Noble Home Health Care LLC

“Organization and administration of services CFR(s): 484.105 Condition of participation: Organization and administration of services. The HHA must organize, manage, and administer its resources to attain and maintain the highest practicable functional capacity, including providing optimal care to achieve the goals and outcomes identified in the patient’s plan of care, for each patient’s medical, nursing, and rehabilitative needs. The HHA must assure that administrative and supervisory functions are not delegated to another agency or organization, and all services not furnished directly are monitored and controlled. The HHA must set forth, in writing, its organizational structure, including lines of authority, and services furnished. This Condition is not met as evidenced by: Based on record review and interview the Governing Body and Administrator failed to ensure the Medicare Provider met the Condition of Participation for Organization and Administration of Services when they failed to provide skilled services to individuals, eligible to receive skilled home health services under their Medicare benefit (See G 942) for 1 of 1 Medicare provider.”

“Discharge Planning CFR(s): 484.58(a) Standard: Discharge planning. An HHA must develop and implement an effective discharge planning process. For patients who are transferred to another HHA or who are discharged to a SNF, IRF or LTCH, the HHA must assist patients and their caregivers in selecting a post-acute care provider by using and sharing data that includes, but is not limited to HHA, SNF, IRF, or LTCH data on quality measures and data on resource use measures. The HHA must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to provide a 15-day discharge notice before the date of discharge in 1 of 1 closed clinical records reviewed due to goals met. (Patient #7) The findings include: A policy updated 04/23/2025 titled “Discharge/Transfer from Service” indicated the agency would notify the patient no later than 15 days before the date on which the discharge would take place and would document the notice of discharge in the clinical record. A clinical record review for Patient #7 evidenced the Patient was discharged on 01/21/2025 and evidenced a letter addressed to the Patient dated 01/14/2025 which indicated the Patient would be discharged from the agency effective 01/21/2025 which was less than 15 days. On 04/30/2025, beginning at 1:05 PM, the Administrator indicated there was no additional documentation to indicate the agency provided discharge notice prior to 01/14/2025. 410 IAC 17-12-2(i)”

“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 evidence medical information regarding patients course of treatment and outcome was sent to the attending physician in 2 of 2 closed clinical records reviewed. (Patient #6 and 7) The findings include: 1. A policy, updated 04/23/2025, titled “Discharge/Transfer from Service,” indicated the agency would send a discharge summary to the attending physician, within 2 business days of discharge. 2. The clinical record for Patient #6 evidenced the Patient was discharged from the agency on 04/10/2025 and failed to evidence a discharge summary was sent to the physician. 3. A clinical record review for Patient #7 evidenced the Patient was discharged from the agency on 01/21/2025 and failed to evidence a discharge summary was sent to the physician. 4. On 04/30/2025, at 12:40 PM, the Administrator indicated the agency did not complete nor send a discharge summary to the physicians. 410 IAC 17-13-2(a)(b)(9)”

“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 provide services as directed in the POC in 1 of 2 active clinical records reviewed with a SOC in 2025. (Patient #5) The findings include: A clinical record review for Patient #5 evidenced a POC for the initial certification period 03/24/2025- 05/22/2025 which indicated the agency was to provide HHA services 2-3 hours per day 5 days a week for 9 weeks. The clinical record failed to evidence the agency provided HHA services until 4/17/2025. On 04/30/2025, at 2:45 PM, the CM indicated the authorization for HHA services was received on 04/10/2025, and the agency was trying to figure out the HHA schedule. 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 Quality Assurance and Performance Improvement (QAPI) program included performance improvement activities for high risk and high frequency areas. The findings include: A review of the hospitalization log for 2025 indicated 6 hospitalizations with an average census of 25. The QAPI program failed to evidence performance improvement activities to address the hospitalizations. On 04/30/2025, at 2:48 PM, the CM indicated the agency had not implemented any performance improvement activities to address the patient hospitalizations.”

“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 the RN appropriately assigned the HHA to care for the Patient in 1 of 1 active clinical record reviewed with dialysis (medical treatment to filter the blood). (Patient #5) The findings include: A clinical record review for Patient #5 evidenced a comprehensive assessment for the SOC dated 03/24/2025 completed by the Alternate CM which indicated the Patient received dialysis (a medical treatment that filters the blood). On 04/30/2025, at 12:36 PM, Person 8 indicated the Patient received dialysis at Entity 6 and was ordered a renal diet and a 32 ounce fluid restriction daily. The HHA Care Plan dated 03/24/2025 and signed by the Alternate CM failed to include the renal diet and fluid restriction in the directions to the HHA. On 04/30/2025, at 2:09 PM, the Alternate CM indicated she had not yet informed the HHA of the Patient’s fluid restriction and renal diet. 410 IAC 17-14-1(m)”

“Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency’s overall management and operation, the provision of all home health services, fiscal operations, review of the agency’s budget and its operational plans, and its quality assessment and performance improvement program. This Standard is not met as evidenced by: Based on record review and interview, the governing body failed to ensure the administrator adhered to the agencies Medicare agreement to accept and provide services to Medicare eligible beneficiaries and the declination to provide skilled services to Medicare beneficiaries, for 1 of 1 agency. Findings include: During the Entrance Conference, conducted on 04/22/2025, beginning at 10:40 AM, the Administrator reported the agency was certified by Medicare, but the agency did not have any Medicare patients on their current census and had not for at least five years. Review of the active patient roster failed to evidence the agency provided services for Medicare patients. Review of the Governing Body Meeting Minutes from 2023, 2024, and 2025 failed to evidence any discussion regarding the failure to accept and provide services to Medicare patients. On 04/22/2025, at 2:20 PM, the Administrator indicated the agency had not provided services for any Medicare patients since she was hired on 12/19/2019. The Administrator indicated the agency did not have SN staff that wanted to provide the intermittent Medicare visits. The administrator relayed any referrals received for Medicare services were referred to another home health agency.”

“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 documentation was completed timely and accurately in 3 of 5 active clinical records reviewed. (Patient #2, 3, 5) The findings include: 1. A policy titled “Timeliness and Accuracy of Entries in the Clinical Record” updated 04/23/2025 indicated staff was to complete clinical progress notes on the date service was rendered. 2. The clinical record for Patient #2 evidenced HHA visit notes completed by HHA 1 dated 04/22/2025, 04/23/2025, and 04/25/2025 which indicated HHA 1 made a visit in the morning and in the evening on each day and provided the Patient a shower both in the morning and in the evening. On 04/28/2025, at 2:01 PM, the Patient indicated they only take a shower in the morning and not in the evening. On 04/29/2025, at 1:52 PM, HHA 1 indicated she does not give the Patient a shower in the evenings but documented she did, because sometimes the Patient spills food and she helps clean him up. On 04/30/2025, at 1:38 PM, the CM indicated the agency had been working with the HHAs to not leave a blank on the visit note and documented a shower since there was only 1 care plan for both morning and evening visits which indicated the HHA was to assist with a shower. 3. A clinical record review for Patient #3 evidenced a POC for recertification period 02/27/2025-04/27/2025 which indicated the Patient’s medication included escitalopram (antidepressant) to be taken daily. On 04/29/2025, at 11:35 AM, the Patient indicated to LPN 1 they had not taken escitalopram all month because the prescription ran out. SN visit notes completed by LPN 1 and dated 04/01/2025, 04/10/2025, 04/15/2025, and 04/22/2025 indicated LPN 1 documented the Patient demonstrated medication compliance, there were no medication changes, and took escitalopram for depression. The clinical record failed to evidence LPN 1 documented the Patient’s inability to take escitalopram as ordered. On 04/29/2025, at 12:18 PM, LPN 1 indicated she did not document the Patient did not have the escitalopram, because the physician was aware. On 04/30/2025, at 2:24 pm, the CM indicated LPN 1 should not have documented there were no changes with medication and the Patient demonstrated medication compliance. 4. A clinical record review for Patient #5 evidenced a POC for the initial certification period 03/24/2025-05/22/2025 which indicated the agency was to provide HHA services 2-3 hours per day 5 days a week for 9 weeks. The clinical record failed to evidence the agency provided HHA services after 4/17/2025. On 04/30/2025, at 2:45 PM, the CM indicated the HHA did provide services on 04/19/2025, 04/22/2025, 04/23/2025, 04/24/2025, and 04/25/2025 but had not yet documented the visits. 410 IAC 17-15-1(b)”

“Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient’s status, and must include, at a minimum, the following information: (1) The patient’s current health, psychosocial, functional, and cognitive status; This Element is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure the comprehensive assessment included the physical status of the patient in 1 of 1 active clinical record review with a gastrostomy (GT, a feeding tube) (Patient #1) and in 1 of 1 active clinical record reviewed with a wound (Patient #5). The findings include: 1. During an observation of care on 04/23/2025, at 11:05 AM, Patient #1 was observed with a tube inserted into the abdomen connected to a bag containing a liquid. A clinical record review evidenced a comprehensive assessment [CA] for recertification, dated 04/11/2025 completed by RN 1, which indicated Patient had a GT for enteral nutrition (provided via a feeding tube directly into the stomach) and indicated Patient received oxygen at 2 liters per minute (the rate of oxygen administration. The CA failed to include the size of the feeding tube and the appearance of the stoma (opening of the skin for the tube) and surrounding skin and failed to include the method of oxygen delivery and frequency. On 04/25/2025, at 4:25 PM, RN 1 indicated the GT was a Mickey button (type of feeding tube) and the size was 14 French (unit of measure for feeding tube) and 2.0 centimeters in length with a balloon to hold it in place filled with 3 milliliters of air. RN 1 indicated the Patient received oxygen as needed via nasal cannula (a tube inserted into the nostrils) to maintain oxygen saturation levels. On 04/30/2025, at 1:41 PM, the Alternate CM indicated the assessment of the feeding tube size and the appearance of the stoma and surrounding skin was not included in the comprehensive assessment and indicated the comprehensive assessment did not include the frequency and method of oxygen delivery. 2. A clinical record review for Patient #5 evidenced a comprehensive assessment for the SOC dated 03/24/2025 completed by the Alternate CM which indicated the Patient had a dressing covering the left heel due to a wound for which Entity 5 provided wound treatment. The comprehensive assessment failed to include an assessment of the wound. The clinical record failed to evidence an order that indicated the wound dressing was not to be removed and failed to evidence any assessment of the wound provided by Entity 5. The assessment indicated Patient received dialysis (a medical treatment that filters the blood) and had a central venous catheter (an thin tube going into a large vein) at the right subclavian (a vein under the upper chest) and failed to include the assessment of the site to include if a dressing was present. On 04/30/2025, at 2:03 PM, the Alternate CM indicated she did not assess the wound to the left foot due to Patient #5 had a dressing in place covering the wound that was applied by Entity 5 and she did not want to remove the dressing. She indicated she did not have an assessment of the wound from Entity 5 and did not include an assessment of the central venous catheter to include a dressing was present over the site. 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 medication review of the drug interactions in 1 of 2 active clinical records reviewed with a SOC in 2025. (Patient #4) The findings include: A clinical record review for Patient #4 evidenced a document titled “Medication Interactions” dated 04/30/2025 which indicated a potential drug interaction between Nayzilam (to treat seizures) and Xcopri (to treat seizures). The POC for the initial certification period 03/31/2025-05/29/2025 indicated the Patient’s medications included Nayzilam and Xcopri. The comprehensive assessment for the SOC dated 03/31/2025 failed to evidence the assessment of the potential drug interaction between Nayzilam and Xcopri. On 04/30/2025, at 12:49 PM, the Alternate CM indicated the comprehensive assessment did not include the drug interaction between Nayzilam and Xcopri. 410 IAC 17-14-1(a)(1)(B)”

“Primary caregiver(s), if any CFR(s): 484.55(c)(6)(i,ii) The patient’s primary caregiver(s), if any, and other available supports, including their: (i) Willingness and ability to provide care, and (ii) Availability and schedules; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the comprehensive assessment included the assessment of the caregiver’s willingness, ability, and capability to provide care in 3 of 3 active clinical records reviewed with a caregiver. (Patient #1, 4, 5) The findings include: 1. A clinical record review for Patient #1 evidenced a comprehensive assessment for recertification dated 04/11/2025 which indicated the Patient was wheelchair bound and dependent on others for personal care and activities of daily living, feeding, and medication administration. The comprehensive assessment failed to identify who the caregiver was and the willingness, ability, and availability of the caregiver in the absence of the home health services. On 04/30/2025, at 1:41 PM, the CM indicated the assessment of the caregiver was not included in the comprehensive assessment. 2. A clinical record review for Patient #4 evidenced a comprehensive assessment for the SOC dated 03/31/2025 which indicated the Patient required seizure precautions and was dependent for personal care and activities of daily living, feeding, and medication administration. The comprehensive assessment failed to identify the willingness and ability of the caregiver in the absence of the home health services. On 04/30/2025, at 1:27 PM, the CM indicated the comprehensive assessment did not include the ability and willingness of the caregiver to provide care. 3. A clinical record review for Patient #5 evidenced a comprehensive assessment for the SOC dated 03/24/2025, which indicated the Patient had a wound and lived with a caregiver, and the assessment failed to include the assessment of the caregiver. On 04/30/2025, at 2:00 PM, the Alternate CM indicated the comprehensive assessment did not include an assessment of the caregiver. 4. On 04/30/2025, at 1:45 PM, the Alternate CM indicated there was not a space for the assessment of the caregiver on the recertification comprehensive assessment form.”

“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 plan of care was individualized to include the patient-specific interventions and goals in 4 of 5 active clinical records reviewed. (Patient #1, 2, 3, 5) The findings include: 1. A clinical record review evidenced a comprehensive assessment for recertification dated 04/11/2025 completed by RN 1 indicated the Patient had no wounds, had a gastrostomy (GT, feeding tube) for enteral nutrition (provided via a feeding tube directly into the stomach), and received oxygen at 2 liters per minute (the rate of oxygen administration). The comprehensive assessment indicated the Patient had a right jugular (neck) port for intravenous (through the vein) access. The POC for the recertification period 04/14/2025-06/12/2025 which indicated the goals included wounds would decrease in size by 75% and indicated the SN interventions included to discontinue wound care when wounds have healed, surgical wounds to remain open to air, change the GT every 90 days, flush the central line (a thin tube inserted into a large vein) with normal saline (solution) and jugular port. The POC failed to include the size of the GT and the administration of oxygen to include the frequency and mode of delivery. On 04/25/2025, at 4:25 PM, RN 1 indicated the GT was a Mickey button (type of feeding tube) and the size was 14 French (unit of measure for feeding tube) and 2.0 centimeters in length with a balloon to hold it in place filled with 3 milliliters of air. RN 1 indicated the Patient received oxygen as needed via nasal cannula (a tube inserted into the nostrils) to maintain oxygen saturation levels and indicated the Patient did not have any wounds or open areas and indicated the Patient only had a jugular port. On 04/30/2025, at 1:47 PM, the CM indicated the GT size and the oxygen administration intervention were not included in the POC and indicated the Patient did not have both a central venous line and a jugular port. The CM indicated the interventions and goals related to wounds should have been removed from the POC since the Patient did not have any wounds. 2. During an observation of care at the home of Patient #2 on 04/24/2025, at 10:30 AM, Person 1 was observed in the home. On 04/24/2025, at 10:30 AM, Person 1 indicated she provided attendant care through Entity 2 for the Patient 2 times a week for 5 hours each day. On 04/28/2025, at 1:37 PM, Person 3 at Entity 2 indicated Entity 2 provided the Patient attendant care 2 days a week for 5 hour a day. A clinical record review evidenced a POC for recertification period 03/06/2025-05/04/2025 which failed to include the services provided by Entity 2. The POC indicated medications Trazadone (antidepressant) and Sertraline (antidepressant) to be taken as needed and failed to provide an indication for use. On 04/30/2025, at 1:29 PM, the Alternate CM indicated Trazadone was to be taken as needed for sleep and was unsure why the Sertraline was to be taken as needed when it is supposed to be taken daily. On 04/30/2025, beginning at 1:29 PM, the CM indicated there were no indications for use on the POC for Trazadone and Sertraline and the attendant care services from Entity 2 were not included in the POC. 3. A clinical record review for Patient #3 evidenced a comprehensive assessment for recertification dated 04/24/2025 which indicated the Patient received homemaker services through Entity 4. The POC for recertification period 04/28/2025-06/26/2025 which failed to include the homemaker services provided from Entity 4. On 04/30/2025, at 2:22 PM, the CM indicated the services provided by Entity 4 were not included on the POC. 4. A clinical record review for Patient #5 evidenced a comprehensive assessment for the SOC dated 03/24/2025 completed by the Alternate CM which indicated the Patient had a dressing covering the left heel due to a wound for which Entity 5 provided wound treatment. The assessment indicated the Patient received dialysis (a medical treatment that filters the blood). On 04/30/2025, at 12:36 PM, Person 8 indicated the Patient received dialysis at Entity 6 and was ordered a renal diet and a 32 ounce fluid restriction daily. The POC for the initial certification period 03/24/2025-05/22/2025 failed to include the wound care and frequency of wound care to the left heel, failed to include the renal diet and 32 ounce fluid restriction On 04/30/2025, beginning at 1:56 PM, the CM indicated the renal diet, fluid restriction, and wound care were not included in the 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 observation, record review, and interview, the agency failed to ensure skin treatment was provided only as ordered by the physician in 1 of 1 observation with a LPN. (Patient #3) The findings include: A clinical record review for Patient #3 evidenced POC for recertification periods 02/27/2025- 04/27/2025 and 04/28/2025- 07/28/2025 indicated the SN was to provide pressure ulcer (wounds from pressure to the skin) prevention care to the right buttock to include cleansing the wound with normal saline (wound cleanser), applying skin preparation (a skin conditioner), and bordered gauze. During an observation of care at Patient’s home, on 04/29/2025 at 12:00 PM, LPN 1 was observed applying a substance from a package labeled “alginate (a wound dressing used to absorb drainage) and a bordered foam dressing to the right buttock area. The SN visit notes completed by LPN 1 and dated 03/04/2025, 03/11/2025, 03/18/2025, 03/25/2025, 04/01/2025, 04/10/2025, 04/15/2025, and 04/22/2025 indicated LPN 1 applied silver alginate and foam dressing. The clinical record failed to evidence a physician order for the alginate and foam dressing. On 04/29/2025, beginning at 12:04 PM, LPN 1 indicated she applied the alginate every time, because it helped with the healing process. On 04/30/2025, at 2:18 PM, the Alternate CM indicated she could not find the order for the alginate and foam dressing. The Alternate CM indicated the list of supplies documented on a physician order was not an order for the use of the alginate and foam dressing. 410 IAC 17-13-1(a)”

“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 verbal orders were written and send to the physician for signature in 1 of 2 active clinical records reviewed with a SOC in 2025. (Patient #4) The findings include: A policy titled “Physician Orders/Plan of Care” updated 04/23/2025 indicated the agency would ensure verbal orders would put into writing, signed and dated by the person receiving the order, and be signed by the physician. A clinical record review for Patient #4 evidenced an initial assessment dated 03/28/2025 completed by the CM which indicated the verbal SOC order was received from the physician. The clinical record failed to evidence the CM sent the verbal order to the physician to be signed. On 04/30/2025, at 1:25 PM, the CM indicated the verbal order was not sent to the physician for signature and just documented on the initial assessment. 410 IAC 17-14-1(a)(H)”

“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 observation, record review, and interview, the agency failed to coordinate care with all entities/disciplines providing care to the patient in 3 of 3 active clinical records reviewed with services provided by another agency. (Patient #2, 3, 5) The findings include: 1. During an observation of care at the home of Patient #2 on 04/24/2025, at 10:30 AM, Person 1 was observed in the home. On 04/24/2025, at 10:30 AM, Person 1 indicated she provided attendant care through Entity 2 for the Patient 2 times a week for 5 hours each day. On 04/28/2025, at 1:37 PM, Person 3 at Entity 2 indicated Entity 2 provided the Patient attendant care 2 days a week for 5 hour a day and indicated there had been no care coordination with the agency. A clinical record review failed to evidence care coordination with Entity 2. On 04/30/2025, at 1:33 PM, the CM indicated there was no care coordination with Entity 2. 2. During an observation of care on 04/29/2025, at 11:47 AM, Patient #3 yelled “ouch” when LPN 1 touched both lower legs/ankles. A clinical record review evidenced a comprehensive assessment for recertification dated 04/23/2025 completed by the Alternate CM which indicated the Patient had no pain and received homemaker services through Entity 4. The clinical record failed to evidence care coordination with Entity 4. SN visit notes completed by LPN 1 dated 04/01/2025, 04/10/2025, 04/15/2025, and 04/22/2025 indicated the Patient had no pain. The clinical record failed to evidence LPN 1 reported the new onset of pain to the RN case manager. On 04/30/2025, at 2:22 PM, the CM indicated there was no care coordination with Entity 4. On 04/30/2025, at 2:25 PM, the Alternate CM/RN case manager indicated she was unaware of the new onset of pain. 3. A clinical record review for Patient #5 evidenced a POC for the initial certification period 03/24/2025-05/22/2025 which indicated the Patient received wound treatment from Entity 5 for a wound to the left heel, received dialysis (a medical treatment to filter the blood) from Entity 6 three days a week, and received PT services from Entity 7 one time per week. The clinical record failed to evidence care coordination with Entities 5, 6 and 7. On 04/30/2025, beginning at 1:56 PM, the CM indicated there was no care coordination with Entities 5, 6, and 7. 410 IAC 17-12-2(g) and 410 IAC 17-12-2(h)”

“Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the HHA provided care as directed in the care plan in 1 of 2 active clinical records reviewed with HHA services. (Patient #5) The findings include: A clinical record review for Patient #5 evidenced a HHA Care Plan dated 03/24/2025 which indicated the HHA was to obtain the temperature, pulse, respiration rate, and blood pressure, assist the Patient with a bath, provide foot care, and record the last bowel movement at every visit. The HHA visit note dated 04/17/2025 failed to evidence the HHA provided a bath, foot care, recorded the last bowel movement, and obtained the temperature, pulse, respiration rate, and blood pressure as directed in the care plan. On 04/30/2025, at 2:12 PM, the Alternate CM indicated the HHA did not provide the services per the care plan.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the discharge summary was sent to the physician within 2 business days in 2 of 2 closed clinical records reviewed. (Patient #6 and 7) 1. The revised policy, dated 04/23/2025 and titled “Discharge/Transfer from Service” indicated the agency would send the physician a discharge summary within 2 business days of discharge. 2. The clinical record for Patient #6 evidenced Patient was discharged from the agency on 04/10/2025; the record failed to evidence a discharge summary was sent to the physician. 3. The clinical record for Patient #7 evidenced Patient was discharged on 01/21/2025; the record failed to evidence a discharge summary was sent to the physician. 4. On 04/30/2025, at 12:40 PM, the Administrator indicated the agency did send a discharge summary to the physician of Patient 6 nor Patient #7. 410 IAC 17-13-2(a)(9)”