Every finding on record at A-1 Nursing Care, LLC

Emergency Preparedness Survey At the time of the emergency preparedness survey completed on 07/07/22, A 1 Nursing Care Inc is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Partial Extended Recertification Survey The following deficiency is based on the partial extended recertification survey completed 07/07/22. A 1 Nursing Care Inc 367193, is not in compliance with the requirements found at 42 CFR Part 484 for Home Health Agencies.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency staff failed to provide services only as ordered by the physician for two of seven patient medical records reviewed (Patient #1 and #2). The agency census was 100. Findings include: 1. Review of the medical record for Patient #1 revealed the patient was admitted to the agency on 01/10/12 with the primary diagnosis of unspecified psychosis and Type II diabetes. Review of the certification period dated 05/17/22 through 07/15/22 revealed physician orders for skilled nursing services two times a day. Review of the plan of care revealed the nurse was to perform a fasting blood sugar every visit using the patient's glucometer and follow vital sign parameters to report to the physician. Review of the skilled nursing (SN) notes revealed there was no documentation the nurse performed a blood sugar test or vital signs for the visits on 05/22/22 at 6:13 AM, 05/29/22 at 5:45 AM, 05/31/22 at 6:30 AM, 06/01/22 at 7:05 AM, 06/05/22 at 5:56 AM, 06/11/22, at 7:46 AM, 06/11/22 at 4:35 PM, 06/25/22 at 8:11 AM, 06/26/22 at 5:33 AM, 07/02/22 at 7:50 AM, and 07/02/22 at 5:39 AM. Interview with Staff B on 07/06/22 at 1:40 PM confirmed the above findings. 2. Review of the medical record for Patient #2 revealed the patient was admitted to the agency on 03/03/22 with the primary diagnosis of Down Syndrome and new insulin dependent diabetic. Review of the certification period dated 05/29/22 through 07/27/22 revealed physician orders for skilled nursing services two times a day Monday through Friday and every other Saturday and Sunday for the certification period. Review of the plan of care revealed the nurse was to perform a fasting blood sugar every visit using the patient's glucometer and follow vital sign parameters to report to the physician. Review of the SN notes revealed no documentation the nurse performed a blood sugar test or vital signs for the visits on 06/02/22 at 5:35 PM, 06/11/22 at 11:50 AM, and 06/13/22 at 10:07 PM. There was no documentation the nurse performed vital signs for the visits on 06/02/22 at 8:26 AM, 06/03/22 at 6:00 PM, 06/06/22 at 6:45 PM, 06/07/22 at 6:35 PM, 06/08/22 at 6:17 PM, 06/09/22 at 5:35 PM, 06/10/22 at 6:05 PM, 06/14/22 at 6:46 PM, 06/15/22 at 6:30 PM, 06/16/22 at 6:00 PM, 06/17/22 at 6:37 PM, 06/20/22 at 7:51 PM, 06/21/22 at 6:15 PM, 06/22/22 at 6:51 PM, 06/23/22 at 8:10 AM, 06/23/22 at 6:27 PM, 06/27/22 at 7:28 PM, 06/28/22 at 7:00 PM. 06/29/22 at 6:18 PM, 06/30/22 at 9:00 PM, 07/01/22 at 6:35 PM, and 07/04/22 at 6:23 PM. Interview with Staff A on 07/06/22 at 11:30 AM confirmed the above findings.