Every finding on record at E Medical Group of Nebraska No. 2, LLC

Community Healthcare and Hospice is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

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 record review, policy and procedure review, observation of the provision of care, and staff interview, the agency failed to ensure 2 of 3 staff, (Staff D and E) observed during the provision of care for 2 of 3 patients (Patients 1 and 2) performed proper hand hygiene, cleaning of equipment, and bag technique according to the agency's policies and procedures. The total sample size was 7. The census was 22. A. Review of the agency's policy and procedure titled Infection Control, no date indicated, revealed staff were to perform proper hand hygiene before applying and after removing gloves. B. Review of the agency's policy and procedure titled Hand Hygiene Policy and Compliance Program, no date indicated, revealed staff were to perform proper hand hygiene before and after a lab draw. C. Review of the agency's policy and procedure titled Nursing Bag Precautions, no date indicated, revealed: 1. Staff were to perform proper hand hygiene before and after entering the nursing bag. 2. Staff were to clean equipment prior to returning it to the nursing bag. D. Review of the clinical records revealed: 1. Patient 1's Home Health Care Certification and Plan of Care (POC) for certification period 6/6/25 through 8/4/25 included orders for Skilled Nursing (SN), 3 times weekly for Peripherally Inserted Central Catheter (PICC, a thin, flexible tube that is inserted into a vein in the upper arm and guided into a large vein near the heart) dressing change, injection cap change and lab draw. 2. Patient 2's Home Health Care Certification and Plan of Care for certification period 6/4/25 through 8/2/25 included orders for Physical Therapy (PT) for muscle strengthening and gait training, and Home Health Aide (HHA) 2 times weekly for hygiene assistance. E. Observation of the provision of care, for Patient 2 on 6/24/25 at 1:00 PM, revealed Staff D failed to clean the tablet prior to returning it to the nursing bag after use by the SN and patient. F. Observation of the provision of care, for Patient 1 on 6/25/25 at 10:30 AM, revealed Staff E failed to: 1. Remove gloves and perform proper hand hygiene after providing PICC dressing change and lab draw prior to entering the nursing bag to obtain equipment. 2. Remove gloves and perform proper hand hygiene after providing patient care and prior to returning clean equipment to the nursing bag. 3. Clean the tablet prior to returning it to the nursing bag after use by the SN and patient. G. During an interview on 6/25/25 at 3:45 PM, the agency Director confirmed that Staff D and E failed to follow the agency's policies and procedures for proper hand hygiene, cleaning of equipment, and bag technique during the provision of care to Patient 1 and 2.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to conduct an on-site home health aide (HHA) supervisory visit by a Registered Nurse (RN), or other appropriate skilled professional, at least every 14 days, to 2 of 4 patients (Patients 2 and 7) receiving HHA services. The total sample size was 7. The census was 22. A. Review of the agency policy and procedure titled Home Health Aide Supervision, revised February 2024, revealed HHA supervisory visits were to be made by an RN, or other appropriate skilled professional, every 14 days. B. Review of Patient 2’s clinical record revealed: 1.The Home Health Care Certification and Plan of Care (POC) for the certification period of 6/4/25 through 8/2/25 included orders for Skilled Nurse (SN) to visit 1 time to perform start of care (SOC), HHA services 2 times weekly to assist with personal care, and Physical Therapy (PT) 2 times weekly to teach gait training exercises and perform pre-gait training activities. 2. The agency failed to conduct an on-site HHA supervisory visit by an RN, or other appropriate skilled professional, every 14 days from 6/8/25 to 6/26/25. C. Review of Patient 7’s clinical record revealed: 1.The POC for the certification period of 2/24/25 through 4/24/25 included orders for SN 1 time to perform SOC, HHA services 1 time weekly to assist with personal care, PT 2 times weekly to establish/upgrade home exercise program for strengthening, gait training, muscle strengthening exercises and perform standing balance, and Occupational Therapy (OT) 1 time per week x2 for transfer training. 2. The agency failed to conduct an onsite HHA supervisory visit by an RN, or other appropriate skilled professional, every 14 days from 2/24/25 to 4/11/25, discharge date. D. During an interview on 6/25/25 at 4:30 PM, the agency Director confirmed the agency failed to conduct an on-site HHA supervisory visit by an RN, or other appropriate skilled professional, every 14 days to Patients 2 and 7.

Community Healthcare and Hospice is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

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 record review, policy and procedure review, and staff interview, the agency failed to include on the physician-approved plan of care, the goals and interventions identified by the patient and the therapist, when the therapist completed their initial comprehensive assessment of the patient's therapy needs after the initial physician-approved plan of care was established for 2 of 5 patient records reviewed, who received therapy services (Patient 5 and Patient 6). The total sample size was 7. The census was 34. Findings are: A. Review of the agency policy and procedure titled Plan of Care-CMS #485 and Physician/Practitioners Orders, revised 2/2021, revealed the individualized plan of care must include patient-specific measurable outcomes and goals identified by the agency and the patient, interventions and education and must be physician approved. The policy also revealed if the plan of care cannot be completed until after an evaluation visit, the physician was to be consulted to approve additions or modifications to the original plan. B. Review of Patient 5's clinical record revealed: 1. The Home Health Certification and Plan of Care (POC) for the certification period of 7/3/22 through 8/31/22 included orders for Occupational Therapy (OT) to assess and evaluate. This POC did not include goals or interventions to be implemented by OT. 2. The OT completed an initial evaluation visit on 7/5/22. 3. There were no orders to modify the physician-approved plan of care to include OT interventions and the patient and agency identified outcomes and goal to be completed with the patient by the OT. C. Review of Patient 6's clinical record revealed: 1. The Home Health Certification and Plan of Care (POC) for the certification period of 1/30/22 through 3/30/22 included orders for Speech Therapy (ST) to assess and evaluate. This POC did not include goals or interventions to be implemented by ST. 2. The ST completed an initial evaluation visit on 2/8/22. 3. A Verbal Order form dated 2/9/22 requesting ST 1 time per week for 2 weeks. The order did not include interventions and the patient and agency identified outcomes and goal to be completed with the patient by the ST. D. During an interview on 8/15/22 at 2:00 PM, the Director of Home Health confirmed modifications to the physician-approved plan of care for Patient 5 and Patient 6 did not include interventions and the patient and agency identified outcomes and goal to be completed with the patient, when the initial therapy comprehensive assessment by the therapist was completed after the initial physician-approved plan of care was established.

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 record review, policy and procedure review, and staff interview, the agency failed to ensure treatment orders were completed as ordered by the patient's physician for 1 of 7 clinical records reviewed (Patient 3). The census was 34. A. Review of the agency policy and procedure titled, Physician Orders, no date indicated, revealed it is the policy of the agency to follow physician orders for all clientele. B. Review of Patient 3's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 4/25/22 through 6/23/22 included orders to insert a Foley catheter (a tube inserted into the bladder through the urethra used to drain urine from the bladder into a collection bag) , size 16 French (Fr) with a 10 milliliter (ml) balloon (the French size is determined based on a calculation using the diameter of the catheter tubing, the balloon is used to anchor the tubing in the bladder). 2. The Home Health Certification and Plan of Care for the certification period of 6/24/22 through 8/22/22 included orders to insert a Foley catheter, size 18 Fr 10 ml balloon. 3. A Skilled Nurse Visit Note dated 7/18/22 revealed the nurse changed the Foley catheter on this visit using a 16 Fr, 10 cc catheter. C. During an interview on 8/15/22 at 2:00 PM, the Director of Home Health confirmed Patient 3's skilled nurse failed to follow the physician order when changing the patient's Foley catheter on 7/18/22.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to include the progress towards the patient and agency identified goals and outcomes on the revised/updated physician- approved plan of care for 2 of 2 patient records reviewed (Patient 2 and Patient 3) who had a revised/updated plan of care. The total sample size was 7. The census was 34. Findings are: A. Review of agency policy and procedure titled, Plan of Care- CMS #485 and Physician/Practitioners Orders, revised 2/2021, revealed the revisions to the physician-approved plan of care must reflect the current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress towards the measurable outcomes and goals identified by the agency and the patient in the plan of care. B. Review of Patient 2's clinical record revealed the revised/updated Home Health Certification and Plan of Care (POC) for the certification period of 4/17/22 through 6/15/22 and for 6/16/22 through 8/14/22, did not include information concerning the patient's progress towards the measurable outcomes and goals identified by the agency and the patient. C. Review of Patient 3's clinical record revealed the revised/updated Home Health Certification and Plan of Care for the certification period of 4/25/22 through 6/23/22 and for 6/24/22 through 8/22/22, did not include information concerning the patient's progress towards the measurable outcomes and goals identified by the agency and the patient. D. During an interview on 8/15/22 at 2:00 PM, The Director of Home Health confirmed staff completing the revised/updated POC for Patient 2 and Patient 3, for the dates listed in B and C above, did not follow the agency policy to include information concerning the patient's progress towards the measurable outcomes and goals identified by the agency and the patient in the plan of care.