Amore Home Health Care Services, Inc.

“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 POC was developed in conjunction with the physician in 1 of 2 active clinical records reviewed with a SOC date after 11/01/2025 in a total sample of 7 clinical records reviewed. (Patient #4) The findings include: A clinical record review for Patient #4 evidenced a physician order dated 11/20/2025 which indicated Patient was admitted for SN services 1 time a week for 9 weeks to include wound care. The record failed to evidence a POC and failed to evidence the POC was reviewed with the physician. On 12/04/2025 at 5:07 PM, the CM indicated the SOC was 11/20/2025, and the POC was not yet developed. The CM indicated the agency had left a message with the physician responsible for the POC but had not yet received a return call from the physician’s office. 410 IAC 17-13-1(a)”

“Program activities CFR(s): 484.65(c) (1) The HHA’s performance improvement activities must— (i) Focus on high risk, high volume, or problem-prone areas; (ii) Consider incidence, prevalence, and severity of problems in those areas; and (iii) Lead to an immediate correction of any identified problem that directly or potentially threaten the health and safety of patients. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure the performance improvement activities focused on high risk and problem-prone areas. The findings include: A review of the Discharge Patient List dated 06/03/2025-12/03/2025 indicated 4 patients that were discharged due to being admitted to the hospital. A review of the agency’s Quality Assurance and Performance Improvement (QAPI) Program failed to include performance improvement activities related to the high risk area of patient hospitalizations. On 12/05/2025 at 3:04 PM, the CM indicated Patients #3, #5, and #8 had hospitalizations but the agency did not have any tracking information or data such as length of hospitalization and admitting diagnosis related to the hospitalizations. The CM indicated the QAPI program did not review data and include performance improvement activities related to the patient hospitalizations.”

“Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA’s quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure a program was developed for the surveillance, identification, prevention, and control of infectious and communicable diseases specific to care and services provided in the home setting and was included in the agency’s Quality Assurance and Performance Improvement (QAPI) program. The findings include: A review of Patient Infection Reports for 2025 indicated 12 patient infections to include 8 urinary tract infections, 2 wound infections, and 2 respiratory infections. The agency failed to evidence an infection control program to include the surveillance of infections to include the aggregations of data to track and trend the patient infections. A review of the QAPI program failed to evidence the data related to the patient infections. On 12/05/2025 at 2:37 PM, the CM indicated there was no surveillance of patient infections, and the infections were not included in the QAPI program.”

“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 record review and interview, the agency failed to ensure the initial assessment was completed within 48 hours of the referral in 1 of 2 active clinical records with only SN services in a total sample of 7 clinical records reviewed. (Patient #2) The findings include: A clinical record review for Patient #2 evidenced a referral document with a faxed date to the agency on 11/07/2025, and the record failed to evidence an initial assessment prior to the comprehensive assessment for the SOC on 11/13/2025. On 12/04/2025 at 12:40 PM, the CM indicated she would look for any additional documentation/information, but none was provided prior to survey exit on 12/05/2025. 410 IAC 17-14-1(a)(1)(A)”

“Patient’s needs CFR(s): 484.55(c)(4) The patient’s medical, nursing, rehabilitative, social, and discharge planning needs; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the comprehensive assessment included the patient’s nursing needs in 1 of 2 active clinical records reviewed with SN services only in 7 clinical records reviewed. (Patient #2) The findings include: A clinical record review for Patient #2 evidenced a POC for the initial certification period of 11/13/2025-01/11/2026 which indicated the primary diagnosis was hypertension (high blood pressure), and the agency would provide SN services 1 time a week for 9 weeks for education of disease management and treatment. The comprehensive assessment for the SOC dated 11/13/2025 indicated the Patient’s blood pressure has been well-controlled. The assessment failed to include the assessment of the nursing needs for home care. On 12/04/2025 at 1:20 PM, the CM indicated she was unsure what the nursing need was. 410 IAC 17-14-1(a)(1)(B)”

“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 record review and interview, the agency failed to ensure the comprehensive assessment included a review of the medication to include drug interactions in 1 of 1 active clinical record review with therapy only services in a total sample of 7 clinical records reviewed. (Patient #3) The findings include: A clinical record review for Patient #3 evidenced a POC for the recertification period 09/27/2025-11/25/2025 which indicated the medications included levothyroxine (to treat underacting thyroid), metoprolol (for high blood pressure), milk of magnesia (for constipation), omeprazole (for gastric reflux), and vitamin D with calcium (mineral supplement). The undated drug interactions indicated 5 drug interactions to include 4 moderate interactions between levothyroxine and metoprolol, levothyroxine and milk of magnesia, levothyroxine and vitamin D with calcium, and omeprazole and vitamin D with calcium. The comprehensive assessment for the recertification completed by PT 1 on 11/21/2025 failed to include the assessment of the drug interactions. On 12/04/2025 at 12:04 PM, the CM indicated the PT did not include the review of the medications for drug interactions in the comprehensive assessment. 410 IAC 17-14-1(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 record review and interview, the agency failed to ensure the POC included all measurable goals, medical equipment, and treatments for 4 of 4 active clinical records reviewed with a POC in a total sample of 7 clinical records reviewed. (Patient #1, 2, 3, 5) The findings include: 1. A clinical record review for Patient #1 evidenced a comprehensive assessment for the SOC dated 08/30/2025 which indicated Patient had frequent pain affecting sleep and day-to-day activities rated 4/10. The assessment indicated the Patient used a bipap/cpap (medical devices used to assist in breathing for sleep apnea) and had a wound to the right leg. The record evidenced wound assessment notes from Entity 1 (wound clinic) dated 08/12/2025 and 09/15/2025 which indicated Patient was recommended to increase protein intake and take a multivitamin to assist wound healing. The POC failed to include the wound care provided by Entity 1 and the recommendations for increased protein and multivitamin. The POC for the initial certification period 08/30/2025-10/28/2025 indicated Patient would have optimal effectiveness of pain and failed to include what was Patient’s optimal level of pain. The POC failed to include the use of the bipap/cpap. On 12/04/2025 beginning at 12:18 PM, the CM indicated the optimal level of pain was not clear and measurable. The CM indicated Patient used a cpap which was not included on the POC. The CM indicated the wound care provided by Entity 1 and their recommendations were not included in the POC. 2. A clinical record review for Patient #2 evidenced a POC for the initial certification period of 11/13/2025-01/11/2026 which indicated the goals included having optimal bowel management and optimal pain management. The POC failed to evidence what was Patient’s optimal bowel and pain management. The POC indicated the caregiver was to demonstrate strategies for symptom management of anemia (low red blood cells) and failed to evidence a diagnosis of anemia. On 12/04/2025 at 1:20 PM, the CM indicated she was unsure how the goals for optimal bowel and pain management were measurable. The CM indicated she was not sure why the POC included the demonstration of anemia symptom management. 3. A clinical record review for Patient #3 evidenced physician orders from Entity 2 (ALF) dated 12/03/2025 which indicated Patient had a wanderguard (an alarming device for patients at risk for elopement) in place. The POC failed to evidence the wanderguard use at Entity 2 and failed to include the delineation of care provided by Entity 2. On 12/04/2025 at 11:10 AM, the CM indicated the wanderguard and the delineation of care at the ALF were not included on the POC. 4. A clinical record review for Patient #5 evidenced a POC for the recertification period 10/14/2025-12/12/2025 which indicated a goal for optimal bowel evacuation and effectiveness of pian management. The POC failed to evidence what was Patient’s optimal bowel and pain management. On 12/05/2025 at 2:04 PM, the CM indicated the goals for bowel evacuation and pain management were not patient specific. 410 IAC 17-13-1(a)(1)(D)(xiii)”

“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 2 of 2 active clinical records reviewed in a total sample of 2 active patients with wounds. (Patient #1, 4) The findings include: 1. A clinical record review for Patient #1 evidenced a comprehensive assessment for the SOC dated 08/30/2025 completed by the CM which indicated the CM completed wound care to include applying a foam dressing to the wound on the right leg. SN visit notes completed by the CM dated 09/02/2025, 09/11/2025, 09/17/2025, 09/25/2025, 10/01/2025, and 10/06/2025 indicated the CM performed wound care to include applying a foam dressing to the right leg. The record failed to evidence a wound care order to include the foam dressing prior to the POC for the initial certification period 08/30/2025-10/28/2025 was signed by the physician on 10/23/2025. On 12/04/2025 at 12:10 PM, the CM indicated she performed the wound care based on what the wound treatment was in place on Patient upon discharge from the hospital. 2. A clinical record review for Patient #4 evidenced a physician order dated 11/20/2025 which indicated the agency was to provide SN services 1 time a week to include wound care. On 12/04/2025 at 5:07 PM, the CM indicated she completed wound care to surgical wounds to the top of the head and the nose to include applying mupirocin (antibiotic ointment) to a gauze and inserting into the surgical wound and covering with a non-stick dry dressing on the SOC on 11/20/2025 and on 11/26/2025. The review failed to evidence a wound care order to include the mupirocin and non-stick dressing. On 12/04/2025 at 5:07 PM, the CM indicated there was not a physician order for specific wound care. 410 IAC 17-13-1(a)”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the physician was notified of changes potentially requiring a change in the POC in 1 of 2 active clinical records reviewed with a hospitalization in a total sample of 7 clinical records reviewed. (Patient #3) The findings include: At an observation of care at Entity 2 on 12/03/2025 at 4:54 PM for Patient #3, a clinical record review evidenced a Discharge Summary from Entity 3 dated 11/05/2025 which indicated physician orders from a physician other than the physician responsible for the POC to begin losartan (for high blood pressure) and discontinue amlodipine (for high blood pressure), clonazepam (for anxiety), and metoprolol (for high blood pressure). The record failed to evidence the agency notified the physician of the change in medication orders upon discharge from the hospital and as administered by Entity 2. On 12/04/2025 at 11:28 AM, the C indicated the physician responsible for the POC was not notified of the change in medication orders. 410 IAC 17-13-1(a)(2)”

“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 all healthcare providers providing services to the patient in 1 of 1 active clinical record reviewed receiving services from a wound clinic (Patient #1) in a total sample of 2 active patients with wounds and in 1 of 1 active clinical record reviewed residing in an Assisted Living Facility (ALF) in a total sample of 7 clinical records reviewed (Patient #3) The findings include: 1. A clinical record review for Patient #1 evidenced wound assessment notes from Entity 1 (wound clinic) dated 08/12/2025 which indicated the wound care included a foam dressing covered by an ABD (absorbent dressing) pad three times a day. The POC for the initial certification period 08/30/2025-10/28/2025 failed to include the ABD pad in the wound care and indicated wound care was every 3-4 days. The record failed to evidence care coordination with Entity 1 to clarify the wound treatment and frequency. On 12/04/2025 at 12:10 PM, the CM indicated there was no care coordination with Entity 1. 2. A clinical record review for Patient #3 evidenced physician orders from Entity 2 (ALF) dated 12/03/2025 which indicated Patient’s medications included gabapentin (for nerve pain), pantoprazole (for gastric reflux), and losartan (for high blood pressure) which were not included in the POC for the recertification period 11/26/2025-01/24/2026. The record failed to evidence care coordination with the ALF to clarify the medication discrepancy. On 12/04/2025 at 11:15 AM, the CM indicated there was no care coordination with the ALF regarding the medication discrepancy. 410 IAC 17-12-2(h)”

“Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the RN completed the clinical documentation at the time services were provided in 2 of 5 active clinical records reviewed. (Patient #1, 4) The findings include: 1. A clinical record review for Patient #1 evidenced a POC for the recertification period of 10/29/2025-12/27/2025 which indicated the agency was to provide SN services 1 time a week. The record failed to evidence a SN visit since 11/20/2025. On 12/04/2025 at 12:28 PM, the CM indicated she completed a SN visit on 11/26/2025 but had not documented the visit yet. 2. A clinical record review for Patient #4 evidenced a SOC date of 11/20/2025 but failed to evidence a comprehensive assessment for the SOC. The clinical record failed to evidence a SN visit. On 12/04/2025 at 5:05 PM, the CM indicated she performed the comprehensive assessment on 11/20/2025 and a SN visit on 11/26/2026 but had not yet documented them. 410 IAC 17-14-1(a)(1)(E)”