Every finding on record at Zion Management Holdings, LLC

A Medicare Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Health Authority. The survey conducted from 05/11/2026 to 05/13/2026 resulted in a finding of standard level citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.102.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.542(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, REHs at §485.542, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on interview, document review and policy review, the Home Health agency failed to ensure 1 of 10 agency staff were trained in Emergency Preparedness as required. The failure to ensure staff were trained in Emergency Preparedness had the potential for staff not to know how to respond in a natural disaster or emergency and this could affect 42 patients currently on census. Findings include: For Submission Purpose During a home visit on 05/13/2026 at 3:20 PM, the Physical Therapist (PT1) was interviewed on what to do in case of a natural disaster and asked if he/she had been trained on Emergency Preparedness. PT1 stated he/she had not been trained by the Home Health Agency or by his/her contract company regarding Emergency Preparedness since his/her hire date of March 2026. He/she did not know who to contact or have knowledge of the emergency plan if an emergency or natural disaster such as an earthquake was to occur. Review of the personal file for PT1 revealed a check-off for competencies that included Emergency Preparedness, however the document did not include the name of the agency or company of where the training occurred. During an interview on 05/13/2026 at 4:23 PM, the Director of Nursing (DON) stated the contract staff bring the training they have with their other company. He/she stated the agency did the training prior to COVID and then the agency never went back to completing the training of contract personnel afterward. Review of the undated agency policy titled, "Emergency Operation Plan (EOP) Training Plan," indicated the following: "…The Agency will do the following: Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement and volunteers, (if applicable) consistent with their expected roles. Provide emergency preparedness training at least annually…" ."

A Medicare Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Health Authority. The survey conducted from 05/11/2026 to 05/13/2026 to the applicable Condition of Participation (CoP) under 42 CFR 484, Subparts A through C with the following standard-level deficiencies. Findings include:

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on interview, document review, and policy review, the Home Health agency failed to ensure medications were reconciled and a list was kept at the patient's home as required for 3 of 3 patients (Patient (P)1, P2 and P3) seen during home visit observations. The failure to ensure medications were reviewed and updated had the potential for medication errors to occur and this could affect 42 patients on census. Findings include: ." 1.Review of the Demographics page in the electronic medical record (EMR) for P1 revealed the agency admitted the patient on 04/30/2026. Review of the patient's Medication Record provided by the facility indicated the patient was on six home medications. During the home visit on 05/13/2026 at 3:00 PM, there was no printed or written list of medications in the patient's home. 2. Review of the Demographics page in the EMR for P2 revealed the agency admitted the patient on 02/25/2026. Review of the patient's Medication Record provided by the agency indicated the patient was on eight daily home medications, however the in-home medication list found in the patients Home Health folder during the home visit on 05/13/2026 at 11:30 AM, only contained three routine home medications and was dated 04/22/2026. During an interview with P2 during the home visit he/she was not aware of a medication list provided by the Home Health Agency. Review of the last skilled nurse visit was dated 05/02/2026 and there was no documentation that the medications were reconciled on that date. 3. Review of the Demographics page in the EMR for P3 revealed the agency admitted the patient on 11/30/2023 with the current recertification date of 03/14/2026. During the home visit on 05/13/2026 at 1:00 PM, the medication list found in the patients Home Health folder revealed a medication list dated 02/15/2025. The Director of Nursing (DON), who was doing the home visit, confirmed the date on the medication list and stated it should have been updated at the last skilled nurse visit that occurred on 05/04/2026. During an interview on 05/13/2026 at 5:15 PM the DON confirmed the patient's medication list should be updated each time the nurse completes a home visit. He/she confirmed there was no evidence that medication reconciliation occurred for P1, P2, and P3 on their last home visits completed by the nurse. Review of the undated agency policy titled, "Medication Reconciliation," indicated the following: "…At the time of admission, the admitting RN, PT, or SLP will create and document a complete list of medications that patient is taking at home, including dose, strength, route, and frequency. Any discrepancies will be reconciled by a RN with the patient's Physician…. Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication. The patient's medication list in the home will also be updated.

This Statement of Deficiencies was generated as a result of an Emergency Preparedness survey conducted at your agency from May 17, 2022 through May 20, 2022, in accordance with 42 Code of Federal Regulations (CFR) and the State Operations Manual (SOM), Appendix Z- Emergency Preparedness for All Provider and Certified Supplier Types. The findings and conclusions of any investigation by the Division of Public and Behavioral Health shall not be construed as prohibiting any criminal or civil investigations, actions or other claims for relief that may be available to any party under applicable federal, state, or local laws. No regulatory deficiencies were identified. No further action is necessary, Retain a copy of this report for your records.

This Statement of Deficiencies was generated as a result of the Medicare Recertification survey and Healthcare Worker (HCW) Vaccine Mandate conducted at your agency from May 17, 2022 through May 20, 2022 , in accordance with 42 CFR (Code of Federal Regulations) Part 484 - Home Health Services. The census on the first day of the survey was 55 patients. Seven clinical records were reviewed. Three home visits were conducted. The investigation of regulatory compliance for COVID-19 Vaccination of Facility Staff included: - Review of Infection Control Surveillance plans. - Review of Vaccination policies including staff members vaccination status, exemptions, (medical and non-medical), temporary delays for vaccinations, additional precautions for unvaccinated staff, contingency plans for unvaccinated staff and additional precautions to prevent the spread of Covid -19. Review of the facility's Healthcare Worker Vaccination policies and facility documentation revealed the facility was at 100% compliance with Healthcare Worker vaccination requirements. The findings and conclusions of any investigation by the Division of Public and Behavioral Health shall not be construed as prohibiting any criminal or civil investigation, actions or other claims for relief that may be available to any party under applicable federal, state, or local laws. The following regulatory deficiencies were identified:

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 observation, clinical record review and interview, the agency failed to ensure it updated a patient's medication profile for 1 of 7 patients (Patient #3). Findings include: Patient #3 On 2/11/2022, the agency admitted Patient #3 with spondylosis. The agency continued to recertify the patient through the current care episode of 4/12/2022 through 6/10/2022. On 5/19/2022, a home visit was conducted with a nurse. During the medication profile review in the home, multiple discrepancies were identified with administration frequency and medication doses. Three of the examples were identified as: Gabapentin 300 milligrams 3x daily on the agency profile vs daily in the home. Hydralazine 50 milligrams every 8 hours on the agency profile vs three times daily in the home. Losartan 100 milligrams daily on the agency profile vs 50 milligrams daily in the home. On 5/20/2022 in the afternoon, the Director of Nursing confirmed the findings. The Medication Reconciliation policy (8.15.1) revealed the medication profile would be updated with each new or changed medication. The patient's medication list in the home would also be updated.

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: Based on clinical record review and interview, the agency failed to ensure skilled nurses followed wound care orders for 1 of 7 patients (Patient #1). Findings include: Patient #1 On 4/6/2022, the agency admitted Patient #1 with a chronic, non-pressure ulcer of the left lateral lower leg. On 4/20-21/2022, a wound care physician ordered medihoney wound application weekly with skilled nursing visits. On 4/25/2022 and 5/2/2022, skilled nursing visits documented the proper order on the wound care worksheet, but the narrative notes revealed the nurse documented the use of triad instead of medihoney. On 5/9/2022, the skilled nursing visit documented the wound closed. On 5/20/2022 in the afternoon, the Director of Nursing confirmed the findings.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on clinical record review and interview, the agency failed to ensure a nurse notified a physician of a blood sugar reading > 300 for 1 of 7 patients (Patient #6). Findings include: Patient #6 On 5/29/2021, the agency admitted Patient #6 with diabetes mellitus type II. On 5/29/2021, the plan of care documented to report a blood sugar exceeding a parameter of > 300 to a physician. On 6/11/2021, a licensed practical nurse documented a skilled nursing visit with a blood sugar of 460. The clinical record lacked documented evidence the blood sugar was reported to a physician. On 5/20/2022 in the afternoon, the Director of Nursing indicated the nurse should have reported the blood sugar to a physician.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on clinical record review and interview, the agency failed to ensure it addressed or completed a physical therapy evaluation within 5 days. Findings include: Patient #2 On 5/5/2022, the agency admitted Patient #2 with bilateral knee osteoarthritis. On 5/5/2022, the plan of care showed a physician ordered a physical therapy evaluation. On 5/18/2022, an initial evaluation home visit was conducted with a physical therapist. The Physical Therapist indicated first awareness of the order on 5/13/2022, when the patient canceled for an eye appointment. The clinical record lacked documented evidence there was any attempt to contact the patient within the first 5 days following the start of care date of 5/5/2022, a reason why the evaluation could not be completed within 5 days, or why the evaluation was delayed. On 5/20/2022 in the afternoon, the Director of Nursing indicated the agency had 5 day expectations to address initial evaluations, confirming the above findings.