Every finding on record at Physician's Choice Home Health Inc

An Emergency Preparedness Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 484.102. Survey Dates: November 12th, 13th 14th, 17th, and 18th. Active Census: 7 At this Emergency Preparedness survey, Physician’s Choice Home Health was not found in compliance with Emergency Preparedness Requirements for Medicaid Participating Providers and Suppliers, 42 CFR 484.102.

Plan Based on All Hazards Risk Assessment CFR(s): 484.102(a)(1)-(2) §403.748(a)(1)-(2), §416.54(a)(1)-(2), §418.113(a)(1)-(2), §441.184(a)(1)-(2), §460.84(a)(1)-(2), §482.15(a)(1)-(2), §483.73(a)(1)-(2), §483.475(a)(1)-(2), §484.102(a)(1)-(2), §485.68(a)(1)-(2), §485.542(a)(1)-(2), §485.625(a)(1)-(2), §485.727(a)(1)-(2), §485.920(a)(1)-(2), §486.360(a)(1)-(2), §491.12(a)(1)-(2), §494.62(a)(1)-(2) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following:] (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.* (2) Include strategies for addressing emergency events identified by the risk assessment. * [For Hospices at §418.113(a):] Emergency Plan. The Hospice must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach. (2) Include strategies for addressing emergency events identified by the risk assessment, including the management of the consequences of power failures, natural disasters, and other emergencies that would affect the hospice's ability to provide care. *[For LTC facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents. (2) Include strategies for addressing emergency events identified by the risk assessment. *[For ICF/IIDs at §483.475(a):] Emergency Plan. The ICF/IID must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing clients. (2) Include strategies for addressing emergency events identified by the risk assessment. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to maintain policies for risks identified via the all-hazards approached in the emergency plan for 1 of 1 agency reviewed. Findings Include: A policy titled, “Emergency Disaster Preparedness”, dated 08/29/2025 indicated staff will have specific measures for anticipated emergencies typical or appropriate of the geographic area served which may constitute an emergency, disruption in services and implementation of the plan, not limited to, blizzard, severe snowstorms, hurricanes, earthquakes, flooding, major power outages, transportation interruptions, fire, hazard material spills, bioterrorism, and suspicious letter, packages or substances. A review of the Emergency Preparedness binder found that it failed to include policies and procedures for addressing agency-identified risks using the all-hazards approach. During an interview on 11/18/2025 at 11:55 PM, the Alternate Administrator/Alternate Clinical Supervisor indicated the policies provided in the Emergency Preparedness binder were the only policies for Emergency Preparedness. She was unable to provide the policies/procedures for the identified risks.

Local, State, Tribal Collaboration Process CFR(s): 484.102(a)(4) §403.748(a)(4), §416.54(a)(4), §418.113(a)(4), §441.184(a)(4), §460.84(a)(4), §482.15(a)(4), §483.73(a)(4), §483.475(a)(4), §484.102(a)(4), §485.68(a)(4), §485.542(a)(4), §485.625(a)(4), §485.727(a)(5), §485.920(a)(4), §486.360(a)(4), §491.12(a)(4), §494.62(a)(4) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years [annually for LTC facilities]. The plan must do the following:] (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation. * * [For ESRD facilities only at §494.62(a)(4)]: (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation. The dialysis facility must contact the local emergency preparedness agency at least annually to confirm that the agency is aware of the dialysis facility's needs in the event of an emergency. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to document attempts at contacting local/regional/state/federal emergency preparedness officials for 1 of 1 agency reviewed. Findings Include: A policy titled, “Emergency Disaster/Preparedness” dated 08/29/2025 indicated the plan defines a process for cooperation and collaboration with local, tribal, regional, state, and federal emergency preparedness officials’ efforts to maintain an integrated response. During an interview on 11/18/2025 at 11:55 PM, the Alternate Administrator/Alternate Clinical Supervisor indicated the agency does not have documentation indicating the agency reached out to local/regional officials.

This visit was for an Initial State Licensure and an Initial Medicaid Survey for a Home Health provider. Survey Dates: November 12th, 13th 14th, 17th, and 18th of 2025 12-month Unduplicated Skilled Admissions: 10 This deficiency report reflects State Findings cited in accordance with 410 IAC 17. QA completed on 11/24/2025 by A4MC

HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator's name, business address, and business phone number in order to receive complaints. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide contact information to include the name of the administrator during the initial visit for 7 of 7 active patient records reviewed (Patient #1, 2, 3, 4, 5, 6, 7) and 3 of 3 discharged patients' records reviewed. (Patient #8, 9, 10) Findings Include: A policy titled, Patient Rights and Responsibilities,” dated 08/2025, indicated the agency will provide all patients with a copy of a written Patient Bill of Rights to include the name and phone number of the professional managing their care and who to call within the organization if there is a complaint. On 11/12/2025, the surveyor reviewed the agency’s admission packet and found it did not include the name of the Administrator designated to receive complaints. During an interview on 11/12/2025 at 9:44 AM, the Administrator/Clinical Supervisor indicated that the admission packet listed the address and a phone number, which was forwarded to her personal cell phone if unanswered; however, she confirmed that her name did not appear in the admission packet.

Written notice within 4 business days CFR(s): 484.50(a)(4) Provide written notice of the patient's rights and responsibilities under this rule and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section to a patient-selected representative within 4 business days of the initial evaluation visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide written notice of the patient’s rights and responsibilities within 4 business days for admission for 1 of 7 active patients records reviewed (Patient #3) and the agency’s transfer and discharge policies within 4 business days of the initial evaluation visit for 7 of 7 active patients' records reviewed. (Patient #1, 2, 3, 4, 5, 6, 7) and 3 of 3 discharged patients' records reviewed. (Patient #8, 9, 10) Findings Include: A policy titled, “Admission Criteria and Policy” dated 08/2025 indicated the agency will provide a welcome letter with various disclosure notices and acknowledgements to be signed by all parties involved and responsible. A document titled “Receipt of Admission Documents Acknowledgement” failed to include the agency's written notice of the transfer and discharge policy for all active and discharged patients reviewed, Patient #1 – 10. The clinical record for Patient #3, SOC 09/22/2025, failed to include a signed acknowledgment confirming the agency provided written Patient Rights and Responsibilities within four business days. A document titled, “Receipt of Admission Documents Acknowledgment” for Patient #3 was signed and dated on 09/29/2025. This document indicates that the patient acknowledges receipt of written notice of the Patient/Client Bill of Rights and Responsibilities. During an interview on 11/13/2025 at 11:50 AM, the Alternate Administrator/Alternate Clinical Supervisor stated that staff admitted Patient #3 on 09/22/2025 but did not provide admission paperwork—including written patient rights, responsibilities, and transfer and discharge policies—until 09/29/2025. She explained that she could not reach the patient’s home at the start of the care visit.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to include the state’s complaint hotline upon admission for 7 of 7 active patient records reviewed (Patient #1, 2, 3, 4, 5, 6, 7) and 3 of 3 discharged patients records reviewed. (Patient #8, 9, 10) Findings Include: A policy titled “Patient Rights and Responsibilities Policy,” dated 08/2025, indicated that information about the state’s complaint hotline will be provided as part of the Patient Bill of Rights.2. A policy titled “Client Complaint Policy” dated 10/2020 stated that if a patient ever has a concern or complaint, they should call their office directly (the agency number was provided) and/or contact the state hotline. The state hotline number was left blank. 3. The clinical record for Patient #1 failed to include a written copy of the state’s complaint hotline received upon admission. 4. The clinical record for Patient #2 failed to include a written copy of the state’s complaint hotline received upon admission. 5. The clinical record for Patient #3 failed to include a written copy of the state’s complaint hotline received upon admission. 6. The clinical record for Patient #4 failed to include a written copy of the state’s complaint hotline received upon admission. 7. The clinical record for Patient #5 failed to include a written copy of the state’s complaint hotline received upon admission. 8. The clinical record for Patient #6 failed to include a written copy of the state’s complaint hotline received upon admission. 9. The clinical record for Patient #7 failed to include a written copy of the state’s complaint hotline received upon admission. 10. The clinical record for Patient #8 failed to include a written copy of the state’s complaint hotline received upon admission. 11. The clinical record for Patient #9 failed to include a written copy of the state’s complaint hotline received upon admission. 12. The clinical record for Patient #10 failed to include a written copy of the state’s complaint hotline received upon admission. 13. During an interview on 11/12/2025 at 11:13 AM, the Administrator/Clinical Supervisor indicated the complaint policy directing patients to the state complaint hotline to voice concerns and/or complaints is blank, and the contact number will be added. 410 IAC 17-12-3(b)(2)(C)

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 the medical plan of care was authenticated/dated by the physician/allowed practitioner within 30 days for 5 of 7 active records reviewed (Patient #2, 3, 4, 5, 7) and 2 of 3 discharged records reviewed. (Patient #8, 9) Findings Include: A policy titled, “Care Plan/Plan of Care” dated 08/2025, indicated the plan of care is to be sent to the physician or allowed practitioner for authentication. 2. The medical plan of care for Patient #2, SOC 09/10/2025, initial certification period 09/10/2025 – 11/08/2025, failed to be authenticated by the physician and or allowed practitioner. During an interview on 11/13/2025 at 9:32 AM, the Administrator/Clinical Supervisor stated that staff faxed Patient #2's plan of care to the physician for review and signature but had not received it back yet. 3. The medical plan of care for Patient #3, SOC 09/22/2025, initial certification period 09/22/2025 – 11/20/2025, failed to be authenticated by the physician and or allowed practitioner. During an interview on 11/13/2025 at 9:47 AM, the Administrator/Clinical Supervisor indicated that staff faxed Patient #3's plan of care to the physician for review and signature, but has not received it back yet. 4. The medical plan of care for Patient #4, SOC 09/18/2025, initial certification period 09/18/2025 – 11/16/2025, failed to be authenticated by the physician and or allowed practitioner. During an interview on 11/13/2025 at 10:01 AM, the Administrator/Clinical Supervisor indicated that staff faxed Patient #4's plan of care to the physician for review and signature, but has not received it back yet. 5. The medical plan of care for Patient #5, SOC 09/23/2025, initial certification period 09/23/2025 – 11/21/2025, failed to be authenticated by the physician and or allowed practitioner. During an interview on 11/13/2025 at 10:12 AM, the Administrator/Clinical Supervisor indicated staff faxed Patient #5 plan of care to the physician for review and signature, but has not received it back yet. 6. The medical plan of care for Patient #7, SOC 09/23/2025, initial certification period 09/23/2025 – 11/21/2025, failed to be authenticated by the physician and or allowed practitioner. During an interview on 11/13/2025 at 10:48 AM, the Administrator/Clinical Supervisor indicated staff faxed Patient #7 plan of care to the physician for review and signature but has not received it back yet. 7. The medical plan of care for Patient #8, SOC 09/22/2025, initial certification period 09/22/2025 – 11/20/2025, failed to be authenticated by the physician and or allowed practitioner. Patient #8 was discharged on 09/24/2025, refusing services. During an interview on 11/13/2025 at 11:07 AM, the Administrator/Clinical Supervisor indicated staff faxed Patient #8 plan of care to the physician for review and signature but has not received it back yet. 8. The medical plan of care for Patient #9, SOC 09/01/2025, initial certification period 09/18/2025 – 10/30/2025, failed to be authenticated by the physician and or allowed practitioner. Staff discharged Patient #9 on 10/28/2025 after the patient met goals. During an interview on 11/13/2025 at 11:22 AM, the Administrator/Clinical Supervisor indicated staff faxed Patient #9's plan of care to the physician for review and signature, but has not received it back yet. 9. The medical plan of care for Patient #10, SOC 09/23/2025, initial certification period 09/23/2025 – 11/21/2025, failed to be authenticated by the physician and or allowed practitioner. Staff discharged Patient #10 on 10/28/2025 after the patient met goals. During an interview on 11/13/2025 at 11:46 AM, the Administrator/Clinical Supervisor indicated staff faxed Patient #2's plan of care to the physician for review and signature, but has not received it back yet. 410 IAC 17-13-1(a)

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 include all services provided, nutritional and psychosocial assessments, medications, medical equipment, activities permitted, and/or goals and outcomes for 7 of 7 active patients reviewed (Patient #1, 2, 3, 4, 6, 7) and 2 of 3 discharged patients reviewed. (Patient #8, 9) Findings Include: A policy titled, “Care Plan/Plan of Care” dated 08/2025, indicated the individualized plan of care must include the following: all services provided, medications, medical equipment, nutritional requirements, psychosocial, and measurable outcomes and goals.2. The active clinical record for Patient #1, SOC 10/24/2025, certification period 10/24/2025 – 12/22/2025, failed to include all services provided (home health aide services), nutritional requirements, and a psychosocial assessment. 3. The active clinical record for Patient #2 SOC 09/10/2025, certification period 09/10/2025 – 11/08/2025, failed to include a psychosocial assessment, medications, medical equipment, activities permitted, and goals and outcomes. During a home visit on 11/13/2025 at 2:00 PM for Patient #2, the surveyor observed a shower chair, diabetic monitoring equipment and supplies, a Continuous Positive Airway Pressure (CPAP) machine, canes, and an adjustable bed in the home; however, staff did not list the items on the plan of care. 4. The active clinical record for Patient #3 SOC 09/22/2025, certification period 09/22/2025 – 11/20/2025, failed to include a psychosocial assessment, medical equipment, medications, and activities permitted. During a home visit on 11/13/2025 at 3:45 PM for Patient #3, the surveyor observed a shower chair, a glucometer, and supplies in the home; however, these items were not listed on the plan of care. 5. The active clinical record for Patient #4 SOC 09/18/2025, certification period 09/18/2025 – 11/16/2025, failed to include a psychosocial assessment, medications, and activities permitted. 6. The active clinical record for Patient #5 SOC 09/23/2025, certification period 09/23/2025 – 11/21/2025, failed to include a psychosocial assessment, activities permitted, and medications. 7. The active clinical record for Patient #6 SOC 09/25/2025, certification period 09/25/2025 – 11/23/2025, failed to include a psychosocial assessment. 8. The active clinical record for Patient #7 SOC 09/23//2025, certification period 09/23/2025 – 11/21/2025, failed to include a psychosocial and activities permitted assessment. 9. The discharged clinical record for Patient # 8 SOC 09/22/2025, certification period 09/22/2025 – 11/20/2025, failed to include a psychosocial assessment and medications. 10. The discharged clinical record for Patient #9 SOC 09/01/2025, certification period 09/01/2025 – 10/30/2025, failed to include a psychosocial assessment. 11. During an interview on 11/13/2025 at 9:28 AM, the Administrator/Clinical Supervisor indicated that once the comprehensive assessment was completed on the patient, all information should be pulled over to create the individualized plan of care automatically. She was unsure why this did not happen. She indicated all assessments were completed on the comprehensive assessment. 410 IAC 17-13-1(a)(1)(C) 410 IAC 17-13-1(a)(1)(D)(i-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 observation, record review, and interview, the agency failed to ensure patient care orders were recorded in the plan of care reflecting accurate current services received for 1 of 7 active patients reviewed. (Patient #1) Findings Include: A policy titled “Physician Order Processing,” dated 07/2025, required a physician or allowed practitioner to order all services before staff provided care to a patient, including any changes to the care plan. A policy titled, “Care Plan/Plan of Care” dated 08/2025, indicated staff should include all services in the plan of care. A document titled “Home Health Certification and Plan of Care” for Patient #1, SOC 10/24/2025, initial certification period 10/24/2025 – 12/22/2025, failed to include home health aide services. A document titled, “Physician/NPP-Verbal Order” dated 10/24/2025 for Patient #1 indicated an order for home health aide services once a week for nine weeks to assist with bathing and activities of daily living. The staff faxed the order to the physician on 10/24/2025. During an interview on 11/13/2025 at 9:30 AM the Administrator/Clinical Supervisor indicated Patient #1 does not receive home health aide services. The staff offered services; however, the patient declined. Staff did not document the refusal of home health aide services in the medical record or notify the physician.

Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This ELEMENT is not met as evidenced by: Based on observation, record review and interview, the agency failed to include services provided on the medical plan of care for 1 of 7 active patient records reviewed. (Patient #2) Findings Include: A policy titled, “Care Plan/Plan of Care” dated 08/2025, indicated staff should include all services in the plan of care. A document titled, “Home Health Certification and Plan of Care” for Patient #2, SOC 09/10/2025, recertification period 11/09/2025 – 01/07/2026 failed to include home health aide services, once a week for nine weeks. During a home observation on 11/13/2025 at 2:00 PM, HHA 1 assisted Patient #2 with bathing and completing activities of daily living. During an interview on 11/13/2025 at 9:32 AM, the Administrator/Clinical Supervisor indicated Patient #2 receives home health aide services once a week and there was an error in including this service on the recertification plan of care.

Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide written instructions naming the clinical manager of the agency for questions regarding services received for 7 of 7 active-patient records reviewed (Patient #1, 2, 3, 4, 5, 6, 7) and 3 of 3 discharged patient records reviewed. (Patient #8, 9, 10) Findings Include: The admission packet, reviewed on 11/13/2025, provided to all new patients upon admission, failed to include the name and contact information of the agency’s clinical supervisor. During an interview on 11/12/2025 at 11:13 AM, the Administrator/Clinical Supervisor stated she was unaware of the requirement to notify patients in writing of the clinical supervisor's name and contact information. She also stated that this information is not included in the admission packet, but will ensure it gets added.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on record reviews and interview, the agency failed to complete home health aide supervisory visits every 14 days for 1 of 1 home health aide visits with skilled nursing services. (Patient #2) Findings Include: A policy titled, “Clinical Supervision” dated 07/2025, indicated a registered nurse/clinical supervisor or other appropriate skilled professional familiar with the patient, the patient’s care plan, and the written care instructions must complete a supervisory assessment of the aide services being provided every 14 days for a patient receiving a skilled service (nursing, physical therapy, occupational therapy, speech-language pathology). The clinical record for Patient #2 indicated a start of care date of 09/10/2025. Home health aide services were ordered on 10/13/2025. A home health aide visit was conducted on 10/15/2025, 10/22/2025, 10/29/2025, 11/5/2025, and 11/13/2025. A document titled, “Oasis Recertification” dated 11/05/2025, indicated a supervisory visit for aide services was completed. During an interview on 11/13/2025 at 9:32 AM, the Administrator/Clinical Supervisor indicated an aide supervisory visit would be completed at every recertification visit, every 60 days. She was unaware of the requirement of aide supervisory visits every 14 days when a skilled service is being provided. During an interview on 11/17/2025 at 1:10 PM via telephone, the Administrator/Clinic Supervisor indicated that home health aide services were not ordered at start of care for Patient #2. Aide services were added on 10/13/2025 and an addendum to the plan of care was made. The first home health aide visit was on 10/15/2025 with an aide supervisory visit due on 10/29/2025. The supervisory visit was not completed until 11/05/2025 during the skilled nursing recertification visit. She indicated the requirement was thought to be every 60 days. 410 IAC 17-14-1(g)

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 a discharge summary was completed/maintained in the clinical record for 1 of 3 discharged patient records reviewed. (Patient #8) Findings Include: A policy titled, “Discharge/Reduction in Services/Transfer” dated 07/2025, indicated the Clinical Manager or registered nurse will complete the discharge/transfer instructions and summary. The summary will be sent to the primary care practitioner responsible for the patient's care and services. The clinical record for Patient # 8, SOC 09/22/2025, indicated a discharge on 09/24/2025. During an interview on 11/13/2025 at 11:07 AM, the Administrator/Clinical Supervisor indicated Patient #8 was admitted to the agency on 09/22/2025 and admitted to the hospital on 09/24/2025. Patient #8 was upset that the agency called an ambulance due to increased blood pressure noted during assessment, and refused services from the agency going forward. During an interview on 11/18/2025 at 11:45 AM, the Alternate Administrator/Alternate Clinical Supervisor stated that all discharge summaries are sent along with the case conference notes and plan of care; however, she was unable to locate a discharge summary in Patient #8’s clinical record. She is confident that the Administrator/Clinical Supervisor communicated this information to the physician by phone, but she could not produce documentation of the call.