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

Recertification survey conducted 4/8/24-4/10/24. No deficiencies to the EP program identified.

An unannounced recertification and complaint investigation was conducted 04/08/24-04/10/24. Standard level deficiencies to the Medicare Conditions of Participation were identified. The complaint was unsubstantiated.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on agency policy review, clinical record review and staff interviews the SN [skilled nurse] failed to assess the PICC [peripherally inserted central line catheter used to access large veins to prevent repeated sticks for medications] line site for 2 of 2 patients with a PICC line [#10,14] and failed to obtain wound measurements for 1 of 5 [#10] patients with a wound. The findings included: The agency procedure guide, PICC [peripherally inserted central line catheter used to access large veins to prevent repeated sticks for medications] Line Management [no date], was provided by employee # 4 on 4/10/24 at 8:30 am. The procedure stated, “…Verify that external length visible outside corresponds to initial placement measurement. If it does not, notify physician before continuing use…Assess for signs of infection, including redness, swelling, inflammation, tenderness, or exudate. Assess for catheter migration. Observe the external catheter length and compare it to the insertion record…” The policy, Wound Care-Assessment and Treatment [9/9/21], was provided by employee # 4 on 4/10/24 at 8:30 am. The policy stated, “…Wounds should be measured in centimeters [cm] once per week and/or as physician’s order…” 1. Patient # 10 had a Start of Care date of 3/11/24 and admitting diagnoses of infection/inflammation reaction due to internal left knee prothesis, methicillin resistant staphylococcus [type of bacteria] infection causing diseases classified elsewhere, and encounter for adjustment and management of VAD [vascular access device- a device which allows repeated and long-term access to the bloodstream for frequent or regular administration of drugs]. Review of the Plan of Care for the certification period 3/11/24-5/9/24 included orders for SN [skilled nursing] 2 times a week for 1 week, 1 time a week for 4 weeks, 2 times a week for 1 week and “PICC [peripherally inserted central line catheter used to access large veins to prevent repeated sticks for medications] care as follows: …cleanse PICC site with alcohol/betadine swab sticks…provide dressing change weekly…” Review of the clinical record revealed the patient received SN visits on 3/18/24, 3/25/24, and 4/1/24. Further review of the clinical record revealed no PICC line assessment was completed. During an interview with employee # 1 on 4/10/24 at approximately 12:30 pm, employee # 1 confirmed the PICC line should have been assessed with each visit. 2A. Patient # 14 had a Start of Care date of 3/4/24 with admitting diagnoses of encounter for change or removal of surgical wound dressing, encounter for orthopedic aftercare following surgical amputation, and acquired absence of other right toe. Review of the Plan of Care for the certification period 3/4/24-5/2/24 included orders for SN [skilled nursing] 3 times a week for 8 weeks, 2 times a week for 1 week and “SN will apply negative pressure wound therapy to right 5th toe amputation site…set device at 125 mmHg …change 3 times per week…educate and monitor for signs and symptoms of infection.” Review of the clinical record revealed the patient had an inpatient stay from 3/18/24-3/26/24. The patient was discharged home with a PICC [peripherally inserted central line catheter used to access large veins to prevent repeated sticks for medications] line. The resumption of care [ROC-assessment after patient is admitted inpatient for at least 24 hours] visit was completed on 3/27/24 by RN # 3. Review of the ROC orders included the following orders “skilled nurse will collect/perform blood sample via venipuncture/PICC line…perform IV site care with PICC supplies using aseptic technique weekly and prn [as needed] …” RN # 3 obtained PICC line measurements during the ROC visit. Review of the clinical record revealed the patient received 5 SN visits from 3/27/24-4/8/24. Review of the visit documentation revealed no PICC line assessment was completed for 3 of the 5 SN visits. During an interview with employee # 1 on 4/10/24 at approximately 2 pm, employee # 1 confirmed the PICC line should be assessed/measured with each visit to prevent complications. 2B. Patient # 14 had a Start of Care date of 3/4/24 with admitting diagnoses of encounter for change or removal of surgical wound dressing, encounter for orthopedic aftercare following surgical amputation and acquired absence of other right toe. Review of the Plan of Care for the certification period 3/4/24-5/2/24 included orders for SN [skilled nursing] 3 times a week for 8 weeks, 2 times a week for 1 week and “SN will apply negative pressure wound therapy to right 5th toe amputation site…set device at 125 mmHg …change 3 times per week…educate and monitor for signs and symptoms of infection.” Review of the clinical record revealed the amputation site measured 5.5 cm x 4 cm x 1.5 cm on 3/4/24. LPN # 2 made routine visits the week of 3/11/24. The clinical record revealed no wound measurements for that week. The patient was hospitalized from 3/18/24-3/26/24 with the resumption of care [ROC-assessment after patient is admitted inpatient for at least 24 hours] visit completed on 3/27/24 by RN # 3. RN # 3 documented wound measurements of 3.5 cm x 0.5 cm x 0.2 cm on 3/27/24. Further review of the clinical record revealed LPN # 2 conducted a routine visit on 4/1/24 and 4/8/24. RN # 3 conducted a PRN visit on 4/1/24. No wound measurements were obtained for any of those visits. During an interview with employee # 1 on 4/10/24 at approximately 10:30 am, employee # 1 stated, “Wounds are to be measured weekly. The patient should have at least 1 RN visit each week so they could have obtained the wound measurements.” During the interview, employee # 1 confirmed the patient’s wound was not measured weekly.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview the SN [skilled nurse] failed to document communication with physician in the clinical record regarding administration of an enema for 1 of 1 patient with an order for an enema [#1]; failed to document communication with the physician regarding bleeding around a G [gastrostomy] tube site for 1 of 1 patient with a G tube [#1]; failed to document communication with the physician regarding an order to discontinue a wound vac for 1 of 1 patient with a wound vac [#14]; failed to document communication with the physician regarding change in a wound for 1 of 5 patients with a wound [#14]. The findings included: 1A. Patient # 1 had a Start of Care date of 8/4/23 and admitting diagnoses of Ileus [obstruction in part of the intestines] and dysphagia [difficulty swallowing] following cerebral infarction [stroke]. Review of the Plan of Care for the certification period 8/4/23-10/2/23 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 2 weeks, 1 time every 2 weeks for 4 weeks, 1 time a week for 1 week. Review of the clinical record revealed a physician’s verbal order dated 8/11/23 to “…assist client with enema due to constipation to be followed by impaction removal if enema is unsuccessful.” RN # 5 conducted a routine visit on 8/11/23 and documented, “Family states patient had a bowel movement prior to my visit use of enema…” Further review of the clinical record revealed no evidence the physician was notified that the RN did not administer the enema. During an interview with RN # 5 on 4/10/24 at approximately 1:15 pm, the RN stated she did notify the physician, however, she failed to document the notification in the client’s record. 1B. Patient # 1 had a Start of Care date of 8/4/23 and admitting diagnoses of Ileus [obstruction in part of the intestines] and dysphagia [difficulty swallowing] following cerebral infarction [stroke]. Review of the Plan of Care for the certification period 8/4/23-10/2/23 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 2 weeks, 1 time every 2 weeks for 4 weeks, 1 time a week for 1 week. Review of the clinical record revealed a coordination note dated 8/12/23 entered by RN # 5. The coordination note stated, “Returned call to patient’s daughter regarding bleeding from G tube [gastrostomy]. Noted patient is on blood thinner and explained to daughter the tube can rub the tissue and it will cause bleeding. Instructed daughter to keep watch and let me know if it continues and a visit can be made to assess.” Further review of the clinical record revealed no evidence the RN advised the physician of the bleeding around the G tube site. During an interview with RN # 5 on 4/10/24 at 1:15 pm, the RN stated she had called the physician about the bleeding, but “forget to document it”. 2A. Patient # 14 had a Start of Care date of 3/4/24 with admitting diagnoses of encounter for change or removal of surgical wound dressing, encounter for orthopedic aftercare following surgical amputation and acquired absence of other right toe. Review of the Plan of Care for the certification period 3/4/24-5/2/24 included orders for SN [skilled nursing] 3 times a week for 8 weeks, 2 times a week for 1 week and “SN will apply negative pressure wound therapy to right 5th toe amputation site…set device at 125 mmHg …change 3 times per week…” Review of the clinical record revealed LPN # 2 conducted a routine visit on 3/13/24 and documented the following information, “…Per PT [patient], wound vac discontinued and pt is now doing daily wet to dry dressings…” Review of the clinical record revealed no physician’s order to discontinue the negative pressure wound therapy. During an interview with LPN # 2 on 4/10/24 at approximately 2:30 pm, the LPN confirmed there was no order to discontinue the wound vac but reported, “I called and spoke with the physician and he did actually give that order. I just failed to note that in the clinical record.” 2B. Patient # 14 had a Start of Care date of 3/4/24 with admitting diagnoses of encounter for change or removal of surgical wound dressing, encounter for orthopedic aftercare following surgical amputation and acquired absence of other right toe. Review of the Plan of Care for the certification period 3/4/24-5/2/24 included orders for SN [skilled nursing] 3 times a week for 8 weeks, 2 times a week for 1 week and “SN will apply negative pressure wound therapy to right 5th toe amputation site…set device at 125 mmhg …change 3 times per week…educate and monitor for signs and symptoms of infection. “Review of the clinical record revealed LPN # 2 conducted a routine visit on 8/3/24 and documented, “…wound care was provided as ordered. Redness around wound as well as on right leg, warmth noted a well…called to report to doctor’s office. Spoke directly to Doctor ______ [name] who states patient has been recently on a large regiment of antibiotics and he is not concerned about an infection. LPN made a visit on 3/11/24 and documented, “Pt continues to have redness around wound. Pt states that his doctor prescribed abx [antibiotic] for possible infection to wound site…” LPN completed a routine visit on 3/15/24 and documented, “Wound care was provided as ordered. Pt continues to have redness around wound. Some drainage from suture site. Pt has another appointment with wound dr. on Monday to evaluate wound…” Review of the clinical record revealed no evidence the LPN notified the physician of her findings on 3/11/24 or 3/15/24. The patient was admitted to _____ [name of hospital] on 3/18/24 for an abscess located at the suture site. During an interview with LPN # 2 on 4/10/24 at approximately 2:30 pm, the LPN stated, “I called the physician and told him about my concerns related to the wound, I just didn’t document the call.”

An onsite recertification survey was conducted 11/29/21- 12/01/21. No deficiencies were identified to the Emergency Preparedness Program. ABH

An onsite recertification survey and follow up survey was conducted 11/29/21 -12/01/21. Deficiencies to the Medicare Conditions of Participation were identified. All previously cited tags were left out of compliance. ABH

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 clinical record review, policy and procedure review, and staff interview the agency failed to follow the plan of care for assessing vital signs for 1 of 1 patients with heart disease (#8). Findings include: A policy, “ Client Care Plan”, revised 07/05/21 was received from the agency director on 12/01/21 at approximately 8:30 a.m. The policy stated, “ the individualized plan of care based on the client’s medical diagnosis, physician’s order…client specific interventions and education...”. Patient #8 had a SOC (start of care) of 04/07/21 and included diagnoses of pressure ulcer of sacral region stage 2, pressure ulcer of left heel, unstageable, and hypertensive heart disease. The plan of care had order for skilled nursing 2 times a week for 3 weeks. Orders included licensed professional to report vital signs outside of the following established parameters: temp less than 96.8 greater than 100.4, pulse less than 60, greater than 100; respiration less than 13, greater than 22; systolic blood pressure less than 95, greater than 165; diastolic blood pressure less than 60, greater than 95. Review of skilled nursing note for 04/30/21 revealed a temperature of 97.6, an oxygen level of 96 percent, and a pain level of 0. No other vital signs are documented in the record for this visit. Interview with Employee #3 on 12/01/21 at 10:44 a.m. revealed, “if I didn’t document it, he may not have let me do it, he was in a memory care unit”

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 and employee interviews the individualized Plan of Care [POC] failed to include all equipment [sling] used by the patient for 1 of 1 patient with a sling [#17]. The findings included: The policy, Client Plan of Care [July 5, 2021], was provided by the agency director on 12/1/21. The policy stated, "...The individualized plan of care must include...All types of services, supplies and equipment..." Patient # 17 had a Start of Care [SOC] date of 11/6/21 and admitting diagnoses of Pathological Fracture, Left Femur and Pathological Fracture, R Shoulder. A review of the Plan of Care [POC] for the certification period 11/6/21 to 1/4/21 revealed orders for PT [physical therapy] 1 time a week for 1 week; 2 times a week for 2 weeks; 2 times a week for 3 weeks; 1 time a week for 2 weeks and OT [occupational therapy] 1 time a week for 2 weeks; 1 time every 2 weeks for 2 weeks; 1 time a week for 2 weeks; 1 time every 2 weeks for 2 weeks. A review of the clinical record revealed on 11/18/21 OT # 25 documented the following information, “…Client not wearing sling… [to right arm/shoulder]”. An interview was conducted with PT # 6 on 12/1/21. [PT # 6 conducted admission assessment]. During the interview PT # 6 confirmed the sling was not included on the POC under the DME section. PT # stated, “No, I didn’t include the sling on the POC. I had never really thought about it, but it should have been included.”

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 clinical record review and staff interviews the agency failed to follow the Plan of Care [POC] related to removing a dressing for 1 of 7 patients [# 3 ]; related to assessing weights for of 2 of 17 patients [#7, 14]; related to assessment of incisions for 1 of 7 patients with a wound [#17]. The findings included: 1. Patient # 3 had a Start of Care [SOC] date of 10/28/21 and admitting diagnoses of Primary Osteoarthritis, Right Hand. A review of the Plan of Care [POC] for the certification period 10/28/21 to 12/26/21 revealed orders for SN [skilled nursing] 2 times a week for 1 week and “ Skilled nurse to remove aquacel dressing to right knee 7 days post of and zipline 14 days post op…” A review of the clinical record revealed Patient # 3 had a procedure to right knee on 10/20/21 and was discharged home on 10/21/21. Before the Start of Care could be completed the patient was readmitted to the hospital on 10/22/21 until 10/25/21 for an unrelated medical condition. The SOC visit was completed on 10/28/21 [per the order the aquacel dressing should have been removed on 10/27/21]. RN # 12 did not remove the aquacel until the 11/4/21. RN # 12 was not available for interview. An interview was conducted with the clinical director on 12/1/21. During the interview the clinical manager confirmed the aquacel dressing was not removed in accordance with the Plan of Care. 2. Patient # 7 had a Start of Care [SOC] date of 10/2/20 and admitting diagnoses of Acute Respiratory Failure with Hypoxia, Chronic Diastolic Congestive Heart Failure. A review of the Plan of Care [POC] for the certification period 10/2/20 to 11/30/20 revealed orders for SN [skilled nursing] 1 time a week for 4 weeks; 1 time every 2 weeks for 4 weeks and “SN to provide skilled observation and teaching of heart failure…notify physician of weight gain of 3 pounds in one day or 5 pounds in one week…”, PT [physical therapy] 1 time a week for 1 week; 1 time every 2 weeks for 2 weeks; 1 time every week for 4 weeks. The POC also contained the following order for SN and PT “…skilled observation and teaching of heart failure…notify physician of weight gain of 3 pounds in one day or 5 pounds in one week… A review of the clinical record revealed RN # 12 completed the admission assessment on 10/2/20. Further review of the admission assessment revealed no weight was obtained. PT # 15 completed a PT evaluation on the patient on 10/2/20. PT # 15 did not obtain a weight during the visit. An interview was conducted the clinical manager on 12/1/21. LPN # 16 made a routine visit on 10/9/20 and 10/12/20. A review of the visit notes revealed no weight was obtained in accordance with the POC. During the interview the clinical manager confirmed the RN, LPN, nor the PT obtained a weight in accordance with the POC. 3. Patient # 14 had a Start of Care [SOC] date of 10/5/21 and admitting diagnoses of Encounter for Attention to Ileostomy, Aftercare Following Surgery for Neoplasm and Malignant Neoplasm of Rectum. A review of the Plan of Care [POC] for the certification period 10/5/21 to 12/3/21 revealed orders for SN [skilled nursing] 2 times a week for 2 weeks; 1 time a week for 3 weeks; 1 time every 2 weeks for 4 weeks and “Licensed professional to report vital signs falling outside the following established parameters…weight less than 180 pounds or greater 197…” A review of the clinical record revealed no weights were documented during the visits on 10/12/21, 10/26/21, 11/4/21 and 11/18/21. An interview was conducted with the clinical manager on 12/1/21. During the interview the clinical manager confirmed no weights were obtained in accordance with the POC. 4 . Patient # 17 had a Start of Care [SOC] date of 11/6/21 and an admitting diagnosis of Pathological Fracture, Left Femur. A review of the Plan of Care [POC] for the certification period 11/6/21 to 1/4/21 revealed orders for PT [physical therapy] 1 time a week for 1 week; 2 times a week for 2 weeks; 2 times a week for 3 weeks; 1 time a week for 2 weeks and “Skilled physical therapist to monitor incisional wounds for proper healing and will notify MD immediately of any signs/symptoms of deterioration or infection…” A review of the clinical record revealed PT # 6 assessed the surgical incision to the left hip on 11/6/21 during the admission process. Further review of the clinical record revealed PTA [physical therapy assistant] # 7 made routine visits on 11/9/21, 11/11/21, 11/16/21 and 11/18/21. During the routine visits there was no evidence the incision was assessed. An interview was conducted with PTA # 7 on 12/1/21. During the interview the PTA confirmed the wound was not assessed in accordance with the POC.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on agency policy and procedure, clinical record review, and staff interview the agency failed to coordinate care with the physician regarding a reported fall for 1 of 1 patients with a history of falling (#10). Findings include: A policy, “Client Care Coordination”, revised 01/13/2018 was received from the agency director on 12/01/21 at approximately 8:30 a.m. The policy stated, “…case coordination involves identification of additional services needs…discussions of the client’s needs and status and follow up as appropriate…”. Patient #10 had a SOC (start of care) of 11/27/2020 and included diagnoses of type 2 diabetes, essential hypertension (high blood pressure), and a history of falling. Review of the physical therapist visit for 12/01/20 revealed Patient #10 had reported a fall to the physical therapist. No documentation was in the record that the physician was notified of the fall. Interview with the nurse manager on 12/01/21 at 11:33 a.m. confirmed no documentation is in the record for reporting the fall to the physician.

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 clinical record review and staff interviews the clinical record failed to include wound assessments/measurements for 1 of 7 charts [#9]; failed to include accurate pain assessments for 2 of 17 patients [#14, #17] ; failed to include accurate weights for 2 of 17 patients [#14, 3]. The findings included: 1. Patient # 9 had a Start of Care [SOC] date of 10/28/20 and admitting diagnoses of Postproc Hemo of a Circ Sys Org Following Cardiac Bypass and Pressure Ulcer of Sacral Region, Stage 2. A review of the Plan of Care [POC] for the certification period 10/28/21 to 12/26/21 revealed 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 and “Skilled nursing to monitor incisions for infection. Skilled nursing to clean coccyx wound with wound cleanser, pat dry, apply calcium alginate and cover with a dry dressing.” A review of the Start of Care completed by RN # on 10/28/21 revealed the SN identified the following wounds: 1- Coccyx 1.9 x .8 x .2, 2- Sternal 19.5 x.1 x 0, 3- Abdominal Right Lower Quad .2 x 1x .3, 4-Abdominal Right Lower quad .3 x 1.3 x .2, 5- Lower Abdominal Midline- .3 x 1.4 x .2 , 6-Distal right thigh medial -3 x .2 x .1. Further review of the clinical record revealed RN # 10 made routine visits on 11-3-21, 11-10-21, 11-17-21, and 11-24-21 by RN #. There were no wound measurements documented for wounds 2-6 during any of visits after the start of care. An interview was conducted with the clinical manager on 12/1/21. During the interview the clinical manager confirmed all wounds are supposed to be measured each week and documented in the clinical record. 2. Patient # 14 had a Start of Care [SOC] date of 10/5/21 and admitting diagnoses of Encounter for Attention to Ileostomy, Aftercare Following Surgery for Neoplasm and Malignant Neoplasm of Rectum. A review of the Plan of Care [POC] for the certification period 10/5/21 to 12/3/21 revealed orders for SN [skilled nursing] 2 times a week for 2 weeks; 1 time a week for 3 weeks; 1 time every 2 weeks for 4 weeks. A review of the clinical record revealed on 10/5/21 RN # 8 documented the following information in the vital sign section of the assessment- pain level: 0 and weight: 187. Further review of the 10/5/21 visit revealed RN # 8 documented a pain level of 2 in the body of the visit and a weight of 177 in the body of the visit. On 10/8/21 RN # 9 documented a pain level of 0 in the vital sign section of the note and a pain level of 2 in the body of the visit. On 12/1/21 an interview was conducted with the clinical manager. During the interview the clinical manager confirmed the clinical record did not include accurate documentation related to the weight and pain level. 3. Patient # 17 had a Start of Care [SOC] date of 11/6/21 and an admitting diagnosis of Pathological Fracture, Left Femur. A review of the Plan of Care [POC] for the certification period 11/6/21 to 1/4/21 revealed orders for PT [physical therapy] 1 time a week for 1 week; 2 times a week for 2 weeks; 2 times a week for 3 weeks; 1 time a week for 2 weeks. A review of the clinical record revealed PT # 6 completed the admission assessment on 11/6/21. Further review of the visit note dated 11/6/21 revealed a pain level of 3 [documented in the vital sign section] and a pain level of 9 documented in the body of the OASIS [The Outcome and Assessment Information Set]. An interview was conducted with PT # 6 on 12/1/21. During the interview PT # 6 confirmed the pain level was documented inconsistently in the clinical record. 4. Patient # 3 had a Start of Care [SOC] date of 10/28/21 and admitting diagnoses of Primary Osteoarthritis, Right Hand. A review of the Plan of Care [POC] for the certification period 10/28/21 to 12/26/21 revealed orders for SN [skilled nursing] 2 times a week for 1 week. A review of the start of care visit revealed RN # 12 documented a weight of 180 in the vital sign section of the visit. Further review revealed the RN documented the weight as 177 in the visit section. RN # 12 was not available for interview. An interview was conducted with the clinical manager on 12/1/21. During the interview the clinical manager confirmed the documentation related to the weight was not accurate/consistent.