Every finding on record at Medical Resources Home Health Corp

A Recertification survey was conducted at Elara Caring, located at 50 Braintree Hill Office Park, Suite 308, Braintree, MA 02184, on 12/9/25, 12/10/25 and 12/11/25 for compliance with 42 CFR Part 484.102 Emergency Preparedness for Home Health Agencies. As a result of this survey, it was determined the agency was in compliance with these requirements. No deficiencies were cited.

A Recertification survey was conducted at Elara Caring, located at 50 Braintree Hill Office Park, Suite 308, Braintree, MA 02184, on 12/9/25, 12/10/25 and 12/11/25 to determine compliance with the 42 CFR Part 488 requirements for Home Health Agencies. As a result of this survey, it was determined the agency was not in compliance with these requirements. Deficiencies were cited.

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 record review and staff interview, the agency failed to ensure staff provided care and services ordered by the physician as indicated in the plan of care (POC) for two patients (#5, and #10), out of a total sample of 17 patients. Findings include: 2.Patient #10 was admitted to the agency in October 2025 with a diagnosis of Joint replacement and required skilled home care services. Review of the physician ordered POC for certification period 10/15/2025 through 12/13/2025 indicated the following: *Physical Therapy (PT) visits 1 time a week for 1 week, 2 times a week for 2 weeks, then 1 time a week for 1 week Review of the clinical record indicated that a missed PT visit occurred on 10/18/2025. The missed visit documentation did not indicate that the physician was notified of the missed visit or the reason for the missed visit. During an interview on 12/10/2025 at 3:30 P.M., the Branch Director said that documentation of the missed visit was not completed in its entirety and that the physician notification and rational for the missed visit was not addressed. Review of the agency’s policy titled, Plan of Care and Coordination of Care, dated 3/4/25, indicated the following: *Care/Services to be provided will be coordinated and will follow the patient’s written plan of care. *The plan of care will specify the care/services necessary to meet the patient-specific needs as identified in the comprehensive assessment and evaluations. 1. Patient #5 was admitted to the agency in October 2025 with a diagnosis of chronic obstructive pulmonary disease (COPD-progressive lung disease that blocks airflow, making it hard to breathe) and required skilled home care services. Review of the physician ordered POC for certification dates 10/23/25 through 12/21/25 indicated the following: *Skilled Nursing (SN) visits once a week for 1 week, 3 times a week for 2 weeks, then 2 times a week for 6 weeks Review of the clinical record indicated no documented evidence that a second SN visit was completed the weeks of 11/9/25 through 11/15/25, 11/16/25 through 11/22/25 and 11/23/25 through 11/29/25. During an interview on 12/10/25 at 12:58 P.M., the Administrator, after reviewing Patient #5's clinical record, said that the physician ordered Plan of Care was not followed for providing skilled nursing visits, as required.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on record review, document review, and interview, the agency failed to ensure there was communication shared with the physician when services were not provided, as ordered, for one patient (#5), out of a total sample of 17 patients. Findings include: Review of the agency’s document titled, Missed Visit Best Practices, undated, indicated but was not limited to the following: Documentation/Care Coordination Requirements: *MD must be notified of missed visits and documented. *Complete each section of the Missed Visit Note; reason for missed visit, any additional details related to the missed visit, name and method of physician/provider notification. Patient #5 was admitted to the agency in October 2025 with a diagnosis of chronic obstructive pulmonary disease (COPD-progressive lung disease that blocks airflow, making it hard to breathe). Review of the physician ordered Plan of Care for certification period 10/23/25 through 12/21/25 indicated the following: *Skilled Nursing (SN) visits once a week for 1 week, 3 times a week for 2 weeks, then 2 times a week for 6 weeks Review of the clinical record indicated no documented evidence that a second SN visit was completed the weeks of 11/9/25 through 11/15/25, 11/16/25 through 11/22/25, and 11/23/25 through 11/29/25. Further review of the clinical record did not indicate Missed Visit Notes for SN for the weeks reviewed including documentation that the physician was notified of the missed visits. During an interview on 12/10/25 at 12:58 P.M., the Administrator, after reviewing the patient's clinical record, said there was no documentation in the clinical record that the physician had been notified of the missed visits, as required.

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 clinical documentation was complete and appropriately authenticated and dated in accordance with currently accepted standards of practice for four patients (#1, #4, #13, and #2), out of a total sample of 17 patients. Findings include: 4.) Patient #2 was admitted to the agency in October 2025 with a diagnosis of chronic kidney disease with heart failure. Review of the Physician POC for certification period 10/16/25 through 12/14/25 indicated the following: *SN 1 time a week for 1 week, once every 2 weeks for 2 weeks, then 1 time a week for 6 weeks Review of the clinical record indicated the SN visit notes were not signed/dated on the day services were rendered: *10/31/25 SN visit, note completed 11/4/25 *11/25/25 SN visit, note completed 12/1/25 During an interview on 12/20/25 at 1:31 P.M., the Branch Manager said that all visit notes should be documented, signed, and entered in the computer within 24 hours of the visit. Review of the facility policy, titled Clinical Record Content-Skilled Home Health, dated 9/9/2020, indicated the following: *Required documentation for each service or care provided must be completed on the day the service is rendered. 1.) Patient #1 was admitted to the agency in October 2025 with a diagnosis of major depressive disorder. Review of the Physician ordered Plan of Care (POC) for certification period 10/9/25 through 12/7/25 and 12/8/25 through 2/5/26 indicated the following: *Skilled Nursing (SN) visits 1 time a week for 1 week, then 3 times a week for 3 weeks, then 2 times a week for 5 weeks. (10/9/25) Review of the clinical record indicated the SN visit notes were not signed/dated on the day services were rendered: *11/5/25 visit, note completed on 11/9/25 *11/13/25 visit, note completed on 11/16/25 *11/16/25 visit, note completed on 11/26/25 2.) Patient #4 was admitted to the agency in October 2025 with a diagnosis of bipolar disorder. Review of the Physician ordered POC for certification period 10/1/25 through 11/29/25 and 11/30/25 through 1/28/26 indicated the following: *SN visits 1 time a week for 1 week, then 2 times a week for 1 week, then 1 time a week for 7 weeks, with 2 PRN (as needed) for med changes or change in condition (10/1/25) *SN visits 4 times a week for 1 week, then 2 times a week for 6 weeks (updated 10/12/25) Review of the clinical record indicated the SN visit notes were not signed/dated on the day services were rendered: *10/18/25 visit, note completed on 10/22/25 *10/20/25 visit, note completed on 10/23/25 *11/6/25 visit, note completed on 11/16/25 *12/1/25 visit, note completed on 12/9/25 3.) Patient #13 was admitted to the agency in October 2025 with a diagnosis of pressure ulcer of the sacrum, stage IV (severe, full thickness wound exposing muscle, tendon, or bone). Review of the Physician POC for certification period 10/8/25 through 12/6/25 and 12/7/25 through 2/4/26 indicated the following: *SN 1 time a week for 7 weeks, then 1 time every 2 weeks for 2 weeks (10/8/25) *SN 2 times a week for 1 week, then 3 times a week for 1 week (updated 11/23/25) *Physical Therapy (PT) 1 time a week for 1 week, then 2 times a week for 4 weeks, then 1 time a week for 4 weeks (10/8/25) *Occupational Therapy (OT) 1 time a week for 1 week, then 2 times a week for 7 weeks (10/20/25) Review of the clinical record indicated the SN, PT, and OT visit notes were not signed/dated on the day services were rendered: *10/16/25 SN visit, note completed 10/20/25 *10/20/25 SN visit, note completed 10/24/25 *10/22/25 PT visit, note completed 11/4/25 *10/24/25 SN visit, note completed 11/4/25 *10/27/25 OT visit, note completed 11/1/25 *10/27/25 PT visit, note completed 10/31/25 *12/5/25 SN visit, note completed 12/8/25

ACTS Reference Number: MA000101080 A Complaint Survey was conducted at Elara Caring on 09/12/23 to determine compliance with the following Home Health Agency Regulations: - 42 CFR 484.50 Patient Rights A statement of deficiency were generated as a result of the investigation of this complaint.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on records reviewed and interviews, for one of three sampled Clients (Client #1), the Agency failed to ensure Client #1 was free from misappropriation, when it was reported that in July of 2023 Homemaker (HM) #1 1 took three rings from Client #1’s home and pawned them. Findings Review of the Agency’s Policy titled Identifying and Reporting Abuse, Neglect-Exploitation of Clients-Massachusetts, dated 05/29/01, indicate clients have the right to be free from misappropriation of client property by anyone furnishing services on behalf of Elara Caring. Review of the Agency's Investigation indicated that the Agency received the call from Client #1's Case Manager regarding Client #1 services to be placed on hold pending the outcome of a theft allegation on 07/17/2023. During an interview on 09/18/23 at 10:34 A.M., Family Member #1 said Client #1 had declining health since last fall 2022, had multiple hospitalizations and kept all his/her rings in a closed jewelry box in his/her bedroom, because he/she did not want to lose them. Family Member #1 said the rings were family heirloom wedding rings. FM #1 said HM #1 had access to Client #1’s bedroom. FM #1 said Client #1 discovered the rings were missing from his/her jewelry box at the end of June 2023. Family Member #1 said she immediately reported the missing rings to the local Police Department, including providing the police with a description of the rings, a photo and a list of the people who had access to Client #1’s home. Family Member #1 said when she asked Homemaker #1 about the rings, Homemaker #1 told her that she found the rings outside on the ground next to Client #1's mailbox. FM #1 said that she did not believe HM #1 claimed to have found the ring outside because Client #1 did not go outside the home. During an interview on 09/14/23 at 3:00 P.M., Homemaker (HM) #1 said she found three rings outside the ground next to Client #1’s mailbox in late March. HM #1 admitted picking up the rings and pawning them. HM #1 said that Agawam Police charged her with pawning stolen jewelry. During an interview on 09/12/23 at 10:30 A.M., The Agency Branch Director said Client #1’s daughter (Family Member) #1 reported that HM #1 said she found Client #1's rings outside on the ground next to Client #1’s mailbox in late March. The Director said HM #1 admitted picking up the rings and pawning them. The Agency terminated Homemaker #1’s employment.

ACTS Reference Number: MA00096560 A Complaint Survey was conducted at Elara Caring on 03/07/23 to determine compliance with the following Home Health Agency Regulations: - 42 CFR 484.50 Patient Rights A statement of deficiency were generated as a result of the investigation of this complaint.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on records reviewed and interviews, for one of three sampled Patients (Patient #1), the Agency failed to ensure Patient #1 was free from misappropriation, when it was reported that in January of 2023 Home Health Aide (HHA) #1 misappropriated a total $33.78 from him/her, when he used Patient #1's credit card to make grocery store purchases for items for his (HHA #1) own personal use, without Patient #1's knowledge or consent. Review of the Agency’s Policy titled Identifying and Reporting Abuse, Neglect-Exploitation of Clients-Massachusetts, dated 05/29/01, indicate clients have the right to be free from misappropriation of client property by anyone furnishing services on behalf of Elara Caring. Review of HHA #1’s Schedule, dated January 2023, indicated he was scheduled to provide homemaking services for Patient #1 from 8:15 A.M. to 9:30 A.M. on 01/17/23 and on 01/31/23. During an interview on 03/08/23 at 12:55 P.M., Patient #1 said on 01/17/23 and 01/31/23, he/she gave HHA #1 a grocery list, his/her pre-paid credit card and the pin number to buy his/her groceries. Patient #1 said the groceries received on both dates (01/17/23 and 01/31/23) accurately reflected the items he/she requested and what was listed on the receipts. Patient #1 said it was discovered upon reviewing his/her credit card statement, that immediately after Patient #1’s purchases were made at the store (by HHA #1), an additional charge of $4.56 was made on 01/17/23, and $29.22 was charged on 01/31/23. Patient #1 said the additional purchases resulted in total charges of $33.78, and were made without his/her knowledge or consent. Review of Patient #1’s credit card transaction statement (undated) indicated that on 01/17/23 at 8:49 A.M., $48.40 was charged, and immediately thereafter at 8:49 A.M. an additional charge of $4.56 was made at that grocery store. The transaction statement indicated at 01/31/23 at 9:10 A.M., $68.50 was charged and at 9:11 A.M. an additional charge of $29.22 was made at that grocery store. During an interview on 03/08/23 at 1:30 P.M., Home Health Aide (HHA) #1 said that after purchasing items for Patient #1, he purchased groceries for himself to drop off at home before bringing Patient #1’s his/her groceries. HHA #1 said he recalled buying one item the first time, and a few items another time. HHA #1 said he was in a rush, and coincidentally had the same pin number on his own personal cards. HHA #1 said apparently on two occasions (01/17/23 and 01/31/23) he swiped Patient #1’s credit card and re-entered the pin number on the key pad when making his own purchases. HHA #1 said Patient #1 did not provide consent for him to make purchases for himself using his/her credit card. During an interview on 03/08/23 at 12:35 P.M., the Coordinator said on 02/07/23 Patient #1 reported an allegation that HHA #1 used his/her credit card and pin number to make grocery store purchases on two occasions for himself after shopping for him/her. The Coordinator said Patient #1 told her that on 01/17/23, within seconds after his/her groceries were purchased for $48.40, a second charge of $4.56 was made at the store. The Coordinator said Patient #1 told her that on 01/31/23, after his/her groceries were purchased for $68.50, a second charge of $29.22 was made at the store. The Coordinator said Patient #1 told her he/she received all groceries requested with the appropriate receipt, however no additional receipts were provided to explain the additional unauthorized transactions made on his/her credit card. The Coordinator said during an initial interview with HHA #1, HHA #1 told her he was unable to provide receipts for any additional purchases made for Patient #1. The Coordinator said on a follow up conversation referencing Patient #1’s credit card statement, HHA #1 indicated that he may have used Patient #1’s credit card instead of his own to make his own purchases.

ACTS Reference Number: 6DFI-140 A Complaint Survey was completed on 04/07/22 to determine compliance with the following Federal Conditions of Participation related to Certified Home Health Agencies: -CFR 483.70 Infection Prevention and Control -CFR 484.50 Patient Rights A statement of deficiency was generated as a result of the investigation of this complaint, the Agency was found to be at Standard Level non-compliance.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on records reviewed and interviews, for one of three sampled Clients (Client #1 and Client #2), the Agency failed to ensure Client #1 and Client #2 were free from misappropriation, when it was reported that during February 2022 Homemaker #1 misappropriated more than $5,000 from Client #1 and Client #2 by stealing, forging and cashing two of their bank checks and making unauthorized purchases using their credit cards. Findings include: Review of the Agency Policy and Procedure titled Identifying and Reporting Abuse/Neglect/Exploitation of Clients, dated 7/15/20, indicated clients have the right to be free from misappropriation of client property by anyone furnishing services on behalf of the Agency. During an interview on 4/26/22 at 4:05 P.M., and on 4/27/22 at 01:15 P.M., Client #1 and Client #2 said they resided together and had joint credit cards and bank checking accounts. Client #1 and Client #2 said Homemaker #1 was assigned to them to provide housekeeping services only and she was not asked to do any errands or make any purchases. Client #1 and Client #2 said they rarely left home to use their credit cards. Client #1 and Client #2 said they do not drive, and because they do not own a vehicle, they said they would not charge any expenses related to the operation of a vehicle. Client #1 and Client #2 said no one had been given the authority to use their credit cards, and both credit cards were discovered to have been stolen. Client #1 and Client #2 said they did not make any checks payable to Homemaker #1. During an interview on 4/12/22 at 01:00 P.M., Client Care Coordinator #1 said Homemaker #1 was not authorized to conduct shopping for Client #1 and Client #2, only housekeeping. Client Care Coordinator #1 said the Agency became aware of the alleged incidents of misappropriation on 03/23/22 when the local Police contacted the Agency to confirm that Homemaker #1 was an individual employed by the Agency and she provided services for Client #1 and Client #2 in their home. Review of copies of two checks belonging to Client #1 and Client #2’s joint account indicated that both were made payable to Homemaker #1, and had been endorsed, and cashed by her. One check was dated 2/15/22 for $400, and the second was dated 2/22/22 for $700. Review of Client #1 and Client #2’s two credit cards statements indicated they identified approximately 54 unauthorized charges made during February 2022 which included payment for automobile insurance, gasoline and service stations, fast food restaurants, and retail stores. During an interview on 04/07/22 at 12:20 P.M., the Police Detective said video surveillance footage was obtained from approximately five locations were Client #1 and Client #2’s credit cards were used. The Police Detective said that with confidence, the individual using the card was identified as Homemaker #1 through her Registry of Motor Vehicles photograph on record. The Police Detective said in addition to the unauthorized use of credit cards, two checks were removed from the middle of Client #1 and Client #2’s checkbook, forged, made payable to Homemaker #1 and cashed in February 2022. The Police Detective said charges were being brought against Homemaker #1.

ACTS Reference Number: 6DFI-130 A Complaint Survey was completed on 01/19/22 to determine compliance with the following Federal Requirements of Participation related Home Health Agencies: - CFR 484.50 Patients Rights The Agency was found to be at Standard Level non-compliance and a Statement of Deficiency was generated.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on interviews and records reviewed, for one of three sampled Clients, the Agency failed to ensure Client #1 was free from physical abuse, when it was reported that on 11/19/21, Home Health Aide (HHA) #1 physically abused Client#1 by pushing his/her chair over so he/she fell onto the floor, and then dragged Client #1 across the floor into another room. Findings include: During an interview on 1/24/22, at 10:34 A.M., Family Member #1 said HHA #1 called her during the evening on 11/19/21, HHA #1 said words to the effect of, “Client #1 was difficult today and I cannot tell you what happened since you are an attorney and might sue me”. Family Member #1 said that prompted her to watch the home surveillance video footage from that day. Review of video surveillance video footage provided by Family Member #1, depicted the following: - Client #1 was sitting in his/her recliner chair and HHA #1 was standing behind the chair. HHA #1 then grabbed onto Client #1’s chair and started moving it forwards and backwards repeatedly until Client #1 slid out of his/her chair and fell onto the floor. - HHA #1 then stood over Client #1, who was lying on the floor, HHA #1 then grabbed Client #1 by his/her pants, and dragged him/her across the floor into another room. - Client #1 attempts to hold onto the doorway while HHA #1 drags him/her into the other room. - Client #1 can be seen trying to use his/her hand to hit HHA #1 who was holding onto his/her pants while dragging him/her across the floor. During an interview on 1/24/22 at 10:34 A.M., Family Member #1 said Client #1 had impaired cognition with limited recall of the incident. Family Member #1 said she could not understand why HHA #1 was so mean to Client #1. Review of Home Health Aide (HHA) #1's Written Witness Statement, dated 12/17/21, indicated that she was excessively aggressive in getting Client #1 into the bathroom, but there was no excuse for her actions. During an interview on 1/24/22 at 1:00 P.M., Home Health Aide (HHA ) #1 said that she was going through a personal problem and said Client #1 was being difficult that day. HHA #1 said she took her anger out on Client #1 and became frustrated with him/her, and said there was no excuse for her actions.