Every finding on record at Elite Staffing Services Inc

Based on the findings of an onsite unannounced home health agency Medicare recertification survey conducted between 4/19/2022-4/21/2022, Elite Staffing Services, Inc. was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an onsite unannounced home health agency Medicare recertification survey conducted between 4/19/2022-4/21/2022, Elite Staffing Services, Inc. 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.

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 upon review of agency policy, medical records (MR), and interview with owner (EMP # 1), agency failed to include all elements in the Plan of Care for four (4) of seven (7) files reviewed. ( MR # 1-2; MR # 4; MR # 7). Findings included: Review of agency policy on 4/21/2022 at approximately 12:00 pm-2:00 PM titled " Plan of Care" stated " (2c) The plan of care shall be completed in full to include: Type, frequency, and duration of all visits/services." Review of MR on 4/19/2022 between approximately 11:00 AM-12:00 PM and 12:30 PM-2:00 PM and 4/21/2022 between approximately 9:00 AM-12:00 PM revealed: MR # 1, Start of Care (SOC) 5/21/2019; ninety-nine (99) year old male with diagnosis of congestive heart failure (CHF) {fluid build up in lungs} and atrial fibrillation {irregular heartbeat}. Physician orders (11/10/2021-1/8/2022) state " HHA {home health aide} 3-9 hrs {hours} per week 9 to assist with personal care, ADL'S {activities of daily living}, laundry, light housekeeping, monitor for safety." No physician orders present for skilled nursing visits documented as completed on 12/1/2021 when returning from hospital and services resumed or skilled nursing supervisory visit documented as completed on 12/29/2021. MR # 2, SOC 2/15/2021; eighty-eight (88) year old male with diagnosis of dementia {chronic disorder of mental processing} and acute respiratory failure {inability of respiratory system to meet metabolic requirement for the patient}. Physician orders (6/15/2021-8/13/2021) state "monitor for safety, meal prep, light housekeeping." No physician orders for taking temperature. Review of aide visit notes dated 6/21/2021-6/25/2021 temperature recorded as 97.9-98.4; 6/28/2021-7/2/2021 temperature recorded as 97.6-98; 7/5/2021-7/9/2021 temperature taken and documented 98-98.5. MR # 4, SOC 5/10/2016; twenty-one (21) year old male with diagnosis of autism {developmental disorder} and intellectual disability. Physician orders (4/8/2022-6/6/2022) state " HHA 6-10 hrs per day 4-7 days per week 9 at assist with ADL's and personal care, Toileting and/or incontinence care, transfers, comfort measures, administer meals and snacks, monitor use of utensils and dishes, light housekeeping, socialization, and supervision for safety." No physician orders present for skilled nursing visit documented as completed on 4/6/2022. MR # 7, SOC 5/7/2020; eighteen (18) year old male with diagnosis of intermittent explosive disorder {repeated sudden explosive violent behavior}, ADHD {attention deficit hyperactivity disorder}, autism {developmental disorder}. Physician orders (3/3/2022-5/1/2022) state " HHA 28 hrs per week 9 to assist with ADL's and personal care, supervision of meal prep and eating to ensure client does not take in too much food at a time, assist with ambulation, assist with exercises as ordered by PT {physical therapy} and OT (occupational therapy), light housekeeping, meal prep and monitor for safety." No physician orders present for skilled nursing visit documented 3/1/2022 and no frequency or specific orders for PT or OT services. Interview with EMP # 1 on 4/21/2022 at approximately 3:00 PM confirmed above findings.

Home Health Aide CFR(s): 484.115(d) Standard: Home health aide. A person who meets the qualifications for home health aides specified in section 1891(a)(3) of the Act and implemented at §484.80. This STANDARD is not met as evidenced by: Based upon review of agency policy, medical records (MR), and interview with owner (EMP # 1), agency staff failed to follow the physician orders for one (1) of seven (7) files reviewed. (MR # 2). Findings included: Review of agency policy on 4/21/2022 at approximately 12:00 pm-2:00 PM titled " Home Health Aide Care Plan" stated " (1) Following the initial assessment and consultation with the client/caregiver, written instructions for home care are prepared by a Registered Nurse or Therapist, as appropriate. (5) The Home Health Aide cannot be responsible for performing any procedure that is not assigned to him/her in writing by the RN..." Review of MR on 4/19/2022 between approximately 11:00 AM-12:00 PM and 12:30 PM-2:00 PM and 4/21/2022 between approximately 9:00 AM-12:00 PM revealed: MR # 2, SOC 2/15/2021; eighty-eight (88) year old male with diagnosis of dementia {chronic disorder of mental processing} and acute respiratory failure {inability of respiratory system to meet metabolic requirement for the patient}. Physician orders (6/15/2021-8/13/2021) state "monitor for safety, meal prep, light housekeeping." No physician orders for taking temperature. Review of aide visit notes dated 6/21/2021-6/25/2021 temperature recorded as 97.9-98.4; 6/28/2021-7/2/2021 temperature recorded as 97.6-98; 7/5/2021-7/9/2021 temperature taken and documented 98-98.5. Interview with EMP # 1 on 4/21/2022 at approximately 3:00 PM confirmed above findings.