Bayada Home Health Care, Inc.

“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 agency policy, observation, and staff interviews, the agency failed to disinfect a point of care device (documentation tablet) after contact with personal items for 1 of 5 patients with a home visit. (patient #13) Findings included: A policy Equipment & Supplies Maintenance (revised 07/12/2021) received on 08/12/2025 at 12:55 PM stated, “Non-critical items are those items that do not come into contact with mucous membranes or non-intact skin. These items can undergo a low level of disinfection… Examples of non-critical items include… Point of Care Devices.” Patient #13 was admitted on 10/30/2024 with a diagnosis of postsurgical malabsorption (a condition that prevents the absorption of nutrients). The plan of care for 06/27/2025-08/25/2025 included orders for skilled nurse (SN) visits 1 time a week for 1 week, 2 times a week for 1 week, 1 time a week for 3 weeks, 2 times a week for 1 week, 1 time a week for 3 weeks. During a home visit conducted on 08/12/2025 at 10:30 AM registered nurse (RN) #5 placed the documentation tablet on the patient’s blanket and handed the documentation tablet to the caregiver for a signature. RN #5 failed to disinfect the documentation tablet prior to carrying it against RN #5’s clothing. During an interview conducted on 08/12/2025 at 3:44 PM RN #5 stated, “I usually clean the tablet before I leave the home, I was nervous” During an interview conducted on 08/12/2025 at 3:52 PM the clinical manager stated, “They [documentation tablets] should be placed on a clean dry surface and disinfected.””

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on agency policy, clinical record review, observation, and staff interviews, the agency failed to include an accurate medication profile in the plan of care for 2 of 5 patients with home visits conducted. (patients #12 & 14) Finding’s included: A policy Client Care Plan (revised 07/05/2021) received on 08/12/2025 at 12:55 PM from the clinical manager stated, “The individualized plan of care… must include the following elements: … All medications and treatments…” A policy Client Assessment & Reassessment (revised 05/06/2024) received on 08/12/2025 at 2:00 PM from the clinical manager stated, “[Agency name] provides individualized client assessment upon admission and periodically throughout the course of care/service for all levels of service provided… Client Assessment and Reassessment Contents, Required content… Medication Reconciliation” 1. Patient #12 was admitted on 05/31/2025 with a diagnosis of pressure ulcer of sacral region, stage 4 (a full thickness wound with tissue loss). The plan of care for 07/30/2025-09/27/2025 included orders for skilled nurse visits 2 times a week for 1 week and 3 times a week for 8 weeks and “skilled nurse will assess and instruct on any changes in co-existing and/or recurring conditions… and continuous review of medications.” A home visit conducted on 08/11/2025 at 3:00 PM with registered nurse (RN) #3 and clinical record review revealed the following medication discrepancies: A. The plan of care included orders for “Oxybutynin Chloride [treats overactive bladder] 5mg tablet 1 tablet at bedtime.” The patient stated, “That was discontinued in January 2025.” B. The plan of care included orders for “Melatonin [sleep aid] 3mg 1 tablet at bedtime.” The patient stated, “I stopped that a long time ago.” C. The plan of care did not include orders for “Oxcarbazepine [calms overactive nerves] 300 mg 1 tablet every 12 hours.” The patient stated, “I have been on that for more than 2 years.” 2. Patient #14 was admitted on 06/02/2025 with a diagnosis of dementia. The plan of care for 08/01/2025-09/25/2025 included orders for physical therapy visits 2 times a week for 2 weeks, 1 time a week for 3 weeks, 2 times a week for 1 week, and 1 time a week for 1 week and “Physical Therapist will assess and instruct on any changes in co-existing and/or recurring conditions… Develop physical therapy plan of care in consultation with the physician that includes… identification of new or changed medications…” A home visit conducted on 08/12/2025 at 9:30 AM with physical therapy assistant (PTA) #6 and clinical record review revealed the following medication discrepancies: A. The plan of care included orders for “Albuterol Sulfate HFA 90mcg/actuation aerosol inhaler [used for shortness of breath] 2 puff [sic] 4 times daily.” The patient’s caregiver stated, “That was stopped at the hospital discharge.” B. The plan of care included orders for “Diclofenac 1% [topical pain cream] 2 times daily.” The patient’s caregiver stated, “That was stopped at the hospital discharge.” C. The plan of care included orders for “Donepezil [treats dementia] 5mg tablet at bedtime.” The patient’s caregiver stated, “That was stopped 3 weeks ago.” D. The plan of care included orders for “Trazadone [anti-depressant] 50 mg 1 tablet at bedtime.” The patient’s caregiver stated, “That was discontinued.” E. The plan of care did not include an order for “Memantine [treats dementia] 10mg 1 tablet daily.” The patient’s caregiver stated, “He been on that for about 30 days.” An interview conducted on 08/12/2025 at 3:10 PM PTA #6 revealed that PTA #6 does not complete comprehensive medication reviews. An interview conducted on 08/12/2025 at 3:15 PM with the clinical manager revealed that PTA’s are not responsible for medication reviews, the physical therapist or nurses do them. During an interview conducted on 08/12/2025 at 3:24 PM PT #7 stated, “We did a recert [recertification visit] a week or 2 ago. So, I typically get his medication bottles.” PT #7 stated that the care giver provided all the medication bottles at the recertification that were listed in the plan of care.””

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on agency policy, clinical record review, observation, and staff interviews, the agency failed to follow the physicians order for a central venous catheter (tube inserted into a vein in the chest) dressing change for 1 of 1 patient with a central line. (patient #13) Findings included: A policy, Central Venous Catheter: Dressing Change (Home Health Care) (undated 06/26/2025) received on 08/12/2025 at 12:55 PM from the clinical manager stated, “ensure appropriate care of the access device and system to decrease the risk of central-line associated blood stream infection… 1. Verify the practitioner’s order…” Patient #13 was admitted on 10/30/2024 with a diagnosis of postsurgical malabsorption (a condition that prevents the absorption of nutrients). The plan of care for 06/27/2025-08/25/2025 included orders for skilled nurse (SN) visits 1 time a week for 1 week, 2 times a week for 1 week, 1 time a week for 3 weeks, 2 times a week for 1 week, 1 time a week for 3 weeks, and “SN to perform IV [intravenous] site care as follows: Don mask and gloves, remove old dressing, don sterile gloves, cleanse site with chlorhexidine [disinfectant] swabs x 3…” During a home visit conducted on 08/12/2025 at 10:30 AM registered nurse (RN) #5 failed to don a mask prior to removing the old dressing. An interview conducted on 08/12/2025 at 3:44 PM with RN #5 revealed that RN #5 routinely does not don a mask prior removing the old dressing. During an interview conducted on 08/12/2025 at 3:54 PM the clinical manager stated, “They should follow the doctor’s order or contact the physician.””