Select Home Health Services, Inc.

“Development of EP Policies and Procedures CFR(s): 484.102(b) §403.748(b), §416.54(b), §418.113(b), §441.184(b), §460.84(b), §482.15(b), §483.73(b), §483.475(b), §484.102(b), §485.68(b), §485.542(b), §485.625(b), §485.727(b), §485.920(b), §486.360(b), §491.12(b), §494.62(b). (b) Policies and procedures. [Facilities] must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. *[For LTC facilities at §483.73(b):] Policies and procedures. The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. *Additional Requirements for PACE and ESRD Facilities: *[For PACE at §460.84(b):] Policies and procedures. The PACE organization must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must address management of medical and nonmedical emergencies, including, but not limited to: Fire; equipment, power, or water failure; care-related emergencies; and natural disasters likely to threaten the health or safety of the participants, staff, or the public. The policies and procedures must be reviewed and updated at least every 2 years. *[For ESRD Facilities at §494.62(b):] Policies and procedures. The dialysis facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. These emergencies include, but are not limited to, fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters likely to occur in the facility’s geographic area. This Standard is not met as evidenced by: Based on record review and interview the agency failed address the agencies communication plan in 1 of 1 emergency preparedness plan. Findings include: A undated document titled “Select Home Health Services Disaster Planning” failed to evidence the communication plan in case of a disaster. During an interview on 08/13/2026 at 11:56 AM, the Interim Administrator stated the Administrator would provide the communication plan for the emergency preparedness program. An email dated 08/12/2026 at 12:05 PM from the Interim Administrator states the communication plan would be to utilize radio stations to make announcements to staff and patients. The agency did not include this in the emergency plan or in a separate communication plan.”

“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 observation, interview, and record review, the agency failed to ensure that a copy of the home health aide (HHA) plan of care instructions was provided and accessible to the patient for 1 of 1 HHA home visit observation. (Patient #18); failed to ensure written home exercise instruction was provided and accessible to the patient for 1 of 1 home observations with physical therapy (Patient #1); failed to ensure written home exercise instruction was provided and accessible to the patient for 1 of 1 home observations with occupational therapy (Patient #7); and failed to provide written treatment instructions to patients for 3 of 3 RN home visits. (Patient # 2, #3, #11) Findings include: 1. During a home visit observation on 08/10/2026 at 2:00 PM, the surveyor reviewed Patient #1’s admission packet. The packet did not include home exercise instructions. During an interview on 08/10/2026 at 2:20 PM, PT 1 stated he did not provide Patient #1 a written instructions for the home exercise program. At that time, Patient #1’s Power of Attorney (POA) stated they did not need a copy of exercise instructions. During an interview on 08/12/2026 at 8:56 AM, the DON stated the agency required a written and accessible copy of the patients home exercise program in the home. 3. During a home visit observation on 08/11/2026 at 1:00 PM, HHA 3 was unable to locate Patient #18’s admission packet or any document outlining the home health aide plan of care instructions within the home. During an interview on 08/11/2026 at 1:30 PM, HHA 3 stated she could not locate any agency-provided documentation in the home outlining the specific services she was assigned to provide to Patient #18. HHA 3 confirmed she was performing care without a physical copy of the plan of care available in the patient’s home. HHA 3 stated she had access to the aide plan of care on her tablet but it was not accessible to the patient. During an interview on 08/12/2026 at 8:56 AM, the DON confirmed the agency required a copy of the aide plan of care to remain in the home. The DON was not able to provide a copy of acknowledgement verifying the aide plan of care had been delivered to the patient. 2. During an observation on 08/11/2026 at 6:53 AM, the Surveyor reviewed the agency admission folder in Patient #2’s home; the agency failed to provide the patient with home exercise instructions or written treatment instructions. During an interview on 08/11/2026 at 6:53 AM, RN 2 stated the paperwork in the agency folder is for the patient to fill out, not the agency staff; no other documents were provided. 3. During an observation on 08/11/2026 at 7:30 AM, the Surveyor reviewed the agency admission folder in Patient #3’s home; the agency failed to provide the patient with written treatment instructions. 4 . During an observation on 08/11/2026 at 9:45 AM, the Surveyor reviewed the agency admission folder in Patient #7’s home; the agency failed to provide the patient with an exercise program or written treatment instructions. During an interview on 08/11/2026 at 9:45 AM, Patient #7 stated she did not have any other documentation from the agency besides the agency folder. During an interview on 08/11/2026 at 9:45 AM, the OT stated exercise programs are to be in the patient’s home. The OT stated he reviews the plan of care at the start of services, but the agency does not provide written treatment instructions to the patient. 8. During an observation on 08/11/2026 at 12:40 AM, the Surveyor reviewed the agency admission folder in Patient #11’s home; the agency failed to provide the patient with an exercise program or written treatment instructions. During an interview on 08/11/2026 at 12:40 AM, Patient #11 stated the admission packet and calendar provided by RN 1 during the visit are the documents she received from the agency; no other documents were in the home.”

“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 observation, record review, and interview, the agency staff failed to follow infection control techniques regarding hand hygiene with wound care for 1 of 2 wound care observations (RN 1); and failed to remove gloves and perform hand hygiene for 2 of 3 home visit observations with a nurse (RN 1, RN 2) and 1 of 1 home visits with a HHA (HHA 1); and failed to maintain appropriate bag technique for 3 of 8 home visit observations. (PT 1, RN 1, RN 2). Findings include: Xx. During a home visit on 08/10/2026 at 2:00 PM, PT 1 placed his supply bag on top of two plastic barriers on Patient #1’s couch. Patient #1’s cats walked and sat on top on the two barriers and supply bag. PT 1 proceeded to disinfect a blood pressure cuff, oxygen saturation device, and thermometer and placed it on top of one plastic barrier. PT 1 failed to replace the contaminated plastic barriers prior to disinfecting equipment or ask the family to remove the cats from the work area. During an interview on 08/10/2026 at 2:30 PM, PT 1 acknowledged the cats should not have walked or sit on the plastic barriers and that the barriers were considered contaminated. Xx. During a home visit on 08/11/2026 at 1:00 PM, HHA 1 washed Patient #18’s buttocks with a soapy loofah sponge with gloved hands. She then rinsed Patient #18 with water and dried them with a towel. She then proceeded to dress the patient and transfer them to a wheel chair with the same soiled gloves. HHA 1 failed to remove gloves and perform hand hygiene after completing the patients shower and before touching clean clothing and the patient’s wheelchair. During an interview on 08/11/2026 at 1:30 PM, HHA 1 stated she probably did not remove gloves and perform hand hygiene as she was supposed to after washing the patient’s buttocks and touching clean items. 2. During an observation on 08/11/2026 at 6:53 AM, RN 2 documented on electronic device and placed the device on a clean barrier with clean vital‑sign equipment. RN 2 then collected the vital‑sign equipment and used it on Patient #2. RN 2 failed to keep dirty electronic devices separate from clean equipment on a different barrier, and RN 2 failed to clean the equipment after it had been placed on the drape with the dirty electronic device and before using it on Patient #2. 3. During an observation on 08/11/2026 at 12:40 PM, RN 1 touched an electronic device and then entered the nursing bag to collect supplies. RN 1 failed to perform hand hygiene before entering the nursing bag. RN 1, while gloved, cleaned Patient #11’s wound on the left lateral calf and left shin; applied Xeroform to both wounds; and placed 2x2 dressings over each wound. RN 1 failed to change gloves and perform hand hygiene between providing care to each wound. During an interview on 08/11/2026 at 12:40 PM, RN 1 stated gloves and hand hygiene are not required when moving from one wound to another. 410 IAC 17-12-1(m)”

“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 complete an initial assessment within 48 hours of a referral for 4 of 14 active records reviewed. (Patients #6, #10, #12, #17) Findings include: xx . A review of Patient #6’s record evidenced an OASIS referral receipt date of 07/01/2026. The record failed to evidence documentation of a physician-ordered alternative start of care date, patient unavailability, or clinical justification to delay care. The agency failed to conduct the initial assessment visit within the mandated 48-hour timeframe, delaying the assessment until the Start of Care (SOC) visit on 07/07/2026. xx. A review of Patient #10’s record evidenced an OASIS referral receipt date of 06/04/2026. The record failed to evidence documentation of a physician-ordered alternative start of care date, patient unavailability, or clinical justification to delay care. The agency failed to conduct the initial assessment visit within the mandated 48-hour timeframe, delaying the assessment until the Start of Care (SOC) visit on 07/06/2026. During an interview on 08/12/2026 at 1:27 PM, the Interim Administrator acknowledged the documented referral dates represented when the agency was first notified of the patients. She confirmed that the agency lacked any documented clinical justification, communication log notes, or alternative physician orders to account for the delayed initial assessment timelines. 3. A review of Patient #11’s record evidenced an OASIS referral receipt date of 06/17/2026, with no physician‑ordered alternative start date specified. The agency failed to conduct the initial assessment visit within 48 hours of receiving the referral, delayed care, and completed the initial assessment on the start of care (SOC) date of 06/17/2026. 4. A review of Patient #12’s record evidenced an OASIS referral receipt date of 02/11/2026, with no physician‑ordered alternative start date specified. The agency failed to conduct the initial assessment visit within 48 hours of receiving the referral, delayed care, and completed the initial assessment on the SOC date of 02/26/2026. 5. A review of Patient #17’s record evidenced an OASIS referral receipt date of 06/15/2026, with no physician‑ordered alternative start date specified. The agency failed to conduct the initial assessment visit within 48 hours of receiving the referral, delayed care, and completed the initial assessment on the SOC date of 06/18/2026. 410 IAC 17-14-1(a)(1)(A)”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on record review and interview, the agency failed to have a signed POC or a verbal POC order from the primary physician before providing services and treatments to patients for 6 of 18 records reviewed, potentially affecting all patient records. (Patients #2, #3, #4, #9, #11, #17); and failed to follow wound care orders as order by the physician for 3 of 4 records reviewed with wounds. (Patients #2, #3, #11). Findings include: Xx. The review of Patient #9’s record for the certification period 06/16/2026 to 08/14/2026 showed the agency provided skilled nursing services on 06/17/2026, 06/19/2026, 06/20/2026, and 06/22/2026; and HHA services on 06/18/2026 before obtaining a detailed verbal order or a signed POC from the physician Wound Care 1. During an observation on 08/11/2026 at 6:53 AM, the Surveyor observed no bilateral buttocks wounds on Patient #2. RN 2 cleaned the area and applied a new dressing to the bilateral buttocks. During an interview on 08/11/2026 at 6:53 AM, RN 2 confirmed there was no dressing in place at the start of wound care. RN 2 confirmed there were no open areas on Patient #2’s buttocks, but still provided wound care. RN 2 indicated that during the nurse’s visit on 08/09/2026, the area looked the same with no wound present. 2. A review of Patient #3’s record included a “Home Health Certification and Plan of Care” that indicates a skilled nurse is to perform/teach wound care to the skin tear on the right lower extremity and left lower extremity. Cleanse with wound cleanser. Pat dry with clean gauze. Apply silver alginate. Cover with a bordered dressing and secure with Tubigrip (elasticated tubular support bandage) using clean/aseptic technique. Change dressing 2x/week and PRN for soilage or dislodgement. During an observation on 08/11/2026 at 7:30 AM, RN 2 applied Cetaphil lotion to the bilateral legs. RN 2 failed to perform wound care as ordered by the physician. During an interview on 08/11/2026 at 7:30 AM, RN 2 stated the cream is not part of the wound care order. RN 2 confirmed that during the last RN visit on 08/09/2026 she did not provide wound care as ordered on the POC and did not call the physician for new orders. 3. A review of Patient #11’s record included an order dated 08/11/2026 at 8:05 AM that indicates a skilled nurse is to perform/teach wound care to right shin scattered skin tears. Cleanse with normal saline and pat dry with clean gauze. Apply Xeroform (a sterile, non-adhering wound dressing made of fine-mesh gauze impregnated with petrolatum (vaseline) and 3% bismuth tribromophenate). Cover with bordered foam or 2 x 2 island dressing using clean/aseptic technique. SN to change dressing 1x/week and PRN for soilage or dislodgement. Patient/caregiver to change dressing every three days and PRN for soilage or dislodgement. During an observation on 08/11/2026 at 12:40 PM, RN 1 provided wound care to Patient #11’s left shin and left calf. RN 1 failed to provide care to the wounds on the right leg as ordered by the physician and provided care to the left leg without an order. 4. During an interview on 08/12/2026 at 8:55 AM, the DON stated staff should follow the orders provided by the physician. The DON stated that if wound care orders need changes, staff should call the physician for different orders, and if no wounds are present, staff should notify the physician and request new orders. Plan of Care 1. The review of Patient #2’s record for the certification period 07/12/2026 to 09/09/2026 showed the agency provided skilled nursing services on 07/12/2026 and 07/14/2026 before obtaining a detailed verbal order or a signed POC from the physician. 2. The review of Patient #3’s record for the certification period 07/22/2026 to 09/20/2026 showed the agency provided skilled nursing services on 07/26/2026, 07/28/2026, 08/02/2026, 08/04/2026, and 08/09/2026 before obtaining a detailed verbal order or a signed POC from the physician. 3. The review of Patient #4’s record for the certification period 07/08/2026 to 09/05/2026 showed the agency provided skilled nursing services on 07/08/2026 before obtaining a detailed verbal order or a signed POC from the physician. 5 The review of Patient #11’s record for the certification period 06/17/2026 to 08/15/2026 showed the agency provided skilled nursing services on 06/17/2026, 06/24/2026, and 07/01/2026 before obtaining a detailed verbal order or a signed POC from the physician. 6. The review of Patient #17’s record for the certification period 06/18/2026 to 08/16/2026 showed the agency provided skilled nursing services on 06/25/2026, 06/29/2026, 07/02/2026, and 07/06/2026 before obtaining a detailed verbal order or a signed POC from the physician. 7. During an interview on 08/11/2026 at 7:00 AM, RN 2 stated the physician is called after the start of care is completed to inform the physician of treatment provided and any changes in the POC. 8. During an interview on 08/11/2026 at 12:40 PM, RN 1 stated she notifies the physician by phone the same day the start of care is completed. RN 1 stated she does not speak to the physician directly and normally leaves a message with after‑hours staff indicating the patient’s name, her name, and that the patient was seen either for start of care or recertification. 9. During an interview on 08/12/2026 at 8:55 AM, the DON stated the agency obtains eval‑and‑treat orders from the physician for start of care. Staff call the physician after start‑of‑care visits and obtain verbal orders for the care to be provided. 410 IAC 17-13-1(a)”

“Standard: Initial assessment visit. CFR(s): 484.55(a) Standard: Initial assessment visit. This Standard is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure an initial assessment was completed within 48 hours of referral for 3 of 4 active patient records reviewed (Patient #19, #20, and #23). Findings include: 1. Policy #6.019.1, Comprehensive Assessment of Patients (OASIS), indicated a comprehensive assessment will be performed on patients within 48 hours of referral or the patient’s return to home or on the physician-ordered start of care date. 2. Patient #19’s clinical record evidenced a referral date of 12/14/23 and a hospital discharge date of 12/15/23. The clinical record included an initial assessment of Patient #19 on 12/23/23. The clinical record failed to evidence a physician order to delay the initial assessment. During an interview on 01/05/24 beginning at 2:12 PM, the Clinical Manager relayed he/she could not find a reason Patient #19’s initial assessment was performed over 48 hours after referral. 3. Patient #20’s clinical record evidenced a referral date of 11/22/23 and evidenced a discharge date from a skilled nursing facility on 11/25/23. The clinical record included an initial assessment of Patient #20 on 11/29/23. The clinical record failed to evidence a physician order to delay the initial assessment. During an interview on 01/05/24 beginning at 2:12 PM, the Clinical Manager relayed there was no documentation in the clinical record to show why the initial assessment had been performed more than 48 hours after Patient #20’s return home from the skilled nursing facility. 4. Patient #23’s clinical record evidenced a referral date of 12/01/23. The clinical record included an initial assessment on 12/05/23. The clinical record failed to evidence a physician order to delay the initial assessment. During an interview on 01/05/24 beginning at 2:12 PM, the Clinical Manager relayed there was no documentation in the clinical record to show why the initial assessment had been performed more than 48 hours after Patient #23’s referral date.”