Every finding on record at Bayada Home Health Care, Inc.

This report is the result of an unannounced complaint survey completed on August 12, 2025. It was determined that the facility was in substantial compliance with the requirements of 42 CFR Title 42, Part 484- Conditions of Participation for Home Health Agencies.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on review of agency policy, medical record review (MR), and interview with staff, it was determined that for 1 out of 6 patients (Patient #1) in the sample, the agency failed to provide services necessary to avoid patient harm. Findings include: Agency policy "Handling Client Emergencies," effective January 1, 1993, last revised November 15, 2024, stated, "...In the event a client requires CPR [cardiopulmonary rescuscitation], and there is a CPR-certified employee present, they should...Initiate CPR; and...Have the caregiver call 911 immediately..." Review of MR1 revealed the following: "Visit Note Report" dated August 6, 2025, completed by EMP5 stated, "...Attempted to perform physical therapy initial evaluation on client. Clients spouse greeted clinician at the door. Spouse reports client had been asleep all morning...After the conversation clinician spoke to the [spouse] about doing a functional assessment as well as getting vital signs for the client. During the course of trying to assess vital signs and trying to have the client participate, client was clearly unresponsive. Vital signs taken were absent. Clinician attempted to arouse patient with sternal rubbing as well as nocious [sic] stimuli to clients fingernail bed with no response. There were no heart or breath sounds upon examination. Clients pupils were fixed and dilated and there were no breath sounds. First responders arrived within a few minutes as they are across the street. Client was then transferred to the floor dependently by EMTs who proceeded to perform CPR..." During an interview on August 12, 2025, at 10:00 AM, EMP5 confirmed that he/she did not start CPR after assessing the patient and finding no heart or breath sounds. EMP5 stated that they were in disbelief at the time of the incident, and it was when the emergency personnel arrived that he/she recognized they should have initiated CPR.

A partial extended recertification survey, which ended on 9/29/23, was conducted at Bayada Home Health Care, for the purpose of determining the agency's compliance with Medicare requirements. Survey activities included the review of 17 clinical records, 7 home visits, agency document and policy review and interviews with patients and staff. The agency was determined to be out of compliance with the following standards as required by 42 CFR Part 484, Requirements for Home Health Agencies.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on observation, medical record review, policy review, and patient and staff interviews, it was determined that the agency failed to reconcile home medications against the Comprehensive Assessment for 3 of 7 home visit patients (Patients #s 6, 11, and 13) sampled. Findings include: Agency policy titled "Client Assessment and Reassessment" stated, "...Required content...Current and past medication use and history..." Agency policy titled "Client Plan of Care" stated, "...For all skilled nursing...and support services, an original plan of care is created by the clinical manager...and based on the initial client assessment...The client plan of care includes:...All medications and treatments..." Agency policy titled "Chart Data Requirements and Format - Home Health Practice" stated, "...Medication Chart Data...All Home Health clients will have a Medication List...includes the following information: a. Notation of medications...currently used by the client, including dose, frequency...Medication Updates. a. The home chart copy or electronically documented medication profile is updated as changes occur...If there is a...medication bottle in the home, the medication list will be updated..." During an interview on 9/28/23 at 8:35 AM, Employee #2 stated that the expectation is the clinician is to reconcile patient's medications at every visit. A. Patient #6 1. During a home visit observation for client care of Patient #6 on 9/27/23 between 9:00 and 10:21 AM, the following was revealed: - Employee #9 asked patient and caregiver if there have been any changes in the medications the patient is taking to which the patient and caregiver responded "no". - Medication bottle for Lisinopril 40 mg (milligrams) 1 tablet daily po (by mouth) ordered by client's cardiologist which client states he/she is taking which was confirmed by client's caregiver. - Medication bottle for Hydrochlorothiazide 25 mg daily po ordered by client's cardiologist which client states he/she is taking which was confirmed by client's caregiver. 2. Medical record review revealed: a. "Home Health Certification and Plan of Care" dated 9/20/23 and signed by Employee #s 11 and 12 documented: - orders for "skilled nurse to...continuous review of medication regimen..." - orders for the following medications: Aspirin 81 mg (milligrams), 1 tablet daily po (by mouth). Miralax 17 gram oral powder packet, 1 packet daily po. Senna 8.6 mg 2 tablets at bedtime po. b. "Client Medication Record" (electronically documented medication profile) dated 9/28/23 documented following active medications: Aspirin 81 mg (milligrams), 1 tablet daily po (by mouth). Miralax 17 gram oral powder packet, 1 packet daily po. Senna 8.6 mg 2 tablets at bedtime po. c. No evidence the following medications were included on the "Client Medication Record" dated 9/28/23 or the "Home Health Certification and Plan of Care" medication list dated 9/20/23: - Lisinopril 40 mg 1 tablet daily po. - Hydrochlorothiazide 25 mg daily po. d. "Encompass Health My Med Schedule" dated 9/19/23 revealed: - Aspirin 81 mg by mouth 2 times every day; morning and bedtime. - No evidence Miralax 17 gram oral powder packet, 1 packet daily po and Senna 8.6 mg 2 tablets at bedtime po is included on the medication schedule. 3. During an interview on 9/27/23 between 9:58 and 10:21 AM, Patient #6's caregiver stated: - Patient is receiving Aspirin 81 mg, 1 tablet po twice a day. - Patient is not taking Miralax 17 gram oral powder packet, 1 packet daily po or Senna 8.6 mg 2 tablets at bedtime po. The finding that Patient #6's medication schedule is not consistent with the Plan of Care or the "Client Medication Report" was confirmed with Employee #1 on 9/28/23 at 2:10 PM. B. Patient #11 1. During a home visit observation for client care of Patient #11 on 9/27/23 between 1:00 and 1:32 PM, the following was revealed: - Employee #8 asked patient twice if there have been any changes in the medications the patient is taking to which the patient responded "no", both times. 2. Medical record review revealed: a. "Home Health Certification and Plan of Care" dated 9/12/23 and signed by Employee #s 11 and 12 documented: - orders for "skilled nurse to...continuous review of medication regimen..." - orders for Diltiazem CD (Cardizem) 120 mg extended release 1 capsule po daily. b. "Client Medication Report" dated 9/28/23 documented the following active medication: - Diltiazem CD (Cardizem) 120 mg extended release 1 capsule po daily. 3. During an interview on 9/27/23 between 1:00 and 1:32 PM, Patient #11 stated he/she is not taking Diltiazem CD (Cardizem) 120 mg extended release 1 capsule po daily and that he/she stopped on "Monday" (9/25/23). The finding that Patient #11's medication schedule is not consistent with Plan of Care or the "Client Medication Report" was confirmed with Employee #1 on 9/28/23 at 2:10 PM. C. Patient #13 1. During a home visit observation for client care of Patient #13 on 9/28/23 between 10:30 AM and 12:00 PM, the following was revealed: - Employee #10 asked patient if there have been any changes in the medications the patient is taking to which the patient responded "no". 2. Medical record review revealed: a. "Home Health Certification and Plan of Care" dated 9/11/23 and signed by Employee #s 12 and 13 documented: - orders for Physical Therapist to complete "...identification of new or changed medications..." - orders for the following medications: Gabapentin 100 mg 1 capsule po three times daily. Oxybutynin Chloride ER (extended release) 10 mg 1 tablet po daily. Tylenol 325 mg 2 tablets po every 4 hours. b. "Client Medication Report" dated 9/28/23 documented the following active medications: - Gabapentin 100 mg 1 capsule po three times daily. - Oxybutynin Chloride ER (extended release) 10 mg 1 tablet po daily. - Tylenol 325 mg 2 tablets po every 4 hours. 2. During an interview on 9/28/23 between 10:30 AM and 12:00 PM, Patient #13 stated he/she is not taking Oxybutynin Chloride ER (extended release) 10 mg 1 tablet po daily and that he/she is only taking 1 tablet of Tylenol 325 mg daily. The finding that Patient #13's medication schedule is not consistent with Plan of Care or the "Client Medication Report" was confirmed with Employee #2 on 9/29/23 at 4:05 PM.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on medical record review, document review, and staff interviews it was determined that the agency failed to ensure provider verbal orders were authenticated per agency policy for 2 out of 17 patients (Patient #s 3 and 15) sampled. Findings include: Facility policy titled Physician's Orders stated, "...A physician signature must be obtained within twenty eight days..." Record review for Patient #15 revealed: -Initial provider orders were placed on 8/9/23 -Orders were signed on 9/26/23 (20 days late) -The agency faxed the provider for signature of the order on 8/22/23 (13 days after the order was placed) These findings were confirmed by Employee #1 on 9/29/23 at 4:19pm. A. Medical record review for Patient #3 revealed: "Home Health Certification and Plan of Care" verbal orders taken on 5/10/23. Physician signature obtained on 6/30/23, 51 days from verbal order. B. During an interview on 9/29/23, Employee #2 was not able to provide evidence of attempts made to secure a physician's signature and confirmed the finding that the signature was obtained 51 days after the verbal order was made.

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 medical record review, document review, and staff interviews it was determined that the agency failed to notify the provider of changes to the patient's plan of care for 2 out of 17 patients (Patient #16 and 17) sampled. Findings include: Facility policy titled "Physician's Orders" stated, "...Any revisions to the plan of care due to a change in client's status must be communicated to the responsible physician..." Record review for Patient #16 revealed: -Orders for Physical Therapy (PT) services to be provided 1 time a week were placed on 8/7/23. -For the week of 9/17/23 - 9/23/23 there was evidence of two PT visits. -There was no evidence of provider notification of a change to the plan of care. This finding was confirmed by Employee #1 on 9/29/23 at 4:07 PM. Record review for Patient #17 revealed: -Orders for Occupational Therapy (OT) services were placed on 8/7/23. -On 9/26/23 the patient was discharged from OT services early. -There was no evidence of provider notification of a change to the plan of care. In an interview on 9/29/23 at 4:30 PM with Employee #1 the above finding was confirmed. Employee #1 verified that the expectation is that the provider would be notified.

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 observations and policy review, it was determined that the Agency failed to follow agency policy to prevent the transmission of infection by agency staff for 1 of 7 home visit patients (Patient #11) sampled. Findings include: 1. Agency policy titled "Hand Hygiene" stated, "Artificial nails or extenders are not permitted for employees who provide direct client care. Nails should be kept short, usually 1/4 inch or less..." 2. Observation of client care provided by Employee #8 to Patient #11 on 9/26/23 between 1:00 and 1:32 PM revealed: - Employee #8 wearing artificial nails. - Employee #8's artificial nails exceeded 1/4 inch in length. This finding wad confirmed with Employee #2 on 9/29/23 at 3:59 PM.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on medical record review, document review, and staff interviews, it was determined that the agency clinicians failed to follow agency policies and procedures related to timely documentation of patient visits for 6 out of 17 patients (Patient #5, 7, 8, 15, 16, and 17) sampled. Findings include: Facility policy titled "Chart Data Requirements and Format - Home Health Practice" stated, "...Electronic documentation will be completed and synched within 24 hours of each visit..." Record review for Patient #5 revealed: -Nursing visit on 5/19/22 was documented on 5/22/22 (2 days late) -Nursing visit on 5/21/22 was documented on 5/23/22 (1 day late) -Nursing visit on 5/24/22 was documented on 5/26/22 (1 day late) -Nursing visit on 5/28/22 was documented on 5/30/22 (1 day late) -Nursing visit on 6/7/22 was documented on 6/12/22 (4 days late) These findings were confirmed by Employee #1 on 9/29/23 at 4:40 PM. Record review for Patient #7 revealed: -Nursing visit on 9/18/23 was documented on 9/20/23 (1 day late) These findings were confirmed by Employee #1 on 9/29/23 at 4:50 PM. Record review for Patient #8 revealed: -Physical therapy visit on 8/14/23 was documented on 8/20/23 (5 days late) -Physical therapy visit on 8/24/23 was documented on 8/27/23 (2 days late) -Nursing visit on 9/26/23 documentation was not completed on date of record review 9/28/23 (1 day late) These findings were confirmed by Employee #2 on 9/28/23 at 1:30 PM. Record review for Patient #15 revealed: -Nursing visit on 8/9/23 was documented on 8/11/23 (1 day late) -Nursing visit on 8/17/23 was documented on 8/21/23 (3 days late) -Occupational therapy visit on 8/25/23 was documented on 8/27/23 (1 day late) -Physical therapy visit on 8/31/23 was documented on 9/3/23 (2 days late) -Physical therapy visit on 9/21/23 was documented on 9/24/23 (2 days late) These findings were confirmed by Employee #1 on 9/29/23 at 4:19 PM. Record review for Patient #16 revealed: -Occupational therapy visit on 8/16/23 was documented on 8/18/23 (1 day late) -Occupational therapy visit on 8/29/23 was documented on 9/1/23 (2 days late) -Occupational therapy visit on 9/15/23 was documented on 9/17/23 (2 days late) -Speech therapy visit on 9/21/523 was documented on 9/25/23 (3 days late) These findings were confirmed by Employee #1 on 9/29/23 at 4:14 PM. Record review for Patient #17 revealed: -Occupational therapy visit on 8/14/23 was documented on 8/16/23 (1 day late) -Occupational therapy visit on 8/21/23 was documented on 8/24/23 (2 days late) -Occupational therapy visit on 9/6/23 was documented on 9/8/23 (1 day late) These findings were confirmed by Employee #1 on 9/29/23 at 4:31 PM.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(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 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 §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on medical record review, document review, and staff interviews it was determined that the agency failed to supervise the home health aid services for 2 out of 17 patients (Patient #s 12 and 16) sampled. Findings include: Facility policy titled Frequency of Clinical Management Visits and Employee Supervision (Medicare Certified Offices) stated, "...Clients receiving Home Health Aide services along with another discipline are visited at least once every fourteen (14) days by an RN or Therapist (therapy only cases) to supervise the Home Health Aide services..." Record review for Patient #16 revealed: -Orders for Home Health Aide services were placed on 8/29/2023 -There was no evidence of a Home Health Aide supervisory visit from 9/14/23 - 9/29/23 This finding was confirmed by Employee #1 on 9/29/23 at 3:57pm. Medical record review for Patient #12 revealed: Orders for Home Health Aide (HHA) services 2 times a week. HHA visits made 2 times a week during the following weeks between 8/1/23 to 9/28/23. HHA supervisory visits were made on the following dates: 8/16/23 (15 days after start if care) 8/23/23 (7 days after last HHA supervisory visit) 8/24/23 (1 day after last HHA supervisory visit) 9/21/23 (28 days after last supervisory visit) The finding that a HHA supervisory visit was not completed between 8/24/23 and 9/21/23 (28 days) was confirmed by Employee #2 on 9/29/23 at 4:23 PM.