Purposecare of Indiana

“Establishment of the Emergency Program (EP) CFR(s): 484.102 §403.748, §416.54, §418.113, §441.184, §460.84, §482.15, §483.73, §483.475, §484.102, §485.68, §485.542, §485.625, §485.727, §485.920, §486.360, §491.12 The [facility, except for Transplant Programs] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility, except for Transplant Programs] must establish and maintain a [comprehensive] emergency preparedness program that meets the requirements of this section.* The emergency preparedness program must include, but not be limited to, the following elements: * (Unless otherwise indicated, the general use of the terms “facility” or “facilities” in this Appendix refers to all provider and suppliers addressed in this appendix. This is a generic moniker used in lieu of the specific provider or supplier noted in the regulations. For varying requirements, the specific regulation for that provider/supplier will be noted as well.) *[For hospitals at §482.15:] The hospital must comply with all applicable Federal, State, and local emergency preparedness requirements. The hospital must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. The emergency preparedness program must include, but not be limited to, the following elements: *[For CAHs at §485.625:] The CAH must comply with all applicable Federal, State, and local emergency preparedness requirements. The CAH must develop and maintain a comprehensive emergency preparedness program, utilizing an all-hazards approach. The emergency preparedness program must include, but not be limited to, the following elements: This Condition is not met as evidenced by: Based on record review and interviews, the agency failed to maintain a comprehensive emergency preparedness program. The agency did not evidence an emergency plan had been developed, reviewed, and updated at least every two years (E0004); a facility-based and community-based, all-hazards risk assessment had been updated every two years (E0006); attempts were made to collaborate with local, regional, state, and federal officials (E0009); emergency preparedness policies and procedures had been reviewed and updated every two years (E0013); a communication plan addressing procedures to follow up with on-duty staff and patients had been developed (E0021); volunteers had been included in the communication plan (E0024); contact information for staff, patients, contracted service entities, physicians, and volunteers had been maintained (E0030); regional and state official contact information had been included (E0031); and the agency participated in a community-based full-scale exercise every two years with analysis of its response (E0039). The cumulative effect of these systemic problems resulted in the agency’s inability to ensure the provision of quality health care in a safe environment and resulted in the agency being found out of compliance with condition 42 CFR §484.102 Emergency preparedness. Findings include: 1. On 07/07/2026 at 12:03 PM, upon request for the agency’s emergency preparedness program, the agency provided an undated and unreviewed policy titled “Emergency Preparedness Management Policy.” When asked about the remainder of the program, Admin 1 and Admin 2 stated, “We are trying to locate it.” 2. On 07/07/2026 at 12:47 PM, Admin 1 stated, “I cannot provide anything. There is nothing in the binder; it is empty.””

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Based on record review and interview, the agency failed to ensure the frequency of visits were met according to the POC (G0572) the plans of care were individualized to include all pertinent all equipment and supplies, treatments, and all safety measures and limitations (G0574), all orders were accepted by authorized personnel and authenticated (G0584), coordinate care with patients living in congregate situations providing care for the patients (G0608), written instructions were provided (G612), visit schedules were provided (G614), patient medication schedules and instructions were provided, and the contact information of the agency’s clinical manager (G622). The cumulative effects of these systemic problems resulted in the home health agency’s inability to ensure the provision of quality health care in a safe environment for the Condition of Participation of 42 CFR 484.60, Care Planning, Coordination of Care, and Quality of Care. Findings Include: *”

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to electronically transmit the completed OASIS assessments to the CMS (Centers for Medicare & Medicaid Services) system within 30 days of completing the patient assessments in 18 of 18 focused clinical records reviewed. (Patients: #15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, and 32) The findings include: 1. A review of an undated agency policy titled “Encoding and Reporting OASIS Data” indicated, but was not limited to, “ … 1. Agency will encode and electronically transmit each completed OASIS assessment to the CMS system within 30 days of completing the assessment … ” 2. A review of the agency’s report titled “HHA Error Summary by Agency,” dated 07/01/2025 to 07/06/2026, evidenced error number 3330 with the description “records submitted late: The submission date is more than 30 days after the M0090.” The report showed 1,907 assessments with this error, representing 36.91% of all assessments reviewed. 3. A focused review of the active clinical record for Patient #15 evidenced the SOC OASIS assessment had an M0090 date of 05/06/2026. The agency submitted the SOC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 4. A focused review of the active clinical record for Patient #23 evidenced the SOC OASIS assessment had an M0090 date of 05/06/2026. The agency submitted the SOC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 5. A focused review of the active clinical record for Patient #24 evidenced the SOC OASIS assessment had an M0090 date of 05/16/2026. The agency submitted the SOC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 6. A focused review of the active clinical record for Patient #25 evidenced the SOC OASIS assessment had an M0090 date of 05/21/2026. The agency submitted the SOC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 7. A focused review of the active clinical record for Patient #26 evidenced the SOC OASIS assessment had an M0090 date of 05/31/2026. The agency submitted the SOC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 8. A focused review of the active clinical record for Patient #27 evidenced the SOC OASIS assessment had an M0090 date of 05/19/2026. The agency submitted the SOC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 9. A focused review of the discharged clinical record for Patient #16 evidenced a SOC date of 01/11/2024 and a DC date of 05/22/2026. The DC OASIS assessment had an M0090 date of 05/22/2026. The agency submitted the DC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 10. A focused review of the discharged clinical record for Patient #17 evidenced a SOC date of 03/25/2026 and a DC date of 05/20/2026. The DC OASIS assessment had an M0090 date of 05/20/2026. The agency submitted the DC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 11. A focused review of the discharged clinical record for Patient #18 evidenced a SOC date of 02/04/2026 and a DC date of 05/25/2026. The DC OASIS assessment had an M0090 date of 05/25/2026. The agency submitted the DC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 12. A focused review of the discharged clinical record for Patient #19 evidenced a SOC date of 04/30/2026 and a DC date of 05/28/2026. The DC OASIS assessment had an M0090 date of 05/28/2026. The agency submitted the DC OASIS on 07/06/2026, which exceeded 30 days from the M0090 assessment completion date. 13. A focused review of the discharged clinical record for Patient #20 evidenced a SOC date of 03/02/2026 and a DC date of 05/31/2026. The DC OASIS assessment had an M0090 date of 05/31/2026. The agency submitted the DC OASIS on 07/06/2026, which exceeded 30 days from the M0090 assessment completion date. 14. A focused review of the discharged clinical record for Patient #21 evidenced a SOC date of 03/26/2026 and a DC date of 05/28/2026. The DC OASIS assessment had an M0090 date of 05/28/2026. The agency submitted the DC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 15. A focused review of the discharged clinical record for Patient #22 evidenced a SOC date of 03/25/2026 and a DC date of 05/21/2026. The DC OASIS assessment had an M0090 date of 05/21/2026. The agency submitted the DC OASIS on 07/01/2026, which exceeded 30 days from the M0090 assessment completion date. 16. A focused review of the discharged clinical record for Patient #28 evidenced a SOC date of 02/09/2026 and a DC date of 05/28/2026. The DC OASIS assessment had an M0090 date of 05/28/2026. The agency submitted the DC OASIS on 07/06/2026, which exceeded 30 days from the M0090 assessment completion date. 17. A focused review of the discharged clinical record for Patient #29 evidenced a SOC date of 04/03/2026 and a DC date of 05/28/2026. The DC OASIS assessment had an M0090 date of 05/28/2026. The agency submitted the DC OASIS on 07/06/2026, which exceeded 30 days from the M0090 assessment completion date. 18. A focused review of the discharged clinical record for Patient #30 evidenced a SOC date of 03/23/2026 and a DC date of 05/11/2026. The DC OASIS assessment had an M0090 date of 05/11/2026. The agency submitted the DC OASIS on 07/02/2026, which exceeded 30 days from the M0090 assessment completion date. 19. A focused review of the discharged clinical record for Patient #31 evidenced a SOC date of 04/01/2026 and a DC date of 05/28/2026. The DC OASIS assessment had an M0090 date of 05/28/2026. The agency submitted the DC OASIS on 07/02/2026, which exceeded 30 days from the M0090 assessment completion date. 20. A focused review of the discharged clinical record for Patient #32 evidenced a SOC date of 04/01/2026 and a DC date of 05/28/2026. The DC OASIS assessment had an M0090 date of 05/28/2026. The agency submitted the DC OASIS on 07/02/2026, which exceeded 30 days from the M0090 assessment completion date. During an interview on 07/07/2026 at 1:37 PM, when asked about the agency’s submission reports, untimely submission process, and who submits OASIS assessments to CMS, Admin 4 communicated they submitted OASIS reports in IQIES. Admin 2, the Care Transition Coordinator, stated the agency had issues with untimely submissions due to branch and parent identifiers that needed to be changed for both the Indianapolis and Ft. Wayne locations. IQIES identified this issue on April 8, 2026. The Indianapolis office identifier was corrected on April 16, 2026, and the Ft Wayne branch identifier was corrected on May 5, 2026. Admin 2 further stated, “They sent the agency’s error reports to the Administrator for follow‑up.” During an interview on 07/10/2026 at 10:52 AM, when asked about the untimely OASIS submissions, Corporate Staff 1, the Vice President of Quality and Compliance, and governing body member stated, “The DON/Administrator had not reported out any errors in OASIS submissions to the governing body.” Corporate Staff 1 further communicated the QAPI program had not contained an updated performance improvement plan to address the ongoing problem of untimely OASIS.”

“Discharge or Transfer Summary Content CFR(s): 484.58(b)(1) Standard: Discharge or transfer summary content. The HHA must send all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility or health care practitioner to ensure the safe and effective transition of care. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure the transfer/discharge summaries were sent to the receiving healthcare providers 1 of 1 active records reviewed transferred to an in-center acute care facility (Patient: #9), and for 2 of 2 inactive records reviewed, patients transferred to a hospice provider. (Patients: #12 and 13) Findings Include: 1. A review of an undated agency policy titled “Client Transfer” indicated but was not limited to, “ … To assure continuity of care by providing pertinent information to another … The original Transfer Summary form shall be sent to the new provider of facility … ” 2. A review of an undated agency policy titled “Client Discharge Process” indicated but was not limited to, “ … A completed discharge summary will be sent to the primary care practitioner or other health care professional who will be responsible for providing care services to the client after discharge within 5 business days of the client’s discharge … ” 3. A review of the active record for Patient #9 SOC date of 05/18/2026, evidenced the patient had been transferred to Entity 9, an acute care facility on 06/17/2026. The record contained a transfer summary dated 06/17/2026, signed by RN 3. The transfer summary indicated PT 5’s last home visit occurred 06/10/2026. The record failed to contain evidence the transfer summary had been sent to Entity 6, the provider assuming Patient #9’s care. 4. A review of the inactive clinical record for Patient #12 evidenced the patient had been transferred to hospice on 03/01/2026. The record contained a discharge summary dated 03/03/2026, signed by RN 2. The discharge summary indicated RN 2’s last skilled visit occurred on 02/26/2026, and Patient #12 experienced a decline in condition, prompting discharge so hospice could admit the patient on 03/02/2026. The record failed to contain evidence that the transfer/discharge summary was sent to the hospice provider assuming Patient #12’s care. 5. A review of the inactive record for Patient #13 evidenced the patient had been transferred to hospice on 01/21/2026. The record contained a discharge summary dated 01/21/2026, signed by PT 4. The discharge summary indicated PT 4’s last skilled visit occurred on 01/21/2026, and Patient #12 experienced a decline in condition, prompting discharge so hospice. The record failed to contain evidence that the transfer/discharge summary was sent to the hospice provider assuming Patient #13’s care. During an interview on 07/07/2026 at 4:03 PM, when asked to provide documentation of the discharge orders and evidence that the transfer/discharge summaries for Patients #12 and #13 had been sent to the hospice providers resuming their care, LPN 1, the LPN Clinical Supervisor, stated, “There’s nothing in [Patient #12’s or 13’s] record showing coordination of care or that the transfer/discharge summary was sent to the hospice provider resuming care. There’s also no discharge order.” When asked if transfer and discharge summaries were to be sent to healthcare provider assuming care for the patients and coordination of care documented, LPN 1 communicated the transfer and discharge summaries had only been sent to the primary care provider of the patients while under care of the agency. 410 IAC 17-13-2(a)(b)(9)”

“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 or caregiver with written instructions regarding the home health services to be provided and the plan of care for 2 of 2 patients (Patients: #1 and 3) during home visits conducted, receiving ongoing continued care. Findings Include: 1. During a home visit at Patient #1’s residence, a group home, on 07/08/2026 at 12:00 PM, Person 10, the group home manager and caregiver for Patient #1, provided the agency folder for review. The agency folder contained an agency booklet but failed to include a plan of care or written instructions regarding the home health services being provided. During an interview on 07/08/2026 at 12:09 PM, when asked about written instructions or the plan of care describing the services to be provided to Patient #1, Person 10 stated, “No, that booklet is all that has been provided.” 2. During a home visit at Patient #3’s residence on 07/08/2026 at 2:00 PM, LPN 2 was observed performing wound care for Patient #3. When asked for the agency folder for review, Patient #3 was unable to provide one. When asked whether they had been provided with a plan of care containing instructions and information regarding the services the home health agency was providing, Patient #3 shook their head no. During an interview on 07/08/2026 at 2:45 PM, when asked about the plan of care in the home and the medication list, LPN 2 reported they used the tablet to review Patient #3’s chart and were unaware of the plan of care being provided to the patients.”

“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 ensure infection control practices were maintained, including hand hygiene, glove changes, and bag technique, for 2 of 4 home visits. (Employees: RN 1 and HHA 1) Findings Include: 1. A review of an undated agency policy titled “Hand Hygiene” indicated, but was not limited to, “Hand hygiene is a general term that applies to either hand washing, antiseptic hand wash, alcohol-based hand rub … Recommended hand hygiene practices will promote client safety and prevent infections … The Centers for Disease Control (CDC) recommends routinely washing hands in the following situations: …Before contact with a client … After caring for a client. Before touching organic material … Before and after handling dressing or touching open wounds. After handling contaminated equipment … ” 2. A review of an undated agency policy titled “Nursing Bag” indicated, but was not limited to, “ … To maintain supplies in a clean environment. To prevent contamination of the nursing bag … When in a client’s home, place a waterproof disposable barrier on a clean and dry surface, then place the bag down on the barrier … ” 3. During a home visit at Patient #1’s residence on 07/08/2026 at 12:00 PM, HHA 1 was observed providing care for Patient #1. HHA 1 performed hand hygiene and donned gloves. HHA 1 then assisted Patient #1 with brushing their teeth. Patient #1 removed their clothes, and HHA 1 turned on the shower and assisted Patient #1 into the shower. While Patient #1 held the handrail in the shower, HHA 1 washed Patient #1’s hair and rinsed with the handheld shower. HHA 1 continued to wash Patient #1’s face, upper body, and lower extremities, and then rinsed each area with the handheld shower. HHA 1 washed and rinsed the patient’s buttocks. HHA 1 turned off the shower and assisted Patient #1 out of the shower. HHA 1 then toweled Patient #1 dry without discarding gloves, performing hand hygiene, or donning clean gloves. HHA 1 retrieved clean clothes from the sink countertop and assisted Patient #1 with dressing. HHA 1 then took the used washcloth and towel to the laundry room hamper, discarded their gloves, washed their hands in the bathroom sink, and turned off the faucet with their bare hand. During an interview on 07/08/2026 at 12:45 PM, when asked about wearing the same gloves during Patient #1’s shower, drying, dressing, and touching dirty areas, HHA 1 stated, “Yes, I wore the same gloves. Should I have changed them? Have you ever tried changing gloves when they are wet?” 4. During a home visit at Patient #2’s residence on 07/08/2026 at 8:05 AM, observed RN 1 completing an initial assessment for Patient #2. RN 1 entered the residence and placed their nursing bag on a chair and their tablet computer on Patient #2’s dining table. RN 1 failed to place a barrier under the nursing bag or under the tablet. RN 1 then obtained vital‑sign equipment from the nursing bag and placed it on the dining table without using a barrier. After completing the vital sign assessment, RN 1 cleaned the equipment with a disinfectant wipe and cleaned the tablet. RN 1 discarded their gloves in Patient #2’s household trash receptacle, washed their hands at the kitchen sink, and turned off the faucet with their bare hand. During an interview on 07/08/2026 at 8:40 AM, when asked about a barrier for their equipment and nursing bag, RN 1 stated, “I probably should have used a barrier, but his house was clean. Bugs can crawl on barriers, too.” When asked whether they should turn a faucet off with their bare hand, RN 1 stated, “I should have used a paper towel.” 410 IAC 17-12-1(m)”

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure Home Health Aides (HHAs) were assigned and provided appropriate instruction in 2 of 2 active clinical records reviewed for patients receiving HHA services. (Patients: # 1 and 7) Findings Include: 1. A review of an undated agency policy titled “Clinical Supervision” indicated but was not limited to, “Skilled Nursing and other therapeutic services are provided under the supervision of a Registered Nurse … To meet the requirements of state/federal guidelines and provide supervision and direction to all staff delivering home health services … ” 2. A review of the active clinical record for Patient #1, SOC date of 02/18/2026, contained a POC for the certification period of 02/18/2026 to 06/17/2026. The POC noted Patient #1 had orders for SN one time a week for 9 weeks to perform wound care to the distal lower left extremity, and HHA 3 times a week for one week, and 5 times a week for 8 weeks, to provide personal care and ADLs. During an interview on 07/08/2026 at 12:45 PM, when asked about the RN oversight and supervision, HHA 1, the HHA for Patient #1 stated, “I am on my own out here. I do not ever see a nurse out here. No one has shown me or tells me what the patients’ needs.” 3. A review of the active clinical record for Patient #7, SOC date of 02/05/2026, and a Resumption of care (ROC) date of 06/02/2026 contained a POC for the recertification period of 06/05/2026 to 08/03/2026. The POC noted that Patient #7 had orders for SN once a week for 6 weeks, with each visit to include a physical assessment emphasizing the disease process, minimizing the risk of rehospitalization, and addressing high-risk medications and compliance. The POC noted orders for HHA, but failed to evidence frequency, to provide personal care and ADLs. A review of a HHA visit note dated 06/08/2026 noted in comments “No care plan available.” During an interview on 07/10/2026 at 11:49 AM, when asked about the oversight of the HHA and care plans, RN 4 stated, “The RNs were to complete the care plan in and then the patients were assigned to the HHAs by the schedulers.””

“Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure a Resumption of care (ROC) assessment had been authenticated and completed for 1 of 1 clinical records reviewed, with a ROC being completed. (Patient #7) Findings Include: 1. A review of an undated agency policy titled “Clinical Documentation” indicated, but was not limited to, “Agency will document each direct contact with the client. This documentation will be completed by the direct caregivers … Purpose: To ensure there is an accurate record of the services provided … ” 2. A review of the clinical record for Patient #7 contained a ROC OASIS dated 06/02/2026 with a visit start time of 4:49 PM and visit end time of 5:32 PM, and electronically signed by Admin 4, the Quality Assurance RN and Interim DON. During an interview on 07/09/2026 at 3:35 PM, Corporate Staff 1, the Vice President of Quality and Compliance, stated, “[Admin 4] does not see patients, and she is not required to see patients in the field. She works remotely.” The Governing Body/agency failed to ensure the proper process for a resumption of care as Admin 4 does not see the patient. 410 IAC 17-15-1(b)”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on observation, record review, and interviews, the agency failed to ensure the RN completed the initial assessment to determine home care needs within 48 hours of receiving the referral for 1 of 1 SOC observations. (Patient: #2) Findings Include: 1. A review of an undated agency policy titled “Comprehensive Client Assessment” indicated, but was not limited to, “The initial assessment visit must be held either within 48 hours of referral or within 48 hours of the client’s return home, or on the physician-ordered start of care date ….” 2. During a home visit at Patient #2’s residence on 07/08/2026 at 8:05 AM, observed RN 1 completing an initial comprehensive assessment for Patient #2. When asked when they returned home from Entity 7, the rehabilitation facility, Patient #2 stated, “I came home from the hospital Friday, July 3, 2026.” A review of the clinical record for Patient #2 contained faxed referral documents from Person 6, the Medical Social Worker and Case Manager of Entity 7. The documents contained a document dated 06/25/2026 and signed by Person 8, a physician at Entity 7, titled “Home Health Care Face-To-Face Encounter Form and Orders.” The Face-to-Face Encounter Form indicated Patient #2 had orders for skilled nursing, physical therapy, occupational therapy, and speech therapy. On 07/08/2026 at 8:40 AM, when asked about the referral and SOC process timeline, RN 1 stated, “The office sends out the referral and sends it out for us to schedule with the patient. I review the referral and then call the patient to schedule an appointment. I do not call the physician after my assessment unless the patient needs physical therapy or something else. I just go by the referral information.” During an interview on 07/09/2026 at 2:07 AM, when asked Person 8 about when they had sent the referral to Purposecare of Indiana for Patient #2, they stated, “Patient #2 discharged on 07/03/2026, and I sent the referral information and orders on 06/25/2026, our first care conference.” During an interview on 07/09/2026 at 2:10 PM, when asked about any calls received to Person 3, Patient #2’s primary care provider, Person 5, an office nurse, stated, “The only note in [Patient #2’s] chart is from yesterday from a [RN1] who contacted us regarding skilled nursing and physical therapy started yesterday.” When asked if there were any other orders or communication regarding a delay in Patient #2’s start of care for home care needs after their rehabilitation stay, Person 5 stated, “No.” 410 IAC 17-14-1(a)(1)(A)”

“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 observation, record review, and interview, the agency failed to ensure the RN reconciled all medication with the patient, and the ordering physician in 1 of 1 SOC observed. (Patient #2) Findings Include: 1. A review of an undated agency policy titled “Medication Reconciliation” indicated but was not limited to, “ … Agency will reconcile all medications taken by the client prior to admission to home care with those ordered at the time of admission … 1. At the time of admission to the home care agency, the admitting professional will document a complete list of medications taken by the client … 2. The information will be obtained from the client … Medications will be reviewed with the client on each home visit … ” 2. On 07/08/2026 at 8:05 AM, RN 1 was observed completing Patient #2’s SOC assessment. Patient #2 showed RN 1 the medication bottles located on the kitchen countertop. RN 1 glanced at the medication bottles but failed to compare the medication labels with the medication list obtained from Entity 7, the rehabilitation facility from which Patient #2 had been discharged. RN 1 failed to complete a medication reconciliation during the SOC. During an interview on 07/08/2026 at 8:40 AM, when asked about medication reconciliation, RN 1 stated, “Medications are to be reviewed and compared to the list we received.” 410 IAC17-14-1(a)(1)(B)”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure the POC contained all of the elements, including mental/cognitive status, psychosocial status, safety, seizure plans, nutritional information, DME and Supplies, discipline orders with frequency and duration, for 4 of 8 active clinical records reviewed (Patient #1, 2, 3, and 7) Findings Include: 1. A review of an undated agency policy titled “Care Plans” indicated, but was not limited to, “ … The Care Plan shall include, but not limited to: Nursing diagnosis(es)/problems and needs identified … Reasonable, measurable, and realistic goals … A list of specific interventions with plans for implementation … “ 2. During a home visit at Patient #1’s residence, a group home, on 07/08/2026 at 12:00 PM, observed HHA 1 providing a shower using a handheld shower to Patient #1. Observed a grab rail in the shower that Patient #1 held onto for balance during their shower. Person 10, the group home manager and caregiver for Patient #1, encouraged Patient #1’s participation with the reward of going to Olive Garden for lunch, and stated: “He loves their breadsticks.” Person 10 had to remind Patient #1 several times to stop scratching their left leg and picking at their skin during the home visit observation. Person #10 stated, “[Patient #1] picks at their left leg and causes open areas needing wound care.” A review of the active clinical record for Patient #1, with a SOC date of 02/18/2026, contained a POC for the certification period of 02/18/2026 to 06/17/2026. The POC included but was not limited to the following diagnoses: Unspecified open wound to the left lower leg, Excoriation (skin-picking) Disorder, Cerebral Palsy (a neurological disorder affecting movement, posture, and muscle coordination due to abnormal brain development), and Anxiety Disorder. The section titled “Nutrition Requirements” noted supplements (Boost), but failed to evidence Patient #1 being on a regular diet. The section titled “Psychosocial Status” noted no problems identified, but failed to address Patient #1’s anxiety and picking at their lower extremities, causing open areas. The section titled “DME and Supplies” noted “None,” failed to list grab bars in the shower, and a handheld shower. 3. A review of the active clinical record for Patient #2 with a SOC date of 07/08/2026, contained a POC for the certification period of 07/08/2026 to 09/05/2026. The POC included but was not limited to the following diagnoses: Epilepsy (a chronic brain disorder characterized by recurrent, unprovoked seizures caused by abnormal electrical activity in the brain), Type 2 Diabetes Mellitus (a condition of the body’s inability to produce insulin to process blood sugar levels), Long Term Use of Insulin, Essential Hypertension (High blood pressure), and Muscle Weakness. The section titled “Safety” listed Diabetic: Do not cut nails, fall precautions, emergency/disaster plan development, keep pathways clear, safety in ADLS, slow position changes, standard precautions/infection control, support during transfer and ambulation, use of assistive device, but failed to list seizure precautions and bleeding precautions. The section titled “DME and Supplies” listed grab bars, care, tub/shower bench, but failed to list glucometer, lancets, and pen needles for diabetic supplies. Patient #2’s medications listed but were not limited to the following; Eliquis (a medication used to prevent blood clotting) 5 milligram (mg) oral tablet BID (twice) by mouth, and Tirzepatide (a medication used to regulate blood sugar levels and appetite) 5mg/0.5 milliliters (ml) subcutaneous auto injector every (Q) 7 days, and Levetiracetam (a medication used in the treatment of seizures) 1,000 mg oral twice daily. During an interview at Patient #2’s residence on 07/08/2026 at 8:05 AM, Patient #2 reported they were on seizure medication for seizures due to seizures. Patient #1 confirmed they have given their own weekly injection if their family member is available, to help with their diabetes. 4. During a home visit at Patient #3’s residence on 07/08/2026 at 2:00 PM, observed Patient #3 sitting on a Hoyer lift pad in a motorized wheelchair in the living area. Observed on Patient #3’s left leg a catheter leg bag, and the patient had blue chucks in the chair and had a blue brief on. LPN 2 provided a tour of all the special equipment in the back area, a living space, and the bathroom Patient #3 had, which included: a hospital bed with an over-the-bed triangle, another motorized wheelchair, incontinence supplies of briefs and chucks, a Hoyer lift, and rails in the bathroom and shower area with a specially designed shower chair. Patient #3 stated, “My daughter checks my sugar and gives me my insulin every morning. A review of the active clinical record for Patient #3 with a SOC date of 02/141/2026, contained a POC for the certification period of 06/11/2026 to 08/09/2026. The POC included but was not limited to the following diagnoses: Type 2 Diabetes, Long Term Use of Insulin, and Paraplegia (paralysis of the legs and lower body caused by a spinal injury or disease). The section titled “Mental/Cognitive Status” had been left blank. The section titled “DME and Supplies” listed a wheelchair and a tub/shower bench, but failed to list a glucometer and diabetic supplies, a Hoyer lift, a hospital bed, a catheter, and catheter supplies. 5. A review of the active clinical record for Patient #7, SOC date of 02/05/2026, and a Resumption of care (ROC) date of 06/02/2026 contained a POC for the recertification period of 06/05/2026 to 08/03/2026. The POC noted that Patient #7 had orders for SN once a week for 6 weeks, with each visit to include a physical assessment emphasizing the disease process, minimizing the risk of rehospitalization, and addressing high-risk medications and compliance. The POC noted orders for HHA but failed to evidence frequency, provide personal care, and document ADLs. During an interview on 07/10/2026 at 9:44 AM, when asked about the process documentation for DME, supplies, and other required elements on the POC, RN 4 indicated that the POC sections came from the comprehensive assessment and that all DME and Supplies should be on the POC. 410 IAC 17-13-1(a)(1)(D)(i-xiii)”

“Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA’s internal policies. (4) When services are provided on the basis of a physician or allowed practitioner’s verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA’s policies, must document the orders in the patient’s clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA’s internal policies. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure that verbal orders were authenticated in 3 of 5 active clinical records reviewed for patients admitted in the last 3 months.(Patients: #1, 5, and 9) Findings include: 1. A review of an undated agency policy titled “Physician Orders” indicated but is not limited to, “ … To assure accurate and complete orders are obtained and verified … When a nurse or therapist receives a verbal order form the physician, he/she shall write the order as given then read the order back to the physician verifying that the person receiving the order heard it correctly and interpreted the order correctly …The verbal order shall verify that the order was taken and verified by documenting this on the form … Verbal orders are accepted by authorized, licensed agency personnel in accordance with applicable law … ” 2. A review of the active clinical record for Patient #1 contained a physician order dated 02/18/2026 and signed by Former Employee 2, a previous LPN. The order stated, “Ok for SN to evaluate for home health services related to wound care,” and indicated that the order had been read back and verified. The order failed to identify from whom Former Employee 2 received the verbal order and did not include the time the order was read back and verified. 3. A review of the active clinical record for Patient #5 contained a physician order dated 05/18/2026 and signed by Former Employee 2, a previous LPN. The order stated, “Ok for PT to evaluate for home health services related to generalized weakness/pain,” and indicated that the order had been read back and verified. The order failed to identify the source of the verbal order to Former Employee 2. 4. A review of the active clinical record for Patient #9 contained a physician order dated 05/18/2026 and signed by Former Employee 2, a previous LPN. The order stated, “Ok for PT to evaluate for home health services related to generalized weakness/recent hospitalization,” and indicated that the order had been read back and verified. The order failed to identify the source of the verbal order to Former Employee 2. During an interview on 07/09/2026 at 10:21 AM, when asked about the orders found in charts obtained by LPN 1 and Former Employee, an LPN for the agency, LPN 1 stated, “We rewrite all the orders in the electronic health record that come in, and they are sent out to the physician for signature.” During a review of concerns on 07/10/2026 at11:56 AM with LPN’s writing orders and no documentation of who the verbal order had been obtained from indicated orders are reviewed by RN QA in the system, where is the documentation that shows the LPN had been directed or whom the verbal order had been obtained from, Corporate Staff 1, Vice President of Quality and Compliance governing body member, could not provide any documentation. 410 IAC 17-14-1(a)(H)”

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure coordination of care had been completed with other entities providing services for 3 of 4 active clinical records reviewed. (Patients: #5, 7, and 8) Findings Include: 1. A review of an undated agency policy titled “Coordination of Client Services” indicated, but was not limited to, “ … Coordination will include providers of care who are not part of the agency … ” 2. A review of the clinical record for Patient #5 contained a POC for the initial certification period 05/18/2026 to 07/16/2026. The POC noted in the section titled “Caregiver Status” Patient #5 lived in Entity 15, an assisted living facility. A review of the SOC OASIS dated 05/18/2026 and signed by PT 2, noted in the section titled “Care Coordination,” the physician had been checked only. The Clinical record failed to evidence coordination of care with Entity 15, the assisted living facility. No communication notes had been documented in the clinical record. During an interview on 07/10/2026 at 12:06 PM, when asked about coordination of care and where it would be located, PT 2 stated, “Coordination of care would be documented in the communication notes.” 3. A review of the clinical record for Patient #7 contained a resumption of care (ROC) POC for the recertification period 06/05/2026 to 08/03/2026. The POC noted in the section titled “Caregiver Status,” Patient #7 had around-the-clock care. The POC failed to provide evidence of coordination of care with Entity 16, the group home, or Person 17, the group home manager. A review of an updated resumption of care, adding the PT POC signed by PT 3, and dated 06/19/2026, noted in the section titled “Living Arrangements,” Patient #7 lived in a congregate situation around the clock. The POC failed to provide evidence of coordination of care with Entity 16, the group home, or Person 17, the group home manager. A review of the ROC OASIS dated 06/02/2026 and signed by Admin 4, the Quality Assurance RN, and Interim DON, noted in the section titled “Care Coordination” that the physician had been checked only. The Clinical record failed to evidence coordination of care with Entity 16, the group home, or Person 17, the group home manager. During an interview on 07/10/2026 at 1:40 PM, PT 3 indicated coordination of care should be documented in communication notes or on the visit notes. 4. A review of the clinical record for Patient #8 contained a POC for the initial certification period 06/05/2026 to 08/03/2026. The POC noted in the section titled “Caregiver Status,” Patient #8 resides in Entity 13, an assisted living facility. A review of the SOC OASIS dated 06/1052026 and signed by RN 5, noted in the section titled “Care Coordination,” the physician had been checked only. The Clinical record failed to evidence coordination of care with Entity 13, the assisted living facility. The clinical record failed to evidence communication notes. During an interview on 07/10/2026 at 12:40 PM, when asked about documenting coordination of care with other healthcare providers, RN 2 indicated coordination of care would be documented in the communication notes or on the visit notes. 410 IAC 17-14-1(a)(1)(F)”

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on record review and interview, the agency failed to provide the patient and caregiver in writing with a copy of the visit schedule in 2 of 2 home visits conducted with patients receiving ongoing services. (Patients: #1 and 3) Findings Include: 1. During a home visit at Patient #1’s residence, a group home, on 07/08/2026 at 12:00 PM, Person 10, the group home manager and caregiver for Patient #1, provided the agency folder for review. The agency folder contained an agency booklet with blank calendars at the back. No visit schedules were found in Patient #1’s home. During an interview on 07/08/2026 at 12:09 PM, when asked about a schedule or plan of care being provided to Patient #1, Person 10 stated, “No, that booklet is all that has been provided. They just call the day of the visit.” 2. During a home visit at Patient #3’s residence on 07/08/2026 at 2:00 PM, LPN 2 was observed performing wound care for Patient #3. When asked for the agency folder for review, Patient #3 was unable to provide one. No written schedules could be found in Patient #3’s home. During an interview on 07/08/2026 at 2:45 PM, when asked about the plan of care in the home and the medication list, written schedules, LPN 2 reported they used the tablet to review Patient #3’s chart and were unaware of the plan of care or written schedules being provided to the patients.”

“Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on record review and interview, the agency failed to provide the patient or caregiver with a medication schedule and instructions for 2 of 2 patients (Patients: #1 and 3), during home visits conducted, receiving ongoing continued care. Findings Include: 1. During a home visit at Patient #1’s residence, a group home, on 07/08/2026 at 12:00 PM, Person 10, the group home manager and caregiver for Patient #1, provided the agency folder for review. The agency folder contained an agency booklet, but failed to include a medication schedule with written instructions. During an interview on 07/08/2026 at 12:09 PM, when asked about the medication list with written instructions or the plan of care being provided to Patient #1, Person 10 stated, “No, that booklet is all that has been provided.” 2. During a home visit at Patient #3’s residence on 07/08/2026 at 2:00 PM, LPN 2 was observed performing wound care for Patient #3. When asked for the agency folder for review, Patient #3 was unable to provide one. When asked whether they had been provided with a plan of care or a medication list, Patient #3 shook their head no. During an interview on 07/08/2026 at 2:45 PM, when asked about the plan of care in the home and the medication list, LPN 2 reported they used the tablet to review Patient #3’s chart and the patient’s medications, and were unaware of a medication list being provided to the patients.”

“Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This Element is not met as evidenced by: Based on record review and interview, the agency failed to provide the name and contact information for the clinical manager for 2 of 2 home visits conducted with patients with ongoing needs. (Patients #1, 3) Findings Include: 1. During a home visit at Patient #1’s residence, a group home, on 07/08/2026 at 12:00 PM, Person 10, the group home manager and caregiver for Patient #1, provided the agency folder for review. The agency folder contained an agency booklet that listed Former Employee 9 as the Administrator/DON. During an interview on 07/08/2026 at 12:09 PM, when asked about getting hold of the Clinical Manager in case of need, Person 10 stated, “No, do not know how to reach them. Just the shower aide test and calls.” 2. During a home visit at Patient #3’s residence on 07/08/2026 at 2:00 PM, LPN 2 was observed performing wound care for Patient #3. When asked for the agency folder for review, Patient #3 was unable to provide one. No contact information was in the home. During an interview on 07/08/2026 at 2:45 PM, when asked about contacting the Clinical Manager, LPN 2 indicated the office has had many changes lately, and the family and patients had their phone numbers.”

“Nursing services supervised by RN CFR(s): 484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k). This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure nursing services were provided under RN supervision for 4 of 9 active clinical records reviewed. (Patients: #1, 3, 5, and 6) Findings Include: 1. A review of an undated agency policy titled “Physician Orders” indicated but is not limited to, “ … To assure accurate and complete orders are obtained and verified … When a nurse or therapist receives a verbal order form the physician, he/she shall write the order as given then read the order back to the physician verifying that the person receiving the order heard it correctly and interpreted the order correctly …The verbal order shall verify that the order was taken and verified by documenting this on the form … Verbal orders are accepted by authorized, licensed agency personnel in accordance with applicable law … ” 2. A review of the active clinical record for Patient #1, with a SOC date of 02/18/2026, contained a physician order dated 02/18/2026 and signed by Former Employee 2, a previous LPN. The order stated, “Ok for SN to evaluate for home health services related to wound care,” and indicated that the order had been read back and verified. The order failed to identify from whom Former Employee 2 received the verbal order and did not include the time the order was read back and verified. In addition, the order was obtained and documented by an LPN, rather than an RN, as required for SOC orders for home health services. 3. A review of the active clinical record for Patient #3, with a SOC date of 02/11/2026, contained a physician order dated 07/02/2026 and signed by LPN 1. The order indicated Patient #3 had new wound‑care directions, including a change in frequency for skilled nursing services to two times per week for five weeks, effective 07/05/2026. The order further noted the wound would be changed by the skilled nurse on Mondays and Wednesdays, and the wound Nurse Practitioner would see the patient on Fridays. The wound‑care instructions for the left heel included: cleanse with normal saline, pat dry, apply Medihoney to the wound bed, cover with alginate, secure with a foam heel cup, and wrap with roll gauze and Coban. The clinical record failed to evidence RN direction or collaboration with LPN 1 in obtaining or writing the physician order for Patient #3’s care. During an interview on 07/09/2026 at 10:21 AM, when asked about the orders found in charts obtained by LPN 1 and Former Employee, an LPN for the agency, LPN 1 stated, “We rewrite all the orders in the electronic health record that come in, and they are sent out to the physician for signature.” 4. A review of the active clinical record for Patient #5, with a SOC date of 05/18/2026, contained a physician order dated 05/18/2026 and signed by Former Employee 2, a previous LPN. The order stated, “Ok for PT to evaluate for home health services related to generalized weakness/pain,” and indicated that the order had been read back and verified. The order failed to identify from whom Former Employee 2 received the verbal order, which had been read back and verified. In addition, the order was obtained and documented by an LPN, rather than an RN, as required for SOC orders for home health services. 5. A review of the active clinical record for Patient #6, with a SOC date of 02/02/2026, contained a POC for the recertification period 06/02/2026 to 07/31/2026. The POC noted Patient #6 had orders for SN one time a week for 1 week and 2 times a week for 8 weeks for wound care to a sacral pressure ulcer. Review of the 07/03/2026 LPN visit note, signed by LPN 2, noted in the “Visit Narrative” section the LPN reported contacting Patient #6’s healthcare provider, Person 12 regarding a significant change in the patient’s sacral wound. Verbal wound care orders were obtained and implemented. The LPN reassessed and remeasured the wound and provided education to the patient and caregiver on monitoring drainage, comfort, and potential side effects related to anticoagulation therapy. The visit note failed to evidence the RN case manager was notified of the significant change in the wound, or LPN 2 had been directed to contact the healthcare provider. Review of the 07/03/2026 physician order, signed by LPN 2, showed Patient #6’s nursing visit frequency was changed to twice weekly for four weeks. The order also added sacral pressure ulcer care for the skilled nurse on Mondays and Fridays, with the nurse practitioner scheduled on Wednesdays. Wound care included cleansing with Vashe (a wound wash), applying alginate (an absorbent wound dressing), lightly filling the tunnel and wound with Hydrofera Blue Classic (a wound foam dressing), and covering with bordered foam using aseptic technique. The clinical record failed to evidence LPN 2 had notified the RN case manager, or had been directed to contact Person 12, Patient #6’s healthcare provider. During an interview on 07/08/2026at 2:45 PM, when asked about significant changes in wounds and the process for calling the healthcare providers for orders, LPN 2 stated, “I call and get orders if there are changes in the patient’s wounds or condition. I do not go through a RN. I just called on [Patient #6] last week due to a significant change in their wound, and I received new orders for wound care.” 6. A review of Personnel records and agency job descriptions for nursing staff evidenced the following: A review of the personnel file for LPN 2 contained an agency document dated 03/25/2025, and signed by LPN 2, titled “Licensed Practical Nurse (LPN) Job Description.” The LPN job description indicated but was limited to, “The Licensed Practical Nurse (LPN) is responsible for ensuring quality home health care services to the Agency’s clients. In addition, to perform other duties as required by the Case Manager … Essential Duties and Responsibilities: Develops and implements client home health care plans … Discusses client plans of care with supervising Case Manager … Reports observations of client conditions to Case Manager … ” A review of the personnel file for LPN 1/Nursing Supervisor contained an agency document dated 10/15/2025 and electronically signed by LPN 1, titled “LPN Clinical Supervisor Job Description.” The LPN Clinical Supervisor job description indicated but was limited to, “The LPN Clinical Supervisor assists, establishes, implements, and evaluates goals and objectives for home health services … Essential Duties and Responsibilities: Coordinates and oversees all direct and indirect patient services provided by clinical organization personnel … Completes plan-of-care with other agencies … Completes documentation/physician orders for changes in patient care … Monitoring clinical compliance … ” A review of the personnel file for RN 1 contained an agency document dated 11/18/2024 and electronically signed by RN 1, titled “Registered Nurse Job Description.” The RN job description indicated, but was not limited to, “ … The Registered Professional Nurse is responsible to apple professional knowledge and skill, in accordance with State and Federal guidelines and professional standards of practice … Essential Duties and Responsibilities: Demonstrates leadership and provides direction to members of the patient care team through case management … Provide supervision of LPN’s assigned to patient caseload, through directing the implementation and evaluating the effectiveness of the nursing … Documents direct patient services, coordination, and collaboration with physician and other disciplines … ” 7. Interviews with other nursing staff evidenced the following: During an interview on 07/10/2026 at 11:53 AM, when asked about being employed with Purposecare of Indiana, RN 3 and Former ADON, stated, “Yes, I work there PRN now. They eliminated my ADON position and offered me a QA role, and I resigned on 06/01/2026. I am only PRN now.” RN 3 further indicated they had received no training and expressed concerns about the training clinicians received, noting the need for RN support. During an interview on 07/10/2026 at 12:00 PM, LPN 4 confirmed they had been employed by Purposcare of Indiana for approximately 1.5 years. When asked about what they did when a patient had a change in condition, or for example, wound deterioration, LPN 4 stated, “If the patient has a change in their condition, I call the physician, then let the office know.” When asked who they reported to at the office, they stated: “[LPN 1].” During an interview on 07/10/2026 at 12:31 PM, LPN 5 confirmed they had been employed with Purposcare of Indiana for a few months. When asked about the training they had received, LPN 6 stated, “They had me go out for a few days with an LPN.” LPN 5 further communicated LPN1 is the one who responds when they have issues. During an interview on 07/10/2026 at 12:40 PM, RN 2 confirmed they had been employed with Purposcare of Indiana for about 10 months. When asked about who they reported to, they stated, “I report to [LPN1] the ADON.” 410 IAC 17-14-1(a)(1)(J)”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure RN supervisory visits were completed at least every 14 days for 2 of 2 active clinical records reviewed, with patients receiving skilled services and HHA services. (Patients: #1 and 7) Findings Include: 1. A review of an undated agency policy titled “Clinical Supervision” indicated but was not limited to, “Skilled nursing and other therapeutic services are provided under the supervision of a Registered Nurs … When clients are receiving skilled nursing services in addition to personal care, the Registered Nurse will make a supervisory visit to the client’s residence no less frequently than every 14 days … the supervisory visit may be conducted by the Therapist in place of the Registered Nurse … ” 2. A review of the active clinical record for Patient #1, SOC date of 02/18/2026, contained a POC for the certification period of 02/18/2026 to 06/17/2026. The POC noted Patient #1 had orders for SN one time a week for 9 weeks to perform wound care to the distal lower left extremity, and HHA 3 times a week for one week and 5 times a week for 8 weeks to provide personal care and ADLs. A review of the HHA visit notes the week of 05/31/2026 through 06/06/2026 evidenced Patient #1 had HHA visits 06/01, 06/02, 06/03, 06/04, and 06/05/2026. A review of the HHA Supervisory Visit notes from 05/05/2026 through 06/15/2026, evidenced Patient #1 received RN visits and Supervisory visits on 05/05, 05/19, 06/09, and 06/15/2026. The record failed to evidence a HHA Supervisory visit 14 days after the Supervisory visit dated 05/19/2026. The week of 05/31/2026 through 06/06/2026, no SN visits were conducted. During an interview on 07/08/2026 at 12:45 PM, when asked about the RN oversight and supervisory visits, HHA 1, the HHA for Patient #1, stated, “I am on my own out here. I have never seen a nurse out here. No one has shown me or told me what the patients’ needs are.” During an interview on 07/10/2026 at 11:50 AM, when asked about HHA supervisory visits, RN 4, the RN for Patient #1, confirmed supervisory visits were to be completed every 14 days. 3. A review of the active clinical record for Patient #7, SOC date of 02/05/2026, and a Resumption of care (ROC) date of 06/02/2026 contained a POC for the recertification period of 06/05/2026 to 08/03/2026. The POC noted Patient #7 had orders for SN one time per week for 6 weeks, with each visit to include a physical assessment emphasizing the disease process, minimizing the risk of rehospitalization, high-risk medications, and compliance. The POC noted orders for HHA, failing to evidence frequency, to provide personal care and ADLs. A review of a PT updated POC dated 06/19/2026, and signed by PT 3, for the certification period 06/05/2026 through 08/03/2026, noted Patient #7 had orders for PT one time a week for 7 weeks, effective 06/19/2026. A review of the HHA visit notes for the week of 06/28/2026 through 07/04/2026 indicates that Patient #7 had HHA visits on 06/29, 06/30, 07/01, 07/03, and 07/04/2026. A review of the HHA 2’s visit notes the week of 07/05/2026 through 07/10/2026 evidenced Patient #7 had HHA visits 07/05, 07/06, 07/08, 07/09, and 07/10/2026. A review of the HHA Supervisory Visit notes from 06/21/2026 through 07/10/2026, evidenced Patient #7 received a PT visit and Supervisory visit on 06/24/2026. The clinical record failed to evidence any other supervisory visits had been conducted. During an interview on 07/10/2026 at 1:44 PM, when asked about the HHA supervisory visits for Patient #7 being missed, PT 3 stated, “I don’t know how that was missed. Yes, every 14 days, HHA supervisory visits are to be completed.” 4. A review of HHA 1’s and HHA 3’s personnel files evidenced the following: A review of the personnel file to HHA 1 contained an agency document dated 11/27/2024 and electronically signed by HHA 1, titled “Home Health Aide (HHA) Job Description.” The HHA job description indicated, but was not limited to, “The home health aide is a member of the home care team who works under the supervision of a registered nurse ... ” A review of the personnel file to HHA 3 contained an agency document dated 01/26/2026 and electronically signed by HHA 3, titled “Home Health Aide (HHA) Job Description.” The HHA job description indicated, but was not limited to, “The home health aide is a member of the home care team who works under the supervision of a registered nurse ... ””

“Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This Element is not met as evidenced by: Based on record review and interview, the agency failed to follow its policy to ensure hired staff were qualified to provide services for 1 of 1 agency. Findings Include: 1. Review of an undated agency policy titled “Clinical Supervision” indicated but was not limited to, “ … The Director of Nursing or a designated qualified Registered Nurse will be available to provide ongoing supervision … The Director of Nursing/Nursing Supervisor shall be responsible for the quality of care provided and supervision of all staff providing therapeutic services, including contract staff … The Nursing Supervision or designated Registered Nurse will give the Licensed Practical Nurse direction for client care …A copy of this written plan of care is to be left in the client’s home … When skilled services are being provided to a client, Registered Nurse/Therapist must make a supervisory visit to the client’s residence no later than 14 days … ” 2. A review of the personnel files for Admin 4, Quality Assurance RN, and Interim DON, LPN 2, RN 1, and Former Employees 1 and 2 failed to evidence documentation of job orientations or a nursing skills list. 3. Review of the clinical records for Patients #3 and #6 showed both had complex wounds with multiple wound‑order changes, episodes of wound deterioration, and use of wound VAC therapy (a treatment using a vacuum-assisted closure providing negative pressure). 4. A review of the personnel file for LPN 1/Nursing Supervisor contained an agency document dated 10/15/2025 and electronically signed by LPN 1, titled “LPN Clinical Supervisor Job Description.” The LPN Clinical Supervisor job description indicated but was limited to, “The LPN Clinical Supervisor assists, establishes, implements, and evaluates goals and objectives for home health services … Essential Duties and Responsibilities: Coordinates and oversees all direct and indirect patient services provided by clinical organization personnel … Completes plan-of-care with other agencies … Completes documentation/physician orders for changes in patient care … Monitoring clinical compliance …” LPN 1, personnel record failed to contain a RN license. During an interview on 07/10/2026 at 11:53 AM, when asked about being employed with Purposecare of Indiana, RN 3 and Former ADON, stated, “Yes, I work there PRN now. They eliminated my ADON position and offered me a QA role, and I resigned on 06/01/2026. I am only PRN now.” RN 3 further indicated they had received no training and expressed concerns about the training clinicians received, noting the need for RN support. During an interview on 07/10/2026 at 12:00 PM, LPN 4 confirmed they had been employed by Purposcare of Indiana for approximately 1.5 years. When asked about what they did when a patient had a change in condition, or for example, wound deterioration, LPN 4 stated, “If the patient has a change in their condition, I call the physician, then let the office know.” When asked who they reported to at the office, they stated: “[LPN 1].” During an interview on 07/10/2026 at 12:40 PM, RN 2 confirmed they had been employed with Purposcare of Indiana for about 10 months. When asked about who they reported to, they stated, “I report to [LPN1] the ADON.” During an interview on 07/08/2026 at 12:45 PM, when asked about the RN oversight and supervisory, HHA 1, a contracted employee with Entity 18, a Personal Services Agency, stated, “I am on my own out here. I do not ever see a nurse out here. No one has shown me or tells me what the patients’ needs.” During an interview on 07/10/2026 at 9:58 AM, when asked about the missing personnel documents, Corporate Staff 1, the Vice President of Quality and Compliance, and a member of the governing body, stated, “We do not do specific job descriptions on staff, only general orientation. The only specific skills and orientation are for Home Health Aides (HHAs). It is not required for the skill checklist or specific orientation.” When asked about how the agency can determine the level of skill and knowledge of the nursing staff and need for further education or training, for example, a new nurse experienced only in a non-skilled facility and the nurse assigned to a wound vac who had never done wounds, the Corporate Staff 1 stated, “We do not do skills lists it is not required.” 410 IAC 17-12-1(d)(8)”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure the RN appropriately and accurately assessed patients according to professional standards for 1 of 1 RN home visits completed. (Patients: #2) Findings Include: 1. A review of an undated agency policy titled “Comprehensive Client Assessment” indicated but is not limited to, “ … The Comprehensive Assessment must accurately reflect the client’s status, and must include … The client’s current health, psychosocial, functional, and cognitive status … ” 2. Constantine, L., MSN, RN, C-FNP. (2004, June 15). Overview of Nursing Health Assessment. Retrieved January 16, 2019, from rn.com “ ... PULMONARY ASSESSMENT: When examining the pulmonary system ... Inspect the thoracic cage, palpate the thoracic cage, Auscultate the anterior and posterior chest: Have patient breath slightly deeper than normal through their mouth, Auscultate from C-7 to approximately T-8, in a left to right comparative sequence. You should auscultate between every rib ... Identify any adventitious breath sounds. .... “ 3. Nurse.org, dated April 7, 2020, indicated: “How to Conduct a Head-to-Toe Assessment : ... LENGTH OF ASSESSMENT ... the duration of the exam is directly in correlation to the patient’s overall health status. Health patients with limited health histories may be completed in less than 30 minutes” … The Order of a Head-to-Toe Assessment: 1. GENERAL STATUS: Vital signs; ... Temperature; ... Pain. 2. HEAD, EARS, EYES, NOSE, THROAT ... 3. NECK ... 4. RESPIRATORY: Listen to lung sounds front and back; Assess respiratory expansion level; Ask about coughing; Palpate thorax. 5. CARDIAC: Palpate the carotid and temporal pulses bilaterally; Listen to heartbeat. 6. ABDOMEN: ... Ask about problems with bowel or bladder. 7. PULSES: Check pulses in arms/legs/feet including, Radial, Femora, Posterior tibial, Dorsalis pedis. 8. EXTREMITIES: ... Check capillary refill on fingernails/toenails. 9. SKIN: Check skin turgor; Check for lesions, abrasions, rashes; Check for tenderness, lumps, lesions; Check if patient is pale, clammy, dry, cold, hot, flushed. 10. NEUROLOGICAL: Oriented x3; Assess gait; Check coordination; Assess reflexes; Check Glasgow Coma Scale.” 4. During a home‑visit observation at Patient #2’s residence on 07/08/2026, from 8:05 AM to 8:37 AM, RN 1 was observed completing a SOC comprehensive assessment for Patient #2. RN 1 obtained vital signs and asked Patient #2 about shortness of breath, diabetes, oxygen equipment or needs, urinary continence issues, bowel movements and last date of movement, and appetite. RN 1 auscultated only the upper two posterior lung fields and failed to assess all posterior fields and anterior lung sounds. RN 1 auscultated the upper two abdominal quadrants for bowel sounds but failed to assess the lower two quadrants. RN 1 then auscultated the patient’s apical heart. RN 1 asked cognitive memory words, questions about bathing and daily activities, and caregiver assistance. RN 1 examined Patient #2’s skin on the back, buttocks, legs, and feet. Patient #2 reported they had fallen and awakened in the hospital with double‑vision changes and inability to walk. Patient #2 further indicated they had been hospitalized the prior fall for a brain bleed and now had to take medication to prevent seizures, as well as one as‑needed medication for nighttime hiccups following the seizure. Patient #2 stated they had received speech therapy to help with vision and word expression, occupational therapy, and physical therapy, and now could walk with a cane but was instructed to use a walker. Patient #2 became tearful and expressed experiencing suicidal ideation during hospitalization due to the lengthy stay and inability to attend a special event with friends and family, and was placed on close observation. RN 1 failed to complete a depression scale test and failed to complete a neurological exam. A review of the clinical record for Patient #2 contained referral documents from Entity 7, the rehabilitation facility dated 06/25/2026. The referral documents contained a document titled “Home Health Care Face-To-Face Encounter Form and Orders.” The face to face and orders form dated 06/25/2026, and signed by Person 8, a physician at Entity 7, noted Patient #2 had a Cerebral Vascular Accident (CVA) (commonly known as a stroke that happens when there is a loss of blood flow to part of the brain causing brain cells to die) and based on the physician’s findings Patient #2 required skilled nursing care for skin assessment and medication management, physical therapy, occupational therapy, and speech therapy. A review of the referral documents contained a document titled “History & Physical,” electronically signed by Person 11, a physician at Entity 7, and dated 06/21/2026. The assessment noted Patient #2 had been admitted to Entity 7 for a multifocal stroke with associated balance and vision impairments and was receiving comprehensive physical therapy, occupational therapy, and speech therapy. The assessment further documented that Patient #2 had a history of a cerebral aneurysm (a bulging or ballooning blood vessel in the brain that can rupture or leak, causing damage to brain cells), seizures treated with Keppra (a medication used to treat various types of seizures), depression currently managed with medication therapy, and Parkinson’s disease (a progressive nervous system disorder characterized by tremor, muscular rigidity, and slowed, imprecise movement). During an interview on 07/08/2026 at 8:40 AM, when asked about neuro checks being completed due to blurred vision and post CVA for Patient #2’s initial SOC assessment, RN 1 stated, “No, I didn’t need to do that. I do the basics for an assessment. I go home and put the rest of the information in using the referral information.” 5. A review of the personnel file for RN 1 contained an agency document dated 11/18/2024 and electronically signed by RN 1, titled “Registered Nurse Job Description.” The RN job description indicated, but was not limited to, “ … The Registered Professional Nurse is responsible to apple professional knowledge and skill, in accordance with State and Federal guidelines and professional standards of practice … “ During a review of the home‑visit observations on 07/09/2026 at 9:34 AM with the management team—Corporate Staff 1, the Vice President of Quality & Compliance and governing body; LPN 1, the Clinical Supervisor; Admin 3, the Director of Operations and Interim Administrator; and Admin 4, the Quality Assurance RN and Interim DON—management was asked about the agency’s process and expectations for a SOC initial assessment completed by an RN. The management team communicated that a full head‑to‑toe assessment should be completed. When asked what should be assessed for a post‑CVA patient, the management team stated that both a head‑to‑toe assessment and a neurological assessment should have been completed.”