Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
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)
G0536 A review of all current medications
CFR(s): 484.55(c)(5)

A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.


This ELEMENT is not met as evidenced by:
Based on interview and record review, the facility failed to ensure medication reconciliation (the process of creating the most accurate and complete list of a patient's medications and comparing it with the current list in use to avoid medication errors) was completed for one of 13 sampled patients (Patient 2) when: 

1. Patient 2’s “Patient Medication List,” from the Home Health Agency (HHA) did not match Patient 2’s “Physician Order Review,” from Patient 2’s assisted living facility.  

2. Physical Therapist (PT) 1 did not perform medication reconciliation during Patient 2’s Start of Care (SOC) assessment (a comprehensive, in-person evaluation conducted at the beginning of a home health care episode to determine a patient's health needs and eligibility for services). 

These failures had the potential to result in Patient 2 taking incorrect or duplicate medications, which could lead to medication interactions (occurs when one medication alters the effects of another medication, food, or dietary supplement in the body) and side effects such as decreased blood pressure and increased risk of bleeding.  


Findings: 

1. During a review of Patient 2’s Patient Profile (admission record), the Patient Profile indicated Patient 2’s SOC date was 10/1/2025, with primary diagnoses of acute pain due to trauma (an unpleasant sensory and emotional experience due to actual or potential tissue damage), wedge compression fracture of the second lumbar vertebra (a break in the second bone of the lower back which results in a wedge shape) and hypertensive heart disease with heart failure (a condition where prolonged high blood pressure damages the heart muscle, leading to impaired pumping function). 

During a review of Patient 2’s “Patient Medication Profile,” for the recertification period from 10/1/2025 to 11/29/2025, the Patient Medication Profile indicated the following medications ordered on 10/1/2025: 

- Acetaminophen (a medication used to treat pain and reduce fever) 500 milligrams (mg, a unit of measurement), 2 tablets by mouth daily. 

- Alprazolam (a medication used to treat anxiety) 0.5 mg, 1 tablet by mouth daily. 

- Amlodipine (a medication used to treat high blood pressure) 5 mg, 1 tablet by mouth daily. 

- Ibuprofen (a medication used to treat pain and reduce fever) 400 mg, 1 tablet by mouth every 12 hours. 

During a concurrent interview and record review on 10/28/2025 at 2:44 p.m., with Licensed Vocational Nurse (LVN) 3 from the assisted living facility, Patient 2’s “Physician Order Review,” dated 10/28/2025 was reviewed. The Physician Order Review indicated Nurse Practitioner (NP) 1 ordered the following medications: 

- Acetaminophen 500 mg, 2 tablets by mouth three times daily, ordered on 2/9/2025. 

- Alprazolam 0.5 mg, 1 tablet by mouth twice a day, ordered on 8/5/2025.  

- Amlodipine 2.5 mg, 1 tablet by mouth daily, ordered on 12/11/2024. 

- Ibuprofen 400 mg, 1 tablet by mouth 3 times a day as needed, ordered on 9/26/2025.  

LVN 3 stated she is the LVN on duty for Patient 2’s assisted living facility. LVN 3 stated she has never seen the medication list titled “Patient Medication Profile,” from the HHA. LVN 3 stated she did not know why the medication list from the HHA was different from the medication list from the assisted living facility. LVN 3 stated the assisted living facility follows the physician orders listed in the “Physician Order Review.” LVN 3 stated she has never seen anyone from the HHA do medication reconciliation to compare both medication lists.    

During an interview on 10/30/2025 at 12:01 p.m., with the Director of Patient Care Services (DPCS), the DPCS stated medication reconciliation is the responsibility of the HHA. The DPCS stated the medication lists from both the HHA and the assisted living facility should match.  

During a review of the facility’s policy and procedure (P&P) titled, “Medication Profile,” revised 11/2024, the P&P indicated, “Medication profiles will be updated for each change to reflect current medications, new, and/or discontinued medications.” 

2. During an interview on 10/29/2025 at 11:41 a.m. with the DPCS, the DPCS stated physical therapists are expected to do medication reconciliation during a patient’s SOC assessment. The DPCS stated physical therapists have the same knowledge and credentials to be able to do medication reconciliation and know what medications are contraindicated. 

During an interview on 10/29/2025 at 3:15 p.m. with Physical Therapist (PT) 1, PT 1 stated he conducted Patient 2’s SOC assessment. PT 1 stated he did not do medication reconciliation during Patient 2’s SOC assessment and has never seen Patient 2’s medication list. PT 1 stated it was the HHA’s responsibility to assign a nurse to ensure Patient 2’s medication lists matched. PT 1 stated the medication lists from both the HHA and the assisted living facility should match because drug doses and frequencies could differ and lead to confusion within the interdisciplinary team (group of professionals from different disciplines who work together to provide comprehensive and coordinated care for patients). PT 1 stated medication reconciliation should be done for clear communication between the interdisciplinary team and to prevent medication errors for the patient.  

During an interview on 10/30/2025 at 3:06 p.m. with the DPCS, the DPCS stated it was his responsibility to ensure every patient’s medication reconciliation was completed. The DPCS stated not doing medication reconciliation could result in patients taking the wrong medications, taking duplicate medications, which could lead to medication interactions and side effects such as low blood pressure and increased risk of bleeding.  

During a review of PT 1’s “Physical Therapist Job Description,” dated 9/1/2022, the Physical Therapist Job Description indicated, the physical therapist “will organize and review a patient’s medications to ensure accuracy, safety, and proper adherence during home visits.” 

During a review of the facility’s policy and procedure (P&P) titled, “Medication Profile,” revised 11/2024, the P&P indicated, “Upon admission to the organization, the admitting clinician will initiate a medication profile to document the current medication regimen, including name, drug classification, date prescribed/discontinued, dose, strength, route, frequency, date and time of administration and any drug or food allergies.”