| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 757280 | (X3) Date Survey Completed 11/04/2025 |
| Name of Provider or Supplier Rely Home Health, Inc. | Street Address, City, State 100 N Brand Blvd Suite 401, Glendale, CA | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| G0000 | The following reflects the findings of the California Department of Public Health during a Complaint Validation Survey. Complaint # 2565290 Census: 94 Sample Size: 13 Home Visit: 5 Closed Records: 4 For G572 On 10/31/2025, at 2:16 PM, The Department called an Immediate Jeopardy (IJ, a situation in which the HHA’s noncompliance with one or more Conditions Participation (minimum health and safety standards that healthcare organizations must meet to participate in the Medicare and Medical programs) has caused, or is likely to cause, serious injury, harm, impairment, or death to a patient), in the presence of the Director of Patient Care Services (DPCS) for failing to demonstrate a process and provide documented evidence that the facility ensured treatments were documented in the patient medical record and patient home visits were completed according to physician orders as indicated on Home Health Certification and Plan of Care for certification period 10/3/2025 through 12/1/2025 for one of 13 sampled patients (Patient 5). On 11/4/2025, at 1:10 PM, the HAA was unable to submit an acceptable IJ removal plan (includes all actions the agency has taken or will take to immediately address the noncompliance that resulted in or made serious injury, serious harm, serious impairment, or death likely). On 11/4/2025, at 1:10 PM, The Department was unable to conduct an exit conference due to the DPCS stating the HHA would no longer cooperate with the ongoing survey. The Department concluded the survey without completing the survey tasks and the IJ situation not removed. For G1024 On 11/4/2025 at 12 PM, while onsite at the agency, the Department called an Immediate Jeopardy (IJ, a situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause serious injury, harm, impairment, or death to a patient), in the presence of the agency’s Director of Patient Care Services (DPCS), for failing to demonstrate a process and provide documented evidence that the facility ensured patient records were not willfully falsified, all entries into the patient health record were appropriately authenticated, and staff obtained unique identifiers to access and authenticate protected health information (any health information that can identify an individual that is in possession of or transmitted by a "covered entity" or its business associates that relates to a patient's past, present, or future health). On 11/4/2025, at 1:10 PM, the HAA was unable to submit an acceptable IJ removal plan (includes all actions the agency has taken or will take to immediately address the noncompliance that resulted in or made serious injury, serious harm, serious impairment, or death likely). On 11/4/2025, at 1:10 PM, The Department was unable to conduct an exit conference due to the DPCS stating the HHA would no longer cooperate with the ongoing survey. The Department concluded the survey without completing the survey tasks and the IJ situation not removed. The following Condition of Participation were not met: 484.60 Condition of participation: Care planning, coordination of services, and quality of care. 484.110 Condition of participation: Clinical records. |