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)
G0570 Care planning, coordination, quality of care
CFR(s): 484.60

Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice.


This CONDITION is not met as evidenced by:
Based on  interview and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutic services to a patient’s personal residence) failed to meet the Condition of Participation (refer to the requirements that healthcare organizations must meet to participate in federal healthcare programs) regarding Care Planning, Coordination, and Quality of Care was met as follows: 


 



The HHA failed to ensure the plan of care was implemented for one of 13 sampled patient (Patient 5) when: 



 



The HHA license nurses did not have documented evidence the wound care was provided according to physician order as indicated on Home Health Certification and Plan of Care for certification period 10/3/2025 through 12/1/2025 for one of thirteen sampled patients (Patient 5) on 10/15/2025, 10/17/2025, and 10/28/2025.  



 



 



The HHA failed to ensure patient home visits were completed according to physician order as indicated on the Home Health Certification and Plan of Care for certification period 10/3/2025 through 12/1/2025 for one of thirteen sampled patients (Patient 5). Patient 5 who had an order for Skilled nursing visits two times a week for wound care and medication management did not have the skilled nurse visits for the week of 10/19/2025 through 10/25/2025.  



 



These failures had the potential to result in Patient 5 to receive inaccurate or inappropriate wound care treatment and the inability to track response to wound care treatment; potentially resulting in Patient 5 experiencing increased pain, delayed wound healing, localized and systemic infections, increased risk for emergency hospitalization, and avoidable traumatic and/or undignified death. (Refer to G572). 



 



The cumulative effect of these systemic practices resulted in the failure of the HHA to deliver statutorily mandated compliance with Federal Regulations for Care Planning, Coordination of Services, and Quality of Care to ensure highest quality health care is provided to patients assessed to receive home health services.