30, 2026. This document contained signatures from the Adm/ADON and the Alt Adm/DON; there was no evidence of participation from individuals representing each scope of service provided by the agency such at PT, OT, ST, MSW, or an HHA. During the entrance conference with the Adm/ADON and the Alt Adm/DON on 9/15/2026 at 09:45 AM, the Adm/ADON stated the Agency provided the following services: SN, HHA, OT, PT, ST, and MSW. Additionally, the Surveyor asked who was on the Agency’s QAPI committee and the Alt Adm/DON stated that she and the Adm/ADON were the only two individuals involved in the QAPI committee. During an interview on 9/18/2026 at 12:12 PM, the Surveyor asked the Adm/ADON and the Alt Adm/DON why all services provided by the Agency were not represented in the QAPI committee. The Alt Adm/DON responded that they were not aware that others needed to be involved. The Surveyor asked if the Adm and the Alt Adm understood the importance of having all provided services represented in the QAPI committee, to which both replied that they recognized the importance. The Surveyor asked why Agency policies and regulations were not followed, the Alt Adm/DON responded that they had a QAPI consultant, and the regulation was never brough to their attention. Agency policy 9.1, under Improving Organizational Performance, titled “Quality Assessment Performance Improvement Plan”, revised 1/29/2020, read in part … “The governing board will assemble a QAPI working team that consists of…individuals representing the scope of services provided by the agency.””