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

Based on the findings of an unannounced onsite Medicare recertification and state re-licensure survey conducted on October 16-19, 2023, Bayada Home Health Care, Inc. was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare recertification and state re-licensure survey conducted on October 16-19, 2023, Bayada Home Health Care, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on review of clinical records (CRs), agency policy, and interview with agency administrator, the agency failed to ensure the plan of treatment was countersigned by the physician within 28 days of the start of the certification period for two (2) of seventeen (17) records reviewed (CRs #5 and #7). Review conducted on October 18, 2023, at approximately 9:00 AM to 3:30 PM and October 19, 2023, at approximately 9:00 AM to 10:30 AM, of clinical records (CRs) revealed: CR#5, start of care (soc) June 22, 2023, certification period: June 22, 2023 - August 20, 2023; Primary Diagnoses: Hypertension, chronic kidney disease stage 1-4/unspecified, Diabetes Mellitus Type 2, chronic heart failure, and fall history; contained a plan of treatment countersigned by the physician on July 7, 2023. Thirty-two days after the start of the certification period. CR#17, soc August 15, 2023, certification period: August 15, 2023 - October 13, 2023; Primary Diagnoses: Diabetes Mellitus Type 2 with diabetic neuropathy, chronic kidney disease stage 1-4/unspecified, legal blindness, anemia, bipolar disorder (unspecified), and fall history; contained a plan of treatment countersigned by the physician on September 29, 2023. Forty-five days after the start of the certification period. Review conducted on October 19, 2023, at approximately 9:00 AM, of agency policy "0-983 Physician Orders" revealed: "Our Procedure: 4.0 A physician signature must be obtained within twenty-eight days (28), unless a shorter timeframe is required by the state or program regulations. The twenty-eight (28) day requirement for obtaining a physician's signature begins when the verbal orders are obtained. C. If the final attempt (for physician signature) proves unsuccessful, and signed orders are not received from the doctor by the end of four weeks, the client and doctor will be informed that client discharge and transfer procedures will be implemented immediately." Interview conducted on October 19, 2023, at approximately 10:00 AM, with agency administrator shared two fax attempts on August 12, and 19, 2023 were performed to obtain physician's signature for CR#5 and four fax attempts on September 1, 13, 14, and 25, 2023 were performed to obtain physician's signature for CR#17. Administrator confirmed the above findings.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of clinical records (CRs), agency policy, and interview with administrator, agency failed to complete wound measurements/dimensions in two (2) out of seventeen (17) clinical records reviewed. (CRs#3 and #10). Review conducted on October 18, 2023, at approximately 9:00 AM to 3:30 PM, of clinical records revealed: CR#3, start of care (soc) January 24, 2023, certification period: May 24, 2023 - July 22, 2023; Physician wound care orders of May 24, 2023 (CMS 485 form) Orders of Discipline and Treatments: "Skilled nurse to assess/evaluate co-morbid conditions including left heel wound and other conditions that present themselves during the course of this episode to identify changes and intervene to minimize complications."; and noted in June 19, 2023 skilled nurse home care visit record, missed weekly required skilled nurse wound measurements (dimensions for length, width, depth) documentation for present on-admission and current left heel pressure ulcer. CR#10, soc June 29, 2023, certification period: August 28, 23 - October 26, 2023; Physician wound care orders of June 28, 2023 (CMS 485 form) Orders of Discipline and Treatments: "Skilled nurse to assess/evaluate co-morbid conditions including diabetes, urinary retention, lymphedema, pressure ulcer and other conditions that present themselves during the course of this episode to identify changes and intervene to minimize complications."; and noted in September 28, 2023 skilled nurse home care visit record, missing skilled nurse wound measurements (dimensions for length, width, depth) documentation for a left buttock pressure ulcer which re-opened (change of condition). Review conducted on October 18, 2023, at approximately 1:30 PM, of agency policy "0-3230 Wound Care - Assessment and Treatment" revealed: Written criteria for 4.0 - 4.6 wound assessment (color, drainage, size, wound thickness, wound healing, and wound deterioration); 4.7 Pressure Injuries; 6.0 Documentation of observations by skilled nurses; and 9.1.11 Home Health - RN/PT Role in Wound Care, "RN or Pt will complete the assessment of the wound by measuring, assessing, and documenting effective wound treatment per provider orders. ... Interpretation of wound assessment and characteristics will be documented at least weekly. All actions taken by clinicians are based on their state acts, scope of practice and Bayada policy." Interview conducted on October 18, 2023, at approximately 1:45 PM, with agency administrator confirmed the above findings.