Every finding on record at Elite Health Care Services, LLC

The following reflects the findings of the California Department of Public Health during the Recertification survey conducted from 7/14/26 through 7/16/26. The agency reported 57 unduplicated annual admissions. The patient sample size was 7 and 3 home visits were conducted. The Department found the agency in compliance with the Emergency Preparedness regulations.

The following reflects the findings of the California Department of Public Health during the Recertification survey conducted from 7/14/26 through 7/16/26. The agency reported 57 unduplicated annual admissions. The patient sample size was 7 and 3 home visits were conducted.

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 interview and record review, the Home Health Agency (HHA) failed to follow the written Plan of Care (POC) for one of 7 sampled patients (Patient 6), when Patient 6 did not receive wound care to her surgical incisions and right leg every visit as documented in the POC. This failure resulted in Patient 6 not receiving the care and treatment ordered by the physician and placed Patient 6 at risk for infection and decline in her health status. A review of Patient 6’s clinical record indicated a SOC (start of care) date of 6/10/26 with a primary diagnosis for aftercare for abdominal surgeries. A review of Patient 6’s POC for the certification period from 6/10/26 through 8/8/26 included physician order for SN (skilled nursing) visits twice a week for three weeks and then once a week for 6 weeks. The POC directed SN to observe Patient 6’s all body systems, focusing on integumentary (skin and everything that protects the outside of person’s body). The POC indicated, “SN for medication and disease process teaching and wound care…Skilled nursing to provide the following wound care: mid line abdominal wound: using standard precautions, cleanse with normal saline [sterile salt water, used for wounds because it is gentle on body tissues], gently pat dry, place sterile gauge, and secure with tape every visit. SN to cleanse RLE [right lower extremity] skin tear with normal saline, apply antibiotic ointment as needed, leave open to air every visit.” The POC indicated further, “Patient’s [Patient 6] wounds will remain free of infection and heal properly by utilizing good wound care management/infection control practices [providing the right treatment to help wounds heal while preventing infection and other complications]. A review of OASIS (Outcome and Assessment Information Set- a detailed assessment that nurses complete to describe patient’s health and care needs), completed 6/15/26 indicated that Patient 6’s surgical incision (operation site) on lower mid abdomen was measured as 5 cm (centimeter, unit of measurement) in length, 0.3 cm wide, and 0.1 cm deep. The assessment indicated the wound had a small amount of serosanguineous (light pink watery fluid that contain a small amount of blood) drainage. The assessment indicated that Patient 6 also had a small surgical incision on her left lower abdomen and a skin tear on right lower leg. A review of the clinical record indicated Patient 6 was seen by SN twice a week as ordered, including 6/12, 6/16, 6/19, 6/23, 6/26, and 6/30/26 visits. There was no documented evidence SN assessed Patient 6’s surgical wounds and right leg skin tear during above visits. There was no documented evidence SN provided wound care to surgical incisions and skin tear as ordered by physician and documented in POC. During a concurrent interview and record review on 7/15/26 at 11:40 a.m., Patient 6’s POC and physician orders for wounds were reviewed with the agency’s administrator (ADM, a nurse by profession). The ADM acknowledged that Patient 6 was admitted with physician orders for care of two surgical wounds on her abdomen and skin tear to right lower leg. The ADM validated that ordered treatments for Patient 6’s abdominal surgical wounds were not provided during SN visits for the first three weeks of service, including 6/12, 6/16, 6/19, 6/23, 6/26 and 6/30/26 visits. The ADM was not able to find any documented evidence that SN applied antibiotic ointment to Patient 6’s right lower leg skin tear as prescribed since the SOC. The ADM stated the expectation was for SN to follow physician orders and POC, assess patient’s wounds every visit, provide ordered treatment and care, accurately document the wounds assessment and upload the assessments into the patient’s clinical record. The ADM stated that it was important to have accurate assessment and documentation to see if there was a progress with wound healing or any complications. A review of the agency’s policy and procedure (P&P) titled, “Care Planning Process,” revised 11/2021, indicated, “Purpose: To provide clinical direction to the clinicians providing care…Services to be provided will be based on the prioritized needs of the patient. Each patient will be monitored for his/her response to care and services provided against established patient goals.” A review of the agency’s P&P titled, “Clinical Services Data Collection,” dated 11/2021 indicated, “Documentation in a clinicals/service record will be timely, detailed, accurate, and reflect the care/services provided…Entries to the clinical/service record will be clear, concise, and specific statements of fact…The clinical/service note will include…What care/service was provided…Treatment…Performed.”

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to ensure the pressure wounds (localized, pressure-related damage to the skin and/or underlying tissue usually over a bony prominence) for one of 7 sampled patients (Patient 5) was documented accurately. This failure had the potential for Patient 5 to not receive the appropriate wound care. A review of Patient 5’s clinical record indicated a Start of Care (SOC) on 8/10/25 with diagnoses including type 2 diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing). A review Patient 5’s Nursing Progress Note dated 2/18/26 indicated, “…[Patient 5] has new areas on pressure to both buttocks…Areas of skin injury include pressure ulcers Stage 2 [partial-thickness loss of skin, presenting as a shallow open sore or wound) that show signs of progressing towards DTIs [Deep Tissue Injury- presents as localized purple or maroon area of discolored skin due to damage of underlying soft tissue from pressure and/or shear).” A review of Patient 5’s Wound Care Worksheet on 2/18/26, 2/27/26, 3/6/26, 3/13/26, and 3/18/26 indicated Stage 2 pressure ulcer on the left and right buttocks. The wound status on both buttocks indicated “Closed”, and the wound measurements indicated “Undefined”. A review of Patient 5’s Nursing Progress Note dated 3/25/26 indicated, “….[Patient 5] previous skin injuries as Stage 2 can be described as Stage 1 [intact skin with a localized area of redness and/or changes in sensation, temperature, or firmness] pressure injuries on the buttocks. The injuries are intact, non-blanchable [redness on the skin does not fade when pressed], with dark skin discoloration…Apply Calmoseptin [sic, moisture barrier used to protect and soothe irritated skin] to the Stage 1 wounds.” A review of Patient 5’s Wound Care Worksheet on 3/25/26, 4/3/26, 4/10/26, 4/16/26, 4/22/26, 4/29/26, 5/7/26, 5/12/26, 5/20/26, and 5/29/26 indicated Stage 1 pressure ulcer on the left and right buttocks. The wound status indicated “intact”, and the wound measurements indicated “Diffuse [spreads over a large area]”. During a concurrent interview and record review on 7/15/26 starting at 1:43 p.m. with the Licensed Nurse 2 (LN 2), Patient 5’s wound documentation was reviewed. The LN 2 stated Patient 5’s wound note on 2/18/26 indicated Patient 5 had stage 2 on both buttocks. The LN 2 described the area as skin almost breaking down and some parts had dark discoloration. The LN 2 further stated on 3/25/26 Patient 5’s wound note indicated the wounds on both buttocks were stage 1. The LN 2 added she cannot downgrade a wound from stage 2 to stage 1, she should have written the wound appeared like stage 1 instead of changing the stage of the wounds. During an interview on 7/16/26 at 10:40 a.m. with the Administrator (ADM), the ADM stated her expectation was for the licensed nurse to document accurately. A review of the HHA’s policy and procedure revised November 2021 and titled, “CLINICAL/SERVICE DATA COLLECTION” indicated, “…Documentation in the clinical/service record will be…accurate…the record…will be reviewed and updated as necessary.”

The following reflects the findings of the California Department of Public Health during a RECERTIFICATION SURVEY conducted 5/16/23 through 5/18/23. Representing the Department of Public Health: Health Facilities Evaluator Nurse (HFEN), 17069 HFEN, 36682 HFEN, 45718 The agency reported 94 unduplicated annual admissions. The patient sample size was 7 and 3 home visits were conducted. The Department was unable to substantiate a violation of the Emergency Preparedness regulations.

The following reflects the findings of the California Department of Public Health during a RECERTIFICATION SURVEY conducted 5/16/23 through 5/18/23. Representing the Department of Public Health: Health Facilities Evaluator Nurse (HFEN), 17069 HFEN, 36681 HFEN, 45718 The agency reported 94 unduplicated annual admissions. The patient sample size was 7 and 3 home visits were conducted.

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 observation, interview, and record review, the Home Health Agency (HHA) failed to ensure the medication profile was reviewed for one of seven sampled patients (Patient 3). This failure had the potential for Patient 3 to receive the incorrect dosage of medications which could cause adverse effects. Findings: A review of Patient 3's clinical records indicated a Start of Care (SOC) date of 4/12/23 with diagnoses that included encounter for change or removal of surgical wound dressing. During an observation of the home visit for Patient 3 on 5/17/23 starting at 3 p.m., the Registered Nurse (RN) failed to review the list of medications with Patient 3. In a concurrent observation and interview on 5/17/23 starting at 3:50 p.m., Patient 3 stated she cannot remember the RN checking her medications. Patient 3 further pointed to three pharmacy paper bags when she was asked where she stores her medications. In an interview on 5/17/23 at 4:05 p.m., the RN confirmed she did not review Patient 3’s medications for this visit. The RN stated she normally would reconcile the medications on every visit and her last visit was conducted on 5/4/23. The RN further stated even if Patient 3 said there was no change with her medications, she should have reviewed Patient 3's medications. In an interview on 5/18/23 at 10:09 a.m., the Administrator (ADM) stated her expectation was for the RN to perform medication reconciliation during each home visit and/or every 14 days. The ADM further stated the RN should attempt medication reconciliation during each visit. A review of an undated HHA policy titled, "MEDICATION PROFILE" indicated, "The Registered Nurse...will complete a medication profile… at the time of admission. The medication profile shall include all prescription and over-the-counter medications ...The Medication Profile shall be reviewed by a Registered Nurse every 14 days and updated whenever there is a change or discontinuation in medication."

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 observation, interview, and record review, the agency failed to ensure infection control practices were followed for one of seven sampled patients (Patient 7) when the agency staff did not perform hand hygiene during the home visit. This failure had the potential to place Patient 7 at increased risk for infection. Findings: During a review of Patient 7's Plan of Care (POC) for the certification period from 4/28/23 through 6/26/23 indicated, Patient 7 was admitted to the agency with a Start of Care (SOC) on 4/28/23 with diagnoses that included aftercare following joint replacement surgery. During a home visit observation with Physical Therapy Assistant (PTA) 1 on 5/17/23 at 4 p.m., PTA 1 was observed wearing gloves while assisting Patient 7 during his leg exercises. PTA 1 was observed touching her face and pulling up her pants with the same gloved hands, then proceeded to touch Patient 7 when she checked his right knee incision site. PTA 1 did not change gloves after she checked Patient 7’s incision site and continued to assist Patient 7 with the exercises. PTA 1 did not remove her gloves until outside Patient 7’s house and did not perform hand hygiene during the whole duration of the home visit. During an interview on 5/17/23 at 4:35 p.m., with the PTA 1, the PTA 1 stated, she does not think she needs to change gloves in between tasks because changing gloves was only done due to COVID (Coronavirus Disease) but nowadays it’s not that important. She further stated, she does her hand hygiene after she leaves the patient’s house because her hand gel is in her car. During an interview on 5/18/23 at 10:09 a.m., with the Administrator (Adm), the Adm stated, she expects the staff to change gloves in between tasks and to sanitize their hands after changing gloves or after each task. She stated she also expects the staff to remove their gloves before leaving the patient’s home and to perform hand hygiene during the visit. During a review of the agency's policy and procedure (P & P) titled, "Hand Hygiene", undated, indicated, “…Personnel providing care in the home setting will regularly wash their hands and use sanitizer…3. Hand decontamination using an alcohol-based hand rub should be performed: A. Before having direct contact with patients…C. After contact with a patient's intact skin…G…After removing gloves…”