Every finding on record at Bayada Home Health Care Inc

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

This was a Federal Recertification and State Re-licensure survey conducted 9/14-16/2023. Bayada Home Health Care is not in compliance with Federal requirements under 42 CFR Part 484 regulations for Home Health Agencies and State requirements under Title 8, Chapter 42, Licensing Standards for Home Health Agencies. Standard-level deficiencies were cited.

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 the review of one out of 12 medical records (Patient (P) 11), and staff interview it was determined that the facility failed to ensure services ordered by the physician are provided in accordance with the plan of care. Findings include: Facility policy titled, 0-6277 MISSED VISITS/HOURS (reviewed 3/24/23) states, “…Our Policy: BAYADA Home Health Care has a process for communication and documentation related to missed visits/hours that are not provided at the frequency stated on the plan of care. Our Procedure: 1.0 COMMUNICATING MISSED VISITS/HOURS. 1.1 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. 1.1.1 Documentation- Home Health and Hospice Offices. 1.1.1.1 A 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 (unless otherwise required by State regulation) of this variation from the plan of care must be entered into the electronic record. 1.1.1.2 Missed Visit Process Flow. The field clinician is responsible for documenting the missed visit in the “Missed Visit Coordination Note” found in the electronic record. 1.1.1.2.1 The Missed Visit Coordination Note will include the following: a. Date missed visit occurred; b. Reason for missed [sic] visit; and c. Method of notification to physician (verbal or fax). …” On 9/15/23, a review of Patient (P) 11’s Plan of Care, for the Certification Period 8/24/2023 through 10/22/2023, indicated the following orders for skilled nursing visits: “SN [Skilled Nurse] 1WK8 [one visit each week for eight weeks], 2WK1 [two visits each week for one week], 1WK1 [one visit each week for one week.]” For the week of 9/10/23, P11’s medical record lacked evidence that a skilled nursing visit was conducted. P11’s medical record lacked evidence of a Missed Visit Coordination Note. P11’s orders for Home Health Aide were “HHA [Home Health Aide] effective 08/27/2020 2wk3 [two visits a week for three weeks]”. The week of 8/27/23, P11 had a HHA visit on 8/31/23. P11’s medical record lacked evidence of a second HHA visit for the week of 8/27/23. P11’s medical record lacked evidence that any HHA visits were made during the weeks of 9/3/23 or 9/10/23. The medical record lacked evidence of Missed Visit Coordination Notes for any of the missed visits. On 9/15/23 at 11:10 AM, during an interview with Staff (S)1, he/she explained that the HHA did not see the patients and then went out on sick leave and subsequently resigned. S1 explained that he/she is waiting to receive the HHA’s tablet to see if documentation of the missed visits were documented. S1 could not reconcile the SN missed visit from the week of 9/10/23. N.J.A.C. 8:42-6.2(a)(6)