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

Based on the findings of an onsite unannounced state license survey completed January 8, 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 onsite unannounced state license survey completed January 8, 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.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CR), and staff (EMP) interview, the agency failed to alert the physician to any changes in the patient's condition or needs that suggest that outcomes are not being achieved or the plan of care should be altered for three (3) of seven (7) records (CR1-CR3). Findings included: Review of agency policy on January 5, 2024, at 12:30 p.m. showed, "0-986 COMMUNICATING WITH PHYSICIANS ... 3.0 COMMUNICATING CHANGES IN STATUS. 3.1 Throughout the duration of service, whenever a change in client status occurs that requires the physician to be notified, the communication will be documented. This can be documented on the Clinical Notes, Nurses Notes, or on a Coordination of Services Form." Review of agency policy on January 8, 2024, at 10:30 a.m. showed, "Percutaneous Endoscopic Gastrostomy, Gastrostomy, and Jejunostomy Tube Care (Home Health) ... 18. Elevate the head of the bed at least 30 degrees when feedings are infusing." Review of CR1 on January 2, 2024, at 12 p.m. showed a physician ordered plan of care for an initial certification period from 11/27/2023 to 1/25/2024. Orders included skilled nursing (SN) to see the patient for care and assessment related to cerebral palsy diagnosis. The patient was to "wear AFOS [ ankle foot orthotic - supportive device for lower extremity] while awake [as] tolerated." Further review of CR1 did not show patient was wearing their AFOs and on 12/5 the nurse documented, "Client was dressed for the day shoes put on, mom still hold AFOs at this time until she can work him back up to the length of time that he needs to wear them." Review of treatment sheets showed the nurse documented an "H" for 11/28, 11/29, and 11/30/2023 to show that the patients AFOs were on hold and not being used. Further review of CR1 on January 5, at 9:30 a.m. did not show that agency notified the physician that the patient's AFOs were on hold. Review of CR2 on January 4, 2024, at 9:30 a.m. showed a physician ordered plan of care with a recertification period from 11/17/2023 to 1/15/2024. The patient's diagnosis included "encounter for attention to gastrostomy [tube inserted into stomach]." SN was to provide care 5-7 nights per week. Review of "Nurse's Shift Note" from 12/18/2023 showed the patient's mom did not elevate the patient's head while the patient was receiving a feeding via their gastrostomy tube, "HOB [head of bed] flat - Mom previously educated on importance of elevating HOB with TF [tube feed] via GT [gastrostomy tube] to avoid aspiration [stomach contents getting into lungs] , verbalized understanding- requests client lay flat this shift." Further review of CR2 on January 5, 2024, at 9:40 a.m. did not show that agency notified the physician concerning patient being fed via GT while lying flat which could increase the patient's risk of aspiration. Review CR3 on January 4, 2023, at 10:30 a.m. showed a physician ordered plan of care with an initial certification period from 6/28/2023 to 8/26/2023. SN was to see patient for care and assessment related to seizures. Orders included, "Apply bilateral AFO's as per recommendation of PT/OT/physician. ... Maintain and encourage safe use of mobility aides and orthotics [AFOs] to decrease risk for falls; notify CM and/or physician regarding concerns." On 6/29/2023, the SN documented, "1:15pm ... Unable to wear AFO's due to improper fit with current shoes." Further review of CR3 on January 5, 2024, at 10 a.m. did not show the physician was notified concerning the improper fir of AFOs. During an interview with EMP3 (manager of clinical operations) on January 5, 2023, from 9:30 a.m. to 11:30 a.m., he/she reviewed the above records and confirmed findings.

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 review of agency policy, clinical records (CR), and staff (EMP) interview, the agency failed to integrate services to assure the coordination of care provided by all disciplines for one (1) of two (2) discharged records (CR3). Finding included: Review of policy on January 5, 2023, at 12:30 p.m. showed, "Client Care Coordination ... 4.0 When more than one service is provided, whether directly or through contact, the Client Service Manager and Clinical Manager work together to assure that the actions and goals of the individual services are complementary. ... When service is provided through liaison with other organizations or individuals, coordination of services is maintained by the team effort of the Client Services Manager and Clinical Manager, and the information is documented in the client chart." Review CR3 on January 4, 2023, at 10:30 a.m. showed a physician ordered plan of care with an initial certification period from 6/28/2023 to 8/26/2023. SN was to see patient for care and assessment related to seizures. Orders included, "Apply bilateral AFO's as per recommendation of PT/OT/physician." CR3 was receiving PT/OT services from another organization. On 6/29/2023, the SN documented, "1:15pm ... Unable to wear AFO's due to improper fit with current shoes." Further review of CR3 on January 5, 2024, at 10 a.m. to include treatment records, did not show patient had worn their AFOs until 8/10/2023 and just prior to the end of episode. There was nothing in the record to show what PT/OT recommended concerning the patient's AFOs. During a staff interview on January 5, 2023, at 10:30 a.m., EMP3 (manager of clinical operations) reviewed the above records and confirmed findings. EMP3 noted he/she could not view or see what the PT/OT recommendations were because they were kept in the patient's home.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CR), and staff (EMP) interview, the licensed practical nurse failed to report changes in the patient's condition to the physician for three (3) of seven (7) clinical records (CR1-CR3). Findings included: Review of agency policy on January 5, 2023, at 12:30 p.m. showed, "JOB DESCRIPTION AND PERFORMANCE EVALUATION LICENSED PRACTICAL NURSE [LPN] ... CLINICAL RESPONSIBILITIES ... 3. Reports any changes in the client's condition to the physician; executes and properly documents any new doctor's orders." Review of CR1 on January 2, 2024, at 12 p.m. showed a physician ordered plan of care for an initial certification period from 11/27/2023 to 1/25/2024. Orders included skilled nursing (SN) to see the patient for care and assessment related to cerebral palsy diagnosis. The patient was to "wear AFOS [ ankle foot orthotic - supportive device for lower extremity] while awake [as] tolerated." Further review of CR1 did not show patient was wearing their AFOs and on 12/5 the LPN documented, "Client was dressed for the day shoes put on, mom still hold AFOs at this time until she can work him back up to the length of time that he needs to wear them." Review of treatment sheets showed the LPN documented an "H" for 11/28, 11/29, and 11/30/2023 to show that the patients AFOs were on hold and not being used. Further review of CR1 on January 5, at 9:30 a.m. did not show that agency notified the physician that the patient's AFOs were on hold. Review of CR2 on January 4, 2024, at 9:30 a.m. showed a physician ordered plan of care with a recertification period from 11/17/2023 to 1/15/2024. The patient's diagnosis included "encounter for attention to gastrostomy [tube inserted into stomach]." SN was to provide care 5-7 nights per week. Review of "Nurse's Shift Note" by the LPN from 12/18/2023 showed the patient's mom did not elevate the patient's head while the patient was receiving a feeding via their gastrostomy tube, "HOB [head of bed] flat - Mom previously educated on importance of elevating HOB with TF [tube feed] via GT [gastrostomy tube] to avoid aspiration [stomach contents getting into lungs] , verbalized understanding- requests client lay flat this shift." Further review of CR2 on January 5, 2024, at 9:40 a.m. did not show that agency notified the physician concerning patient being fed via GT while lying flat which could increase the patient's risk of aspiration. Review CR3 on January 4, 2023, at 10:30 a.m. showed a physician ordered plan of care with an initial certification period from 6/28/2023 to 8/26/2023. SN was to see patient for care and assessment related to seizures. Orders included, "Apply bilateral AFO's as per recommendation of PT/OT/physician. ... Maintain and encourage safe use of mobility aides and orthotics [AFOs] to decrease risk for falls; notify CM and/or physician regarding concerns." On 6/29/2023, the LPN documented, "1:15pm ... Unable to wear AFO's due to improper fit with current shoes." Further review of CR3 on January 5, 2024, at 10 a.m. did not show the physician was notified concerning the improper fir of AFOs. During an interview with EMP3 (manager of clinical operations) on January 5, 2023, from 9:30 a.m. to 11:30 a.m., he/she reviewed the above records and confirmed findings.

Based on the findings of an onsite unannounced Medicare recertification survey completed March 1, 2021, 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 onsite unannounced Medicare recertification and state license survey completed March 1, 2021, 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.

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 review of agency policy, clinical records (CR), and staff (EMP) interviews, the agency failed to integrate and coordinate all services for three (3) of three (3) clinical records who had laboratory testing (labs/blood draw) (CR1, CR2, & CR4). Findings included: Review of agency policy on March 1, 2021, at 11:34 a.m. showed, "0-944 CLIENT CARE COORDINATION ... last revised Jan. 13, 2018 ... 6.0 When service is provided through liaison with other organizations or individuals, coordination of services is maintained by the team effort of the Client Services and Clinical Managers, and the information is documented in the client chart. Communication from other sources, ... must be documented in the client chart." On February 24, 2021, at 11 a.m. surveyor requested lab results for clinical records that would be reviewed. On February 24, 2021, at 2:19 p.m., EMP1 sent email to surveyor that showed, "You asked me about the labs, we do not do them for any of our clients, they have a visit agency come in." Review of CR1 on February 24, 2021, at 2 p.m. showed a physician ordered plan of care beginning 1/14/2019 for a recertification period from 1/3/2021 to 3/3/2021. Skilled nursing services were ordered twice a week. Per the plan, the patient was to have labs completed weekly and monthly to check his blood count, liver function, bleeding times, iron levels, and vitamins/minerals. The ordered labs were extensive in nature, related to the patient's malabsorption diagnosis, prescribed medications, and his need for parenteral nutrition (supplemental nutrition provided intravenously [TPN]). The plan also contained the following order, "Notify physician and clinical manager for abnormal clinical findings, abnormal lab values." Interview with EMP1 (administrator) and EMP4 (clinical manager) on March 1, 2021, at 9:30 a.m. confirmed above findings. EMP1 and EMP4 noted that they do not have, and do not know what patient's weekly and monthly lab values are. EMP1 and EMP4 confirmed the patient's labs had been completed by another home health agency (VNA), and that that agency is responsible if anything (lab results) is critical (severely out of range). Review of CR2 on February 26, 2021, at 9 a.m. showed a physician ordered plan of care beginning 10/19/2020 for an initial certification period ending 12/17/2020. Skilled nursing services were ordered 5 days per week. The plan contained orders for, "All lab draws done by patient's family." The plan also contained the order, "Notify physician and clinical manager for ... abnormal laboratory values." Review of nursing notes showed another agency was obtaining patient's labs: "10/19/2020 ... blood draw obtained [by another home care agency];" "10/27/2020 ... Mom reports that [Patient] will have labs drawn this morning. Mom will draw the [labs] then [other home health agency] nurse will transport the specimens to the lab;" "11/2/2020 ... [Other home health agency] visiting nurse arrived lab draw obtained. ... Blood being taken to children's hospital lab;" "11/17/2020 ... [Other home health agency] nurse arrived to transport blood work to lab." During interview with EMP4 on February 26, 2021, at 9:38 a.m., he/she confirmed agency does not know what patient's lab results are currently or for above certification period, "Because we aren't doing it." Review of CR4 on February 26, 2021, at 1 p.m. revealed a physician ordered plan of care beginning 6/30/2014 with a recertification period from 1/31/2020 to 3/30/2020. Skilled nursing services were ordered 5 days per week. Other orders included, "Notify physician and clinical manager for ... abnormal laboratory values ... Mother draws and delivers all lab specimens from [central venous line] and coordinates lab schedule with the physician." Review of skilled nurse visit note from 2/11/2020 showed, "Mom ... drew labwork from CVL [central venous line]." Interview with EMP1 and EMP4 on March 1, 2021, at 9:45 a.m. confirmed above findings. When EMP4 was asked how often the patient gets labs done he/she said, "I don't know." Further review of CR4's medications and medication administration record showed patient was ordered to receive Venofer (iron supplement) intravenously every month. Review of patient's February MAR (medication administration record) showed the patient did not get the Venofer for that month. EMP4 confirmed the finding and suspected the patient did not receive February's Venofer dose because his laboratory values must have been normal. EMP4 noted Venofer administration is based on lab results but, "I don't have."

Assure patient needs are continually assessed CFR(s): 484.105(c)(4) Assuring that patient needs are continually assessed, and This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CR), and staff (EMP) interview, the clinical manager failed to provide oversight of all patient care services to ensure the needs of the patient were continually assessed for three (3) of three (3) clinical records reviewed who required laboratory tests to determine the effectiveness of treatments and medications (CR1, CR2, & CR4). Findings included: On February 24, 2021, at 11 a.m. surveyor requested lab results for clinical records that would be reviewed. On February 24, 2021, at 2:19 p.m., EMP1 sent email to surveyor that showed, "You asked me about the labs, we do not do them for any of our clients, they have a visit agency come in." Review of agency policy on March 1, 2021, at 11:34 a.m. showed, "0-944 CLIENT CARE COORDINATION ... last revised Jan. 13, 2018 ... 6.0 When service is provided through liaison with other organizations or individuals, coordination of services is maintained by the team effort of the Client Services and Clinical Managers." Review of job descriptions on March 1, 2021, at 11:40 a.m. showed, "CLINICAL MANAGER ... HOME CARE ... PRIMARY RESPONSIBILITIES ... 2. Conduct client assessments and complete the care planning process including development, implementation and updates to the client's individualized plan of care. a. Perform a comprehensive client assessment ... on an ongoing basis. b. Identify the client's needs for specific services and resources and direct accordingly. ... 3. Responsible for clinical and client case management. a. Act as internal case manager and client advocate. Communicate and collaborate with team members regarding client status, care plan and expected outcomes." Review of CR1 on February 24, 2021, at 2 p.m. showed a physician ordered plan of care beginning 1/14/2019 for a recertification period from 1/3/2021 to 3/3/2021. Diagnosis was malabsorption. Skilled nursing services were ordered twice a week. The plan showed medications ordered for which labs were required, "Lovenox [blood thinner/anticoagulant] 12 mg [twice daily] ... Heparin [blood thinner/anticoagulant] ... add to TPN [total parenteral nutrition] bag-IV [intravenous] ... Venofer [iron supplement] ... 120 mg - PRN [as needed] q [every] 4-6 weeks depend on lab results ... Notify physician and clinical manager for ... abnormal laboratory values ... purpose of IV therapy: Nutrition." Per the plan, the patient was to have labs completed weekly and monthly to check his blood count (Venofer), liver function, bleeding times (PTT/PT/INR) (Heparin/Lovenox), iron levels (Venofer), and vitamins/minerals (TPN/nutrition). The ordered labs were extensive in nature, related to the patient's malabsorption diagnosis, prescribed medications, and his need for parenteral nutrition (supplemental nutrition provided intravenously [TPN]). Interview with EMP1 (administrator) and EMP4 (clinical manager) on March 1, 2021, at 9:30 a.m. confirmed above findings. EMP1 and EMP4 noted that they do not have, and do not know what patient's weekly and monthly lab values are. EMP1 and EMP4 confirmed the patient's labs had been completed by another home health agency (VNA), and that that agency is responsible if anything (lab results) is critical (severely out of range). Review of CR2 on February 26, 2021, at 9 a.m. showed a physician ordered plan of care beginning 10/19/2020 for an initial certification period ending 12/17/2020. Diagnosis was gastroschisis (intestinal/digestive problem). Skilled nursing services were ordered 5 days per week. The plan contained orders for, "All lab draws done by patient's family." The plan also contained the order, "Notify physician and clinical manager for ... abnormal laboratory values. ... TPN ... daily over 20 hours ... Purpose of IV therapy: Nutrition." Review of nursing notes showed another agency was obtaining patient's labs: "10/19/2020 ... blood draw obtained [by another home care agency];" "10/27/2020 ... Mom reports that [Patient] will have labs drawn this morning. Mom will draw the [labs] then [other home health agency] nurse will transport the specimens to the lab;" "11/2/2020 ... [Other home health agency] visiting nurse arrived lab draw obtained. ... Blood being taken to children's hospital lab;" "11/17/2020 ... [Other home health agency] nurse arrived to transport blood work to lab." During interview with EMP4 on February 26, 2021, at 9:38 a.m., he/she confirmed agency does not know what patient's lab results are currently or for above certification period, "Because we aren't doing it." Review of CR4 on February 26, 2021, at 1 p.m. revealed a physician ordered plan of care beginning 6/30/2014 with a recertification period from 1/31/2020 to 3/30/2020. Diagnosis was intestinal malabsorption. Skilled nursing services were ordered 5 days per week. Other orders included, "Notify physician and clinical manager for ... abnormal laboratory values ... Mother draws and delivers all lab specimens from [central venous line] and coordinates lab schedule with the physician." Medication orders included, "TPN ... daily 7 days/week ... iron sucrose (Venofer) ... Purpose of IV therapy: Nutrition Review of skilled nurse visit note from 2/11/2020 showed, "Mom ... drew labwork from CVL [central venous line]." Interview with EMP1 and EMP4 on March 1, 2021, at 9:45 a.m. confirmed above findings. When EMP4 was asked how often the patient gets labs done he/she said, "I don't know." Further review of CR4's medications and medication administration record showed patient was ordered to receive Venofer (iron supplement) intravenously every month. Review of patient's February MAR (medication administration record) showed the patient did not get the Venofer for that month. EMP4 confirmed the finding and suspected the patient did not receive February's Venofer dose because his laboratory values must have been normal. EMP4 noted Venofer administration is based on lab results but, "I don't have."