Every finding on record at Nhc/Op, L.P.

The Emergency Preparedness (EP) review was conducted with the recertification survey beginning on 5/4/2026- 5/6/2026. The Home Health Agency was determined in compliance with EP requirements.

A recertification survey was initiated on 5/4/2026 at 9:00 AM. The entrance conference was held with the Administrator and the Clinical Manager. An exit meeting was held on 5/6/2026 with the following in attendance: Regional Administrator, Regional Administrator in training, Administrator, Intake Coordinator, Clinical Manager, Office Manager and the Patient Services Coordinator. The facility representatives were informed about the survey findings and given the opportunity to ask questions.

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, observation and interview, the facility failed to ensure medications were accurately documented in the medical record for 3 of 5 (Patient #1, #2, and #9) sampled patients observed during home visits. The findings included: 1. Review of the agency's "Clinical Services- Nursing Medication Review and Reconciliation” policy revised 5/2022 revealed, "... Purpose: To establish processes that maximize patient safety and outcomes related to medications and to comply with related state and federal regulations and clinical best practice. Policy:…Medication compliance, effects and changes are assessed at every skilled visit…Medication review and reconciliation is a multi-faceted and on-going process performed via interview and observation techniques. It included: Eyes on- review of all prescription and non- prescription medications the patient is currently using… " 2. Medical record for Patient #1 revealed a Start of Care (SOC) date of 4/13/2026 and a primary diagnosis of a fracture of the right femur. Observations in Patient #1's home on 5/5/2026 at 1:30 PM, revealed the following medications were in the Patient's home, but were not included on the Client Medication Report: Mucus Relief over the counter (OTC) 400 milligram (mg) once a day Centrum Men 50 plus daily vitamin (OTC) once a day Mucinex DM Maximum (OTC) 1 tablespoon daily Advil (OTC) one tablet once a day During an interview on 5/5/2026 at 1:33PM, Patient #1 confirmed he was taking the above medications. Patient #1 verified the above medications were not new medications. 3. Medical record review for Patient #2 revealed a SOC date of 4/17/2026 and a primary diagnosis of Acute Cystitis. Observations in Patient #2's home on 5/5/2026 at 9:17 AM, revealed the following medications were in the Patient's home, but were not included on the Client Medication Report: Amlodipine Besylate 5 mg by mouth once a day Tramadol 50 mg by mouth every 8 hours as needed for pain Metformin HCL ER 500 mg by mouth once a day Dutasteride 0.5 mg by mouth once a day Vitamin D3 25 micrograms (mcg) by mouth every Monday Eliquis 2.5 mg by mouth once a day Pilocarpine 1 percent (%) eye drops, no instructions on the bottle During an interview on 5/5/2026 at 9:25 AM, Patient #2's niece confirmed the Patient was taking the above medications. The following medications were included on the Client Medication Report but were not in the Patient's home: Myrbetriq 50 mg ER by mouth once a day Xarelto 15 mg by mouth once a day During an interview on 5/5/2026 at 9:25 AM, Patient #2's niece stated Patient #2 was no longer taking the Myrbetriq or Xarelto. 4. Medical record review for Patient #9 revealed a SOC date of 3/13/2026 and diagnoses which included a Stage 3 Pressure Ulcer of the left heel and a Stage 2 Pressure Ulcer of the Sacral area. Observations in Patient #9's home on 5/5/2026 at 11:14 AM revealed the following: Pitavastin 2 mg by mouth once daily. The Client Medication Record showed 1 mg daily. Losartan 50 mg by mouth twice a day. The Client Medication Record showed 2 tablets (a total of 100 mg) twice a day. The following mediations were included on the Client Medication Record, however, Patient #9 stated she was no longer taking them: Acetaminophen 650 mg by mouth once a day Aspirin 81 mg by mouth once a day Biotin 1 mg by mouth once a day Bumetanide 0.5 mg by mouth twice a day Calcium 600 mg + Vitamin D3 5mcg by mouth twice a week Fish Oil 1,000 mg by mouth once a day Garlic 1,000 mg by mouth once a day Lyrica 75 mg by mouth at bedtime Magnesium Oxide 400 mg by mouth twice a week Naproxen Sodium ER 375 mg, 2 tablets by mouth daily Oxycodone 5 mg by mouth every 4 hours as needed for pain Vitamin E mixed 400 unit capsule by mouth twice a week The following medications were being taken by Patient #9, but were not included on the Client Medication Record: Wound Vite 2 capsules by mouth once a day Vitamin C 1,000 mg by mouth once a day During an interview on 5/5/2026 at 11:17 AM, Registered Nurse #1, Patient #9 and her husband verified the above information. 5. During an interview on 5/6/2026 at 9:07 AM, the Administrator verified all clinical staff should assess and document any medication changes in the medical record, at each home visit.

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 policy review, medical record review, and interview the agency failed to ensure weekly wound measurements were documented in the medical record for 1 of 3 (Patient #9) sampled patients with wounds. The findings included: 1. Review of the agency's "Documentation of Wounds and Wound Care" policy revised 5/2024 revealed, "...Documentation of Wound Assessments and Care...Each wound is measured and documented at least weekly..." 2. Medical record review for Patient #9 revealed a Start of Care date of 3/13/2026 with diagnoses which included a Stage 3 Pressure Ulcer of the left heel and a Stage 2 Pressure Ulcer of the Sacral area. Review of the Visit Note Reports dated 3/13/2026 through 4/27/2026 revealed no documentation the Patient's sacral wound was measured the weeks of 3/15/2026, 3/22/2026, and 3/29/2026. 3. During an interview on 5/5/2026 at 2:07 PM, the Regional Administrator (RA) verified the sacral wound wasn't measured the weeks of 3/15/2026, 3/22/2026, and 3/29/2026. The RA stated wounds should be measured once a week.

A Heath Emergency Preparedness and Recertification survey was initiated on 7/24/2023. The survey was resumed on 8/2/2003 through 8/3/2023. This agency complies will all Health Emergency Preparedness Regulations.

A Recertification and Health Emergency Preparedness survey were initiated on 7/24/2023 and resumed on 8/2/2023 and 8/3/2023. An entrance conference was held with the Administrator on 7/24/2023. An exit conference was held with the Regional Administrator and the Director of Clinical Services on 8/3/2023. They were afforded to opportunity to ask questions of the surveyor.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on policy review, medical record review and interview, the agency failed to ensure staff followed their policy for wound measurements for 1 of 4 (Patient #1) sampled patients with wounds, and failed to ensure the plan of care was followed for home health aide services for 1 of 2 (Patient #2) sampled patients receiving home health aide services. The findings included: 1. Review of the agency's policy titled, "Documentation of Wounds and Wound Care" revised 6/2020 revealed, "...Each wound is measured and documented at least weekly..." Medical record review for Patient #1 revealed a Start of Care (SOC) date of 1/25/2023 with diagnoses which included Stage 4 Sacral Pressure Ulcer, Neuromuscular dysfunction of Bladder, Indwelling Urinary Device, and Type 2 Diabetes Mellitus. Review of the Plan of Care (POC) for 5/25/2023 through 7/23/2023 revealed, "...Pt [patient] stated goal is to have wound healed...Skilled Nurse to assess/evaluate co-morbid conditions including...chronic wound...and other conditions that present themselves during the course of this episode to identify changes and intervene to minimize complications...Skilled Nurse to observe and assess integumentary status to identify changes and intervene to minimize complications...Skilled Nurse to perform/teach pressure ulcer care to sacral area weekly..." Review of the Skilled Nurse Visit Notes dated 5/25/2023 through 7/22/2023 revealed Patient #1's sacral wound was measured on 6/5/2023, 6/19/2023, and 7/19/2023. There were no other wound measurements documented for the entire certification period. In an interview on 8/2/2023 at 2:35 PM, the Director of Clinical Services verified there were no further wound measurements documented for Patient #1. The Director of Clinical Services then stated, "Wounds are measured once a week unless ordered differently." 2. Review of the agency's policy titled, "The Home Health Plan of Care" revised 7/2021 revealed, "...Each patient will receive the care and services written in their individualized plan of care, including any revisions or additions, and which is established, periodically reviewed, and signed by a physician or allowed practitioner..." Medical record review for Patient #2 revealed a SOC date of 6/14/2023 with diagnoses which included Dementia with Behavioral Disturbance, Lower Back Pain and Weakness. Review of the POC for 6/14/2023 through 8/12/2023 revealed the patient was to receive home health aide services one time a week for 5 weeks effective 6/18/2023. Review the visit notes dated 6/14/2023 through 8/2/2023 revealed a home health aide visit was completed on 6/23/2023 and 6/28/2023. There were no other home health aide visits documented. In an interview on 8/2/2023 at 2:26 PM, the Director of Clinical Services verified only two of 5 home health aide visits were conducted and there was no documentation the physician was notified.

Rehab services supervised by PT, OT CFR(s): 484.75(c)(2) Rehabilitative therapy services are provided under the supervision of an occupational therapist or physical therapist that meets the requirements of §484.115(f) or (h), respectively. This ELEMENT is not met as evidenced by: Based on policy review, medical record review and interview, the agency failed to provide oversight and supervision of rehabilitative services provided by a Certified Occupational Therapy Assistant (COTA) for 1 of 7 (Patient #1) sampled patients. The findings included: 1.Review of the agency's policy titled, "Clinical Services and Supervision" revised 6/2020 revealed, "...On-going general supervision by the OT [Occupational Therapist], including review of changes to the POC [plan of care] prior to the delivery of care; re-evaluation of the patient and treatment program as below...Documentation of the supervision is maintained in the patient's MR [Medical Record]...Required in-home supervision for each patient receiving Occupational Therapy services from an OTA [Occupational Therapy Assistant], in-home supervision is required...At least every 30 calendar days, the OT must perform in-home supervision of the OTA (with or without the OTA present) at least every 30 calendar days..." 2. Medical record review for Patient #1 revealed a Start of Care (SOC) date of 1/25/2023 with diagnoses which included Stage 4 Sacral Pressure Ulcer, Neuromuscular dysfunction of Bladder, Indwelling Urinary Device, and Type 2 Diabetes Mellitus. Review of the Plan of Care (POC) for 5/25/2023 through 7/23/2023 revealed, the patient was to receive Occupational Therapy (OT) services one time a week for 5 weeks effective 5/28/2023. Review of a physician's ordered dated 6/28/2023 revealed OT services were to be continued one time a week for 5 more weeks. Review of the Visit Notes dated 5/28/2023 through 6/23/2023 revealed OT services were provided by a COTA as ordered on 5/31/2023, 6/7/2023, 6/14/2023, an 6/23/2023. Review of the OT Reassessment Visit Note dated 6/28/2023 revealed "...Were Supervisory Functions Performed? No..." Review of the Visit Notes dated 6/29/2023 through 7/21/2023 revealed OT services were provided by a COTA as ordered. There were no occupational therapy supervisory visits documented for the entire certification period. In an interview on 8/2/2023 at 2:35 PM, the Director of Clinical Services verified there were no documented occupational therapy supervisory visits completed. The Director of Clinical Services then stated, the OT is expected to conduct supervisory visits of the COTA every 30 days.