Every finding on record at Bayada Home Health Care, Inc

The facility is in substantial compliance with Appendix Z-Emergency Preparedness for All Provider and Supplier Types, Interpretive Guidance 484.22, Condition of Participation for Home Health Agencies for this survey only.

This was a Federal Recertification Survey, Focused COVID-19 Infection Control Survey, and State Relicensure Survey conducted on September 20, 21, and 22, 2021, that resulted in Standard Level deficiencies. Bayada Home Health Care is not in compliance with 42 CFR Part 484, Conditions Of Participation for Home Health Agencies.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on observation, staff interviews, review of four (4) of eight (8) medical records, and review of facility policies and procedures, it was determined the facility failed to ensure that patient care services are provided in accordance with a physician's order. Findings include: Reference: Facility policy, Missed Visits/Hours, states, “… Physician Ordered Services … The physician must be notified when the plan of care is altered due to fewer visits or hours of service being provided as ordered. Notification of the missed visits/hours is timely, and as directed on a schedule determined in collaboration with the physician.” 1. Upon review of Medical Record #5, the following was noted: a. The home health aide visit frequency orders beginning 7/18/21 states, “2wk4 (two visits a week for four weeks)” i. The week of 7/25/21, the home health aide missed a visit on 7/26/21 and 7/29/21. The physician was not notified. 2. Upon review of Medical Record #6, the following was noted: a. The skilled nursing visit frequency orders beginning 8/4/21 states, “1wk4 (one visit a week for four weeks), 1q2wkx2 (one visit every two weeks for two weeks)” i. The weeks of 8/29/21 through 9/11/21, the skilled nurse did not visit. The physician was not notified. b. The home health aide visit frequency orders beginning 8/15/21 states, “1wk5 (one visit a week for five weeks)” i. The week of 8/22/21, the Home Health Aide missed a visit on 8/22/21. The physician was not notified. 3. The above findings were confirmed with Staff #3 and Staff #5 on 9/22/21 at 1 PM. N.J.A.C. 8:42-13.2(a)6 Reference: Facility policy titled, "37-301 Fall Prevention Program" states, "...5.0 Interventions. Appropriate interventions are put into place to reduce a client's risk of falls. ..." 1. Review of Medical Record #1 on 9/21/21, revealed the following: a. The Plan of Care states that Patient #1 had a history of falling. b. On the Plan of Care, under the section titled DME [durable medical equipment], the following was noted: "DME-Rails/Grab Bars; DME Shower/Tub equipment; DME-Walker with or without wheels PRN [as needed]." c. On the Aide Care Plan Report, under the section titled Personal Care, the following was noted: "Equipment: Bath Chair/Bench." d. A home visit was conducted on 9/20/21 at 11:30 AM at an assisted living facility. During the home visit, a tour of Patient #1's bathroom was conducted in the presence of Staff #9. i. There was no bath chair/bench present in Patient #1's shower. ii. On 9/20/21 at 12:30 PM, Patient #1 stated that shortly after he/she moved in, the shower chair broke and began to accumulate mold, subsequently it was removed and never replaced. iii. On 9/20/21 at 12:45 PM Staff #9 confirmed that a bath/shower chair would reduce the chances of a fall and should have been provided. 2. The above findings were confirmed with Staff #1 and Staff #2 on 9/22/21 at 12 PM. Reference: Facility policy titled, "0-6277 Missed Visits/Hours" states, "...Our Procedure:...The physician must be notified when the plan of care is altered due to fewer visits or hours of service being provided as ordered. ... Documentation...Missed Visit Notification note to capture the reason that the visit was missed as well as evidence that the physician was informed verbally or by fax..." 1. Review of Medical Record #8 on 9/22/21, revealed the following: a. The SOC [Start of Care] began on 8/24/21. b. The Plan of Care states "MSW [Medical Social Worker] 1WK1 [one time per week for one week], 1Q2WK2 [once every two weeks for two weeks]" c. During the week of 9/5/21, there was no evidence that a visit was conducted by the MSW. i . There was no evidence that the physician was notified of the missed visit. ii. There was no documentation in the medical record regarding the missed visit. d. The Plan of Care states, "HHA [Home Health Aide], 1WK2 [one time per week for two weeks], 2WK7 [two times per week for seven weeks]" i. There was no evidence that a HHA visit was conducted the week of 9/5/21. ii. There was no evidence that the provider was notified of the missed visit. 2. Review of Medical Record #7 on 9/22/21 revealed the following: a. The SOC began on 8/8/21. b. The Plan of Care states, OT [Occupational Therapist] 1WK2;1Q2WK2, 1WK3 [once every week for three weeks]. i. During the week of 8/22/21, there was no evidence that an Occupational Therapist conducted a visit. ii. There was no evidence that the provider was notified of the missed visit. 3. Review of Medical Record #1 on 9/21/21, revealed the following: a. The SOC began on 8/28/21. b. The POC states, "HHA Effective 08/29/21 2WK8 [two times per week for eight weeks]. c. During the week of 9/5/21 and 9/12/21, there were no HHA visits conducted for two consecutive weeks, resulting in a total of four missed HHA visits. There was no evidence that the provider was notified. 4. The above findings were confirmed with Staff #2 on 9/22/21.

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 of one (1) of two (2) home visits for wound care, staff interviews, and review of facility policies and procedures, it was determined the facility failed to adhere to acceptable standards of practice for hand hygiene. Findings include: Reference #1: Facility policy titled, "Hand Hygiene" states, "... Indications for hand decontamination… Before applying and after removing gloves… Between contact with the environment and the client… ." Reference #2: Facility policy titled, "Wound Care - Assessment and Treatment" states, "... With gloved hands, remove old dressing and discard. … Remove gloves, decontaminate hands, apply new gloves." Reference #3: Facility policy titled, "Bag Technique" states, "... Decontaminate hands with alcohol based waterless hand gel or antimicrobial soap and water prior to entering the bag." 1. On 9/20/21, during a home visit for Patient #4, the following was observed: a. At 1:45 PM, Staff #11 doffed his/her gloves and failed to sanitize his/her hands. b. At 1:53 PM, Staff #11 removed a dressing from the patient's right hip, cleaned the wound, and applied a new dressing without changing his/her gloves. c. At 1:56 PM, Staff #11 doffed his/her gloves and failed to sanitize his/her hands. d. At 1:58 PM, Staff #11 touched the patient's foot with gloved hands, then removed a barrier pad from his/her nursing bag without removing his/her gloves and performing hand hygiene. 2. The above findings were confirmed with Staff #1 and Staff #3 on 9/21/21 at 12:40 PM. N.J.A.C. 8:42-12.3(a)4