Enhabit Home Health

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure the new practitioner was consulted in order to approve of the existing plan of care in 1 of 1 clinical record reviews of patients who changed providers within the first 60 days of service. (Patient 1) Findings include: A clinical record review for Patient 1 evidenced two POC’s, each signed by two different practitioners. The record failed to evidence when the most recent practitioner took over care for Patient 2 or when the initial practitioner ceased to care for Patient 2. The record failed to evidence documentation that the current practitioner approved of or agreed to continue the initial POC that was developed with the initial practitioner. During an interview on 02/11/2026 beginning at 3:44 PM, the Administrator indicated that she believed the current practitioner took over care of Patient 2 on 12/17/2025. The administrator indicated that there was no documentation of the current practitioner agreed to continue the initial POC.”

“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 ensure services were provided only as ordered by a physician in 1 of 2 active clinical records reviewed. (Patient #3) The findings include: A clinical record review for Patient #3 evidenced a physician order dated 12/23/2025 which indicated PT services were placed on hold due to a suspected deep tissue injury (deep tissue damage that could evolve into a severe open wound) on the left heel. The record indicated PT services were provided without an order on 01/02/2026, 01/05/2026, 01/12/2026, and 01/20/2026. On 02/11/2026 at 3:10 PM, the Administrator indicated there was no signed physician order for PT services provided beginning 01/02/2026 through 01/20/2026. 410 IAC 17-13-1(a)”

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure care was coordinated with the assessing therapist in 4 of 4 clinical records reviewed. (Patient #1, 2, 3, 4) The findings include: 1. A clinical record review for Patient #3 evidenced an initial PT evaluation completed by PT 1 dated 11/26/2025 which indicated the PT frequency was to be 2 times a week for 6 weeks and 1 time a week for 3 weeks. A physician order dated 11/26/2025 indicated the PT frequency was changed to 2 times a week for 2 weeks and 1 time a week for 7 weeks. An initial OT evaluation by OT 1 dated 12/15/2025 indicated the OT frequency was to be 1 time a week for 4 weeks. A physician order dated 12/15/2025 indicated the OT frequency was changed to 1 time a week for 6 weeks. The record failed to evidence care coordination with PT 1 and OT 1 regarding the frequency change and what the change was in the assessment to warrant the change in frequency. On 02/11/2026 beginning at 2:57 PM, the Administrator indicated there was no documentation in the record the agency notified PT 1 and OT 1 of the frequency changes. A physician order dated 12/23/2025 indicated PT services were placed on hold due to a suspected deep tissue injury (deep tissue damage that could evolve into a severe open wound) on the left heel. The record indicated PT services were provided without an order on 01/02/2026, 01/05/2026, 01/12/2026, and 01/20/2026. The record failed to evidence care coordination with the PT and PTA regarding the hold for PT services. On 02/11/2026 at 3:10 PM, the Administrator indicated there was no care coordination with the PT and PTA regarding the hold for PT services. 2. A clinical record review for Patient #4 evidenced an initial OT evaluation completed by OT 1 dated 12/15/2025 which indicated the OT frequency was to be 1 time a week for 6 weeks. A physician order dated 12/15/2025 indicated the OT frequency was changed to 1 time a week for 8 weeks. An initial PT evaluation completed by PT 2 dated 12/06/2025 indicated the PT frequency was to be 2 times a week. The POC for the initial certification period 12/06/2025-02/03/2026 indicated the PT frequency was 1 time a week for 9 weeks. The record failed to evidence care coordination with PT 2 and OT 1 regarding the frequency change and what the change was in the assessment to warrant the change in frequency. On 02/11/2026 beginning at 3:18 PM, the Administrator indicated there was no documentation in the record the agency notified PT 2 and OT 1 of the frequency changes. 3. On 02/11/2026 beginning at 12:23 PM, PT 1 indicated he/she was unsure how orders were changed related to the PT frequency and indicated there is no communication from the agency related to frequency change. PT 1 indicated after the therapy evaluation is completed and the therapist determine the visit frequency, the frequency that is actually provided to patient is determined by an Artificial Intelligence (AI) recommendation on the “back end” by administration. 4. On 02/11/2026 beginning at 1:01 PM, OT 1 indicated he/she was not sure why the difference in frequency from the initial assessment and the ordered frequency. 5. On 02/11/2026 at 2:21 PM, the Administrator indicated the frequency should be based on the clinician’s assessment. The Administrator indicated the agency utilized PULSE which was an AI program based on thousands of medical records which the agency used as an analytic tool to give recommended frequencies based on patients with similar diagnoses and assessments. The Administrator indicated if the PULSE recommended frequency was different than the clinician’s frequency based on assessment, the agency would ask the clinician to provide additional documentation to support their assessed frequency. The Administrator indicated she can change the frequency of visits in the scheduling program which auto-populates onto the POC and/or physician order. 1.A clinical record review for Patient 1 evidenced a CA, dated 11/05/2025, by OT 1, that indicated an Occupational Therapy frequency of once weekly for 4 weeks for the certification period of 11/05/2025 to 01/03/2026. A Physician Order, dated 11/06/2025, electronically signed by OT 1 and the Administrator, indicated an Occupational Therapy Frequency of once weekly for 1 week. The record evidenced a CA, dated 12/30/2025, by PT 1, that indicated a Physical Therapy frequency of once weekly for 4 weeks. A POC for the certification period 01/04/2026 to 03/04/ 2026 indicated a Physical Therapy frequency of once weekly for 3 weeks, then twice weekly for 1 week. 2.A clinical record review for Patient 2 evidenced a CA, dated 12/11/2025, by PT 1, that indicated a Physical Therapy frequency of once weekly for 8 weeks for the certification period of 12/11/2025 to 02/08/2026. A Physician Order, dated 12/11/2025, electronically signed by PT 1 and the Administrator, indicated a Physical Therapy frequency of once weekly for 9 weeks. The record evidenced a CA, dated 12/16/2025, by OT 1, that indicated an Occupational Therapy frequency of once weekly for 6 weeks for the certification period of 12/11/2025 to 02/08/2026. A Physician Order, dated 12/16/2025, electronically signed by OT 1 and the Administrator, indicated an Occupational Therapy frequency of once weekly for 7 weeks. 3.During an interview on 02/11/2025 beginning at 2:30 PM, the Administrator indicated that visit frequencies are often changed due when Pulse (and artificial intelligence tool used by the agency) reviews patient information and suggests an alternate frequency. The Administrator indicated that there was no documentation that the staff assigned to Patient 1 or Patient 2 was aware of the change in frequency from the CA’s.”

“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 care was coordinated with the patient in 4 of 4 clinical records reviewed. (Patient #1, 2, 3, 4) The findings include: 1. A clinical record review for Patient #3 evidenced an initial PT evaluation completed by PT 1 dated 11/26/2025 which indicated the PT frequency was to be 2 times a week for 6 weeks and 1 time a week for 3 weeks and indicated PT 1 informed Patient of the PT POC. A physician order dated 11/26/2025 indicated the PT frequency was changed to 2 times a week for 2 weeks and 1 time a week for 7 weeks. An initial OT evaluation by OT 1 dated 12/15/2025 indicated the OT frequency was to be 1 time a week for 4 weeks and indicated OT 1 informed Patient of the OT POC. A physician order dated 12/15/2025 indicated the OT frequency was changed to 1 time a week for 6 weeks. A Home Health Change of Care Notice signed and dated by Patient on 11/26/2025 indicated the PT frequency was 2 times a week for 6 weeks and 1 time a week for 3 weeks. The record failed to evidence care coordination with Patient regarding the frequency change. On 02/11/2026 beginning at 12:23 PM, PT 1 indicated the PT frequency discussed with Patient was 2 times a week for 6 weeks and 1 time a week for 3 weeks and did not discuss the change in PT frequency with Patient since PT 1 was unaware of the frequency change. On 02/11/2026 beginning at 2:57 PM, the Administrator indicated there was no documentation in the record the agency notified Patient of the change in PT and OT frequency. 2. A clinical record review for Patient #4 evidenced an initial OT evaluation completed by OT 1 dated 12/15/2025 which indicated the OT frequency was to be 1 time a week for 6 weeks and indicated OT 1 informed Patient of the OT POC. A physician order dated 12/15/2025 indicated the OT frequency was changed to 1 time a week for 8 weeks. An initial PT evaluation completed by PT 2 dated 12/06/2025 indicated the PT frequency was to be 2 times a week and indicated PT 2 informed Patient of the PT POC. The POC for the initial certification period 12/06/2025-02/03/2026 indicated the PT frequency was 1 time a week for 9 weeks. The record failed to evidence care coordination with Patient regarding the frequency change. On 02/11/2026 beginning at 3:18 PM, the Administrator indicated there was no documentation in the record the agency notified Patient of the frequency changes. 3. On 02/11/2026 beginning at 1:01 PM, OT 1 indicated the frequency determined at tine of the evaluation was the frequency discussed with the patients. 1.A clinical record review for Patient 1 evidenced a CA, dated 11/05/2025, by OT 1, that indicated an Occupational Therapy frequency of once weekly for 4 weeks for the certification period of 11/05/2025 to 01/03/2026. A Physician Order, dated 11/06/2025, electronically signed by OT 1 and the Administrator, indicated an Occupational Therapy Frequency of once weekly for 1 week. The record evidenced a CA, dated 12/30/2025, by PT 1, that indicated a Physical Therapy frequency of once weekly for 4 weeks. A POC for the certification period 01/04/2026 to 03/04/2026 indicated a Physical Therapy frequency of once weekly for 3 weeks, then twice weekly for 1 week. The record failed to evidence documentation that Patient 1 was notified of the change in OT and PT frequency 2. A clinical record review for Patient 2 evidenced a CA, dated 12/11/2025, by PT 1, that indicated a Physical Therapy frequency of once weekly for 8 weeks for the certification period of 12/11/2025 to 02/08/2026. A Physician Order, dated 12/11/2025, electronically signed by PT 1 and the Administrator, indicated a Physical Therapy frequency of once weekly for 9 weeks. The record evidenced a CA, dated 12/16/2025, by OT 1, that indicated an Occupational Therapy frequency of once weekly for 6 weeks for the certification period of 12/11/2025 to 02/08/2026. A Physician Order, dated 12/16/2025, electronically signed by OT 1 and the Administrator, indicated an Occupational Therapy frequency of once weekly for 7 weeks. The record failed to evidence that Patient 2 was notified of the change in PT and OT frequency. 3.During an interview on 02/11/2025 beginning at 3:30 PM, the Administrator indicated that there was not documentation that Patient 1 or Patient 2 was notified of the change in frequencies.”