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

An onsite recertification survey was conducted 1/27/25-1/29/25. No deficiencies to the Emergency Preparedness Plan were identified.

An unannounced, onsite recertification survey was conducted 1/27/25-1/29/25. Standard level deficiencies to the Medicare CoP were identified.

Accuracy of encoded OASIS data CFR(s): 484.45(b) Standard: The encoded OASIS data must accurately reflect the patient's status at the time of assessment. This STANDARD is not met as evidenced by: Based on clinical record review and staff interviews the Start of Care OASIS' [Outcome and Assessment Information Set-collection of data elements that home health agencies use to assess and report on patient quality] were incorrect for 3 of 13 patients [#1, 8, and 4]. The findings included: 3. Patient #4 had a Start of Care date of 01/09/2025 with an admitting diagnosis of hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles) following cerebral infarct (stroke) affecting left, non-dominant side. Review of the Plan of Care for the certification period 01/09/2025-03/09/2025 included orders for PT (physical therapist) 1 time a week for 1 week, 2 times a week for 4 weeks, 1 time a week for 3 weeks. Review of the clinical record revealed PT #11completed the start of care OASIS (Outcome and Assessment Information Set- group of standard data elements used to measure home health patient outcomes) on 1/9/2025. NO415 (high risk medications) was answered incorrectly. The patient was taking Tramadol (an opioid pain medication used for moderate pain) 50mg 2 times daily and Plavix (anti-platelet drug used to prevent blood clots). NO415 indicated the patient was not taking any opioids or anti-coagulation (affects blood clotting) medication. Patient # 1 had a Start of Care [SOC] date of 12/5/24 and an admitting diagnosis of disrupt/dehisce closure wound [surgical wound reopens]. Review of the Plan of Care [POC] for the certification period 12/5/24-2/2/25 included orders for SN [skilled nursing] 1 time a week for 1 week; 2 times a week for 1 week, 1 time a week for 7 weeks. Review of the clinical record revealed RN # 9 completed the SOC OASIS [Outcome and Assessment Information Set-collection of data elements that home health agencies use to assess and report on patient quality] on 12/5/24. Review of the OASIS question NO415 [high risk medications] indicated the patient was taking an antibiotic and hypoglycemic only. Review of the POC revealed the patient was also using Oxycodone [opioid] 5 mg every 6 hours as needed for pain. NO415 did not capture the use of an opioid. During an interview with the agency director on 1/29/25 at approximately 10 am, the director confirmed the OASIS information was not accurate. Patient # 8 had a Start of Care [SOC] date of 12/4/24 with admitting diagnoses of disruption of wound [wound re-opens], infection following a procedure, and type 2 diabetes without complications. Review of the plan of care for the certification period 12/4/24-2/1/25 included orders for SN 1 time a week for 1 week, 2 times a week for 1 week, 1 time a week for 7 weeks. Review of the clinical record revealed RN # 1 completed the OASIS [Outcome and Assessment Information Set-collection of data elements that home health agencies use to assess and report on patient quality] on 12/4/24. Review of the OASIS question NO415 [high risk medications] indicated the patient was not taking an opioid. Review of the POC revealed the patient was ordered Oxycodone [pain medication] 5 mg every 6 hours as needed for pain. During an interview with the agency director on 1/29/25 at 9:45 am the director the OASIS was incorrect.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on policy review, client record review, and staff interviews, the agency failed to update the plan of care for skilled nursing missed visits for 1 of 13 records reviewed (7); .and failed to update the care plan interventions for 2 of 13 patients [#4 and 8]. The findings included: The policy, Client Care Plan [1/1/93], was provided by the agency director on 1/27/25 at 2:07 pm. The policy stated, "...Actions and interventions are consistant with the plan of care and are documented..." 3. Patient # 8 had a Start of Care [SOC] date of 12/4/24 with admitting diagnoses of disruption of wound [wound re-opens], infection following a procedure, and type 2 diabetes without complications. Review of the plan of care for the certification period 12/4/24-2/1/25 included orders for SN 1 time a week for 1 week, 2 times a week for 1 week, 1 time a week for 7 weeks and “SN will assess and instruct...on diabetes management including...hypoglycemia/hyperglycemia, monitoring blood glucose...notify physician of blood glucose greater than 350 or less than 60.” Review of the clinical record revealed RN # conducted the SOC on 12/4/24 and documented, “Patient needs glucometer.” The patient received 9 SN visits from 12/4/24-1/23/25. No blood sugar readings were documented 9 out of 9 visits. During an interview with the agency director on 1/29/25 at approximately 11 am, the director stated, “The patient refused to check his blood sugars. We should have updated the POC to indicate that.” 2. Patient #4 had a Start of Care date of 01/09/2025 with admitting diagnoses of hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles) following cerebral infarct (stroke) affecting left, non-dominant side and heart failure, unspecified (heart unable to pump sufficient amount of blood). Review of the Plan of Care for the certification period 01/09/2025-03/09/2025 included orders for PT (physical therapist) 1 time a week for 1 week, 2 times a week for 4 weeks, 1 time a week for 3 weeks and “physical therapist will assess and instruct on management of heart failure, early recognition of signs of exacerbation and client caregiver self-management including activity intolerance and client’s weight. Notify physician of weight gain of 3 pounds in one day or 5 pounds in one week.” Review of clinical record, on 1/15/2025, 1/16/2025, and 1/23/2025 visits, PTA #8 charted under interventions provided “…educated client on self-management of heart failure, breathing techniques, energy conservation, self-monitoring tools, oxygen management, and daily weights. On 1/15/2025, 1/16/2025, 1/23/2025, and 1/24/2025 visits under vital signs portion, PTA #8 charted “clinical exception-unable to weigh”. During phone interview on 01/29/2025 at approximately 10 am with PTA #8 with agency director present, it was confirmed that client can not weigh in home due to wheelchair bound and balance issues and client is not on oxygen. PTA #8 and Director stated that “interventions provided section automatically populates based on diagnosis and the plan of care interventions were not updated based on the patient's inability to weigh and no supplemental oxygen in the home”. Review of a policy “0-945 Client Care Plan”, revised 7/5/21 was received from the agency director on 1/28/25 at 2:07 PM. The policy stated, …” changes in the client’s medical conditions and environment are reflected in ongoing revisions made to the original plan of care…” 1.Patient #7 was admitted on 12/7/24 with diagnoses of hemiplegia (weakness on one side of the body), essential hypertension (high blood pressure), and chronic pain. Orders were for skilled nursing 1 time a week for 5 weeks, 1 time every 2 weeks for 2 weeks, and 1 time a week for 1 week. Review of the clinical record on 1/28/25 revealed missed nursing visits for the weeks of 12/20/24 thru 1/24/25 for a total of 6 weeks. The plan of care was not updated to discontinue skilled nursing. Interview with the RN #1 on 1/29/25 at 9:19 AM revealed, “I never got to see Patient #7, she didn’t want a visit, always had to reschedule, or wouldn’t answer the phone”. “I kept on giving her the benefit of doubt, I didn’t want to discharge her without seeing her, I didn’t think about updating the plan of care”.

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 agency policy, clinical record review, home visit observations, and staff interviews the Plan of Care failed to include all/current medications the patient was taking for 4 of 5 home visits [#1, 5, 2, and 4]. The findings included: The policy, Medication Managament and Administration [1/1/93], was presented by the agency director on 1/27/25 at 2:07 pm. The policy stated, "...medication reconcilation should be done on every assessment and reassessment..." 3. Patient #2 had a Start of Care date of 12/30/2024 with admitting diagnoses of Urinary tract infection, pneumonia, hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles) following cerebral infarct (stroke) affecting right, dominant side. Review of the Plan of Care for the certification period 12/30/2024 - 02/27/2025 included orders for PT (physical therapist) 1 time a week for 1 week, 2 times a week for 2 weeks, 1 time a week for 5 weeks. “…physical therapist will develop physical therapy plan of care in consultation with the physician that includes…identification of new or changed medications…” A joint visit with PT #11 was conducted on 01/27/2025 at approximately 4 pm. During the visit a medication review was conducted using a medication profile provided by the agency. The following discrepancies were noted: Melatonin (sleep aid) 3 mg as needed at bedtime, Docusate Sodium (stool softener)100 mg daily as needed, and Tylenol (for mild pain) 500mg 2 caplets as needed. The patient’s husband states that patient takes these medications when she needs them. During an interview with the agency director on 1/29/2025 at approximately 9:45 am, it was determined that the plan of care did not include all the correct medications the patient was using. 4. Patient #4 had a Start of Care date of 01/09/2025 with an admitting diagnosis of hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles) following cerebral infarct (stroke) affecting left, non-dominant side. Review of the Plan of Care for the certification period 01/09/2025-03/09/2025 included orders for 1 time a week for 1 week OT (occupational therapist) evaluation. Supplemental order was dated 1/12/2025 for 1 time every other week for 2 weeks, 1 time a week for 2 weeks. During a joint visit with OT #10 on 01/28/2025 at approximately 1pm, a medication review was conducted using a medication profile provided by the agency. The patient’s caregiver presented all the patient’s medication bottles for review. The patient confirmed that he takes all the medications presented by the paid caregiver. The following discrepancies were noted: The medication profile listed Amiodarone (used to treat an irregular heartbeat) 200mg daily. This medication was not found in the patient’s home with his other medications and the patient denies taking it. The patient reported using the following medications that were not listed on the agency provided medication list: Atorvastatin (used to treat high cholesterol) 80mg 1 tablet at bedtime, Tamsulosin (used to treat symptoms such as decreased urine flow in men with an enlarged prostate) 0.4 mg 1 tablet daily, Lisinopril (used to treat high blood pressure and heart failure) 10 mg 1 tablet daily, Senna (laxative for constipation) over the counter, 8.6 mg as needed, Aspirin (low dose preventative daily dose for treating risk of heart attack and stroke) 81mg 1 tablet daily, and a generic Men’s 50+ multivitamins over the counter. During an interview with the agency director on 1/29/2025 at approximately 9:30 am, it was determined that the plan of care did not include the correct medications. Patient # 1 had a Start of Care date of 12/5/24 and an admitting diagnosis of disrupt/dehisce closure wound [surgical wound reopens]. Review of the Plan of Care for the certification period 12/5/24-2/2/25 included orders for SN [skilled nursing] 1 time a week for 1 week; 2 times a week for 1 week, 1 time a week for 7 weeks. There was a supplemental order written on 12/15/24 for SN 2 times a week for 1 week and 3 times a week for 6 weeks. On 1/17/25 at approximately 4:30 pm, a joint visit was conducted with RN # 9. During the visit a medication review was conducted using the medication profile provided by the agency. The following discrepancies were noted: The medication profile listed Methocarbamol [muscle relaxant] 500 mg 3 times per day, Sulfamethoxazole 800 mg/Trimethoprim 160 mg [antibiotic]. Take 1 tablet 2 times per day, and Famotidine 40 mg [used for reflux]. Take 1 tablet every evening. During an interview with the patient on 1/27/25 at approximately 5:30 pm, the patient stated, “I don’t use those medicines.” During an interview with the agency director on 1/29/25 at approximately 9:30 am, the director confirmed the plan of care did not include the correct medications the patient was taking. Patient # 5 had a Start of Care date of 11/5/24 and admitting diagnoses of type 2 diabetes mellitus with foot ulcer, and non-pressure chronic ulcer other part left foot limited to breakdown of skin. Review of the plan of care for the certification period 1/4/25-3/4/25 revealed orders for SN [skilled nursing] 1 time a week for 8 weeks and “...continuous review of medication regimen...” On 1/28/25 at approximately 9:30 am a joint visit was made with RN # 7. During the visit a medication review was conducted using a medication profile provided by the agency. The following discrepancies were noted: The medication profile listed oxycodone [pain medication] 5 mg. Take 1 capsule every 6 hours as needed for pain. [There was a 5-day supply ordered with a start day of 11/13/24]. During an interview with the patient, he reported “I haven’t had any of those pills in a long time.” The patient reported using Tylenol 325 mg 2 tablets every 4 hours as needed for pain. The Tylenol was not on the medication profile. During an interview with the agency director on 1/29/25 at approximately 9:45 am, the director confirmed the plan of care did not include all/correction medications the patient was using.

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 policy review, client record review, and staff interviews, the agency failed to follow the physicians order for physical therapy evaluations for 2 of 9 records reviewed with physical therapy (1 and 12). Findings included: Review of a policy “0-945 Client Care Plan”, revised 7/5/21 was received from the agency director on 1/28/25 at 2:07 PM. The policy stated, …” changes in the client’s medical conditions and environment are reflected in ongoing revisions made to the original plan of care…” 2. Patient #12 was admitted on 3/13/24 with diagnoses of pressure ulcer stage 2, right buttock; osteoarthritis, kidney disease, and heart failure. Orders were for physical therapy 1 time a week for 1 week effective the week of 3/17/24. Review of the clinical record on 1/27/25 revealed the physical therapy evaluation was completed on 3/27/24 not as ordered the week of 3/17/24. Interview with the agency director on 1/29/25 at 10:00 AM revealed, “I didn’t see any documentation on the reason the physical therapy evaluation was delayed”. 1. Patient # 1 had a Start of Care date of 12/5/24 and an admitting diagnosis of disrupt/dehisce closure wound [surgical wound reopens]. Review of the clinical record revealed a supplemental order dated 12/23/24 to for PT [physical therapy] to eval. Further review of the clinical record revealed no PT evaluation as of 1/27/25. During an interview with the agency director on 1/29/25 at approximately 10 am, the director confirmed the patient did not receive a PT evaluation.

An unannounced, onsite recertification survey was conducted 02/14/22 to 02/16/22. No deficiencies to the Emergency Preparedness Program were identified. -MHB

An unannounced, onsite recertification survey was conducted 02/14/22 to 02/16/22. Deficiencies to the Medicare Conditions of ParticIpation were identified. -MHB

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 policy review, clinical record review, and staff interviews the agency failed to provide services as ordered by the physician for 4 of 8 patients with occupational therapy services (#2, #7, #13 and #14). Findings included: A policy, “Client Plan of Care”, revised 12/02/21 was received by the agency director on 02/15/22 at 4:05 p.m. The policy stated, “… the registered nurse/therapist is responsible for documenting the plan of care for clients receiving nursing/therapy/home health aide services, any revisions or changes to the client’s condition will be communicated with the provider…” Patient #2 was admitted on 12/22/21 with diagnoses including left femur (thigh bone) fracture and surgical repair, cellulitis (a bacterial infection of the skin) of the left lower limb, hypertension, atrial fibrillation (an irregular heart beat), chronic respiratory failure, chronic obstructive pulmonary disease. Plan of Care from 12/22/21 to 02/19/22 included orders for skilled nursing 1 time per week for 1 week, 2 times per week for 2 weeks and 1 time per week for 6 weeks; physical therapy 1 time per week for 2 weeks, 2 times per week for 4 weeks, and 1 time per week for 4 weeks; occupational therapy 1 time per week for 1 week effective 12/26/21; medical social worker 1 time per week for 1 week effective 12/26/21; home health aide 2 times per week for 7 weeks and 1 time per week for 1 week. Review of the clinical record revealed an occupational therapy assessment performed on 01/20/22. There was no evidence of an occupational therapy visit prior to the 01/20/22 visit. An interview with the agency director on 02/16/22 at 12:20 p.m. revealed, “…no other documentation is in the record regarding the occupational therapy visits”. Patient #7 was admitted on 01/26/22 with diagnoses of occlusion and stenosis of bilateral carotid arteries, syncope and collapse, hemiplegia following cerebral infarction, heart failure, old MI (myocardial infarction), and type 2 diabetes. The plan of care for 1/26/22 to 03/26/22 included orders for physical therapy 1 time a week for 1 week, and 2 times a week for 4 weeks, and occupational therapy 1 time a week for 1 week. Review of the occupational therapy note for 02/10/22 revealed a missed visit was conducted and it stated reschedule. No other occupational therapy documentation was in the record. An interview with the agency director on 02/16/22 at 12:20 p.m. revealed, “no other documentation is in the record regarding the occupational therapy visits”. Patient #13 was admitted on 01/24/22 with diagnoses of secondary malignant neoplasm of large intestine and rectum, old MI (myocardial infarction), essential hypertension, hyperlipidemia (high cholesterol), and GERD (gastro esophageal reflux disease). The plan of care for 01/24/22 to 03/24/22 had orders for skilled nursing 2 times a week for 3 weeks, physical therapy 1 time a week for 1 week, and occupational therapy 1 time a week for 1 week. Review of the occupational therapy note for 02/10/22 revealed a missed visit was conducted and it stated reschedule. No other occupational therapy documentation was in the record. An interview with the agency director on 02/16/22 at 12:20 p.m. revealed, “no other documentation is in the record regarding the occupational therapy visits”. Patient #14 was admitted to the agency on 11/28/21 with diagnoses including encounter for surgical aftercare following surgery on the genitourinary system, chronic kidney disease, Type 2 diabetes, generalized muscle weakness, atrial fibrillation (an irregular heart rhythm), gastritis, and thrombocytopenia (a condition with low blood platelet levels). Plan of Care from 11/28/21 to 01/26/22 revealed orders for skilled nursing 2 times per week for 1 week and 1 time per week for 6 weeks, physical therapy 2 times per week for 3 weeks, 1 time per week for 1 week, 2 times per week for 3 weeks and 1 time per week for 1 week, occupational therapy 1 time per week for 1 week effective 12/12/21, and medical social worker 1 time per week for 1 week. Coordination note of 12/20/21 revealed, “Caregiving daughter declined OT (occupational therapy) evaluation for Thursday requested [sic] OT evaluation take place next week…” There was no evidence of an occupational therapy evaluation in the clinical record at the time of survey. An interview with the agency director on 02/16/22 at 12:20 p.m. revealed, “…no other documentation is in the record regarding the occupational therapy visits”.

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on policy review, clinical record review and staff interview, the agency failed to notify the physician of a patient’s reported medication changes and failed to notify the physician of a new onset of symptoms for 1 of 24 (Patient #14) records reviewed. Findings included: Policy Client Plan of Care, revised 12/01/21, was received on 02/15/22 at 4:05 PM from the agency director. This policy stated, “All home health services are furnished under a provider’s order, based on the client’s plan of care that is established in collaboration with the client, the provider, and the (agency name) staff…the plan of care is reviewed by each discipline involved in the client’s care on each visit and revised as often as the severity of the client’s condition and/or changes in the environment require…” and “…all personnel providing services maintain a liaison to assure that their efforts effectively complement each other and support the goals and objectives outlined in the client’s plan of care…the home health agency must promptly alert the relevant provider(s) to any change in the client’s condition or needs that suggest outcomes are not being achieved and/or that the plan of care should be altered…” 1. Patient #14 was admitted to the agency on 11/28/21 with diagnoses including encounter for surgical aftercare following surgery on the genitourinary system, chronic kidney disease, Type 2 diabetes, generalized muscle weakness, atrial fibrillation (an irregular heart rhythm), gastritis, and thrombocytopenia (a condition with low blood platelet levels). Plan of Care from 11/28/21 to 01/26/22 revealed orders for skilled nursing 2 times per week for 1 week and 1 time per week for 6 weeks, physical therapy 2 times per week for 3 weeks, 1 time per week for 1 week, 2 times per week for 3 weeks and 1 time per week for 1 week, occupational therapy 1 time per week for 1 week effective 12/12/21, and medical social worker 1 time per week for 1 week. Physical therapy assistant note dated 01/10/22 revealed, “Pt (patient) c/o (complains of) nausea, out of meclizine (an anti-nausea medication), taking pepto bismal [sic] (Pepto Bismol-an over the counter medication used for gastrointestinal symptoms) tabs for nausea. Pt called PCP (primary care physician) for new meclizine prescription.” Physical therapy assistant note dated 01/12/22 revealed, “Pt is taking OTC (over the counter) Prilosec for stomach issues.” 2. Employee #6, a registered nurse, discharged from Patient #14 from skilled nursing services on 01/12/22. The patient’s blood glucose level was documented as unknown. There is no evidence of coordination or collaboration between agency staff or with the physician regarding Patient #14’s stomach symptoms. Physical therapy assistant visit note dated 02/02/22 revealed, “Pt has had no stomach upset since she quit taking double BP meds (blood pressure medication).” 3. Employee #13, the supervising physical therapist, performed a physical therapy reassessment visit on 01/19/22. There was no evidence of coordination or collaboration between agency staff or with the physician regarding Patient #14 taking duplicate medication. In an interview on 02/16/22 at 11:10 AM, Employee #4, the physical therapy assistant, stated, “The supervising PT (physical therapist) went out to see her for reassessment. He found out that she was taking double the medication. He was doing a medication reconciliation. He identified that she was taking two of the same medications…She had been having stomach problems…since she found that out her daughter and (Employee #13) discovered that she was taking both of those when he did his reassessment visit…Her doctor is aware now that she had been doing that…(Employee #13) was the one that figured out that she was taking the extra one (medication).” In an interview on 02/16/22 11:15 AM, Employee #13, the supervising physical therapist, stated, “I don’t recall” when asked if the physician had been notified regarding Patient #14 taking duplicate medication. Employee #13 further stated, “I had discussed that with the daughter and I believe she had all of her pills together…there was a duplicate order that I saw on one of the visits…No, the double medication, I did not document that…I did not do that (report to the physician). I believe (Employee #4) did. Employee #13 stated if the physical therapy assistant did not report this information to the physician, the physical therapist should. In an interview on 02/16/22 11:15 AM, Employee #1, the agency director, stated, “The PT should document that, and it should be reported to the physician.” In an interview on 02/16/22 12:11 PM, Employee #6, a registered nurse, stated, “With the blood sugar, I honestly don’t remember…usually I know when I put unknown when I’m asking them what the blood sugar level was for that day…I ask what the usual blood sugar is and they don’t know, I will put unknown…I honestly don’t remember that patient since I only did the discharge.” In an interview on 02/16/22 at 12:17 PM, Employee #1, the agency director, stated that the expectation of a clinician in this situation would be to “…check the blood sugar, try to figure out what’s going on, report that to the doctor, possibly put the nursing discharge on hold and get orders to continue services.”

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 policy review, client record review, and staff interview the agency failed to provide an accurate care plan for 1 of 5 patients with a home health aide (#11). Findings included: Review of policy “Aide Documentation”, revised 07/14/2021 was received from the agency director on 02/15/22 at 4:05 p.m. The policy stated,” …completing all parts and providing the aide with the necessary information to carry out his/his duties safely…”. Patient #11 was admitted on 12/10/2021 with diagnoses of multiple fractures of ribs, pneumonia, unspecified dementia, headache and rheumatoid arthritis. The plan of care for 02/08/22 to 04/08/22 had orders for skilled nursing 1 time a week for 5 weeks, physical therapy 2 times a week for 3 weeks, and 1 time a week for 4 weeks, and occupational therapy 2 times a week for 4 weeks. The home health aide saw the patient 2 times a week for 2 weeks. Review of the home health aide care plan revealed the patient was to have a shower every visit and a partial sponge bath as requested every visit. Interview with the clinical manager on 2/16/22 at 11: 56 a.m., revealed, “our protocol is one or the other regarding a bath or shower, not both”. The aide was not available to interview.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on policy review, client record review, and staff interview the clinical record failed to include wound measurements for 3 of 11 charts with wounds (#8, 15, and #17) PICC (peripherally inserted central catheter) line measurements for 2 of 2 charts with PICC lines (#5 and #24). Findings included: Review of an undated policy “Wound Assessment and Documentation”, was received from the agency director on 02/15/22 at 4:05 p.m. The policy stated,” ….it is (agency's name) policy to measure wounds at least once weekly…”. Review of policy “PICC Line Protocol and Procedure”, revised 12/6/2021 was received from the agency director on 02/15/22 at 8:47 a.m. The policy stated,” …on admission measure 2 inches above the PICC line insertion site the circumference of the arm in centimeters… measure the external length of the PICC line from the insertion site to the beginning of the hub (hard plastic piece) in centimeters…”. 1. Patient #8 was admitted on 01/14/22 with diagnoses of aftercare following joint replacement, presence of left artificial hip joint, gout, atrial fibrillation, essential hypertension, and long-term use of anticoagulants. The plan of care for 01/14/22 to 03/14/22 had orders for skilled nursing 1 time a week for 2 weeks, 2 times a week for 1 week, and 1 time a week for 5 weeks. Orders for skilled nursing to observe and assess integumentary status to identify changes and intervene to minimize complications. Review of skilled nursing notes for dates of 01/14/222, 01/18/22, 01/25/22, 01/27/22, 02/01/22, 02/10/22 revealed measurements were not obtained for the week of 01/25/22. Interview with Employee #6 on 2/16/22 at 12:11 p.m. revealed, “I didn’t do measurements, I looked the wounds but didn’t do the measurement”. 2. Patient #15 was admitted was admitted on 7/1/21 with diagnoses of encounter for aftercare following other organ transplant, type 2 diabetes with foot ulcer, non-pressure chronic ulcer other part of foot, cutaneous abscess of right foot, and peripheral vascular disease. The plan of care for 12/28/21 to 02/25/22 had orders for skilled nursing 2 times a week for 9 weeks. Orders for skilled nurse to perform/teach wound care to cleanse with dakins or wound cleanser hydrofera blue classic then foam to heel. Change daily iodoform in distal wound cover with hydrofera blue and foam as well. Review of skilled nursing notes for dates of 01/05/22, 01/07/22, 01/12/22, 01/14/22, 01/19/22, 01/22/22, 01/26/22, 01/28/22, 02/02/22, 02/04/22, 02/09/22, and 02/11/22 revealed measurements were not obtained for the weeks of 02/02/22 and 02/09/22. Interview with Employee #8 on 2/16/22 at 11:33 a.m., stated” I think the dressing could not be removed due to going to the doctor to have surgery”.“ it looks like the measurement code was on Friday and since she wasn’t seen on Friday that’s why it was missed”. 3. Patient #17 was admitted on 12/01/21 with diagnoses of type 2 diabetes with foot ulcer, chronic osteomyelitis (bone infection), end stage renal disease, venous insufficiency, mixed hyperlipidemia (high cholesterol), and dependence on dialysis. The plan of care for 01/30/22 to 03/30/22 had orders for skilled nursing 3 times a week for 8 weeks and 2 times a week for 1 week. Orders for skilled nurse to perform/teach wound care: clean with soap and water, irrigate wound with ½ strength dakins, apply aquacel ag to wound bed cover with foam secure with tape and burn netting and apply 2 layer wrap to right leg, change 3 times a week and prn (as needed) heavy drainage. Review of skilled nursing notes for dates of 01/31/22, 02/02/22, 02/04/22, and 02/11/22 revealed measurements were not obtained for the week of 2/7/22. Interview with Employee #8 at 12:15 p.m. on 02/16/22 revealed “I didn’t do the wound measurements”. 4. Patient #5 was admitted on 01/28/22 with diagnoses of infection reaction due to internal right knee prosthesis, cutaneous abscess of right lower limb, encounter for adjustment and management of VAD (vascular access device), long term use of antibiotic, and essential hypertension. The plan of care for 01/28/22 to 03/28/22 had orders for skilled nursing 1 time a week for 8 weeks, and 2 times a week for 1 week. Orders for skilled nurse for observation/assessment of iv (intravenous) access site, response to medication and skilled teaching regarding infusion procedure, care of infusion line and site care, care and use of infusion equipment and signs/symptoms of complications of IV therapy. Review of the start of care skilled nurse visit note of 1/28/22 revealed PICC line measurements were not obtained. Interview with Employee #5 on 2/16/22 at 11:45 a.m. revealed, “no I didn’t measure on his admission the infusion nurse was coming at 4, and I didn’t mess with his PICC line”. 5. Patient #24 was admitted on 03/19/21 with diagnoses of other acute osteomyelitis (bone infection), left foot and ankle, type 2 diabetes mellitus with foot ulcer, encounter for adjustment and management of VAD (vascular access device), and essential hypertension. The plan of care for 03/19/21 to 05/17/21 had orders for skilled nursing 1 time a week for 9 weeks. Orders for skilled nurse for observation/assessment of iv (intravenous) access site, response to medication and skilled teaching regarding infusion procedure, care of infusion line and site care, care and use of infusion equipment and signs/symptoms of complications of IV therapy. Review of skilled nursing notes for dates of 3/19/21, 3/23/21, 3/31/21, 4/7/21, 4/13/21, and 4/21/21 revealed no PICC line measurements were obtained on any of the nursing visits. Interview with Employee #10 on 2/16/22 at 11:23 a.m., revealed, “I usually document the measurements in the PICC line section”, “I don’t know why I put no for IV access device”.