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)
G0728 Rehab services supervised by PT, OT
CFR(s): 484.75(c)(2)

Rehabilitative therapy services are provided under the supervision of an occupational therapist or physical therapist that meets the requirements of §484.115(f) or (h), respectively.


This ELEMENT is not met as evidenced by:
Based on interview and record review, the facility failed to ensure physical therapy assistants were supervised by a physical therapist for one of 13 sampled patients (Patient 2). 

This failure had the potential to result in Patient 2 not meeting the mobility goals established in the plan of care by the physical therapist. 

 


Findings: 

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 an interview on 10/28/2025 at 2:25 p.m. with Physical Therapist Assistant (PTA) 2, PTA 2 stated she was PTA assigned to Patient 2 to help perform mobility exercises. PTA 2 stated a physical therapist has never supervised her during patient visits.  

During an interview on 10/29/2025 at 3:15 p.m. with Physical Therapist (PT) 1, PT 1 stated he was the PT assigned to Patient 2. PT 1 stated he does not do any supervisory visits for PTA 2. PT 1 stated not having supervisory visits could result in Patient 2 not meeting the mobility goals established in the plan of care. PT 1 stated it would be difficult to verify if Patient 2 was progressing or declining in terms of range of motion, balance, transferring, and walking without PTA supervisory visits. 

During a review of PT 1’s “Physical Therapist Job Description,” dated 9/1/2022, the Physical Therapist Job Description indicated, the physical therapist “Supervises physical therapy assistants according to organization policy and state regulations.”