Every finding on record at Life's Touch Home Health Inc

This visit was for a Federal/State complaint survey of a Home Health Provider. Survey Dates: 02-10-2025, 02-11-2025, and 02-12-2025 Complaint: IN00112626 with related deficiencies cited. 12 Month Unduplicated Skilled Admissions: 6 QR completed by A3 on 2-17-2025.

Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This ELEMENT is not met as evidenced by: Based on record review and interview the Administrator failed to ensure an employee was qualified and in good standing to provide care, in 1 of 5 Home Health Aide (HHA) hired in the last 30 days. (Employee: HHA 2). Findings include: 1. A review of an agency policy dated 02-08-2022, titled 'EMPLOYMENT' stated, "… the agency will employ only individuals who meet the licensure or certification requirements and are in good standing thereunder … 8. License Certification: … all applicants must be able to furnish for inspection their current license or certificate …" 2. A review of the Personnel File for HHA 2 evidenced a date of hire of 12-27-2024, with a first patient contact date of 1-04-2025, and a Home Health Aide certification issued 1-14-2025. 3. On 02-12-2025 at 12:50 PM, the Director of Nursing (DON) indicated staff can't see patients until they were on the aide registry, the DON further revealed they were unaware HHA 2 had been issued their HHA certification on 1-14-2025, but had been seeing one patient, Patient #5, a family member, since 01-04-2025. 4. On 02-12-2025 at 1:42 PM, the Administrator indicated they were unaware HHA 2's date of first patient contact was 01-04-2025 and their Home Health certification had not been issued until 1-14-2025. The Administrator indicated the aide should have received their certification before providing care to a patient. 410 IAC 17-12-1(d)(8)

Home Health Aide CFR(s): 484.115(d) Standard: Home health aide. A person who meets the qualifications for home health aides specified in section 1891(a)(3) of the Act and implemented at §484.80. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure a Home Health Aide (HHA) was qualified to provide care, in 1 of 1 HHA hired in the last 30 days. (Employee: HHA 2). Findings include: 1. A review of an agency policy dated 02-08-2022, titled 'EMPLOYMENT' stated, "… the agency will employ only individuals who meet the licensure or certification requirements and are in good standing thereunder … 8. License Certification: … all applicants must be able to furnish for inspection their current license or certificate …" 2. A review of the Personnel File for HHA 2 evidenced a date of hire of 12-27-2024, with a first patient contact date of 1-04-2025, and a Home Health Aide certification was not issued until 1-14-2025. 3. On 02-12-2025 at 12:50 PM, the Director of Nursing indicated staff can't see patients until they were on the aide registry, were not aware HHA 2 had been issued their Home Health Aide certification on 1-14-2025, but had been seeing one patient, Patient #5, a family member, since 01-04-2025. 4. On 02-12-2025 at 1:42 PM, the Administrator indicated they were unaware HHA 2's date of first patient contact had been on 01-04-2025 and their Home Health certification had not been issued until 1-14-2025. The Administrator indicated the aide should have received their certification before providing care to a patient. 410 IAC 17-14-1(l)(1)(A) and (B)

An Emergency Preparedness Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 481.102. Survey Dates: 06-04, 06-05, and 06-06-2024. Active Census: 30 At this Emergency Preparedness survey, Life’s Touch Home Health Incorporated was found in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 484.102. QR completed by Area 3 on 6-10-2024.

This visit was for a Federal Recertification and State Re-Licensure survey of a Home Health Provider. Survey Dates: 06-04, 06-05, and 06-06-2024. 12-Month Unduplicated Skilled Admission: 46 This deficiency report reflects State Findings cited in accordance with 410 IAC 17. Refer to State Form for additional State Findings. QR completed by Area 3 on 6-10-2024.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure all patients were provided a written visit schedule or were made aware of the visit schedule, including the frequency of visits by the home health agency staff for 2 of 3 home visits conducted. (Patients: #2, and 3) Findings Include: 1. During a home visit at Patient #2’s residence on 06-05-2024 at 10:05 AM, 2 green admission folders were reviewed and failed to provide evidence Patient #2 received a written schedule for the visits provided by the home health agency staff. The Home Health Aide (HHA) 1 confirmed the folder contained an old plan of care dated 03-13-2024 through 05-11-2024 and a 2021 plan of care. During an interview on 06-05-2024 at 10:30 AM at the residence of Patient #2, Patient #2 indicated the staff did not write on their calendar when they were coming to visit. Patient #2 further indicated they had yet to receive a schedule of visits from the home health agency staff. 2. During a home visit at Patient #3’s residence on 06-05-2024 at 10:50 AM, a review of the green admission folder was reviewed and failed to provide evidence Patient #3 received a written schedule for the visits provided by the home health agency staff. HHA 2 confirmed the folder contained an old plan of care dated 02-15-2024 through 04-14-2024. During an interview on 06-05-2024 at 11:25 AM, when asked about a schedule and the agency folder showing when the staff would do visits, Patient #3 and HHA 2 laughed. Patient #3 stated, “No, that is a joke. I know they do not give me a schedule.”

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a medication list was provided to the patient in plain language for 2 of 3 home visits conducted. (Patients: #2, and 3) Findings Include: 1. A review of a revised 02-08-2022 Life’s Touch Home Health policy titled “Medication Profile” indicated but was not limited to, “ … The Medication Profile shall be reviewed by a Registered Nurse every sixty (60) days and updated whenever there is a change … Medication profiles created … will have a copy in the patient's record and patient’s home … ” 2. During a home visit at Patient #2’s residence on 06-05-2024 at 10:05 AM, 2 green admission folders were reviewed and failed to evidence Patient #2 received a medication list. The Home Health Aide (HHA) 1 confirmed the patient did not have a medication list in their home. During an interview on 06-05-2024 at 10:30 AM at the residence of Patient #2, Patient #2 indicated the Clinical Manager came to their home and did not provide a medication list. When questioned if they had any medication lists in the home, they indicated they had not. 3. During a home visit at Patient #3’s residence on 06-05-2024 at 10:50 AM, a review of the green admission folder was reviewed and failed to provide evidence Patient #3 received a written medication list. HHA 2 confirmed the folder contained an old plan of care dated 02-15-2024 through 04-14-2024. During an interview on 06-05-2024 at 11:25 AM, when queried about a medication list, Patient #3 and HHA 2 laughed. Patient #3 stated, “No, that is a joke. No one has updated that folder for 8 months now.”

Treatments and therapy services CFR(s): 484.60(e)(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patients were informed and received instruction regarding the plan of care treatments and services to be provided by the home health agency staff in 2 of 3 home visits. (Patients: #2 and 3) Findings Include: 1. A review of a revised 02-08-2022 Life’s Touch Home Health policy titled “Plan of Care” indicated but was not limited to, “ … Planning for care is a dynamic process that addresses the care, treatment, and services to be provided … The patients … and other agency personnel shall participate in developing the Plan of Care … The patients shall be informed … ” 2. During a home visit at Patient #2’s residence on 06-05-2024 at 10:05 AM, 2 green admission folders were reviewed and failed to evidence Patient #2 received a plan of care that contained services and treatments to be by the home health agency staff. The Home Health Aide (HHA) 1 confirmed the folder contained an old plan of care dated 03-13-2024 through 05-11-2024 and a 2021 plan of care. During an interview on 06-05-2024 at 10:30 AM, at the residence of Patient #2, Patient #2 indicated they had not received a plan of care containing the services and treatments the home health agency provided. 3. During a home visit at Patient #3’s residence on 06-05-2024 at 10:50 AM, a review of the green admission folder was reviewed and failed to provide evidence Patient #3 received an updated plan of care outlining the treatment and services being provided by the home health agency staff. HHA 2 confirmed the folder contained an old plan of care dated 02-15-2024 through 04-14-2024. During an interview on 06-05-2024 at 11:25 AM, when questioned about the services and treatments or plan of care provided by the home care agency, Patient #3 and HHA 2 laughed. Patient #3 stated, “No, that is a joke. That hasn’t been updated in over 8 months.”

This visit was for a Federal and State complaint survey of a Home Health Care agency. Survey Dates: 3/28/22, 3/30/22, 3/31/22, and 4/4/22. Complaint: 62155 - Substantiated with related and unrelated findings. Federal and State deficiencies were cited. Census: 21 This deficiency report reflects State Findings cited in accordance with 410 IAC 17. QR by Area 3 on 4-13-2022

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 patients received all services ordered in the plan of care for 2 (Patients 4 and 5) of 5 active and closed clinical records reviewed. Findings include: 1. A review of an agency policy titled 'Plan of Care,' dated 11/05/22, stated, "POLICY Home Care services are furnished under the supervision and direction of the client's physician. The Plan of Care is based on a comprehensive assessment and information provided by the client/family and health team members. Planning for care is a dynamic process that addresses the care, treatment, and services to be provided. The plan will be consistently reviewed to ensure that client needs are met and will be updated as necessary, but at least every sixty (60) days...PURPOSE To provide guidelines for Life's Touch Home Health Services staff to develop a plan of care individualized to meet specific identified needs...To assure that the plan meets state/federal guidelines, and all applicable laws and regulations...SPECIAL INSTRUCTIONS...The Plan of Care shall be completed in full to include:...C. Type, frequency, and duration of all visits/services...6. The client and other Life's touch personnel including Home Health Aide and/or Attendant shall participate in developing the plan of care. The client shall be informed of any changes in the Plan of Care...9. Professional staff shall promptly alert the physician to changes that suggest a need to alter the plan of care..." 2. A review of the clinical record for Patient 4 with a Start of Care of 9/29/21, and a recertification date of 12/30/21 to 2/27/22, with diagnoses that included, but were not limited to, Chronic Obstructive Pulmonary Disease (COPD - a group of lung diseases that block airflow and make it difficult to breathe), emphysema (a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness), pulmonary fibrosis (a lung disease that occurs when lung tissue becomes damaged and scarred, this thickened stiff tissue makes it more difficult for your lungs to work properly, as it worsens you become progressively more short of breath), had orders to receive home health aide visits 6 hours per day, 5 days per week for 26 weeks, "to support safely living at home alone...aide to assist with personal care...activities of daily living and instrumental activities of daily living; bathing, grooming, dressing, hair and nail care, skin care, ambulation, mobility, light housekeeping as pertains to care, sweeping, laundry, meal preparation and clean up, removal of trash." A review of agency documents titled ‘Cancelled Events By Reason,’ and ’60 Day Client Calendar,’ for Patient 4, between the dates of 12/30/21 to 2/27/22, on 1/3/22, 1/4/22, 1/5/22, were missed visits and the Patient 4 did not receive the 5 ordered care visits for the clinical week, 1/10/22, 1/11/22, and Patient 4 did not receive the 5 care visits ordered for the clinical week, 1/27/22, 1/28/22, and the Patient 4 did not receive the 5 ordered care visits for the clinical week, 2/3/22, 2/4/22, 2/5/22, and Patient 4 did not receive the ordered care visits for the clinical week, 2/10/22 and 2/11/22, and Patient 4 did not receive the 5 ordered care visits for the calendar week. When visits were not provided as ordered, Patient 4 did not receive support with living safely at home alone, did not receive assistance with personal care, did not receive assistance with activities of daily living and instrumental activities of daily living; did not have assistance with bathing, grooming, dressing, hair and nail care, skin care, did not have needed assistance with ambulation, mobility, or incidental light housekeeping as pertained to care, sweeping, laundry, meal preparation and clean up, or removal of trash. The agency failed to ensure Patient 4 received all care visits as ordered in the plan of care. Review of the clinical record for Patient 5 with a Start of Care date of 10/27/21 and a recertification date of 12/26/21 to 2/23/22, with diagnoses that included but were not limited to Dissociative personality disorder (a mental health condition, having multiple distinct personalities. The various identities control a person's behavior at different times, can cause memory loss, delusions or depression), post-traumatic stress disorder (disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event), fibromyalgia (widespread muscle pain and tenderness often accompanied by fatigue and altered sleep, memory, and mood), major depressive disorder, type 2 diabetes (chronic condition that affects the way the body processes blood sugar {glucose}), had orders to receive home health aide visits 4 hours per day, 5 days per week and 2 hours per day, 1 day per week for 60 days to, "assist with personal care needs: activities of daily living, instrumental activities of daily living, effective personal hygiene, assist with bathing, grooming, hair care, and skin care. Assist with safety during ambulation and transfers as needed, light housekeeping as requested, prepare meals and assist with food set-up, meal preparation, and clean up after meals, assist with laundry as requested." A review of agency documents titled ‘Cancelled Events By Reason,’ and ’60 Day Client Calendar,’ for Patient 5, for the time period of 12/26/21 to 2/23/22, missed care visits were on 12/27/22, 12/28/21, 12/29/21, 12/30/21, 12/31/21, and Patient 5 did not receive the 6 ordered care visits for the clinical week, 1/4/22, 1/5/22, 1/6/22, 1/7/22, and Patient 5 did not receive the ordered care visits for the clinical week. When the agency failed to provide care visits as ordered, Patient 5 did not receive assistance with assistance with personal care needs: activities of daily living, instrumental activities of daily living, effective personal hygiene, assistance with bathing, grooming, hair care, and skincare, nor assistance with safety during ambulation and transfers, light housekeeping as requested, assistance with meal preparation, assistance with food set-up, assistance with clean up after meals, assistance with laundry as needed. Patient 5 informed the agency on 2/22/22, he/she had gone to another agency. The agency failed to ensure Patient 5 received all care visits as ordered in the plan of care. 3. In an interview on 3/30/22 at 10:48 AM, the alternate clinical manager and clinical manager, when queried as to why Patient 4 requested discharge from the agency, both indicated that the patient decided to return to her, "original agency." In an interview on 3/31/22 at 4:13 PM, Patient 4 stated the reason for leaving the agency was "staffing" was not being provided, and indicated he/she expressed to the agency that if they had had better staffing he/she would have stayed. In an interview on 3/31/22 at 4:32 PM, Patient 5 stated the reason for leaving the agency was, "not enough people to come, wouldn't communicate about the schedule," and indicated he/she at one point during services had, "gone one month" without care visits from the agency. Stated further, "I don't blame the company, I blame the quality of the staff hired." In an interview on 4/4/22 at 12:25 PM, the administrator and clinical manager nodded in agreement when queried if the agency had been experiencing difficulty keeping home health aides on staff. 410 IAC 17-13-1(a)

This visit was for a Federal Recertification and State Re-Licensure survey, in conjuction with 4 complaints. This was a partially extended survey reported to the agency administrator and clinical supervisor on Thursday March 11th, 2021 at 2:15 p.m. Complaint #: IN00319478 Unsubstantiated IN00300866 Substantiated: Federal and State Deficiencies were cited IN00273703 Substantiated: Federal and State Deficiencies were cited IN00269495 Substantiated: Federal and State Deficiencies were cited Survey Dates: March , 9, 10, 11, and 12, 2021 Facility number: 0111480 Provider number: 15K039 These deficiencies reflect State Findings cited in accordance with 410 IAC 17. Quality Review Completed on 04/06/2021 by Area 3

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 the services as ordered by the physician in the plan of care for 1 of 3 active records reviewed of patients receiving home health aide services. (Patient #10) The findings included: Review of the Plan of Care for the Certification period of 01-24-2021 to 03-23-2021, Patient #10 was to receive home health aide services 4 hours per day, 3 days per week for 60 days on Dialysis days (Tuesday, Thursday, and Saturdays). Review of the home health aide visit notes revealed 3 hour visits were received on the Tuesday, Thursday, and Saturday Dialysis days during the period of 1-24-2021 through 03-04-2021. In an interview with employee H and employee B on 03-10-2021 at 1:55 p.m. they confirmed that Patient #10 was receiving 3 hour visits instead of 4 hour visits. 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 they communicated with the physician of the need to revise the plan of care home health aide frequency for 1 of 3 active patient records reviewed of patients receiving home health aide services. The findings included: Review of the Plan of Care for the Certification period of 01-24-2021 to 03-23-2021, Patient #10 was to receive home health aide services 4 hours per day, 3 days per week for 60 days on Dialysis days (Tuesday, Thursday, and Saturdays). Review of the home health aide visit notes revealed 3 hour visits were received on the Tuesday, Thursday, and Saturday Dialysis days during the period of 1-24-2021 through 03-04-2021. In an interview with employee H and employee B on 03-10-2021 at 1:55 p.m. they confirmed that Patient #10 was receiving 3 hour visits instead of 4 hour visits and that the Physician had not been informed and the Plan of Care was not updated. 410 IAC 17-13-1(a)(2)