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 757375 (X3) Date Survey Completed 07/07/2025
Name of Provider or Supplier Intense Home Health Inc Street Address, City, State 3786 La Crescenta Ave. Suite 104, 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)
G0572 Plan of care
CFR(s): 484.60(a)(1)

Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan.


This STANDARD is not met as evidenced by:
Based on interview and record review, the Home Health Agency (HHA - a public or private organization that delivers skilled nursing and other therapeutic services to a patient’s place of residence) failed to ensure one of seven sampled patients (Patient 1) plan of care was followed as ordered. 

 

This deficient practice resulted in the physician not being aware of the missed services to the patient by the HHA and the patients not receiving their ordered treatments.


During a record review of Patient 1’s Home Health Certification and Plan of Care for certification period 5/30/2025 to 7/28/2025, indicated a primary diagnosis of Poly osteoarthritis (multiple joints get stiff, causing pain and/or discomfort). 



During a concurrent interview and record review on 7/3/2025, at 2:21 p.m., the Director of Patient Care Services (DPCS) reviewed the skilled nursing visit notes for 6/2/2025, 6/6/2025, 6/10/2025, 6/14/2025, 6/17/2025, 6/24/2025, 7/1/2025, and the plan of care (POC), for certification period 5/30/2025 to 7/28/2025. The DPCS stated Patient 1 was receiving HHA services for pain management and medication teaching. The DPCS reviewed the nursing visit notes and stated Patient 1 did not receive pain management education during her visits. The DPCS stated the POC indicted medication and disease management, but the nurse visits did not indicate that Patient 1 received medication management education. The DPCS stated the importance of pain management education was to prevent overdose of medication, prevent organ failure by not taking too much or too little medication. Patients can have other complications depending on the medication being taken. Medication management teaching was very important.  

 



During a record review of the HHA’s undated document titled, Plan of Care, the document indicated, “The care will be provided in compliance with the therapeutic and diagnostic orders and accepted standards and practice”.