Continuum Pediatric Nursing Services

“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 a review of clinical records (CR) and employee interview, the agency failed to ensure the nurse clarified indications for as needed medications on Plan of Care for five (5) of seven (7) clinical records (CR) reviewed (CR1-5). Findings included: CR1, start of service (SOS) 8/11/25, dates reviewed 12/9/25-1/8/26. Plan of care (POC) included: Albuterol sulfate 90mcg/actuation breath activated inhaler-180mcg/2 puffs PRN (pro re nata-as needed)/inhalation, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. POC also included: Baqsimi 3mg/actuation nasal spray-3mg/1 nasal spray PRN/nasal, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. CR2, SOS 8/18/25, dates reviewed 12/19/25-1/8/26. POC included: Naproxen 250mg tablet- give 1 tab by mouth as needed, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. CR3, SOS 4/21/18, dates reviewed 11/10/25-1/98/26. POC included: Albuterol sulfate 2.5mg/3mL solution for nebulization- 2.5mg/3mL twice daily PRN, no indicator to identify what symptoms require the need for use of medication. Hydrocortisone 2.5% topical cream- 2.5% twice daily /topical to skin PRN, no indicator to identify what symptoms require the need for use of medication, the amount, or location to use the medication. Protective Ointment- thin layer/application with each diaper change topical to peri area PRN, no indicator to identify what symptoms require the need for use of medication. Salicylic acid 40% topical patch- 40% per package instructions topical pad as needed, no frequency included for as needed use and no indicator to identify what symptoms require the need for use of medication. Senne 8.8mg/5mL oral syrup- give 8.8mg/5mL daily via gastric tube PRN, no indicator to identify what symptoms require the need for use of medication. Triamcinalone acetonide 0.1% topical cream- thin layer/1 application twice daily topical to gastric tube stoma PRN, no indicator to identify what symptoms require the need for use of medication. Water oral liquid- 200ml/270ml/hour via feeding pump/gastric tube PRN, no indicator to identify what symptoms require the need for use of medication. CR4, SOS 8/8/22, dates reviewed 11/20/25-1/8/26. POC included: Bisacodyl 10mg rectal suppository- 1 suppository PRN daily rectally, no indicator to identify what symptoms require the need for use of medication. Lansoprazole 3mg/ml-15mg/5ml daily via gastric tube PRN, no indicator to identify what symptoms require the need for use of medication. LanzaPro Flex 4% topical patch- 1 patch PRN daily topical to gastric tube stoma, no indicator to identify what symptoms require the need for use of medication. CR5, SOS 3/4/25, dates reviewed 12/25/25-1/8/26. POC included: Acetaminophen 160mg/5mL oral elixir- 320mg/10ml PRN every 6 hours oral, no indicator to identify what symptoms require the need for use of medication. Valtoco 10mg/spray nasal spray- 10mg/0.1ml PRN nasal, no indicator to identify what symptoms require the need for use of medication. Interview with Director of Nursing, 2 Clinical Supervisors, National Director of Nursing, National Administrator, and Compliance on 1/13/26 at 3:00pm confirmed findings.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on a review of clinical records (CR) and employee interview, the agency failed to ensure services provided per Plan of Care for three (3) of seven (7) clinical records (CR) reviewed (CR1,2, & 5). Findings included: CR1, start of service (SOS) 8/11/25, dates reviewed 12/9/25-1/8/26. Skilled nurse (SN) frequency ordered 1/6/26- “...4-5 days a week Monday-Friday up to 8 hours/day to accompany (patient) to school through certification period...” No documentation of services Monday 12/22/25-Friday 12/26/25 or Monday 12/29/25-Friday 1/2/25. During Interview on 1/7/26 at approximately 2:00pm, Director of Nursing reported, “ no services were provided because they are ordered while in school and there was not school these days.” Clinical record failed to include documentation reflecting days school was not in session. CR2, SOS 8/18/25, dates reviewed 12/19/25-1/8/26. Home health aide (HHA) frequency ordered 12/19/25- “...home health aide services 4-5 days a week Monday through Friday to attend school up to 7.5 hours a day...” Missed visits documented Monday 12/22/25-Friday 12/26/25. No documentation of services Monday 12/29/25. During Interview on 1/7/26 at approximately 2:00pm, Director of Nursing reported, “ no services were provided because they are ordered while in school and there was not school these days.” Clinical record failed to include documentation reflecting days school was not in session. Missed visits also documented inability of agency to staff. CR5, SOS 3/4/25, dates reviewed 12/25/25-1/8/26. SN frequency ordered 12/25/25- “SN care Monday through Saturday 5-6 days per week up to 12 hours...” Review of service records and interview with SN on 1/7/26 at approximately 1:00pm revealed schedule to consistently be Monday through Saturday one week followed by Sunday through Friday to result in working Monday through Friday and every other Saturday and Sunday to coordinate with mother’s schedule. CR failed to include documentation reflecting adjustment of frequency for SN services. Interview with Director of Nursing, 2 Clinical Supervisors, National Director of Nursing, National Administrator, and Compliance on 1/13/26 at 3:00pm confirmed findings”