Every finding on record at Nos Healthcare Inc.

An unannounced, onsite recertification survey was conducted on 06/09/2025 at NOS Healthcare Inc. in Milwaukee WI. NOS Healthcare Inc. was found to be out of compliance with the Medicare Conditions of Participation 42 CFR 484 for Home Health Agencies. 42 CFR 484.105 Condition of Participation: Basis & Scope is NOT MET. Agency total active census was 19 unskilled patients (personal care) and 0 skilled patients.

Basis and Scope CFR(s): §484.1 Basis and Scope (a) Basis. This part is based on: (1) Sections 1861(o) and 1891 of the Act, which establish the conditions that an HHA must meet in order to participate in the Medicare program and which, along with the additional requirements set forth in this part, are considered necessary to ensure the health and safety of patients; and (2) Section 1861(z) of the Act, which specifies the institutional planning standards that HHAs must meet. (b) Scope. The provisions of this part serve as the basis for survey activities for the purpose of determining whether an agency meets the requirements for participation in the Medicare program. This CONDITION is not met as evidenced by: Based on record review and interview, the agency failed to primarily provide services to skilled patients, per federal regulation requirements, for 19 of 19 patients served. Findings include: A review of OASIS reporting history revealed the agency has not submitted evidence of serving skilled patients since 12/10/2021. During an entrance interview with Substitute Administrator A on 06/09/2025 at 10:00 AM it was determined that the agency has the capacity to serve skilled patients and employs a Registered Nurse (RN) and a Home Health Aide. Zero skilled services had been provided to patients since last recertification survey on 07/05/2022. Currently the agency provides personal care services (PCA) (nonskilled) to 19 patients. Substitute Administrator A stated that it had been, “maybe 3 years” since the agency last served a skilled patient. During a phone interview with Administrator B on 06/09/2025 at 11:15 AM Administrator B confirmed that the agency was not serving any skilled patients. When asked why the agency hasn’t served any skilled patients since 2021, Administrator B stated, “We have just been focusing on personal care” and stated that the agency is interested in serving skilled patients in the near future and did not want to seek voluntary termination of their Medicare certification and state licensure to pursue a PCA certification.

An unannounced onsite Verification survey was conducted on 08/29/2022 - 08/30/2022 at NOS Healthcare in Milwaukee, WI as a follow up to the recertification survey that was attempted on 07/05/2022. The agency was found to be in compliance with the Emergency Preparedness for home health 42 CFR 484.22. Citations are issued at a standard level or below.

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on record review and interview, agency staff failed to review and update the agency's emergency preparedness plan at least every two years in 1 of 1 plan reviewed. Findings include: Review of the agency's "Emergency Preparedness Plan" dated 3/2019, revealed in part, "The Emergency Preparedness Plan was last reviewed and updated 3/11/2020." An interview on 08/29/2022 at 3:30 PM with Administrator A. When asked if the emergency plan had been reviewed since 3/11/2020. Administrator A stated, "I do not recall doing one since 2020."

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on record review, and interview, agency staff failed to ensure a method is in place for identifying and documenting that required exempted/unvaccinated staff are appropriately screened for COVID-19. The agency failed to ensure that policies and procedures were in place for tracking COVID vaccine status as well as a process for receiving and approving exemptions or delays. The agency failed to have a contingency plan to mitigate risk of transmission by exempted staff in 1 of 1 COVID-19 policies reviewed. Findings Include: Review of CDC Nationally Recognized Standard for Source Control last updated 02/02/2022 revealed in part "Interim Infection Prevention and Control Recommendations for Healthcare Personnel During COVID-19: CDC's new COVID-19 community levels recommendations do not apply in healthcare settings. Instead, healthcare settings should continue to use community transmissions rates and continue to follow CDC's infection prevention and control recommendations for healthcare settings. For Healthcare Facilities: COVID-19 Community Levels do not apply in healthcare settings...1. Recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic...Implement Source Control Measures. Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person's mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. Source control options for HCP (health care providers) include: A well-fitting facemask...Source control and physical distancing (when physical distancing is feasible and will not interfere with provision of care) are recommended for everyone in a healthcare setting. This is particularly important for individuals, regardless of their vaccination status, who live or work in counties with substantial to high community transmission. While it is generally safest to implement universal use of source control for everyone in a healthcare setting, the following allowances could be considered for individuals who are up to date with all recommended COVID-19 vaccine doses...in healthcare facilities located in counties with low to moderate community transmission...HCP who are up to date with all recommended COVID-19 vaccine doses: Could choose not to wear source control or physically distance when they are in well-defined areas that are restricted from patient access (e.g., staff meeting rooms, kitchen). They should wear source control when they are in areas of the healthcare facility where they could encounter patients (e.g., hospital cafeteria, common halls/corridors). Review of policy titled "COVID-19 Care Plan" dated 03/11/2019 revealed in part, "Policy, the health and welfare of our patients and employees is imperative and the emergency preparedness COVID-19 policy and emergency preparedness policy shall be reviewed and followed by all staff to ensure a safe work environment and wellbeing of our patients." There is no documentation within the policy for tracking COVID vaccine status or the process for receiving and approving exemptions or delays. There was no documentation within the policy for documenting that exempted/unvaccinated staff are appropriately screened for COVID-19, There is no documentation within the policy for compliance with contracted staff, and no plan in place to mitigate the spread of COVID-19 infections for unvaccinated staff. During a telephone interview on 08/29/2022 at 2:30 PM, Administrator A was asked if Administrator A knew of the CMS guidance for COVID-19 vaccination of staff. Administrator A stated, "I don't believe we have that." During an Interview with Substitute Administrator B on 8/29/2022 at 2:35 PM. Substitute Administrator B was asked how they keep track of staff's vaccination status. Substitute Administrator B stated, "Personal Care workers do not follow that rule, but I have the nurses bi-weekly testing from the nurse's other employer."

An unannounced, onsite recertification survey was attempted on 07/05/2022 at N O S Healthcare, in South Milwaukee, WI. N O S Healthcare was found to be out of compliance with the Medicare Conditions of Participation 42 CFR 484 for Home Health Care. 42 CFR 484.105 Organization and Administration of Services is NOT MET. Please be advised that pursuant to sections 1891(a)(3)(D) of the Social Security Act, 42 CFR Section 484.36, since your agency is not in compliance with a Condition of Participation, the Agency is precluded from conducting home health aide training and or competency evaluations for 24 months, effective 7/7/2022.

Organization and administration of services CFR(s): 484.105 Condition of participation: Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient's plan of care, for each patient's medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished. This CONDITION is not met as evidenced by: Based on interview, the agency staff failed to maintain effective administration and organization of the agency functions and services when the administration failed to be available for 1 of 1 recertification survey attempted. Findings Include: This agency administrator failed to maintain the day to day operations of the Home Health Agency. See Tag G948. This agency administrator failed to ensure the clinical manager was available during operating hours of this agency. See tag G950. This agency administrator failed to ensure a qualified person was available to act in the absence of the administrator. See tag G954. The cumulative effect of these systemic problems resulted in the home health agency's inability to ensure the provision of quality health care in a safe environment.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on interview, this agency failed to ensure that a qualified individual was present to oversee the management of this agency when the administration failed to be available for 1 of 1 recertification survey attempted. Findings Include: On 07/05/2022 at 10:50 AM, entrance was attempted at this agency with Office Assistant B. The surveyor asked to speak with the Administrator, Office Assistant B stated, "The office is closed today because it's a holiday." Office Assistant B pointed to the sign on the door and advised us to call the Administrator's number posted on the sign. A phone call was placed to Administrator A on 07/05/2022 at 11:03 AM. Administrator A stated "the agency is closed today, it's a holiday, and Administrator A is 40 to 60 minutes away." Administrator A was asked who is in charge when Administrator A is absent. Administrator A stated "The director of nursing or the clinical manager, Administrator A will contact them." A return phone call was placed to Administrator A on 07/05/2022 at 11:23 AM. Administrator A was asked the status of director of nursing or clinical manager. Administrator A stated "I am trying to reach them." On 07/05/2022 at 11:30 AM a phone call was received from Administrator A. Administrator A stated "I am not able to get there today and I am not able to reach anyone to help with a audit today, but I could be available tomorrow."

Ensure clinical manager is available CFR(s): 484.105(b)(1)(iii) (iii) Ensure that a clinical manager as described in paragraph (c) of this section is available during all operating hours; This ELEMENT is not met as evidenced by: Based on interview, this agency's administrator failed to ensure the clinical manager was available during all operating hours when the administration and/or the Clinical Manager failed to be available for 1 of 1 recertification survey attempted. Findings Include: A phone call was placed to Administrator A on 07/05/2022 at 11:03 AM. Administrator A stated "the agency is closed today, it's a holiday, and Administrator A is 40 to 60 minutes away." Administrator A was asked who is in charge when Administrator A is absent. Administrator A stated "The director of nursing or the clinical manager, Administrator A will contact them." A return phone call was placed to Administrator A on 07/05/2022 at 11:23 AM. Administrator A was asked the status of director of nursing or clinical manager. Administrator A stated "I am trying to reach them." On 07/05/2022 at 11:30 AM a phone call was received from Administrator A. Administrator A stated "I am not able to reach anyone to help with a audit today, but I could be available tomorrow."

Ensures qualified pre-designated person CFR(s): 484.105(b)(2) When the administrator is not available, a qualified, pre-designated person, who is authorized in writing by the administrator and the governing body, assumes the same responsibilities and obligations as the administrator. The pre-designated person may be the clinical manager as described in paragraph (c) of this section. This ELEMENT is not met as evidenced by: Based on interview, the agency failed to ensure that a qualified individual was available to act in the absence of the Administrator when the administration and/or the substitute administrator failed to be available for 1 of 1 recertification survey attempted. Findings Include: A phone call was placed to Administrator A on 07/05/2022 at 11:03 AM. Administrator A stated "the agency is closed today, it's a holiday, and Administrator A is 40 to 60 minutes away." Administrator A was asked who is in charge when Administrator A is absent. Administrator A stated "The director of nursing or the clinical manager, Administrator A will contact them." A return phone call was placed to Administrator A on 07/05/2022 at 11:23 AM. Administrator A was asked the status of director of nursing or clinical manager. Administrator A stated "I am trying to reach them." On 07/05/2022 at 11:30 AM a phone call was received from Administrator A. Administrator A stated "I am not able to reach anyone to help with a audit today, but I could be available tomorrow."