| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 757287 | (X3) Date Survey Completed 11/03/2025 |
| Name of Provider or Supplier Summa Home Health Care, Inc. | Street Address, City, State 2500 E Foothill Blvd Unit 417, Pasadena, 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) |
| G1008 | Clinical records CFR(s): 484.110 Condition of participation: Clinical records. The HHA must maintain a clinical record containing past and current information for every patient accepted by the HHA and receiving home health services. Information contained in the clinical record must be accurate, adhere to current clinical record documentation standards of practice, and be available to the physician(s) or allowed practitioner(s) issuing orders for the home health plan of care, and appropriate HHA staff. This information may be maintained electronically. 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) for Clinical records as follows: The HHA failed to maintain a clinical record containing past and current information of patient receiving home health services for one of seven sampled patients (Patient 1) by failing to: 1. Ensure Patient 1 General Acute Care Hospital (GACH) Discharge order to administer Ertapenem (medication used to treat bacterial infections) Intravenous (IV- a way of giving a drug or other substance through a needle or tube inserted to a vein) every 24 hours was included in Patient 1’s plan of care. 2. Ensure Patient 1 medication and treatment orders were included on Patient’s 1 plan of care. 3. Ensure License staff document all interventions, including medication administration, treatments and services and responses to the interventions for Patient 1. 4. Ensure license staff completed an initial evaluation using the Outcome and Assessment Information Set (OASIS initial evaluation, a comprehensive evaluation of a patient's health and needs conducted at the beginning of home health care services) on 8/3/2025 for Patient 1. 5. Ensure Patient 1 had a plan of care developed to outline the specific plan for medical, rehabilitation, and supportive services a patient needs at home 6. Ensure Patient 1 had nursing notes completed for nursing visit conducted on 8/3/2025 and 8/4/2025. 7. Ensure to complete Oasis discharge comprehensive assessment (a required evaluation of a home health patient's clinical and functional status upon leaving the agency's care) for Patient 1. These failures had a potential to result with miscommunication within the interdisciplinary team (a group of professionals from different fields who collaborate to address complex issues, such as patient care), medication error, inappropriate treatment and services that could cause patient suffering severe harm, hospitalization and death. (Refer to G1012). The cumulative effect of these systemic practices resulted in the failure of the HHA to deliver mandated compliance (in a way that is decided and controlled by law) with Federal regulations for Clinical Records to ensure the provision of health care services in a safe manner is provided to patients. |