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 July 31, 2023 through August 2, 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 July 31, 2023 through August 2, 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.

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on a review of clinical records (CR), home health agency (HHA) policy, and an interview with the administrator and director of clinical operations, the HHA failed to ensure that the plan of care was updated for one (1) of seventeen (17) records reviewed: CR#15. Findings include: A review of the Home Health Agency's Policy Client Plan of Care (Policy #0-945) conducted on August 1, 2023 at 3:00 PM reads in part, "3.0 Implementation of the Plan of Care - At regular intervals during the course of care, the client's progress toward achieving desired outcomes is monitored, evaluated, and documented. 3.3 Changes in the plan of care will also be documented, such as change in frequency, additional services, or discontinuation of services. 4.2 For skilled cases, the clinical manager or RN (registered nurse) designee establishes the client's plan of care in conjunction with the physician and the client/caregiver, which reflects diagnoses, treatments required (including medication and procedures), and precautions and limitations that affect the plan of care. 4.3 A reassessment is performed at least every sixty (60) days or earlier based on the client's needs per client assessment and reassessment at which time the plan of care is updated and signed by the physician. In addition, the physician reviews and revises the order periodically as appropriate to: change in the client's physical condition, the client's response to care or services, the client's outcome related to care or service, changes in diagnoses, treatment including procedures and medications, and equipment. The client's problems are continuously updated via verbal orders and nurses' clinical notes. Interventions and goals are updated via verbal orders and recertification of the 485 (Centers for Medicare and Medicaid Services (CMS) 485 Home Health Certification and Plan of Care). Outcomes are documented on the outcome section of the nurses' clinical notes." A review of clinical records (CR) was conducted on July 31, 2023 starting at approximately 11:00 AM, and again on August 1, 2023 starting at approximately 8:30 AM. The start of care (SOC) and Certification Period (CP) for the Home Health Certification and Plan of Care (POC) is indicated below. CR#15 SOC 06/24/2023, CP 06/24/2023 to 08/22/2023 contained an order on the POC which read, "Skilled Nurse to perform anticoagulant monitoring via fingerstick or venipuncture and report results to physician. Skilled Nurse observe and assess the effectiveness of anticoagulation regimen and provide skilled teaching related to anticoagulation therapy." The clinical record revealed that the patient was receiving Eliquis (a direct oral anticoagulant) five (5) milligrams (mg) twice per day. There was no evidence of anticoagulant monitoring via fingerstick or venipuncture nor any evidence of monitoring the "effectiveness of the anticoagulation regimen." There was no evidence that the plan of care was updated to further clarify the process by which the physician intended for the anticoagulation regimen to be monitored for a patient who is receiving a direct oral anticoagulant (DOAC), nor was there a physician order to discontinue monitoring for the effectiveness of the anticoagulation regimen, nor an order to discontinue the fingerstick or venipuncture for the purpose of anticoagulant monitoring. In an interview conducted with the Director of Clinical Operations (DCO) and Administrator on August 1, 2023 at approximately 3:00 PM, the DCO stated that the order for fingerstick/venipuncture is automatically generated by the HHA's electronic medical record (Homecare Homebase) for patients who are receiving oral anticoagulants irrespective of the type of oral anticoagulant therapy that is ordered, and even if the anticoagulant therapy monitoring order, that is automatically generated, is not applicable for a patient who is receiving a DOAC. An interview conducted with the Administrator and Director of Clinical Operations on August 2, 2023 starting at 2:00 PM confirmed the above findings.