Elite Professionals Home Care Company

“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 record review, policy and procedure review, and staff interview, the agency failed to ensure patient’s medication orders, on the Plan of Care and the medication profile (a real-time document used by the agency that lists the patient’s medication) were accurate for 8 of 17 (Patients 2, 4, 5, 6, 7, 10, 13, and 14) patient records reviewed and/or failed to ensure the physician was made aware when discrepancies were identified. The census was 186. Findings are: A. Review of the agency policy and procedure titled C-600 Medication Profile, updated 1/2/17, revealed: 1. The Registered Nurse (RN) or Therapist is to complete a Medication Profile for each patient at the time of admission. 2. The Medication Profile is to include all prescription and over-the-counter medications. 3. The profile is to be updated as needed to reflect the current medications the patient is taking. 4. The RN/Therapist is to promptly report any problems to the patient’s physician. 5. If the physician changes the medication orders, the Nurse/Therapist must add the newly ordered drugs or medications to the Medication Profile. 6. The Medication Profile is to be reviewed and updated every 60 days and whenever changes occur. B. Review of Patient 2’s clinical record revealed: 1. A Skilled Nurse (SN) Visit Note Report dated 3/9/26. The SN documented the patient was receiving Warfarin (anticoagulant “blood thinner”) 4 milligrams (mg) daily due to a low INR (International Normalized Ratio-a blood test used to measures how long it takes for blood to clot) last month. 2. The Client Medication Report (the medication profile) printed on 4/29/26 included orders for warfarin 2 mg tablet, take 1.5 tablets (3 mg) on Wednesday and Saturday, and 1 tablet (2 mg) all other days. The profile indicates the start date for this order was 10/30/24. The profile contains multiple warfarin changes in the “discontinued medications” list but none of those listed changes occurred after the above 10/30/24 date. 3. The Client Medication Report did not include the 3/9/26 SN notated warfarin dose of 4 mg every day. C. Review of Patient 4’s clinical record revealed: 1. Patient’s start of care was 7/10/24. Patient was hospitalized at Bryan Medical Center East 4/13/26 through 4/17/26. A resumption of care assessment was completed on 4/17/26. 2. An After Visit Summary (AVS) from Bryan Medical Center East, dated 4/17/26, included orders for Acetaminophen (used to treat pain) and Lactobacillus rhamnoses GG (used to support digestive health). 3. The patient’s medication profile: a. Failed to include Acetaminophen and Lactobacillus rhamnoses GG. b. Included Advair Diskus (used to treat respiratory disease), Clearshield Sodium Chloride (saline flush), Diclofenac topical Gel (used to treat joint pain), Diphenhydramine (used for sleep), Insulin Glargine (used to treat diabetes), Lidocaine Gel (used for pain during wound care), Silver Sulfadiazine topical cream (used to treat skin infection), and Spiriva (used to treat respiratory disease). These medications were not included in the AVS. 4. There was no documentation that the physician was notified of the medication discrepancies. D. Review of Patient 5’s clinical record revealed: 1. The patient’s start of care was 12/19/25, with certification periods including 12/19/25 through 2/16/26, 2/17/26 through 4/17/26, and 4/18/26 through 6/16/26. 2. The The Home Health Certification and Plan of Care (POC) for the certification period of 2/17/26 through 4/17/26 (period reviewed during survey) had a verbal order date of 2/13/26. 3. An AVS dated 2/19/26, received at 9:35 AM, included an updated medication list. 4. A Physicians Order form was sent to the physician on 2/19/26, 12:36 PM listing the patient’s current medications reconciled from the medications on the POC dated 2/17/26 through 4/17/26 and the AVS dated 2/19/26. The following medications were not reconciled on the physician order: a. Alprazalom (an anti-anxiety medication)- on both the POC and the AVS, but not on the 2/19/26 Physician Order. b. Dorzolamide-timolol eye drops (used for glaucoma)- on the POC, not on the AVS or 2/19/26 Physician Order. c. Iproatropium Bromide Nasal Spray (a respiratory allergy medication)- on the POC and AVS but not on the 2/19/26 Physician Order. d. Methenamine Hippurate (antibacterial agent used to prevent recurrent urinary tract infections)- on the POC, but not on the AVS or 2/19/26 Physician Order. e. Lactobacillus acidophilus-bifidobacterium bifidum/lactis- (a probiotic)- on the AVS, but not on the POC or 2/19/26 Physician Order. E. Review of Patient 6’s clinical record revealed: 1. The POC for certification period of 3/25/26 through 5/23/26, and the medication profile included orders for Acetaminophen. 2. Discharge documents from Nebraska Methodist Hospital, dated 3/24/26, did not include orders for Acetaminophen. 3. There was no documentation of an order for acetaminophen. 4. There was no documentation the physician was notified of the discrepancy in medications between the discharge documents, the medication profile, and the POC. F. Review of Patient 7’s clinical record revealed: 1. Referral orders from US Veterans Affairs, dated 3/3/26, included orders for Cetirizine (use for allergy symptoms), Multivitamin (supplement), Fluticasone Propionate (used for allergy symptoms), and Lisdexamfetamine Dimesylate (stimulant). 2. The POC for certification dates 3/12/26 through 5/10/26, and the medication profile failed to include the orders for Cetirizine, Multivitamin, Fluticasone Propionate, and Lisdexamfetamine Dimesylate. 3. There was no documentation the physician was notified of the discrepancy in medications between the referral documents, the medication profile, and the POC. G. Review of Patient 10’s clinical record revealed: 1. Referral orders from Bryan Medical Center East, dated 2/25/26, included orders for Fluticasone Propionate, Hydrocodone-Acetaminophen (used to treat pain), 10-325 mg (milligrams) 1 tablet, 3 times daily, Lantus insulin (used to treat diabetes) 12 units every morning, Novolog insulin (used to treat diabetes) 0-12, units 3 times daily with meals per sliding scale, and Promethazine-DM (used for cough). 2. The POC for the certification periods of 2/26/26 through 4/26/26 and 4/27/26 through 6/25/26: a. Failed to include Fluticasone Propionate, Promethazine-DM and Novolog insulin. b. Included orders for Hydrocodone-Acetaminophen 10-325 mg, ½ tablet 2 times daily. c. Included order for Lantus insulin 26 units at bedtime. d. Included an order for Guaifenesin ER (used to treat cough) and was not included in referral orders. 3. There was no documentation the physician was notified of the medication discrepancies between the referral orders and the POC. H. Review of Patient 13’s clinical record revealed: 1. The start of care was 11/19/25. 2. The AVS (referral document) dated 11/14/25- 11/18/25 included medications orders. 3. The POC for the certification period of 11/19/25 through 1/17/26 included orders for artificial tears (for dry eyes), Aspirin (for stroke prevention), cholecalciferol (Vitamin D supplement), Risperidone (atypical antipsychotic medication used to treat schizophrenia, bipolar disorder, and irritability associated with autism) 1 mg every night at bedtime, and Risperidone 0.5 mg two times daily. These medications were not included on the AVS document. 4. There was no documentation the physician was notified of the medication discrepancies between the AVS documents and the POC. I. Review of Patient 14’s clinical record revealed: 1. The start of care was 11/11/25. 2. A Discharge Summary (referral document) dated 11/10/25 included orders for hydrocortisone cream. This was not included on the POC or the Client Medication Report. 3. The POC for the certification period of 11/11/25 through 1/9/26 and the Client Medication Report included orders for Farxiga (a medication for type 2 diabetes), olanzapine (atypical antipsychotic medication), ondansetron (for nausea), pyridostigmine (used to treat muscle weakness caused by myasthenia gravis). These medications were not included on the discharge summary orders received on 11/11/25. 4. There was no documentation the physician was notified of the medication discrepancies between the Discharge Summary documents, and the POC and Client Medication Report. 5. A Client Coordination Note Report dated 11/14/25. The SN documented an as needed (PRN) visit was completed due to an elevated INR on 11/13/25. The SN documented that the warfarin was changed to 6 mg and the Lovenox was stopped; both changes were on 11/13/25. 6. A Client Coordination Note Report dated 11/24/25. The SN documented the INR is 2.0 and the current warfarin dose is 9 mg daily. 7. There was no documentation that the 11/13/25 warfarin change to 6 mg daily was updated on the Client Medication Report. 8. There was no documentation that the warfarin change to 9 mg daily as noted on 11/24/25 was updated on the Client Medication Report until 12/2/25. J. During an interview on 5/6/26 at 5:00 PM, the Director of Nursing confirmed the agency failed to ensure patient’s medication orders, on the Plan of Care and the medication profile were accurate for Patients 2, 4, 5, 6, 7, 10, 13, and 14 and/or failed to ensure the physician was made aware when discrepancies were identified.”

“Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA’s internal policies. (4) When services are provided on the basis of a physician or allowed practitioner’s verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA’s policies, must document the orders in the patient’s clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA’s internal policies. This Element is not met as evidenced by: Based on record review, policy and procedure review and staff interview, the agency failed to follow their policy and procedure to ensure verbal orders were put into writing when received, for authentication by the ordering physician for 2 of 17 (Patient 2 and 14) patient records reviewed. The census was 186. Findings are: A. Review of the agency policy and procedure titled C-500 Physicians Orders, undated, revealed: 1. When the nurse or therapist receives a verbal order from the physician, they shall immediately record the date, specific order, sign the telephone order form, and send it to the physician for signature. 2. If the client or caregiver initiates changes that have been communicated to them by the physician, the nurse/therapist is to write and date the order the days they were informed of the change. 3. All orders will be maintained in the clinical record. B. Review of Patient 2’s clinical record revealed: 1. A Skilled Nurse (SN) Visit Note dated 3/9/26. The SN documented that the patient is receiving warfarin (an anticoagulant “blood thinner”) 4 milligrams (mg) daily due to a low International Normalized Ratio (INR- a test used to check blood clotting time) the prior month. 2. The Client Medication Report (medication profile- a real time document of the patient’s medications) includes orders for warfarin 2 mg tablet, take 1.5 tablets (3 mg) on Wednesday and Saturday, and take 1 tablet (2 mg) all other days. This order start date was 10/30/24. 3. There was no documentation that a physician order was completed for the warfarin 4 mg daily. C. Review of Patient 14’s clinical record revealed: 1. A Client Coordination Note Report dated 11/14/25. The SN documented an as needed visit (PRN) was completed for a recheck of the INR, which was 4.1 on 11/13/25. The nurse also documented that the provider changed the warfarin to 6 mg and discontinued the Lovenox (an injectable blood thinner). 2. A Client Coordination Note Report dated 11/24/25. The SN documented the INR on this date was 2.0, and the current warfarin dose is 9 mg daily. 3. The Client Medication Report, printed on 4/29/26, revealed: a. Lovenox was discontinued on 11/13/25. b. Warfarin 3 mg tablet, take 4 tablets daily (12 mg) (started 11/11/25-patient’s start of care date). This medication was discontinued in the electronic medical record (EMR) on 12/1/25 c. Warfarin 1 mg tablet, take 0.5 tablets daily (0.5 mg) (started 11/11/25). This medication was discontinued in the EMR on 12/1/25. d. Warfarin 3 mg tablet, take 3 tablets daily (9 mg) was entered in the EMR as started on 12/1/25. 4. There was no documentation that a physician order was written on 11/13/25 when the warfarin was changed to 6 mg. 5. There was no documentation that a physician order was written on 11/13/25 when the Lovenox was discontinued. 6. There was no documentation that a physician order was written on 11/24/25 (or prior) when the warfarin was changed to 9 mg daily. D. During an interview on 5/6/26 at 5:00 PM, the Director of Nursing confirmed the agency failed to follow their policy and procedure to ensure verbal orders were put into writing when received for authentication by the ordering physician for Patient 2 and 14.”

“Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient’s updated comprehensive assessment, and contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview the agency failed to include the progress towards the patient and agency identified goals on the revised plan of care for 7 of 7 (Patient 2 , 3, 4, 5, 9, 10, and 16) patients who had a revised plan of care. The total sample size was 17. The census was 186. Findings are: A. Review of the agency policy and procedure titled C-480 Plan of Care, undated, revealed: 1. The plan of care is reviewed by the patient’s physician as needed but at least every 60 days. 2. The policy does not include updating the revised plan of care to include information regarding the patient’s progress toward the patient and agency identified goals and outcomes. B. Review of Clinical Records revealed: 1. Patient 2’s start of care (SOC) was 1/4/23. The revised/updated Home Health Certification and Plan of Care (POC) for the certification periods of 2/17/26 through 4/17/26 and 4/18/26 through 6/16/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the home health Agency (HHA) and patient. 2. Patient 3’s SOC was 8/28/25. The revised/updated POC for the certification periods of 2/24/26 through 4/24/26 and 4/25/26 through 6/23/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient. 3. Patient 4’s SOC was 7/10/24. The revised/updated POC for the certification periods of 3/2/26 through 4/30/26 and 5/1/26 through 6/29/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient. 4. Patient 5’s SOC was 12/19/25. The revised/updated POC for the certification periods of 2/17/26 through 4/17/26 and 4/18/26 through 6/16/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient. 5. Patient 9’s SOC was 12/29/25. The revised/updated POC for the certification period of 2/27/26 through 4/27/26 and 4/28/26 through 6/26/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient. 6. Patient 10’s SOC was 2/26/26. The revised/updated POC for the certification period of 4/27/26 through 6/25/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient. 7. Patient 16’s SOC was 2/2/18. The revised/updated POC for the certification period of 12/27/25 through 2/24/26 and 2/25/26 through 4/25/26 did not contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient. C. During an interview on 5/6/26 at 5:00 PM, the Director of Nursing confirmed the agency failed to include the progress towards the patient and agency identified goals on the revised plan of care for Patient 2 , 3, 4, 5, 9, 10, and 16.”

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure timely coordination with all physicians involved in the plan of care for 1 of 17 (Patient 5) patient records reviewed and failed to have a policy and procedure for coordination of care. The census was 186. Findings are: A. Review of the agency policy and procedure titled C-480 Plan of Care, undated, revealed: 1. An individualized Plan of Care/485 signed by the physician shall be required for each client receiving home health care services. 2. This policy did not include processes for including alternate/other physicians involved in the patient’s plan of care. 3. The agency did not provide a policy and procedure for coordination with all physicians involved in the patient’s plan of care. B. Review of Patient 5’s clinical record revealed: 1. The start of care date was 12/19/25. 2. A Physician Order dated 12/18/25 indicated [the ordering physician (who is a general surgeon)] would follow on home health per signed orders and it is ok to accept orders from the patient’s primary care physician (PCP). On the signed/authenticated copy of the Physician Order, the ordering physician commented that [gender] would write for wound care and all other care to be by the patient’s PCP. 3. The Home Health Certification and Plan of Care (POC) for the certification period of 12/19/25 through 2/16/26 was sent to the [ordering physician] for signature and approval. The authenticated/signed copy was signed on 1/8/26 by the [ordering physician] with a note ‘stating wound care orders only’. 4. The POC for the certification period of 2/17/26 through 4/17/26 was sent to the [ordering physician] for signature and approval. The authenticated/signed copy was signed on 2/26/26 by the [ordering physician] with a note stating ‘wound care orders only’. 5. The POC for the certification period of 4/18/26 through 6/16/26 was sent to the [ordering physician] for signature and approval. The authenticated/signed copy was signed on 4/23/26 by the [ordering physician]. There was no note added to this POC. 6. There was no documentation in the clinical record the agency collaborated with the patient’s primary care physician for the non-wound care orders included on the POCs for 12/19/25 through 2/16/26, 2/17/26 through 4/17/26 and 4/18/26 through 6/16/26. 7. The first order found in the record showing collaboration with the PCP was a physician order dated 4/15/26. The PCP requested the patient come in for a medication review with the clinical pharmacy team. C. During an interview on 5/6/26 at 5:00 PM, the Director of Nursing confirmed he agency failed to ensure timely coordination with all physicians involved in the plan of care for Patient 5 and failed to have a policy and procedure for coordination of care.”

“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 record review, policy and procedure review, and staff interview, the agency failed to conduct an onsite visit by the registered nurse (RN) at least every 14 days to the home of 2 of 4 (Patient 2 and 16) patients who received home health aide (HHA) services to ensure the care and services provided are meeting the needs of the agency patient. The total sample size was 17. The census was 186. Findings are: A. Review of the agency policy and procedure titled C-310 Supervision of Staff, undated, revealed: 1. The purpose is to ensure staff are demonstrating competence in the area of communication, identifying and responding to client needs, and performing procedures/techniques properly. 2. The RN (or other appropriate skilled professional) is to make supervisory visits to the patient’s residence at least every two weeks. B. Review of Patient 2’s clinical record revealed: 1. The Home Health Certification and Plan of Care (POC) for the certification period of 2/17/26 through 4/14/26 included orders for skilled nursing (SN) 1 time per week for 1 week, 1 time every 3 weeks for 6 weeks, and 1 time every 2 weeks for 2 weeks, and up to 2 as needed (PRN) visits; and HHA 1 time per week for 8 weeks. 2. The POC for the certification period of 4/18/26 through 6/16/26 included orders for SN 1 time per week for 1 week, 1 time every 2 weeks for 2 weeks , 1 time per week for 1 week, and 1 time every 3 weeks for 3 weeks, and up to 2 PRN visits; HHA 2 times per week for 8 weeks, then 1 time per week for 1 week. 3. There was no documentation of an RN conducting an onsite visit to the patient’s home from 2/17/26 through 4/11/26 and 4/13/26 through 5/5/26 to ensure HHA care and services provided are meeting the needs of the agency patient (a total of 5 missed supervisory visits). C. Review of Patient 16’s clinical record revealed: 1. The POC for the certification period of 12/27/24 through 2/24/25 included orders for SN 1 time per week for 1 week, then 1 time every 2 weeks for 6 weeks, and up to 3 PRN visit; HHA 8 times per week for 1 week, then 28 times per week for 8 weeks, then 8 times per week for 1 week. 2. The POC for the certification period of 2/25/25 through 4/25/25 included orders for SN 1 time per week for 1 week, then 1 time every 2 weeks for 6 weeks, and up to 3 PRN visit; HHA 20 times per week for 1 week, 28 times per week for 7 weeks, and 24 times per week for 1 week. 3. There was documentation of an RN conducting an onsite visit to the patient’s home 1/6/25. The next supervisory visit by an RN was conducted on 1/22/25 (16 days later). D. During an interview on 5/6/26 at 5:00 PM, the Director of Nursing confirmed the agency failed to conduct an onsite visit by the RN at least every 14 days to the home of Patient 2 and 16 to ensure the HHA care and services provided are meeting the needs of the patient.”