Every finding on record at Senior Preferred Homecare LLC

A Recertification Survey entrance conference was conducted on 09/05/23 with the Administrator and CFO at 1:41 PM. Entrance Attempt 1: 09/05/23 at 10:00 AM Census L&CHHS: 3 An exit conference was conducted on 09/07/23 with the Administrator and CFO at 2:25 PM. The preliminary findings were discussed. The agency is in substantial compliance with no deficiencies cited.

A Recertification Survey entrance conference was conducted on 09/05/23 with the Administrator and CFO at 1:41 PM. Entrance Attempt 1: 09/05/23 at 10:00 AM Census L&CHHS: 3 An exit conference was conducted on 09/07/23 with the Administrator and CFO at 2:25 PM. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. Acronyms: L&CHHS: Licensed and Certified Home Health Services CFO: Chief Financial Officer

Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure that the designated supervising nurse maintained a current RN license in accordance with the Texas Board of Nursing rules for Nurse Licensure Compact. This failure places clients at risk of lack of nursing oversight and supervision from someone who does not meeting professional standards. Findings include: Record review document titled “Texas Board of Nursing, Primary Source of License Verification,” dated 03/27/2023, revealed that the RN license for the Supervising Nurse was current but set to expire 04/30/2023. After completing a new search using the Texas Board of Nursing, record review document titled “Texas Board of Nursing, Primary Source of License Verification,” dated 09/06/2023, revealed that the RN license for the Supervising Nurse was delinquent and noted the expiration date of 04/30/2023. Record review of policy titled “Personnel Records,” no date, revealed that personnel contents for agency employees would include “License, certification, and/or registration verification – when current licensure, certification, or registration are required by law or regulation to practice a profession, the organization verifies these credentials with the primary source at the time or hire and upon expiration of the credentials.” Record review of policy titled “Responsibilities of the Supervising Nurse,” no date, stated “the Supervising Nurse and Alternate Supervising Nurse must each be a registered nurse (RN) licensed in Texas or in accordance with the Texas Board of Nursing rules for Nurse Licensure Compact and have at least one year of experience as an RN within the last 36 months.” Surveyor completed interview with the Agency Administrator on 09/06/2023 at 1:30 PM. Surveyor showed the Agency Administrator the Texas Board of Nursing license verification report that was in the personnel record and the more recent license verification report. Surveyor showed administrator that the license for the Supervising Nurse was delinquent. The Agency administrator responded “I see that it is delinquent.” Surveyor asked Agency Administrator “How often does the agency check professional licensure to ensure that licenses and certifications are current?” Agency Administrator responded “We check every few months, but we do not have a consistent schedule.” Surveyor asked Agency Administrator “Is the Supervising Nurse currently working with clients or performing roles of the supervisory nurse? Would it be possible for me to interview the Supervising Nurse?” Agency Administrator responded “She does not currently work with patients, but she does function as the supervising nurse. She is currently on vacation though so she cannot be reached.”