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 observation, staff interview, and review of facility policies, it was determined the facility failed to ensure acceptable infection prevention standards of practice were implemented by; 1. Not following proper bag technique according to facility policy, in two of five home visits (Patient (P) 2 and P5), and 2. Not adhering to appropriate equipment disinfection protocols, according to facility policy, in two of six home visits (P6 and P7). Facility policy titled, “0-1570 Equipment & Supplies Maintenance,” dated 01/01/24, stated, “… Our Procedure: 1.0 General Information. ... 1.3 Contact time is the length of time that the disinfectant must remain wet on the object or surface to effectively disinfect it. Clinical research supports contact time for each product; contact times will vary from product to product and will be noted on the product Requirements for Use (RFUs) … 2.0 Cleaning Procedures for Non-critical, Semi-critical, and Critical Items. ... 2.1 Non-critical Items ... 2.1.2 Client care/assessment items: Client care and assessment items … such as bandage scissors, stethoscopes, and blood pressure cuffs should be disinfected after client use before returning to the supply bag … These items can be disinfected with 70% alcohol … or a germicidal wipe. The solution must be allowed to completely dry prior to returning items to the supply bag …” The “Sani-Cloth Germicidal Disposable Wipe” RFU, was reviewed and stated, “DIRECTIONS FOR USE: … TO DISINFECT AND DEODORIZE HARD, NONPOROUS SURFACES: … Unfold wipe and thoroughly wet surface. Allow surface to remain wet for two (2) minutes. Let air dry. …” On 01/22/26 at 10:36 AM, Staff (S)12 was observed conducting a home visit for P7. At 11:35 AM, S12 had his/her stethoscope positioned with the headset and ear tubes around his/her neck and the bell dangling loosely on his/her chest. As S12 repositioned P7 in the bed, the bell of the stethoscope was observed making contact with P7’s Foley catheter bag (indwelling urinary catheter), P7’s linens, and P7’s barrier pad. At 11:37 AM, S12 used a Sani-Cloth germicidal disposable wipe to clean the stethoscope and placed it on a clean barrier to dry. At 11:38 AM, S12 placed the stethoscope back in the supply bag (one minute of contact time). At 12:30 PM, an interview was conducted with S12. S12 stated, he/she does not typically wear the stethoscope around his/her neck after vital signs are completed. S12 stated, he/she was unaware that the stethoscope bell made contact with P7’s bed and Foley catheter bag. S12 stated, he/she was unsure of the contact time for the Sani-Cloth wipes. S12 stated, he/she usually cleans vital signs equipment as soon as he/she is finished using it and gives it time to dry while performing other tasks with the patient. S12 stated he/she was not aware that the stethoscope only had one minute of contact time before being returned to his/her supply bag. On 01/23/26 at 1:15 PM, an interview was conducted with S4. When asked about contact time for Sani-Cloth wipes, S4 stated equipment should air dry for at least 2.5 minutes after the Sani-Cloth wipe is used. S4 stated, one minute of contact time would not be long enough. Findings include: Facility Policy titled, “0-1314 Bag Technique,” dated 03/25/25 stated, “… Our Procedure: ... 6.0 Bag Technique Procedure ... 6.3 Keep the bag closed when not in use … 6.5 Open the bag, remove all needed items from the bag … 6.6 Close bag … 6.8 When care is complete, disinfect items with an EPA-registered disinfectant wipe … Place items on a clean barrier until dry …” 1. On 01/21/26 at 3:02 PM, Staff (S) 8 was observed conducting a home visit for Patient (P) 2. At 3:09 PM, S8 was observed hanging his/her bag on P2’s kitchen chair. After entering his/her clinical bag, S8 left the clinical bag unzipped. The bag was observed to be left unzipped throughout the entire home care visit. At 3:54 PM, an interview was conducted with S8. When asked whether the bag should be left unzipped after removing any patient equipment needed, S8 stated, “I always leave it open.” 2. On 01/22/26 at 9:01 AM, S10 was observed conducting a home visit for P6. At 9:04 AM, S10 placed two clean barriers onto P6’s side table. S10 was observed placing a tablet and a mobile cellular phone onto a clean barrier. The surveyor did not observe S10 disinfecting the mobile cellular phone or the tablet prior to placing them onto the clean barrier. The barrier was thus considered potentially contaminated. At 9:38 AM, S10 was observed removing the tablet and the mobile cellular phone from the potentially contaminated barrier. At 9:39 AM, S10 was observed disinfecting the reusable equipment used on P6 (thermometer, Pulse Oximeter, and an automatic Blood Pressure monitor with cuff) and placed each equipment piece onto the potentially contaminated barrier, thus potentially re-contaminating the cleaned equipment. At 10:07 AM, an interview was conducted with S10. When discussing the observation made regarding the tablet and mobile cellular phone being removed off a barrier and then clean equipment placed on that same barrier to dry, S10 stated that he/she will be sure to be mindful of clean versus dirty barriers during future home visits. On 01/23/26 at 1:15 PM, an interview was conducted with S4. When asked about a mobile cellular phone being placed on a clean barrier, S4 stated that the barrier would then be considered dirty and a new barrier would be needed for equipment to dry. On 01/22/26 at 10:10 AM, Staff (S) 6 was observed conducting a home visit for P5. After entering his/her clinical bag, S6 left the clinical bag unzipped. The clinical bag remained unzipped throughout the entire home visit. At 10:58 AM, S6 was asked if the bag should be zippered when not in use, S6 responded stating, “I was never told it had to be kept zippered.” On 01/23/26 at 1:15 PM, an interview was conducted with S4. S4 explained that the clinical bag should always be closed throughout the entire visit. NJAC 8:42-12.2(b)”

“Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This Element is not met as evidenced by: Based on staff interview, facility document review, and review of medical records, it was determined the facility failed to ensure that all patients with Medicare coverage received a “Notice of Medicare Non-Coverage (NOMNC),” in six of six discharged Medicare patients (Patients (P) 13, P14, P15, P16, P17, and P18). Findings include: Facility Policy titled, “0-322 Home Health Change of Care Notice (HHCCN), Advanced Beneficiary Notice of Non-Coverage (ABN), Notice of Medicare Non-Coverage (NOMNC) and Fast Track Appeal Review Procedures,” dated 01/01/25, stated, “… Our Procedure: … 3.0: Notice of Medicare Noncoverage (NOMNC). 3.1: A standardized Review Notice, NOTICE OF MEDICARE NON-COVERAGE (NOMNC), #0-3195, is given on paper or electronically, to all beneficiaries when Medicare coverage is about to end based on the physician’s orders and all home healthcare is ending, (except those admitted to a facility or hospital) no later than two (2) days prior to discharge … 3.2: The Initial Notice of Medicare Provider Non-Coverage is delivered as follows: a. Face to face and signed and dated by the client and representative, b. If the Initial Notice of Medicare Provider Non-Coverage cannot or will not be signed, a notation is made on the notice explaining why and dated …” On 01/23/26, a review of P13, P14, P15, P16, P17, and P18’s medical records was conducted and revealed the following: On 07/31/25, P13 was discharged from Home Care services. P13’s medical record lacked evidence of a signed NOMNC. On 10/23/25, P14 was discharged from Home Care services. P14’s medical record lacked evidence of a signed NOMNC. On 10/15/25, P15 was discharged from Home Care services. P15’s medical record lacked evidence of a signed NOMNC. On 11/11/25, P16 was discharged from Home Care services. P16’s medical record lacked evidence of a signed NOMNC. On 10/10/25, P17 was discharged from Home Care services. P17’s medical record lacked evidence of a signed NOMNC. On 09/09/25, P18 was discharged from Home Care services. P18’s medical record lacked evidence of a signed NOMNC. On 01/23/26 at 1:44 PM, Staff (S) 1 confirmed that the medical records for P13, P14, P15, P16, P17, and P18 lacked evidence of a signed NOMNC form. When asked if these patients should have signed a NOMNC form prior to discharge, S1 reported that P13, P14, P15, P16, P17, and P18 should have signed a NOMNC form prior to discharge and a copy should be in their medical record.”

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on medical record review, staff interview, and review of facility policy, it was determined the facility failed to ensure that staff communicate with the physician when a missed visit occurs, in three of eight active medical records reviewed (Patient (P) 6, P9, and P12). Findings include: Facility policy titled, “0-6277 Missed Visits/Hours,” dated 03/24/23, stated, “… Our Procedure: 1.0 Communicating Missed Visits/Hours. 1.1 Physician Ordered Services. The physician must be notified when the plan of care is altered due to fewer visits … being provided as ordered … 1.1.1 Documentation – Home Health and Hospice Offices. … 1.1.1.1 A Missed Visit Notification note to capture the reason that the visit was missed as well as evidence that the physician was informed … must be entered in the electronic record. 1.1.1.2 Missed Visit Process Flow. The field clinician is responsible for documenting the missed visit in the “Missed Visit Coordination Note” … 1.1.1.2.1 The Missed Visit Coordination Note will include the following: … c. Method of notification to physician …” A review of P6’s medical record was conducted and revealed the following: P6’s Plan of Care Orders for the certification period beginning 10/02/25 contained a physician order for the Home Health Aide (HHA) as “… Frequency/Duration of Visits: ... HHA Effective 10/05/2025 1WK7 [one visit a week for seven weeks] …” For the week of 10/12/25 through 10/18/25, P6’s medical record lacked evidence that P6 received a HHA visit as per order and that the physician was notified of the missed visit. A review of P9’s medical record was conducted and revealed the following: P9’s Plan of Care Orders for the certification period beginning 11/29/25 contained a physician order for the HHA as “… Frequency/Duration of Visit: ... HHA Effective 11/30/2025 1WK6 [one visit a week for six weeks] …” For the week of 12/21/25 through 12/27/25, P9’s medical record lacked evidence that P9 received a HHA visit as per order and that the physician was notified of the missed visit. A review of P12’s medical record was conducted and revealed the following: P12’s Plan of Care Orders for the certification period beginning 12/25/25 contained a physician order for the HHA as “… Frequency/Duration of Visits: ... HHA Effective 12/28/2025 1WK5 [one visit a week for five weeks] …” For the week of 12/28/25 through 01/03/26 and 01/04/26 through 01/10/26, P12’s medical record lacked evidence that P12 received HHA visits as per order and that the physician was notified of the missed visit. On 01/23/26 at 1:49 PM, an interview was conducted with Staff (S) 1. S1 stated that the physician should be notified when a missed visit occurs and the notification should be documented in the electronic medical record. S1 confirmed that the medical records for P6, P9, and P12 lacked the appropriate missed visit documentation and notification to the physician. 8:42-6.1(a)(3)”