G0159: Plan Of Care
CMS level: Standard Moderate. On this site, a condition-level citation is labeled Serious, a standard-level citation Moderate, and an element-level citation Minor. What the labels mean · How to choose an agency
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-21; CMS agency list file dated 2026-09-21. CMS source file. What the labels mean
Where it was cited
- Texas5
- California4
- Colorado2
- Florida2
- Georgia2
- Iowa2
- Illinois2
- New York2
- Ohio2
- Oregon2
- Pennsylvania2
- Connecticut1
- Kansas1
- Louisiana1
- Michigan1
- Minnesota1
- Utah1
- Wyoming1
Most recent citations
The 20 most recent of 34 citations. Newest inspection first.
Healthwise Home Care Solutions Inc
The Home Health Agency (HHA) failed to ensure the plan of care (POC) was specific to the patient's needs for one of five sampled patients (Patient 2).
Mission Home Health of Portland
The agency failed to develop a plan of care that covered all pertinent diagnoses, and other appropriate items for 1 of 16 patient records reviewed (Patient #15).
Florida Hospital Waterman Home Care Services Priva
No longer in CMS listThe facility failed to ensure the physician's ordered plan of care was followed and notify the physican of the plan of care modification for 1 (Patient #1) of 10 patients sampled.
Rock Bridge Home Health Agency Inc
The agency failed to ensure the Plan of Care (POC) included all required elements including specific treatment and activity orders for 1 of 8 active patients (#3) whose records were reviewed.
Providence Home Health Agency, Inc.
The agency failed to ensure that nursing care services were made in accordance with the orders on the plan of care for five (5) of eight (8) clinical records.
Coffeyville Regional Medical Center
No longer in CMS listThe agency failed to ensure each plan of care was complete and individually developed for each patient by failing to: Ensure all goals established in the goal/locator #22 section of each patient's plan of care was patient-specific, for 10 (ten) of 10 (ten) sampled patients, #1, #2, #3, #4, #5, #6…
Golden Home Healthcare Pittsburgh
The agency failed to develop a plan of care (POC) that covered all pertinent diagnoses, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitation, activities permitted, nutritional requirements, medications and treatments, safety…
Amazing Care Home Health Services LLC
The agency did not ensure that patients had an individualized plan of care containing all required elements, based on an assessment of their needs, for 10 of 16 sampled patients.
Hartford Healthcare at Home
The agency staff failed to ensure the physician-certified plan of care addressed the patient's needs.
Centerwell Home Health
The agency failed to ensure a complete Plan of Care (POC) was developed to meet the individualized needs of the patient and/or included parameters for the administration of care and patient monitoring in four out of twenty records (Patient # 1, 7, 8, 16).
Good Shepherd Primary Health Care LLC
The agency failed to ensure the Plans of Care (POC) included treatment and activity orders for one of ten patients (Patient 3) whose records were reviewed.
Lyfe Home Health
The Agency failed to ensure that the PsOC covered all pertinent diagnoses, frequencies, medications and treatments.
Optimum Care Home Health Agency
The Registered Nurse failed to make sure that the POC for 9 of 10 patients (#1, 2, 3, 5, 6, 7, 8, 9 and #10) included mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional…
Adventist Health Home Care Services
The agency failed to develop a plan of care that covered all pertinent diagnoses, and other appropriate items for 1 of 20 patient records reviewed (Patient #2).
Golden Angels Home Health Care
The agency failed to develop a plan of care for two of ten sampled patients (Patient 3 and 6) when Patient 3 and 6 had no documented skilled nursing plan of care.
Premier Home Health Care Services, Inc.
No longer in CMS listThe agency failed to ensure that a comprehensive Plan Of Care was developed for all patients.
Rock Springs Young at Heart
Staff interview the agency failed to develop a comprehensive POC including all pertinent information for 3 of 10 sample patients (#4, #8, #9).
Visiting Nurse Health System, Inc
The agency failed to include orders to cover all pertinent diagnoses to ensure the patients' identified needs were addressed and failed to ensure disease specific treatments/interventions were included on plans of care/treatment for 7 of 20 (#5, #11, #13, #16, #17, #18 and #19) sampled patients.
Vitalcaring Group
The agency failed to ensure the plan of care was developed in consultation with the agency staff and covers all pertinent diagnoses and types of services for the patient as evidenced by: 1. No documentation for Patient #5 whom was admitted to the agency with a diagnosis of heart failure that the…