Every finding on record at Care United Home Health LLC

This visit was for a Federal/State complaint survey of a HHA Provider. Survey Dates: 05/20/2026 and 05/21/2026 Complaint: IN002977021 with related deficiencies cited. 12 Month Unduplicated Skilled Admissions:1 Care United Home Health LLC is out of compliance with 42 CFR 484.50 Patient Rights as related to this complaint. Abbreviations: HHA- Home Health Aide DON- Director of Nursing ADON- Alternate Director of Nursing POC- Plan of Care QR completed by Area 3 on 5/26/2026.

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to document the existence and resolution for 1 of 1 patient complaints (Patient #5). Findings Include: 1. Review of an undated agency policy titled "Client/Family Complaint/Grievance Policy" indicated but is not limited to, " … A complaint is defined as 'any expression of dissatisfaction by a client/family regarding care or services' … The agency must: a. Investigate complaints made by a client, the client's representative (if any) and the client's caregivers and family … b. Document both the existence of the complaint and the resolution of the complaint …" 2. Review of the complaint logs dated 01/01/2026 through 05/20/2026 failed to evidence Patient #5 voiced a complaint. 3. During an interview on 05/20/2026 at 10:29 AM, Patient #5 indicated they fired the agency in March. When queried about their concerns, Patient #5 indicated the agency notified the patient Former Employee 1 did not complete their training. Patient #5 indicated Former Employee 1 was their caregiver with Entity 4, a Personal Service Agency, and Former Employee 1 missed several visits with no call or no showed. Patient #5 indicated the agency attempted to schedule visits outside of their preferred times with the Personal Service Agency, and when informed the morning visits were not preferred the patient was told they were uncooperative. Patient #5 indicated the agency was unwilling to coordinate the visit with their schedule. When queried if they shared their concerns with any staff, Patient #5 indicated they voiced their concerns with the Chief Financial Officer, the DON, the Administrator, and the Owner. 4. During an interview on 05/20/2026 at 1:19 PM, the Administrator indicated the agency had a deadline to start services for the HHA hours they did not meet. The Administrator indicated Patient #5 preferred to have Former Employee 1 as their HHA. The Administrator indicated the agency provided Patient #5 with other options including staffing a different HHA while Former Employee 1 completed their training. The Administrator indicated Former Employee 1 started their training in January 2026, and finished March 2026. 5. During an interview on 05/20/2026 at 2:06 PM, the DON indicated Patient #5 admitted on 01/20/2026. The DON indicated Patient #5's recertification was due 03/20/2026, so the agency needed to staff or discharge the patient and start the process over again. The DON indicated Patient #5 refused to start the process again. 6. During an interview on 05/21/2026 at 2:30 PM, the Administrator indicated they did not have any additional information regarding the complaint made by Patient #5. The Administrator indicated the DON would have the complaint information. 7. During an interview with the Owner, Administrator, and DON on 05/21/2026 at 2:58 PM, when queried regarding how complaints were documented, they explained informal complaints were in the communication logs and they will try to resolve the issue. A formal complaint should have been investigated and included in the complaint log with the resolution. They indicated they needed to work on better communication and documentation of conversations. 410 IAC: 17-12-3(c)(2)

E0000 Emergency Preparedness An Emergency Preparedness Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 484.102. Survey Dates: 09-09-2024, 09-10-2024, and 09-11-2024. Active census: 8 At this Emergency Preparedness survey, Care United Home Health, LLC. was found to be in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 484.102. QR completed by Area 3 on 09-16-2024.

This survey was for an initial Medicaid Federal Certification and State Licensure survey of a Home Health Provider. Survey Dates: 09-09, 09-10, and 09-11-2024 Facility ID: 017722 Unduplicated Skilled Admissions for the past 12-months: 11 This deficiency report reflects State Findings cited in accordance with 410 IAC 17. QR completed by Area 3 on 09-16-2024.

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 Plan of Care (POC) included all elements and was individualized to the patient for 3 of 8 active clinical records reviewed. (Patients #3, #6 and #10) Findings Include: 1. An undated policy titled "Plan of Care", Policy No. C-580 indicated but was not limited to, " … 1. An individualized Plan of Care … for each client receiving home health … 2. The Plan of Care shall be completed in full to include: … e. Need for/presence of home medical equipment and assistive devices … q. Treatment goals … u. Other appropriate items …" 2. A review of Patient #3's clinical record evidenced POCs with a Start of Care (SOC) date of 06-28-2024 and certification periods from 06-28-2024 to 08-26-2024 and 08-27-2024 to 10-25-2024. The POCs evidenced the following diagnoses: Hypertension (high blood pressure), Intermittent Asthma (a lung disease where the airway narrows and swells), and Hyperlipidemia (high amount of lipids in the blood). The POC included a section titled "DME (sic Durable Medical Equipment) and Supplies" and indicated the patient had a walker, cane, alcohol pads, exam gloves, gauze pads, and tape. A review of Patient #3's clinical record evidenced an "OASIS-E Start of Care" document dated 06-28-2024. A section titled "Narrative" indicated, "Patient walks independently with no assistive device". Patient #3's clinical record evidenced an "OASIS-E Recert" document dated 08-26-2024. A section titled "Narrative" indicated, "Patient walks independently with no assistive device". During an interview with Patient #3 on 09-09-2024 at 2:09 PM, they indicated they were not using a cane or walker to assist with walking. Patient #3 evidenced they had not used a walker or cane in a while. Patient #3 indicated they had used the walker and cane in the past and kept them if needed for later. During an interview with the Administrator on 09-10-2024 at 3:30 PM, they indicated Patient #3 walked without an assistive device. They indicated the walker and cane should not be listed on the POC. 3. A review of Patient #6's clinical record evidenced POCs with a SOC date of 06-26-2024 and certification periods from 06-26-2024 to 08-24-2024 and 08-25-2024 to 10-23-2024. The POCs evidenced a primary diagnosis of Hypertension. The POCs indicated the patient took 5 milligrams (mg) of Amlodipine Desylate by mouth (treats high blood pressure) and 81mg of Aspirin by mouth (prevents blood clotting). A section titled "Goals/Rehabilitation Potential/Discharge Plans", evidenced the patient would be able to demonstrate how to flush a peripheral intravenous (PIV) line (a tube inserted into the vein to inject treatments). The POC failed to evidence the patient was taking a medication intravenously. A review of Patient #6's clinical record evidenced an "OASIS-E Start of Care" document dated 06-26-2024. A section titled "IV Access" indicated the patient had no PIV. A review of Patient #6's clinical record evidenced an "OASIS-E Recert" document dated 08-21-2024. A section titled "IV Access" indicated the patient had no PIV. During an interview with the Administrator on 09-11-2024 at 3:10 PM, they evidenced Patient #6 did not have a PIV, and the goal should not have been listed on the POC. 4. A review of Patient #10's clinical record evidenced a "Case Conference" document dated 08-15-2024. The document evidenced the patient had a Personal Service Agency, Entity 1, provide care for them on Mondays, Wednesdays, and Fridays from 11:00 AM to 4:00 PM. A review of Patient #10's clinical record evidenced a POC with a SOC date of 07-18-2024 and a certification period from 07-18-2024 to 09-15-2024. The POC evidenced the following diagnoses: Toxic Liver disease with Fibrosis and cirrhosis of the liver (the liver is damaged from toxins causing scar tissue to form and causing the liver to not function appropriately), Hyperlipidemia, and Mild Intermittent Asthma. The POC failed to include Entity 1 and the days and hours they provided care for the patient. During an interview with Patient #10 on 09-10-2024 at 11:53 AM, they evidenced Entity 1 provided care for them 3 times a week. During an interview with the Director of Nursing (DON) on 09-11-2024 at 3:48 PM, they indicated the POC should include Entity 1 and the days and hours they provide care for Patient #10. 410 IAC 17-13-1(a)(1)(D)(ii and xiii)

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure all physician orders were included on the plan of care, in 6 of 8 active clinical records (Patients #3, #4, #5, #6, #7, and #10) Findings include: 6. A review of Patient #3's clinical record evidenced POCs with a Start of Care (SOC) date of 06-28-2024 and certification periods from 06-28-2024 to 08-26-2024 and 08-27-2024 to 10-25-2024. The POCs evidenced the following diagnoses: Hypertension (high blood pressure), Intermittent Asthma (a lung disease where the airway narrows and swells), and Hyperlipidemia (high amount of lipids in the blood). The POCs indicated the Skilled Nurse (SN) provided care to the patient once a week for 9 weeks but failed to include all the procedures they provided. The physician signed a document titled "Physician Order" for Patient #3 on 07-03-2024. The order evidenced the SN was to visit the patient weekly for medication set-up. During an interview with Patient #3 on 09-09-2024 at 2:09 PM, they indicated the Administrator, Admin 1, came out once a week for medication set-up. 7. A review of Patient #6's clinical record evidenced POCs with a SOC date of 06-26-2024 and certification periods from 06-26-2024 to 08-24-2024 and 08-25-2024 to 10-23-2024. The POCs evidenced a primary diagnosis of Hypertension. The POCs indicated the SN provided care to the patient once a week for 9 weeks but failed to include all the procedures they provided. A review of documents titled "Physician Order" for Patient #6 was signed by the physician on 06-26-2024 and 08-21-2024. The order evidenced the SN was to visit the patient weekly for medication set-up. A review of Patient #7's clinical record evidenced a POC with a SOC date of 08-01-2024 and a certification period from 08-01-2024 to 09-29-2024. The POC evidenced the following diagnoses: Hypertension, Post-Traumatic Stress Disorder, and Benign Prostatic Hyperplasia with lower urinary tract symptoms (a condition where the prostate is enlarged causing frequent urination). The POC indicated the Skilled Nurse (SN) provided care to the patient once a week for 9 weeks but failed to include all the procedures they provided. The physician signed a document titled "Physician Order" for Patient #7 on 07-31-2024. The order evidenced the SN was to visit the patient weekly for medication set-up. During an interview with Patient #7 on 09-11-2024 at 1:03 PM, they indicated the nurse came out once a week for medication set-up. 8. A review of Patient #10's clinical record evidenced a POC with a SOC date of 07-18-2024 and a certification period from 07-18-2024 to 09-15-2024. The POC evidenced the following diagnoses: Toxic Liver disease with Fibrosis and cirrhosis of the liver (the liver is damaged from toxins causing scar tissue to form and causing the liver to not function appropriately), Hyperlipidemia, and Mild Intermittent Asthma. The POC indicated the Skilled Nurse (SN) provided care to the patient once a week for 9 weeks but failed to include all the procedures they provided. A review of a document titled "Physician Order" for Patient #10 was signed by the physician on 07-24-2024. The order evidenced the SN was to visit the patient weekly for medication set-up. During an interview with Patient #10 on 09-10-2024 at 11:53 PM, they indicated the Director of Nursing (DON, Admin 2) came out once a week for medication set-up. During an interview with Admin 2 on 09-11-2024 at 3:48 PM, they evidenced Patient #10 received medication set-up once a week. Admin 2 indicated the patient's POC failed to indicate the SN was to set up the medications in the pill box and should be included. 9. During an interview with Admin 1 on 09-11-2024 at 3:10 PM, they evidenced Patients #3, #6, and #7 all received medication set-up once a week. Admin 1 indicated the patient's POCs failed to indicate the SN was to set up the medications in the pill box and it should be included. 1.Review of an agency document titled 'PLAN OF CARE C-580' stated, "… To ensure the plan meets state /federal guidelines, and all applicable laws and regulations … 2. The Plan of Care shall be completed in full to include: … procedures …" and failed to evidence requirement to ensure all physician orders were included in the plan of care. 3.Review of the clinical record for Patient #4 with a start of care date of 07-10-2024, an recertification period of 07-10-2024 to 09-07-2024, evidenced an MD order dated 07-10-2024 which stated, "… Verbal order for SN (Skilled Nurse) weekly visit for med-setup, blood pressure check, education, and compliance …" The plan of care dated 07-10-2024 stated, "Orders for discipline and Treatments …" and failed to evidence the skilled nurse would be providing the physician ordered medication set-up. 4.Review of the clinical record for Patient #5 with a start of care date of 07-30-2024 and recertification period of 07-30-2024 to 09-27-2024, evidenced an MD order dated 07-29-2024 which stated, "… Verbal order for SN (Skilled Nurse) weekly visit for med-setup, blood pressure check, education, and compliance …" The plan of care dated 07-30-2024 stated, "Orders for discipline and Treatments …" and failed to evidence the skilled nurse would be providing the physician ordered medication set-up. 8.On 09-11-2024 at 8:55 AM, the Administrator indicated needed to ensure the Quality Assurance (QA) process ensures the Plan of Care is complete. 9.On 09-11-2024 at 3:56 PM, the Director of Nursing indicated 'missed' adding the physician ordered 'medication set-up' to the template used to complete the plan of care, but the care had still been provided to patients as ordered.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure the after-hours on-call number was answered as noted with 2 of 2 attempts to reach an agency nurse after-hours and with the potential to effect 8 of 8 active patients. (Patients #2, 3, 4, 5, 6, 7, 9, and 10) Findings include: 1. A policy titled "Provision For 24-Hour RN (sic Registered Nurse) Availability", Policy No. C-180, indicated but was not limited to, " … Hours of operation are from 8:00 a.m. to 5:00 p.m., Monday through Friday. A Registered Nurse shall be accessible at all times, 24 hours per day. … 4. The on-call Nurse shall respond to all messages in a timely manner …" 2. During the Entrance Conference on 09-10-2024 at 9:29 AM, the Administrator (Admin 1) and the Director of Nursing (DON, Admin 2) indicated they had a phone for after-hours and Admin 2 had the phone all the time and answered it after-hours. 3. On 09-10-2024 at 7:03 PM, an attempt was made to call the after-hours on-call number listed on the admission packet. A voicemail was left requesting a return call. The call was not returned. 4. On 09-11-2024 at 7:16 AM, a second attempt was made to call the after-hours on-call number listed on the admission packet. A voicemail was left requesting a return call. The call was returned on 09-11-2024 at 7:58 AM, 2 minutes before the agency opened and 42 minutes after the second attempt. 5. During an interview with Admin 1 and Admin 2 on 09-11-2024 at 4:04 PM, Admin 2 indicated the on-call phone was silenced and they saw they had 2 voicemails in the morning. They evidenced they should ensure the phone is on, charged, and with them at all times. 410 IAC 17-12-1(c)(1)