QA Investigation Results

Pennsylvania Department of Health
BAYADA HOME HEALTH CARE, INC.
Health Inspection Results
BAYADA HOME HEALTH CARE, INC.
Health Inspection Results For:


There are  17 surveys for this facility. Please select a date to view the survey results.

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Initial Comments:

Based on the findings of an unannounced, onsite Medicare recertification survey conducted on September 8 through September 11, 2020, 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.







Plan of Correction:




484.50(d)(5)(ii) ELEMENT
Make efforts to resolve the problem(s)

Name - Component - 00
(ii) Make efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation;

Observations:

Based on review of agency policies/procedures, documentation and clinical records, and based on interview with the administrator, the agency failed to ensure patient rights notifications included language that the agency would make efforts to resolve the behavioral issues when the agency discharged a patient due to patient behavior/non-compliance with the home health plan of care.

Findings include:

On September 11, 2020 at approximately 2:52 PM, review of agency policy 0-0301, titled "Client Rights-Medicare Certified Home Care and Home Health Offices" revealed the following:
"Our Policy: Bayada Home Health Care honors client rights and informs clients of their responsibilities upon admission and prior to the delivery of services...2.0 Written and Verbal Notification of Client Rights and Timeframe...2.1 Written Notice of Client Bill of Rights-Medicare Certified Offices...is provided to each Medicare-certified client...
4.0 Client Rights...4.3 receive Bayada's transfer and discharge policies...4.17 to participate in the resolution of any conflicts which arise regarding care provision, (i.e., between his/her wishes and the care being provided)..."

Patient #2: On September 8, 2020 at approximately 1:16 PM, review of the clinical record revealed the start of care date was November 20, 2019, the primary diagnosis was hypertensive heart/chronic kidney disease with heart failure and stage 1 to 4 chronic kidney disease (heart and kidney disease) and that skilled nursing (SN), physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services were to be provided as documented on the "Home Health Certification and Plan of Care" for the initial certification period of November 20, 2019 through January 18, 2020.
Review of interim verbal order documentation dated 01/08/2020 revealed the ST (employee #5) documented that the patient was being discharged due to "none" (non) compliance with the plan of care and because patient no longer homebound.
There was no documentation in the clinical record which provided evidence that the agency attempted to resolve plan of care compliance issues/concerns prior to the patient's discharge on January 8, 2020.

Patient #11: On September 10, 2020 at approximately 2:25 PM, review of the clinical record revealed the start of care date was June 29, 2020, the primary diagnosis was hypertensive heart disease with heart failure (heart disease) and that SN, PT, OT, medical social services (MSW) and home health aide services (HHA) services were to be provided as documented on the "Home Health Certification and Plan of Care" for the initial certification period of June 29 through August 27, 2020 .
Review of interim order documentation revealed the SN visit frequency effective August 2, 2020 was as follows: SN to be provided one (1) time a week for three (3) weeks.
Review of "Client Care Coordination Note Report" documentation revealed the following:
-August 3, 2020: The registered nurse (employee #4) documented that the patient was discharged to community needing toileting assistance because the patient was non-compliant with plan of care; and
-August 3, 2020: The rehabilitation manager (employee #12) documented that the patient refused to utilize supplemental oxygen and refused transport/admission to the hospital. The rehabilitation manager (RM), who is a licensed PT, documented that when the SN educated the patient that the patient was unsafe to be home alone, the patient became more agitated and requested that the SN leave. The RM contacted the physician's office at which time the RM notified the physician that the patient was being discharged due to non-compliance.
There was no documentation in the clinical record which provided evidence that the patient had requested discharge from the agency prior to or on August 3, 2020.
Review of the interim physician order dated August 3, 2020 revealed the RM manager obtained the following verbal order: "Client is discharged from home health services due to repeated non-compliance.
There was no documentation in the clinical record which provided evidence that the agency attempted to resolve "repeated" plan of care compliance issues/concerns prior to the patient's discharge on August 3, 2020.

On September 8, 2020 at approximately 2:19 PM, review of "Client Bill of Rights for Medicare-Certified Home Care and Home Health Offices" form, which was included in the agency/patient admission folder, failed to reveal that the form included notification that the agency was required to maintain documentation of efforts to resolve issues with patient behavior/non-compliance with the home health plan of care.

During interview conducted on September 11, 2020 at approximately 3:05 PM, the administrator confirmed the "Client Bill of Rights for Medicare-Certified Home Care and Home Health Offices" form did not include notification that the agency was required to maintain documentation of efforts to resolve issues regarding patient behavior/non-compliance with the home health plan of care.























Plan of Correction:

Based on an analysis of the specific deficiencies cited, the corrective plan and actions taken are to address the lack of demonstrated knowledge resulting in failure to ensure client right notifications included language that the agency would make efforts to resolve client behavioral issues when the agency discharged the client due to behavior/non-compliance with the home health plan of care. The plan of correction will be completed through comprehensive focused education.

By 10/9/2020, the Clinical Manager/designee will reeducate all licensed clinicians on Agency policy Client Transfer and Discharge Medicare Certified Home Health and Home Care offices, 0-9307 which details the discharge process for a client being discharged for cause and due to disruptive behavior:
"Every effort will be made to resolve the problem(s) presented by the client's behavior, the behavior of other persons in the client's home or situation. The problem(s) and effort(s) to resolve the problem(s) must be documented as follows on Coordination of Services (COS) Note, #786 or on a comparable form and entered into the client's record: identification of the problems encountered; Assessment of the situation; Communication with clinical manager, director and the physician responsible for the plan of care; and a plan to resolve the issues.
The client and representative (if any) will be provided with contact information for other agencies or providers which may be able to provide care. Evidence in the client record will include client/representative has been provided contact numbers for other community resources and/or names of other agencies which may be able to provide services."
Education will also include a review of policy Client Rights Medicare Certified Home Care and Home Health offices, 0-9301 with emphasis on the client's right to be fully informed, in advance, of any impending changes in care and treatments as well as the client's right to participate in the resolution of any conflicts which arise regarding the care provision, (i.e., between his/her wishes and the care being delivered). Additionally, education will be provided by the Clinical Manager to all licensed field staff regarding identifying client problems related to behavior that interferes in the provision of care during daily huddles/team meetings.

Effective 10/9/2020 for three months, the Clinical Manager and Director will review the records of all clients being considered for discharge due to disruptive behavior and/or non-compliance with the plan of care to ensure documentation is present including identification of the problem, assessment of the situation, communication with the appropriate persons, and a plan to resolve the issue and to assess whether the client is appropriate for discharge. The expected compliance threshold will be 100%. Failure to achieve 100% will be addressed through focused education with the individual staff members by the Clinical Manager/ clinical designee. Sustained improvement will be monitored through quarterly clinical record reviews conducted as a required component of the Organizations Quality Assurance and Performance Improvement program.

The Director has overall responsibility for implementation and oversight of the plan



484.50(d)(5)(iii) ELEMENT
Provide contact info other services

Name - Component - 00
(iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and

Observations:

Based on review of agency policies/procedures and clinical records, and based on interview with the administrator, the agency failed to ensure the "Client Bill of Rights for Medicare-Certified Home Care and Home Health Offices" form included notification that the agency was required to provide the names and contact information for other agencies/providers which would be available to provide home health services when the agency discharges a patient due to non-compliance with the home health plan of care.

Findings include:

On September 11, 2020 at approximately 2:52 PM, review of agency policy 0-0301, titled "Client Rights-Medicare Certified Home Care and Home Health Offices" revealed the following:
"Our Policy: Bayada Home Health Care honors client rights and informs clients of their responsibilities upon admission and prior to the delivery of services...2.0 Written and Verbal Notification of Client Rights and Timeframe...2.1 Written Notice of Client Bill of Rights-Medicare Certified Offices...is provided to each Medicare-certified client...
4.0 Client Rights...4.3 receive Bayada's transfer and discharge policies..."

Patient #2: On September 8, 2020 at approximately 1:16 PM, review of the clinical record revealed the start of care date was November 20, 2019, the primary diagnosis was hypertensive heart/chronic kidney disease with heart failure and state 1 to 4 chronic kidney disease (diseases of the heart and kidney) and that skilled nursing (SN), physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services were to be provided as documented on the "Home Health Certification and Plan of Care" for the initial certification period of November 20, 2019 through January 18, 2020.
Review of interim verbal order documentation dated January 8, 2020 revealed the ST (employee #5) documented that the patient was being discharged due to "none" (non) compliance with the plan of care and because patient no longer homebound.
There was no documentation in the clinical record which provided evidence that the agency had provided the names and contact information of other agencies/providers which would be available to provide home health services when the agency discharged the patient on January 8, 2020 due to non-compliance with the home health plan of care.

Patient #11: On September 10, 2020 at approximately 2:25 PM, review of the clinical record revealed the start of care date was June 29, 2020, the primary diagnosis was hypertensive heart disease with heart failure (heart disease) and that SN, PT, OT, medical social services (MSW) and home health aide services (HHA) services were to be provided as documented on the "Home Health Certification and Plan of Care" for the initial certification period of June 29 through August 27, 2020.
Review of interim order documentation revealed the SN visit frequency effective August 2, 2020 was as follows: SN to be provided one (1) time a week for three (3) weeks.
Review of "Client Care Coordination Note Report" documentation revealed the following:
-August 3, 2020: The registered nurse (employee #4) documented that the patient was discharged to community needing toileting assistance because the patient was non-compliant with plan of care; and
-August 3, 2020: The rehabilitation manager (employee #12) documented that the patient refused to utilize supplemental oxygen and refused transport/admission to the hospital. The rehabilitation manager (RM), who is a licensed PT, documented that when the SN educated the patient that the patient was unsafe to be home alone, the patient became more agitated and requested that the SN leave. The RM contacted the physician's office at which time the RM notified the physician that the patient was being discharged due to non-compliance.
There was no documentation in the clinical record which provided evidence that the patient had requested discharge from the agency prior to or on August 3, 2020.
Review of the interim physician order dated August 3, 2020 revealed the RM manager obtained the following verbal order: "Client is discharged from home health services due to repeated non-compliance.
There was no documentation in the clinical record which provided evidence that the agency had provided the names and contact information of other agencies/providers which would be available to provide home health services when the agency discharged the patient on August 3, 2020 due to non-compliance with the home health plan of care.

On September 8, 2020 at approximately 2:19 PM, review of "Client Bill of Rights for Medicare-Certified Home Care and Home Health Offices" form, which was included in the agency/patient admission folder, failed to reveal that the form included notification that the agency was required to provide the names and contact information of other agencies/providers which would be available to provide home health services when the agency discharged a patient due to non-compliance with the home health plan of care.

During interview conducted on September 11, 2020 at approximately 3:05 PM, the administrator confirmed the "Client Bill of Rights for Medicare-Certified Home Care and Home Health Offices" form did not include notification that the agency was required to provide the names and contact information of other agencies/providers which would be available to provide home health services when the agency discharged a patient due to non-compliance with the home health plan of care.














Plan of Correction:

Based on an analysis of the specific deficiencies cited, the corrective plan and actions taken are to address the lack of demonstrated knowledge resulting in failure to ensure the names and contact information for other agencies/providers which would be available to provide home health services were provided at discharge. The plan of correction will be completed through comprehensive focused education.

By 10/9/2020, the Clinical Manager/designee will reeducate all office employees on Agency policy Client Transfer and Discharge Medicare Certified Home Health and Home Care offices, 0-9307 with emphasis on the requirement to provide the client/representative contact numbers for other community resources and/or names of other agencies which may be able to provide services.

Effective 10/9/2020 for three months, the Clinical Manager and Director will review the records of all clients being considered for discharge due to disruptive behavior and/or non-compliance with the plan of care to ensure contact numbers for other community resources and/or names of other agencies which may be able to provide services are part of the information provided to the client/representative at discharge. The expected compliance threshold will be 100%. Failure to achieve 100% will be addressed through focused education with the individual staff members by the Clinical Manager/ clinical designee. Sustained improvement will be monitored through quarterly clinical record reviews conducted as a required component of the Organizations Quality Assurance and Performance Improvement program.

The Director has overall responsibility for implementation and oversight of the plan.




484.60(e)(3) ELEMENT
Treatments and therapy services

Name - Component - 00
Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services.

Observations:

Based on review of agency policies/procedures, documentation and clinical records, and based on interview with the administrator, the agency failed to ensure written instructions regarding the type of treatments to be provided by skilled nursing (SN) were provided to five (5) of five (5) patients for whom the "Home Health Certification and Plan of Care" included wound care or Foley (urinary) catheter orders. (Patients #5, #6, #7, #8 and #9)

Finding include:

On September 11, 2020 at approximately 2:51 PM, review of agency policy 0-945, titled "Client Care Plan" revealed the following: "Our Policy: Bayada Home Health Care develops and implements an individualized plan of care for/with each patient."
On September 11, 2020 at approximately 2:52 PM, review of agency policy 0-0301, titled "Client Rights-Medicare Certified Home Care and Home Health Offices" revealed the following: "4.0 Client Rights...4.15 to be fully informed, in advance, of the care and treatment to be provided and any impending changes as time goes on..."

Patient #5: On September 11, 2020 at approximately 9:27 AM, review of the clinical record revealed the start of care date was August 13, 2020, the primary diagnosis was type 2 diabetes mellitus (diabetes) with other skin ulcer and that SN was to provide the following wound treatment to the left lower extremity (leg) surgical wound as documented on the "Home Health Certification and Plan of Care" for the initial certification period of August 13 through October 1, 2020: Cleanse with normal saline solution (NSS), pat dry, pack with plain packing moistened with strength Dakin's (wound treatment), cover with dry sterile dressing daily and as needed.
Review of "Visit Note Report" documentation revealed SN provided the above referenced wound care during SN visits performed in August and September 2020.
During home visit conducted on September 9, 2020 at approximately 10:40 AM, review of the agency's admission folder revealed there was no documentation in the folder which provided evidence that written instructions regarding the above referenced wound care had been provided to the patient.

Patient #6: On September 11, 2020 at approximately 10:00 AM, review of the clinical record revealed the start of care date was October 20, 2019, diagnoses included pressure ulcer of the sacral region (base of spine) and that SN was to provide the following treatments/perform the following procedures as documented on the "Home Health Certification and Plan of Care" for the recertification period of August 15 through October 13, 2020:
-Stage 4 (wound depth) sacral pressure ulcer: Cleanse with NSS, pack with NSS or Dakin's moistened gauze every third day, cover with ABD (thick dressing) using clean technique. Change dressing twice a day; and
-Insert #18 (size) Foley (urinary) catheter with 10 cubic centimeter (cc) balloon. Change every 30 days and as needed for dislodgement or stoppage (blockage).
Review of "Visit Note Report" documentation revealed SN provided the above referenced wound care during SN visits performed on August 13, 16, 18 and 25, 2020 and on September 1, 2020.
During home visit on September 9, 2020 at approximately 12:25 PM, review of the agency's admission folder revealed written instructions dated August 17, 2020, which were documented on the "Patient Instruction Report", included a weekly outline of the skilled nursing, physical/occupational therapy and home health aide visit frequencies, a list of the current medications and an outline of physical therapy interventions which were to be provided, but there was no documentation in the admission folder which provided evidence that written instructions regarding the type of wound care which would be provided by agency staff, nor above referenced Foley catheter orders, had been provided to the patient in writing. During interview conducted during the home visit, the patient confirmed that SN provides wound care and performs Foley catheter changes.

Patient #7: On September 11, 2020 at approximately 10:38 AM, review of the clinical record revealed the start of care date was August 30, 2020, the primary diagnosis was venous insufficiency (poor circulation) and that SN was to provide the following wound treatment to both lower extremity maceration wounds (wound caused by contact with moisture for extended period) as documented on the "Home Health Certification and Plan of Care" for the initial certification period of August 30 through October 28, 2020: Cleanse with soap and water, pat dry, apply Xeroform (wound dressing) to thickened skin, wrap with gauze dressing using clean technique. Change twice a week. Apply ace wrap every morning and remove every evening.
Review of "Visit Note Report" documentation revealed SN provided the above referenced wound care during SN visits performed in August and September 2020.
During home visit conducted on September 10, 2020 at approximately 9:03 AM, review of the agency's admission folder revealed there was no documentation in the folder which provided evidence that written instructions regarding the above referenced wound care had been provided to the patient.

Patient #8: On September 11, 2020 at approximately 11:07 AM, review of the clinical record revealed the start of care date was August 23, 2020, the primary diagnosis was type 2 diabetes mellitus with other skin ulcer and that SN was to provide the following wound treatment to the left lower leg ulcer as documented on the "Home Health Certification and Plan of Care" for the initial certification period of August 23 through October 21, 2020: Cleanse with NSS, apply Silvadene (wound ointment), cover with DSD, wrap with Kerlix (gauze) using clean technique. Change dressing daily.
Review of "Visit Note Report" documentation revealed SN provided the above referenced wound care during SN visits performed in August and September 2020.
During home visit conducted on September 9, 2020 at approximately 9:55 AM, review of the agency's admission folder revealed there was no documentation in the folder which provided evidence that written instructions regarding the above referenced wound care had been provided to the patient.

Patient #9: On September 11, 2020 at approximately 11:17 AM, review of the clinical record revealed the start of care date was December 14, 2019, the primary diagnosis was atherosclerotic disease of native arteries of left leg with ulceration of calf (wound caused by arterial disease) and that SN was to provide the following wound treatment to the left posterior (back of) calf arterial ulcer as documented on the "Home Health Certification and Plan of Care" for the recertification period of August 10 through October 8, 2020: Cleanse with NSS, pat dry, apply strength Dakin's moistened gauze to wound bed, cover with gauze and ADB, wrap with Kling (gauze wrap), secure with tape using clean technique. Change dressing twice a day.
Review of "Visit Note Report" documentation revealed SN provided the above referenced wound care during SN visits performed in August and September 2020.
During home visit conducted on September 10, 2020 at approximately 11:00 AM, review of the agency's admission folder revealed there was no documentation in the folder which provided evidence that written instructions regarding the above referenced wound care had been provided to the patient.

During interview on September 11, 2020 at approximately 3:05 PM, the administrator confirmed that the agency does not provide written instructions to patients related to the type of wound care and urinary catheter maintenance/care which will performed/provided by agency staff.











Plan of Correction:

Based on an analysis of the specific deficiencies cited, the corrective plan and actions taken are to address the lack of demonstrated knowledge resulting in failure to ensure written instructions regarding the type of treatment to be provided by skilled nursing were provided to the client. The plan of correction will be completed through comprehensive focused education.

By 10/9/2020, the Clinical Manager/designee will reeducate all licensed clinicians on policy Admission Criteria and Procedure - Medicare Certified Offices, 0-672 with emphasis on providing in writing to the client and representative any treatments, including therapy services to be administered by BAYADA and contractors and any other pertinent instruction(s) related to the client's care and treatments specific to the client's needs.

Effective 10/9/2020 for three months, the Clinical Manager/ designee will review weekly the clinical records of all new admissions to ensure written information is present in the home for any treatments, including therapy services, to be administered by BAYADA and contractors and any other pertinent instruction(s) related to the client's care and treatments specific to the client's needs. This will be completed by viewing a picture uploaded to the electronic record by a field clinician who is present in the home after admission. The expected compliance threshold will be 100%. Failure to achieve 100% will be addressed through focused education with the individual staff members by the Clinical Manager/ clinical designee. Sustained improvement will be monitored through quarterly clinical record reviews conducted as a required component of the Organizations Quality Assurance and Performance Improvement program.

The Director has overall responsibility for implementation and oversight of the plan.



484.80(g)(1) STANDARD
Home health aide assignments and duties

Name - Component - 00
Standard: Home health aide assignments and duties.
Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist).

Observations:

Based on review of agency policies/procedures, clinical records and the Pennsylvania Department of Health home health state licensure regulations (Chapter 601), and an based on interview with the administrator, the agency failed to ensure that the home health aide plan of care was prepared/revised by the case manager/registered nurse (RN) for two (2) of four (4) active patients for whom skilled nursing (SN) and home health aide (HHA) services were ordered on the "Home Health Certification and Plan of Care". (Patients #6 and #7)
Findings include:
On September 11, 2020 at approximately 2:51 PM, review of agency policy 0-945, titled "Client Care Plan" revealed the following: "5.0 Assistive Care Services...5.1 For personal care is established by the Clinical Manager, or case managing RN or therapist in accordance with his/her assessment, participation of client/caregiver and as applicable to program and services, with the physician..."
On September 11, 2020 at approximately 3:50 PM, review of the PA DOH Chapter 601 revealed the following as documented under "601.35 Home Health Aide Services": (b) Assignment and duties of the home health aide. The home health aide shall be assigned to a particular patient by a registered nurse. Written instructions for patient care shall be prepared by a registered nurse or therapist as appropriate."

Patient #6: On September 11, 2020 at approximately 10:10 AM, review of the clinical record revealed the start of care date was October 20, 2019, the primary diagnosis was pressure ulcer (wound) of the sacral region (base of spine) and that SN, physical therapy (PT), occupational therapy (OT) and HHA services were to be provided as documented on the "Home Health Certification and Plan of Care" for the recertification period of August 15 through October 13, 2020.
"Visit Note Report" documentation revealed the following:
-SN services were provided on August 18 and 28, 2020 and September 3 and September 9, 2020; and
-HHA services were provided on August 19 and 26, 2020 and September 2 and 9, 2020.
Review of the "Aide Care Plan Report" revealed the rehabilitation manager (RM-employee #12), who is a physical therapist, entered and approved the updated HHA care plan on September 8, 2020.
There was no documentation in the clinical record which provided evidence that the case manager/RN (employee #7) had approved the "Aide Care Plan Report" dated September 8, 2020.

Patient #7: On September 11, 2020 at approximately 10:38 AM, review of the clinical record revealed the start of care date was August 30, 2020, the primary diagnosis was venous insufficiency (poor circulation) and that SN, PT, OT and HHA services were to be provided as documented on the "Home Health Certification and Plan of Care" for the initial certification period of August 30 through October 28, 2020.
"Visit Note Report" documentation revealed the following:
-SN services were provided on August 30, 2020 and September 3, September 8 and September 10, 2020; and
-HHA services were provided on September 3 and 10, 2020.
Review of the "Aide Care Plan Report" revealed the RM (employee #12) entered and approved the home health aide care plan on September 1, 2020.
There was no documentation in the clinical record which provided evidence that the case manager/RN (employee #7) had approved the "Aide Care Plan Report" dated September 8, 2020.

During interview conducted on September 11, 2020 at approximately 3:05 PM, the administrator confirmed the RM, not the case manager/RN, had established or reviewed the "Aide Care Plan Report" for the above identified patients.























Plan of Correction:

Based on an analysis of the specific deficiencies cited, the corrective plan and actions taken are to address the lack of demonstrated knowledge resulting in failure to ensure the home health aide plan of care was prepared/revised by the case manager/registered nurse. The plan of correction will be completed through comprehensive focused education.

By 9/25/2020, a new Home Health Aide care plan was developed by a Registered Nurse for clients #6 and #7.

By 10/9/2020, the Clinical Manager/designee will reeducate all offices staff and licensed clinicians on policy Client Care Plan, 0-945 with emphasis on the Clinical Manager or a designated Registered Nurse developing the care plan for a client receiving Home Health Aide services.

Effective 10/9/2020 for three months, the Clinical Manager/ designee will review the records of all new admissions receiving Home Health Aide services to ensure the care plan was developed by a Registered Nurse. The expected compliance threshold will be 100%. Failure to achieve 100% will be addressed through focused education with the individual staff members by the Clinical Manager/ clinical designee. Sustained improvement will be monitored through quarterly clinical record reviews conducted as a required component of the Organizations Quality Assurance and Performance Improvement program.

The Director has overall responsibility for implementation and oversight of the plan.



484.110(a)(2) ELEMENT
Interventions and patient response

Name - Component - 00
All interventions, including medication administration, treatments, and services, and responses to those interventions;

Observations:

Based on review of agency policies/procedures and clinical records, observation and based on interview with the administrator, the agency failed to ensure cardiovascular and respiratory assessments were documented by the skilled nursing (SN) for three (3) of three (3) for whom the primary diagnosis inclued heart failure. (Patients #2, #10 and #11)

Finding include:

On September 11, 2020 at approximately 2:49 PM, review of agency policy 0-988, titled "Client Assessment and Reassessment" revealed the following: "4.0 Client Assessment and Reassessment Contents...4.1 All Other Practices. Assessment and reassessments will reflect, as appropriate: Note: If any component of the assessment is not able to be obtained, the rationale must be clearly documented on the assessment form...Assessment of physical...symptoms relative to the intervention that is provided..."
On September 11, 2020 at approximately 2:54 PM, review of agency nursing procedure titled "Cardiovascular-Heart Failure: Assessment & Management" revealed the following:
Procedure...Perform a cardio-respiratory (heart/lungs) assessment of all heart failure patients at every visit as appropriate to discipline...b. Perform physical assessment of patient...3. Cardiac auscultation (listen for apical (center of chest) pulse, gallop (heart rhythm). 4. Pulmonary auscultation (listen for crackles which do not clear with cough)...
After care...3. Document in the patient' s medical record...b. All assessment findings...

Patient #2: On September 8, 2020 at approximately 1:16 PM, review of the clinical record revealed the start of care date was November 20, 2019, the primary diagnosis was hypertensive heart disease/chronic kidney disease with heart failure and stage 1 to 4 chronic kidney disease (heart and kidney disease) and that skilled nursing (SN) interventions included the following as documented on the "Home Health Certification and Plan of Care" for the initial certification period of November 20, 2019 through January 18, 2020: "SN to provide skilled observation...of heart failure..."
Review of "Visit Note Report" documentation dated November 27, December 4, December 18 and December 23, 2019 revealed the registered nurse (RN-employee #7) had failed to document the findings from the assessment of heart and lung sounds.

Patient #10: On September 11, 2020 at approximately 11:32 AM, review of the clinical record revealed the start of care date was June 22, 2020, the primary diagnosis was hypertensive heart disease with heart failure and that SN interventions included the following as documented on the "Home Health Certification and Plan of Care" for the recertification period of August 22 through October 19, 2020: "RN to evaluate client for needs requiring physician orders and skilled nursing interventions."
During home visit conducted on September 10, 2020 at approximately 11:55 AM, observation of the SN assessment revealed the licensed practical nurse (LPN-employee #6) assessed the patient ' s heart and lung sounds. During interview during the home visit, the patient reported agency nursing staff thoroughly assesses the patient during each SN visit.
Review of "Visit Note Report" documentation dated August 22 and 26, 2020 and September 3, 2020 revealed the registered nurse (employee #15) had failed to document the findings from the assessment of heart and lung sounds.

Patient #11: On September 10, 2020 at approximately 2:23 PM, review of the clinical record revealed the start of care date was June 29, 2020, the primary diagnosis was hypertensive heart disease with heart failure and that SN interventions included the following as documented on the "Home Health Certification and Plan of Care" for the initial certification period of June 29 through August 27, 2020: "SN to provide skilled observation...of heart failure..."
Review of "Visit Note Report" documentation dated July 7 and 13, 2020 (employee #7) and July 25, 2020 (employee #14) revealed the LPN's had failed to document the findings from the assessment of heart and lung sounds.

During interview on September 11, 2020 at approximately 3:05 PM, the administrator confirmed that the above referenced nursing staff had failed to document the heart and lung sound assessment findings for the above identified patients.











Plan of Correction:

Based on an analysis of the specific deficiencies cited, the corrective plan and actions taken are to address the lack of demonstrated knowledge resulting in failure to ensure cardiovascular and respiratory assessment were documented by the skilled nurse. The plan of correction will be completed through comprehensive focused education.

Client #2 is no longer receiving services from this Agency.
The clinical notes from Client #10's visit do not reflect an assessment of heart and lung sounds. The Clinicians associated with this client will be educated by 10/9/2020 on documentation requirements related to cardiovascular assessments.
Client #11 is no longer receiving services from this Agency.

By 10/9/2020, the Clinical Manager/designee will reeducate all licensed clinicians on Agency policies Heart Failure: Assessment and Management, 0-8784 and Client Assessment and Reassessment, 0-988 with emphasis on the required components of a cardiovascular assessment and the requirement to clearly document the rationale if any component of the assessment is not able to be obtained.

Effective 10/9/2020 for three months, the Clinical Manager/ clinical designee will review the clinical records of 25% active clients with a diagnosis of cardiac disease for the completion of a cardiovascular assessment as directed by the care plan or for documentation of the rationale if any component of the assessment is not able to be obtained. The expected compliance threshold will be 100%. Failure to achieve 100% will be addressed through focused education with the individual staff members by the Clinical Manager/ clinical designee. Sustained improvement will be monitored through quarterly clinical record reviews conducted as a required component of the Organizations Quality Assurance and Performance Improvement program.

The Director has overall responsibility for implementation and oversight of the plan.




Initial Comments:

Based on the findings of an unannounced, onsite Medicare recertification survey conducted on September 8 through September 11, 2020, 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.







Plan of Correction: