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

An onsite unannounced recertification survey was conducted 9/25/23-9/27/23. No deficiencies were identified to the Emergency Preparedness Plan.

An onsite non-announced recertification/follow up survey was conducted 9/25/23-9/27/23. G0536 will remain out of compliance. Other standard level deficiencies were identified, as well.

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 agency failed to complete the Start of Care [SOC] [The Outcome and Assessment Information Set-a group of standard data elements] accurately for 6 of 12 active patients [#6, 8, 11 12, 16 and 18]. The findings included: 1. Patient # 6 had a Start of Care [SOC] date of 8/30/23 and admitting diagnoses of encounter for adjustment and management of VAD [vascular access device-a thin flexible device inserted into a vein to enable the administration of fluids or medications into the blood stream], methicillin susceptible staphylococcus aureus [type of bacteria] infection and bacteremia [bacteria in the blood stream]. Review of the clinical record revealed the SOC OASIS [The Outcome and Assessment Information Set-a group of standard data elements] was completed by RN # 12 on 8/30/23. Review of question N0415 on the OASIS indicated the patient was receiving an anticoagulant [blood thinner], antibiotic, opioid [pain medication] and hypoglycemic. The patient was receiving Aspirin [anti-platelet]. The OASIS did not indicate the patient was receiving the anti-platelet. RN # 12 was not available for interview. During an interview with the agency administrator on 9/27/23 at 11 am. The administrator confirmed the OASIS question was not answered accurately. 2. Patient # 8 had a Start of Care [SOC] date of 8/30/23 and an admitting diagnosis of COVID-19. Review of the clinical record revealed PT [physical therapist] # 13 completed the SOC OASIS [The Outcome and Assessment Information Set-a group of standard data elements] on 8/30/23. Review of question N0415 on the OASIS indicated the patient was not taking any high-risk medications. Review of the Plan of Care revealed the patient was ordered Ultram [opioid]. PT # 13 was not available for interview. During an interview with the agency administrator on 9/27/23 at approximately 10:15 am, the director confirmed the OASIS question was answered incorrectly. 3. Patient # 11 had a Start of Care [SOC] date of 8/30/23 and admitting diagnoses of encounter for change or removal of surgical wound dressing, acquired absence of right foot, acquired absence of other left toes and type 2 diabetes mellitus with diabetic chronic kidney disease [high blood glucose damages blood vessels in the kidneys]. Review of the clinical record revealed RN # 5 completed the SOC OASIS [The Outcome and Assessment Information Set-a group of standard data elements] on 8/30/23. Review of question N0415 on the OASIS did not indicate the patient was taking an opioid [pain medication]. Further review of the clinical record revealed the patient was prescribed Oxycodone [opioid] 15 mg every 6 hours as needed for pain. During an interview with the agency administrator on 9/27/23 at approximately 11 am, the administrator confirmed N0415 was not answered correctly. 4. Patient # 12 had a Start of Care date of 9/19/23 with an admitting diagnosis of polymyalgia rheumatica [inflammatory condition causing muscle pain and stiffness around the shoulders and hips]. Review of the clinical record revealed the SOC OASIS [The Outcome and Assessment Information Set-a group of standard data elements] was completed by PT [physical therapist] # 11 on 9/19/23. Review of question N0415 on the OASIS did not indicate the patient was ordered an opioid [pain medication]. Review of the plan of care revealed the patient was receiving Ultram [opioid pain medication]. PT # 11 was not available for interview. An interview was conducted with the agency administrator on 9/27/23 at approximately 10:15 am. During the interview, the administrator confirmed the OASIS question was answered incorrectly. 5. Patient # 16 had a Start of Care [SOC] date of 8/23/23 and admitting diagnoses of collapsed vertebra, lumbar region [lower end of the spinal column] and spinal stenosis [narrowing of the spinal canal]. Review of the clinical record revealed the SOC OASIS [The Outcome and Assessment Information Set-a group of standard data elements] was completed by PT [physical therapist] # 4 on 8/23/23. Review of question N0415 on the OASIS indicated the patient was receiving an anticoagulant [blood thinner] and an antibiotic. Review of the medications revealed no order for an antibiotic. An interview was conducted with PT # 4 on 9/27/23 at approximately 9:30 am. During the interview PT # 4 confirmed the question N0415 was answered incorrectly. “I don’t see where she was taking an antibiotic. I guess it was a mistake.” 6. Patient # 18 had a Start of Care [SOC] date of 8/21/23 with admitting diagnoses of encounter for adjustment and management of VAD [VAD [vascular access device-a thin flexible device inserted into a vein to enable the administration of fluids or medications into the blood stream] and infection/inflammatory reaction due to other cardiac/vascular device/implanted graft [patient had infection of previous vascular graft-procedure performed to redirect blood flow from one area to another by reconnecting blood vessels]. Review of the clinical record revealed RN # 3 completed the SOC OASIS [The Outcome and Assessment Information Set-a group of standard data elements] on 8/21/23. Review of question N0415 on the OASIS indicated the patient was receiving only an antibiotic. Further review of the clinical record revealed the patient was prescribed Ultram [opioid] 5 mg daily as needed for pain. During an interview with Rn # 3 on 9/27/23 at approximately 9:30 am, RN # 3 stated, “I guess it was an oversight.” RN # 3 confirmed the OASIS question N0415 was not answered accurately.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on agency policy, home visit observations, clinical record review, interviews with patient/caregivers and staff the agency failed to complete a comprehensive review of all medications for 4 of 7 patients who received home visits [#11, 12, 16 and 15]. The findings included: #4. Patient #15 was admitted was admitted on 09/05/23 with disruption of external surgical operation, sepsis (blood infection), cellulitis of right lower limb (skin infection), type 2 diabetes, and chronic kidney disease. The plan of care for 09/05/23 to 11/03/23 had orders for skilled nursing 2 times a week for 6 weeks. A home visit with the registered nurse was observed on 09/26/23 at 3:55 p.m. The medication review during the home visit revealed the following discrepancy: hydrocodone 7.5-325mg(milligrams) 1 tablet every 6 hours for pain. Interview with the patient confirmed the patient has been taking this medication for 6 or 7 years. Interview with Employee #3 on 9/27/23 at 9:14 a.m. revealed, “I look at the bottles and I look at the discharge papers when I do medication reconciliation” The policy, Chart Data Requirements and Format-Home Health Practice [revised 1-1-23], was provided by the agency administrator on 9/26/23 at 2:53 pm. The policy stated, “…All Home Health clients will have a Medication List…The medication list is used when we are assessing, monitoring and teaching medications in the home…” 1. Patient # 11 had a Start of Care date of 8/30/23 and admitting diagnoses of encounter for change or removal of surgical wound dressing, acquired absence of right foot and type 2 diabetes mellitus with diabetic chronic kidney disease [high blood glucose damages blood vessels in the kidneys]. Review of the Plan of Care [POC] for the certification period 8/30/23 to 10/28/23 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 1 weeks, 3 times a week for 7 weeks. On 9/26/23 at 1 pm a joint visit was conducted with RN # 5. 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 Semglee [type of insulin] 100 units subcutaneously [under the skin] 2 times per day. During an interview with the patient, the patient stated he did not use Semglee. The patient stated, “I use Humalog insulin 40 units in the morning and 80 units at night. I have been using the Humalog since I came home from the nursing home.” During an interview with the administrator conducted on 9/27/23 at approximately 10 am, the administrator confirmed the medications were not reviewed by the clinician. 2. Patient # 12 had a Start of Care date of 9/19/23 with an admitting diagnosis of polymyalgia rheumatica [inflammatory condition causing muscle pain and stiffness around the shoulders and hips]. Review of the Plan of Care [POC] for the certification period 9/19/23 to 11/17/23 included orders for PT [physical therapy] 2 times a week for 3 weeks, 1 time a week for 1 week, 2 times a week for 2 weeks, 1 time a week for 3 weeks. On 9/26/23, a joint visit was conducted with PTA [physical therapy assistant] # 7 at 2 pm. 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 Warfarin [blood thinner] 4 mg. Take 1 to 1.5 tablets each day. The medication profile did not specify which days the patient should take 1 or 1.5 tablets. During an interview with the patient the patient advised she used supplemental oxygen at 2 liters via nasal cannula at night and as needed for shortness of breath. The medication profile did not include the supplemental oxygen. During an interview with the agency administrator on 9/27/23 at approximately 10 am, the administrator confirmed the medications were not reviewed prior to placing on the POC. 3. Patient # 16 had a Start of Care date of 8/23/23 and admitting diagnoses of collapsed vertebra, lumbar region [lower end of the spinal column] and spinal stenosis [narrowing of the spinal canal]. Review of the Plan of Care [POC] for the certification period 8/23/23 to 10/21/23 included orders for OT [occupational therapy] 1 time a week for 3 weeks, 1 time every 2 weeks for 2 weeks, 1 time a week for 1 week. On 9/27/23, at approximately 1 pm, a joint visit was conducted with OT # 10. 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 the following medications: Gabapentin [used for nerve pain] 300 mg. Take 1 capsule in the morning and tablets in the evening. The medication profile included the following, “daughter states patient not taking.” During an interview with the patient during the home visit the patient stated, “I take 5 capsules a day. This was increased when I came home from rehab.” Lidocaine [used for pain] 5% topical patch. Place 1 patch onto skin daily and remove within 12 hours. During the interview with the patient the patient stated, “I don’t use that anymore. It started breaking me out while I was at rehab.” Lyrica [used to treat muscle and nerve pain] 300 mg capsule. Take 1 capsule in the morning and 3 in the evening. The medication profile included the following note, “not included on the dc [discharge] summary.” During the interview with the patient, the patient stated, “I don’t think I have ever used that. I have never heard the name.” During an interview with the agency director on 9/27/23 at approximately 10 am. The director confirmed the medications were not reviewed prior to placing on the POC.

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 and procedure review, clinical record review and staff interview the agency failed to measure wounds for 1 of 6 patients with a wound (#9). Findings included: Review of policy, “0-3230 Wound Care – Assessment and Treatment”, revised 09/09/21, was received from the agency executive director on 09/26/23 at 2:56 p.m. The policy stated”, …wounds should be measured in centimeters once per week and /or as per physician’s order…” Patient #9 was admitted on 08/16/23 with diagnoses of pressure ulcer of left heel, unstageable and diabetes type 2. The plan of care for 08/16/23 to 10/14/23 had orders for skilled nursing 2 times a week for 2 weeks, 3 times a week for 2 weeks, and 2 times a week for 1 week. Review of the clinical record on 9/25/23 revealed no wound measurements were in the chart for the week of 8/16/23. Interview with Employee #3 on 09/27/23 at 9:12 a.m. revealed, “I didn’t do it that day because he had been to the wound center that day and he wouldn’t let me even look at the wound”. Interview with Employee #6 on 9/27/23 at 9:34 a.m. “I realized measurements weren’t done later after I did the visit, I thought the measurements were done at start of care on Wednesday”.

An unannounced onsite complaint investigation was conducted 8/15/22. The allegation was unsubstantiated. Deficiencies to the Medicare CoP were identified.

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 staff interviews the Plan of Care failed to include the route of administration for 1 of 1 patient with orders for oxygen [#2]; and order to flush a PBD [percutaneous biliary (related to bile or bile duct) drain] for 1 of 1 patient with a PDB [#3]. The findings included: The policy, Client Care Plan [ 7-5-21], was provided by the agency director on 8-15-22 at approximately 3 pm. The policy stated, “…The individual plan of care…must include the following elements…All medications and treatments…” 1. Patient # 2 had a Start of Care date of 7/7/22 and admitting diagnoses of COVID-19 [an acute respiratory illness caused by a coronavirus] and Pneumonia due to Coronavirus Disease. A review of the Plan of Care [POC] [medication section] for the certification period 7/7/22 to 9/4/22 included “02-Oxygen 3 liters Continuous”. There was no method of delivery for the oxygen. An interview was conducted with the branch director on 8/15/22 at approximately 2 pm. During the interview the director confirmed the route of administration should have been included on the POC. 2. Patient # 3 had a Start of Care date of 7/14/22 and admitting diagnoses of Obstruction of Bile Duct, Encounter for Change or Removal of Drains and Intrahepatic Bile Duct Carcinoma [cancer that forms in the bile ducts inside the liver]. The Plan of Care for the certification period 7/14/22 to 9/11/22 included orders for SN [skilled nursing] 1 time a week for 5 weeks and “SN to perform wound care and instruct caregiver/client to perform wound care. Perform wound care to RUQ [right upper quadrant] PBD [percutaneous biliary (relating to bile or the bile duct) drain]. Cleanse with NS [normal saline] and cover with dry dressing, secure with tape…” Review of the hospital discharge orders dated 7/11/22 included the following order, “Home health to maintain uncapped PBD drains. Flush with 10 cc twice daily and daily dressing changes…” The POC did not include the orders to flush the PDB. An interview was conducted with the agency director on 8/15/22 at approximately 2 pm. During the interview, the director confirmed the POC should have included the order to flush the PBD.

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, clinical record review and staff interviews the agency failed to notify the physician of a patient fall for 1 of 1 patient with a recorded fall [#2]. The findings included: The policy, Communicating with Physicians [1-13-2018], was provided by the branch director on 8-15-22 at approximately 3 pm. The policy stated, “…Throughout the duration of service, whenever a change in client status occurs that requires the physician be notified, the communication must be documented…” Patient # 2 had a Start of Care date of 7/7/22 and admitting diagnoses of COVID-19 [an acute respiratory illness caused by a coronavirus] and Pneumonia due to Coronavirus Disease. The Plan of Care [POC] [medication section] for the certification period 7/7/22 to 9/4/22 included orders for SN [skilled nursing] effective 7/10/22 1 time a week for 1 week, 2 times a week for 1 weeks, 1 time a week for 2 weeks; PT [physical therapy] 1 time a week for 1 week, 2 times a week for 3 weeks. Review of the clinical record indicated on 7/21/22 PT # 1 and LPN # 2 made routine visits to see the patient. PT # 1 documented, “…caregiver states patient did have a fall yesterday as she was standing holding to the bedside

An onsite recertification survey was conducted 06/28/21 to 06/30/21. No deficiencies to the Emergency Preparedness Program were identified. ABH

An onsite recertification survey was conducted 06/28/21 to 06/30/21. A deficiency to the Medicare Conditions of Participation was identified. ABH

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on observation, clinical record review, and patient interviews, the agency failed to review all current medications for 2 of 7 patients that received a virtual home visit (#12, and 13). Findings include: 1a. Patient #12 was admitted on 06/19/21 with aftercare following joint replacement surgery, hypertensive chronic kidney disease, prediabetes, and bilateral primary osteoarthritis of knee. The Plan of Care (POC) for 06/19/21 to 08/17/21 included the following orders: physical therapy 1 time a week for 1 week, 2 times a week for 3 weeks, and 1 time a week for 4 weeks. A virtual home visit via zoom was conducted on 06/29/21 at 9:00 a.m. with the physical therapist. A review of current medications was conducted with the patient during the home visit. The review revealed the following discrepancy: The medication profile provided by the agency did not include Tylenol as a current medication. The patient confirmed that he is taking Tylenol 500mg (milligram) 2 tablets by mouth every 6 hours as needed for pain. The patient stated” the other medicine makes make break out into hives”. 1b. Patient #13 was admitted on 06/09/21 with rheumatic heart failure, type 2 diabetes, chronic kidney disease, and acute kidney failure. The Plan of Care (POC) for 06/09/21 to 08/07/21 included the following orders: skilled nursing 1 time a week for 7 weeks; physical therapy 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 5 weeks, and occupational therapy 1 time a week for 4 weeks. A virtual home visit via zoom was conducted on 06/29/21 at 12:30 p.m. with the occupational therapist. A review of current medications was conducted with the patient during the home visit. The review revealed the following discrepancy: The medication profile provided by the agency included the following medication: colchicine 0.6mg(milligram) by mouth 1 tablet daily for gout. The patient confirmed that she doesn’t take this medication anymore that it is “an old prescription”.