Every finding on record at Benton County Health Department Home Health Agency

The Emergency Preparedness regulations were reviewed as part of the Medicare recertification survey completed on 05/06/2026. During the survey it was determined the home health provider is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Providers.

A partial extended survey for Medicare recertification for the home health provider was completed on 05/06/2026. The provider had 45 current patients.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on policy review, record review, observation, and interview, the home health provider failed to ensure that all medications the patient was taking were current in one of three home visit observation records reviewed (Record/Patient #3). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Medication Profile,” revised 04/09/2014, showed that: - The provider shall ensure effective and accurate documentation and client education regarding the medications (prescription and over the counter) that the client is currently taking; and - The medication profile shall be reviewed by a registered nurse every 60 days and updated whenever there is a change or discontinuation in medication. The registered nurse shall sign and date the medication profile upon initiation and minimally every 60 days thereafter. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 04/16/2026 with a primary diagnosis of acute posthemorrhagic anemia (a person quickly loses a large volume of blood), atrial fibrillation (abnormal heart rhythm characterized by rapid and irregular heartbeat), rheumatoid arthritis (chronic condition that causes pain, swelling and irritation, called inflammation, in the joints), chronic pain (pain that persists for more than three to six months, lasting beyond the typical healing time for an injury or illness), surgical aftercare following surgery, and age-related osteoporosis (abnormal loss of bone density) without fracture. The patient resided at home with his/her spouse. Observation and interview on 05/05/2026 at 9:17 AM, showed the following discrepancies between the provider's current medication profile (printed on 05/05/2026) and the patient's home medication profile: - The provider’s current medication profile showed the patient was to use bumetanide (diuretic to treat swelling) 2 milligrams (mg) daily, and the patient stated that he/she took 1 mg daily; - The patient stated that he/she took hydrocodone/acetaminophen 5/325 mg one every eight hours as needed for pain. The provider failed to list the pain medication on their medication profile; and - The patient stated that he/she used Eucerin Advanced Repair Lotion for a red rash on his/her legs. The provider failed to list the lotion on their medication profile. During an interview on 05/06/2026 beginning at 10:18 AM, the administrator stated that medications were to be reconciled at admission, recertification, resumption of care, and with any medication changes. The licensed practical nurse, therapist or registered nurse were to make any medication changes, and the registered nurse was to perform a medication review.

A partial extended survey for Medicare recertification for the home health provider was completed on 05/17/2023. The agency had 43 current patients. The COVID-19 Health Care Staff Vaccination regulation was reviewed as part of the Medicare recertification survey. During the survey it was determined the home health provider was in compliance with the regulation. The Emergency Preparedness regulations were reviewed as part of the Medicare certification survey completed on 05/17/2023. One standard level deficiency was identified.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.542(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, REHs at §485.542, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on personnel file review, and interview, the agency failed to ensure one contracted staff was provided orientation and/or biennial Emergency Preparedness training consistent with their expected roles in one of seven personnel files reviewed (Employee #3). This deficient practice has the potential to affect the care and services provided to all patients during an emergency. Findings included: EMPLOYEE #3: - Date of hire: 08/28/2018; and - No evidence of emergency preparedness training between 08/28/2018 and 2023. During an interview on 05/17/2023 beginning at 12:55 PM, the administrator stated that the therapy manager wasn’t aware employee #3 needed EP training.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on policy review, record review, home visit observation, and interview, the home health provider failed to ensure the registered nurse performed an accurate review/update of all medications the patient was currently using in, but not limited to, two of five full records reviewed (Records/Patients #1 and #2). This deficient practice has the potential to affect all patients served by the home health provider. Findings included: Review of the home health provider’s policy titled, “Medication Profile,” dated/revised 04/09/2014, showed in part: - At the time of admission, the registered nurse (RN), shall check all medications a client may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindicated medication and promptly report any problems to the physician within 24 hours; - The nurse shall record on the medication profile all of the prescribed and over-the-counter (OTC) medications the client is currently taking; - If the physician changes the medication orders, the nurse must add newly ordered drugs or medication changes to the medication profile; - The nurse/therapist shall review all medications with the client and/or caregiver to ensure their understanding of how the drugs are to be stored, administered, and to be aware of side effects which could be experienced following administration; - The nurse shall review all medication effectiveness to ensure appropriateness and identify potential complications; and - The medication profile shall be updated whenever there is a change or discontinuation in medication. RECORD/PATIENT #1: Review of the patient’s medication profile and observation on 05/16/2023 at 11:00 AM, during the patient’s home visit, showed the following medication discrepancies: - The medication profile showed rosuvastatin (used to treat high cholesterol) 20 milligrams (mg) by mouth at bedtime; - The patient’s medication bottle showed the rosuvastatin dosage was 40 mg; - The medication profile showed doxazosin (used to treat urinary retention and high blood pressure) 4 mg by mouth twice daily; - The patient’s medication bottle, dated 04/11/2023, showed the doxazosin was to be taken one time daily at bedtime; - The medication profile showed the patient was taking fish oil 500 mg capsules by mouth daily; - The patient’s OTC fish oil medication showed the capsules were 1000 mg and contained 300 mg of Omega-3 fatty acids; - The medication profile showed furosemide (a diuretic) 40 mg by mouth daily; - The patient’s medication bottle, dated 03/30/2023, showed additional instructions to take one tablet by mouth daily and to take one extra tablet by mouth in the afternoon if having increased leg swelling, trouble breathing, or a two to three pound weight gain; - The medication profile showed tadalafil (used to treat erectile dysfuntion, enlarged prostate, and pulmonary hypertension) 20 mg by mouth daily as needed; - The patient and spouse stated that he/she no longer takes tadalafil because it does not work; - The medication profile showed NovoLOG FlexPen (insulin) 100units/milliliter (units/mL), take 10 units via subcutaneous injection (SQ), three times daily; - The patient’s medication, with a label dated 05/06/2023, showed instructions to take 35 units, plus 2 units for every 50 milligrams/deciliter (mg/dL) over 100 mg/dL, SQ before meals; - The medication profile showed Lantus (insulin) 100u/mL, take 50 units SQ twice daily; - The patient and spouse stated that they only use Lantus as a “back up” and he/she forgot to tell the nurse the NovoLOG had changed; - The patient had a bottle of docusate sodium (a stool softener) 250 mg by mouth twice daily; and - The docusate sodium was not on the provider’s medication profile. RECORD/PATIENT #2: Review of the patient’s medication profile, and observation on 05/17/2023 at 10:00 AM, during the patient’s home visit, showed the following medication discrepancies: - The medication profile showed aspirin (used to treat pain, fever, headache, and inflammation) 81 mg tablet take once daily; - The patient did not have aspirin in the home; - The medication profile showed citalopram (used to treat depression) 20 mg tablet take once daily; - The patient’s medication bottle showed the citalopram dosage was 40 mg, once daily; - The medication profile showed Flonase (used to treat congestion and prevent asthma attacks) 50 microgram/inhalation two sprays daily as needed for allergies; - The patient did not have Flonase in the home; - The medication profile showed Mucinex (used to treat/thin mucus) 600 mg tablet take twice daily as needed; - The patient did not have Mucinex in the home; - The medication profile showed Tylenol (used to treat minor aches and pains) 500 mg tablet take every four hours as needed for pain; - The patient did not have Tylenol in the home; - The medication profile showed famotidine (used to prevent and treat heartburn) 20 mg once daily; - The patient did not have famotidine in the home; - The medication profile showed Insulin Lispro Kwikpen (used to manage blood sugar levels) 100 units/mL, four units, three times daily with meals; - The patient did not have Lispro insulin in the home; - The medication profile showed Lantus Solostar Pen (insulin, used to manage blood sugar levels) 100 units/mL, inject 13 units at bedtime; - The patient did not have Lantus insulin in the home; - The medication profile showed docusate-senna (used to treat constipation) 50 mg-8.6 mg, twice daily as needed for constipation; - The patient did not have docusate-senna in the home. - The patient had a pack of ondansetron (used to treat nausea) 4 mg as needed for nausea; - The ondansetron was not on the provider’s medication profile; - The patient had a bottle of lorazepam (used to treat anxiety) 0 .25 mL, by mouth, as needed for anxiety; - The lorazepam was not on the provider’s medication profile; - The patient had a bottle of Sudogest (pseudoephedrine, used to narrow the blood vessels to decrease swelling and congestion) 60 mg, as needed, twice daily for congestion; - The Sudogest was not on the provider’s medication profile; - The patient had a bottle of hydroxyzine pamoate (used to treat itching caused by allergies) 25 mg, three times daily, as needed for allergies; - The hydroxyzine pamoate was not on the provider’s medication profile; - The patient had a bottle of Eliquis (used to treat and prevent blood clots and to prevent stroke) 5 mg, twice daily; - The Eliquis was not on the provider’s medication profile; - The patient had a bottle of vitamin D3 50000 international units, 1 capsule daily; - The vitamin D3 was not on the provider’s medication profile; - The patient had a bottle of levetiracetam (used to treat seizures) 500 mg take two tablets twice daily; and - The levetiracetam was not on the provider’s medication profile. During an interview on 05/17/2023 at 10:15 AM, the program coordinator stated that medication reconciliation does not exist and is not complete unless you look at the bottles. The expectation is for the clinician to look at the medication bottles every visit. They were planning on developing an in-service to re-educate staff to look at medication bottles in the home but their survey happened before they could make it happen.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview the home health provider failed to alert the physician to any changes that suggest the plan of care should be altered in two of five full records reviewed (Records/Patients #2 and #3). This deficient practice has the potential to affect all patients served by the home health provider. Findings included: Review of the provider’s undated policy titled, “Plan of Care,” showed: -The professional staff shall promptly alert the physician to any changes that suggest a need to alter the plan of care (POC); and -A range in frequency of visits for each service may be ordered by the physician. If fewer visits are provided than ordered, the physician is notified and either a telephone order for missed visit is obtained or documentation of physician’s notification is incorporated into the clinical record. RECORD/PATIENT #2: Review of the POC, dated 04/28/2023, showed an order for skilled nursing (SN) to visit one time a week for one week, two times a week for four weeks, and one time a week for three weeks. Review of the SN visit notes, with dates ranging from 04/28/2023 through 05/11/2023 showed: -A SN visit on 05/01/2023; -A missed visit (visit number two) for the week of 04/30/2023 through 05/06/2023; -The SN notes failed to contain any documentation of an attempt to reschedule the missed visit; and -The provider failed to produce documentation that the physician was notified of the missed visit. During an interview on 05/17/2023 at 12:35 PM, the program coordinator stated that all missed visits should be reported to the physician and he/she would expect the physician to be notified. RECORD/PATIENT #3: Review of the POC, dated 04/13/2023 to 06/11/2023, showed an order for skilled nursing (SN) to visit one time a week for one week, two times a week for one week, and one time a week for one week and a new order dated 04/26/2023 for SN to visit two times a week for two weeks, and one time a week for three weeks. An order for physical therapy (PT) to visit one time a week for one week, three times a week for one week, and two times a week for one week. Review of the SN visit notes, with dates ranging from 04/26/2023 through 05/06/2023 showed: - A SN visit on 04/26/2023, 04/28/2023, and 05/01/2023; - A missed visit (visit number two) for the week of 04/30/2023 through 05/06/2023; - The SN notes failed to contain any documentation of an attempt to reschedule the missed visit; and - The provider failed to produce documentation that the physician was notified of the missed SN visit. Review of the PT visit notes, with date ranges from 04/13/2023 through 04/22/2023 showed: - A PT visit on 04/13/2023, 04/17/2023, and 04/19/2023; - A missed visit (visit number three) for the week of 04/16/2023 through 04/22/2023; - The PT notes failed to contain any documentation of an attempt to reschedule the missed visit; and - The provider failed to produce documentation that the physician was notified of the missed PT visit. During an interview on 05/17/2023 at 10:50 AM, the program coordinator stated that the missed SN visit wasn’t made up for no apparent reason and the physician was not notified and the missed PT visit was not made up due to it was on a Friday but the provider does have PT on call for the weekends and the physician was not notified.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on policy review, home visit observation, and interview, the home health provider failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases in, but not limited to, one of three home visit observations conducted (Record/Patient #1). This deficient practice has the potential to affect all patients served by the home health provider. Findings included: Review of the home health provider’s undated policy titled, “Infection Control,” showed, in part: - Gloves should be worn whenever there is potential for contact with bodily fluids (changing bed linens, bed baths, dressing changes); - Change gloves and wash hands once the gloves have become contaminated; and - If you bring a laptop or other electronic device into the home, it should be cleansed with an approved antiseptic wipe between patients. RECORD/PATIENT #1: Observation on 05/16/2023 at 11:00 AM, during the patient’s home visit, showed: - Registered nurse A (RN-A) donned gloves to obtain vital signs; - With same gloved hands, RN-A was observed touching screen of tablet to enter data; - RN-A donned gloves to remove soiled dressings and measured wounds on the patient’s feet and legs; - With same gloved hands, RN-A was observed touching screen of tablet to enter data; - RN-A donned gloves to clean and measure burn wounds to the patient’s hands, bilaterally; - With same gloved hands, RN-A was observed touching screen of tablet to enter data; - RN-A had patient sign the tablet screen with his/her finger; - RN-A closed the tablet case and placed in the backseat of his/her vehicle; - RN-A failed to cleanse the tablet with an antiseptic wipe. - During the patient’s home visit, RN-A touched the patient’s medication planners and the outside of all of the patient’s medication bottles; and - RN-A opened each bottle, shook out medications into his/her ungloved hand and placed each pill into the planner with his/her ungloved hands. During an interview immediately following the home visit, RN-A acknowledged that he/she should have cleaned the tablet and could see how that failing to clean it could spread germs to another patient. He/she stated that he/she did not think about handling the medications but should have worn gloves when putting medications into the planner. During an interview on 05/17/2023 at 10:15 AM, the program coordinator stated that he/she is not aware of a policy regarding medication set-up by the nurse but he/she would expect the clinician to handle medication tablets/capsules with gloves, not with bare hands. They (the clinicians) have been told that before but RN-A told him/her they ran out of gloves during the visit. He/she would also expect the clinician to remove soiled gloves and perform hand hygiene prior to touching their tablet and would expect the tablet to be wiped down and cleaned at the completion of the visit.

Infection control education CFR(s): 484.70(c) Standard: Education. The HHA must provide infection control education to staff, patients, and caregiver(s). This STANDARD is not met as evidenced by: Based on employee file review and interview, the agency failed to maintain a coordinated agency-wide infection control program that included infection control education for a contracted staff which affected one (Employee #3) of five employee files reviewed. This deficient practice has the potential to affect the health and safety of all patients served by the agency. Findings included: EMPLOYEE #3 (E3): Review of E3's employee file showed: - Contracted employee; - Position: Speech therapist; - Date of hire: 08/28/2018; - No documentation found for orientation or yearly infection control training. During an interview on 05/17/2023 at 12:50 PM, the administrator stated that he/she would expect infection control training to be done.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview the home health provider failed to ensure services were provided as ordered by the physician as indicated in the plan of care in two of five full records reviewed (Records/Patients #2 and #3). This deficient practice has the potential to affect all patients served by the home health provider. Findings included: Review of the provider’s undated policy titled, “Plan of Care,” showed the professional staff shall promptly alert the physician to any changes that suggest a need to alter the plan of care (POC). RECORD/PATIENT #2: Review of the POC, dated 04/28/2023, showed an order for skilled nursing (SN) to visit one time a week for one week, two times a week for four weeks, and one time a week for three weeks. Review of the SN visit notes, with dates ranging from 04/28/2023 through 05/11/2023 showed: -A SN visit on 05/01/2023; -A missed visit (visit number two) for the week of 04/30/2023 through 05/06/2023; and -The SN notes failed to contain any documentation of an attempt to reschedule the missed visit. During an interview on 05/17/2023 at 10:50 AM, the program coordinator stated that he/she would expect missed visits to be rescheduled. RECORD/PATIENT #3: Review of the SN visit notes, with dates ranging from 04/26/2023 through 05/06/2023 showed: - A SN visit on 04/26/2023, 04/28/2023, and 05/01/2023; - A missed visit (visit number two) for the week of 04/30/2023 through 05/06/2023; and - The SN notes failed to contain any documentation of an attempt to reschedule the missed visit. Review of the PT visit notes, with date ranges from 04/13/2023 through 04/22/2023 showed: - A PT visit on 04/13/2023, 04/17/2023, and 04/19/2023; - A missed visit (visit number three) for the week of 04/16/2023 through 04/22/2023; and - The PT notes failed to contain any documentation of an attempt to reschedule the missed visit.

Participate in HHA-sponsored in-service CFR(s): 484.75(b)(9) Participation in HHA-sponsored in-service training. This ELEMENT is not met as evidenced by: Based on employee file review and interview, the agency failed to ensure staff were provided with agency in-service training in one of seven employee files reviewed (Employee #3). This deficient practice has the potential to affect all agency staff. EMPLOYEE #3 (E3): Review of E3's employee file showed: - Contracted staff; - Hire date: 08/28/2018; - No documentation of any agency in-service training. During an interview on 05/17/2023 at 12:50 PM, the administrator stated that the therapy manager wasn’t aware the employee needed annual in-service training.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on state law, the agency policy, employee file review, and interview, the agency failed to ensure all staff had the Employee Disqualification List (EDL) checked prior to hire for two of seven employee files reviewed (Employee #3, and #6,) and failed to ensure all staff had the Family Care Safety Registry (FCSR) checked prior to date of first patient contact, in one of seven employee files reviewed (Employee #6.) This deficient practice has the potential to affect all patients served by the agency. Findings included: Review of Section 192.2490.12 RSMo: "No person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) and (7) of subsection 11 of this section shall knowingly employ any person who is on the employee disqualification list." Review of Section 192.2495.5 RSMo: An applicant for a position to have a contract with patients or residents of a provider shall: - (1) Sign a consent form as required by Section 43.540 so the provider may request a criminal records review; - (2) Disclose the applicant's criminal history. For the purposes of the subdivision "criminal history" includes any conviction or a plea of guilty to a misdemeanor or felony charge and shall include any suspended imposition of sentence, any execution of sentence or any period of probation or parole; - (3) Disclose if the applicant is listed on the employee disqualification list as provided in section 192.2490; and - (4) Disclose if the applicant is listed on any of the background checks in the family care safety registry established under section 210.903. A provider not otherwise prohibited from employing an individual listed on such background checks may deny employment to an individual listed on any of the background checks in such registry. Review of Section 192.2495.6, RSMo: "A provider is guilty of a Class A misdemeanor if the provider knowingly hires or retains person to have contact with patients or residents and the person has been found guilty in this state or any other states or has been found guilty of a crime, which if committed in Missouri would be a Class A or B felony violation of Chapter 565, 566, or 569, or any violation of Subsection 4 of section 198.070 or section 568.020." Review of the home health provider’s policy titled, “Background Checks,” dated 04/06/2016, showed the following: - A background check is an information-gathering process which includes, but not limited to: * Checking the Employment Disqualification List (EDL) (reviewed quarterly); * Examining the criminal records of the Missouri Uniform Law Enforcement System (MULES) or any criminal history, including being finally adjudicated and found guilty or entering a plea of guilty or nolo contendere; and * Family Care Safety Registry. EMPLOYEE #3 (E3): Review of the E3's personnel file showed: - Speech Therapist (ST): - Date of hire: 08/28/2018; and - Failed to show EDL results prior to hire (dated 01/08/2019.) EMPLOYEE #6 (E6): Review of the E6's personnel file showed: - Certified Nurse Aide (CNA); - Date of hire: 07/05/2022; - Date of first patient contact: 07/12/2022; - Failed to show EDL results prior to hire (dated 07/06/2022); and - Failed to show FCSR results prior to patient contact (dated 07/18/2022.) During an interview on 05/17/2023, the administrator stated that the EDL should be done prior to hire and the FCSR should be done prior to patient contact.