Good Samaritan Home Care Services of Vincennes in

“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 staff failed to follow infection control techniques for hand hygiene and wound care in 2 of 3 wound care observations (RN 1, RN 2); and failed to maintain appropriate bag technique in 1 of 1 home visit observations with an LPN. (LPN 1) Findings include: 1. The revised 11/14/2025 policy titled ‘Hand Hygiene’ required staff to perform hand hygiene after contact with body fluids and wound dressings, whether or not they wore gloves. 2. A revised 05/07/2024 policy titled “Bag Technique” required staff to use a suitable impervious container when the home environment did not appear clean, and to prepare the equipment for both clean and dirty areas. 3. During a home visit on 02/19/2026 at 10:30 AM, RN 1 applied gloves and removed the wound dressing from Patient #5’s left upper thigh. RN 1 cleaned the wound and applied a new dressing without changing gloves or performing hand hygiene. During an interview on 02/23/2026 at 10:00 AM, RN 1 stated she changed gloves before and after removing soiled dressings and after direct patient contact. 4. During a home visit on 02/19/2026 at 3:00 PM, RN 2 applied gloves and removed the wound dressing from Patient #6’s buttocks. RN 2 cleansed the wound and retrieved 4x4 gauze and a foam dressing from clean supplies. RN 1 failed to change gloves and perform hand hygiene after removing the soiled dressing and obtaining clean supplies. During an interview on 02/19/2026 at 3:30 PM, RN 2 stated she knew she must change gloves and perform hand hygiene when providing wound care. 5. During a home visit on 02/20/2026 at 3:00 PM, LPN 1 opened a clear container holding vital sign equipment (blood pressure cuff, thermometer, oxygen saturation device). She took Patient #7’s vital signs, cleaned the equipment, and placed it on the inner lid of the container, which was designated the dirty area. She then placed the cleaned equipment back in the container, closed the lid, and thereby contaminated it. LPN 1 did not properly designate clean and dirty areas, which could have led to cross-contamination. During an interview on 02/20/2026 at 3:15 PM, LPN 1 stated she did not bring the agency equipment bag into homes with compromised environments. She used a clear container, designating the inside as the clean area and the inside lid as the dirty area. 410 IAC 17-12-1(m)”

“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 provide services as ordered by the physician for 1 of 1 active records reviewed with patients receiving HHA services (Patient #1), 10 of 10 active records reviewed with patients receiving SN services (Patients #2, #3, #4, #6, #7, #8, #9, #10, #11, #12), and 4 of 5 inactive records reviewed with patients receiving SN services (Patients #13, #15, #16, #17) Findings include: 1. A revised 03/05/2024 policy titled “Plan of Care and Physician and Allowed Practitioner Orders” indicates the POC was developed by the clinician with the physician and sent to the office for signature. The policy states that a written verification by the clinician must accompany a verbal order from the physician. The policy states that a verbal order was sufficient to implement the POC until a signed POC is returned. 2. The review of Patient #1’s record for the certification period 12/29/2025 to 02/26/2026 showed the agency received a verbal start-of-care order from the physician on 12/30/2025. The agency provided Home Health Aide services on 01/02/2026 and 01/07/2026 before obtaining a detailed verbal order or a signed POC from the physician. 3. A review of Patient #2’s record for the certification period 1/16/2026 to 03/16/2026 showed a Communication Note dated 01/21/2026 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 01/17/2026, 01/21/2026, 01/28/2026, and 02/04/2026 before obtaining a detailed verbal order or a signed POC from the physician. 4. A review of Patient #3’s record for the certification period of 01/26/2026 to 03/23/2026 showed a Communication Note dated 01/24/2026 indicating the agency received a verbal start-of-care from the physician. The agency provided physical therapy services on 01/27/2026, 02/04/2026, 02/11/2026, and 02/11/2026; occupational therapy services on 01/29/2026, 02/06/2026, 02/09/2026, and 02/16/2026; and skilled nursing on 01/30/2026 and 02/13/2026. The agency provided these services without obtaining a detailed verbal order or a signed Plan of Care (POC) from the physician. 5. A review of Patient #4’s record for the certification period 11/23/2025 to 01/21/2026 showed a Communication Note dated 12/04/2025 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 12/02/2025 before obtaining a detailed verbal order or a signed POC from the physician. 6. A review of Patient #5’s record for the certification period 02/07/2026 to 04/07/2026 showed a Communication Note dated 02/09/2026 indicating the agency received a verbal start-of-care from the physician. The agency provided Physical therapy services on 02/09/2026, 02/11/2026, 02/13/2026, 02/16/2026, and 02/18/2026 before obtaining a detailed verbal order or a signed POC from the physician. 7. A review of Patient #6’s record for the certification period 01/12/2026 to 03/12/2026 showed a Communication Note dated 01/12/2026 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 02/19/2026 before obtaining a detailed verbal order or a signed POC from the physician. 8. A review of Patient #7’s record for the certification period 12/30/2025 to 2/27/2026 showed a Communication Note dated 01/02/2026 indicating the agency received a verbal start‑of‑care order from the physician. The agency provided Skilled nursing services on 01/05/2026, 01/09/2026, 01/12/2026, and 01/16/2026 before obtaining a detailed verbal order or a signed POC from the physician. 9. A review of Patient #8’s record for the certification period 10/03/2025 to 12/01/2026 showed a Communication Note dated 10/05/2025 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 10/08/2026 and 10/10/2026 before obtaining a detailed verbal order or a signed POC from the physician. 10. A review of Patient #9’s record for the certification period 02/03/2026 to 04/03/2026 showed a Communication Note dated 02/03/2026 indicating the agency received a verbal-start-of-care from the physician. The agency provided Skilled nursing services on 02/010/2026, occupational services on 02/05/2026, and 02/09/2026 before obtaining a detailed verbal order or a signed POC from the physician. 11. A review of Patient #10’s record for the certification period 01/08/2026 to 03/08/2026 showed a Communication Note dated 01/12/2026 indicating the agency received a verbal-start-of-care from the physician. The agency provided Skilled nursing and Occupational services on 01/15/2026 before obtaining a detailed verbal order or a signed POC from the physician. 12. A review of Patient #11’s record for the certification period 02/07/2026 to 04/07/2026 showed a Communication Note dated 02/13/2026 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 02/12/2026, 02/14/2026, and 02/17/2026 before obtaining a detailed verbal order or a signed POC from the physician. 13. A review of Patient #12’s record for the certification period 10/22/2025 to 12/20/2025 showed a Communication Note dated 10/23/2025 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 10/28/2025 before obtaining a detailed verbal order or a signed POC from the physician. 14. A review of Patient #13’s record for the certification period 06/03/2025 to 08/01/2025 showed a Communication Note dated 06/03/2025 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 06/10/2025 before obtaining a detailed verbal order or a signed POC from the physician. 15. A review of Patient #14’s record for the certification period 01/23/2025 to 03/23/2025 showed a Communication Note dated 01/27/2025 indicating the agency received a verbal start-of-care from the physician. The agency provided Physical therapy services on 01/24/2025 and 01/27/2025 before obtaining a detailed verbal order or a signed POC from the physician. 16. A review of Patient #15’s record for the certification period 02/14/2025 to 04/14/2025 showed a Communication Note dated 02/28/2025 indicating the agency received a verbal-star-of-care from the physician. The agency provided Skilled nursing services on 02/19/2025, 02/21/2025, and 02/26/2025 before obtaining a detailed verbal order or a signed POC from the physician. 17. A review of Patient #16’s record for the certification period 04/08/2025 to 06/06/2025 showed a Communication Note dated 04/29/2025 indicating the agency received a verbal start-of-care from the physician. The agency provided Skilled nursing services on 04/17/2025 and 04/22/2025 before obtaining a detailed verbal order or a signed POC from the physician. 18. A review of Patient #17’s record for the certification period 04/11/2025 to 06/09/2025 showed a Communication Note dated 04/11/2025 indicating the agency received a verbal start‑of‑care order from the physician. The agency provided Skilled nursing services on 04/18/2025 and 04/23/2025 before obtaining a detailed verbal order or a signed POC from the physician. 19. During an interview on 02/20/2025 at 10:30 AM, the Alternate Administrator stated the agency does not obtain a detailed verbal order to start care or obtain a physician-signed POC before providing services. She states that the staff obtained a verbal order, which was recorded in a Communication Note. 410 IAC 17-13-1(a)”

“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 record review and interview, the Administrator failed to ensure staff completed all documentation on the day patient visits were assigned for 5 of 10 record reviews without home visits (Patients #8, 10, #11, #12, #16) Findings include: 1. The revised policy “Documentation in the Medical Record,” dated 05/08/2025, required staff to complete timely, authenticated documentation in accordance with professional standards. 2. The record review for Patient #8, certification period 10/03/2025 to 12/01/2025, showed staff completed visit documentation late, outside the time frame set by the agency, on the following days: 10/10/2025, 10/15/2025, 10/17/2025, 10/21/2025, 10/25/2025, 10/27/2025, 10/29/2025, 11/05/2025, 11/07/2025, 11/08/2025, 11/19/2025, 11/21/2025, and 11/26/2025. 3. The record review for Patient #10, certification period 01/08/2026 to 03/08/2026, showed staff completed visit documentation late, outside the agency’s required time frame, on 01/02/2026. 4. The record review for Patient #11, certification period 02/07/2026 to 04/07/2026, showed staff completed visit documentation late, outside the agency’s required time frame, on 02/12/2026 and 02/17/2026. 5. The record review for Patient #12, certification period 10/22/2025 to 12/20/2025, showed staff completed visit documentation late, outside the agency’s required time frame, on 11/13/2025 and 12/08/2025. 6. The record review for Patient #16, certification period 04/08/2025 to 06/06/2025, showed staff completed visit documentation late, outside the agency’s required time frame, on 04/17/2025, 04/22/2025, and 05/01/2025. 7. During an interview on 02/25/2026 at 11:01 AM, the Alternate Administrator stated the agency expected staff to submit documentation within 24 hours of a visit. She stated that some staff struggled to turn in notes on time. 410 IAC 17-12-1(c)(1)”