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

Based on the findings of an onsite unannounced Medicare recertification survey completed on 1/8/2021, 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 relicensure survey completed on 1/8/2021, 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.

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 a review of agency policy, medical record (MR) and staff (EMP) interview, it was determined that the agency failed to maintain an accurate medication profile to ensure review of all medications the patient was taking for two (2) of seven (7) MR's reviewed (MR4 and MR5). Findings Included: Review of the agency policy and procedures was conducted on 1/8/2021 at approximately 2:00 PM which revealed, Policy " 0-990 MEDICATION MANAGEMENT AND ADMINISTRATION ...1.0 MEDICATION ORDERS, 1.1 Acceptable Medication Orders must contain these basic elements: a. Physician name b. Date c. Client name d. Medication name (generic and brand names are acceptable) e. Dosage including milligrams/milliliters f. Frequency g. Route h. Indication for use if " PRN " i. Parameters for increase/decrease in dosage ...PRE-ADMINISTRATION PROCEDURES ...2.2 Verify that there are acceptable, written physician ' s orders for all drugs the client is taking. If there is no order or prescription for a drug, including over-the-counter medications and herbal products, an Addendum must be completed and sent for signature ... " Review of MR4 on 1/6/2021 at approximately 2:15 PM revealed, "Home Health Certification and Plan of Care" with a start of care date of 10/23/2020 and a current certification period starting 10/23/2020 and ending 12/21/2020. The primary diagnosis was "Secondary Malignant Neoplasm of Bone." The Home Health Certification and Plan of Care listed under section ordered " SN (skilled nursing) TO CHECK PULSE OX EACH SHIFT AND PRN STATUS CHANGE. CLIENT MAY HAVE OXYGEN UP TO 5L(liters)/MIN (Minute) via NC (nasal cannula) per (Patient) COMFORT LEVEL ... " Review of the Medication profile and plan of care did not list Oxygen under the medication section. Review of MR6 on 1/8/2021 at approximately 10:05 AM revealed, "Home Health Certification and Plan of Care" with a start of care date of 7/25/2018 and a current certification period starting 11/14/2020 and ending 01/12/2021. The primary diagnosis was "ENCOUNTER FOR ATTENTION TO GASTROSTOMY." The Home Health Certification and Plan of Care listed under section " ...21. Orders for Discipline and Treatments (Specify Amount/Frequency/Duration) ...ADMINISTER OXYGEN VIA TRILOGY, START O2 AT 0.5L PM CAN TITRATE UP BY 0.5LPM TO MAX OF 4LPM. MAINTAIN SPO2 93% & ABOVE ... " Review of the medication profile and plan of care did not list Oxygen under the medication section. An exit interview with the following staff: (via phone) senior associate, director regulation compliance, division director and division director (onsite) director, director, and clinical manager. The exit interview was conducted on 1/8/2021 at approximately 3:30 PM which confirmed the above findings.

Revisions communicated to patient and MDs CFR(s): 484.60(c)(3)(i) (i) Any revision to the plan of care due to a change in patient health status must be communicated to the patient, representative (if any), caregiver, and all physicians issuing orders for the HHA plan of care. This ELEMENT is not met as evidenced by: Based on review of agency policy and procedure, a medical record review (MR) and staff (EMP) interview the agency failed to communicate to all caregivers the agency plan of care for one (1) of seven (7) MR reviewed (MR4). Findings Included: Review of the agency policy and procedures was conducted on 1/8/2021 at approximately 9:51 AM which revealed, Policy "0-944 CLIENT CARE COORDINATION...Our Procedure: 1.0 Coordination of client services is the shared responsibility of the Client Services Manager and Clinical Manager. Both are qualified professionals, with an adequate amount of experiences and knowledge to do the job effectively. 2.0 Both professionals regularly communicate with the staff directly providing care to the clients. The Client Services Manager remains in the office, Providing full time case coordination. The Clinical Manager provides on-site supervision, oversees the direct care of clients and coordinates referrals. Together, they provide full service coordination. 3.0 Case coordination involves identification of additional services needed, contacting community resources for these services, discussions of the client ' s needs and status and follow-up, as appropriate. 4.0 When more than one service is provided, whether directly or through contract, the Client Services Manager and clinical Manager work together to assure that the actions and goals of the individual services are complementary. Regular communication is maintained among supervisors, field employees, and clients by telephone, written reports, on-site supervisory visits, and interdisciplinary conferences. Documentation of such is made in the client chart; all updated care plans are also kept in the home, to which all service providers have access. Communication can be documented on COORDINATION OF SERVICES (COS) NOTE, #786. 5.0 The clinical manager will review the goals presented by all disciplines and communicate the pertinent goals to all health care team members. Also, the Clinical Manager is responsible for reviewing the care plans for clients who are receiving several services, making sure that there is no duplication of services. When duplication does occur, there is an immediate effort made to correct the situation, which is documented in the client chart. 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, such as reports from the aides/field nurses and additional collateral contacts, must be documented in the client chart..." Review of MR4 on 1/6/2021 at approximately 2:15 PM revealed, "Home Health Certification and Plan of Care" with a start of care date of 10/23/2020 and a current certification period starting 10/23/2020 and ending 12/21/2020. The primary diagnosis was "Secondary Malignant Neoplasm of Bone." The Home Health Certification and Plan of Care listed under section "21. Orders for Discipline and Treatments (Specify Amount/Frequency/Duration)...CLIENT IS UNDER THE CARE OF...HOSPICE..." Documentation within the medical record confirmed communication between the (agency) and the hospice agency providing services. The surveyor requesting documentation of the agency providing the plan of care to the hospice agency or the plan of care received from the hospice agency to confirm coordination of care between the two agencies. An interview was conducted with EMP1 on 1/8/2021 at approximately 11:10 AM which confirmed, documentation was not available to confirm a plan of care was provided to the hospice agency or a request for the plan of care from the hospice agency. An exit interview with the following staff: (via phone) senior associate, director regulation compliance, division director and division director (onsite) director, director, and clinical manager. The exit interview was conducted on 1/8/2021 at approximately 3:30 PM which confirmed the above findings.