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

Based on the findings of an unannounced onsite Home Health Agency Medicare Recertification Survey conducted June 26, 2023 through June 28, 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 Home Health Agency Medicare Re-Certification Survey conducted June 26, 2023 through June 28, 2023 Bayada Home Health Care, Inc. was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on a review of the home health agency's (HHA) complaint log, agency policy, and an interview with the administrator, the agency failed to provide documentation confirming that an investigation was conducted, investigative findings were recorded, and the complaint was resolved for one (1) of two (2) complaints reviewed. Findings include: A review of the HHA's Policy, "11-368 Client Complaints" was conducted on June 27, 2023 at approximately 4:30 PM. The policy reads in part, "All complaints, verbal and written, are documented in the applicable electronic system. This includes the nature of the complaint, the investigation findings, any follow-up action that is needed and the date of follow-up with the client. Notification made to the client is also documented. Written complaints are scanned and attached to the electronic complaint report;" and "Medicare-Certified Home Health and Home Care offices only: Complaint documentation must include: nature of the complaint, the investigation findings, action(s) to prevent further potential occurrences, including retaliation, while the complaint is being investigated and resolution of the complaint." A review of the electronic complaint log was conducted on June 26, 2023 at approximately 2:00 PM. A complaint dated 09/21/2022 was documented in the electronic log. While a description of the complaint was documented in the electronic log, there was no evidence of the investigative findings, any follow-up action that was required, date of follow-up with the client, and subsequent notification to the client. The column on the complaint log with the header "case closed" was blank. An interview was conducted with the Area Director on June 28, 2023 at approximately 12:00 PM. The Area Director confirmed that other than the information contained in the electronic complaint log, there was no other documentation to support that the complaint was investigated and resolved. An interview conducted with the Area Director on June 28, 2023 starting at 2:15 PM confirmed the above findings.

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 a review of clinical records (CR), home health agency (HHA) policies, and an interview with the area director and client services manager, the agency failed to provide care according to the Centers for Medicare and Medicaid Services (CMS)-485 Home Health Certification and Plan of Care (POC) for one (1) of seven (7) CR's reviewed (CR#6), and failed to ensure that the CMS-485 Home Health Certification and Plan of Care (POC) was signed by the physician for one (1) of seven (7) clinical records reviewed (CR#7). Findings Include: A review of Policy 0-945 Client Plan of Care conducted on June 28, 2023 at approximately 12:45 PM reads in part, "Medicare-Certified Home Care and Home Health Offices: The client plan of care includes....d) the frequency and duration of visits to be made; i) Nutritional requirements; k) Safety measures to protect against injury;" and "A Home Health Certification and Plan of Care (CMS-485), signed by the physician, is required for all clients receiving skilled services." A review of policy 0-6277 Missed Visits/Hours conducted on June 28, 2023 at approximately 12:45 PM reads in part, "The physician must be notified when the plan of care is altered due to fewer visits or hours of services being provided as ordered." A review of policy 0-983 Physician's Orders conducted on June 28, 2023 at approximately 1:00 PM reads in part, "Signed orders for care and treatment are obtained from the client's physician on a timely basis and in accordance with applicable law and regulation;" and "A physician signature must be obtained within twenty-eight (28) days unless a shorter time frame is required by the state or program regulation. For CMS-485 Home Health Certification and Plan of Care, the date the order is obtained is reflected in the Verbal Start of Care (Verbal SOC) date." A review of policy 0-3546 Chart Data Requirements and Format - Home Health Practice conducted on June 28, 2023 at approximately 1:00 PM reads in part, "Client Agreement Form - The signed Client Agreement Form Medicare Certified Offices is entered into the client chart as evidence that the client has been informed of these procedures.....This form includes...visit schedule;" and "Physician Orders - The CMS-485 Home Health Certification and Plan of Care, physician's orders and the documentation of the nursing care plan process for the care and services to be provided includes but is not limited to....l) level, frequency and duration of services to be provided; m) diet and dietary restrictions; p) safety measures to protect against injury." An interview was conducted with the Area Director and Client Services Manager (CSM). The CSM stated that CR#6 was receiving services from Special People in Northeast (SPIN) Human Services, an organization intended to provide services to individuals with autism and intellectual/developmental disabilities. CR#6 resided in a Community Living Arrangement (CLA) with twenty-four hour, seven (7) day a week direct support. SPIN engaged Bayada to provide home health services. The CSM stated that when Bayada was unable to provide services in accordance with the plan of care due to staffing unavailability, SPIN would assume responsibility for services. The CSM stated that Bayada missed shifts were not viewed as missed shifts since SPIN provided services during those times. A review of clinical records (CR) was conducted on June 26, 2023 starting at approximately 11:30 AM and again on June 27, 2023 starting at approximately 12:40 PM. The Start of Care (SOC) and Home Health Certification Period (CP) are shown below. CR#6 SOC 11/28/2022 and CP 03/28/2023 to 05/21/2023 contained a CMS-485 Home Health Certification and Plan of Care (POC) with physician orders for skilled nursing (SN) to provide care sixteen (16) to twenty-four (24) hours per day, seven (7) days per week for sixty (60) days. A review of the visit calendar found missed visits on (all 2023): 04/02, 04/08, 04/09, 04/16, 04/22, 04/23, 04/30, 05/06, 05/07, 05/14, and shift lengths less than the minimum sixteen hours on 03/28, 03/31, 04/01, 04/03, 04/07, 04/10, 04/12, 04/14, 04/15, 04/17, 04/21, 04/24, 04/26, 04/28, 04/29, 05/01, 05/04, 05/05, 05/08, 05/12, 05/13, and 05/15. The POC stated, "please reference SPIN information located in front of chart for contact information and further details regarding client's care." A review of the document "located in the front of the chart" titled Bayada Service Request for Home Care contained information regarding nursing procedures/assistive care tasks required, but did not address the frequency of visits. There was no evidence in the clinical record that in the absence of services being provided by the HHA, the services would be provided by SPIN, nor was there an addendum or change to the plan of care regarding the decrease in visit frequency by the HHA, nor was there evidence of communication to the physician regarding the visit frequency by the HHA which was less than the minimum 16 hours per day, 7 days per week nor the missed shifts. Further review of the clinical record and POC found that a mechanical soft, thin liquids diet was ordered, and safety measures included aspiration precautions. On 05/17/2023, the nurses' note documented "mechanical soft diet lunch available to client at 1147. Client self-feeding, had 5 bites of lunch with no difficulty. At 1153, client presented with visible signs of choking. This nurse immediately initiated back blows and abdominal thrusts while SPIN aide called 911 for assistance. Client remained conscious with dusky lips. Visible food in mouth cleared with finger sweep. Abdominal thrusts continued, food dislodged from client's airway. Color immediately returned to lips/face. Fire department and EMS arrived, administered oxygen and transported patient to the hospital. Call placed to HHA and HHA RN Clinical Manager was notified." A review of the Clinical Manager Coordination of Services (COS) note contained in the CR states, "employee was feeding client a slice of pepperoni pizza that was cut into bite-size pieces while client was sitting upright in bed, and client began to choke..." The physician's orders for a mechanical soft, thin liquids diet and aspiration precautions were not followed as pepperoni pizza is not a soft food source. CR# 7 SOC 02/02/2023 and CP 04/03/2023 to 06/01/2023 contained a POC that as of 06/28/2023 had not been signed by the physician. An interview with the Area Director conducted on June 28, 2023 starting at 2:15 PM confirmed the above findings.