Americare in Home Nursing, Home Recovery

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on document review, interview, and policy review, the Home Health Agency (HHA) failed to complete an initial assessment visit within 48 hours of a referral, or the patients return home from an inpatient facility stay, or on the practitioner ordered start of care date for four of eight patients (Patient (P) 1, P2, P4, and P8). The delay in the initial assessment had the potential to affect patient safety or delay identification of signs or symptoms of health concerns which could result in rehospitalization. Findings include: Review of the agency’s policy titled, “Referral/Intake Coordination,” dated May 2024, revealed “The admitting clinician will plan to see the patient within 48 hours of the referral or on the date requested by physician or patient/family.” The agency policy did not include that the practitioner would need to be contacted to change the start of care date if the patient or family member requested a delay. 1. Review of P1’s electronic medical record (EMR) revealed a referral located in the “Misc” tab, dated 08/07/25, for home health physical therapy (PT) and occupational therapy (OT) following an inpatient hospital stay from 07/29/25 to 08/04/25. Review of a note, dated 08/11/25, four days after the referral, located in the EMR in the “Communication” tab, written by the Clinical Manager (CM), revealed “This writer called NP [Nurse Practitioner] notifying the provider of delayed SOC [start of care] per patient’s request.” Review of P1’s “OASIS [Outcome and Assessment Information Set] E-1 Start of Care” assessment located in the EMR in the “PT” tab, revealed the PT completed the initial visit on 08/11/25. 2. Review of P2’s EMR revealed a referral located in the “Misc” tab, dated 07/18/25, for PT services due to osteoarthritis in both knees. Review of P2’s “OASIS E-1 Start of Care” assessment located in the EMR in the “PT” tab, revealed the PT completed the initial visit on 07/24/25. 3. Review of P4’s EMR revealed a signed practitioner order, dated 07/10/25, located in the “Misc” tab for “Home PT/OT eval and treat” following a hospital and rehabilitation stay due to a pubic bone fracture following a fall at home. Review of a “Patient Communication,” dated 07/10/25, located in the “Communication” tab, revealed “Transition and completed referral from [name of marketer] on 07/09/25 … D/C [Discharge] 7/11, SOC 7/14 [son of patient] asking for afternoon appt.” Review of P4’s “OASIS E-1 Start of Care” assessment located in the EMR in the “PT” tab revealed the PT completed the initial visit on 07/14/25. Further review of P4’s EMR failed to show the licensed practitioner was consulted regarding the delay in the SOC. 4. Review of P8’s EMR revealed a document titled, “Face to Face Note/Home Health Orders,” dated 06/20/25, located in the “Misc” tab. The document included physician orders for home health skilled nursing (SN), PT, and OT following an inpatient hospital stay due to an acute intraparenchymal hematoma (a type of stroke where bleeding occurs within the brain tissue itself). Review of a document titled, “Discharge/Transfer Summary,” located in the “Misc” tab in the EMR revealed P8 was admitted to [Name] Hospital on 06/14/25 and discharged on 06/20/25. Review of P8’s “OASIS E-1 Start of Care” assessment located in the EMR in the “SN” tab, revealed the Registered Nurse (RN) completed the initial visit on 06/24/25. During an interview on 08/14/25 at 9:30 AM, the Administrator stated that the agency was part of a larger corporation and that it utilized a “referral process” which obtained referrals either through marketers or a referral platform and that the “intake department” received the referrals, verified insurance, and availability of staff prior to the agency being notified of the referral in most cases. During an interview on 08/15/25 at 3:45 PM, the Administrator confirmed that the identified patient’s start of care visits occurred more than 48 hours after the referral or inpatient facility discharge date.”

“5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care. This Element is not met as evidenced by: Based on document review, interview, and policy review, the Home Health Agency (HHA) failed to complete the patient comprehensive assessment no later than five calendar days after the start of care for three of eight patients (Patient (P) 3, P5, and P8). The failure to complete a thorough patient assessment in a timely manner could affect the determination of services needed to meet the patient’s goals. Findings include: Review of the agency’s policy titled, “Comprehensive Assessment of Patients,” dated April 2024, revealed the following regarding the start of care (SOC) OASIS (Outcome and Assessment Information Set) assessment, “Initiate during the start of care visit and complete during that visit whenever possible … no later than five calendar days after the start of care date.” 1. Review of P3’s “OASIS-E1 Start of Care” assessment located under the “SN” (skilled nursing) tab in the electronic medical record (EMR) revealed a SOC date of 07/03/25. Review of a “Patient Communication” note, dated 08/07/25, located under the “Communication” tab in P3’s EMR, revealed changes were made in the comprehensive OASIS patient assessment in the following areas: 1. Transferring and 2. Management of Oral Medications. The note states, “Locking the OASIS assessment indicates clinician approval of post-review edit corrections.” During an interview on 08/15/25 at 3:45 PM, the Administrator confirmed changes were made to P3’s Comprehensive OASIS assessment and provided a lock date verifying completion of assessment of 08/11/25. 2. Review of P5’s “OASIS-E1 Start of Care” assessment located under the “SN” tab in the EMR revealed a SOC date of 05/08/25. Review of a “Patient Communication” note, dated 05/22/25, located under the “Communication” tab in P5’s EMR, revealed multiple changes were made to the responses in the comprehensive OASIS patient assessment including the following areas: 1. Ability to dress upper body, 2. Ability to dress lower body, 3. Bathing, 4. Toileting, 5. Transferring, 6. Ambulation, 7. Oral hygiene, 8. Mobility, and 9. Management of oral medication. During an interview on 08/15/25 at 3:45 PM, the Administrator confirmed changes were made to P5’s Comprehensive OASIS assessment and provided a lock date verifying completion of the assessment of 05/23/25. 3. Review of P8’s “OASIS-E1 Start of Care” assessment located under the “SN” tab in the EMR revealed a SOC date of 06/24/25. Review of a “Patient Communication” note, dated 07/16/25, located under the “Communication” tab in P8’s EMR, revealed multiple changes were made to the responses in the comprehensive OASIS patient assessment including the following areas: 1. Ability to dress upper body, 2. Ability to dress lower body, 3. Toilet transferring, 4. Toileting hygiene, 5. Transferring, 6. Ambulation, 7. Hospitalization risk, 8. Management of oral medications. During an interview on 08/15/25 at 3:45 PM, the Administrator confirmed changes were made to P8’s Comprehensive OASIS assessment and provided a lock date verifying completion of the assessment of 07/21/25.”

“Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on document review, interview, and policy review, the Home Health Agency (HHA) failed to provide the patient or caregiver with a written medication list which included the name of the medication, dosage, and frequency written in plain language for two of two patients (Patient (P) 3 and P4) reviewed during a home visit observation. This failure had the potential to contribute to medication errors which could result in patient harm. Findings include: Review of the agency’s policy titled, “Medication Management,” dated November 2021, revealed it failed to include that the agency completes and provides to the patient/caregiver a medication list written in plain language. Review of the agency’s admission booklet provided to the patient/caregiver during the admission process showed it included a blank “Medication Profile” form. 1. Review of P3’s admission booklet during a home visit observation on 08/15/25 at 1:00 PM revealed the “Medication Profile” form was not completed. 2. During P4’s home visit observation on 08/14/25 at 1:00 PM, an interview with Family Member (F) 1 revealed they had not received a written list of medications from the HHA. F1 stated, “We got a list of medications from the hospital when [P4] was discharged.” During an interview on 08/15/25 at 3:45 PM, the Administrator stated the staff person completing the admission comprehensive assessment was supposed to complete the “Medication Profile” form in the admission booklet after reviewing and reconciling the patient’s medications. The Administrator confirmed that the agency did not have a policy that specifically stated that the medication list was to be completed and provided to the patient/caregiver.”