Every finding on record at Staffing Village Inc.

Based on the findings of an unannounced onsite Home Health Agency Medicare Re-Recertification Survey conducted on September 8, 2025, through September 11, 2025, Staffing Village Home Health Care was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite Home Health Agency Medicare Re-Certification Survey conducted on September 8, 2025, through September 11, 2025, Staffing Village Home Health Care was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This ELEMENT is not met as evidenced by: Based on a review of clinical records (CR), agency policies, the agency failed to ensure a comprehensive assessment was conducted the last 5 days of every 60 days beginning with the start-of-care date for two (2) of five (5) CR reviewed: CR# 2 and 4. Findings include: A review of agency’s policies was conducted on 9/11/25 2 pm. A policy titled, “Comprehensive Assessment of Patients (OASIS)” reads, “…Policy: A comprehensive assessment incorporating the Outcomes and Assessment Information Set (OASIS) utilizing the most current approved version will be performed on qualified patients at: … When the patient’s condition warrants due to major decline or major improvement, but not less frequently than every second month; … 7. Every second calendar month at recertification, a follow-up OASIS assessment will be performed. The follow-up skilled visit assessment shall be performed no earlier than five days prior to the last day of the certification period (between and including days 56-60). A review of CR’s including Alora.com and paper format was conducted on 9/8/25 starting at approximately 10 am, and again on 9/9/25 starting at 10:30 AM. The Start of Care (SOC) and CMS-485 Home Health and Certification Period (CP) are shown below. CR#2 SOC 5/6/25, contained a recertification comprehensive assessment completed on 7/6/25 for certification period 7/5/25 – 9/2/25 which is late. CR#4 SOC 12/18/24, contained a recertification comprehensive assessment completed on 8/8/25 for certification period 8/15/25 – 10/13/25 which is too early. An interview with administrator on 9/10/25 11am confirmed the above findings.

Based on the findings of an on-site unannounced home health agency initial Medicare certification survey conducted January 17, 2023, through January 20, 2023, and concluded off-site on January 23, 2023, Staffing Village Home Health Care was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an on-site unannounced home health agency initial Medicare certification survey conducted January 17, 2023, through January 20, 2023, and concluded off-site on January 23, 2023, Staffing Village Home Health Care was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of clinical records (CR), agency policy, and interview with the agency Administrator, the agency failed to ensure that the registered nurse reviewed all medications in accordance with agency policy for four (4) of seven (7) clinical records reviewed. (CR # 1, 3, 4, and 6). Review of agency policy 4.009.1 titled, "Medication Profile", on January 19, 2023, at approximately 2:15 PM states " Nursing staff check all medications a patient may be taking to identify possible effectiveness, ineffectiveness, side effects, toxic effects, desired effects, allergic reactions, unusual/unexpected effects, actual or potential drug interactions, duplicate drug therapy, non-adherence, the need for laboratory monitoring of drug levels, drug allergies, and contraindicated medication, and promptly report any problems to the physician... The medication profile will be updated at least every 60 days or more often as needed. All new medications will be added to the medication profile and checked for interaction risks by the case manager." Review of clinical records (CR) on January 19, 2023, from approximately 9:30 A.M. to 4:00 P.M., January 20, 2023, from approximately 2:30 P.M. to 4:00 P.M. and January 23, 2023, from approximately 10:00 A.M. to 12:00 P.M. revealed the following: CR #1, start of care September 19, 2022. Certification period reviewed November 19, 2022, to January 16, 2023. Diagnosis: Anxiety. Review of Home Health Certification and Plan of Care (POC) and the medication profile revealed the following discrepancies: Cetirizine (antihistamine) is documented on the POC as follows: 10 mg (milligram) tab (tablet), one tab by mouth twice daily. This medication is not documented on the medication profile. Diltiazem (antihypertensive) is documented as follows in the POC: 360mg/24 hours oral capsule ER (extended release), one cap (capsule) by mouth once daily. This medication is not documented on the medication profile. Fluconazole (antifungal) is documented on the POC as follows: 150 mg tab, one tab by mouth once- Repeat does in 3 days if symptoms persist. This medication is not documented on the medication profile. Fluticasone nasal (anti-inflammatory) is documented on the POC as follows: (fluticasone 50 mcg/inh (inhalation) nasal spray) instill 2 sprays into each nostril once daily. This medication is not documented on the medication profile. Pantoprazole (acid reducer) is documented on the POC as follows: 40 mg tab DR, one tab by mouth once daily 30 minutes before breakfast – GERD. This medication is not documented on the medication profile. CR #3, start of care October 3, 2022. Certification period reviewed, December 2, 2022, through January 29, 2023. Diagnosis: Mitochondrial Metabolism (genetic disorder). Review of the POC, medication profile and medication administration record (MAR) revealed the following: Novolog (Aspart)(insulin, used to regulate blood sugar) is documented on the POC and medication profile as follows: Novolog (Aspart) 40 units at 10 am, skip for BS (blood sugar) 90 or less, BS 91-110 give ½ dose SQ (subcutaneously); Novolog (Aspart) 40 units at 2 pm, skip for BS 90 or less, BS 91-110 give ½ dose SQ; Novolog (Aspart) 40 units at 6pm, skip for BS 90 or less, BS 91-110 give ½ dose SQ; Novolog (Aspart) 28 units at 10 pm, skip for BS 90 or less, BS 91-110 give ½ dose SQ. The MAR for December, 2022, noted the following new orders on December 9, 2022: Novolog (Aspart) 26 units at 10 am, skip for BS 100 or less, BS 101-125 give ½ dose SQ; Novolog (Aspart) 40 units at 2 pm, skip for BS 100 or less, BS 101-125 give ½ dose SQ; Novolog (Aspart) 26 units at 6 pm, skip for BS 100 or less, BS 101-125 give ½ dose SQ; Novolog (Aspart) 28 units at 10 pm, skip for BS 100 or less, BS 101-125 give ½ dose SQ. There was no documentation of a verbal order obtained for the medication changes, and the POC and medication profile have not been updated. Sliding scale (inuslin dosage based on blood sugar level): Novolog (Aspart) is documented on the POC and medication profile as follows: Novolog (Aspart) blood sugar 201-250 – 4 units SQ. This medication is not listed on the MAR. Lantus insulin 38 units at bedtime SQ is documented on the POC, medication profile, and MAR. The December, 2022, MAR noted the dosage was changed to 34 units. There was no documentation of a verbal order obtained for the medication change, and the POC and medication profile have not been updated. Tolnaftate 1% solution (anti-fungal) is documented on the POC and MAR as follows: thin layer to 2nd left toenail daily (topical). The medication is not documented on the medication profile. L-Argenine (400 mg/ml suspension) (amino acid) is documented on the POC and MAR as follows: 4000 mg (10 ml) 3x day J-tube. The dosage is documented on the medication profile as (1mcg/ml) 0.25 mcg (0.25 ml) 2x day J-tube. There is no drug category listed on the medication profile. B complex liquid (vitamin supplement) is documented on the POC as follows: 8 ml daily – J-tube. The medication is documented on the medication profile and MAR as follows: B complex liquid 5 ml daily- J-tube. Sodium chloride tablets (electrolyte) is documented on the POC, medication profile, and MAR as 1000 mg (1mg) 3 x day- J-tube (tube inserted through the abdomen into the jejunum). This should be 1 gram (G). Baclofen (muscle relaxant) is documented on POC and MAR as follows: 5mg BID @ 6am and 6pm -J-tube. The medication is not documented on the medication profile. Tums sugar free (antacid) is documented on POC and medication profile as follows: 750 mg tab crushed 2x day – J-tube. This medication is not documented on the MAR. Airborne original (supplement) is documented on the POC and medication profile as follows: (1000 mg vit C/tab) ½ tab (500 mg Vit C) – daily PRN congestion/cough- J-port. This medication is not documented on the MAR. Oragel or ambesol topical (topical anesthetic) is documented on the POC and medication profile as follows: small amount to affected area mucous membrane mouth- up to 4X day PRN (as needed) mouth sores or discomfort – topical. This medication is not documented on the MAR. Benadryl (antihistamine) is documented on the POC and medication profile as follows: 12.5 mg – Q PM PRN allergy symptoms – J-tube. This medication is not documented on the MAR. Baclofen (muscle relaxant) is documented on the POC and medication profile as follows: 5 mg Q 24 PRN muscle spasms – J-tube. This medication is not documented on the MAR. Vicks Vapor (vapor rub) is documented on the POC as follows: thin layer to heels or chest- up to 3 x Day PRN congestion – topical. This medication is not documented on medication profile or MAR. Melatonin (sleep aid) is documented on the MAR as follows: 3mg tab, one tab via G-tube (tube inserted through the abdomen into the stomach) PRN for sleep. This medication is not documented on the POC or medication profile. Robitussin (cough suppressant) cough and chest congestion is documented on the MAR as follows: 10 ml soln (solution), give 10 ml via J-port every 12 hours as needed for congestion/cough. This medication is not documented on the POC or medication profile. Nystatin Ointment (anti-fungal) is documented on the MAR as follows: TID (3 times per day) to affected area x 10 days -sent to her CVS pharmacy. Massage the area to which ointment is being applied to promote circulation. This medication is not documented on the POC or medication profile. CR #4, start of care September 29, 2022. Certification period reviewed, November 28, 2022, through January 28, 2022. Diagnosis: Fabry (Anderson) Disease (neurological disorder). Review of the POC, medication profile and MAR revealed the following discrepancies: Atorvastatin (for high cholesterol) is documented on the POC as follows: 20 mg tab, on tab by mouth every evening for high cholesterol. This medication is not documented on the medication profile or MAR. Brillinta (to prevent stroke) is documented on the POC as follows: 90 mg tab, one tab by mouth every twelve hours. This medication is not documented on the medication profile or MAR. Fluticasone propionate (anti-inflammatory) is documented on the POC and the medication profile as follows: (flonase) 5mcg/actuation. The medication strength is documented as 50 mcg on the MAR. Riboflavin (vitamin B2) is documented on the POC and medication profile as follows: 100 mg tab, take 4 tabs by mouth daily. The medication dosage is documented on the MAR as 400 mg (4) tabs by mouth daily-supplement. Dantrolene (Dantrium)(muscle relaxant) is documented on the POC and MAR as follows: 50 mg caps, one cap by mouth three times daily as directed. The medication is documented on the medication profile as Dantrium 50 mg caps, give 100 mg cap by mouth. No frequency is listed and the dosage conflicts with the POC and medication profile. Motrin (Ibuprofen) tabs (NSAID) is documented on the MAR as follows: 200 mg, administer 600 mg (3 tabs) by PO for headache PRN. The medication is not documented on the POC or the medication profile. There is no verbal order for the medication. Olopatadine (Patanase) (allergy relief) is documented on the POC and medication profile as follows: 0.6% spray, non-aerosol, administer 2 sprays into each nostril twice daily as directed-seasonal allergies. The MAR only lists the medication with no dosage or frequency. Trazadone (antidepressant) is documented on the MAR as follows: 100 mg, take 1 tab (100 mg total) by mouth nightly. This medication is not documented on the POC or medication profile. There is no verbal order for this medication. CR #6, start of care December 11, 2017. Certification period reviewed, December 8, 2022, through February 5, 2023. Review of the POC and medication profile revealed the following discrepancies: Ibuprofen (NSAID) is documented on the medication profile as follows: take one tab by mouth every 8 hours with food as needed for pain. This medication not documented on the POC. No strength is listed for the medication. Senna (stool softener) is documented on the medication profile as follows: 8.6 mg tabs take one tab by mouth once daily to prevent constipation. This medication not documented on the POC. Colace (stool softener) is documented on the medication profile as follows: 100 mg caps take two (2) by mouth once daily to prevent constipation. This medication is not documented on the POC. An interview with the administrator and board director on January 19, 2023, at approximately 3:00 P.M. and follow-up email communication on January 23, 2023, at approximately 10:00 A.M. confirmed the above findings.