Every finding on record at Taylored by Renee's Helping Hands Home Health

An Emergency Preparedness Survey was conducted by the Indiana Department of Health in accordance with 42 CFR §484.102. Survey Dates: 10/22/2025 and 10/23/2025. Active Census: 8 At this Emergency Preparedness survey, Taylored By Renee’s Helping Hands Home Health was found to be in compliance with Emergency Preparedness Requirements for a Medicaid Participating Providers and Suppliers, 42 CFR §484.102. QR completed by Area 3 on 10/27/2025.

This visit was for an Initial Federal Medicaid and State Licensure survey of a home health agency. Survey dates: 10/22/2025 and 10/23/2025. Facility Number: 018703 12-month unduplicated census: 10 This deficiency report reflects State Findings cited in accordance with 410 IAC 17. Refer to State Form for additional State Findings. Abbreviations: HHA Home Health Aide DME Durable Medical Equipment RN Registered Nurse CM Clinical Manager POC Plan of Care MD Medical Doctor SOC Start of Care PSA Personal Service Agency ATTC Attendant OASIS Outcome and Assessment Information Set SN Skilled Nurse ADLs Activities of Daily Living QR completed by Area 3 on 10/27/2025.

Discharge or Transfer Summary Content CFR(s): 484.58(b)(1) Standard: Discharge or transfer summary content. The HHA must send all necessary medical information pertaining to the patient's current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility or health care practitioner to ensure the safe and effective transition of care. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure discharge summaries were completed and sent to the providers for 2 of 2 discharged clinical records reviewed. (Patients: #9 and 10) Findings include: 1. A review of an agency policy revision date April 2019, titled “Discharge Summary,” indicated, but was not limited to, “Each patient discharged from a service and/or from the organization will have a written discharge summary … 3. A copy of the discharge summary will be provided to the patient’s primary care practitioner … within five (5) business days of the patient’s discharge … ” 2. A review of the inactive clinical record for Patient #9 with a SOC date of 08/11/2025, contained an OASIS-E1 Discharge Assessment dated 09/03/2025, electronically signed by the Administrator/CM. The record failed to evidence a discharge summary had been completed and sent to the patient’s primary care practitioner. A review of a signed physician order dated 09/03/2025 evidenced Patient #9 requested discharge. 3. A review of the inactive clinical record for Patient #10 with a SOC date of 07/10/2025, contained an OASIS-E1 Discharge Assessment dated 08/11/2025, electronically signed by the Administrator/CM. The record failed to evidence a discharge summary had been completed and sent to the patient’s primary care practitioner. A review of a signed physician order dated 08/11/2025 evidenced Patient #10’s wound had healed and to discharge from home health care services. During an interview on 10/22/2025 at 2:25 PM, when requested the location of the discharge summaries and notifications they had been sent to the primary care practitioners for Patients #9 and #10, the Administrator/CM reviewed the clinical records for Patients #9 and #10 and stated, “No ma’am, they are not there.”

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 POC was individualized and included all necessary elements, including nutrition, frequency and duration of visits, DME, and seizure plan for 4 of 8 active clinical records reviewed. (Patients: #1, 3, 4, and 5) Findings Include: 1. A review of an agency policy revision date April 2019, titled “Care Planning Process,” indicated but was not limited to, “ … 1. Individualized Plan Of Care: The patient-specific clinical plan of care includes: …L. Nutritional requirements … P. Supplies and Equipment required … S. Frequency and duration of visits … X. Other appropriate items … ” 2. During a home visit at Patient #1’s residence on 10/23/2025 at 10:00 AM, observed the Administrator/DON providing a foley catheter (a medical tube that helps drain urine from the bladder) flush to Patient #1’s 18 French foley catheter. Observed Patient #1 lying in a hospital bed with an emergency alert necklace around their neck. When asked about their emergency alert necklace, Patient #1 laughed and stated, “I accidentally rolled over and set it off once and had to let them know they had not fallen.” The Administrator/CM asked Patient #1 to roll on their side for assessment and suppository insertion. Noted Patient #1 wearing Depends and lying on one cloth bed pad and one disposable chucks. A review of the clinical record for Patient #1, SOC date of 03/12/2025, contained a POC for the recertification period 09/08/2025 to 11/06/2025. The POC indicated, but was not limited to, diagnoses of Neuromuscular Dysfunction of Bladder (a condition that affects bladder function due to nervous system problems), Multiple Sclerosis (a disease that causes breakdown of the protective covering of the nerves, causing weakness, numbness, trouble walking, and vision changes), and Hypotension (a condition of low blood pressure). The POC in the section titled “DME and Supplies” listed bedside commode, elevated toilet seat, wheelchair, grab bars, hospital bed, tub/shower bench, irrigation set, irrigation solution, but failed to list 18 French foley catheters, depends, chucks, and emergency alert call necklace. During an interview on 10/23/2025 at 10:20 AM, the Administrator/DON indicated that they changed Patient #1’s catheter once a month and all DME and supplies were to be listed on the POC. 3. During a home visit at Patient #3’s residence on 10/23/2025 at 8:50 AM, observed HHA 1 providing Range of Motion to Patient #3’s lower extremities. Observed a feeding tube placed on Patient #3’s abdomen connected to an Infinity pump infusing water through the connection tubing to Patient #3’s feeding tube. HHA 1 communicated Patient #3 received water and feeding through the Infinity pump (a mobile medical device designed to deliver nutrition or water at a prescribed rate). Patient #3 had been lying in the mother's queen-size bed with head propped with a pillow, hard to arouse, smiling during sleep with jerking movements, when HHA 1 tried to get Patient #3 awake. HHA 1, and the mother of Patient #3, communicated that Patient #3 had seizures frequently and their medications had been adjusted. When asked regarding a seizure plan, HHA 1 reported they cradled Patient #3 during their seizure to make sure they were safe. When asked about a nebulizer used for breathing treatments, HHA 1 confirmed Patient #3 used the nebulizer with a mask as needed for respiratory issues. HHA 1 further revealed that Patient #3 had an eye-gaze communication board, which they used. A review of the clinical record for Patient #3, SOC date of 07/28/2025, contained a POC for the recertification period 09/26/2025 to 11/24/2025, electronically dated 09/25/2025, and signed by the Administrator/CM. The POC indicated, but was not limited to diagnoses of Spastic Quadriplegic Cerebral Palsy (a condition that affects muscles and movement characterized by increased muscle tone, making muscles stiff and movements jerky and awkward), Neuromuscular Scoliosis (a condition of irregular curvature of the spine), and Epilepsy (a condition caused by disruptions in the brain’s electrical activity causing seizures). The section subtitled “Nutrition Requirements” noted Eternal Nutrition Kate Farm 1.2 (formula) milliliters (ml)/hour (hr) per PEG via Bolus. The section titled “DME and Supplies” listed medical car seat, standing aide, medical stroller, hand braces, leg braces, and glasses, but failed to list pulse oximeter, nebulizer, masks, Infinity pump, and feeding supplies. The POC failed to include seizure plans with interventions. During an interview with the Administrator/ DON on 10/23/2025 at 11:10 AM, when asked about the seizure plan and missing DME regarding nebulizer, pulse oximeter, feeding tube, feeding tube supplies, and pump, the Administrator/CM reviewed the POC and stated, “I do not see them listed. It should be on there. No ma’am should be on there.” 4. A review of the clinical record for Patient #4, SOC date of 08/07/2025, contained a physician signed POC for the certification period 08/07/2025 to 10/05/2025, electronically signed by the Administrator/CM. The POC indicated, but was not limited to, diagnoses Spondylolysis, Lumbar Region (a stress fracture of defect in the small segments of bone that connects the upper and lower facets of a vertebra), Type 2 Diabetes (a chronic condition where the body cannot use insulin effectively, leading to high blood sugar levels), and Essential Hypertension (a condition of high blood pressure). The section titled “Nutritional Requirements” had been left blank. The section titled “Orders for Discipline and Treatment (Specify Amount/Frequency/Duration) indicated Patient #4 had orders to receive SN services 1 time a month, for diabetes management, pain management, and supervisory visits, and HHA 2 times a week for 9 weeks for ADL assistance. The POC failed to list Nutritional requirements and failed to list the duration for SN frequency. During an interview on 10/23/2025 at 2:44 PM, when questioned about the blank section for Nutritional Requirements on the POC for Patient #4, the Administrator/DON confirmed the section had been left blank and communicated the POCs should be completely filled out. 5. A review of the clinical record for Patient #5, SOC date of 08/07/2025, contained a physician signed POC for the certification period 08/07/2025 to 10/05/2025, electronically signed by the Administrator/CM. The POC indicated, but was not limited to, diagnoses Prediabetes (higher than normal blood sugar levels without lifestyle changes increased risk for Type 2 Diabetes), Obesity, and Moderate Persistent Asthma (a condition where patients experience daily asthma symptoms, swelling in airways, and enhanced mucus production, reducing the amount of air passing through the bronchi and into the lungs). The section titled “Nutritional Requirements” had been left blank. The POC failed to list Nutritional requirements. During an interview on 10/23/2025 at 3:38 PM, when questioned about the blank section for Nutritional Requirements on the POC for Patient #5, the Administrator/DON reviewed the POC and stated, “It is missing Nutrition again.” 410 IAC 17-13-1(a)(1)(D)(ii,iii,vii,viii,xiii)

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 record review and interview, the agency failed to provide services as ordered by the physician for 1 or 7 active records reviewed (Patient: #4), receiving SN and HHA services. Findings include: 1. A review of an agency policy revision dated April 2019, titled “Physician Participation In Plan of Care,” indicated but was not limited to, “ …services are provided on the basis of a physician’s orders … ” 2. A review of the active clinical record for Patient #4 with a SOC date of 08/07/2025, contained a POC for the certification period 08/07/2025 through 10/05/2025, electronically signed by the Administrator/CM. The POC indicated but was not limited to diagnoses Spondylolysis, Lumbar Region (a stress fracture of defect in the small segments of bone that connects the upper and lower facets of a vertebra), Type 2 Diabetes (a chronic condition where the body cannot use insulin effectively, leading to high blood sugar levels), and Essential Hypertension ( a condition of high blood pressure). Patient #4 had orders to receive SN services 1 time a month for diabetes and pain management, supervisory visits, and HHA 2 times a week for 9 weeks for ADL assistance. A review of the HHA notes for Patient #4 dated 08/31/2025 through 10/04/2025 evidenced HHA 2 saw Patient #4 3 times a week as follows: the week of 08/31/2025 through 09/06/2025, HHA 2 provided services on 09/02, 09/03, and 09/04/2025; the week of 09/07/2025 through 09/13/2025, HHA 2 provided services on 09/08 and 09/10/2025; week of 09/14/2025 through 09/20/2025, HHA 2 provided services on 09/15, 09/17, and 09/18/2025; week of 09/21/2025 through 09/27/2025, HHA 2 provided services on 09/22, 09/24, and 09/25/2025; and 09/28/2025 through 10/04/2025, HHA 2 had provided services 09/30, 10/01, and 10/02/2025. The agency failed to follow the POC regarding HHA services to be provided. During an interview on 10/23/2025 at 2:44 PM, when asked about Patient #4’s HHA frequency being provided 3 times a week and, per the POC, having been ordered 2 times a week, the Administrator/CM asked Admin 4 about the increased frequency. Admin 4, the Office Manager, reviewed the visits for Patient #4 and confirmed Patient #4 had been receiving HHA services 3 times a week for shower assistance since 09/02/2025. Admin 1 further communicated to the Administrator/CM they had forgotten to inform them of the change in the increased scheduled visits, as reported needed by Patient #4 and HHA 2.

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 follow standard precautions to prevent the transmission of infection and communicable diseases by failing to practice proper hand hygiene during 1 of 1 RN home visits observed. (Employee: Administrator/CM) Findings Include: 1. Centers for Disease Control, last updated January 2021. When to Perform Hand Hygiene. Retrieved from cdc.gov/handhygiene/providers/index.html indicated "Use an Alcohol-Based Hand Sanitizer: Immediately before touching a patient. Before performing an aseptic task [e.g., placing an indwelling device] or handling invasive medical devices. Before moving from work on a soiled body site to a clean body site on the same patient. After touching a patient or the patient's immediate environment. After contact with blood, body fluids or contaminated surfaces. Immediately after glove removal. Wash with Soap and Water: When hands are visibly soiled. ... After known or suspected exposure to spores.... When using alcohol-based hand sanitizer, put the product on your hands and rub them together. Cover all surfaces until your hands feel dry. This should take around 20 seconds. ... The CDC Guideline for Hand Hygiene in Healthcare Settings recommends: When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product ... and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse your hands with water, then use disposable towels to dry them. Use a towel to turn off the faucet. ... Other entities have recommended that you clean your hands with soap and water for about 20 seconds. Either time is acceptable. The focus should be on cleaning your hands at the right time. ... When and How to Wear Gloves: Wear gloves ... when ... contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur ... Change gloves and perform hand hygiene during patient care, if gloves become damaged, gloves become visibly soiled ... moving from work on a soiled body site to a clean body site on the same patient or in another .... " 2. During a home visit at Patient #1’s residence on 10/23/2025 at 10:25 AM, observed the Administrator/CM completing their assessment of Patient #1. The Administrator/CM completed hand hygiene, donned gloves, and applied a wrist blood pressure monitor to Patient #1’s right wrist, then obtained Patient #1’s temporal temperature. Afterward, the Administrator removed the wrist blood pressure monitor, touching Patient #1’s wrist, and provided the blood pressure reading to Patient #1. Further observed the Administrator/CM placing the wrist blood pressure monitor on the prepped barrier area, reaching into their nursing bag to obtain a stethoscope, and auscultated Patient #1’s lung and bowel sounds. The Administrator failed to discard their gloves and perform hand hygiene after removing the wrist blood pressure monitor and touching Patient #1, prior to removing the stethoscope from their bag. During an interview on 10/23/2025 at 10:44 AM, when questioned about obtaining clean equipment out of their bag and wearing gloves that had touched the Patient #, the Administrator/CM confirmed they had not removed their gloves nor performed hand hygiene after removing the wrist blood pressure monitor and touching Patient #1 and should had done so prior to obtaining their stethoscope out of their bag. 410 IAC 17-12-1(m)

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 Administrator/Case Manager failed to ensure the aide care plan was individualized and patient-specific for 1 of 1 active patients receiving HHA services (Patient: #3) with a known history of having seizures. Findings Include: 1. A review of an agency policy revision date April 2019, titled “Home Health Aide Plan of Care,” indicated, but was not limited to, “Each patient receiving home health aide 0services will have an individualized plan of care developed … ” 2. A review of an undated agency policy titled “Seizure Management Policy” indicated, but was not limited to, “To ensure prompt, safe, and effective care is provided to clients experiencing a seizure while under care of the home health agency … ” 3. During a home visit at Patient #3’s residence on 10/23/2025 at 8:50 AM, observed HHA 1 attempted to awaken Patient #3 for range of motion and dressing. Observed a feeding tube placed on Patient #3’s abdomen with tubing connected to an Infinity pump administering water. Patient #3 had jerking, uncontrolled movements as they were lying in bed, smiling. HHA 1, and the mother of Patient #3, communicated Patient #3 has had several seizures. When asked about a seizure plan, HHA 1 stated they had just held Patient #3 to ensure they were okay. HHA 1 further indicated Patient #3’s medication had been adjusted by their neurologist, who provided it for their seizures. When questioned regarding the peg tube care and feedings provided to Patient #3 during clock-in times, HHA 1 stated, “No, that is not allowed under home health. I get her ready for school by bathing and dressing her up.” A review of the clinical record for Patient #3, SOC date of 07/28/2025, contained a POC for the recertification period 09/26/2025 to 11/24/2025, electronically dated 09/25/2025, and signed by the Administrator/CM. The POC indicated, but was not limited to, diagnoses Spastic Quadriplegic Cerebral Palsy (a condition that affects muscles and movement characterized by increased muscle tone, making muscles stiff and movements jerky and awkward), Neuromuscular Scoliosis (a condition of irregular curvature of the spine), and Epilepsy (a condition caused by disruptions in the brain’s electrical activity causing seizures). A review of the HHA Care Plan dated 09/26/2025, and signed by the Alternate Administrator/Alternate CM, indicated Patient #3 had a primary diagnosis of Spastic Quadriplegic Cerebral Palsy, and a secondary diagnosis of Neuromuscular Scoliosis. Patient #3’s diet noted enteral feeding via a PEG. Patient #3 had ordered services to be provided by an HHA 3 times a week for 9 weeks. The safety precaution section noted the following: proper position during meals, seizure precautions, fall precautions, keep side rails up, standard precautions, use of assistive devices, safety precautions with chair lift and narrow stair pathway, ensure patient is with head elevated pre and post tube feedings, safety precautions with tube feedings. Plan details included chair bath, hair care, shampoo, skin care, oral care, assist with dressing, observe for pressure areas, and incontinence care. The HHA Care Plan failed to be individualized to the patient’s specific safety needs and seizure plan. The plan details indicated morning medications, which HHA 1 had not been completing this task. During an interview on 10/23/2025 at 11:20 AM, when asked if they could show the seizure plan for HHA 1 while providing care for Patient #3, the Administrator/CM could not provide one. When asked about what their seizure protocol was for Patient #3 and the agency policy for seizure patients, the Administrator stated, “No, there is no seizure plan on the HHA care plan or the POC. This information from our Seizure Management policy should had been on both of them.” 410 IAC 17-13-2(a)

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 record review and interview, the agency failed to provide the frequency of services as ordered by the physician for 1 or 7 active records reviewed, receiving SN and HHA services. (Patient: #4) Findings include: 1. A review of an agency policy revision date April 2019, titled “Home health Aide Plan of Care,” indicated but was not limited to, “ …Each patient receiving home health aide services will have an individualized plan developed by an appropriate professional and utilized to direct the care performed by the assigned aide … ” 2. A review of the active clinical record for Patient #4 with a SOC date of 08/07/2025, contained a POC for the certification period 08/07/2025 through 10/05/2025, electronically signed and dated 08/07/2025, by the Administrator/CM. The POC indicated, but was not limited to, diagnoses. Patient #4 had orders to receive SN services 1 time a month for diabetes and pain management, supervisory visits, and a HHA 2 times a week for 9 weeks for ADL assistance. A review of the HHA Hourly Care Plan, dated 08/07/2025 through 10/05/2025, and electronically signed by the Administrator/CM, contained orders for HHA 2 times per week for 9 weeks. The HHA care plan in the section titled “Plan Details” indicated Patient 34 received HHA assistance with medication reminder, shower, hair care, skin care, oral care, assist with dressing, assist with ambulation, and assist with transfers, HHA’s household tasks including making the bed, changing linens, light housekeeping, and meal set up. A review of the HHA notes for Patient #4 dated 08/31/2025 through 10/04/2025 evidenced HHA 2 saw Patient #4 3 times a week as follows: the week of 08/31/2025 through 09/06/2025, HHA 2 provided services on 09/02, 09/03, and 09/04/2025; the week of 09/07/2025 through 09/13/2025, HHA 2 provided services on 09/08 and 09/10/2025; week of 09/14/2025 through 09/20/2025, HHA 2 provided services on 09/15, 09/17, and 09/18/2025; week of 09/21/2025 through 09/27/2025, HHA 2 provided services on 09/22, 09/24, and 09/25/2025; and 09/28/2025 through 10/04/2025, HHA 2 had provided services 09/30, 10/01, and 10/02/2025. The HHA failed to follow the HHA care plan regarding the frequency of HHA services to be provided. During an interview with HHA 2 during the home visit at the residence of Patient #4, on 10/23/2025 at 12:55 PM, when asked about the care Patient #4 received from HHA 2, the HHA confirmed they provided care to Patient #4 3 times a week.