Every finding on record at Continuum Pediatric Nursing Services

Based on the findings of an unannounced onsite Medicare Recertification and State Re-Licensure survey completed on January 13, 2026, Continuum Pediatric Nursing Services, was found to be in compliance with the requirements of 42 CFR, Par 484.22. Subpart B, Conditions of Participation: Home Health Agencies: Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare Recertification and State Re-Licensure survey completed on January 13, 2026, Continuum Pediatric Nursing Services, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 a review of clinical records (CR) and employee interview, the agency failed to ensure the nurse clarified indications for as needed medications on Plan of Care for five (5) of seven (7) clinical records (CR) reviewed (CR1-5). Findings included: CR1, start of service (SOS) 8/11/25, dates reviewed 12/9/25-1/8/26. Plan of care (POC) included: Albuterol sulfate 90mcg/actuation breath activated inhaler-180mcg/2 puffs PRN (pro re nata-as needed)/inhalation, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. POC also included: Baqsimi 3mg/actuation nasal spray-3mg/1 nasal spray PRN/nasal, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. CR2, SOS 8/18/25, dates reviewed 12/19/25-1/8/26. POC included: Naproxen 250mg tablet- give 1 tab by mouth as needed, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. CR3, SOS 4/21/18, dates reviewed 11/10/25-1/98/26. POC included: Albuterol sulfate 2.5mg/3mL solution for nebulization- 2.5mg/3mL twice daily PRN, no indicator to identify what symptoms require the need for use of medication. Hydrocortisone 2.5% topical cream- 2.5% twice daily /topical to skin PRN, no indicator to identify what symptoms require the need for use of medication, the amount, or location to use the medication. Protective Ointment- thin layer/application with each diaper change topical to peri area PRN, no indicator to identify what symptoms require the need for use of medication. Salicylic acid 40% topical patch- 40% per package instructions topical pad as needed, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. Senne 8.8mg/5mL oral syrup- give 8.8mg/5mL daily via gastric tube PRN, no indicator to identify what symptoms require the need for use of medication. Triamcinalone acetonide 0.1% topical cream- thin layer/1 application twice daily topical to gastric tube stoma PRN, no indicator to identify what symptoms require the need for use of medication. Water oral liquid- 200ml/270ml/hour via feeding pump/gastric tube PRN, no indicator to identify what symptoms require the need for use of medication. CR4, SOS 8/8/22, dates reviewed 11/20/25-1/8/26. POC included: Bisacodyl 10mg rectal suppository- 1 suppository PRN daily rectally, no indicator to identify what symptoms require the need for use of medication. Lansoprazole 3mg/ml-15mg/5ml daily via gastric tube PRN, no indicator to identify what symptoms require the need for use of medication. LanzaPro Flex 4% topical patch- 1 patch PRN daily topical to gastric tube stoma, no indicator to identify what symptoms require the need for use of medication. CR5, SOS 3/4/25, dates reviewed 12/25/25-1/8/26. POC included: Acetaminophen 160mg/5mL oral elixir- 320mg/10ml PRN every 6 hours oral, no indicator to identify what symptoms require the need for use of medication. Valtoco 10mg/spray nasal spray- 10mg/0.1ml PRN nasal, no indicator to identify what symptoms require the need for use of medication. Interview with Director of Nursing, 2 Clinical Supervisors, National Director of Nursing, National Administrator, and Compliance on 1/13/26 at 3:00pm confirmed findings.

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 a review of clinical records (CR) and employee interview, the agency failed to ensure services provided per Plan of Care for three (3) of seven (7) clinical records (CR) reviewed (CR1,2, & 5). Findings included: CR1, start of service (SOS) 8/11/25, dates reviewed 12/9/25-1/8/26. Skilled nurse (SN) frequency ordered 1/6/26- "...4-5 days a week Monday-Friday up to 8 hours/day to accompany (patient) to school through certification period..." No documentation of services Monday 12/22/25-Friday 12/26/25 or Monday 12/29/25-Friday 1/2/25. During Interview on 1/7/26 at approximately 2:00pm, Director of Nursing reported, " no services were provided because they are ordered while in school and there was not school these days." Clinical record failed to include documentation reflecting days school was not in session. CR2, SOS 8/18/25, dates reviewed 12/19/25-1/8/26. Home health aide (HHA) frequency ordered 12/19/25- "...home health aide services 4-5 days a week Monday through Friday to attend school up to 7.5 hours a day..." Missed visits documented Monday 12/22/25-Friday 12/26/25. No documentation of services Monday 12/29/25. During Interview on 1/7/26 at approximately 2:00pm, Director of Nursing reported, " no services were provided because they are ordered while in school and there was not school these days." Clinical record failed to include documentation reflecting days school was not in session. Missed visits also documented inability of agency to staff. CR5, SOS 3/4/25, dates reviewed 12/25/25-1/8/26. SN frequency ordered 12/25/25- "SN care Monday through Saturday 5-6 days per week up to 12 hours..." Review of service records and interview with SN on 1/7/26 at approximately 1:00pm revealed schedule to consistently be Monday through Saturday one week followed by Sunday through Friday to result in working Monday through Friday and every other Saturday and Sunday to coordinate with mother's schedule. CR failed to include documentation reflecting adjustment of frequency for SN services. Interview with Director of Nursing, 2 Clinical Supervisors, National Director of Nursing, National Administrator, and Compliance on 1/13/26 at 3:00pm confirmed findings

Based on the findings of an unannounced on-site Medicare recertification and State re-licensure survey completed on January 12, 2023, Continuum Pediatric Nursing Services was found to be in compliance with the requirements of 42 CFR, Part 418.113, Subpart D, Conditions of Participation: Hospice Care - Emergency Preparedness.

Based on the findings of an unannounced on-site Medicare recertification and State re-licensure survey completed on January 12, 2023, Continuum Pediatric Nursing Services was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on a review of clinical records (CR), agency policies, and staff interview (EMP), the agency failed to ensure a plan of care was developed in consultation with agency staff that covered frequency of visits for four (4) of seven (7) clinical records reviewed (CR3, CR5, CR6, CR7). Findings included: Review of agency policies on 1/12/23 revealed ...Subject: Plan of Care/485...Policy: Health Care services will be furnished under the general supervision of a physician based on a complete and legible plan of care/485...Procedure:5. the plan of care/485 form will be completed in full to include but not limited to: C. Type, frequency and duration of nursing, aide or other rehabilitative or social services(s)... CR3 Start of Care 4/27/21, reviewed on 1/12/23 at approximately 9:50 AM. Certification Period 12/18/22 to 2/15/23...Orders for Discipline and Treatments: Skilled Nursing (SN) care 4 to 5 days through certification period of 12/18/22-2/15/23…Auth shared with [another Home Health Agency] … CR Frequency/Duration documentation on plan of care did not disseminate the SN frequency of visits/shifts for the agency. Surveyor unable to discern specific SN visit/shift frequency/duration. CR5 Start of Care 4/6/16, reviewed on 1/12/23 at approximately 11:00 AM. Certification Period 12/31/22 to 2/28/23...Orders for Discipline and Treatments: Skilled Nursing (SN) care RN/LPN (registered nurse/licensed practical nurse) 6 to 7 days a week through certification period of 12/31/22 to 2/28/23… CR Frequency/Duration documentation on plan of care did not disseminate the SN frequency of visits/shifts for the agency. Surveyor unable to discern specific SN visit/shift frequency/duration. CR6 Start of Care 10/10/22, reviewed on 1/12/23 at approximately 12:30 PM. Certification Period 12/9/22 to 2/6/23...Orders for Discipline and Treatments: Skilled Nursing (SN) care 4 to 5 days through certification period of 12/9/22 to 2/6/23… CR Frequency/Duration documentation on plan of care did not disseminate the SN frequency of visits/shifts for the agency. Surveyor unable to discern specific SN visit/shift frequency/duration. CR7 Start of Care 3/15/22, reviewed on 1/12/23 at approximately 1:15 PM. Certification Period 11/10/22 to 1/8/23...Orders for Discipline and Treatments: Skilled Nursing (SN) visit 2 to 3 days per week for the certification period of 11/10/22-1/8/23…Auth is shared with {another Home Health Agency] … CR Frequency/Duration documentation on plan of care did not disseminate the SN frequency of visits/shifts for the agency. Surveyor unable to discern specific SN visit/shift frequency/duration. An exit conference was conducted on 1/12/23 with Administrator (EMP1) and Alternate Administrator (EMP2) at approximately 3:20 PM. Above findings were reviewed.

Non-skilled direct observation every 60 days CFR(s): 484.80(h)(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, the registered nurse must make an on-site visit to the location where the patient is receiving care no less frequently than every 60 days in order to observe and assess each aide while he or she is performing care. This ELEMENT is not met as evidenced by: Based on a review of clinical records (CR), agency policies, and staff interview (EMP), the agency failed to ensure home health aide (HHA) services provided to a patient who is not receiving skilled services was observed and assessed by a registered nurse on-site visit no less frequently than every 60 days for two (2) of two (2) clinical records reviewed receiving only HHA services (CR2, CR4). Findings included: Review of agency policies on 1/12/23 revealed: … Subject: Clinical Supervision...To assure staff member’s performance is appropriately supervised…6. The RN (registered nurse) supervisory visit for skilled nursing care patients must be on site…In the case of home health aide services…the RN must be on site…every 60 days if only home health aide services are being provided… CR2 Start of Care 8/7/19, reviewed on 1/11/23 at approximately 12:55 PM. Certification Period 11/19/22 to 1/17/23...Orders for Discipline and Treatments: Home Health Aide services 5 to 6 nights a week… Most recent HHA on-site RN supervisory visit documented was completed on RN visit 9/19/22. There were no RN HHA supervisory visits documented between last certification period start date 9/20/22 and 1/12/23 (date of CR review). CR4 Start of Care 8/8/22, reviewed on 1/12/23 at approximately 10:15 AM. Certification Period 12/6/22 to 2/3/23...Orders for Discipline and Treatments: Home Health Aide services 6 to 7 days a week… There were no RN HHA supervisory visits documented between last certification period start date 10/7/22 and 1/12/23 (date of CR review). An exit conference was conducted on 1/12/23 with Administrator (EMP1) and Alternate Administrator (EMP2) at approximately 3:20 PM. Above findings were reviewed.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on observations, and staff interview, the agency administrator failed to ensure a policy and procedure for a physician order was in place for the administration of tuberculin skin test medications and Flu vaccines stored at the agency location for agency staff members and failed to ensure policy and procedures were in place for immediate allergic reactions in accordance with United States Food and Drug Administration Tuberculin Purified Protein Derivative directions for use and Fluad Quadrivalent (Influenza Vaccine, Adjuvanted) directions for use. Findings included: Review of U.S. Food and Drug Administration package insert directions for use of Tuberculin Purified Protein Derivative (Mantoux) on 1/12/23 revealed: ...Allergic reactions may occur following the use of TUBERSOL even in persons with no prior history of hypersensitivity to the product components... Review of U.S. Food and Drug Administration package insert directions for use of Fluad Quadrivalent (Influenza Vaccine, Adjuvanted) on 1/12/23 revealed: …5.2. Preventing and Managing Allergic Reactions, Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine… Observation at agency conducted on 1/12/23 at approximately 3:05 PM by surveyor found the agency maintained Tuberculin Purified Protein Derivative (Mantoux) (Tuberculin Skin Test injectable medication) and Fluarix Quadrivalent single dose vaccine stored on site in a small mini refrigerator located in an agency office space. Surveyor observed the refrigerator contained one package (one vial) of Tuberculin Purified Protein Derivative (Mantoux), Lot C5994AA (Expiration 9/26/24), and one package of Fluarix Quadrivalent single dose vaccine (10 single dose package) Lot F7332 (expiration 6/30/23). Administrator confirmed Tuberculin and Flu vaccine medications were stored to be available and administered to agency staff members for employee TB screening and employee Flu vaccination. Administrator was not able to provide surveyor with a physician order (standing order) policy/procedure for the administration of Tuberculin Skin Testing or Flu vaccine medications to agency staff members in the agency office setting. There was no documentation of a physician order and/or policy/procedure for treatment or interventions for allergic reactions related to the administration of the medications in the office setting. An exit conference was conducted on 1/12/23 with Administrator (EMP1) and Alternate Administrator (EMP2) at approximately 3:20 PM. Above findings were reviewed.