Bayada Home Health Care, Inc.

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on policy and procedure, clinical record review, and staff interview the agency failed to review all current medications for 1 of 1 patients with lupus anticoagulant syndrome (inflammatory autoimmune disease causing blood clots) (#14). Findings included: The policy, “Chart Data Requirements and Format”, revised10/23/23 was provided by the agency associate director on 01/24/24 at 8:45 a.m. The policy stated, “...notations of medications (prescribed and over the counter) currently used by the client…” 1.Patient #14 was admitted on 06/18/23 with lupus anticoagulant syndrome, essential hypertension, and lymphedema (swelling in the extremity caused by lymphatic blockage). The plan of care for 12/14/23 to 02/11/24 included the following orders: skilled nursing 1 time a week for 8 weeks. Review of the skilled nursing visit conducted on 12/19/23 noted that the patient used over the counter biofreeze ointment (used for pain) for pain control. Review of the current medication profile did not include biofreeze as a medication. Interview with the director of clinical operations on 01/24/24 at 11:02 a.m. revealed, “I didn’t see any update to med list with bio freeze”.”

“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 and staff interviews, the agency failed to include all medications on the plan of care for 3 of 7 patients with home visits [#12, 17, 11] 3.Patient #11 was admitted on 11/03/23 with diagnoses of heart failure, type 2 diabetes, chronic kidney disease, and anemia. The Plan of Care (POC) for 01/02/24-03/01/24 included orders for physical therapy 1 time a week for 4 week, 1 time every 2 weeks for 2 weeks and skilled nursing 1 time a week for 9 weeks. A home visit was conducted with the physical therapist on 01/22/24 at 3:45 p.m. A medication review was conducted and revealed the following discrepancy: -atorvastatin (cholesterol medication) 80 mg (milligrams) by mouth daily at bedtime was included on the plan of care Interview with the patient on 01/22/24 at 4:37 p.m. revealed the doctor stopped that medicine 3 weeks ago. The policy, Chart Data Requirements and Format-Home Health Practice [10/23/23], was provided by the agency administrator on 1/24/24 at 8:45 am. The policy stated, “…The home chart copy or electronically documented medication profile is updated as changes occur…” 1. Patient # 12 had a Start of Care date of 1/12/24 and an admitting diagnosis of unspecified dementia, mild with agitation. Review of the Plan of Care [POC] for the certification period 1/12/24-3/11/24 included orders for OT [occupational therapy] 1 time a week for 6 weeks with an effective date of 1/14/24. A joint visit was made with OT # 5 was completed on 1/23/24 at approximately 9 am. During the visit a medication review was completed using the medication profile provided by the agency. The follow discrepancy was noted: The medication administration record [MAR] from the facility listed Hydrocodone [pain medication] 5/325 mg. Take 1 tablet every 6 hours as needed for pain. The start date for the hydrocodone was 1/3/24. The medication profile provided by the agency did not list the hydrocodone. During an interview with RN # 4 on 1/24/24 at approximately 9 am, the RN confirmed the POC did not include all medications the patient was taking. 2. Patient # 17 had a Start of Care date of 12/21/23 and admitting diagnoses of laceration [cut] without foreign body of left elbow, vascular dementia, and chronic diastolic heart failure [heart does not pump adequately]. Review of the Plan of Care [POC] for the certification period 12/21/23 to 2/18/24 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 1 week and 1 time a week for 3 weeks. On 1/23/24 at approximately 11 am a joint visit was made with RN # 7. During the visit, a medication review was conducted using a medication profile provided by the agency. The following discrepancies were noted: The medication administration record [MAR] from the facility listed Tylenol 8-hour Arthritis Pain Tablet Extended Relief 650 mg. Take 1 tablet by mouth every 8 hours as needed for pain with a start date of 2/10/22. The medication profile provided by the agency listed Arthritis Pain Relief [Acetaminophen] ER [extended relief] 650 mg. Take 2 tablets 3 times a day. During an interview with RN # 4 on 1/24/24 at approximately 9 am, RN # confirmed the POC did not include the correct medication.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient’s home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This Element is not met as evidenced by: Based on agency policy, clinical record review and staff interviews the agency failed to conduct aide supervisory visits each 14 days for 2 of 4 patients [ #10 and 9 ] who received home health aide services. The findings included: 2.Patient #9 had a SOC (start of care) of 12/02/23 and included diagnoses of sepsis (infection), type 2 diabetes, osteomyelitis of vertebra (infection in bone), and pressure ulcer of sacral region. Home health aide orders were 2 time a week for 3 weeks. Review of the home health aide visits for the weeks of 12/3/23, 12/10/23, and 12/17/23 revealed no home health aide supervision visits were completed. Interview with agency director of clinical operations on 1/24/24 at 10:51 a.m. revealed, “I was unable to find any aide supervisory visits”. The policy, Frequency of Clinical Management Visits and Employee Supervision [1/1/23], was provided by the agency administrator on 1/24/24 at approximately 8:45 am. The policy stated, “…Clients receiving HHA services along with another discipline are visited at least every 14 days by an [sic] RN or therapist…” 1. Patient # 10 had a Start of Care date of 12/29/23 with admitting diagnoses of acute sphenoidal sinusitis and unspecified dementia with mood disturbance. Review of the Plan of Care [POC] for the certification period 12/29/23-2/26/24 included orders for SN [skilled nursing] 1 time a week for 9 weeks; PT [physical therapy] 1 time a week for 8 weeks; OT [occupational therapy] 1 time a week for 7 weeks; ST [speech therapy] 1 time a week for 2 weeks; home health aide 1 time a week for 1 week, 2 times a week for 2 weeks. Review of the clinical record revealed the home health aide made visits on 1/8/24, 1/12/27, 1/15/24 and 1/18/24. No aide supervisory visit had been completed as of 1/24/24 at 9 am. During an interview with RN # 4 on 1/24/24 at approximately 10 am, the RN stated, “There was a home aide supervisory visit scheduled for 1/19/24, unfortunately the visit was moved.””