Essex County Nursing Service

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on clinical record reviews, and staff interviews, the agency failed to ensure all paraprofessionals receive a complete Home Health Aide plan of care when providing patient care. This was evident in one of one clinical records reviewed for patients receiving aide services (Patient #6). Failure to ensure all paraprofessionals receive a complete Home Health Aide plan of care has potential for negative patient outcomes. Findings: Patient #6 (start of care 01/02/2026) has diagnoses of Amytrpoic Lateral Sclerosis and Unspecified Dysphagia. The Home Health Care Certification and Plan of Care for certification period 03/03/2026 though 05/01/2026 contains an order for aspiration precautions. The Aide Plan of Care (dated 01/07/2026) lacks aspiration precautions. The clinical record lacks documented evidence of complete written patient care instructions for a home health aide to follow. The finding was confirmed on 03/14/2026 at 10 AM with Director of Patient Services; no additional evidence was provided.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on clinical record review and staff interview, the agency failed to ensure in one of six clinical records (Patient # 2) professional staff maintain an accurate, current and clearly documented record related to the provision of the patient’s care. Failure to maintain an accurate, current and clearly documented record has the potential for staff to make clinical decisions based on inaccurate and/or missing information with the potential to result in negative patient outcomes. Findings: Patient #2 (start of care 05/21/2023) has a diagnosis of Diabetes Mellitus, Osteomyelitis. The clinical record contains an interdisciplinary communication note (dated 04/13/2026) which states “as of 3/6/2026 diet is high protein...and no concentrated sweets.” The POC for certification period 03/06/2026 through 05/04/2026, contains a diet order for “high protein; low sodium diet.” The clinical record requires clarification regarding the diet for this patient. The finding was confirmed on 03/14/2026 at 10 AM with Director of Patient Services; no additional evidence was provided.”

“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 Certification and Survey Provider Enhanced Reports (CASPER) review and staff interview the agency failed to encode and electronically transmit each completed Outcome and Assessment Information Set (OASIS), 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. Failure to encode and electronically transmit each completed OASIS assessment, 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 has the potential for incorrect and incomplete reporting data. On 04/17/2025 the surveyors reviewed Certification and Survey Provider Enhanced Reports (CASPER) “Home Health Agency Error Summary Report by Agency” for the report period 01/01/2024 - 12/31/2024. The report contains a warning code -3330 “Record Submitted Late”: The submission date is more than 30 days after M0090 “Date Assessment Completed” on this new record. The CASPER report states 28 (2.53%) out of 1108 assessments processed were submitted more than 30 days after M0090. The agency lacks documented evidence the agency submitted required documents timely for 28 out of 1108, or 2.53% of submissions. The finding was confirmed on 04/22/2025 at 3:00 PM M with the Director of Patient Services and Nursing Supervisor; no additional evidence was provided.”

“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 clinical record review and staff interview the agency failed to ensure a complete Plan of Care (POC) was developed to meet the individualized needs of the patient in six of ten patient records reviewed (Patient # 1, 3, 5, 6, 8 and 9). Failure to develop a comprehensive POC has the potential for unmet patient needs and places patients at risk for receiving incorrect and/or inappropriate care. Patient #1 (start of care 02/25/2025) has diagnoses of (Idiopathic) Normal Pressure Hydrocephalus and Parkinson’s Disease. The POC for certification period 02/25/2025 through 04/25/2025 contains an order for: Miralax17-gram (GM) power for reconstitution; Take 17 GM packet(s) twice daily as needed for constipation 12 hours apart. The POC is incomplete as it fails to include reconstitution instructions for type and amount of fluid. Patient #3 (start of care 06/03/2020 has diagnoses of Type 2 Diabetes Mellitus and Chronic Osteomyelitis with Draining Sinus. The POC for certification period 03/10/2025 through 05/08/2025 contains an order for Polyethylene Glycol 3350 oral powder for reconstitution; Administer 17 gm(s) orally once a day as needed for constipation. As needed for constipation/no bowel movement (BM) times (x) 3 days. The POC is incomplete as it fails to include reconstitution instructions for type and amount of fluid. Patient #5 (start of care 02/15/2025) has diagnoses of Diffuse Traumatic Brain Injury (TBI) with Loss of Consciousness (LOC) and Hemiplegia (Hemiplga) following Cerebral Infarction (Infrc) Affecting Left Nondominant Side. The POC for certification period 04/16/2025 through 06/14/2025 contains an order for Polyethylene Glycol 3350 oral powder for reconstitution; Administer 100 gm(s) orally 2 times a day; ****taking as needed (PRN) due to frequent, loose stools. The POC is incomplete as it fails to include reconstitution instructions for type and amount of fluid. Patient #6 (start of care 10/29/2024 discharged 03/192025) has diagnoses of Cystostomy Catheter and Type 2 Diabetes Mellitus. The POC for certification period 02/25/2025 through 04/26/2025 contains an order for Polyethylene Glycol 3350 oral powder for reconstitution oral powder for reconstitution; Administer 17 gm(s) every 12 hours prn as needed; as needed for constipation or no BM greater than 24 hours via ostomy, reviewed at start of care (SOC) PC Registered Nurse 10/29/2024 maximum daily dose (MDD) 2 doses mix 17 grams with your choice of non-carbonated fluids and mix well. The POC is incomplete as it fails to include the amount of fluid for reconstitution of the medication. Patient # 8 (start of care 01/15/2025 discharged 03/10/2025) has diagnoses of Peripheral Vascular Disease and Essential Hypertension. The POC for certification period 01/15/2025 through 03/15/2025) contains orders for: Calmoseptine 0.44%-20.6 topical ointment; Apply 1 application topical 1 to 4 times a day; for protection per daughters reporting. The POC is incomplete as it does not give an anatomical location to apply the treatment;Deep Seal Nasal Spray 0.65% nasal spray; Administer 2 spray(s) intranasally 4 times a day as needed for dryness. The POC is incomplete as it is lacking direction for the spray to be applied to left, right or both nostrils; Fluticasone 50 micrograms (mcg)/inhalation (inh) nasal spray; 50 mcg/inh; Administer 1 spray(s) intranasally every 12 hours as needed for stuffiness. The POC is incomplete as it is lacking direction for the spray to be applied to left, right or both nostrils and Polyethylene Glycol 3350 with electrolytes oral powder for reconstitution; Administer 17 gm(s) packet oral once a day (in the morning); In coffee. The POC is incomplete as it fails to include reconstitution instructions for amount of coffee to use.Patient # 9 (start of care 11/25/2024) has diagnoses of Encounter for Orthopedic Aftercare Following Surgical Amputation and Polyneuropathy. The POC for certification period 03/25/2025 through 05/23/2025 contains an order for Eliquis 5 mg tablet. Take 1 tab(s) orally every 12 hours. High Risk Medication. The POC is incomplete as it fails to include bleeding precautions related to anticoagulant medication use. Also, the POC requires clarification as it contains orders for treatments, interventions and goals for the skilled nurse, but the record lacks any orders for skilled nurse visits. The findings were confirmed on 04/22/2021 at 3:00 PM and 04/23/2025 at 3:00 PM with the Director of Patient Services and the Nursing Supervisor; no additional evidence was provided.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on clinical record review and staff interview evidence is lacking in one of ten records (Patient # 1) the physician was contacted regarding changes that suggest the need to alter the Plan of Care (POC). Failure to consult with the physician when changes occur in the patient’s condition has the potential for unmet patient needs and/or negative patient outcomes. Patient #1 (start of care 02/25/2025) has diagnoses of (Idiopathic) Normal Pressure Hydrocephalus and Parkinson’s Disease. The record contains communication notes on 03/11/2025 “reporting a fall on Thursday” and 03/26/2025 stating the wife reports “patient fell back onto bed and slid to the floor”. The record lacks evidence the physician was notified of the patient’s falls. The finding was confirmed on 04/22/2025 at 3:00 PM with the Director of Patient Services and the Nursing Supervisor; no additional evidence was provided.”