Bayada Home Health Care, Inc.

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on policy review, record reviews, observations, and staff (EMP) interview, the Home Health Agency failed to follow all orders listed in the patient care plans for 2 of 7 observed patients (PT6 and PT10). Findings include: Review of policy “Client Care Plan,” dated 9/19/2025, stated, “For all skilled nursing, personal care, and support services, the clinical manager (CM) or a designated CM creates an original plan of care based on the initial client assessment. Actions and interventions are consistent with the plan of care and are documented…” 1. PT6 Review of PT6’s medical record revealed the following: a. Skilled nursing visit note report, dated 1/23/2026, revealed diagnoses of “type 2 diabetes mellitus with diabetic chronic kidney disease…symptoms poorly controlled, patient needs frequent adjustments in treatment and dose monitoring…chronic diastolic (congestive) heart failure…symptoms poorly controlled, patient needs frequent adjustments in treatment and dose monitoring.” b. Resumption of care orders, dated 1/23/2026, stated, “skilled nurse will assess and instruct on management of heart failure, early recognition of signs of exacerbation, client/caregiver self-management, and observation of client’s weight. Notify physician of weight gain of 3 pounds in one day or 5 pounds in one week…Skilled nurse will assess and instruct client/caregiver on diabetes management including prevention, detection and treatment of acute and chronic complications of hypoglycemia/hyperglycemia, monitoring blood glucose, A1C, foot care and benefits of activity. Skilled nurse to perform/instruct the client caregiver to monitor blood glucose prn [as needed] for signs and symptoms of hypoglycemia/hyperglycemia and notify physician of blood glucose greater than 300 or less than 70…” c. Skilled nursing visit note reports, dated 1/27/2026, 1/30/2026, 2/2/2026, 2/5/2026, 2/9/2026, and 2/13/2026, revealed no documentation that blood glucose monitoring or education was performed, weight was assessed, and education on management of heart failure was performed. During an observation of PT6’s homecare visit on 2/13/2026 starting at 8:40 AM, EMP3 did not weigh the patient, asked staff caring for the patient at the assisted living facility (ALF) what the patient’s weight was, and educated the ALF’s staff on the importance of daily weights for management of heart failure and assessing blood glucose levels. 2. PT10 Review of PT10’s medical record revealed the following: a. Skilled nursing visit note report, dated 1/23/2026, revealed a diagnosis of “”Heart failure, unspecified…symptoms controlled with difficulty, affecting daily functioning, patient needs ongoing monitoring.” b. Add on discipline orders, dated 2/6/2026, stated “Skilled nurse will assess and instruct on management of heart failure, early recognition of signs of exacerbation, client/caregiver self-management, and observation of client’s weight. Notify physician of weight gain of 3 pounds in one day or 5 pounds in one week…” c. “Home Health Certification and Plan of Care,” dated 1/7/2026, stated, “Physical therapist will assess and instruct on management of heart failure, early recognition of signs of exacerbation and client/caregiver self-management including activity tolerance and client’s weight. Notify physician of weight gain of 3 points in one day or 5 pounds in one week….” d. Physical therapy visit note report, dated 1/8/2026, revealed weight was “not assessed.” There was no documentation indicating that education on the management of heart failure was provided. e. Skilled nursing visit note report, dated 2/13/2026, revealed no documentation that the patient’s weight was assessed. Under the narrative section, the nurse documented that the “client has SOB [shortness of breath] with moderate exertion…Client states [they] do not take weight daily, but client and aide is [sic] aware that client is to make physician aware if client has a weight gain of 3 pounds in a day or 5 pounds in a week…” There was no documentation on baseline weight, that the nurse attempted to weigh the patient, or that education was provided to the patient on the importance of taking daily weights. During an observation of PT10’s homecare visit on 2/13/2026, starting at 10:20 AM, EMP5 brought a scale to the visit; however, they did not weigh the patient, ask the caregiver for the patient’s weight, or educate the caregiver on the importance of taking and recording daily weights for heart failure management. During an interview on 2/16/2026 at 12:00 PM, EMP2 confirmed that the care plans for PT6 and PT10 included assessing weights for heart failure management, but was unable to provide evidence that weights were assessed for PT6 and PT10. EMP2 stated, “All the clinicians are provided with scales.” EMP2 confirmed that monitoring blood glucose levels was on PT6’s care plan, but was unable to provide evidence that it was performed.”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on policy review, observations, and staff (EMP) interview, the Home Health Agency (HHA) failed to follow standard infection control precautions for 2 of 7 observed patients (PT6, and PT7). Findings include: Review of policy “Hand Hygiene,” revised 6/3/2024, stated, “Hands are decontaminated preferably using alcohol-based waterless hand gel/foam or alternatively with an antimicrobial soap used with water, as follows:…b. Before applying and after removing gloves or other personal protective equipment. c. Between contact with the environment/inanimate objects and the client (medical equipment, bedside tables, personal cellphone) in the immediate vicinity of the client before moving to another task…Apply a dime sized amount of product or more, per manufacturers instruction located on the bottle, to the palm of one hand. Rub hands together, making sure all the surfaces of the hands (thumbs, fingertips, between fingers) are covered, until hands are dry. Hands will take around twenty (20) seconds to dry when an adequate volume of product is applied…” Observation of PT7’s homecare visit on 2/12/2026 at 1:20 PM revealed EMP4 removed the patient’s socks with gloved hands, noted a wound on the patient’s toe, removed one glove to retrieve a cell phone to take a photograph of the wound, placed hand sanitizer in one hand, rubbed the hand lightly, and immediately placed a glove on. Observation of PT6’s homecare visit on 2/13/2026 at 8:40 AM revealed EMP3 removed the soiled dressing from the patient’s leg, placed the dressing on the dirty field, and reached into the supply box to retrieve gauze pads without removing the soiled gloves or performing hand hygiene. This practice was observed twice during EMP3’s wound care. During an interview on 2/16/2026 at 12:00 PM, EMP2 confirmed that neither EMP3 nor EMP4 followed standard infection control precautions.”

“Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This Element is not met as evidenced by: Based on review of agency policy, medical record review (MR), and interview with staff, it was determined that for 1 out of 6 patients (Patient #1) in the sample, the agency failed to provide services necessary to avoid patient harm. Findings include: Agency policy “Handling Client Emergencies,” effective January 1, 1993, last revised November 15, 2024, stated, “...In the event a client requires CPR [cardiopulmonary rescuscitation], and there is a CPR-certified employee present, they should...Initiate CPR; and...Have the caregiver call 911 immediately...” Review of MR1 revealed the following: “Visit Note Report” dated August 6, 2025, completed by EMP5 stated, “...Attempted to perform physical therapy initial evaluation on client. Clients spouse greeted clinician at the door. Spouse reports client had been asleep all morning...After the conversation clinician spoke to the [spouse] about doing a functional assessment as well as getting vital signs for the client. During the course of trying to assess vital signs and trying to have the client participate, client was clearly unresponsive. Vital signs taken were absent. Clinician attempted to arouse patient with sternal rubbing as well as nocious [sic] stimuli to clients fingernail bed with no response. There were no heart or breath sounds upon examination. Clients pupils were fixed and dilated and there were no breath sounds. First responders arrived within a few minutes as they are across the street. Client was then transferred to the floor dependently by EMTs who proceeded to perform CPR...” During an interview on August 12, 2025, at 10:00 AM, EMP5 confirmed that he/she did not start CPR after assessing the patient and finding no heart or breath sounds. EMP5 stated that they were in disbelief at the time of the incident, and it was when the emergency personnel arrived that he/she recognized they should have initiated CPR.”