Valley Med Home Health Care, LLC

“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 a review of agency policy, a review of clinical records, and an interview with the agency Administrator, the agency failed to ensure that services ordered by a nurse practitioner included a collaborating or supervising physician identified in the patients written plan of treatment for one (1) of seven (7) clinical records (CR) reviewed that included orders by a nurse practitioner (CR#1). ‘House Bill No. 2401, Session of 2022’ section (2) “ Home health care services may be ordered by nurse practitioners and physician assistants as provided under section 1814(a) and 1835(a) of the Social Security Act (49, Stat. 620, 42 U.S.C. § 1395 et. seg.), if the nurse practitioners (CRNP) or physician assistants (PA) collaborating or supervising physician is identified in the patients written plan of treatment. ... “ Agency policy/procedure reviewed on February 5, 2026 at approximately 1:45 p.m. Policy ‘Supervision When the physician Listed on Plan of Treatment is a CRNP or PA’ ‘Policy Statement’ “If the physician identified on the plan of treatment is a CRNP or PA, the following supervision requirements must be met: ‘Supervisory Physician Identification:’ The plan of treatment must clearly identify the supervising physician responsible for overseeing the CRNP or PA.” ‘Documentation:’ All plans of treatment must include the name, credentials, and contact information of both the CRNP/PA and their supervising physician.” A review of CRs was completed on February 5, 2026 at approximately 1:45 p.m. The patients start of care (SOC) is listed below. CR#1 SOC 02/03/26: Verbal order from a nurse practitioner was taken by a registered nurse on 02/03/26 for the certification period 02/03/26 - 04/03/26. The nurse practitioners collaborating/supervising physician was not identified in the patients written plan of treatment. An interview conducted with agency Administrator on February 5, 2026 at approximately 2:00 p.m. confirmed the above findings.”

“Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA’s quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This Standard is not met as evidenced by: Based on a review of agency policy, review of employee files, and an interview with the agency Administrator, the agency failed to conduct TB (tuberculosis) testing and/or TB screening, per policy, for five (5) out of seven (7) employee files (EFs) initial documentation reviewed (EF#3 - EF#7). Agency policy/procedure reviewed on February 5, 2026 at approximately 1:45 p.m. Policy ‘Employees Health Assessments’ ‘Procedure’ “ ... (B) “The written health assessment report shall: .... (4) Tuberculosis screening shall be required for staff with direct patient contact as follows: (a) A baseline TB screening upon hire, using a two-step TST (tuberculin skin test) or a single BAMT (blood assay for Mycobacterium tuberculosis) to test for infection with M. tuberculosis. .... (d) ..... After baseline testing, tuberculosis screening must: (i) Be completed annually; (ii) if no exposure to TB is suspected a TB questionnaire may be utilized to determine the need for a TST. .... “ A review of EFs was conducted on February 4, 2026 at approximately 11:00 a.m. The employees date of hire (DOH) is listed below. EF#3 DOH 11/05/24: Documentation provided of a one-step TST being conducted on 06/21/24. No documentation provided of the second-step TST being conducted. EF#4 DOH 11/26/24: Documentation provided of a one-step TST being conducted on 11/19/24. No documentation provided of the second-step TST being conducted. No documentation provided of a 2025 TB symptom screening questionnaire. EF#5 DOH 11/13/24: No documentation provided of a 2025 TB symptom screening questionnaire. EF#6 DOH 10/25/24: No documentation provided of a 2025 TB symptom screening questionnaire. EF#7 DOH 10/23/23: No documentation provided of a 2024 TB symptom screening questionnaire. An interview conducted with agency Administrator on February 5, 2026 at approximately 2:00 p.m. confirmed the above findings.”

“Classroom and supervised practical training CFR(s): 484.80(b)(1) Home health aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while providing services to an individual under the direct supervision of a registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse. Classroom and supervised practical training must total at least 75 hours. This Element is not met as evidenced by: Based on a review of agency policy, review of employee files, and an interview with the agency Administrator, the agency failed to ensure home health aides completed a minimum of 75 hours of classroom and supervised practical training, per policy, for one (1) of one (1) employee files (EF) reviewed (EF#7). Agency policy/procedure reviewed on February 5, 2026 at approximately 1:45 p.m. Policy ‘Certified Nursing Aide/Home Health Aide’ ‘Qualifications/Educational Requirements’ “A qualified home health aide is a person who has successfully completed: (1) A training and competency evaluation program as specified in this policy; or (2) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of Chapter 483.151 through Chapter 484.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or (3) The requirements of a state licensure program that meets the provisions of the training and competency requirements. “ (A) Training Requirement: Content and duration of home health aide classroom and supervised practical training. (1) .... Classroom and supervised practical training must total at least 75 hours. .... (4) The HHA must maintain documentation that demonstrates that the requirements of this standard have been met. (B) Competency Requirement: An individual may furnish home health aide services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. ....” A review of EFs was conducted on February 4, 2026 at approximately 11:00 a.m. The employees date of hire (DOH) is listed below. EF#7 DOH 10/23/23: Employees first work shift as a home health aide was on 10/30/23. No documentation provided of the employee meeting the agency policy requirements of a minimum of (75) hours of a combination of classroom and supervised practical training. An interview conducted with agency Administrator on February 5, 2026 at approximately 2:00 p.m. confirmed the above findings.”