Bayada Home Health Care, Inc.

“Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide’s performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This Standard is not met as evidenced by: Based on a review of agency policy, review of employee files, and an interview with the agency Administrator, the agency failed to ensure the competency evaluation addressed each of the subjects listed in paragraph (b)(3) of this section, for one (1) of five (5) employee file (EF) initial competency evaluations reviewed (EF#7). Agency policy reviewed March 19, 2025 at approximately 2:45 p.m. Policy 0-510 ‘Home Health Aide Requirements (Medicare-Certified Offices)’ section 3.0 ‘Competency Evaluation Requirements’ section 3.2.4 “Reading, recording temperature, pulse, and respiration.” Policy 0-5821 ‘Competency Assessments-HHA, HMKR, Companion, Chore Service Worker’ ‘Our Procedure’ section 2.2 ‘Skills Demonstration’ “HHAs hired or rehired after January 1, 2003, must be tested .... as part of a Bayada - approved training program on each of the required skills listed on the appropriate Home Health Aide Competency Evaluation Skills Demonstration Checklist. Note: All HHAs are required to demonstrate TPR (temperature/pulse/respirations) if listed as a required skill on the home Health Aide Competency Evaluation Skills Demonstration Checklist. if a HHA is unable to demonstrate any of these skills, the HHA may still work, but may not be sent to any client requiring the monitoring of these vital sign(s), or the CM (clinical manager) may retrain and test again until the HHA gains competency.” (Note: This policy is not compliant with regulation.) A review of EFs was conducted on March 17, 2025 at approximately 11:30 a.m. The employees date of hire (DOH) is listed below. EF#7 DOH 07/14/23: Documentation provided of a ‘Home Health Aide Competency Evaluation Skills Demonstration Checklist (Medicare Certified)’ ‘Skill Evaluated’ section ‘Taking, Reading, and Recording: Temperature: Oral/Axillary, Pulse, and Respiration’ ‘Initial Passed with Client/Pseudo client or Computerized mannequin (Date)’ blank with no entries. (All other sections in this column were dated 7/17/23.) Documentation provided of a ‘Pediatric Home Health Aide Competency Evaluation Skills Demonstration Checklist - Medicare Offices’ ‘Skills Evaluated’ section ‘Taking, Reading, and Recording: Temperature: Oral/Axillary, Pulse, and Respiration’ ‘Initial Passed with Client/Pseudo client or Computerized mannequin (Date)’ blank with no entries. (All other sections in this column were dated 7/17/23.) No other documentation provided of the employee successfully completing competency testing/evaluation, to include ‘Reading and recording temperature, pulse, and respiration’, prior to providing services to patients independently. An interview conducted with agency Administrator on March 19, 2025 at approximately 2:00 p.m. and email correspondence with the agency Administrator on March 20, 2025 at approximately 2:00 p.m. confirmed the above findings.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on a review of agency policy, review of clinical records, and an interview with the agency Administrator, the agency failed to complete the initial assessment visit within 48 hours of referral, or within 48 hours of the patients return home, or on the physician-ordered start of care (SOC) date, for one (1) of four (4) clinical records (CR) reviewed (CR#8). Agency policy reviewed March 19, 2025 at approximately 2:45 p.m. Policy 0-672 ‘Admission Criteria & Procedure-Medicare Certified Offices’ ‘Our Procedure’ section 9.1: “The initial assessment must be completed either within: a. 48 hours of referral, or b. 48 hours of the clients return home, or c. On the physician ordered start of care date.” A review of CRs was completed on March 19, 2025 at approximately 1:30 p.m. The patients start of care (SOC) is listed below. CR#8 SOC 11/13/23: Referral from (parent) on 09/25/23. No physician ordered start of care date specified. Documentation of initial assessment visit by a registered nurse on 11/13/23. (49 days). An interview conducted with agency Administrator on March 19, 2025 at approximately 2:00 p.m. and email correspondence with the agency Administrator on March 20, 2025 at approximately 2:00 p.m. confirmed the above findings.”

“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 a review of agency policy, a review of clinical records, and an interview with the agency Administrator, agency failed to ensure the patient plan of care included the duration of visits to be made for two (2) of four (4) clinical records (CR) reviewed (CR#1, CR#8). Agency policy reviewed March 19, 2025 at approximately 2:45 p.m. Policy 0-945 ‘Client Care Plan’ section 2.0 ‘Plan of Care Content’ “Medicare certified offices. The individualized plan of care is based on the clients medical diagnosis, physician/healthcare practitioners order, comprehensive assessment, and client input must include the following elements: ..... d. The frequency and duration of visits to be made.” A review of CRs was completed on March 19, 2025 at approximately 1:30 p.m. The patients start of care (SOC) is listed below. CR#1 SOC 08/29/16: Recertification period 03/16/25 - 05/14/25 reviewed. ‘Home Health Certification and Plan of Care’ included section 21, ‘Orders for Discipline and treatments (Specify Amount/Frequency/Duration) “.... SN (skilled nurse) 98 hours/week (including 8-9 hours/night x 7 nights/week). Plus 120 additional hours of skilled nursing services per year.” No duration listed. CR#8 SOC 11/13/23: Recertification period 03/08/25 - 05/06/25 reviewed. ‘Home Health Certification and Plan of Care’ included section 21, ‘Orders for Discipline and treatments (Specify Amount/Frequency/Duration) “.... HHA (home health aide) services 11.25 hour/day x 5 day/week for care in home, school (virtual and in person), transportation, ...... 8 hours week EHHD.” No duration listed. An interview conducted with agency Administrator on March 19, 2025 at approximately 2:00 p.m. and email correspondence with the agency Administrator on March 20, 2025 at approximately 2:00 p.m. confirmed the above findings.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on a review of agency policy, a review of clinical record review documentation, and an interview with the agency Administrator, agency failed to ensure a completed discharge summary was sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge for one (1) of one (1) discharge summaries (DC) reviewed (DC #6). Agency policy reviewed March 19, 2025 at approximately 2:45 p.m. Policy 0-9307 ‘Client Discharge & Transfer-Medicare- Certified Home Health and SNU Offices’ section 3.0 ‘Communication and Documentation Requirements For Discharge and transfer’ section 3.1.2 “The clients primary care practitioner or other health care professional who will be responsible for providing care and services to the client must receive a 781- Discharge Summary (clients under 18) or 0-689 Last Visit & Discharge Summary (clients 18 and over) ....within five (5) business days of the clients discharge ...” A review of CRs was completed on March 19, 2025 at approximately 1:30 p.m. The patients start of care (SOC) is listed below. CR#6 SOC 08/23/23: Recertification period 04/19/24 - 06/17/24 reviewed. ‘Home Health Certification and Plan of Care’ included section 21, ‘Orders for Discipline and treatments (Specify Amount/Frequency/Duration) “SN (skilled nurse) 4-6 hours/day x 3-5 days/week for care at school ..... x 60 days.” The recertification period 04/19/24 - 06/17/24 was the last certification period with verbal orders obtained by a registered nurse on 04/19/24 and signed by the physician on 04/19/24. Documentation provided of the last day that agency provided services to this patient was on 05/26/24. Per the agency Administrator on 03/20/25 at approximately 1:43 p.m., the patient was on “hold”. No documentation provided of the agency discharging the patient upon the completion of the most recent physician signed certification period of 04/19/24 - 06/17/24. Per the agency Administrator via email correspondence on 03/20/25 at approximately 1:43 p.m., the patient was on “hold”. Documentation provided of ‘Addendum To Plan Of Care’, signed by a registered nurse and dated 09/30/24, “Discontinue SN/HHA services as of September 30, 2024. The addendum was signed by a physician on 10/31/24. Documentation provided of a Discharge Summary sent to the physician on 10/31/24. (31 days after agency eventually discharged the patient.) An interview conducted with agency Administrator on March 19, 2025 at approximately 2:00 p.m. and email correspondence with the agency Administrator on March 20, 2025 at approximately 2:00 p.m. confirmed the above findings.”