I J Healthcare Nursing Resource Inc.

“Development of EP Policies and Procedures CFR(s): 484.102(b) §403.748(b), §416.54(b), §418.113(b), §441.184(b), §460.84(b), §482.15(b), §483.73(b), §483.475(b), §484.102(b), §485.68(b), §485.542(b), §485.625(b), §485.727(b), §485.920(b), §486.360(b), §491.12(b), §494.62(b). (b) Policies and procedures. [Facilities] must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. *[For LTC facilities at §483.73(b):] Policies and procedures. The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. *Additional Requirements for PACE and ESRD Facilities: *[For PACE at §460.84(b):] Policies and procedures. The PACE organization must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must address management of medical and nonmedical emergencies, including, but not limited to: Fire; equipment, power, or water failure; care-related emergencies; and natural disasters likely to threaten the health or safety of the participants, staff, or the public. The policies and procedures must be reviewed and updated at least every 2 years. *[For ESRD Facilities at §494.62(b):] Policies and procedures. The dialysis facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. These emergencies include, but are not limited to, fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters likely to occur in the facility’s geographic area. This Standard is not met as evidenced by: Based on a review of the Agency’s Emergency Preparedness Plan and staff interview, it was determined the Agency failed to establish policies and procedures based on a risk assessment. This has the potential to affect all Pts. that receive service from the Agency. Findings include: 1. The Emergency Preparedness Plan last updated on 12/23/23 was reviewed on 5/20/24. The Plan included multiple policies, procedures, and the Agency’s risk assessment form titled “Hazard Vulnerability Analysis (HVA): Agency (Facility-Based)”. The HVA form contained different types of potential emergencies associated with weather, utility failures, hazardous materials, security, terrorism, community mass casualty and other emergencies. The Agency was required to indicate the level of impact (low, moderate, or high) for the different types of emergencies, sign and date the form. The HVA form was left blank. The Agency failed to develop policies and procedures based on a completed risk assessment. 2. During an interview with the Administrator and Director of Nursing on 5/22/24 at 1:10 PM, both confirmed the above findings.”

“EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.542(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, REHs at §485.542, OPO, “Organizations” under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility’s] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility’s] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient’s home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice’s response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice’s emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility’s] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility’s] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE’s response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE’s emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility’s emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID’s emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA’s emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO’s response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI’s and OPO’s] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI’s response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI’s emergency plan, as needed. This Standard is not met as evidenced by: Based on a review of the Agency’s Emergency Preparedness Plan and staff interview, it was determined the Agency failed to conduct a full-scale exercise, facility-based exercise, or activate the Agency’s Plan as required. This has the potential to affect all Pts. that receive service from the Agency. Findings include: 1. The Emergency Preparedness Plan last updated on 12/23/23 was reviewed on 05/20/24. The Plan contained documentation that the Agency conducted table-top exercises in 2021, 2022, 2023, and on 01/14/24. 2. During an interview with the Administrator and Director of Nursing on 05/22/24 at 1:10 PM, the Director of Nursing confirmed that the Agency conducted only table-top exercises from 2021 to 2024. During the same interview, the Administrator and the Director of Nursing confirmed the Agency had not activated their Emergency Preparedness Plan since March 2020, and as of 5/22/24 the Agency did not participate in a full-scale or facility-based exercise from 2021 to 2024.”

“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 review of the Error Summary report and staff interview, it was determined that in 218 of 415 reports submitted for the last 12 months, the Agency failed to submit a timely report, resulting in a warning. Findings include: 1. The Error Summary report for 05/01/23 to 04/30/24 (12 months), was reviewed on 05/22/24. The report included a warning for 218 (52.53%) of 415 assessments with Error # -3330 Record submitted late, more than 30 days after completing the assessment. 2. During an interview with the Administrator and Director of Nursing on 05/23/24 at 9:45 AM, the Administrator stated that the timeframe for submission of OASIS is within 30 days after completion. During the same interview, the Administrator confirmed the above findings.”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on interview and observation during a home visit, clinical record review, Agency policy review, and staff interview, it was determined that in 1 of 7 (Pt. #2) clinical records reviewed, the Agency failed to inform staff for the need to use infection control practices in accordance with the Infection Prevention Standard of Practice, while providing service to a Pt. with an active infectious condition. Findings include: 1. Pt. #2 was admitted to Home Health Services on 11/09/23 with the primary diagnosis of Bilateral Primary Osteoarthritis of Knee. A home visit was conducted on 05/21/24 at 11:00 AM with Employee #6. During the home visit, an interview was conducted with the Pt. that stated she was uncomfortable due to having “Shingles”, observed Pt. #2 scratching her head and upper body. After the home visit an interview was conducted with Employee #6 that stated, the Agency did not inform him the Pt. has Shingles. The clinical record was reviewed on 05/21/24 at 12:30 PM. The record contained the “Encounter Home Visit” form signed by the Physician and faxed to the Agency on 05/13/24, the form included a new diagnosis of “Zoster with other complications”. The Agency failed to inform staff of the necessary precautions to prevent the spread of a viral infection. 2. The Agency’s policy titled, “Communicable/Infectious Disease Information Table” was reviewed on 5/23/24 at 9:40 AM. The policy included: “Disease/Infection - Herpes Zoster (Shingles) localized disseminated... Mode of Transmission - Contact with moist lesions... Signs and Symptoms - Skin lesions”. 3. During an interview with the Administrator and Director of Nursing on 5/22/24 at 1:10 PM, both confirmed the Agency failed to notify the RN and PT that Pt. #2 had an infectious condition. During an interview with the Director of Nursing on 5/23/24 at 9:20 AM, the Director of Nursing stated the Agency is required to notify staff of Pts. that have an infectious condition, so that staff may use correct precautions like gloves when in contact with the Pt., and to use dedicated equipment (blood pressure machine, thermometer, gait belt) to leave in the patient’s home.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on clinical record review and staff interview, it was determined that in 2 of 7 (Pts. # 5 and 6) clinical records reviewed, the Agency failed to ensure that initial assessments were conducted within 48 hours of receiving the referral. Findings include: 1. Pt. #5 was admitted to Home Health Services on 10/30/23 with Diagnosis of Type 2 Diabetes Mellitus without complications. The clinical record was reviewed on 05/21/24. The SOC assessment dated 10/30/23, documented a referral date of 10/27/23, patient was not discharged from an inpatient facility, or did not have a physician ordered specific SOC date. The SOC assessment was conducted after 48 hours of the referral. 2. Pt. #6 was admitted to Home Health Services on 07/03/23 with Diagnosis of Primary Osteoarthritis. The clinical record was reviewed on 05/21/24 and 05/22/24. The SOC assessment dated 07/03/23, documented a referral date and inpatient discharged date of 06/26/23. The clinical record did not indicate a Physician ordered specific SOC date. The SOC assessment was conducted after 48 hours of the referral. 3. During interview with the Administrator and Director of Nursing on 05/23/24 at 9:45 AM, the Director of Nursing confirmed the above findings.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on clinical record review, and staff interviews, it was determined that in 2 of 7 (Pts. #2 and 5) clinical records reviewed, the Agency failed to ensure the POC was updated to include Physician orders. Findings include: 1. Pt. #2 was admitted to Home Health Services on 11/09/23 with the primary diagnosis of Bilateral Primary Osteoarthritis of Knee. A home visit was conducted on 05/21/24 at 11:00 AM with Employee #6. During the home visit, the Pt. stated she was uncomfortable due to having “Shingles”. After the home visit an interview was conducted with Employee #6 that stated, the Agency did not inform him that the Pt. has Shingles. The clinical record was reviewed on 05/21/24 at 12:30 PM. The record contained the “Encounter Home Visit” form completed by the Physician Assistant on 04/29/24, signed by the Physician and faxed to the Agency on 05/13/24 which included, a new diagnosis of “Zoster with other complications”, and medications ”Ketoconazole (Topical) 2% apply 1 application to affected area 2 times per week for 4 weeks, Lidocaine HCI 3 % External Cream 3 times a day, Triamcinolone Acetonide (Topical) Apply 1 application topically to affected area daily for 4 weeks, Valacyclovir HCI 1 GM Take 1 tablet (1,000 mg) by mouth 3 times a day for 7 days”. As of 5/22/24, the POC effective 5/7/24 lacked an update to include the diagnosis and treatment of “Zoster with other complications”. 2. Pt. #5 was admitted to Home Health Services on 10/30/23 with primary diagnosis of Type 2 Diabetes Mellitus without complications. The clinical record was reviewed on 05/21/24. The Physician orders for recertifcation dated 2/23/24 and 04/25/24, indicated Agency to check A1C lab every 3 to 4 months. As of 05/23/24, the POC effective 02/27/24 to 04/26/24 and 04/27/24 to 06/25/24, lacked an update to include orders for Agency to check A1C lab every 3 to 4 months. 3. During interviews with the Administrator and Director of Nursing on 05/22/24 at 1:10 PM and on 05/23/24 at 9:45 AM, the Director of Nursing confirmed the above findings.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on a review of clinical records and staff interviews, it was determined that in 3 of 7 (Pts. #2, 4 and 5) clinical records reviewed, the Agency failed to ensure staff provide treatment or service, as ordered by the Physician. Findings include: 1. Pt. #2 was admitted to Home Health Services on 11/09/23 with the primary diagnosis of Bilateral Primary Osteoarthritis of Knee. The clinical record was reviewed on 05/21/24. The record contained the RN visit note dated 04/25/24 which included, “…I instructed patient to take Melatonin 5mg at bedtime…” The POC for the certification period of 03/08/24 to 05/07/24 required Pt. #2 to take “Melatonin 3 mg-at bedtime”. 2. Pt. #4 was admitted to Home Health Services on 04/05/24 with the primary diagnosis of Stage 3 Pressure Ulcer of Left Hip. The clinical record was reviewed on 05/21/24. The record contained the Face to Face Encounter/Physician order form signed by the Physician, and forwarded to the Agency on 04/26/24. The order included: “Physical Therapy For: To evaluate and treat for functional deficits, related to mobility...Home safety evaluation. Strength, Gait, Balance training. Transfer training. Instruct on Fall prevention... Establish H.E.P (Home Exercise Program)...” As of 5/21/24, the record lacked documentation the Agency provided Physical Therapy on/or after 04/26/24. During an interview with the Administrator and Director of Nursing on 5/22/24 at 1:10 PM, both stated that the Agency has not referred Pt. #4 for a Physical Therapy evaluation. 3. Pt. #5 was admitted to Home Health Services on 10/30/23 with Diagnosis of Type 2 Diabetes Mellitus without complications. The clinical record was reviewed on 05/21/24. The Physician orders dated 2/23/24 and 04/25/24, indicated Agency to check A1C lab every 3 to 4 months. The clinical record included an A1C lab report dated 11/02/23. There were no modification of physician orders or communication as to why A1C lab was not done after 11/02/23. 4. During interviews with the Administrator and Director of Nursing on 05/22/24 at 1:10 PM and on 05/23/24 at 9:45 AM, the Director of Nursing confirmed the above findings.”

“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, it was determined in 1 of 2 (Pt. #6 ) clinical records reviewed, wherein the Pt. received Home Health Aide services, the Agency failed to ensure the RN conduct Home Health Aide supervision every 14 days. 2. Pt. #3 was admitted to Home Health Services on 04/23/24 with the primary diagnosis of Other Seqelae of Cerebral Infarction. The clinical record was reviewed on 05/22/24. The record contained weekly Home Health Aide visit notes dated 05/03/24 and 05/06/24. As of 05/22/24, the record lacked documentation of any Home Health Aide supervision by the RN. 3. During interviews with the Administrator and Director of Nursing on 05/20/24 at 9:22 AM, the Director of Nursing stated only the RN conducts Home Health Aide supervision, and this is done every 14 days. During interviews with the Administrator and the Director of Nursing on 05/22/24 at 1:10 PM, and 05/23/24 at 9:45 AM, both confirmed the above findings. Findings include: 1. Pt. #6 was admitted to Home Health Services on 07/03/23 with primary diagnosis of Primary Osteoarthritis. The clinical record was reviewed on 05/21/24 and 05/22/24. The record contained Home Health Aide visit notes dated 07/24/24, 07/31/24 and 08/07/24. As of 05/22/24, the record lacked documentation of Home Health Aide supervision by the RN from 07/24/23 to 08/14/23.”