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)
G0584 Verbal orders
CFR(s): 484.60(b)(3)(4)

(3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies.


This ELEMENT is not met as evidenced by:
Based on interview and record review the Home Health Facility (HHA) staff failed to ensure there was physician's order to perform wound care treatment for one of seven sampled patients (Patient 4). 

 

This failure resulted in HHA staff performing wound care treatment to the patient's wound without a physician’s order.


During a record review of Patient 4’s Home Health Certification and Plan of Care for certification period 7/11/2024 to 9/8/2024, indicated a primary diagnosis of chronic venous hypertension (high blood pressure in the leg veins). 



During an interview on 7/7/2025, at 12:19 p.m., Patient 4’s caregiver (CGV 1) stated Patient 4 received nursing services for wound care to the right ankle. 



During a concurrent interview and record review on 7/7/2025, at 12:45 p.m., the Director of Patient Care Services (DPCS) reviewed Patient 4’s medical records., to include the plan of care (POC) for certification period 7/11/2024 to 9/8/2024, and the nursing visit notes. The DPCS stated wound care was done to Patient 4’s right ankle on the nursing visit of 7/14/2024. The DPCS stated there was no physician's order for wound care. A physician's order was important because the order validates what needs to be assessed and what treatment the patient needs. 

 



During a record review of the HHA’s undated document titled, Plan of Care, the document indicated, “The attending physician (or other authorized licensed independent practitioner) will participate in the care planning process by initiating, reviewing and revising therapeutic and diagnostic orders...Physician, dentist, podiatrist or any other licensed practitioner within his or her scope of practice orders will be individualized, based on patient’s needs and include...B. Treatments and/or procedures needed, included type, frequency, duration, and goals.”