Home Care Network, Inc.

“Supervise skilled professional assistants CFR(s): 484.75(c) Standard: Supervision of skilled professional assistants. This Standard is not met as evidenced by: Based on record review, interview and policy review, the facility failed to ensure staff competency was observed during an in person visit. This affected two (Patients #1 and #5) with the potential to affect all patients receiving skilled nursing care by this agency. The agency census was 18. Findings include: 1. Record review revealed Patient #1 started care on 05/13/13 with a primary diagnosis of Myoclonus (sudden movements) and seizures. A recertification assessment was completed for Patient #1 on 5/07/25 by Staff B which included a supervisory visit for the licensed practical nurse. This visit was completed virtually. 2. Record review revealed Patient #5 started care on 06/25/24 with the a primary diagnosis of rheumatoid arthritis. A recertification assessment was completed on 04/17/25 by a Registered nurse (RN) which included a supervisory visit. This visit was completed virtually. During an interview on 05/30/25 at 11:45 AM, Staff B stated supervision of a licensed practical nurse (LPN) should be completed every 60 days when the recertification occurs. Staff B further indicated a virtual visit occurred for Patients #1 and #5, so no observations were completed with a staff member present. Review of the policy titled “Supervision of Staff” stated if the agency is providing skilled services to ensure competency an RN must observe a skill being performed and document the staff member’s competency in performance of a skill/task during supervisory visits when the staff member is present.”

“Incorporate OASIS items CFR(s): 484.55(c)(8) Incorporation of the current version of the Outcome and Assessment Information Set (OASIS) items, using the language and groupings of the OASIS items, as specified by the Secretary. The OASIS data items determined by the Secretary must include: clinical record items, demographics and patient history, living arrangements, supportive assistance, sensory status, integumentary status, respiratory status, elimination status, neuro/emotional/behavioral status, activities of daily living, medications, equipment management, emergent care, and data items collected at inpatient facility admission or discharge only. This Element is not met as evidenced by: Based on record review, interview and policy review, the agency failed to complete a comprehensive assessment with recertifications. This affected three (Patients # 1, #5 and #6) with the potential to affect all patients cared for by this agency. The facility census was 18. Findings include? 1. Record review revealed Patient #1 started care on 5/13/13 with a primary diagnosis of Myoclonus (sudden movements) and seizures. The recertification periods reviewed were for 03/11/25 through 05/09/25 and 05/10/25 through 07/08/25. Patient #1 had skilled nursing ordered 41 hours per week. A recertification was completed for Patient #1 on 5/07/25 by Staff B. This recertification included a comprehensive assessment but lacked evidence of an integumentary status or respiratory assessment and no vital signs (V/S) were completed. Notes further indicated this visit was completed virtually. 2. Record review revealed Patient #5 started care on 06/25/24 with the a primary diagnosis of rheumatoid arthritis. The certification periods reviewed were for 02/20/25 through 04/20/25 and 04/21/25 through 06/19/25. Skilled nursing was ordered for one hour per week to fill medications. A recertification was completed on 04/17/25 by the skilled nurse but lacked evidence of a thorough comprehensive assessment with a note stating this was completed virtually. 3. Record review revealed Patient #6 started care on 01/22/25 with a primary diagnosis of Type 2 Diabetes. . The certification periods reviewed were for 01/22/25 through 03/22/25 and 03/23/25 until discharge on 04/15/25. Home health aide services were ordered for 15 hours per week A recertification was completed on 03/21/25 via telehealth with no documentation that vital signs, skin or respiratory assessment were completed. During an interview on 05/30/25 at 10:50 AM, Staff B verified comprehensive assessments were not completed for Patients # 1, #5 and #6. Review of the policy titled “Client Reassessment/Update of Comprehensive Assessment” stated the RN was to complete an assessment to include the Outcomes and Assessment Information Set (OASIS). This reassessment should be completed every 55-60 days while the client is receiving skilled services. The facility policy titled “Comprehensive Client Assessment” stated an assessment will be completed by a registered nurse (RN) and will include a general health status/system assessment to include respiratory status and integumentary status.”

“Non-skilled direct observation every 60 days CFR(s): 484.80(h)(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, — (A) The registered nurse must make an onsite, in person visit every 60 days to assess the quality of care and services provided by the home health aide and to ensure that services meet the patient’s needs; and (B) The home health aide does not need to be present during this visit. (ii) Semi-annually the registered nurse must make an on-site visit to the location where each patient is receiving care in order to observe and assess each home health aide while he or she is performing non-skilled care This Element is not met as evidenced by: Based on record review, interview and policy review, the facility failed to ensure supervisory visits were completed in person. This affected two (Patients #4 and #6) with the potential to affect all patients receiving skilled nursing care by this agency. The agency census was 18. Findings include: 1. Record review revealed Patient #4 started care on 10/05/18 with a primary diagnosis of mild intellectual disabilities. Home Health Aide services were ordered for 14 hours per week. A supervisory visit for the home health aide was completed virtually on 04/29/25 . 2. Record review revealed Patient #6 started care on 01/22/25 with a primary diagnosis of Type 2 diabetes. Home Health Aide services were ordered 15 hours per week. The patient was discharged on 04/15/25. A supervisory visit for the home health aide was completed virtually on 03/21/25. During an interview on 05/30/25 at 10:50 AM, Staff B verified the supervisory visit was not completed with direct observation of the home health aide providing care. The policy titled “ Supervision of Staff” stated if clients are receiving only home health aide services and there is no skilled service provided, a Registered Nurse will make a supervisory visit while the aide is providing care, at least once every 60 days.”