Every finding on record at Premier Home Health Care LLC

An Emergency Preparedness Survey was conducted by the Indiana Department of Health in accordance with 42 CFR 484.102. Survey Dates: April 10, 11, 14, 15, and 16, 2025 Active Census: 69 At this Emergency Preparedness survey, Premier Home Health Care was found in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 484.102.

This visit was for a Federal Recertification and State Re-Licensure survey of a Home Health Provider in conjunction with one complaint. Survey Dates: April 10, 11, 14, 15 and 16, 2025 Complaint #: IN114222 with unrelated deficiencies cited. 12-Month Unduplicated Skilled Admissions: 28 This survey was partially extended on 04/14/2025 at 42 CFR 484.70 Condition of participation: Infection prevention and control. This deficiency report reflects State Findings cited in accordance with 410 IAC 17. Refer to State Form for additional State Findings. Abbreviations: OASIS - Outcome and Assessment Information Set, QAPI - Quality Assurance Performance Improvement, CM - Clinical Manager, PT-Physical Therapist QR 4/23/25 A2

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on record review and interview, the home health agency failed to transmit OASIS assessments within 30 days of assessment completion for 4 of 404 OASIS assessments processed in the previous 12 months (Patient # 4, 8, 9, 10). Findings include: 1. Review of OASIS Final Validation reports included a late assessment transmission for Patient #4. 2. Review of OASIS Final Validation reports included a late assessment transmission for Patient #8. 3. Review of OASIS Final Validation reports included a late assessment transmission for Patient #9. 4. Review of OASIS Final Validation reports included a late assessment transmission for Patient #10. 5. During an interview on 04/16/2025 at 3:12 PM, the Office Manager indicated she was the person who transmitted the OASIS assessments. The Office Manager indicated she remembered one late transmission in the past 12 months, and that was due to the clinician not closing the assessment in time.

Program data CFR(s): 484.65(b)(1),(2),(3) Standard: Program data. (1) The program must utilize quality indicator data, including measures derived from OASIS, where applicable, and other relevant data, in the design of its program. (2) The HHA must use the data collected to- (i) Monitor the effectiveness and safety of services and quality of care; and (ii) Identify opportunities for improvement. (3) The frequency and detail of the data collection must be approved by the HHA's governing body. This STANDARD is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure the governing body approved the frequency and detail of data collection for 1 of 1 agency QAPI program. Findings include: 1. Review of the QAPI policy, revised 01/21/2025, indicated “… The frequency and detail of the data collection must be approved by the governing body…” 2. Review of the governing body meeting minutes failed to include approval of the frequency and detail of data collection for the agency’s QAPI program. 3. During an interview on 04/16/2025 at 4:02 PM, the CM indicated the governing body oversees QAPI, but she did not see the governing body’s approval of the frequency and detail of data collection in the governing body meeting minutes.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, record review, and interview, the home health agency failed to ensure infection control policies and procedures related to bag technique were followed for 1 of 1 PT home visit observations (PT 1). Findings include: 1. Review of the Nursing Bag policy, revised 03/20/2023, indicated “… All items removed from the bag should be cleaned before returning to the bag…” 2. On 04/14/2025 at 8:32 AM, PT 1 was observed providing care for Patient #1. PT 1 placed the clinician bag on a barrier on the patient’s floor and failed to close the clinician bag during the visit when it was not being accessed. PT 1 further wiped the tablet and stylus used during the visit with disinfectant wipes and allowed two minutes wet time before placing the tablet and stylus into the clinician bag. PT 1 failed to place the bag on a surface that was not the floor and failed to close the bag when it was not being accessed. PT 1 failed to allow the manufacturer’s recommended wet time of four minutes before placing the tablet and stylus into the clinician bag. 3. During an interview on 04/14/2025 at 9:20 AM, PT 1 indicated he usually puts the clinician bag on the floor during a visit and sometimes leaves the bag open during the visit. PT 1 further indicated the manufacturer’s wet time for the disinfectant wipes used during the visit was four minutes. 4. During an interview on 04/14/2025 at 3:18 PM, the CM indicated it probably wasn’t the best idea for bags to be placed on the floor, and they shouldn’t be left open on the floor. The CM further indicated items should remain wet for the manufacturer’s recommended wet time before being placed into the bag.

An Emergency Preparedness Survey was conducted by the Indiana State Department of Health in accordance with 42 CFR 484.102 Survey Dates: 8/16, 8/17, 8/18, 8/19, and 8/22/2022 Census: 61 At this Emergency Preparedness survey, Premier Home Health was found in compliance with Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, 42 CFR 484.102.

This visit was for a Federal Recertification and State Re-licensure survey of a Home Health Provider. This survey was announced as partially extended on 8/17/2022 at 3:15 PM. Survey Dates: 8/16, 8/17, 8/18, 8/19, and 8/22/2022. Facility Number: IN 010001 Census: 61 This deficiency report reflects State Findings cited in accordance with 410 IAC 17.

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, document review, and interview, the agency failed to ensure the plan of care included patient specific goals for 1 of 1 patients (Patient #2) with a skilled nurse visit observation. Findings include: 1. During an observation of a skilled nurse visit with Patient #2 on 8/16/2022 at 1:00 PM, the patient was observed receiving a tube feeding (nutrition that goes through a tube into the stomach). Patient #2 was observed to be minimally responsive to the environment and people, unable to reposition herself, and had limited verbal responses. 2. Clinical record review for Patient #2 included a plan of care for certification period 8/8/2022 – 10/6/2022 with goals that included to "eat small frequent meals ... adhere to diabetic diet ... demonstrate compliance with medication … not miss any doses.” The plan of care included “Nutrition and medication is to be given through … tube … Medications are to be crushed through … tube.” 3. During an interview on 8/17/2022 at 3:00 PM, the Clinical Supervisor confirmed the goals were not specific for a patient who received nutrition through a feeding tube and has all medication administered by a nurse.

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 document review and interview, the agency failed to ensure wound care was provided as ordered by the physician in 1 of 2 active patients (Patient #6) receiving wound care, with the potential to affect all patients requiring wound care. Findings include: 410 IAC 17-13-1(a) 1. Review of an agency policy titled “Physician Orders” dated 1/6/2022, indicated “… treatments and services provided … must be ordered by a physician …” and “… orders will be accepted … from physicians who have a current license ….” 2. Review of the clinical record for Patient #6 evidenced an order from Physician A, signed on 8/10/2022. The order identified a faxed date of 8/10/2022, from Entity B. The wound care orders were “change dressing 3 times a week we will change when patient has an appointment. Wash wounds right leg with wound cleanser, moisturize both legs, xeroform [medicated gauze dressing] and 4x4 [gauze pads] to wounds, wrap in kerlex [type of bandage roll] secure with tape, apply medigrips [tubular bandage] and farrow wraps [a type of compression wrap] to both legs.” An order, entered by Registered Nurse 2, indicated an order date of 8/10/2022, for wound care. The wound care order read, “1: Wound care: wash wounds with wound cleanse Moisturized both legs Xerofrom and 4 x 4 to wounds wrap in kerlix Secure with tape Apply medigrips and farrow wraps to both legs; read back and confirmed Start date: 8/10/2022.” The order was electronically signed by Registered Nurse 2 on 8/15/2022 at 11:36 PM. 3. Review of a skilled nurse care visit note, dated 8/12/2022, completed by licensed practical nurse [LPN] #3 indicated wound care was provided during visit and used xeroform, covered with gauze pads and kerlex and secured with tape. The wound care frequency was listed as needed, 3 times per week. The documentation failed to evidence the wound care provided followed the new physician order received on 8/10/22 and to include the use wound cleanse and the use of medigrips and farrow wraps. 4. During an interview, on 8/18/2022 at 3:00 PM, the Clinical Supervisor indicated the wound care order was entered into the electronic medical record late and was not available for LPN #3 at the time of the 8/12/2022 nurse visit with Patient #6.

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 home health agency failed to ensure the home health aide care plan was specific to the needs of the patient for 2 of 2 active patients reviewed who received home health aide services [Patients #2 and #3]. Findings include: 1. Agency policy C-751 titled "Home Health Aide Care Plan" indicated the purpose of the aide care plan was to provide a means of assigning duties to the Home Health Aide that are clear to the aide and to provide documentation that the client's care is individualized to his/her specific needs. 2. Record review for Patient #2, start of care (SOC) 06/25/2019, contained a plan of care (POC) for the certification period 08/08/2022 - 10/06/2022 that identified safety measures and included safe transfers, to keep pathways clear, fall precautions, needle and oxygen precautions, head of bed elevated, skin breakdown prevention, lock wheelchair with transfers, transfer precautions, safe surfaces, infection control, aspiration precautions, and ambulation precautions. An agency document titled "Multidisciplinary Care Plan" contained the Aide Care Plan that failed to evidence specific, individualized precautions for Patient #2. 3. Record review for Patient #3, SOC 02/25/2020, contained a POC for certification period 08/13/2022 - 10/11/2022 that indicated safety measures included safe transfers, keep pathways clear, fall precautions, needle precautions, skin breakdown prevention, bleeding precautions, home emergency plan, transfer precautions, infection control, evacuation plans, ambulation precautions, and diabetic precautions. Agency document, titled "Multidisciplinary Care Plan" failed to evidence specific, individualized precautions for Patient #3. 4. During an interview on 08/22/2022, the clinical supervisor confirmed the safety precautions from the Plan of Care were not included in the HHA care plan.

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 observation, document review and interview, the agency failed to ensure the Home Health Aide provided a bed bath consistent with Home Health Aide training in 1 of 1 patient observation of a bed bath (home health aide #1), with the potential to affect all patients requiring a bed bath. Findings include: 1. Review of an agency document titled “Bathing the Bedbound Patient,” dated 2022, indicated “…Remove the patient’s clothing, keeping … covered with a blanket …” and “… provide perineal care last.” According to the document, the patient is to remain covered unless that part of the body is being cleaned. The document also indicates the bed bath begins with the face and ends with the perineal area. 2. The personnel record for Home Health Aide (HHA) #1 evidenced 3 documents regarding HHA 1’s performance of personal care; one was a certificate of completion for “Providing Personal Care,” dated 1/19/2022; the second was an annual evaluation, dated 11/5/2021 that did not include a category for evaluating skill performance and indicated the aide was without deficiency in their performance of care; the third document was a skills competency, completed on 11/22/2019 which indicated a skill demonstration of a bed bath was completed without a deficiency. 3. Observation of HHA #1 while performing a bed bath for Patient #3, was condcted on 8/17/2022. During the first portion of the bed bath, HHA#1 used a blue washcloth to wash and a rust-colored washcloth to rinse. HHA #1 provided the blue wash cloth to Patient who then washed their face, HHA #1 then began cleaning patient’s left leg and ankle, then repeated the procedure with the right leg, using the blue cloth. The blue washcloth was then rinsed and given to Patient #3 to rinse their face. Then the HHA cleaned Patient #3’s genitalia, wiping from back to front, then rinsed and rolled Patient to the right and cleaned buttock and anus. Patient #3 was then rolled to the left and the left buttock was washed, rinsed, and dried. HHA#1 then dumped the water and returned with the basin and clean water and the two washcloths, blue and rust. For this portion of the bath, the rust washcloth was used to wash and the blue washcloth to rinse. HHA #1 then washed, rinsed, and dried Patient #3’s chest, back and arms. Patient #3 remained uncovered throughout the bed bath. 4. During an interview on 8/17/2022 at 3:00 PM, the Clinical Supervisor confirmed the bed bath was not performed per agency policy.