Quality Caregivers Health Care Inc.

“Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This Condition is not met as evidenced by: Based on observation, record review and interview, the Adm failed to maintain compliance with this Condition of Participation to ensure the agency’s skilled professional services included skilled nursing services, physical therapy, speech- language pathology services, and occupational therapy, physician or allowed practitioner, and medical social work services, and ensure skilled personnel who provided services to patients directly or under arrangement participated in the coordination of care in that: The agency did not allow a surveyor entry to the Agency to begin a survey during regular business hours to determine if agency’s skilled professionals assumed responsibly for patient care and on-going interdisciplinary assessment of the patient. Refer to G 706.”

“Organization and administration of services CFR(s): 484.105 Condition of participation: Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished. This Condition is not met as evidenced by: Based on observation, record review and interview, the Adm failed to maintain compliance with this Condition of Participation to ensure that the agency organized, managed and administered its resources to maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcome identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs and ensure that administrative and supervisory functions were not delegated to another agency and all services not furnished directly were monitored in that: The Adm failed to be responsible for all day-to-day operations of the agency when the agency was not ready for attempted survey on 08/26/26. Based on observation, record review and interview, the Adm failed to maintain compliance with this Condition of Participation to ensure that the agency organized, managed and administered its resources to maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcome identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs and ensure that administrative and supervisory functions were not delegated to another agency and all services not furnished directly were monitored in that: The Adm failed to be responsible for all day-to-day operations of the agency when the agency was not ready for attempted survey on 08/26/26. Refer to G0948 The Adm or designated person failed to be available during all operating hours of the agency when the agency was not ready for attempted survey on 08/26/26 Refer to G0956 The agency failed to ensure skilled services and at least one therapeutic service (physical therapy, speech- language pathology or occupational therapy, medical social services, or home health aide services) were made available on a visiting basis, in a place or residence used as a patient’s home, and ensure the agency provided at least one of the services directly, or may provide the second services and additional services under arrangement with another agency when the agency was not ready for attempted survey on 08/26/26. Refer to G0982”

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on observation, record review and interview, the agency failed to ensure that skilled professional services were delivered and supervised by healthcare professionals who met applicable qualifications and practiced in accordance with the agency’s policies and procedures in that: The Adm/DON refused to permit the Surveyor to conduct the survey and did not provide surveyor access necessary to review the agency’s records, personnel qualifications, professional services, supervision and related documentation. This failure placed all potential patients at risk of receiving substandard care and at risk of poor outcomes. Findings include: Review of the agency’s account page in Texas Unified License Information Portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 08/26/26 revealed agency’s contact information as Agency’s address. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 5pm. Monday through Friday. Continued review of the Agency’s TULIP account revealed agency’s census was 3 as of 3/31/2024. During an observation on 8/26/26 at 10:58 AM, Surveyor arrived at the agency address listed in TULIP. The agency was located at a personal residence. Two vehicles were observed parked in the driveway in front of the residence. Surveyor pressed the doorbell and knocked on the door several times, however, no one answered the door. The agency information was posted on the inside of a glass door frame. The agency’s posted information included an after-hours telephone number XXX-XXX-XXX. Surveyor then observed a third vehicle arrive and park in the driveway in front of the residence. A male individual was observed seated inside the vehicle during Surveyors observation. No further activity involving the individual was observed. During an interview on 08/26/26 at 11:00 AM Surveyor called the agency’s after-hours telephone number. The telephone was answered by a female who identified herself as the agency’s Adm/DON. Surveyor introduced herself and explained that the purpose of the call was to conduct a re-licensure and recertification survey. The Adm/DON stated that she was in the hospital caring for a sick family member . The Adm/DON stated that she was “going through a lot” and was unable to focus on the survey at the time. The Adm/DON further stated that the Alt Adm and ADON were also unavailable for the survey. The Adm/DON stated that she was the only person who could provide the records requested for the survey and stated the male individual that was observed inside the vehicle was a family member that was not employed by the agency. The Adm/DON stated that she had too much going on in her life and was not available to participate in the survey or provide the requested records. The Adm/DON further stated that the agency had no active patients and that she believed the agency’s last patient had been discharged approximately 2 to 3 years ago. Surveyor informed the Adm/DON that the surveyor had a 2 hour wait limit for the agency’s survey entrance and explained the consequences of refusing the survey. The Adm/DON acknowledged understanding of the information provided by the surveyor. the agency did not make an authorized representative available to provide access to the agency’s records or facilitate the survey. The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm/DON on 08/26/26 at 1:08 PM.”

“Skilled services furnished CFR(s): 484.105(f) Standard: Services furnished. Skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are made available on a visiting basis, in a place of residence used as a patient’s home. An HHA must provide at least one of the services described in this subsection directly, but may provide the second service and additional services under arrangement with another agency or organization. This Standard is not met as evidenced by: Based on observation, record review and interview, the agency failed to ensure that skilled nursing services and at least one therapeutic service ( physical therapy, speech-language pathology or occupational therapy, medical social services, or home health aide services) were made available on a visiting basis, in a place of residence uses as a patient’s home, and ensure the agency provided at least one of the services directly, or may provide the second services and additional services under arrangement with another agency in that: The Adm/DON refused to participate in the recertification and re-licensure survey and failed to demonstrate that the required services were available during the attempted survey on 08/26/26. This failure placed all potential patients at risk of receiving substandard care and at risk of poor outcomes. Findings include: Review of the agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 08/26/26 revealed agency’s contact information as Agency’s address. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 5pm. Monday through Friday. The agency’s categories of service were listed as L&CHHS, LHHS and PAS. Continued review of the Agency’s TULIP account revealed agency’s census was 3 as of 3/31/2024. During an observation on 8/26/26 at 10:58 AM, Surveyor arrived at the agency address listed in TULIP. The agency was located at a personal residence. Two vehicles were observed parked in the driveway in front of the residence. Surveyor pressed the doorbell and knocked on the door several times, however, no one answered the door. The agency information was posted on the inside of a glass door frame. The agency’s posted information included an after-hours telephone number XXX-XXX-XXX. Surveyor then observed a third vehicle arrive and park in the driveway in front of the residence. A male individual was observed seated inside the vehicle during Surveyors observation. No further activity involving the individual was observed. During an interview on 08/26/26 at 11:00 AM Surveyor called the agency’s after-hours telephone number. The telephone was answered by a female who identified herself as the agency’s Adm/DON. Surveyor introduced herself and explained that the purpose of the call was to conduct a re-licensure and recertification survey. The Adm/DON stated that she was in the hospital caring for her sick family member. The Adm/DON stated that she was “going through a lot” and was unable to focus on the survey at the time. The Adm/DON further stated that the Alt Adm and ADON were also unavailable for the survey. The Adm/DON stated that she was the only person who could provide the records requested for the survey and stated the male individual that was observed inside the vehicle was a family member that was not employed by the agency. The Adm/DON stated that she had too much going on in her life and was not available to participate in the survey or provide the requested records. The Adm/DON further stated that the agency had no active patients and that she believed the agency’s last patient had been discharged approximately 2 to 3 years ago. Surveyor informed the Adm/DON that the surveyor had a 2 hour wait limit for the agency’s survey entrance and explained the consequences of refusing the survey. The Adm/DON acknowledged understanding of the information provided by the surveyor. Despite being Informed of the purpose of the survey, the surveyors limited wait time and the consequences of refusing or failing to facilitate the survey, the agency did not make an authorized representative available to provide access to the agency’s records or facilitate the survey. The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 08/26/26 at 1:08 PM.”

“Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This Element is not met as evidenced by: Based on observation, record review and interview, the Adm failed to be responsible for all day-to-day operations of the agency in that: The Adm/DON and or Alt Adm failed to be available to a HHSC representative to conduct a recertification and re-licensure survey during regular business hours and during the agency’s operating hours on 08/26/26. This failure placed all potential patients at risk of receiving substandard care and at risk of poor outcomes. Findings include: Review of the agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 08/26/26 revealed agency’s contact information as Agency’s address. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 5pm. Monday through Friday. The agency’s categories of service were listed as L&CHHS, LHHS and PAS. Continued review of the Agency’s TULIP account revealed agency’s census was 3 as of 3/31/2024. During an observation on 8/26/26 at 10:58 AM, Surveyor arrived at the agency address listed in TULIP. The agency was located at a personal residence. Two vehicles were observed parked in the driveway in front of the residence. Surveyor pressed the doorbell and knocked on the door several times, however, no one answered the door. The agency information was posted on the inside of a glass door frame. The agency’s posted information included an after-hours telephone number XXX-XXX-XXX. Surveyor then observed a third vehicle arrive and park in the driveway in front of the residence. A male individual was observed seated inside the vehicle during Surveyors observation. No further activity involving the individual was observed. During an interview on 08/26/26 at 11:00 AM Surveyor called the agency’s after-hours telephone number. The telephone was answered by a female who identified herself as the agency’s Adm/DON. Surveyor introduced herself and explained that the purpose of the call was to conduct a re-licensure and recertification survey. The Adm/DON stated that she was in the hospital caring for her sick family member. The Adm/DON stated that she was “going through a lot” and was unable to focus on the survey at the time. The Adm/DON further stated that the Alt Adm and ADON were also unavailable for the survey. The Adm/DON stated that she was the only person who could provide the records requested for the survey and stated the male individual that was observed inside the vehicle was a family member that was not employed by the agency. The Adm/DON stated that she had too much going on in her life and was not available to participate in the survey or provide the requested records. The Adm/DON further stated that the agency had no active patients and that she believed the agency’s last patient had been discharged approximately 2 to 3 years ago. Surveyor informed the Adm/DON that the surveyor had a 2 hour wait limit for the agency’s survey entrance and explained the consequences of refusing the survey. The Adm/DON acknowledged understanding of the information provided by the surveyor. the agency did not make an authorized representative available to provide access to the agency’s records or facilitate the survey. The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 08/26/26 at 1:08 PM.”

“Available during all operating hours CFR(s): 484.105(b)(3) The administrator or a pre-designated person is available during all operating hours. This Element is not met as evidenced by: Based on observation, record review and interview, the administrator or a designated person failed to be available during all operating hours in that: The Adm/DON and or Alt Adm failed to be available to a HHSC representative to conduct a recertification and re-licensure survey during the agency’s operating hours on 08/26/26. This failure placed all potential patients at risk of receiving substandard care and at risk of poor outcomes. Findings include: Review of the agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 08/26/26 revealed agency’s contact information as Agency’s address. Agency’s phone Number as XXX-XXX-XXXX, agency’s operational hours as 9am – 5pm. Monday through Friday. Continued review of the Agency’s TULIP account revealed agency’s census was 3 as of 3/31/2024. During an observation on 8/26/26 at 10:58 AM, Surveyor arrived at the agency address listed in TULIP. The agency was located at a personal residence. Two vehicles were observed parked in the driveway in front of the residence. Surveyor pressed the doorbell and knocked on the door several times, however, no one answered the door. The agency information was posted on the inside of a glass door frame. The agency’s posted information included an after-hours telephone number XXX-XXX-XXX. Surveyor then observed a third vehicle arrive and park in the driveway in front of the residence. A male individual was observed seated inside the vehicle during Surveyors observation. No further activity involving the individual was observed. During an interview on 08/26/26 at 11:00 AM Surveyor called the agency’s after-hours telephone number. The telephone was answered by a female who identified herself as the agency’s Adm/DON. Surveyor introduced herself and explained that the purpose of the call was to conduct a re-licensure and recertification survey. The Adm/DON stated that she was in the hospital caring for her sick family member. The Adm/DON stated that she was “going through a lot” and was unable to focus on the survey at the time. The Adm/DON further stated that the Alt Adm and ADON were also unavailable for the survey. The Adm/DON stated that she was the only person who could provide the records requested for the survey and stated the male individual that was observed inside the vehicle was a family member that was not employed by the agency. The Adm/DON stated that she had too much going on in her life and was not available to participate in the survey or provide the requested records. The Adm/DON further stated that the agency had no active patients and that she believed the agency’s last patient had been discharged approximately 2 to 3 years ago. Surveyor informed the Adm/DON that the surveyor had a 2 hour wait limit for the agency’s survey entrance and explained the consequences of refusing the survey. The Adm/DON acknowledged understanding of the information provided by the surveyor. Despite being Informed of the purpose of the survey, the surveyors limited wait time and the consequences of refusing or failing to facilitate the survey, the agency did not make an authorized representative available to provide access to the agency’s records or facilitate the survey. The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 08/26/26 at 1:08 PM.”