Every finding on record at Bayada Home Health Care Inc

On 9/06/22 through 9/08/22, a complaint survey was conducted. This resulted in a partial extended survey at Bayada Home Health Care. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. H81254441C/27706 was substantiated, and deficiencies were issued at G430 and G488, as a result of the complaint investigation. The Condition of Participation: Patient Rights 42 CFR 484.50 at G408 was found not met.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on the number and/or severity of the deficiencies citied, the Condition of Participation: Patient Rights 42 CFR 484.50 at G408 was not met. The home health agency (HHA) failed to ensure a patient was free from abuse for 1 of 1 patients (P1) reviewed when RN-A was seen on video verbally, physically, and sexually abused P1. See G430.

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 interview and document review, the home health agency (HHA) failed to ensure a patient was free from abuse for 1 of 1 patients (P1) reviewed when RN-A was seen on video verbally, physically, and sexually abused P1. P1’s Pediatric Nursing Assessment dated 7/19/22 completed by RNCC indicated P1’s age range cognition was 12 months. P1 had no lesions, rashes, wounds, abuse/neglect indicated “no problem noted.” P1's Home Health Certification And Plan Of Care (POC) for the certification period 7/27/22 through 9/24/22, indicated P1 had diagnosis of epilepsy, spastic quadriplegic (dysfunction of the upper and lower extremities), encephalopathy (diffuse disease of the brain that alters brain function or structure), tube feeding, microcephaly (birth defect where baby head is much smaller than expected), and acute respiratory failure with other diseases of the lung. The POC further indicated P1 was to receive skilled nursing 10 to 12 hours per day, 5 to 7 days a week for vital signs, changes for incontinent care, medication via gastrostomy tube, BiPap machine for breathing, care for abuse, neglect, verbal abuse, sexual abuse, emotional abuse/psychological abuse, and substantial child abuse. Approximately 20 video clips with audio from 7/04/22 through 8/25/22 from the police department were reviewed on 9/08/22, at 10:30 a.m. indicating the following: Observation of video footage dated 7/04/22, at 1:34 p.m. showed P1 in his bed, on his back with his face pointed towards the wall with the television on. RN-A was standing on the right side of P1’s bed. RN-A removed the blanket covering P1, lifted his right arm and leg off the mattress, and flopped him down on his left side where P1 was observed bouncing up from the mattress. RN-A pulled P1 back towards her where RN-A forcefully moved P1’s head left to right, in a back-and-forth motion. Neither RN-A nor P1 could be heard in the video during the incident. Observation of video footage of 8/04/22, at 7:08 a.m., showed RN-A walking towards P1's bed saying, “I already told you whining is not going to do anything for yah, not a darn thing”. RN-A picks up a cloth at the left side of P1's head, turns P1's head to the left, forcefully pushes the back of P1's neck with her left hand, then pushes the cloth down covering P1's head with her right hand. RN-A said, “I don’t play that game buddy, you know that.” At 7:10 a.m. RN-A was observed to be pushing P1's head against the mattress while changing his diaper. Then with both hands RN-A held a cloth and hand pushed P1's head straight down into the mattress two times. RN-A lifted P1’s head off the mattress, forcefully put P1’s BiPap mask on his face and dropped his head onto the mattress. Observation of video footage of 8/04/22, at 2:46 p.m., showed P1 was on his back with his head towards his right side, P1 could be heard breathing. RN-A was sitting near the foot of his bed, rose to a standing position and told P1 “Ok we are going to go on your other side then”. RN-A then places her two hands on P1’s head forcefully moving P1’s head left to right, in a back-and forth motion. RN-A lifted his right arm and leg off the mattress and flopped him down on his left side. RN-A said to P1 “I told you I am done”. Observation of video footage of 8/05/22, at 6:57 a.m. P1 was on his back with his BiPAP mask on. RN-A yanked P1 towards her by grabbing his diaper to remove P1’s shirt. RN-A pulled P1’s shirt off and pushed P1's head into the mattress with her left hand. RN-A removed two diapers and started cleaning P1's soiled buttock. Observation of video footage of 8/05/22 at 9:42 a.m. showed RN-A wiping P1's face with a cloth, then lifting his head up, pulling the BiPap cord from behind, the releasing P1’s head, where P1’s head flopped on the mattress. The compression from the mattress springs can be heard in the audio. Observation of video footage of 8/11/22, at 3:20 p.m., showed P1 in bed on his back with his head facing toward the television. RN-A was observed to be lying on the floor, next to P1’s bed. P1 could be heard crying, RN-A got up from the floor, stood at the window, and shut the window blind halfway. RN-A told P1, “I told you, I told you what was going to happen”. RN-A continued to tell P1, “Now you have nothing to cry about, so you have at it. Then you cry as much as your little heart desires now”. The video audio showed at 3:45 p.m. P1 could be heard crying and RN-A telling P1 "I am not playing, your attitude sucks today". At 3:48 p.m. the video showed RN-A in the process of changing P1's soiled diaper and having to use several wipes to clean his buttock. RN-A told P1 "You know I don’t tolerate this bullshit”. At 3:49 p.m. video showed RN-A rolling P1 on his back and telling P1 “Now you can look at the wall and do nothing". Observation of video footage on 08/12/22 at 11:22 a.m. showed P1 was lying in his bed on his left side. RN-A lifted P1’s right leg while cleaning his buttock and pulled the bed pad towards her then used both hands on P1’s torso to reposition P1 so his buttock was raised in air and P1’s chest and head were on the mattress. RN-A continued to wipe P1’s buttock. RN-A can be heard on audio saying, "gross kid" and then rolled P1 on his back, saying "are you kidding me." RN-A rolled P1, so his body is against the wall where he is face down and his buttock was raised in the air. RN-A continued to wipe P1’s buttocks and told P1 “I’m going to stick a wipe up your ass, what I am going to do”. RN-A proceeded to grab a wipe with her right hand and shoved the wipe into P1’s rectum with her gloved fingers. RN-A can be seen moving her fingers from side to side at P1’s rectum while pushing the wipe inside his rectum. RN-A angerly said “Because I am not dealing with it anymore”. RN-A started to pull the wipe from P1’s rectum, leaving half of the wipe inside and the other half outside of P1’s body. RN-A can be heard saying “Fucking gross” when the video ends. Observation of video footage on 8/25/22 at 1:56 p.m. showed RN-A pulling P1’s shirt. P1 can be heard crying, RN-A tells P1 “You can sit there and cry all you want, I don’t care. RN-A is removes P1’s diaper, telling P1 “Your BiPap is going on the rest of the day.” RN-A is seen wiping feces off P1, quickly turns him over to his back, pushing P1 towards the wall, telling P1 “You are not watching any lights, that’s not happening.” RN-A attempts to secure the diaper, then pulls it off with enough force to lift P1’s left leg off the bed, RN-A grabs P1’s right arm and right leg lifting P1 in the air, pushing P1 back to his left side facing the wall. RN-A attempts to secure the diaper with tape then lifts P1’s right arm and right leg, P1 is off the mattress then RN-A drops him to his left side. RN-A uses her right arm pushing P1 on his buttock, P1 rolls. P1 one can be heard making a whimpering sound. At 2:01 RN-A cradles P1 lifting P1 closer to the middle of the bed, pushes P1 towards the wall with enough force that P1 is heard making contact with the wall. The police report dated 9/06/22 indicated P1’s family member (FM)-A provided approximately 20 video clips with audio from 7/24/22 through 8/25/22, where RN-A cared for P1 and was verbally, physically, and sexually abusive to P1. In addition, the police report indicated an interview was done with P1’s family member who alleged RN-A was rough while providing cares to P1. The police report indicated the home care agency was interviewed and they were unaware of any abuse occurring to P1. The police report indicated RN-A personal file from the home care agency was reviewed with no related issued with abuse were addressed in her employee file. During interview on 9/07/22, at 10:30 a.m. the Director of Home Care Services stated FM-A provided only the video footage of the incident that occurred on 8/25/22 that showed RN-A was rough during incontinent change and it was felt the RN-A was punishing him for having a soiled diaper. RN-A was immediately removed from the schedule. The incident was immediately reported to the police department, the Minnesota Board of Nursing, and a report was made to the State Agency. During interview on 9/07/22, at 12:16 p.m. Director of Home Care Services stated during their investigation the incident with RN-A was found substantiated and the employee was immediately terminated. The director of home care services stated they were in shock this had occurred, and they had never had any reported concerns with RN-A cares. RN-A only patient was P1, and she provided cares to P1 for the last 4 years. During interview on 9/07/22, at 12:30 p.m. RN clinical coordinator (RNCC) for P1 stated she goes out to P1's home every 60 days while RN-A was in the home and never saw any signs of abuse. RNCC stated she completed an assessment for abuse while she was there in July 2022 and documented no abuse occurred but stated she did not interview P1’s family about any concerns of abuse occurring. During interview on 9/07/22, at 1:55 p.m. the police officer stated P1 was being cared for by RN-A and he had obtained video footage from P1’s family (FM)-A. During interview on 9/08/22, at 12:00 p.m. FM-A stated RN-A had been taking care of P1 since 2018 and she never thought RN-A would be abusing P1, doing the things she saw in the video. FM-A stated she received a grant to place the camera in P1's room several years ago and RN-A knew they were in P1’s room. FM-A stated she never looked at the footage because she trusted RN-A. FM-A stated the reason she viewed the video footage was because on 8/25/22, RN-A complained of back pain, so she looked at the footage and saw all the awful things RN-A had done. FM-A stated that after she say the 8/25/22 footage she decided to go back to see if there were any more concerning incidents, found more incidents, and felt the detective needed to see them. FM-A stated there was a time in June 2022 when they went on vacation and RN-A stayed alone with P1, when they returned RN-A told us she had a tough time with P1. FM-A stated she never had tough times with P1, and RN-A always told me she did. FM-A stated RN-A probably did have tough times with P1 the way RN-A treated him. Bayada Abuse Policy revised 10/11/21, indicated Bayada Home Health has a process in place to assess, identify and appropriately report abuse, neglect, and exploration. In addition, the policy indicated staff was trained in indicators of abuse.

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on interview and document review, the agency failed to immediately report an allegation of abuse for 1 of 1 patient (P1), patient who was verbally, physically, and sexually abused by a registered nurse (RN)-A. The HHA was notified on of the incident at 8/25/22 late afternoon but reported to the State agency the late morning of 8/26/22. P1's Home Health Certification And Plan Of Care (POC) for the certification period 7/27/22 through 9/24/22, indicated C1 had diagnosis of epilepsy, spastic quadriplegic (dysfunction of the upper and lower extremities), encephalopathy ( diffuse disease of the brain that alters brain function or structure), tube feeding, microcephaly (birth defect where baby head is much smaller than expected), and acute respiratory failure with other diseases of the lung. The POC further indicated C1 was to receive skilled nursing 10 to 12 hours per day, 5 to 7 days a week for vital signs, changes for incontinent care, medication via gastrostomy tube, bi-pap machine for breathing, care for abuse, neglect, verbal abuse, sexual abuse, emotional abuse/psychological abuse, and substantial child abuse. During interview on 9/7/22, at 10:30 a.m. the Director of Home Care Services stated RN-A was rough during incontinent change and it was felt the RN-A was punishing him for having a soiled diaper. The Director stated they received video footage of the incident that occurred on 8/25/22 at around 5:00 p.m. and removed RN-A from the schedule so she would not work her next scheduled shift on 8/26/22. A report to the state agency (SA) dated 8/26/22, at 11:56 a.m. indicated on 8/25/22, the home care agency received a phone call from [C1]'s family member (FM)-A who reported RN-A informed her she had a sore back. FM-A stated she reviewed the in-home video footage of [C1]'s room and RN-A was pulling on [C1] and "whipping him around". RN-A was punishing the child for having a soiled diaper. RN-A had been pulled from the schedule pending an internal investigation. The report was reported the next day. During interview on 9/8/22, at 2:00 p.m. the director of health care services stated she was aware the report was made the next day and thought they had 24 hours to make the report to the state agency. Bayada Abuse Policy revised 10/11/21, indicated Bayada Home Health has a process in place to assess, identify and appropriately report abuse, neglect, and exploration. In addition, the policy indicated staff are trained in indicators of abuse. The policy further indicated all incidents must be reported as soon as possible, but not more than 24 hours after learning of the potential incident. The policy should have stated incidents should be reported immediately.