Visiting Nurse Association of the Wabash Valley in

“Written instructions to patient include: CFR(s): 484.60(e) Standard: Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: This Standard is not met as evidenced by: Based on record review and interview, the agency failed to provide the patient with a copy of the aide POC in the home for 1 of 1 non-skilled patient home visits. (Patient #10) Findings include: During a home visit conducted on 05/14/2026 at 3:00 PM, the surveyor reviewed Patient #10’s admission packet. The packet did not contain a copy of the aide POC, as required. During an interview on 05/14/2026 at 3:10 PM, HHA 1 stated Patient #10 did not have a copy of the aide POC in the home. During an interview on 05/14/2026 at 3:30 PM, the Alternate Administrator stated the agency did not provide a copy of the aide POC in the home.”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observation, record review, and interview, the agency failed to adhere to infection control procedures for 4 of 6 skilled patient home visits. (Patients #2, #3, #5, #8) Findings included: 2. During an observation on 05/12/2026 at 12:05 PM, RN 3 removed stethoscope from around neck, listened to Patient #3’s lungs then placed stethoscope back around her neck. RN 3 failed to clean stethoscope before and after use on Patient #3. RN 3 scrunched up dirty drape in left hand, holding it with her last 3 fingers, while using her thumb and first finger to do a head to toe assessment on Patient #3. RN failed to dispose of dirty supplies, glove change and hand hygiene after touching dirty drape and before touching patient. RN 3 gloved, then touched Patient #3’s G-tube insertion site. RN 3 failed to hand hygiene before gloving. During an interview on 05/12/2026 at 1:00 PM, RN 3 indicates hand hygiene is to be completed before and after glove change, she indicated she knew she missed some infections control during the home visit. 3. During an observations on 05/12/2025 at 2:57 with Clinical Supervisor present, LPN 1 cleaned skin on Patient #5’s right AC touched skin with gloves finger then pierced skin with a butterfly needle. LPN 1 rolled used needle up in glove, LPN 1 second attempt for labs, LPN 1 held lab tube in mouth while attempting to collect lab in right forearm, removed tube from mouth, attached to a vacutainer. Then LPN 1 provided Patient #5 family member with a syringe and needle to attempt to collect labs from right AC; family member palpated site, punctured skin using needle/syringe provided by LPN 1. LPN 1’s third attempt for labs, LPN 1 healed lab tube in mouth while attempting to collect lab in right hand. LPN 1 touched skin then pierced skin with butterfly. LPN 1 removed lab tube from mouth, laying on patient chair. LPN 1 then removed right glove, entered nursing bag collected needle from nursing bag, used bare hand to remove butterfly needle from syringe and connected new needle to syringe. LPN 1 rolled butterfly needle, syringe and capped needle used during third attempt into used left glove. LPN 1 told patient/family member she has sharps container in car. LPN 1 then returned clean equipment in nursing bag without hand hygiene before touching clean equipment. LPN 1 and family member failed to hand hygiene before and after gloving, clean access site after touching and before piercing skin with needle; LPN 1 failed to properly discard biohazard material, failed to keep clean lab equipment from contacting LPN 1’s body fluids, failed to hand hygiene before entering nursing bag, and failed to don gloves before touching blood contaminated lab equipment. During an interview on 05/12/2026 at 4:15 PM, the Clinical Supervisor indicated lab tubes are not to be placed in clinicians mouth, family members are not allowed to draw labs for agency, there was hand hygiene and infection control concerns that she noted during visit. 2. During an observation on 05/12/2026 at 1:30 PM, the surveyor observed an ant on the floor in front of Patient #2’s chair. LPN 1 placed a paper barrier on the floor in front of the patient’s chair, next to three half‑full plastic milk jugs containing a yellow liquid. She placed her tablet and a packet of Sani‑wipes on the paper barrier. One milk jug made direct contact with the barrier. LPN 1 applied a dressing to the patient’s wound, wrapped the area with gauze, and applied pantyhose to secure it. She removed one glove to retrieve a roll of tape from her supply bag and then applied tape to the foam dressing. LPN 1 did not maintain a clean area for reusable supplies and did not remove gloves and perform hand hygiene before donning clean gloves and handling clean items. During an interview on 05/12/2026 at 1:40 PM, LPN 1 stated the milk jugs contained “pee.” She confirmed she placed her tablet and Sani‑wipes on the paper barrier and stated the barrier was considered a dirty area. During an interview on 05/13/2026 at 8:38 AM, the Alternate Administrator stated staff should place the barrier and equipment on a hard surface, ideally a table or chair, and not on the floor. 3. During an observation on 05/13/2026 at 9:30 AM, LPN 3 removed a soiled bandage from Patient #8’s right great toe while wearing gloves. She retrieved a bottle of wound cleaner from the clean supply box while still wearing the same contaminated gloves. LPN 3 did not remove gloves and perform hand hygiene after removing the soiled dressing and before accessing clean supplies. During an interview on 05/13/2026 at 10:05 AM, LPN 3 stated the wound cleaner in the box was located in a clean area. She stated she cleaned the bottle with a disinfectant wipe after use and acknowledged she should remove gloves before accessing the clean supply box. During an interview on 05/13/2026 at 10:20 AM, the Alternate Clinical Supervisor stated the nurse should not access the clean supply box while wearing dirty gloves. 410 IAC 17-12-1(m) 1. During an observation on 05/12/2026 at 12:05 PM, RN 3 removed stethoscope from around neck, listened to Patient #3’s lungs then placed stethoscope back around her neck. RN 3 failed to clean stethoscope before and after use on Patient #3. RN 3 scrunched up dirty drape in left hand, holding it with her last 3 fingers, while using her thumb and first finger to do a head to toe assessment on Patient #3. RN failed to dispose of dirty supplies, glove change and hand hygiene after touching dirty drape and before touching patient. RN 3 gloved, then touched Patient #3’s G-tube insertion site. RN 3 failed to hand hygiene before gloving. During an interview on 05/12/2026 at 1:00 PM, RN 3 indicates hand hygiene is to be completed before and after glove change, she indicated she knew she missed some infections control during the home visit. 2. During an observation on 05/12/2026 at 1:30 PM, the surveyor observed an ant on the floor in front of Patient #2’s chair. LPN 1 placed a paper barrier on the floor in front of the patient’s chair, next to three half‑full plastic milk jugs containing a yellow liquid. She placed her tablet and a packet of Sani‑wipes on the paper barrier. One milk jug made direct contact with the barrier. LPN 1 applied a dressing to the patient’s wound, wrapped the area with gauze, and applied pantyhose to secure it. She removed one glove to retrieve a roll of tape from her supply bag and then applied tape to the foam dressing. LPN 1 did not maintain a clean area for reusable supplies and did not remove gloves and perform hand hygiene before donning clean gloves and handling clean items. During an interview on 05/12/2026 at 1:40 PM, LPN 1 stated the milk jugs contained “pee.” She confirmed she placed her tablet and Sani‑wipes on the paper barrier and stated the barrier was considered a dirty area. During an interview on 05/13/2026 at 8:38 AM, the Alternate Administrator stated staff should place the barrier and equipment on a hard surface, ideally a table or chair, and not on the floor. 3. During an observations on 05/12/2025 at 2:57 PM, with Clinical Supervisor present, LPN 1 cleaned skin on Patient #5’s right AC touched skin with gloves finger then pierced skin with a butterfly needle. LPN 1 rolled used needle up in glove, LPN 1 second attempt for labs, LPN 1 held lab tube in mouth while attempting to collect lab in right forearm, removed tube from mouth, attached to a vacutainer. Then LPN 1 provided Patient #5 family member with a syringe and needle to attempt to collect labs from right AC; family member palpated site, punctured skin using needle/syringe provided by LPN 1. LPN 1’s third attempt for labs, LPN 1 healed lab tube in mouth while attempting to collect lab in right hand. LPN 1 touched skin then pierced skin with butterfly. LPN 1 removed lab tube from mouth, laying on patient chair. LPN 1 then removed right glove, entered nursing bag collected needle from nursing bag, used bare hand to remove butterfly needle from syringe and connected new needle to syringe. LPN 1 rolled butterfly needle, syringe and capped needle used during third attempt into used left glove. LPN 1 told patient/family member she has sharps container in car. LPN 1 then returned clean equipment in nursing bag without hand hygiene before touching clean equipment. LPN 1 and family member failed to hand hygiene before and after gloving, clean access site after touching and before piercing skin with needle; LPN 1 failed to properly discard biohazard material, failed to keep clean lab equipment from contacting LPN 1’s body fluids, failed to hand hygiene before entering nursing bag, and failed to don gloves before touching blood contaminated lab equipment. During an interview on 05/12/2026 at 4:15 PM, the Clinical Supervisor indicated lab tubes are not to be placed in clinicians mouth, family members are not allowed to draw labs for agency, there was hand hygiene and infection control concerns that she noted during visit. 4. During an observation on 05/13/2026 at 9:30 AM, LPN 3 removed a soiled bandage from Patient #8’s right great toe while wearing gloves. She retrieved a bottle of wound cleaner from the clean supply box while still wearing the same contaminated gloves. LPN 3 did not remove gloves and perform hand hygiene after removing the soiled dressing and before accessing clean supplies. During an interview on 05/13/2026 at 10:05 AM, LPN 3 stated the wound cleaner in the box was located in a clean area. She stated she cleaned the bottle with a disinfectant wipe after use and acknowledged she should remove gloves before accessing the clean supply box. During an interview on 05/13/2026 at 10:20 AM, the Alternate Clinical Supervisor stated the nurse should not access the clean supply box while wearing dirty gloves.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on record review and interview, the agency failed to have a signed POC or a valid verbal POC order including the physician’s name, the date and time of the verbal order, the specific services and treatments authorized, and the name and title of the staff member receiving the order from the primary physician before providing services and treatments to patients in 9 of 17 record reviews, potentially affecting all patient records. (Patients #5, #8, #9, #10, #11, #12, #13, #14, #16) Findings include: 1. A review of Patient #5’s record for the certification period 05/07/2026 to 07/05/2026 evidenced a Communication Note dated 05/04/2026 indicating the agency received a verbal start of care from the physician. The agency provided skilled nursing services on 05/12/2026 and 05/14/2026 without obtaining a valid verbal order or a signed POC from the physician. 2. A review of Patient #8’s record for the certification period 04/06/2026 to 06/04/2026 evidenced a Communication Note dated 04/03/2026 indicating the agency received a verbal start of care from the physician. The agency provided skilled nursing services on 04/08/2026, 04/14/2026, 04/17/2026, 04/20/2026, 04/22/2026, 04/24/2026, 04/29/2026, 05/01/2026, and 05/04/2026 without obtaining a valid verbal order or a signed POC from the physician. 3. A review of Patient #9’s record for the certification period 03/24/2026 to 05/22/2026 evidenced a Communication Note dated 03/11/2026 indicating the agency received a verbal start of care from the physician. The agency provided skilled nursing services on 03/26/2026, 03/30/2026, 04/02/2026, 0406/2026, and 04/10/2026 without obtaining a valid verbal order or a signed POC from the physician. 4. A review of Patient #10’s record for the certification period 04/17/2026 to 06/15/2026 evidenced a Communication Note dated 04/15/2026 indicating the agency received a verbal start of care from the physician. The agency provided skilled nursing services on 04/21/2026, 04/28/2026, 05/04/2026; provided HHA services on 04/24/2026, 04/28/2026, and 04/30/2026 without obtaining a valid verbal order or a signed POC from the physician. 5. A review of Patient 11’s record for the certification period 04/05/2026 to 06/03/2026 evidenced a Communication Note dated 04/30/2026 indicating the agency received a verbal start of care from the physician. The agency provided and skilled nursing services on 04/09/2026, 04/16/2026, 04/23/2026, 04/30/2026 and 05/07/2026 without obtaining a valid verbal order or a signed POC from the physician. 6. A review of Patient #12’s record for the certification period 04/04/2026 to 06/02/2026 evidenced a Communication Note dated 03/31/2026 indicating the agency received a verbal start of care from the physician. The agency provided OT services on 04/08/2026, 04/10/2026, 04/21/2026, 04/23/2026, and 04/29/2026 without obtaining a valid verbal order or a signed POC from the physician. 7. A review of Patient #13’s record for the certification period 12/18/2025 to 02/15/2026 evidenced a Communication Note dated 12/11/2025 indicating the agency received a verbal start of care from the physician. The agency provided skilled nursing services on 12/23/2025 and 12/30/2025 without obtaining a valid verbal order or a signed POC from the physician. 8. A review of Patient 14’s record for the certification period 01/28/2025 to 03/28/2025 evidenced a Communication Note dated 01/27/2025 indicating the agency received a verbal start of care from the physician. The agency provided and skilled nursing services on 02/04/2025, 02/10/2025, 02/23/2025, 02/27/2025, 03/03/2025, 03/05/2025, 03/10/2025, 03/12/2025,03/17/2025, and 03/19/2025 without obtaining valid verbal order or a signed POC from the physician. 9. A review of Patient #16’s record for the certification period 01/12/2026 to 03/12/2026 evidenced a Communication Note dated 01/09/2026 indicating the agency received a verbal start of care from the physician. The agency provided PT services on 01/16/2026, 01/21/2026 and OT services on 01/22/2026 without obtaining a valid verbal order or a signed POC from the physician. 410 IAC 17-13-1(a)”

“Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure staff completed a nursing assessment for 5 of 7 home visit observations with a nurse. (Patients #2, #5, #8, #11) Findings include: 2. During an observation on 05/12/2026 at 1:30 PM, LPN 1 did not complete a head‑to‑toe assessment, including a skin assessment, for Patient #2. During an interview on 05/12/2026 at 2:00 PM, LPN 1 stated she completed the patient’s head‑to‑toe assessment, although she did not assess the patient’s back, buttocks, left lower leg, heels, or the areas between the toes. 3. During an observation on 05/13/2026 at 9:30 AM, LPN 3 failed to complete a head to toe assessment on Patient #8. During an interview on 05/13/2026 at 10:00 AM, LPN 3 stated she completed a head to toe assessment although she did not assess the patients back, buttock, posterior legs, heels, and in-between all toes. 4. During an observation on 05/14/2026 at 12:00 PM, LPN 2 failed to assess Patient #11’s back, buttocks, feet, and toes, buttock, and back. During an interview on 05/13/2026 at 12:30 PM, LPN 2 stated the patient’s caregiver completed wound care prior to her visit. LPN 2 stated she sees the patient weekly for wound care and measurements but stated she would mark the measurement as missed for that visit. During an interview on 05/13/2026 at 8:38 AM, the Alternate Administrator stated nurses are expected to do a full head to toe assessment on the patient at each visit. The expectation to assess back, between patients toes, heels, buttock, and back. During an interview on 05/132026 at 9:00 AM, the Clinical Supervisor stated nurses are to do a full assess head to toe assessment on all patient visits. 410 IAC 17-12-2(g) 2. During an observations on 05/12/2026 at 2:57 PM with Clinical Supervisor present, prior to entering visit LPN 1 indicated this was the first home visit after start of care. LPN 1 failed to assess Patient # 5’s a skin, lungs, or abdomen during visit. Patient #5 remained in recliner for the entire home visit. At end of visit, Patient #5 asked for Clinical Supervisor and Surveyor to step out while LPN looked at PureWick (a non-invasive urine management device designed for adults experiencing urinary incontinence). LPN indicated she was done with visit after that, due to time restraint to get labs delivered. LPN failed to preform wound care. A review on Patient #5’s record evidence a POC with a cert period of 05/07/2026 to 07/05/2026, a start of care date of 05/07/2026 indicates Skilled nurse to assess and evaluate co-morbid conditions including HTN, DM, LT arm DVT, COPD and conditions that present themselves during the course of episode. The POC indicates the skilled nurse to perform pressure ulcer care to Lt buttock area as follows: clean with saline apply hydrogel, cover with bordered gauze, to be changed daily. The POC also indicates no wound assessment was conducted on 05/07/2026 and skilled nursing visits are weekly. During an interview on 05/12/2026 at 4:15 PM, the Clinical Supervisor indicated the visit was completed and LPN would not be providing any other care to patient other than looking at PureWick placement. The Clinical Supervisor indicated she took notes during the visit and had concerns related to infection control, no mention of wound care not being provided or a head to toe completed.”

“Provide contact info other services CFR(s): 484.50(d)(5)(iii) (iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and This Element is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure that the patient and their representative were provided with contact information for other community resources and with the names of alternative agencies or providers available to assume care, for 1 of 1 discharge‑for‑cause records reviewed (Patient #1). Findings include: A policy titled “Discharge Criteria and Process” dated 01/2025 required the agency to document its decision to terminate or reduce services, including the circumstances and notification to the patient and responsible family member. The agency must document efforts to resolve problems before discharge. If continued care is needed, the patient must receive contact information for other home health agencies and providers. The Clinical Manager or a designee is responsible for these actions. An undated document titled “Patient Rights and Responsibilities” states that the agency should comply with all applicable local, state, and federal laws or regulations and accepted professional standards or principles of practice. A review of Patient #1’s record for the certification period 01/08/2026 to 03/08/2026 included a physician order dated 02/17/2026 to discharge the patient due to safety concerns. During an interview on 03/02/2026 at 2:08 PM, Patient #1’s family stated that the agency terminated services effective immediately without providing 15 days’ written notice. They said the agency discharged the patient due to staff safety concerns, but did not provide details about the specific issues. They stated the agency failed to facilitate a safe transfer to another provider. Despite the patient’s high-acuity needs—including a colostomy (opening in the abdominal wall), a Foley catheter (tube inserted to drain urine), and cardiac/pulmonary comorbidities (medical conditions)—the agency “simply stopped services,” and they received no discharge paperwork by mail. The family expressed concern that this lack of coordination and failure to ensure continuity of care placed Patient #1 at immediate risk for hospitalization. During an interview on 03/03/2026 at 10:04 AM, the Clinical Supervisor stated staff reported feeling unsafe due to the brother’s intimidating behavior, such as standing in doorways and closing doors behind clinicians. During the final visit, several unidentified men were present in the home, prompting the clinical manager to cancel further staff visits due to safety concerns. She said the agency implemented “dual visits” for a month to keep staff safe. The Home Health Aide (HHA) performed only limited hygiene care because the patient refused full baths. The agency then stopped HHA services and wound care when the home became too dangerous for staff. She said she spoke with the Power of Attorney (POA) about the transition of care. The agency did not issue a 15-day discharge notice. It considered the situation an “immediate” safety risk. The medical social worker (MSW) did not participate in this episode. She coordinated follow-up appointments with the patient’s doctors and the wound center. She stated that the agency did not send the POA any mail notification with contact information and resources for other home health agencies and providers. During an interview on 03/03/2026 at 10:04 AM, the Alternate Administrator reviewed the case and questioned whether the Clinical Supervisor should have provided a list of alternative home health agencies and community resources. She noted that the patient was near the end of their care episode, remained mentally competent to make their own decisions, and had not verbalized any personal concerns regarding their safety. The agency failed to provide written contact information and resources as required by 484.50(d).”