Novus Lifecare

“Accessibility CFR(s): 484.50(f)(1,2) Standard: Accessibility. Information must be provided to patients in plain language and in a manner that is accessible and timely to— (1) Persons with disabilities, including accessible web sites and the provision of auxiliary aids and services at no cost to the individual in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. (2) Persons with limited English proficiency through the provision of language services at no cost to the individual, including oral interpretation and written translations. This Standard is not met as evidenced by: Based on admission packet review and interview, the home health provider failed to ensure patients were informed of the right to have access to patient rights information that was provided and accessible to persons with disabilities. This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the admission folder, provided to the state agent coordinator on 06/01/2026, showed the notice of patient rights and other information given to a patient during the initial visit, failed to contain information regarding this patient right. During an interview on 06/03/2026 at 3:58 PM, the administrator stated that the patient rights failed to contain the right to contain provision of auxiliary aids and how to access auxiliary aids. It was not included in the handbook.”

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure that each patient received the home health services that were written in the individualized plan of care (POC), in but not limited to, one of five records reviewed (Record/Patient #5). This deficient practice has the potential to affect all the patients on service. Findings included: Review of the provider’s undated policy titled, “Care Plan,” showed in part: - Each patient will have an individualized plan of care that specifies the care and services necessary to meet the patient’s specific needs as identified in the comprehensive assessment; and - Home health services for members of the agency (provider) staff, as well as those under contractual arrangements, shall be provided in accordance with the plan of treatment and the patient care plan. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to home health services on 01/12/2026 with a primary diagnosis of fracture of the lower end of the left femur, subsequent for closed fracture with routine healing (a break in the lower part of the thigh bone above the knee). The patient resided at home with their spouse. Review of the POC, dated 01/12/2026 to 03/12/2026 showed physical therapy 2 wk 3 (twice a week for three weeks), 1 wk 6 (once a week for six weeks). Further review of week one of the clinical record showed: - A physical therapy evaluation on 01/12/2026; - A note dated 01/16/2026 with “This physical therapy assistant (PTA) was unavailable and couldn’t see the patient with schedule conflict and limited staffing. Other clinicians were not able either.”; and - Physical therapy failed to perform a second visit for the week of 01/11/2026 to 01/17/2026, as ordered in the POC.. During an interview on 06/03/2026 beginning at 3:14 PM the clinical manager stated that this PTA (the one that documented the 01/16/2026 note) failed to notify the provider and had been terminated.”

“Access to auxiliary aids and language service CFR(s): 484.50(c)(12) Be informed of the right to access auxiliary aids and language services as described in paragraph (f) of this section, and how to access these services. This Element is not met as evidenced by: Based on admission packet review and interview, the home health provider failed to ensure patients were informed of the right to have access to auxiliary aids and how to access these services. This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the providers admission packet titled, “Home Health Admission Booklet,” dated 2026-2027 showed in part: - Patient rights and resposibilities: * The patient has the right/responsibility: * To be given the option of an interpreter if needed by the completion of second visit. To be informed that language assistance will be provided using competent bilingual staff, staff interpreters, contracts, formal arrangements with local organizations providing interpretation services, or technology and telephonic interpretation services; and * The agency failed to include patients have the right to be informed of the right to access auxiliary aids (essential devices, services and technologies that ensure effective communication for individuals with disabilities) and how to access these services. During an interview on 06/03/2026 at 3:58 PM, the administrator stated that auxiliary aids were essential devices and technology for individuals with disabilities and that it was not included in the handbook.”

“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 policy review, record review, observation, and interview, the home health provider failed to ensure that all medications the patient was taking were current in one of three home visit observation records reviewed (Record/Patient #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Medication Profile,” showed in part the following: - To ensure all patients and clients have a current list of medications; - The comprehensive assessment includes a review of all medications the patient is currently using, both prescription and non-prescription; - The drug regimen review occurs as an ongoing part of the care to the patient; - The medication profile must contain all current patient medication(s); - Medication profiles must be updated at least every 60 days, and whenever there is a change in the medication regimen; - The nurse performs ongoing medication monitoring; - A medication profile will be filled out upon initial evaluation of each patient/client. A copy is kept in the patient/client home and updated as personnel are made aware of any changes; - The copy that is placed in the patient/client’s chart will be updated, as appropriate, but no less than every recertification period; and - The profile will include both prescription and non-prescription medications. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 05/11/2026 with a primary diagnosis of acute and chronic respiratory failure with hypoxia (body’s tissues and organs do not receive enough oxygen to function properly), secondary diagnosis includes hypertensive heart and chronic kidney disease with heart failure and unspecified chronic kidney disease (CKD) (high blood pressure, stage 1, 2, 3, 4, or unspecified CKD, and damage to the heart that results in the heart’s inability to pump effectively) and congestive heart failure (CHF; a decrease in the ability of the heart to pump blood). The patient resided at home with his/her spouse. Review of the plan of care (POC), dated 05/11/2026 through 07/09/2026, showed the skilled nurse (SN) was to visit the patient 1w1 (one time a week for one week), 2w1 (two times a week for one week), and 1w7 (one time a week for seven weeks). The SN made weekly visits. Observation and interview on 06/02/2026 at 1:44 PM, showed the following discrepancies between the provider’s current medication profile (printed on 06/01/2026) and the patient’s home medication bottles: - The provider’s current medication profile showed the patient was to use MiraLax (constipation) Oral 17 gram (GM)/scoop in 8 ounces fluid daily as needed. The spouse/caregiver stated that he/she took in the AM and afternoon after seeing the physician; - The provider’s current medication profile showed the patient’s trazodone (antidepressant) hydrochloride (HCL) oral 50 milligrams (mg) one tablet at night for sleep was discontinued 05/22/2026. The spouse/caregiver stated that he/she restarted the trazodone; - The provider’s current medication profile showed the patient’s amlodipine (blood pressure) besylate oral 10 mg one tablet in AM was discontinued 05/22/2026. The spouse/caregiver stated that he/she restarted the amlodipine after seeing the physician; - The patient’s spouse/caregiver stated he/she takes nephplex (vitamin and mineral supplement formulated specifically for patients undergoing kidney dialysis) one by mouth every twenty-four hours (filled 05/12/2026 and takes midday). The provider’s medication profile failed to include nephplex; - The patient’s spouse/caregiver stated he/she takes zinc picolinate (zinc supplement) 50 mg one by mouth in the AM. The provider’s medication profile failed to include zinc picolinate; - The patient’s spouse/caregiver stated he/she takes torsemide (diuretic) 20 mg one by mouth in AM and PM. The provider’s medication profile failed to include torsemide; - The patient’s spouse/caregiver stated he/she takes hydroxyzine (antihistamine) 25 mg one by mouth three times a day as needed. The provider’s medication profile failed to include hydroxyzine; and - The patient’s spouse/caregiver stated he/she takes magnesium oxide (magnesium supplement) 400 mg one by mouth two times a day. The provider’s medication profile failed to include magnesium oxide. During an interview on 06/03/2026 beginning at 12:45 PM, the administrator stated that the SN reconciled medications at the start of care and with any medication changes.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on policy review, record review, observation, and interview, the provider failed to ensure that each patient’s written individualized plan of care (POC) included patient-specific interventions and education, all safety measures regarding high-risk medications, and the physical therapy (PT) frequency and duration of visits to be made, and measurable outcomes and goals as identified in the comprehensive assessment, in four of five full records reviewed (Records/Patients #1, #2, #3, and #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Care Plan,” showed in part: - Each patient will have an individualized POC that specifies the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s) and the measurable outcomes that the agency anticipates will occur; - The care plan is started upon initiation of service by the registered nurse (RN), based upon the plan of treatment and an assessment of the patient’s needs, resources, family and environment; - Continuing evaluation and service modifications are to be provided as indicated as an integral part of the ongoing provision of agency (provider) services; - Home health services for members of the provider’s staff, as well as those under contractual arrangements, shall be provided in accordance with the plan of treatment and the patient’s care plan; - The patient care plan shall be written by appropriate members of the home health services team based upon the plan of treatment and an assessment of the patient’s needs, resources, family and environment; - The patient care plan shall be updated as often as the patient’s/ client’s condition indicates but at least every 60 days; and - Steps to be taken in developing the care plan include: * Collection of baseline data including all pertinent diagnoses, including mental status, types of services, identification any services furnished by other providers and how those services are coordinated, equipment required, frequency and duration of visits, prognosis, rehab potential, functional limitations, ability to perform basic activities of daily living, activities permitted, the family or other caregivers ability to provide care, patient/client and family’s teaching needs, instructions for timely discharge or referral and any other appropriate items; * Identification of the clients continuing need for home care and meet the clients medical, nursing, rehabilitative, social and discharge planning needs including health needs/ problems with which a patient/family needs assistance; * All patient care orders, including verbal orders, must be recorded in the plan of care; * Determination of the nature of the home care service(s) needed, with consideration of applicable medical orders, the specific needs of the patient, measures required for comfort, safety, and prevention of complications, Actions that must be taken to achieve goals; * Staff responsible for each element of service; * Anticipated outcome of service approach with an estimated time frame for completion; * The establishment of a schedule for the provision of services which lists the description and frequency of each healthcare service, the required treatment and procedure, as well as the medication and diet regimen to be provided; and * Revision of the POC as frequently as necessary to reflect the changing care needs of the patient/ client but no less frequently than every 60 days. Review of the provider’s undated policy titled, “Medication Profile,” showed in part: - The comprehensive assessment includes a review of all medications the patient is currently using; - Agency staff reviews all medicines a patient/client may be taking to identify effectiveness of drug therapy, drug side effects, immediate desired effects, unusual and unexpected effects, actual or potential drug interactions, duplicate drug therapy, non-adherence with drug therapy, drug therapy currently associated with laboratory monitoring, allergic reactions, and changes in the patient’s condition that contraindicates continued administration of the medication; - The medication profile must contain all current patient medications and potential side effects; - The nurse performs ongoing medication monitoring to determine their action, indications, special precautions, patient/client’s response to therapy, side effects, allergies and contraindications, and ensure appropriateness and continuity of care and includes the information necessary for creating an accurate medication history and a complete medication profile and to identify the potential complications from the therapy being provided and to help ensure the safety of the medication use process as follows: * Significant side effects; * Special precautions; and - The profile will also serve as a tool for the purpose of patient/client/caregiver education. RECORD/PATIENT #1: Review the clinical record showed the patient was admitted to home health services on 05/18/2026 with a primary diagnosis of a urinary tract infection. He/she lived in a small shed converted into a home next door to family who provided support. Review of a referral with a fax cover sheet titled discharge (DC) and home health (HH) orders, dated 05/15/2026, showed: recommend basic metabolic panel (BMP- A standard blood test that measures eight key substances in your blood including kidney markers) in one week to follow up on renal (kidney) function. Review of an OASIS (Outcome and Assessment Information Set; a standardized data collection tool) start of care (SOC) assessment dated 05/18/2026 showed on page 36 0f 37: “Ensure follow-up BMP and physician appointments are completed.” Review of the physical therapy (PT) evaluation note that was sent to the physician for signature, dated 05/18/2026, showed: - Frequency and duration were once a week for six weeks; - A treatment plan for therapeutic exercise, establish or upgrade a home exercise program, transfer training, gait training, pulmonary physical therapy, balance training, muscle re-education, stairs/steps training, home safety training, assistive device training, and O2 (oxygen) saturation (the level of oxygen in the bloodstream) monitoring as needed; and - Treatment goals (This information failed to be included on the initial POC). Review of the Initial POC dated 05/18/2026 to 07/16/2026 showed: - SN to instruct patient on measures to detect and alleviate edema (swelling of the tissues); and - PT eval and treat. - The initial POC failed to include BMP in one week, and patient-specific PT interventions and education, measurable outcomes and goals, and the PT visit frequency and duration. Further review of the clinical record showed: - A SN visit note dated 05/21/2026 with documentation that the patient had compression stockings removed at the time of the visit; - The record failed to include BMP results or any documentation of coordination with the physician’s office regarding the BMP; and - The POC failed to be updated with the use of the compression stockings. During an interview on 06/03/2026 starting at 3:14 PM the clinical manager stated that: - He/she would have expected the BMP to have been addressed on the POC or documentation of communication about the BMP; - The POC should have been updated about the use of the compression stockings when the nurse found out that the patient was wearing them; and - The provider has POCs per each discipline because their EMR doesn’t allow them to be combined. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 04/14/2026 with a primary diagnosis of Stage 4 pressure ulcer (a full thickness loss of the skin with extensive destruction, exposing muscle, bone, tendon, or ligaments) of sacral (area at the base of the spine, just above the tailbone) region. The patient resided alone in their own home. Review of an OASIS (Outcome and Assessment Information Set; a standardized data collection tool) start of care (SOC) assessment dated 04/14/2026 showed Veterans Administration (VA) orders included medication management, however, at the time of admission, the patient declined skilled nursing assistance with medication setup. Patient reported medications were kept in the bathroom medicine cabinet and were organized by his preference. Skilled nursing would continue to assess patients understanding and medication regimen and willingness to allow assistance with medication management to ensure safety and compliance. Review of the next SN visit note dated 04/17/2026 (three days later and within the five-day comprehensive assessment window) showed “pillbox (medication planner box) filled again today.” The patient is showing compliance when filled by SN. Review of the POC dated 04/14/2026 to 06/12/2026 failed to show SN to fill the medication planner box. Further review of the clinical record failed to show orders to update the POC with orders for SN to fill the medication planner box. During an interview on 06/03/2026 starting at 3:14 PM the clinical manager stated that he/she would expect the filling of the medication planner on the POC. RECORD/PATIENT #1: Review the clinical record showed the patient was admitted to home health services on 05/18/2026 with a primary diagnosis of a urinary tract infection. He/she lived in a small shed converted into a home next door to family who provided support. Review of a referral with a fax cover sheet titled discharge (DC) and home health (HH) orders, dated 05/15/2026, showed: recommend basic metabolic panel (BMP- A standard blood test that measures eight key substances in your blood including kidney markers) in one week to follow up on renal (kidney) function. Review of an OASIS (Outcome and Assessment Information Set; a standardized data collection tool) start of care (SOC) assessment dated 05/18/2026 showed on page 36 0f 37: “Ensure follow-up BMP and physician appointments are completed.” Review of the physical therapy (PT) evaluation note that was sent to the physician for signature, dated 05/18/2026, showed: - Frequency and duration were once a week for six weeks; - A treatment plan for therapeutic exercise, establish or upgrade a home exercise program, transfer training, gait training, pulmonary physical therapy, balance training, muscle re-education, stairs/steps training, home safety training, assistive device training, and O2 (oxygen) saturation (the level of oxygen in the bloodstream) monitoring as needed; and - Treatment goals (This information failed to be included on the initial POC). Review of the Initial POC dated 05/18/2026 to 07/16/2026 showed: - SN to instruct patient on measures to detect and alleviate edema (swelling of the tissues); and - PT eval and treat. - The initial POC failed to include BMP in one week, and patient-specific PT interventions and education, measurable outcomes and goals, and the PT visit frequency and duration. Further review of the clinical record showed: - A SN visit note dated 05/21/2026 with documentation that the patient had compression stockings removed at the time of the visit; - The record failed to include BMP results or any documentation of coordination with the physician’s office regarding the BMP; and - The POC failed to be updated with the use of the compression stockings. During an interview on 06/03/2026 starting at 3:14 PM the clinical manager stated that: - He/she would have expected the BMP to have been addressed on the POC or documentation of communication about the BMP; - The POC should have been updated about the use of the compression stockings when the nurse found out that the patient was wearing them; and - The provider has POCs per each discipline because their EMR doesn’t allow them to be combined. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 05/11/2026 with a primary diagnosis of acute (sudden onset) and chronic (lasting more than 12 months) respiratory failure (lungs can’t get enough oxygen into your blood) with hypoxia (body or a specific region of your tissue doesn’t receive enough oxygen to function properly), secondary diagnosis includes hypertensive heart and chronic kidney disease with heart failure and unspecified chronic kidney disease (CKD) (high blood pressure, stage 1, 2, 3, 4, or unspecified CKD, and damage to the heart that results in the heart’s inability to pump effectively) and congestive heart failure (CHF; a decrease in the ability of the heart to pump blood). The patient resided at home with his/her spouse. Review of an OASIS SOC assessment dated 05/11/2026 showed in part, the following: - Item N0415 High-Risk Drug Classes: Use and indication – Check if the patient is taking any medications by pharmacological classification, not how it is used, in the following classes: E. Anticoagulant - checked; and - Item M2010 (Has the patient/caregiver received instructions on special precautions for all high-risk medications such as hypoglycemics (medication that lowers blood sugar levels), anticoagulants (medication that thins the blood), and how and when to report problems that may occur? Coded as one- yes. Review of the initial POC, dated 05/11/2026 to 07/09/2026 showed: - Dabigatran etexilate mesylate oral 150 milligrams (mg) one capsule two times a day for heart/blood thinner (anticoagulant); and - The POC failed to include specific safety measures regarding high-risk medications (dabigatran etexilate mesylate). Observation and interview on 06/02/2026 at 1:44 PM, showed on the provider’s current medication profile (printed on 06/017/2026) and the patient’s home medication bottles: Dabigatran etexilate mesylate oral 150 milligrams (mg) one capsule two times a day. During an interview on 06/03/2026 at 3:34 PM, the clinical manager stated orders for all care are to be on the plan of care. RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to home health services on 04/14/2026 with a primary diagnosis of Stage 4 pressure ulcer (a full thickness loss of the skin with extensive destruction, exposing muscle, bone, tendon, or ligaments) of sacral (area at the base of the spine, just above the tailbone) region. The patient resided alone in their own home. Review of an OASIS (Outcome and Assessment Information Set; a standardized data collection tool) start of care (SOC) assessment dated 04/14/2026 showed Veterans Administration (VA) orders included medication management, however, at the time of admission, the patient declined skilled nursing assistance with medication setup. Patient reported medications were kept in the bathroom medicine cabinet and were organized by his preference. Skilled nursing would continue to assess patients understanding and medication regimen and willingness to allow assistance with medication management to ensure safety and compliance. Review of the next SN visit note dated 04/17/2026 (three days later and within the five-day comprehensive assessment window) showed “pillbox (medication planner box) filled again today.” The patient is showing compliance when filled by SN. Review of the POC dated 04/14/2026 to 06/12/2026 failed to show SN to fill the medication planner box. Further review of the clinical record failed to show orders to update the POC with orders for SN to fill the medication planner box. During an interview on 06/03/2026 starting at 3:14 PM the clinical manager stated that he/she would expect the filling of the medication planner on the POC. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to home health services on 05/15/2026 with a primary diagnosis of osteoporosis with current pathologic fracture of the left pelvis (osteoporosis-related (fragility) pelvic fracture occurs from low-energy trauma or a simple fall due to weakened bones), and secondary diagnosis included congestive heart failure (a decrease in the ability of the heart to pump blood), and peripheral venous insufficiency (happens when leg vein valves become weak or damaged and prevents blood from flowing efficiently back to the heart, causing it to pool in the legs and increase vein pressure). The patient lived in his/her own home with caregivers/family. Review of an OASIS SOC assessment dated 05/15/2026 showed the following: - Item M1400 – Cardiovascular: Edema – coded as yes, (bilateral feet/ankle); and - Skin assessment completed with bilateral lower extremities assessed and patient noted to have venous insufficiency with two plus pitting edema present. Patient currently wears compression stockings and uses compression pumps throughout the day to assist with venous return. Review of the initial POC, dated 05/15/2026 to 07/13/2026 showed: - Furosemide 20 mg (milligrams) one every morning for fluid retention; - Skilled nurse (SN) to instruct patient on measures to detect and alleviate edema; and - The initial POC failed to include patient-specific interventions and education, measurable outcomes and goals, to alleviate edema. During an interview on 06/03/2026 at 1:03 PM, the administrator stated the compression stockings are not on the plan of care. During an interview on 06/03/2026 at 3:34 PM, the clinical manager stated orders for all care are to be on the plan of care.”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on review of Missouri statute, policy review, employee file review, Alzheimer’s training content review, and interview, the home health provider failed to ensure that a check of the Employee Disqualification List (EDL) was performed prior to hire and a Family Care Safety Registry (FCSR) was performed prior to first patient contact on in two of four employee files reviewed (Employees #1 and #3) and failed to ensure Alzheimer’s and dementia training, provided on orientation and annually to all employees, contained education on understanding and dealing with family issues. These deficient practices have the potential to affect all the patients served by the provider. Findings included: Review of Section 192.2490.12 RSMo: “No person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) to (7) of subsection 11 of this section shall knowingly employ any person who is on the employee disqualification list.” Review of Section 192.2495 RSMo, requires employees of licensed home health agencies under contract with the Missouri Department of Health and Senior Services, to register with the Family Care Safety Registry regardless of hire date. This section also requires home health agencies to conduct criminal background screenings by checking the Family Care Safety Registry. Review of Section 192.2495.6, RSMo: “A provider is guilty of a class A misdemeanor if the provider knowingly hires or retains a person to have contact with patients or residents and the person has been found guilty in this state or any other state or has been found guilty of a crime, which if committed in Missouri would be a class A or B felony violation of chapter 565, 566 or 569, or any violation of subsection 3 of section 198.070 or section 568.020.” Review of Section 192.2495.7, RSMo (effective August 28, 2018): “Any in-home services provider agency or home health agency shall be guilty of a class A misdemeanor if such agency knowingly employs a person to provide in-home services or home health services to any in-home services client or home health patient and such person either refuses to register with the family care safety registry or if such person: (1) Has any of the disqualifying factors listed in subsection 6 of this section; (2) Has been found guilty of or pleaded guilty or nolo contendere to any felony offense under chapter 195 or 579; (3) Has been found guilty of or pleaded guilty or nolo contendere to any felony offense under section 568.045, 568.050, 568.060, 568.175, 570.023, 570.025, 570.030, 570.040 as it existed prior to January 1, 2017, 570.090, 570.145, 570.223, 575.230, or 576.080; (4) Has been found guilty of or pleaded guilty or nolo contendere to a violation of section 577.010 or 577.012 and who is alleged and found by the court to be an aggravated or chronic offender under section 577.023; (5) Has been found guilty of or pleaded guilty or nolo contendere to any offense requiring registration under section 589.400; (6) Is listed on the department of health and senior services employee disqualification list under section 192.2490; (7) Is listed on the department of mental health employee disqualification registry under section 630.170; or (8) Has a finding on the child abuse and neglect registry under sections 210.109 to 210.183.” Review of 19 CSR 30-26.010 (1) (B) required: “Licensed home health agencies shall provide dementia-specific training about Alzheimer’s disease and related dementias to their employees and those persons working as independent contractors who provide direct care to or may have daily contact with residents, patients, clients or consumers with Alzheimer’s disease or related dementias. 1. The training for persons providing direct care shall address the following areas, at a minimum: (A) An overview of Alzheimer’s disease and related dementias; (B) Communicating with persons with dementia; (C) Behavior management; (D) Promoting independence in activities of daily living; and (E) Understanding and dealing with family issues. 2. Employees or independent contractors who do not provide direct care for, but may have daily contact with, persons with Alzheimer’s disease or related dementias shall receive dementia-specific training that includes, at a minimum: (A) An overview of Alzheimer’s disease and related dementias; and (B) Communicating with persons with dementia. 3. Dementia-specific training about Alzheimer’s disease and related dementias shall be incorporated into orientation for new employees with direct patient contact and independent contractors with direct patient contact. The training shall be presented by an instructor who is qualified by education, experience, and knowledge in the current standards of practice regarding individuals with Alzheimer’s disease and other related dementias. The training shall be provided annually and updated as needed. “ Review of the provider’s undated policy titled, “Screening and Hiring,” showed in part that that the policy failed to contain any information about EDL or FCSR screenings. Review of the provider’s undated policy titled, “Development and Continuing Education Including In-services,” showed in part that: -All direct care staff must have a minimum of 12 hours of in-services per year. These in-services would include, but were not limited to Alzheimer’s Disease; and - The minimum dementia specific training for employees and contracted staff involved in the delivery of care to persons with Alzheimer’s or related dementias training would include: * An overview of Alzheimer’s and related dementias; * Communicating with persons with dementia; * Behavior management; * Promoting independence in activities of daily living; and * Understanding and dealing with family issues. EMPLOYEE #1: Review of the employee file showed: - Date of hire: 06/23/2025; - Date of first patient contact: 06/23/2025; - The EDL check was received on 06/24/2025 (one day after hire); and - The FCSR check was received on 06/24/2025 (one day after first patient contact). EMPLOYEE #3: Review of the employee file showed: - Date of hire: 06/23/2025; - Date of first patient contact: 06/23/2025; - The EDL check was received on 06/24/2025 (one day after hire); and - The FCSR check was received on 06/24/2025 (one day after first patient contact). Review of the Alzheimer’s training content, provided to all employees, failed to include information on understanding and dealing with family issues. During an interview on 06/02/2026 at 1:55 PM, the administrator stated that: - They were unable to find information on understanding and dealing with family issues in the Alzheimer’s module used for training new hires and annual education; and - They have used the same training module for years. During an interview on 06/03/2026 at 3:14 PM, the administrator stated that he/she would have expected the EDL to have been done prior to hire and the FCSR prior to first patient contact on all new employees.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to provide a completed transfer summary to the receiving health care facility providing care to the patient within two (2) days of becoming aware of the transfer in one of five full records reviewed (Record/Patient #3). This deficient practice has the potential to adversely affect the post discharge care of all the patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Discharge/Transfer Policy,” showed in part: - The agency (provider) will maintain a process for the ongoing assessment of each patient/client’s continuing care and discharge planning needs; - Call transferred patients will have required documentation to ensure appropriate communication is provided to the receiving agency (provider); - A transfer form is required for patients who are temporarily admitted to the hospital for exacerbation of illnesses if it is expected that home care will be resumed after hospitalization; and - The transfer summary is sent within two business days of planned transfer, or two business days after becoming aware of unplanned transfer if the patient is still receiving health care services. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 04/14/2026 with a primary diagnosis of Stage 4 pressure ulcer (a full thickness loss of the skin with extensive destruction, exposing muscle, bone, tendon, or ligaments) of sacral (area at the base of the spine, just above the tailbone) region. The patient resided alone in their own home. Review of the transfer summary, dated 05/11/2026, showed the patient was transferred to the hospital on 05/11/2026. Further review of the clinical record showed the provider failed to send a transfer summary to the receiving institution. Review of a log kept by the clinical manager (not part of the clinical record) showed under the column titled “transfer summary faxed (name, time, date, fax #)” with a response of “yes” documented. During an interview on 06/02/2026 at 2:00 PM, the clinical manager stated that: - He/she had a log that was kept that showed the transfer summary was sent to the receiving institution. (This log failed to show the date and time the transfer summary was sent).”