Realcare Home Health, Inc.

The provider failed to develop an individualized plan of care (POC) that identifies patient-specific measurable outcomes and goals on 1 out of 5 Sampled Patients (SP).

The provider failed to demonstrate it had provided written notice of the patient's rights and responsibilities, and the Home Health Agency's transfer and discharge policies for 1 out of 5 Sampled Patients (SP).

The provider failed to demonstrate it had obtained the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities. for 1 out of 5 Sampled Patients (SP).

The provider failed to demonstrate it had the patient(s) participate in, be informed about, and consent or refuse care in advance of and during treatment of the care to be furnished, the disciplines that will furnish the care, and the frequency of visits for 1 out of 5 Sampled Patients (SP).

The provider failed to notify the patient, his or her representative (if any), that the Home Health Agency (HHA) is considering a discharge for cause on 1 out of 5 Sampled Patients (SP).

The provider failed to document the problem(s) and efforts made to resolve the problem(s), and enter this documentation into the patient's clinical record before the Home Health Agency (HHA) consider a discharge for cause on 1 out of 5 Sampled Patients (SP).

The provider failed to document the existence of an investigation and resolution of complaint(s) for 1 out of 5 Sample Patients (SP).

The provider failed to complete a comprehensive resumption of care (ROC) assessment within 48 hours of the patient's return to the home from a hospital admission in 1 out of 5 Sampled Patients (SP).

The provider failed to include in the individualized plan of care (POC) the following components: description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors; and information related to any…

The provider failed to ensure the home health aide(s) kept a record of the provision of hands-on personal care activities for 1 out 5 Sampled Patients (SP).