Absolute Home Health LLC

The Home Health Agency failed to provide documentation of the development, implementation, evaluation, and maintenance of an effective, ongoing, HHA-wide, data-driven Quality Assessment and Performance Improvement (QAPI) program since January 19, 2019. Therefore, the Condition of Participation, 42…

The Home Health Agency failed to set forth, in writing, its organizational structure, including lines of authority since February, 2026, as evidenced by: The agency failed to ensure the administrator was appointed by and reports to the governing body.

The Agency failed to ensure measurable indicators were developed, analyzed and tracked to identify trends in patient care.

The Agency failed to ensure quality indicators were utilized to measure the effectiveness of the safety of services, the quality of care provided and identified opportunities for improvement.

The Agency failed to ensure performance improvement focused on high risk safety indicators, identified opportunities for immediate improvement and monitored the success of the interventions implemented.

The Home Health Agency failed to track all adverse patient events, to determine through subsequent analysis whether they were the result of errors that should have been preventable, to reduce the likelihood of such events in the future.

The Agency failed to ensure performance improvement projects were identified and implemented annually.

The Governing Board failed to ensure a quality improvement and patient safety program was implemented and maintained.

The Agency failed to ensure a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases is in place and is an integral part of the HHA’s quality assessment and performance improvement (QAPI) program.

The Home Health Agency failed to measure its success and track performance to ensure that improvements are sustained.

The Facility failed to ensure the administrator was appointed by the governing body.

The facility failed to ensure outdated biologicals were not available for patient use.

The Agency failed to ensure a pre-designated person who assumes the same responsibilities and obligations as the administrator when the administrator is not available, was provided in writing, as authorized by the administrator and governing body.

The Agency failed to prepare and plan an annual budget.

The Agency failed to obtain an informed consent prior to the start of care for 1 of 3 (Patient #3) clinical records reviewed.

The Agency failed to ensure the Administrator was responsible for day-to-day operations.

The Agency failed to ensure patient care provided by staff under arrangement was supervised.

The Agency failed to include all required items in the clinical record for 2 of 3 (Patients # 1 and 2) clinical records reviewed.

The Agency failed to ensure the Emergency Operation Plan was reviewed biennially.

The Agency failed to complete a risk assessment.

The Agency failed to review and revise the Plan's policies and procedures biennially.

The Agency failed to ensure the communication plan was reviewed biennially.

The Agency failed to ensure the communication plan contained all the required components.

The Agency failed to ensure staff received initial and ongoing training of the Emergency Operation Plan.

The Agency failed to ensure the SN updated the comprehensive assessment due to a significant change in the patient's condition.

The Agency failed to ensure staff provide service/treatment, as ordered by the Physician and indicated in the POC.

The Agency failed to ensure Pts. were informed and/or participated in the disciplines to provide care/service and the frequency of visits provided by each discipline.

The Agency failed to ensure Pts. were informed of their financial responsibility (if any) for payment of Agency care/services.

The Agency failed to ensure complete information regarding the State Telephone Hotline was provided to Pts.

The Agency failed to ensure staff update and revise the comprehensive assessment, within the last 5 days of the 60-Day certification period.

The Agency failed to ensure the POC contained the required interventions.

The Agency failed to ensure the Agency assessed the need for Pneumococcal Pneumonia and/or Influenza vaccines.

Staff failed to notify the Physican regarding falls.

The Agency failed to ensure discharge summaries were completed within 5 days and sent to the Physician.

The Agency failed to ensure immunization screening for pneumococcal pneumonia and/or influenza was conducted at the time of Start of Care.

The Administrator failed to ensure that a documented, pre-designated person was authorized to assume administrative duties in the Administrators absence.