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

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, observation, document review, and interview. In 2 of 19 (11%) clinical records reviewed and home visits observed, the agency did not ensure that all of the patients' current medications were included in the patients' drug profiles. Agency Policy #0-990 "Medication Management & Administration" (dated 05/06/2024) stated in part, "Medication reconciliation should be completed on every comprehensive assessment and reassessment. The comprehensive assessment includes: Drug profile (medication reconciliation), including prescriptions, over-the-counter medications, supplements, herbal remedies, and other alternative treatments that could affect drug therapy." CLINICAL RECORD 4/HOME VISIT 4: On 01/22/2026, an observed home visit was conducted with a Registered Nurse (Personnel Record 11). During the observed visit the patient's current medications in the home were reviewed with the Registered Nurse. A bottle labeled "Men's One-A-Day Multivitamins" was found. The patient reported taking the multivitamin. The current medication profile provided by the agency dated 01/22/2026 did not include the multivitamin. During interview at the end of the visit, the Registered Nurse stated "He has been taking the multivitamin for a couple weeks. I must have forgot to enter the order for that and add that to his medication list." CLINICAL RECORD 7: The patient elected the hospice benefit on 09/15/2025. A PRN (pro re data; as needed) nursing visit note dated 11/23/2025 documented in part "Suprapubic catheter flushed with normal saline". The patient's current medication profile, dated 01/20/2026, did not include normal saline. During joint record reviews on 01/21/2026 and 01/22/2026, the Director of Clinical Operations confirmed the above findings, stating "I do not see normal saline or a multivitamin on these patients' medication lists."

It is required that Hospice Aides are supervised by a Registered Nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the Hospice Aide, and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The Hospice Aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 5 of 14 (36%) clinical records reviewed with Hospice Aide (HA) services provided, the agency did not ensure that HA supervisory visits were completed by a Registered Nurse (RN) no less frequently than every 14 days. CLINICAL RECORD 3: The patient elected the hospice benefit on 06/30/2025. The plans of care (POC) dated 06/30/2025 through 09/27/2025 and 09/28/2025 through 12/26/2025 ordered "HA 2 times per week". The first HA visit was dated 07/02/2025. HA supervisory visits were dated 07/10/2025, 07/22/2025, 07/29/2025, 08/05/2025 and 08/18/2025. The next HA supervisory visit was dated 09/23/2025 (36 days from the previous documented supervisory visit). A subsequent HA supervisory visit was dated 10/02/2025. The next HA supervisory visit was dated 11/10/2025 (39 days from the previous documented supervisory visit). CLINICAL RECORD 9: The patient elected the hospice benefit on 11/30/2025. The initial POC dated 11/30/2025 through 02/27/2026 ordered "HA 3 times per week". The first HA visit was dated 12/02/2025. The first HA supervisory visit was dated 12/31/2025, (29 days from the first documented supervisory visit). CLINICAL RECORD 10: The patient elected the hospice benefit on 06/02/2025. The POCs dated 06/02/2025 through 07/31/2025, 08/01/2025 through 09/29/2025, 09/30/2025 through 11/28/2025, and 11/29/2025 through 01/27/2026 ordered "HA 2 times per week". The first HA visit was dated 06/05/2025. The first HA supervisory visit was dated 06/19/2025. The next HA supervisory visit was dated 07/15/2025 (26 days from the first documented supervisory visit). The next HA supervisory visit was dated 08/04/2025 (20 days from the previous documented supervisory visit). HA supervisory visits were dated 08/12/2025, 08/18/2025, 09/01/2025, and 09/15/2025. The next HA supervisory visit was dated 10/14/2025 (29 days from the 09/15/2025 supervisory visit). HA supervisory visits were dated 10/24/2025, 11/06/2025, 11/17/2025, 11/29/2025, and 12/09/2025. The next HA supervisory visit was dated 01/13/2026 (34 days from the previous documented supervisory visit). CLINICAL RECORD 12: The patient elected the hospice benefit on 06/12/2025. The POCs dated 06/12/2025 through 09/09/2025, 09/10/2025 through 12/08/2025, and 12/09/2025 through 02/06/2026 ordered "HA 3 times per week". The first HA visit was dated 06/16/2025. HA supervisory visits were dated 06/24/2025, 07/08/2025, 07/16/2025, and 07/23/2025. The next HA supervisory visit was dated 08/14/2025 (22 days from the previous documented supervisory visit). A HA supervisory visit was dated 08/19/2025. The next Hospice Aide supervisory visit was dated 09/08/2025 (19 days from the previous documented supervisory visit). HA supervisory visits were dated 09/16/2025, 09/24/2025, 10/07/2025, 10/14/2025, 10/20/2025, 10/29/2025, 11/11/2025, 11/19/2025, 11/24/2025, 12/01/2025, and 12/15/2025. The next HA supervisory visit was dated 01/05/2026 (21 days from the previous documented supervisory visit). CLINICAL RECORD 13: The patient elected the hospice benefit on 06/20/2025. The POCs dated 06/20/2025 through 08/18/2025 and 08/19/2025 through 10/17/2025 ordered "HA 3 times per week". The first HA visit was dated 06/24/2025. HA supervisory visits were dated 07/03/2025, 07/15/2025, 07/24/2025, 08/05/2025 and 08/14/2025. The next HA supervisory visit was dated 10/02/2025 (49 days from the previous documented supervisory visit). During joint record reviews and interviews on 01/21/2026, 01/22/2026 and 01/23/2026, the Director of Clinical Operations confirmed the above findings that HA supervisory visits were completed less frequently than every 14 days.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: Physician orders. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the patients' clinical records included all physician's orders. CLINICAL RECORD 4/HOME VISIT 4: On 01/22/2026, an observed home visit was conducted with a Registered Nurse (Personnel Record 11). During the observed home visit the patient's current medications in the home were reviewed with the Registered Nurse. A bottle labeled "Men's One-A-Day Multivitamins" was found. The patient reported taking the multivitamin. The clinical record was absent documentation of a physician's order for the multivitamin. During interview at the end of the visit, the Registered Nurse stated "He has been taking the multivitamin for a couple weeks. I must have forgot to enter the order for that and add that to his medication list." CLINICAL RECORD 7: The patient elected the hospice benefit on 09/15/2025. A PRN (pro re data; as needed) nursing visit note dated 11/23/2025 documented in part "Suprapubic catheter flushed with normal saline." The clinical record was absent documentation of a physician's order for suprapubic catheter irrigation with normal saline. During joint record reviews and interview on 01/21/2026 and 01/22/2026, the Director of Clinical Operations confirmed the above findings, stating "I do not see orders for catheter irrigation with normal saline or a multivitamin in these charts."

Based on review of hospice policy, clinical records (CR) and staff interview, the agency failed to ensure the needs of the patients were met for one (1) of one (1) CRs reviewed with documented wounds (CR #2). Findings Include: Review of hospice policy "0-3230 Wound Care Assessment and Treatment" on October 19, 2021, at approximately 11:00 A.M. stated, "11.3 Size: Wound should be measured in centimeters (cm) once per week and/or as per physician's order.... " Review of CR on October 19, 2021, at approximately 10:00 A.M. revealed: CR #2, start of care October 2, 2021, certification period reviewed, October 2, 2021, through December 30, 2021, contained orders for skilled nursing (SN) one (1) visit per week for one week, then two (2) visits per week for thirteen (13) weeks. Review of SN visits revealed that an initial SN visit was conducted on October 2, 2021. The SN documented three wounds on the wound assessment sheet. Wound #1 on left hand, which was bandaged and wound care had been completed by the caregiver, was not assessed. Wound #2 on the left patellar area was documented as a stage 2, was not measured due to patient refusal. Wound care was performed. Wound #3, on the right buttock was documented as a stage 3, was not measured due to patient refusal. The SN documented, "Pt (patient) with severe contractures. Sacral wound decubitus ulcer and several other ulcers, treatment complete, due to pt screaming, unable to fully assess..." October 5, 2021, SN visit conducted, wound care documented as follows: Wound #1, caregiver provided wound care, wound not assessed. Wound #2, refused measurement. Wound care provided, cleansed with NSS (normal saline solution), applied MediHoney, covered with gauze. Wound #3, refused measurement, wound care provided, cleansed with NSS, MediHoney applied and covered with gauze. October 7, 2021, SN visit conducted. Wound care provided as ordered for wound #1, 2, and 3. Patient refused measurements. October 11, 2021, SN visit conducted. Wound #1 and 2, care provided by caregiver, not assessed. Wound #3, wound care provided per physician orders. Measurement 5 cm (centimeters) by 5 cm by 0.5 cm. October 14, 2021, SN visit conducted. Wound #1 and 2, care provided by caregiver, not assessed. Wound #3, wound care provided per physician orders, no measurements taken. The SN documented that skin protectant was ordered. October 18, 2021, SN visit conducted. Wound #1 measured 2cm by 2cm by 0.3 cm. Wound #2 measured as 10cm by 6 cm by 0.3 cm. Wound #2 measured 5 cm by 5 cm by 0.5 cm. Wound care provided per physician orders. The SN documented "Patient is unable to reposition. Sacral wound increased in depth and area. Wound care provided..." October 19, 2021, the clinical manager documented the SN reported wound score deviation and conferenced with medical director on change in severity. New orders were obtained for calcium alginate and transparent film dressing. Interview with the clinical manager on October 19, 2021, at approximately 11:00 A.M. confirmed the above findings. A follow-up telephone call with the clinical manager on October 22, 2021, confirmed the above findings.