Every finding on record at Lhcg Lxv, LLC

The Emergency Preparedness regulations were reviewed as part of the Medicare recertification survey completed on 08/21/2025. During the survey it was determined the home health provider is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Providers.

An extended survey for Medicare recertification for the home health was completed on 08/21/2025. The provider had 86 current patients. One condition-level deficiency was identified during this survey. A condition-level deficiency was identified at §484.75 Condition of Participation: Skilled Professional Services. A home health provider that is found out of compliance with any Condition of Participation evaluated as part of a standard survey may not train or competency evaluate their home health aides for a period of two (2) years following the date of this survey. A deficiency has been cited at §484.80(f)(3) (See Tag G0782).

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 policy review, record review, home visit observation, and interview, the home health provider failed to ensure staff maintained an accurate/updated medication profile in two of five full records reviewed (Records/Patients #1 and # 5). This deficient practice has the potential to affect all the patients served by the provider. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 04/21/2025 with a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure (a serious condition where high blood pressure damages the heart and kidneys, leading to heart failure). The patient had secondary diagnoses of diabetes (a chronic disease that affects how the body uses sugar for energy) and dementia (decline in mental capacity) with anxiety. The patient resided in his/her own home with the assistance of his/her adult child who lived next door to the patient. Review of the medications listed in a physician progress note dated 04/14/2025 showed in part that the patient was to take: - Atorvastatin (to lower cholesterol); - Naproxen (for pain, fever, and inflammation); and - Tamsulosin (to relax the muscles in the prostate to make it easier to pass urine). Review of the comprehensive nursing assessment documentation dated 04/21/2025 showed in part: - No issues were found during review of the patient’s medications; and - The physician was notified on 04/21/2025 of the patient’s admission to home health services and orders were received for the plan of care; and - The visit note failed to contain documentation to address the omission of atorvastatin, naproxen, and tamsulosin from the patient’s medication list. Review of the patient’s plan of treatment dated 04/21/2025 showed that the document failed to contain orders for atorvastatin, naproxen, and tamsulosin. During an interview on 08/20/2025 at 1:40 PM, the administrator stated that: - They expect clinicians to notify the physician of discrepancies between the medications listed in the referral paperwork and what is reported by the patient; - They were unable to locate documentation of physician notification that the patient was not taking the atorvastatin, naproxen, and tamsulosin. Findings included: Review of the provider’s policy titled, “Monitoring Medication”, revised 07/01/2024, showed in part: - Purpose: To provide a process to ensure continuous monitoring of medications in the patient's home; and - Policy: * A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode; * For patients receiving skilled nursing and therapy services, the skilled nurse is responsible for medication review and reconciliation throughout the episode. The therapist will participate by monitoring and reporting any identified medication issues or non-compliance to the Patient Care Manager; * For patients receiving only therapy services, the therapist is responsible to facilitate drug regimen review and medication reconciliation throughout the episode; * The therapist will collaborate with the Patient Care Manager to complete the process; and * The physician is contacted immediately if any discrepancies between agency information and patient medications are found. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services on 06/02/2025 with a primary diagnosis of heart failure, and secondary diagnoses that included gastrointestinal hemorrhage (bleeding in the digestive tract), hypertension (abnormally high blood pressure), diabetes (a chronic disease that affects how the body uses sugar for energy), and anxiety (a feeling of worry, nervousness, or unease). The patient resided at home with a spouse. Observation and interview on 08/19/2025 at 9:40 AM, showed the following medication discrepancies with the provider’s medication profile: -The medication profile showed an order for buspirone (used to treat anxiety), 5 milligram (mg) tablet, take one tablet by mouth, two times daily. The patient’s spouse stated that this medication dosage was increased on 07/30/2025 to 10 mg tablet, take one tablet by mouth, two times daily; --The patient took Delsym (a cough suppressant), 30 mg liquid, take one by mouth, every 12 hours. This medication was not included on the provider's medication profile; -The patient took medication losartan (a medication to treat high blood pressure) 25 mg tablet, one tablet to be taken by mouth, daily. The provider's medication profile failed to include this medication; and -The patient took the medication aspirin, 81 mg tablet, take one tablet, by mouth, daily. The provider's medication profile failed to include this medication. Per an interview conducted during observation, physical therapist (PT) - A stated that each patient should have their medication checked and compared to the current medication list during each visit to ensure accuracy. During an interview on 08/20/2025 at 2:50 PM, the administrator stated that all staff should follow the medication monitoring policy, which consisted of the visual comparison of all current medications in the patient’s home to the medication list during each visit to ensure accuracy. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 04/21/2025 with a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure (a serious condition where high blood pressure damages the heart and kidneys, leading to heart failure). The patient had secondary diagnoses of diabetes (a chronic disease that affects how the body uses sugar for energy), and dementia (decline in mental capacity) with anxiety. The patient resided in his/her own home with the assistance of his/her adult child who lived next door to the patient. Review of the referral paperwork, received by the provider on 04/17/2025, showed a physician progress noted dated 04/14/2025 that showed, in part, that the patient was to take: - Atorvastatin (to lower cholesterol); - Naproxen (for pain, fever, and inflammation); and - Tamsulosin (to relax the muscles in the prostate to make it easier to pass urine). Review of the comprehensive nursing assessment documentation dated 04/21/2025 showed in part: - No issues were found during review of the patient’s medications; - The physician was notified on 04/21/2025 of the patient’s admission to home health services and orders were received for the plan of care; and - The visit note failed to contain documentation to address the omission of atorvastatin, naproxen, and tamsulosin from the patient’s medication list. Review of the patient’s plan of treatment dated 04/21/2025 showed that the document failed to contain orders for atorvastatin, naproxen, and tamsulosin. During an interview on 08/20/2025 at 1:40 PM, the administrator stated that: - They expect clinicians to notify the physician of discrepancies between the medications listed in the referral paperwork and what is reported by the patient; and - They were unable to locate documentation of physician notification that the patient was not taking the atorvastatin, naproxen, and tamsulosin.

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 on policy review, record review, and interview, the provider failed to ensure that each patient's written individualized plan of care (POC) included all safety measures regarding high-risk medications in two of five full records reviewed (Records/Patients #3 and #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Plan of Care (POC),” revised 04/01/2025, showed in part: - Each patient has an individualized POC developed in consultation with the patient, physician or authorized practitioner, and staff that integrates comprehensive assessment findings to address patient problems, needs, and goals, as well as to address specific services being provided; - The POC is developed for all patients and updated no less than every 60 days; - The POC includes: - Medications and treatments; - Safety measures to protect against injury; and - Patient specific interventions and education, measurable outcomes and goals identified by the provider and patient. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services on 06/02/2025 with a primary diagnosis of heart failure and secondary diagnoses that included gastrointestinal hemorrhage(bleeding in the digestive tract),hypertension (abnormally high blood pressure), diabetes (a group of diseases that results in too much sugar in the blood), and anxiety (a feeling of worry, nervousness, or unease). The patient resided at home with a spouse. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 06/02/2025 with a primary diagnosis of a primary diagnosis of chronic obstructive pulmonary disease (COPD- a group of lung diseases that block airflow and make it difficult to breathe), and secondary diagnoses that included hypertension (abnormally high blood pressure), and diabetes (a group of diseases that results in too much sugar in the blood).The patient resided at home alone, and had a daytime caregiver. Review of the plan of care (POC), dated 08/01/2025 to 09/29/2025, failed to show constipation as a medical diagnosis for the patient. Review of the plan of care (POC), dated 08/01/2025 to 09/29/2025, showed an order for the patient related to signs and symptoms of constipation. The order directing staff to ensure taking prescribed medications for the condition if not already prescribed, then instruct to initiate17 grams of MiraLAX,(an over-the-counter (OTC) osmotic laxative designed to address occasional constipation) by mouth until normal bowl regime resumes and /or instruct the patient initiate Senna (an OTC stimulant laxative used to promote bowel movement) 15 grams by mouth twice until normal bowl regime resumes. If normal bowl movements do not resume in two days contact physician for additional orders. Review of the patient's most current medication list failed to show medications to ensure regular bowel movement and/or prevent constipation. During a home visit conducted on 08/19/2025 at 2:30 PM the patient's caretaker stated that the patient has not had an episode of constipation in over a year. During an interview conducted on 08/20/2025 at 2:55 PM the administrator stated that following a patient's initial POC, each patient's POC thereafter should be individualized to the specific needs of the patient using indications. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to home health services on 03/01/2025 with a primary diagnosis of type 2 diabetes mellitus with diabetic chronic kidney disease (a group of diseases that results in too much sugar in the blood) and a secondary diagnosis of dependence on renal dialysis (treatment for kidney failure). The patient lived at home with a family caregiver. Review of the skilled nurse visit note, dated 07/09/2025, showed the patient was dialysis with a dialysis catheter to the right upper chest. Review of the plan of care (POC), dated 06/29/2025 to 08/27/2025, failed to show interventions relating to the patient’s dialysis. During an interview on 08/20/2025 at 2:00 PM, the home health administrator stated that the home health does not do anything for the patient’s dialysis, therefore interventions for the dialysis did not automatically populate onto the POC. The home health administrator stated that he/she will figure out a way to add dialysis clinic information to the POC for the future.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure clinicians updated the plan of care (POC) in one of five full records reviewed (Record/Patient #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Plan of Care,” revised 04/01/2025, showed in part: - The qualified clinician develops and revises the POC under the direction of the physician or authorized practitioner. The POC is established prior to providing services; and - Physician/authorized practitioner’s orders are obtained to update the POC and may include problems and goals. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 04/21/2025 with a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure (a serious condition where high blood pressure damages the heart and kidneys, leading to heart failure). The patient had secondary diagnoses of diabetes (a chronic disease that affects how the body uses sugar for energy) and dementia (decline in mental capacity) with anxiety. The patient resided in his/her own home with the assistance of his/her adult child who lived next door to the patient. Review of the plan of care dated 04/21/2025 showed physician parameters: - Report blood pressure diastolic less than 50 or greater than 90, and systolic less than 90 or greater than 160; and - Report blood sugar less than 70 or greater than 250 to the physician. Review of the nursing visit documentation dated 05/14/2025 showed in part: - The patient had blood pressure reading of 110/48 that was below the physician ordered parameters for the patient; - The patient’s cardiologist had ordered Farxiga (a medication used to help the kidneys remove blood sugar from the body); - The patient had started taking the Farxiga that morning; - The clinician notified the patient’s primary care physician (PCP) of the low blood pressure reading and new medications; - The clinician received a verbal order from the patient’s PCP to discontinue the Farxiga; - The visit documentation failed to show the name and contact information for the patient’s cardiologist, or cardiologist notification of the patient's reaction to the Farxiga; and - The clinician failed to update the patient’s POC to include the name and contact information of the cardiologist for a patient with heart failure. Review of the nursing visit documentation dated 05/21/2025 showed in part: - The patient’s blood sugar reading was 351, above the physician ordered parameters for the patient; - The clinician notified the patient’s PCP and received orders to administer Novolog (injectable medication used to lower blood sugar) “per the scale in the home;” and - The clinician failed to update the patient’s POC to include the insulin scale present in the patient’s home. During an interview on 08/20/2025 at 1:40 PM, the administrator stated that: - They would expect clinicians to update the plan of care with changes; and - They were unable to locate POC updates to include the cardiologist’s name and contact information on the POC, and the Novolog scale.

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: Based on policy review, job description review, record review, and interview, the home health provider failed to ensure skilled professionals accepted responsibility for: - The provision of services that are ordered by the physician as indicated in the plan of care (G0710); - The provision of patient and caregiver education (G0714); and - The preparation of clinical notes (G0716). The cumulative effects of these deficient practices have the potential to affect all the patients served by the provider.

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: Based on job description review, record review, and interview, the home health provider failed to provide ordered care in one of five full records reviewed (Record/Patient #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated job description titled, “Registered Nurse (RN) Job Description,” showed, in part, the RN provides high quality clinical services within the scope of practice and within infection control standards, in accordance with the plan of care, and in coordination with other members of the health care team. Review of the provider’s undated job description titled, “Licensed Practical Nurse (LPN) Job Description,” showed, in part, the LPN provides high quality clinical services within the scope of practice, as defined by the state laws governing the practice of nursing, in accordance with the plan of care, and in coordination with other members of the health care team, following all applicable infection control procedures. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 04/21/2025 with a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure (a serious condition where high blood pressure damages the heart and kidneys, leading to heart failure). The patient had secondary diagnoses of diabetes (a chronic disease that affects how the body uses sugar for energy) and dementia (decline in mental capacity) with anxiety. The patient resided in his/her own home with the assistance of his/her adult child who lived next door to the patient. Review of the comprehensive nursing assessment documentation dated 04/21/2025 showed in part: - The patient had dementia and required the assistance of his/her caregivers to meet his/her needs; - The patient had no wounds and wound care was not provided this visit; - The patient’s primary care physician (PCP) was notified of the start of care and the clinician received verbal orders for the plan of care (POC); - The patient and caregiver were educated on the grievance policy, on-call services, and scheduling. All questions were answered and the patient and caregiver verbalized understanding; - The patient had a wound on his/her right shin that measured 2.2 centimeters (cm) long by 1.8 cm wide by 0.1 cm deep, and wound care was not provided/not ordered for this visit; - The nurse had delivered cotton tipped applicators, Optifoam (a waterproof foam dressing used to absorb moderate to heavy drainage), gauze, gloves, saline wound spray, and Opticel AG (a silver-infused antibacterial wound dressing); and - The patient refused to let the nurse obtain a weight. Review of the POC dated 04/21/2025 showed, in part, that the skilled nurse was to: - Perform/instruct the patient/caregiver on the care procedure for the wound on the patient’s right shin two times per week, and caregiver/patient to perform in the absence of the skilled nurse; and - The patient was to weigh daily. Review of the nursing visit documentation dated 04/28/2025, 04/30/2025, and 05/14/2025, showed, in part, that: - The patient’s wound had healed; and - The patient’s weight was not obtained. During an interview on 08/20/2025 at 1:40 PM, the administrator stated that: - The patient was admitted on 04/21/2025 with a wound, and no wound assessments or care was provided until 04/28/2025, seven days after the patient was admitted for home health services; - They would have expected nursing visits to be made to provide wound care as ordered; and - They would expect clinicians to weigh the patient each visit or document a reason why weights were not obtained.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to provide patient education in one of five full records reviewed (Record/Patient #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Patient Education,” revised 11/01/2017, showed, in part, that: - The patient and caregiver receive ongoing information specific to their identified needs, at a level appropriate to their learning abilities, including patient/caregiver plan of care responsibilities and infection control; - Using the progress/visit note, the clinician documents the level of patient/caregiver comprehension, patient/caregiver return demonstration of skill(s) taught, compliance, and any follow-up with team members; and - Concerns are reported to the patient’s physician. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 04/21/2025 with a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure (a serious condition where high blood pressure damages the heart and kidneys, leading to heart failure). The patient had secondary diagnoses of diabetes (a chronic disease that affects how the body uses sugar for energy) and dementia (decline in mental capacity) with anxiety. The patient resided in his/her own home with the assistance of his/her adult child who lived next door to the patient. Review of the comprehensive nursing visit documentation, dated 04/21/2025, showed in part: - The patient had dementia and required the assistance of his/her caregivers to meet his/her needs; - The patient had no wounds and wound care was not provided this visit; - The patient’s primary care physician (PCP) was notified of the start of care and the clinician received verbal orders for the plan of care (POC); - The patient and caregiver were educated on the grievance policy, on-call services, and scheduling. All questions were answered, and the patient and caregiver verbalized understanding; - The patient had a wound on his/her right shin that measured 2.2 centimeters (cm) long by 1.8 cm wide by 0.1 cm deep, and wound care was not provided/not ordered for this visit; - The nurse had delivered cotton tipped applicators, Optifoam (a waterproof foam dressing used to absorb moderate to heavy drainage), gauze, gloves, saline wound spray, and Opticel AG (a silver-infused antibacterial wound dressing); and - The visit note failed to contain documentation of patient/caregiver education related to the care of the wound on the patient’s right shin. Review of the POC, dated 04/21/2025, showed in part that the skilled nurse was to perform/instruct the patient/caregiver on the care procedure for the wound on the patient’s right shin, and caregiver/patient to were perform the wound care in the absence of the skilled nurse. Review of the nursing visit documentation, dated 04/28/2025, showed in part: - The patient’s caregiver was not present during the visit; - The nurse performed care to the wound on the patient’s right shin; and - The nurse left written wound care instructions for care to the right shin wound for the patient’s caregiver to review at a later time. Review of the nursing visit documentation dated 04/30/2025 showed in part: - The nurse performed care to the wound on the patient’s right shin; - The visit note failed to contain documentation that the patient/caregiver were instructed on provision of care to the wound on the patient’s right shin; - The nursing visit frequency was decreased to one time per week; and - The patient/caregiver were expected to provide care to the right shin wound independently the week of 05/04/2025. Review of the nursing visit documentation for 05/14/2025 showed the wound on the patient’s right shin had healed. During an interview on 08/20/2025 at 1:40 PM, the administrator stated that they would expect clinicians to: - Verbally instruct patients/caregivers in the wound care procedures; - Leave written instructions for patients/caregivers on wound care procedures; and - Have the patient/caregiver provide a return demonstration of wound care before expecting them to perform wound care independently.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure clinicians prepared accurate clinical notes in two of five full records reviewed (Records/Patients #4 and #5). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Job Description: Registered Nurse-Home Health,” showed, in part, the registered nurse accurately and timely completes the comprehensive assessments including medication reconciliation. Review of the provider’s undated policy titled, “Job Description: Licensed Practical Nurse/Licensed Vocational Nurse-Home Health,” showed, in part, the licensed practical nurse documents patient visits thoroughly and completely per policy and payer requirements and syncs timely per [named company] policy. This includes maintaining and accurate and current medication listing. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to home health services on 03/01/2025 with a primary diagnosis of type 2 diabetes mellitus with diabetic chronic kidney disease (a group of diseases that results in too much sugar in the blood) and a secondary diagnosis of unspecified open wounds. The patient lived at home with a family caregiver. Review of the registered nurse resumption of care visit, dated 07/02/2025, the patient had major risk factors on their nutritional screen of stage II or greater pressure ulcers. Review of the wound assessment during the visit showed a stage I pressure ulcer to the patients right lateral lower leg and a stage I pressure ulcer to the patients left lateral lower leg. The wound assessments showed no further wounds. During an interview on 08/20/2025 at 2:00 PM, the home health administrator stated that he/she would expect clinical documentation to be accurate to the patient assessment. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 04/21/2025 with a primary diagnosis of hypertensive heart and chronic kidney disease with heart failure (a serious condition where high blood pressure damages the heart and kidneys, leading to heart failure). The patient had secondary diagnoses of diabetes (a chronic disease that affects how the body uses sugar for energy) and dementia (decline in mental capacity) with anxiety. The patient resided in his/her own home with the assistance of his/her adult child who lived next door to the patient. Review of the comprehensive nursing assessment dated 04/21/2025 showed the nurse documented: - A gastrointestinal assessment showing the patient was on a regular diet with no restrictions, and a nutritional assessment that showed the patient was on a therapeutic diet (e.g. low salt, diabetic, or low cholesterol); and - A pain assessment that showed the patient’s pain was zero (0) on a 0-10 high scale, and documented the patient: * Had pain almost constantly on the OASIS (Outcome and Assessment Information Set) data collection tool; * A fall risk related to pain affecting the patient’s level of function; * A homebound status that showed a normal inability to leave the home as evidenced by pain impacting mobility; and - The patient was admitted to home health services for skilled nursing and physical therapy services, and physical therapy services had not made a visit to the patient’s home during the admission process. During an interview on 08/20/2025 at 1:40 PM, the administrator stated that they would: - Expect clinicians to document assessments that accurately reflect the patient’s condition; - The clinician had documented conflicting assessments in his/her comprehensive assessment of the patient; and - The provider had not received orders for physical therapy to evaluate the patient during the admission process.

Eligible training/competency evaluation orgs. CFR(s): 484.80(f) A home health aide training program and competency evaluation program may be offered by any organization except by an HHA that, within the previous 2 years: (1) Was out of compliance with the requirements of paragraphs (b), (c), (d), or (e) of this section; or (2) Permitted an individual who does not meet the definition of a "qualified home health aide" as specified in paragraph (a) of this section to furnish home health aide services (with the exception of licensed health professionals and volunteers); or (3) Was subjected to an extended (or partially extended) survey as a result of having been found to have furnished substandard care (or for other reasons as determined by CMS or the state); or (4) Was assessed a civil monetary penalty of $5,000 or more as an intermediate sanction; or (5) Was found to have compliance deficiencies that endangered the health and safety of the HHA's patients, and had temporary management appointed to oversee the management of the HHA; or (6) Had all or part of its Medicare payments suspended; or (7) Was found under any federal or state law to have: (i) Had its participation in the Medicare program terminated; or (ii) Been assessed a penalty of $5,000 or more for deficiencies in federal or state standards for HHAs; or (iii) Been subjected to a suspension of Medicare payments to which it otherwise would have been entitled; or (iv) Operated under temporary management that was appointed to oversee the operation of the HHA and to ensure the health and safety of the HHA's patients; or (v) Been closed, or had its patients transferred by the state; or (vi) Been excluded from participating in federal health care programs or debarred from participating in any government program. This STANDARD is not met as evidenced by: Based on the results of this extended level survey resulting in noncompliance with one Condition of Participation: Skilled Professional Services, the provider may not train, or competency evaluate their home health aides for a period of two (2) years following the date of this survey. The restriction ends 08/21/2027.

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 Missouri regulation review, policy review, employee file review, and interview, the home health provider failed to ensure all staff had the Employee Disqualification List (EDL) checked prior to hire in one of three employee files reviewed (Employee File #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of Section 192.2490.12 RSMo: "No person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) to (7) of subsection 11 of this section shall knowingly employ any person who is on the employee disqualification list." Review of the provider's policy titled, "Background Checks," revised date 05/01/2025, showed, in part, that all employment offers are contingent upon acceptable background check results. Candidates may begin computer and office-based orientation once the background check has been initiated. Candidates will not have patient interaction until the search results have been returned and are deemed acceptable. The provider's policy failed to state the EDL must be checked prior to the hire date of the employee. EMPLOYEE FILE #2: Review of the employee file showed: - Physical Therapy Assistant (PTA-A); - Date of hire: 07/28/2025; and - The filed failed to contain an EDL check prior to the employee's date of hire. During an interview on 08/20/2025 at 9:30 AM, the administrator stated that PTA-A's employment was contingent upon the background check results and the employee was allowed to begin training and would have no patient contact until the background check results were obtained.