Every finding on record at Elite Care at Home, Inc

Recertification survey completed. Standard level deficiencies cited. Abbreviations: x = times wk = week # = number AM = morning SN = Skilled Nurse POC = Plan of care SOC = Start of care PsOC = Plans of Care RN = Registered Nurse PM = afternoon/evening Pt./ Pts. = Patient/Patients PT = Physical Therapy/Therapist OT = Occupational Therapy/Therapist ST = Speech Therapy/Therapist MSW = Medical Social Worker

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: A. Based on clinical record review and staff interview, it was determined that the Agency failed to provide services only as ordered by physician. This was found in 3 of 7 (Pts #4, #5 and #7) clinical records reviewed. Findings: 1. Pt #4 SOC 07/03/2019 Diagnoses: Multiple Sclerosis and Hypertension. The clinical record was reviewed on 09/08/2021 at 1:00 PM. The clinical record contained Plan of Care for certification period of 05/29/2021 to 07/27/2021 that required SN visit frequency of 2 times a week for 8 weeks, 1 time a week for 1 week. The record contained SN notes dated 07/19 and 07/22 (week 9). The same clinical record also contained a Plan of Care for certification period of 07/28/2021 to 09/25/2021 that required SN visit frequency of 1 time a week for 1 week, 2 times a week for 8 weeks. The record contained a recertification assessment dated 07/26 and SN visit note dated 07/29 (week 1). No modification orders were found in the clinical record. 2. Pt #5 SOC 04/10/2020 Diagnoses: Myotonic Muscular Dystrophy and Repeated Falls. The clinical record was reviewed on 09/09/2021 at 9:00 AM. The clinical record contained Physical therapy (PT) visit notes from 07/30/2021 to 08/27/2021 and Occupational therapy (OT) visit notes from 07/29/2021 to 08/19/2021. The POC for certification period for 08/03/2021 to 10/01/2021 lacked physician orders for Physical therapy or Occupational therapy services. No modification orders were found in the clinical record. 3. Pt. # 7 SOC 11/18/2021 Diagnosis: Hypertensive Chronic Obstructive Pulmonary Disease. The clinical record was reviewed on 09/07/2021 at 11:00 AM. For certification period 01/17/2020 to 03/16/2020, the clinical record contained Aide visits 2 times a week for week 1, week 2 and week 3 of certification period. The POC for certification period 01/17/2020 to 03/16/2020 lacked physician orders for the Aide services. No modification orders were found in the clinical record. 4. Findings of Agency staff providing services without a physician order were confirmed during an interviews with the Alternate Administrator on 09/09/2021 between 10:00 AM and 11:00 AM.

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: A. Based on clinical records review and staff interviews, it was determined that the Agency failed to ensure patients received services as ordered by the physician in the POC. This was found in 2 of 7 clinical records reviewed (Pts. # 2 and 5). Findings include: 1. Pt. # 2 SOC 04/29/2021 Diagnoses: Alzheimer's Disease, Expressive Language Disorder and Essential (Primary) Hypertension. The clinical record was reviewed on 09/08/2021 at 10:00 AM. The clinical record contained a POC for certification period 04/29/2021 to 06/27/2021 that required ST to assess communication disorder. The clinical record lacked ST visits. No modification orders were found in the clinical record. 2. Pt #5 SOC 04/10/2020 Diagnoses: Myotonic Muscular Dystrophy and Repeated Falls. The clinical record was reviewed on 09/09/2021 at 9:00 AM. The clinical record contained Plans of care for certification period of 06/04/2021 to 08/02/2021 and 08/03/2021 to 10/01/2021 required “Medical Social Worker to assess psychosocial issues that impact health care, need for counseling, financial health, need for access to community resources and long-term care planning. MSW to establish a plan as discussed with Case Manager and approved by physician.” The clinical record lacked an MSW evaluation as ordered by physician. There were no modifications orders in the clinical record. 3. During interviews with Alternate Administrator on 09/09/2021 between 10:30 AM and 11:00 AM, the above findings were confirmed.

Ensure clinical manager is available CFR(s): 484.105(b)(1)(iii) (iii) Ensure that a clinical manager as described in paragraph (c) of this section is available during all operating hours; This ELEMENT is not met as evidenced by: A. Based on staff interview and document review, it was determined that Administrator failed to ensure that skilled nursing services and other therapeutic services were under direct supervision by an RN in the absence of the Agency Supervisor. Findings include: 1. On 09/07/2021 at 10:00 AM, during the Entrance interview, Alternate Administrator stated that the Agency Supervisor is out on Family Medical Leave of Absence (FMLA). 2. On 09/07/2021 at 11:00 AM, a request was made to the Alternate Administrator for a letter of designation for Alternate Agency Supervisor. A letter of designation titled "Authority to Act" was presented for review on 11:15 AM. The letter lacked the name and signature of designated nurse assuming the role in the absence of the Agency Supervisor. 3. During the interview 09/09/2021 at 10:30 AM, the Alternate Administrator confirmed the lack of a designated Alternate Agency Supervisor assuming the role in the absence of the Ageny Supervisor.