Every finding on record at Nursing Resource Home Health

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 07/14/25. The Agency was in compliance with the Condition, 42 CFR 484.102 Establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements, on 07/14/25. Standard level deficiencies cited. Abbreviations: Pt./Pts. = Patient/Patients RN = Registered Nurse AM = morning PM = afternoon POC = Plan of Care PsOC = Plans of Care SOC = Start of Care # = number % = percent OASIS = Outcome and Assessment Information Set

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on the review of the Error Summary report and staff interview, the Agency failed to submit 25 of 200 assessments timely in the last 12 months, resulting in a warning. Findings include: 1. The Error Summary report for 07/01/24 to 07/01/25 was reviewed on 07/10/25 at 12:30 PM. The report included error # -3330. Of 200 submissions, 25 (12.5 %) OASIS reports were submitted more than 30 days after the assessments were completed. 2. During an interview with the Administrator and Director of Clinical Services on 07/11/25 at 11:00 AM, it was confirmed that the error occurred.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on a review of clinical records and staff interview, the Agency failed to have Pts. participate in, be informed about, and consent to or refuse care in advance of and during treatment. This was found in 7 of 7 clinical records reviewed (Pts. # 1, 2, 3, 4, 5, 6 and 7). Findings Include: 1. The following clinical records were reviewed on 07/10/25 and 07/11/25. Pt. #1 SOC: 05/10/25 Pt. #2 SOC: 02/14/25 Pt. #3 SOC: 08/22/24 Pt. #4 SOC: 06/11/25 Pt. #5 SOC: 10/11/24 Pt. #6 SOC: 02/10/25 Pt. #7 SOC: 11/01/24 The records lacked documentation of the Pts. consenting to the disciplines that will provide care and frequency of these visits on admission. 2. During interviews with the Administrator and Director of Clinical Services on 07/11/25 between 10:00 AM and 12:00 PM, the Administrator confirmed that the patients' admission consents lacked documentation of Pts. being informed of, and consenting to the services that will be providing care.

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 a review of clinical records and staff interviews, the Agency failed to ensure PsOC included all the requirements. This was found in 2 of 7 (Pts. # 2 and 3) clinical records reviewed. Findings include: 1. Pt. #2 was admitted to home health services on 02/14/25 with the diagnosis of but not limited to Hypertensive Heart Disease with Heart Failure and Chronic Diastolic (Congestive) Heart Failure (CHF). The clinical record was reviewed on 07/11/25 and included the PsOC from 02/14/25 through 08/12/25. The PsOC lacked interventions and Pt. education addressing medication management, reconciliation, and safety. The PsOC also lacked parameters for weight monitoring. During an interview with the Director of Clinical Services on 07/11/25, it was stated that Pts. admitted with the diagnosis of Heart Failure or CHF should be weighed weekly. The Director of Clinical Services stated that based on parameters that should be established in the POC, results that are out of range should be reported to the Physician. 2. Pt. #3 was admitted to home health services on 08/22/24 with the diagnosis of but not limited to, Hypertensive Heart Disease with Heart Failure and Gastrostomy Status. The clinical record was reviewed on 07/11/25 and included a POC effective 06/18/25. The POC lacked documentation of interventions and caregiver education for the care of the Gastrostomy tube. The POC also lacked documentation of supplies, treatment, and procedure for the care of the skin surrounding the ostomy. 3. During an interview with the Administrator and Director of Clinical Services on 07/11/25 at 11:00 AM, the above findings were confirmed.

Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This ELEMENT is not met as evidenced by: Based on a review of clinical records, Agency policy review, and staff interview, in 5 of 7 clinical records reviewed (Pts # 1, 2, 3, 5 and 6) the Agency failed to assess Pts. for pneumonia status on admission as per Agency policy. Findings include: 1. The following clinical records were reviewed on 07/10/25 and 07/11/25. The records lacked documentation indicating Pts. were assessed for pneumonia status. Pt. #1 SOC: 05/10/25 Pt. #2 SOC: 02/14/25 Pt. #3 SOC: 08/22/24 Pt. #5 SOC: 10/11/24 Pt. #6 SOC: 02/10/25 2. The Agency policy titled "Pneumonia Vaccination" was reviewed on 07/11/25 and required, "Procedure: …1. The staff of Nursing Resource Home Health, Inc (NRHH) shall document through a note in the clinical record of each patient, and who also received services from NRHH, that the need for pneumonia vaccination was addressed all throughout the year." 3. During interviews with the Administrator and the Director of Clinical Services on 07/11/25, the Administrator and Director of Clinical Services confirmed the Agency staff failed to assess Pts. for pneumonia status.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on a review of clinical records and staff interview, the Agency failed to ensure that the Home Health Aide was supervised by the RN every 14 days. This was found in 2 of 2 clinical records reviewed (Pts. # 1 and 4), who received Home Health Aide services beyond 14 days. Findings include: 1. Pt. # 1 was admitted to home health services on 05/10/25 with Diagnosis of Weakness. The clinical record was reviewed on 07/10/25. The clinical record had an Aide services care plan dated 05/10/25 that required weekly Aide visits. The weekly Aide visits began 05/25/25, and week 4 to week 9 of certification period lacked RN supervision every 14 days. 2. Pt. # 4 was admitted to home health services on 06/11/25 with Diagnosis of Atrial Fibrillation. The clinical record was reviewed on 07/10/25. The clinical record had an Aide services care plan dated 06/11/25 that required weekly Aide visits. The weekly Aide visits beginning 06/15/25, and week 2 to week 5 of certification period lacked RN supervision every 14 days. 3. The finding of the lack of Aide supervision was confirmed during an interview with the Administrator and Director of Clinical Services on 07/11/25 at 10:00AM.

Recertification survey completed. Standard level deficiencies cited. Abbreviations: # = number AM = morning SN = Skilled Nurse SOC = Start of care POC = Plan of Care PM = afternoon/evening Pt./ Pts. = Patient/Patients

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: A. Based on the clinical record review, policy review and Staff interview, it was determined the Agency Staff did not conform to the Physician’s order for the visit frequency. This was found in 2 of 7 (Pts. #4 and 7) records reviewed. Findings include: 1. Pt. #4 SOC 12/21/21. Diagnoses: Paroxysmal Atrial Fibrillation and Muscle Weakness (Generalized). The clinical record was reviewed on 03/30/22 at 1:00 PM. The Plan of Care dated 12/21/21 included orders for the Aide services 1 time a week for 9 weeks. The Aide missed a visit during the week of 03/06/22 (week #9). The clinical record lacked the missed visit note and lacked documentation that the Physician was notified. The POC was not modified by the Physician. 2. Pt. #7 SOC 08/28/21. Diagnoses: Encounter for Surgical Aftercare following Surgery and Essential (Primary) Hypertension. The clinical record was reviewed on 03/29/22 at 11:30 AM. The Resumption of Care orders dated 09/12/21 included orders for the Aide services 1 time a week for 9 weeks. The Aide missed a visit during the weeks of 10/10/21 and 10/17/21 (weeks #7 and 8). The clinical record lacked the missed visit notes and lacked documentation that the Physician was notified. The POC was not modified by the Physician. The clinical record also included a recertification plan of care dated 10/27/21 with orders for the SN visit frequency of: 1 time a week for 9 weeks. The SN did not provide any care during the weeks of 11/21/21 and 11/28/21 (weeks #5 and 6). The clinical record lacked the missed visit notes and lacked documentation that the Physician was notified. The POC was not modified by the Physician. 3. The Agency’s policy titled “Missed Visits” was reviewed on 03/31/22 at 9:30 AM. The policy required “…PROCEDURES: … 3. Clinicians must notify the physician… 5. Clinicians must set a date for rescheduled visit… 6. Clinicians must document and use the missed visit report form…” 4. On 03/31/22 at 9:30 AM, during the interview with the Administrator, it was stated that the Agency works hard to provide quality care but somehow there was an oversight with documenting the missed visits. 5. The above findings related to the Staff not conforming to the Physician’s order for the visit frequency of 1 time a week for 9 weeks were confirmed with the Agency Supervisor and Administrator on 03/31/22 at 9:30 AM.