Every finding on record at Right Hand Home Health LLC

This visit was for an initial Federal Medicaid and State Licensure survey of a home health agency. Survey dates: 08/11/2025 and 08/12/2025 Facility Number: 018781 12-month unduplicated census: 11 During this Federal Initial Survey, Right Hand Home Health LLC was found to be out of compliance with 42 CFR 484 and out of compliance with 410 IAC 17 for a home health provider. Abbreviations used: RN - Registered Nurse POC - Plan of Care SOC - Start of Care QR by Area 3 on 8/15/2025.

Strengths, goals, and care preferences CFR(s): 484.55(c)(2) The patient's strengths, goals, and care preferences, including information that may be used to demonstrate the patient's progress toward achievement of the goals identified by the patient and the measurable outcomes identified by the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure patients comprehensive assessments accurately reflected patients patient-centered goals, in 4 of 8 active records reviewed. (Patients #2, #5, #7, and #8) Findings include: 1. A review of an undated agency policy titled 'Initial and Comprehensive Patient Assessment' stated, "… The HHA will provide each patient with a patient-specific comprehensive assessment that accurately reflects … the patient's strengths, goals, and care preferences …" 2. A review of the clinical record for Patient #2 with a start of care date of 06/09/2025 with an initial comprehensive assessment for the certification period of 06/09/2025 to 08/07/2025 contained diagnoses which included but were not limited to: Congestive Heart Failure (or CHF, the heart doesn't pump blood efficiently) and Hypertension (or elevated blood pressure, a condition where the force of blood against your artery walls is consistently too high, which can damage the heart, brain, kidneys, and other organs). The comprehensive assessment failed to evidence patient-centered goals. 3. A review of the clinical record for Patient #5 with a start of care date of 05/21/2025, with an initial comprehensive assessment for the certification period of 05/21/2025 to 07/19/2025 contained diagnoses which included but were not limited to: Chronic Obstructive Pulmonary Disease (or COPD, a lung condition that obstructs airflow, making it difficult to breathe) and Hypertension (elevated blood pressure, a condition where the force of blood against your artery walls is consistently too high, which can damage the heart, brain, kidneys, and other organs). The comprehensive assessment failed to evidence patient-centered goals. 4. A review of the clinical record for Patient #7 with a start of care date of 07/02/2025 with an initial comprehensive assessment for the certification period of 07/02/2025 to 08/30/2025, contained diagnoses which included but were not limited to: Unspecified intellectual disabilities (a diagnosis when someone is believed to have intellectual or developmental delays, but their specific level of intellectual disability cannot be accurately assessed due to various factors) and Diabetes Mellitus (a metabolic disease where blood glucose levels are too high due to the body's inability to produce enough insulin or use it effectively). The comprehensive assessment failed to evidence patient centered goals. 5. A review of the clinical record for Patient #8 with an initial comprehensive assessment for the certification period of 08/01/2025 to 09/29/2025, diagnoses of heart failure, diabetes, and poor vision . The comprehensive assessment section titled "Goals Identified by Patient", was left blank. 6. On 08/12/2025 at 3:46 PM, in an interview, the Administrator who was also the visiting nurse, indicated patient-centered goals were 'not yet' on comprehensive assessments.

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 patient’s individualized plan of care included frequency and/or duration of visits, in 8 of 8 active record reviews, (Patient #1, #2, #3, #4, #5, #6, #7, and #8). Findings Include: A review of the clinical record for Patient #2 with a start of care date of 06/09/2025, contained a POC for the initial certification period of 06/09/2025 to 08/07/2025 and a POC for the recertification period of 08/08/2025 to 10/06/2025 each with orders for Skilled Nurse for medication set up "every two weeks", and failed to evidence a duration. The plans of care also failed to include a pillbox was utilized for med set-ups, and failed to evidence interventions related to medication management. A review of the clinical record for Patient #5 with a start of care date of 05/21/2025, contained a POC for the initial certification period of 05/21/2025 to 07/19/2025 and a POC for the recertification period of 07/20/2025 to 09/17/2025, each with orders for Home Health Aide "twice weekly" for assistance with bathing and hygiene and Skilled Nurse for medication set-up "every two weeks", and failed to evidence a duration for both services. The plans of care also failed to include a pillbox was utilized for med set-ups, and failed to evidence interventions and goals related to medication management. A review of the clinical record for Patient #7 with a start of care date of 07/02/2025, contained a POC for the initial certification period of 07/02/2025 to 08/30/2025 with orders for Home Health Aide services "twice weekly" for assist with bathing and Skilled Nurse for medication set up "every two weeks", and failed to evidence a duration for both services. The POC also failed to include a pillbox was utilized for med set-ups, and failed to evidence interventions and goals related to medication management. On 08/12/2025 at 3:31 PM, in an interview, the Administrator confirmed the frequency was missing from the plan of care for Patient #8 and it should have been written as biweekly for Skilled Nursing. The Administrator indicated when skilled nursing was ordered for medication set-up, teaching/education and goals needed to be documented, along with documenting patients compliance with goals. The Administrator was aware pillboxes had not been included as 'supplies' on plans of care for patients who received skilled nursing services for medication set-up. The Administrator also indicated the duration of services had not been included in patient POCs. 410 IAC 17-13-1(a)(1)(B) A review of the POC for Patient #1 evidenced a SOC of 05/13/2025 and a recertification period for 07/12/2025 to 09/09/2025 with orders for a home health aide twice weekly to assist with bathing but failed to include how many weeks home health aide services were to be provided. A review of the POC for Patient # 6 evidenced a SOC of 05/14/2025 and a recertification period for 07/13/2025 to 09/10/2025 with orders for a home health aide twice weekly to assist with bathing but failed to include how many weeks home health aide services were to be provided. A review of an undated agency policy titled 'Clinical Care Planning' stated, "… "The plan of care will be developed…including…types of service…frequency and duration of visits to be made" A review of the POC for Patient #3 evidenced a SOC of 05/15/2025 and a recertification period for 05/15/2025 to 07/13/2025 with orders for a skilled nurse biweekly to assist with med setup but failed to include how many weeks skilled nurse services were to be provided. The plan of care also failed to include a pillbox was utilized for med set-ups, and failed to evidence interventions related to medication management. A review of the POC for Patient #4 evidenced a SOC of 05/15/2025 and a recertification period for 05/15/2025 to 07/13/2025 with orders for a home health aide twice weekly to assist with bathing but failed to include how many weeks home health aide services were to be provided. A review of the POC for Patient #8 evidenced a SOC of 08/01/2025 and an initial certification period for 08/01/2025 to 09/29/2025 failed to evidence type of service provided, frequency or duration. The plan of care also failed to include a pillbox was utilized for med set-ups, and failed to evidence interventions related to medication management.

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 patient plans of care were updated/revised with interim orders, in 1 of 8 active clinical records reviewed. (Patient #7) Findings include: 1. A review of an agency policy titled 'Care Planning' stated, "… It is the clinician's responsibility to make any necessary revisions to the plan of care based on the order …" 2. A review of the clinical record for Patient #7 with a start of care date of 07/02/2025, contained a POC for the initial certification period of 07/02/2025 to 08/30/2025. The clinical record evidenced interim orders dated 07/17/2025 which included additional diagnoses of: COPD (a lung disease characterized by ongoing inflammation and narrowing of the airways, leading to difficulty breathing), Depression (disorder that negatively affects how you feel, think, act, and perceive the world), Hyperlipidemia (high levels of fat particles (lipids) in the blood), GERD (or gastroesophageal reflux disease, a digestive disease in which stomach acid or bile irritates the food pipe lining) , Epilepsy (disorder in which nerve cell activity in the brain is disturbed, causing seizures), Dementia (group of conditions characterized by impairment of at least two brain functions, such as memory loss and judgment). The record contained additional orders dated 07/17/2025 to discontinue the following medications: Lisinopril (used treat high blood pressure and heart failure), Metformin (used to treat elevated blood sugar levels), and Melatonin (used to regulate sleep cycle). The orders listed additional drug allergies which included: Penicillin (antibiotic used to treat bacterial infections) and Valium (used to relieve anxiety), with orders to start new medications: Ergocalciferol (Vitamin D 2) 50,000 units P.O. (by mouth) weekly, Cetirizine (antihistamine used to relieve allergy symptoms) 10 mg P.O. (by mouth) daily, Famotidine (used to treat ulcers, (GERD), and conditions that cause excess stomach acid) 20 mg P.O. daily, and Glimepiride (used to treat high blood sugar levels) 3 mg P.O. (by mouth) daily. The Plan of Care failed to be updated with the new orders. 3. On 08/12/2025 at 4:00 PM, in an interview, when queried as to the interim orders for Patient #7 not being included on the patient's plan of care, the Administrator who was also the visiting nurse, indicated she was not aware the plan of care needed to be continually updated/revised with new orders, and stated would make sure orders get updated to plans of care going forward.

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 agency failed to ensure staff adhered to infection prevention measures while providing care to patients, in 1 of 3 home visit observations. (Patient #2) Findings include: 1. A review of an agency policy dated December 2018, titled 'CLEAN VS. ASEPTIC TECHNIQUE' stated, "… 3. Decontaminate the hands using an alcohol-based hand rub before … 8. Remember that anything around the clean work area is considered "dirty," …" A review of an agency policy dated December 2018, titled 'STANDARD PRECAUTIONS' stated "… Hand Hygiene: 1. Hand hygiene will be performed to prevent cross-contamination between the patient and Personnel … 3. When hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands …" 2. On 08/12/2025 at 10:00 AM, during a home visit, the Director of Nursing was observed setting up a pillbox for Patient #2. The Director of Nursing, with bare hands, handled the patient's home binder, a clipboard, then proceeded to handle the patient's two pillboxes and multiple prescription bottles. The Director of Nursing used both hands to twist the caps off of the medication bottles, one at a time. When handling the aspirin (used as an anti-inflammatory and blood thinner) and Levothyroxine (used to treat hypothyroidism) bottles, poured pills from the bottles directly into the palm of their bare hand, and later returned excess pills from their hand, back into the bottle. While filling the patient's Carvedilol (used to treat high blood pressure and heart failure), Furosemide (used to treat fluid retention), and Spirinolactone (used to treat high blood pressure and fluid retention), the nurse used their forefinger to reach into the bottles and retrieved individual pills, then placed the pills into the patient's pillbox. 3. On 08/12/2025 at 2:50 PM, in an interview, when queried as to the infection control breaches during the pillbox set-up at the home visit with Patient #2, the Director of Nursing indicated they should have worn gloves. The Administrator indicated the inside of the lid/cap of a prescription bottle was a clean surface that could be utilized during pill transfer. 410 IAC 17-12-1(m)