Every finding on record at Innovative Senior Care Home Health of Indianapolis LLC

An Emergency Preparedness survey was conducted by the Indiana Department of Health in accordance with 42 CFR 484.102, For Home Health Providers and Suppliers. Survey Dates: 05-16-2023, 05-17-2023, 05-18-2023 Active Census: 65 Unduplicated Skilled Census: 325 At this Emergency Preparedness survey, Caretenders, was found to have been in compliance with the requirements of Emergency Preparedness for Medicare and Medicaid participating providers and suppliers at 42 CFR 484.102. QR completed 5/23/2023 A4

This visit was for a Recertification and State Re-Licensure survey of a Non-Deemed Home Health Agency. Survey Dates: 05-16-2023, 05-17-2023, and 05-18-2023 Facility Number: 011129 Active Census: 65 Unduplicated Skilled Census: 325

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 include all durable medical equipment in 3 of 4 active patient records reviewed with a diagnosis of Diabetes Mellitus (a condition that affects the way the body processes blood sugar/glucose). (Patients #2, 3, and 10) The findings include: 4. On 05-17-2023 at 10:30 AM, Patient #2’s clinical record was reviewed. The clinical record evidenced a plan of care (POC) with a start of care date of 03-13-2023 and a certification period of 05-12-2023 to 07-10-2023. The POC evidenced a diagnosis that included but was not limited to, “… Type 2 Diabetes Mellitus without complications…”. The POC failed to indicate supplies necessary for a patient with Diabetes, as evidenced by, “… DME (sic Durable Medical Equipment) and Supplies: Dressing-Foam; Gauze; Gauze-Impregnated; Tape; Wound Cleanser…”. IAC 410 17-13-1(a)(1) 1. A policy received from the Executive Director on 05-18-2023 at 12:28 PM titled, “Plan of Care (POC)” revised 12-01-2021, included but not limited to…”Each patient has an individualized Plan of Care (POC) developed…to address patient problems, needs, and goals…The POC includes…Required equipment and supplies…” 2. A record review of Patient #3 with a start of care (SOC) 03-22-2023 and a certification period of 03-22-2023 to 05-20-2023 and diagnoses to include but not limited to Type 2 Diabetes Mellitus ( a condition that affects the way the body processes blood sugar/glucose) with foot ulcer and long term use of insulin. Physician orders included instructing patient on diabetes including the disease process, signs and symptoms of exacerbation, complications, and management. The plan of care (POC) failed to evidence durable medical equipment, including a glucometer machine (machine to measure blood sugar), testing strips, and insulin injection and disposal supplies. 3. A record review of Patient #10 with a SOC 05-04-2023 and a certification period of 05-04-2023 to 07-02-2023 and diagnosis to include but not limited to Type 2 diabetes and long term current use of insulin. Physician orders included skilled nurse to provide instruction on Diabetes Type 2 including disease process, associated signs, and symptoms, and causes of disease process. The plan of care (POC) failed to evidence durable medical equipment, including a glucometer machine (machine to measure blood sugar), testing strips, and insulin injection and disposal supplies.