Every finding on record at Thank You Nurses Ltd

Purpose of Visit: Recertification and Relicensure Survey, 2 Incidents and 1 Complaint Investigation An entrance conference was conducted on 10/16/23 at 2:56 p.m., with the Administrator. Agency Census: Licensed and Certified Home Health Services – 3 Licensed Home Health Services – 0 Personal Assistance Services – 107 An exit conference was conducted on 10/20/23 at 5:40 p.m., with the Administrator. The Administrator was informed of the preliminary findings and was afforded the opportunity to provide additional information throughout the survey. The agency is in compliance with federal/state requirements no deficiencies/violations were cited. Incident #330271 – Unsubstantiated Complainant #430162 – Unsubstantiated Incident #430483 - Unsubstantiated ANE – Abuse, Neglect & Exploitation FM – Family Member Attendant PAS - Personal Assistance Services

Purpose of Visit: Recertification and Relicensure Survey, 2 Incidents and 1 Complaint Investigation An entrance conference was conducted on 10/16/23 at 2:56 p.m., with the Administrator. Agency Census: Licensed and Certified Home Health Services – 3 Licensed Home Health Services – 0 Personal Assistance Services – 107 An exit conference was conducted on 10/20/23 at 5:40 p.m., with the Administrator. The Administrator was informed of the preliminary findings and was afforded the opportunity to provide additional information throughout the survey. Written instructions were provided for submitting a plan of correction within 10 calendar days of receipt of the statement of deficiencies/ licensing violations. Incident #330271 – Unsubstantiated Complainant #430162 – Unsubstantiated Incident #430483 - Unsubstantiated ANE – Abuse, Neglect & Exploitation FM – Family Member Attendant PAS - Personal Assistance Services

Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to immediately report within 24 hours, knowledge of an alleged act of abuse, neglect, or exploitation of a client by an agency employee to the Department of Family and Protective Services and to the Health and Human Services Commission, for one of 13 patients (#5) whose records were reviewed. This failure placed Patient #5 at risk of harm, continued abuse and negative outcomes when not reporting knowledge of an alleged act of A, N and E within the required timeframe for immediate investigation. The findings included: Record review of the agency’s Complaint Log revealed a document titled “Client/Employee Grievance” dated 02/04/22. The Complainant reported concerns regarding Patient #5’s Attendant. The Complainant reported that Attendant L was rude and disrespectful to Client #5, that the client’s demeanor changed when Attendant L speaks to Patient #5 in that, the client looked down and stopped speaking. The Complainant stated that during a visit on 02/01/22, the Complainant noted that when Patient #5 was trying to get up to walk, Attendant L told Patient #5 to pick up her feet and then slapped the patient's (#5) leg and stated, “she needs to pick up her feet.” Further review of the document stated that the Complainant was concerned with how Attendant L behaved towards Patient #5 and feared how Attendant L/FM L may be treating the patient when providing care. During concurrent record review and interview on 10/17/23 at 4:30 p.m., the Administrator stated, "no, the agency did not file a self-reported incident." She stated that the complaint was reviewed by the quality assessment (QA)/Alternate Supervising Nurse, to determine if there was a risk identified. She stated that the QA Nurse recommended that a home visit be done by the PAS Supervisor. She stated that both Attendant L and Patient #5 denied the allegations during the in-person Supervisory visit and would provide the documents of the agency’s internal investigation. Review of the agency’s internal investigations revealed the following: Review of “Client/Employee Grievance” dated 02/04/22 revealed the Complainant called the agency to report concerns regarding Patient #5’s attendant, Attend/FM L. The grievance reported stated that Attend/FM L was rude and disrespectful to Patient #5, that the patient’s demeanor changed when Attendant L spoke to Patient #5, in that the patient [#5] looked down and stopped speaking. The Complainant stated that during visit on 02/01/22, the Complainant noted that when Patient #5 was trying to get up and walk, Attendant L told Patient #5 to pick up her feet and then slapped the client's leg and stated, “she needs to pick up her feet.” Further review of the document revealed that the Complainant was concerned with how Attendant L behaved towards and treated Patient #5 when providing care. Administrator determined based on the home visit findings that it was not a reportable incident and that the agency would monitor patient and home situation periodically. Review of the document titled, “Attendant Orientation/Supervisory Visit” dated 02/17/22 read in part, “no new conditions…Reason for visit was to verify a few concerns and to see if patient [#5] had any changes as this was a scheduled supervisory visit. Patient #5 reports she is satisfied with her services…review of the assigned tasks had satisfactory for all…Patient [#5] was asked about Attendant L if he ever struck her in the leg…or if Attendant L was ever rude or disrespectful towards her? Patient #5 stated, “no.” Attendant L was asked the same question, and stated, “he did not recall.” Further review revealed that the PAS Supervisor advised Attendant L to be mindful when he addressed Patient #5. Further review of the agency's internal investigation revealed that the PAS Supervisor conducted the supervisory visit on 02/17/22, which was 13 days after the agency was made aware of the allegations (02/04/22); that the Administrator determined based on the home visit findings that it was not a reportable incident and would monitor patient and home situation periodically. During an interview on 10/20/23 at 3:05 p.m., the QA/Alternate Supervising Nurse stated, stated that the home visit was to clarify and determine “relative vs. attendant” meaning if Attendant L was acting as the family member (relative) of Patient #5 or if he was working as the attendant. She stated that from experience with Attendant L, that is his usual mannerism since Patient #5 tends to be resistive to activities of daily living (ADL) care. She stated that her recommendation was to do a home visit and ensure that Attendant L was not overstepping his boundaries or being too assertive with Patient #5. She stated that based on the home visit and interviews, Attendant L required re-training in the care of Patient #5 and more frequent monitoring/supervisory visits. During the interview, the Nurse Surveyor asked why did it take 13 days to conduct the home visit? The QA/Alternate Supervising Nurse stated, “not sure why supervisory home visit was done 13 days later…when I recommended the follow-up visit it was meant to be done now.” During an interview on 10/20/23 at 3:45 p.m., the PAS Supervisor stated that the Complainant reported the incident on 02/04/22, that the incident occurred on 01/31/22. She stated that a “Client/Employee Grievance” report was completed and sent to the QA/Alternate Supervising Nurse for review. That re-orientation/training was recommended for Attendant L. She stated that both Attendant L and Patient #5 live in the same home and supervisory/home visit was done on 02/17/22 since that was the next scheduled supervisory visit. She stated that Attendant L was not removed from the case because Patient #5 refused, and the incident was not reported to Adult Protective Services. During the same interview on 10/20/23 at approximately 4:00 p.m., the Administrator stated, “looking back at the scenario, hindsight is 20/20…just based on the verbal was enough to do a self-report and adding the slap in the client’s [#5] leg, a self-report should have been done.”