Every finding on record at Egan Healthcare of Plaquemines, Inc.

The entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey

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 record review and interview the agency failed to ensure an accurate medication reconciliation was maintained for patients medications for 3 (Patient #1, Patient #2, and Patient #3) of 7 (Patient #1, Patient #2, Patient #3, Patient #5, Patient #7, Patient #8, and Patient #11) sampled patients observed during home visits. Findings: Patient #1 Review of Patient #1’s Client Medication Report presented on 10/23/2023 as Patient #1’s most current medication list revealed, in part, Oxycontin Extended Release (ER) (medication used to treat pain) 10 milligrams (mg) one tablet every six hours. Further review revealed Trazadone (medication used to treat depression), Magnesium Oxide (medication used to treat low magnesium level), Torsemide (medication used to remove extra fluid from the body), and Simvastatin (medication used to treat high cholesterol) were not listed as current medications. Observation on 10/25/2023 at 12:07 p.m. during Patient #1’s home visit revealed, in part, Oxycontin 30mg one tablet twice a day had a fill date of 09/30/2023; Trazadone 50mg one tablet every night had a fill date of 10/21/2023; Magnesium Oxide 400mg one tablet by mouth twice a day as needed had a fill date of 09/13/2023; Torsemide 20mg one tablet by mouth daily had a fill date of 10/20/2023 and a second bottle of Torsemide had a fill date of 02/15/2023; and Simvastatin 20mg one tablet by mouth every evening had a fill date of 09/13/2023. Review of Patient #1’s Referral Paperwork dated 08/15/2023 revealed, in part, Magnesium Oxide 400mg two tablets by mouth twice a day; Simvastatin 20mg one tablet by mouth nightly; and Torsemide 20mg one tablet by mouth daily. Review of Patient #1’s record revealed the last home visits was conducted by agency staff on 10/20/2023 and 10/23/2023. In an interview on 10/26/2023 at 3:51 p.m., S1Administrator/Director of Nursing (DON) stated the nurse had not updated Patient #1’s medication list timely. S1Adminsitrator/DON further stated the medication had not been updated until after the medication list was presented to the surveyor on 10/23/2023. Patient #2 Review of Patient #2’s Client Medication Report presented on 10/23/2023 as Patient #2’s most current medication list revealed Xarelto (anticoagulant medication used to prevent blood clots) was not listed as a current medication. Observation on 10/24/2023 at 2:40 p.m., during Patient #2’s home visit, revealed Xarelto 15 mg one tablet every day had a fill date of 09/29/2023. Review of Patient #2’s Hospital Referral paperwork dated 10/03/2023 revealed the following medication, in part, Xarelto 15mg one tablet by mouth daily. Review of Patient #2’s record revealed the last home visit conducted was on 10/19/2023. In an interview on 10/26/2023 at 3:30 p.m., S1Administrator/DON stated Xarelto 15mg one tablet by mouth was not listed on the medication list and should have been. Patient #3 Review of Patient #3’s Client Medication Report presented on 10/23/2023 as Patient #3’s most current medication list revealed the following medications were not listed as being current medications, in part, Metoprolol (a medication used to treat high blood pressure); Triphrocaps (supplement medication for patient with kidney disease); Valsartan (a medication used to treat high blood pressure); Duloxetine Delayed Release (DR) (medication used to treat depression); Norco (medication used to treat pain); Oxycodone (medication used to treat pain); Sevelamer Carbonate (supplement medication for patient with kidney disease); and Aspirin (medication used for pain and preventing clotting). Observation on 10/24/2023 at 1:22 p.m. during Patient #3’s home visit revealed, in part, Metoprolol 100mg one tablet by mouth daily had a fill date of 05/31/2023 (dispensed 90 pills); Triphrocaps 1mg by mouth daily had a fill date of 09/25/2023 (dispensed 90 pills); Valsartan 80mg one tablet by mouth daily had a fill date of 08/22/2023 (dispensed 90 pills); Duloxetine DR 60mg one tablet by mouth daily had a fill date of 09/27/2023 (dispensed 90 pills); Norco 7.5/325mg one tablet every eight hours as needed had a fill date of 07/28/2023 (dispensed 20 pills); Oxycodone 10mg one tablet by mouth every 4 hours as needed for pain had a fill date of 08/30/2023 (dispensed 35 pills); Sevelamer Carbonate 800mg one tablet by mouth three times a day had a fill date of 09/25/2023 (dispensed 90 pills); and Aspirin 81mg one tablet by mouth daily. In an interview on 10/24/2023 at 1:22 p.m., Patient #3 and Patient #3’s caregiver stated the medications were being taken as stated in the above mentioned observation. Review of Patient #3’s record revealed the last home visit conducted by agency staff was on 10/19/2023. In an interview on 10/26/2023 at 3:44 p.m., S1Administrator/DON stated Patient #3’s medication list was not being updated as it should be on every visit.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure a request for medical social worker services and repairs to a tub transfer bench were coordinated to ensure care was received timely for 1 (Patient #8) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for coordination of care. Findings: Review of Patient #8’s Occupational Therapy (OT) Visit Note Report dated 10/06/2023 revealed, in part, Patient #8 needed repairs to the existing tub transfer bench. Review revealed the OT documented Patient #8 required ongoing care from an additional caregiver to bathe the patient a few times a week, and requested a medical social worker (MSW) to evaluate for resources. Further review revealed the OT was to coordinate with Patient #8’s caregiver and case manager the need for the MSW. Review of Patient #8’s record revealed no documented evidence and the agency presented no documented evidence of the OT having communicated the concerns to Patient #8’s case manager, and/or ensured Patient #8’s physician had been notified of the request for MSW services and the need for repair of the tub transfer bench. In an interview on 10/26/2023 at 3:45 p.m., S1Administrator/Director of Nursing and S2Business Office Manager stated the agency did not have any documented evidence of the OT’s concerns for MSW services and the tub transfer bench repairs being communicated to the case manager and Patient #8’s physician to coordinate care.

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 and interview the agency failed to: 1. Ensure the nurse changed gloves and performed hand hygiene after cleaning a wound and prior to contact with other parts of the body and/or items in the patients environment for 2 (Patient #1 and Patient #11) of 2 (Patient #1 and Patient #11) sampled patients observed for wound care; and 2. Ensure the nurse changed gloves and performed hand hygiene after touching items in the patients environment and cleaning an open wound for 2 (Patient #1 and Patient #11) of 2 (Patient #1 and Patient #11) sampled patients observed for wound care. Findings: Review of the Center for Disease Control’s guidance on Hand Hygiene in the Health Care Setting revealed health care professionals are to change gloves and perform hand hygiene, in part: -Before moving from work on a soiled body site to a clean body site on the same patient; -After touching a patient or the patient’s immediate environment; and -After contact with blood, body fluids, or contaminated surfaces. Patient #1 Observation on 10/25/2023 at 12:32 p.m. of wound care provided by S6Registered Nurse (RN) revealed S6RN cleaned Patient #1’s right ischium (lower part of buttock) wound then without changing gloves or performing hand hygiene picked up dressing, placed the dressing back down, and then touched her electronic device for documentation. S6RN did not change her gloves or perform hand hygiene and proceeded to clean the right ischium wound. In an interview on 10/25/2023 at 12:32 p.m., S6RN was informed of the above observations, and S6RN confirmed she should have changed her gloves between cleaning the wound and touching items in the general environment, and after touching her electronic device and prior to cleaning the wound. Patient #11 Observation on 10/25/2023 at 10:45 a.m. of wound care provided by S5Licensed Practical Nurse (LPN) revealed S5LPN cleaned Patient #11’s left lower leg with wound cleanser and gauze and then without changing gloves or performing hand hygiene cleaned Patient #11’s left second toe amputation wound bed. Observation continued to reveal S5LPN did not change gloves or perform hand hygiene and then cleaned Patient #11’s other toes to the left foot, and then cleaned the left second toe amputation wound bed again. Further observation revealed S5LPN then removed her gloves, performed hand hygiene, and proceeded to open dressings. S5LPN moved supplies around with gloved hands and then without changing her gloves after contact with the environment, proceeded to apply the clean dressings to the wound. In an interview on 10/25/2023 at 1:10 p.m., S1Administrator/Director of Nursing (DON) was notified of the above findings and confirmed the nurses did not adhere to infection control standards of practice.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure all patient infections were reviewed for agency trends for 5 (Patient #1, Patient #11, Patient #15, Patient #16, and Patient #17) of 5 (Patient #1, Patient #11, Patient #15, Patient #16, and Patient #17) sampled patients who had infections. Findings: Patient #1 Review of Patient #1’s record revealed Patient #1 was prescribed Daptomycin (antibiotic/medication used to treat infections) 500 milligrams (mg) intravenous (medication administered in the vein) daily with a start date of 09/29/2023. Further review revealed Zerbaxa (antibiotic/medication used to treat infections) 1.5 gram (gm) intravenous every eight hours with a start date of 09/29/2023. Patient #11 Review of Patient #11’s record revealed Patient #11 was prescribed Ampicillin (antibiotic /medication used to treat infections) 2 grams intravenous over 24 hours for wound infection with a start date of 08/18/2023. Patient #15 Review of Patient #15’s record revealed Patient #15 was prescribed Augmentin (antibiotic/medication used to treat infections) 875/125 mg one tablet by mouth twice a day on 06/28/2023 for a urinary tract infection. Further review revealed Patient #15 was prescribed Levofloxacin (antibiotic/medication used to treat infections) 750mg one tablet daily on 07/05/2023 for urinary tract infection. Patient #16 Review of Patient #16’s record revealed Patient #16 was prescribed Cefpodoxime (antibiotic/medication used to treat infections) 100mg one tablet by mouth every 12 hours for 5 days on 05/11/2023. Further review revealed Patient #16 was prescribed Cipro (antibiotic/medication used to treat infections) 500mg one tablet by mouth twice a day for seven days on 05/18/2023. Patient #17 Review of Patient #17’s record revealed Patient #17 was prescribed Cefepime (antibiotic/medication used to treat infections) 1 gram twice a day per injection for sepsis on 04/20/2023. Review of the agency’s monthly Quality Improvement (QI) Event Summary for January 2023 through September 2023 revealed no documented evidence, and the agency presented no documented evidence, the agency had identified the above mentioned infections and included the data in the agency’s surveillance plan. In an interview on 10/26/2023 at 3:05 p.m., S1Administrator/Director of Nursing (DON) stated when a patient was identified as having an infection or starting a new antibiotic the employee who identified the new infection was to notify the nurse and complete an infection report. S1Administrator/DON stated this information would then be used in surveillance of infections to assist with identifying trends. S1Administrator/DON further stated after reviewing the above mentioned patients and antibiotics with the QI Event Summaries the agency did not provide appropriate surveillance on the above mentioned patients infections. S1Administrator/DON stated the agency was not tracking and trending any infections which the patients had present on admission and therefore were not looking at trends which involved these infections.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(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 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 §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a home health aide supervisor visit was conducted every 14 days for 1 (Patient #4) of 2 (Patient #4 and Patient #8) sampled patients who receive home health aide services. Findings: Review of Patient #4’s Home Health Certification and Plan of Care for certification of 09/26/2023 thru 11/24/2023 revealed, in part, Patient #4 was to receive home health aide services once a week for eight weeks effective on 10/01/2023. Review of Patient #4’s record revealed Patient #4 received home health aide services on 10/06/2023, 10/12/2023, and 10/19/2023. Further review revealed no documented evidence and the provider presented no documented evidence a home health supervisory visit was completed every 14 days. In an interview on 10/26/2023 at 3:37 p.m., S1Administrator/Director of Nursing (DON) stated the registered nurse did not complete the supervisory visit which was scheduled or 10/11/2023, due to she was not aware the services had started, and therefore the agency did not have a supervisory within 14 days of home health aide services having started.

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 record review and interview, the agency failed to ensure a registered nurse assessed and measured patient wounds weekly for changes for 2 (Patient #1 and Patient #8) of 4 (Patient #1, Patient #8, Patient #11, and Patient #16) sampled patients reviewed with pressure ulcers. Findings: Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed assessment and documentation of wound status, which includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes: dimensions and depth; presence, location and depth of any sinus tracts or undermining areas; status and characteristics of the wound bed; volume, color, and odor of exudates; evidence of infection in surrounding tissues. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Patient #1 Review of Patient #1’s record revealed Patient #1 had a right lower buttock stage III pressure ulcer (open wound with fat tissue visible) and left lower buttock wound stage III pressure ulcer. Review of Patient #1’s record and Wound Record Report revealed no documented evidence, and the agency presented no documented evidence, of wound care measurements had been obtained on Patient #1’s wounds on the following weeks, in part: 08/20/2023 thru 08/26/2023; 08/27/2023 thru 09/02/2023; and 09/03/2023 thru 09/09/2023. Patient #8 Review of Patient #8’s record revealed Patient #8 had a mid-coccyx (tailbone area) stage II (open wound without fat tissue exposed) which measured 3 centimeters (cm) by 1 cm on 09/22/2023. Review of Patient #8’s record and Wound Record Report revealed no documented evidence, and the agency presented no documented evidence, of wound care measurements had been obtained on Patient #8’s wound from the week of 09/24/2023 thru the week ending 10/21/2023. In an interview on 10/26/2023 at 3:45 p.m., S1Administrator/Director of Nursing and S2Business Office Manager stated, after reviewing the above records, the agency did not have any documented evidence Patient #1 and Patient #8’s wounds were assessed and measured weekly by a registered nurse per professional standards.

Complaint Survey #LA71624

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure patients received services for the amount of hours indicated in their plan of care for 5 (Patient #1, Patient #2, Patient #3, Patient #4, and Patient #5) of 5 sampled patients reviewed for care and services. Findings: Patient #1 Review of Patient #1’s Home Health Certification and Plan of Care dated 04/19/2022 to 06/17/2022 revealed Patient #1 was to receive, in part, 60 hours of nursing services per week for one certification period. Review of Patient #1’s Home Health Certification and Plan of Care dated 06/18/2022 to 08/16/2022 revealed Patient #1 was to receive, in part, 60 hours of nursing services per week for 9 weeks. Review of Patient #1’s Schedule Report for April 2022 to July 2022 revealed, in part: Week of 04/24/2022 to 04/30/2022 only 54 hours of services were provided; Week of 05/01/2022 to 05/07/2022 only 54 hours of services were provided; Week of 05/08/2022 to 05/14/2022 only 54 hours of services were provided; Week of 05/15/2022 to 05/21/2022 only 56.83 hours of services were provided; Week of 05/22/2022 to 05/28/2022 only 57 hours of services were provided; Week of 05/29/2022 to 06/04/2022 only 54 hours of services were provided; Week of 06/05/2022 to 06/11/2022 only 58 hours of services were provided; Week of 06/122022 to 06/18/2022 only 30 hours of services were provided; Week of 07/17/2022 to 07/23/2022 only 22 hours of services were provided; and, Week of 07/24/2022 to 07/30/2022 only 15.38 hours of services were provided. In an interview on 09/13/2022 at 4:20pm, Patient #1’s mother stated the nurse was only working 22 hours a week. Patient #1’s mother stated the agency never coordinated the schedule. Patient #1’s mother further stated she would suggest a schedule to the nurse, but the nurse would let her know what hours she could provide. Patient #2 Review of Patient #2’s Home Health Certification and Plan of Care dated 07/31/2022 to 09/28/2022 revealed Patient #2 was to receive skilled nursing services 80 hours a week for one certification period. Review of Patient #2’s Schedule Report for August 2022 to September 2022 revealed, in part: Week of 07/31/2022 to 08/06/2022 only 70 hours of services were provided; Week of 08/07/2022 to 08/13/2022 only 72.55 hours of services were provided; Week of 08/14/2022 to 08/20/2022 only 41.58 hours of services were provided; Week of 08/21/2022 to 08/27/2022 only 55 hours of services were provided; Week of 08/28/2022 to 09/03/2022 only 40 hours of services were provided; Week of 09/04/2022 to 09/10/2022 only 38.25 hours of services were provided; and, Week of 09/11/2022 to 09/17/2022 only 42 hours of services were provided. In an interview on 09/19/2022 at 10:00am, Patient #2’s mother stated the agency did not communicate the schedule of what services were to provided based on what dates. Patient #3 Review of Patient #3’s Home Health Certification and Plan of Care dated 07/27/2022 to 09/24/2022 revealed Patient #3 was to receive skilled nursing services for 84 hours a week for one certification period. Review of Patient #3’s Schedule Report for August 2022 to September 2022 revealed, in part: Week of 07/31/2022 to 08/06/2022 only 31.25 hours of services were provided; Week of 08/07/2022 to 08/13/2022 only 31 hours of services were provided; Week of 08/14/2022 to 08/20/2022 only 44.45 hours of services were provided; Week of 08/21/2022 to 08/27/2022 only 51.67 hours of services were provided; Week of 08/28/2022 to 09/03/2022 only 52.25 hours of services were provided; Week of 09/04/2022 to 09/10/2022 only 44 hours of services were provided; and, Week of 09/11/2022 to 09/17/2022 only 57 hours of services were provided. Patient #4 Review of Patient #4’s Home Health Certification and Plan of Care dated 08/10/2022 to 10/08/2022 revealed Patient #4 was to receive skilled nursing services for 40 hours a week for one certification period. Review of Patient #4’s Schedule Report for 07/31/2022 to September 2022 revealed, in part: Week of 07/31/2022 to 08/06/2022 only 17 hours of services were provided; Week of 08/07/2022 to 08/13/2022 only 8 hours of services were provided; Week of 08/14/2022 to 08/20/2022 only 12.5 hours of services were provided; Week of 08/21/2022 to 08/27/2022 only 18 hours of services were provided; Week of 08/28/2022 to 09/03/2022 only 18 hours of services were provided; and, Week of 09/04/2022 to 09/10/2022 only 16 hours of services were provided. Patient #5 Review of Patient #5’s Home Health Certification dated 08/21/2022 to 10/19/2022 revealed Patient #5 was to receive skilled nursing services for 84 hours a week for one certification period. Review of Patient #5’s Schedule Report for 07/31/2022 to 09/17/2022 revealed, in part: Week of 07/31/2022 to 08/06/2022 only 63 hours of services were provided; Week of 08/07/2022 to 08/13/2022 only 64 hours of services were provided; Week of 08/14/2022 to 08/20/2022 only 63 hours of services were provided; Week of 08/21/2022 to 08/27/2022 only 61.5 hours of services were provided; Week of 08/28/2022 to 09/03/2022 only 61.5 hours of services were provided; Week of 09/04/2022 to 09/10/2022 only 61.5 hours of services were provided; and, Week of 09/11/2022 to 09/17/2022 only 57 hours of services were provided. In an interview on 09/19/2022 at 1:22pm, S2EHH (Extended Home Health)/DON (Director of Nursing) stated we try to schedule based on hours of the plan of care; however, the agency gave the nurses the responsibility to communicate with the families as to what the schedule should be for each week. S2EHH/DON further stated the nurse will then submit the schedule and then they will run reports at end of week to determine if patients received their hours as required. S2EHH/DON further stated the agency had no system in place to determine if the schedule was reviewed and approved by the patient’s caregivers for the approval of amount of services by the nurse. S2EHH/DON stated the agency had no documented evidence of the patient and/or caregiver approved the above mention reduction in hours provided by the nurse.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on observation, record review, and interview the agency failed to ensure patients and their responsible parties were provided a schedule of skilled nursing visits for 5 of 5 patients (Patient #1, Patient #2, Patient #3, Patient #4, and Patient #5) reviewed for care and services per the plan of care. Findings: In an interview on 09/13/2022 at 4:20pm, Patient #1’s mother stated she would let the nurse know what hours were needed and the nurse would let me (Patient #1’s mother) know what hours she could work, however the agency never provided her (Patient #1’s mother) with a copy of the schedule of what hours were to be provided. In an interview on 09/14/2022 at 3:18pm, Patient #3’s mother stated she was not provided a copy of the schedule of skilled nurse visits. Observation on 09/14/2022 at 3:20pm, of Patient #3’s home folder revealed no documented evidence of a nursing schedule being present in the home. In an interview on 09/19/2022 at 10:00am, Patient #2’s mother stated at times the nurse had personal issues and did not communicate the schedule. Patient #2’s mother stated the agency had never provided her with a schedule or discussed the amount of hours she should expect weekly. Review of Patient #1, Patient #2, Patient #3, Patient #4, and Patient #5’s records revealed no documented evidence and the agency provided no documented evidence of patients’ families having been provided a schedule of nursing services to be provided. In an interview on 09/19/2022 at 11:26am, S3Extended Home Health Assistant Director of Nursing (EHH ADON) stated nursing schedules are based on the availability of the nurse and the hours allowed on the plan of care. S3EHH ADON stated the nurse and the family are to discuss what hours can be provided and then submit the information to the office weekly. S3EHH ADON further stated to her knowledge there was no system in place to ensure the family had agreed to the schedule, and/or had a copy of the schedule to follow to ensure staff was providing appropriate care. In an interview on 09/19/2022 at 1:22pm, S2Extended Home Health Director of Nursing (EHH DON) stated the agency had not provided nursing schedules to any of the EHH patients’ families. S2EHH DON stated the agency had given the nurses the responsibility to communicate with the families what the schedule should be for the week.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure the times services were provided were accurately documented in the patient’s record for 1 of 5 patients (Patient #1) reviewed for documentation of care and services. Findings: Review of Patient #1’s Client Schedule report revealed the following dates and times the nurse had documented as having provided services to Patient #1: 04/05/2022 from 12pm to 10pm; 04/07/2022 from 12pm to 10pm; 04/12/2022 from 12pm to 10pm; 04/14/2022 from 12pm to 10pm; 04/19/2022 from 12pm to 10pm; 04/21/2022 from 12pm to 10pm; 05/03/2022 from 12pm to 10pm; 05/12/2022 from 12pm to 10pm; 05/17/2022 from 12pm to 10pm; 05/26/2022 from 12pm to 10pm; 05/31/2022 from 12pm to 10pm; 06/01/2022 from 5:00am to 3:00pm; 06/02/2022 from 12pm to 10pm; and 06/07/2022 from 12pm to 10pm. Review of Patient #1’s Pediatric Day Health Care Attendance Log revealed Patient #1 was in attendance at the Pediatric Day Health Care as follows: 04/05/2022 from 7:31am to 1:55pm; 04/07/2022 from 7:25am to 1:50pm; 04/12/2022 from 7:28am to 1:20pm; 04/14/2022 from 7:28am to 1:54pm; 04/19/2022 from 7:26am to 2:00pm; 04/21/2022 from 7:30am to 1:55pm; 04/28/2022 from 7:50am to 2:23pm; 05/03/2022 from 7:56am to 2:14pm; 05/12/2022 from 8:00am to 2:13pm; 05/17/2022 8:02am to 2:17pm, 05/26/2022 from 8:06am to 2:14pm; 05/31/2022 from 7:39am to 2:30pm; 06/01/2022 from 7:53am to 2:07pm; 06/02/2022 from 7:47am to 2:06pm; and 06/07/2022 from 7:33am to 2:05pm. In an interview on 09/19/2022 at 2:12pm, S5LPN (Licensed Practical Nurse) stated the dates and times she submitted for Patient #1 should have been accurate within a few minutes. Surveyor then went over the times documented as the nurse providing services and the times Patient #1 was in attendance at the pediatric day health care, and S5LPN stated there were times she had forgotten to change the time on her notes. S5LPN stated she did not ensure hours were recorded accurately for services provided.