YERMONT - Home Page | Division of Licensing and …dlp.vermont.gov/sites/dlp/files/documents/Bayada-federal...Voice/TTY (802) 241-2345 To Report Adult Abuse: (800) 564-1612 Fax (802)

~YERMONT

.------- ---------- -------------

AGENCY OF HUMAN SERVICESDEPARTMENT OF DISABILITIES, AGING AND INDEPENDENT LIVING

Division of Licensing and Protection103 South Main Street, Ladd Hall

Waterbury VT 05671-2306http://www.dail. vermont.gov

Voice/TTY (802) 241-2345To Report Adult Abuse: (800) 564-1612

Fax (802) 241-2358

July 7, 2011

Tracy Chellis, AdministratorBayada Nurses, Inc110 Kimball Avenue, Suite 250So Burlington, VT 05403-0188

Provider ID #:477019

Dear Ms. Chellis:

Enclosed is a copy of your acceptable plans of correction for the survey conducted on June 13,2011.

Follow-up may occur to verify that substantial compliance has been achieved and maintained.

Sincerely,

Pamela M. Cota, RN I.,

Licensing Chief

PC:jl

Enclosure

Disability and Aging ServicesLicensing and Protection

Blind and Visually ImpairedVocational Rehabilitation

07/01/2011 15:58 Bayada Nurses (FAX)802 254 7072RECEIVED

.. ----i51iiE5i"6n. of

P.002/010

JUL - I 11

DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICES

STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION

~1) PRO~D~UPPU6VCUAIDENTIFICATION NUMBER:

477019

Licensing andProtection

(X2) MULTIPLE CONSTRUCTION

A. BUILDING

B. WING

t""II',1II:U: UO/£U/£U I I

FORM APPROVEDOMB NO 0938-0391(X3) DATE SURVEY

COMPLETED

C06/13120:11

NAME OF PROVIDER OR SUPPLIER

BAYADA NURSES, INC

G O~O I INITIAL COMMENTS

10PREFIXTAG

(llS)COMPLETION

DATE

STREET ADDRESS, CITY. STATE, ZIP CODE110 KIMBALL AVENUE, SUITE 250SO BURLINGTON, VT 05403 .

PROVIDER'S PLAN OF CORRECTION~CHcORRECnvEACTIONSHOULDBE

CROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)

GOOD

SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYiNG INFORMATION)

~4)IDPREFIXTAG

This STANDARD is not met as evidenced by:Based on record review and staff interview theagency failed to provide one patient in the sample(Patient # 1) accepted for tr:eatment thereasonable expectation that the patient's medicalneeds could be adequately be met by the agency.Findings Include:

G157:

Bayada Nurses provides home healthservices to the entire state through fourlocations.

An unannounced onsite visit for a complaintinvestigation was conducted and completed on6/13111 by the Division of Licensing & Protection.The following Federal regulatory violations arerelated to this complaint

G 157 484.18 ACCEPTANCE OF PATIENTS, POC,MED SUPER

Patients are accepted for treatment on the basisof a reasonable expectation that the patient'smedical, nursing, and social needs can be metadequately by the agency In the patienrs place of .residence. I

I

G 157 Bayada Nurses has added additional therapy _<lstaff to their teams throughout the state, and (/lwill continue to do so, in order to ensure that ~ 8clients receive care in a timely manner. ~ ~

In the event that a particular Bayada NursesC -{ ~ 1,.. 1/office faces challenges in staffing a client, ~?4' t.,they will collaborate with other Bayada 't" \.offices in the state to meet the needs of the ~ :client. I ~

Whenever a staffing collaboration Is calledfor, the Office Clinical Manager will infonnthe Office Director, who will facilitate staffsharing with other Directors. All Directorsand Clinical Managers will be instructed inthis practice by 7/6111.

In the Bratueboro office, re-education will begiven to all professional c1iniclans, as well asoffice staff involved in the referral process.regarding the requirement for timelyservices. This education shall be providedby the clinical manager, and shall take placeon or before July 8, 2011.

Per record review on 6/13/11 Patient # 1who wasadmitted to the agency on 12/21110 withphysician identified physical therapy (PT) andoccupational therapy (On needs had orders forPT & OT evaluations after being discharged froma skilled nursing facility. The agency failed toprovide.PT services after an initial PT evaluation(which occurred on 12/29/10 , 8 days after thepatient was admitted) identified the need forfurther therapy services. When the initial PT The Brattleboro Office Director will auditevaluation was completed, the physical therapist 100% of admissions to ensure that thisI requested orders from the physician for services timeliness standard is met, as well as all! '3 x a week X 6 weeks' (three times a week times related Bayada Nurses policies and, procedures.! six weeks) and no further PT visits were made. ~)r ,. ._ l)(,., / (<:(1=--'1..e7 '111

LABORATORY DIRECTOR s OR PRO~DERISUPPUER REPRESENTATIVE'S SIGNATURE TITLE (XS) DATE

...~ 0!. tl) ~ ~--D ...M.xyh.!\usf-/\ Ciiirfl. I) - J -' ( JAny defiCielley statement eJ1\ling with an asterisk r) denotes a deficiency which the Institution may be excused from correctlng provIding it is determined thatother safeguards provide sufficient protectlon to the patlents. (See Instructions.) Except for nUlSlng homes, the findings staled above are dlsclosable 90 daysfollowing the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are dlsclosable 14days following the date these documents are made available 10 the facility. If deficiencies are cited, an approved plan of correction is requisite to continued

program participatIon.

FORM CMS-25B7(D2.S9) Previous VersiDns Obsolete Event 10: HK9011 Faclnly 10:4nD19 If contlnuation sheet Page 1 of 5

07/01/2011 15:59 BayadaNurses (FAX)802 254 7072 P.003/010

DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID sERVICES


~1) PRO~D~SUPPU~CUAIDENTIFICATION NUMBER:

477019


ABUILDING

B. WING

FORM APPROVEDOMS NO 0938-0391(X3) DATE SURVEY

COMPLETED

C'0611312011

NAME OF PROVIDER OR SUPPUER

BAYADA NURSES, INC

10PREFIXTAG

(X4)ID IPREFIXTAG

I

SUMMARY STATEMENT OF DEFICIENCIES(IOACHDEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMATION)

STREET ADDRESS, CITY, STATE, ZIP CODE110 KIMBALL AVENUE, SUITE 250SO BURUNGTON, VT 05403 ._. _.. _

PRO~DER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTlON SHOULD BE

CROSs-REFERENCED TO THE APPROPRIATEDEFICIENCY)

(lG) -CDMPLEflON

DAn

G 157 Continued From page 1 G 157In a~dition, there was no evidence that the perdiem OT had been contacted or was available todo an evaluation anellor provide services to thispatient.

Per interview with the Acting Director on 6/13111at 12 noon, slhe confirmed that the initial PTeval~atlon was cOmpleted by a therapist from....--.- -.- -affoth-erallen-cy1)raneh:Thevenjiempl1ysical".' ---- - - -._- -.--- .'-' --"- ..---- - ---- - -.-- - ..-.-----.,.therapist that worked from this branch (slheworked part time, usually 2 days per week, asIable) was not working for the agency for a periodof approximately 7-10 days durlng the time periodthat the patient was admitted. At this time, therewere no other physIcal therapists working at this .branch_Slhe also confirmed that a physical therapist frtJmanother branch was contacted and completed theinitial PT evaluation. However. due to a'miscommunication between branches' therewere'rio further PT visits provided to the patient~fi~rJh~.jnIt!~L~~<iJy~!:iQ!l"lnJag.Qrn91Ul.It.b.Q!I.9.t:L.-.-.there was a per diem OT that worked out of thisbranch there was no evidence that this personhad been contacted or was available to do anevaluation andlor provide services to this patient

. .Ih.e.J::I.om~J:l.e.alth..AdY.anc~_B.eoefjciaIY..Notic.EL- - ------.completed by staff on 115/11 stated that skillednursing visits would be discontinued thenbecause, 'We cannot provide physical therapyservices you need and you request no more visitsfrom Bayada.'

G 164 484.18(b) PERIODIC REVIEW OF PLAN OF G 164CARE

Agency professional staff promptly alert thephysician to any changes that suggest a need to

FORM CMS-2567(02-99) Prevlous Versloos ObsDlBlll EIIBIIIIO; HK9D11 Facility 10; 4n019 If continuation sheet Page 2 of 5

07/01/2011 16:00 Bayada Nurses (FAX)802 254 7072 P.004/010

UI:I-'AK I MI:N" OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICES

STATEMENT OF DEFICIENCIESAND PlAN OF CORRECTION

~1) PR~EUSUPPU8VCUAJDENTlFlCATION NUMBER:

4n019


ABUILDING

B. WING

. "

FORMAPPROVEDOMB NO. 0938-0391(X3) DATE SURVEY

COMPLETED

C06/13/2011


BAYADA NURSES, INC

10PREFIX .TAG

~4)IDPREFIXTAG

SUMMARY STATEMENT OF DEFlCIENCIES(EACH DEFlCIENCY MUST BE PRECEDED BY FUllREGULATORY OR LSC IDENTIFYING INFORMATION)

STREET ADDRESS, CITY, STATE, ZIP CODE110 KIMBALL AVENUE, SUITE 250

. ~~_BURLINGTON.VT O~3._ .'PROVIDER'S PlAN OF CORRECTION

(EACH CORRECTIVE ACTION SHOULD BECRoss-REFERENCED TO THE APPROPRIATE

DEFICIENCY)-

(XS)COMPLeTIONDATe

G 164 Continued From page 2alter the plan of care.

G164

G 164:

Bayada Nurses has established secure e-mail for all licensed field clinicians, as of April1, 2011. This allows faster, secure deliveryof client information, and has improvedcommunication between field and office staff.

The clinical manager shall be responsible forensuring this standard is met, and ensuringthat all appropriate Bayada policies andprocedures regarding this area are fol/owed.

In the Brattleboro office, re-education will begiven to all professional clinicians, as well asoffice staff involved in the referral process,that any changes to the plan of Care requirenotification of the physician. as well as

Iobtaining a verbal order approving this

, change. As part of this re-education, it shall ~be reinforced that all communications

, between members of the care team, whetheri they are Bayada employees or not, must be 8'documented, in order to clearly demonstratefull coordination of care .. A copy of eachcommunication shall be forwarded to theclinical manager in order to keep them fullyaware of the change to the plan of care.This re-education shall be provided by theclinical manager, and shall take place on orbefore July 8,2011. --_ .._._-----

Per Intlarvlew with the ActitlQ Director on 6/13/11at 12 noon, slhe confirmed the case ma.nager forPatient # 1 (who was no longer working for theagency) had documented In the nursing notes on1/2/11 that 'physical therapy came and did eval(evaluation) an.d has not returned.' S/heconfirmed there was no documentation of afollow-up by the case manager to notify the .physician or the agency administrative staff andthat the first time the Acting Director was made

This STANDARD Is not met as evidenced by:Based on record review and staff interview,agency staff failed to infonn the physician and/oragency administrative staff In a timely manner

. ihat one patienfs physical therapy and- _.-_ .._- '-- -occupational t1leraPYlfeedlr(Patient#-1 rwenrnor ...-.----

being met Findings Include:

Per record review on 6/13/11 Patient # 1, who .was admitted to the agency on 12/21/10 withphysicianidentified physical therapy (PT) and occupationaltherapy (OT) needs had orders for a PT & OTevaluation after being discharged frama skillednursing facility. Although the Initial PT evaluationwas completed on 12/29/10 (eight days afteradmission) there were no further physical therapyvisits made even when the physical therapistr:f(!,qy"e2~~_.9ffi~~J9L ~eJ,'(i,~@~~.!i!Jl~_~YY~~.~.fqr .6 weeks' after the Initial evaluation. In addition,although there was no OT (OccupationalTherapy) evaluation completed there was noevidence of notification of either the physician oragency administrative staff.

-----

FORM CMS-25117{02-ll9)Previous Verslans Obsolete EventlD: HKBD11 Facility 10; 477019 If continuation sheet Page 3 of 5

07/0112011 16:00 Bayada Nurses (FAX)B02 254 7072 P.005/010


STATEMENT OF OEACIENCIESAND PLAN OF CORRECTION

~1}PRO~D~UPPU~CUAIDENllFlCAnON NUMSER:

477019

~)MULnPLECONSTRUCnON

A. BUILDING

B. WING

PRINTED: 06/2012011FORM APPROVED

OMB NO 0938-:0391(X3) DATE SURVEY

COMPLETED

C06/13/2011

NAME OF PRO~OER OR SUPPUER STREET ADDRESS, CITY, STATE, ZIP CODE110 KIMBALL AVENUE, SUITE 250

. ._.. _.-.- .-SCrBURL1NG'fON~-Vfo5403---.--_._--_ .._-_ _._----_.

~4)IDPREFIXTAG

SUMMARY STATEMENT OF DEACIENCIES(EACH DEFICIENCY MUST SE PRECEDED BY FULLREGULATORY OR LSC IOENllFYING INFORMATION)

10PREFIXTAG

PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE

CROSs-REFERENCED TO THEAPPROPRlATEDEFICIENCY)

lX51COMPLETION

DATE

G 164 Continued From page 3aware of this was either 1/3 or 1/4/11.

G 236 484.48 CUNICAL RECORDS

G164

G236

A clinical record containing pertinent past andcurrent findings in accordance with acceptedprofessional standards is maintained for everypatient receiving home health services. In

........_- ..- .. aacitibnlO1heplifri orcai't!,"lhe recoracontaiiis ..- --_.-_.- .._.-appropriate Identifying information; name ofphysician; drug, dietary, treatment, and activityorders; signed and dated clinical and progressnotes; copies of summary reports sent to theattending physician; and a discharge summary.

This STANDARD is not met as evidenced by:Based on record review and staff Interview, theagency failed to have evidence of a referral forone patient In the sample (Patient # 1) after theIh6~~~~~im~g~~:~~~~:-:f~u~e~other.....Per record review on 6/13/11 Patient # 1 who wasadmitted to the agency on 12/21/10 withphysician.

____ ..idJmtified p~c.alJh.erapy_{EI}..arulQccupatlQ[]aL ---therapy (On needs had orders for PT & OTevaluations after b~ing discharged from a skillednursing facility on 12/20/10. The agency failed toprovide the services even after an initial PTevaluation (which occurred on 12/29/10 , 8 daysafter the patient was admitted) Identified theneed for therapy services. When the Initial PTevaluation was completed, the physical therapistrequested orders from the physician to see thepatient '3 x a week x 6 weeks' (three times aweek times six weeks) however no further PT

G236:

Bayada NurseS has a referral form which Isto be included as part of every client record.The clinical manager or their designee willbe responsible for reviewing this form at thetime of referral to ensure it is complete,signing the referral, and shall then ensure .that this form is part of the client chart being ;l. A

put together at the time of admission. U _7All transfer of Clients to another provider <0 f"shall be documented on a HHABN and . I)Bayada Form 37-6 "client transfer Form"shall be completed, appropriatelydisseminated and included in the client chart

Each Office Clinical manager Is responsibleto ensure that this standard, as well asapplicable Bayada Nurses policies andprocedures, are being met. Office Director __ - ....will review each transfer to ensure completecompliance on an ongoing basis.

,rOC ~ 7-?-(!()

))CHIS£tJ~

FORM CMS-25S7{02-99) Previous Vanilcns Obsolate evant 10: HKiD11 Fadilly 10: 477019 If continuation sheet Page 4 of 5

07/01/2011 16:01 Bayada Nurses (FAX)802 254 7072 P.006/010



~1) PROVlDBVSUPPUEWCUAIDENTlACATlON NUMBER:

477019

[X2) MULTIPLE CONSTRUCTION

A. BUIlDING

B.WlNG

PRINTED: 06r.lU1Z\111FORM APPROVED

OMB NO 0938-0391(X3) DATE SURVEY

COMPLETED

C0611312011

(lCS)COMPLETlONDA'mSUMMARY STATEMENT OF OEACIENCIES

(EACH DEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMATION)

(X4)IDPREAXTAG

NAME OF PROVIDER OR SUPPUERSTREET ADDRESS. CITY, STATE, ZIP CODE

-.-B.AyKO.-A--.•.•U.RSES •...l •.'C ...--.----- ..- . '.. .. 110 KIMBALL AVENUE, SUITE 250,.. n ...--'--'" -'-50 BURuNGTO'N;vr-OS'W3----------------- .-----10 PROVIDER'S PLAN OF CORRECTION

PREFIX (EACH CORRECTIVE ACTION SHOULD BETAG CROSS-REFERENCED TO THE APPROPRIATE

DEfICIENCY)

G 236 Continued From page 4vil?,~swere. J;I1adeto this patient. In addition, therewas no evidence that eki OT was available to dothe initial evaluation/assessment of the patient's.needs.

G236

Per Interview with the Acting Director on 6/13/11___. .at.12.noon •.s1he--conflrm~gJb.~!Jh~9T ~valuatlonwas not completed and that after the initiaCPr .< •• _ •• - •••• _- •• _- ••••••••••••. - •.• , •••• -----.- •• -- •• - ••••••• - _ •••• -.-- •• -.--- ••• ---.

evaluation, completed on 12129110, no other PTvisits were made to the patient Slhe alsoconfirmed that the Home Health AdvanceBeneficiary Notice completed by agency staff on1/5/11 stated that skilled nursing visits would bediscontinued then because, 'We cannot providephysical therapy services you need and yourequest no more visits from Bayada' After hlslherreview of the patients file. s1he confirmed thatthere was no evidence that a referral had beensent to the other home health agency that thepatient had been transferred to.

FORM CM5-25B7(OZ-99) Previous Ver&lorlS Obsole1e Event ID:HKSD11 Facility 10: 477019 If conlinuation sheet Page 5 of 5

07/01/2011 16:02 Bayada Nurses (FAX)B02 254 7072 P.007/010

PRINTED: 06/23/2011FORM APPROVED

Division of Llcenslnn and Protection

STATEMENT OF DEFICIENCIESAND PLAN OF CORRECll0N

(X1) PROVIDERlSUPPLIER/CLIAIDENTIFICATION NUMBER:

417019

(X2) MUL llPLE CONSTRUCTION

A. BUILDINGB.WING

(X3) DATE SURVEYCOMPLETED

C06/13/2011

NAME OF PROVIDER OR SUPP.L1ER

BAYADA NURSES, INC

STREET ADDRESS. CITY. STATE, ZIP CODE

110 KIMBALL AVENUE. SUITE 250SO BURLINGTON, VT 05403

(X4)IDPREAXTAG

SUMMARY STATEMeNT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMAll0N)

10PREFIXTAG

PROVIDER'S PLAN OF CORRECTION(EACH CORRECTlVEACTJON SHOULD BE .

CROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)

(X5)COMPLETE

DATE

H 001 Initial Comments

An unannounced onsite investigation wasconducted and completed by the Division ofLicensing & Protection on 6/13/11. The followingregulatory violations are under the State. HomeHealth Designation Regulations. .

H 001

H 513:

Bayada Nurses provides home healthservices to the entire state through fourlocations.

H 513 5.3 Requirements for Operation H 51388=0

V. Requirements for Operation

5.3 A home health agency shall have the staffingand supplies necessary to provide the services itoffers. A home health agency shall ensure thatservices and staff are available to meet theneeds of patients who have been accepted forservices within the home health agency I sspecified geographic area and that there arecontingency plans for each. patient in the event ofan unexpected, temporary unavallability ofscheduled services

This REQUIREMENT is not met as evidencedby: -Based on record review and staff interview, theagency failed to have the necessary staffing toprovide the services it offers for one patient in thesurvey (Patient # 1). Findings Include:

Per record review on 6/13/11 Patient #.1 whowas admitted to the agency on 12/21/10 withphysician identified physical therapy (PT) andoccupational therapy (OT) needs had orders forPT & OT evaluations when discharged from askilled nursing facility on 12120/10. The agencyfailed to provide the services even after an initialPT evaluation (which occurred on 12/29/10 , 8days after the patient was admitted} identifiedthe need for therapy services. When the initial PTevaluation was completed. the physical therapist

Bayada Nurses has added additional therapystaff to their teams throughout the state, andwill continue to do so, in order to ensure thatclients receive care in a timely manner.

In the event that a particular Bayada Nursesoffice faces challenges in staffing a client,they will collaborate with other Bayadaoffices in the state to meet the needs of theclient.

Whenever a staffing collaboration is calledfor, the Office Clinical Manager will informthe Office Director, who will facilitate staffsharing with other Directors. All Directorsand Clinical Managers will be instructed inthis practice by 7/6/11.

In the Brattleboro office, re-education will begiven to all professional clinicians, as well asoffice staff involved in the referral process.regarding the requirement for timelyservices. This education shall be providedby the clinical manager, and shall take placeon or before July 8, 2011.

The Brattleboro Office Director will audit100% of admissions to ensure that thistimeliness standard is met. as well as allrelated Bayada Nurses policies andprocedu~res. . 1-7~ f/f'ac -7:--=j)c:fJ

c (Jc)}

Division of Licensing and Protection

~}. no. rjl--L{ ~ J..~LABORATORYDiRECTQ;.S OR'pROVIDER/SUPPLIER REPRESENTAnVE"S SIGNATURE

STATE FORM - HK9D11

(X6) DATE

-,- ;-11If cortlinuation sheet 1 of 7

07/0112011 16:02 Bayada Nurses (FAX)802 254 7072 P.008/010

I"'Uro;1V1I'\t"t"ro;vv c:uDivision of Ucensino and Protection


(X1) PROVIDER/SUPPLlER/CLlAIDENTlFICATION NUMBER:

477019

(X2) MULTIPLE CONSTRUCTlON .

A. BUILDING

B. WING


C06/13/2011


BAYADA NURSES, INC

STREET ADDRESS, CITY. STATE, ZIP CODe

110 KIMBALL AVENUE, SUITE 250SO BURLINGTON, VT 05403

----(X4)-ID -- ." ----SUMMAR'f-STATEMENT-OF-DERClENClES---.---- - ------10.- --.--.-- _.eROYlO~SP.J.AN_OF ..c.oBBECIJQ~L- _______---lX51 _PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIve ACTION SHOULD BE' COMPLETETAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROS5-REFlERENCEO TO THE APPROPRlA'TE DATE

DEFICIENCY)

H 513 Continued From page 1 H 513

requested orders from the physician to see thepatlent '3 x a week x 6 weeks' (three times aweek times six weeks) however no further PTvisits were made for this patient In addition,there was no evidence that an OT evaluation wasmade nor attempts to obtain an ors servIces.

Per interview with the Acting Director on 6/13/11at 12 noon, s/he conflnned that although theinitial PT evaluation was completed by a therapistfrom another one of their branches, the physicaltherapist at their branch works per diem (parttime for the agency, 2 days a weel<, as able) andwas not working for a period of approximately7-10 days during the time period that the patientwas admitted. There were no other physicaltherapists working out of this branch at that time.S/he also confirmed that a physical therapistfromanother branch was contacted and completed theinitial PT evaluation (B days after the patienfsadmission) however, due to a 'miscommunicationbetween the branches' there were no further PT. visits provided .to lhepatientafter.the initial.-,_'-'evaluation. In addition, although there was a perdiem OT that worked out of this branch there wasno evidence that this person had been contactedor was available to do an evaluation and/orprovide services to this patient

The Home Health Advance BenenciarY Noticecompleted by staff on 1/5/11 stated that skillednursing visits would be discontinued because,'yve cannot provide physical therapy services youneed and you request no more visits fromBayada.'

H 828 B.2(h) Skilled Nursing ServicesSS=D

VlIl.Skllled Nursing Services

Division of Ucensing and ProtectionSTATE FORM

H828

HK9D11 Ifcontinuation sIleet 2 01 7

07/0112011 16:03 BayadaNurses (FAX)802 254 7072 P.009/010

FO~M APPROVEDDivisIOn of Licenslno and Protection


(X1) PROVlDERISUPPUERICLIAIDENTIFICATION NUMBER:

4n019


A. BUILDING

B. WING


C06/13/2011


BAYADA NURSES, INC

STREET ADD~E55. CITY, STATE, ZIP CODE

110 KIMBALL AVENUE. SUITE 250SO BURLINGTON, VT 05403

H 828 Continued From page 2

82 The registered nurse shall:

(h) Inform the physician and other personnel ofchanges in the patient's condition and needs (n atimely manner;

-- - .•....._.10

PREFIXTAG

H 828

••. -- PROVIDER'S'P[ANOFCORRECTlON -- .. ---- -(X5) .....(EACH CORRECTIVE ACTION SHOULD BE COMPlETE

CROS5-REFERENCEDTO THE APPROPRlATE • DATEDEFICIENCY)

H 828:

IVc ~ '1$(!J-II1)CfJl~

The clinical manager shall be responsible forensuring this standard is met, and ensuringthat all appropriate Bayada policies andprocedures regarding this area are followed.

Bayada Nurses has established secure e-mail for all licensed field clinicians, as of April1, 2011. This allows faster, secure deliveryof client Information, and has improvedcommunication between field and office staff.

In the Brattleboro office, re-education will be ~ pgiven to all professional clinicians, as well as (office staff involved in the referral process, <cJ /)that any changes to the plan of care require .notification of the physician, as well asobtaining a verbal order approving thischange. As part of this re-educatlon, it shallbe reinforced that all communicationsbetween members of the care team, whetherthey are Bayada employees or not, must bedocumented, in order to clearly demonstrate'--'.""full coordination of care. A copy of eachcommunication shall be forwarded to theclinical manager in order to keep them fullyaware of the change to the plan of care.This re-education shall be provided by theclinical manager, and shall take place on orbefore July 8,2011.

This REQUIREMENT is not met as evidencedby:Based on record review and staff interview.agency staff failed to inform the physician and/oragency administrative staff in a timely mannerthat one patient's physical therapy andoccupational therapy needs (Patlent # 1) werenot being met. Findings include:

Per record review on 6/13/11 Patient #. 1, whowas admitted to the agency on 12/21/10 withphysicianidentified physical therapy (PT) and occupationaltherapy (aT) needs had orders for a PT & aTevaluation after being discharged from a skilled..'hUi'Siitg'fi3'cility: AttndUg hthe.initial-PT'evaluationwas completed on 12129/10 (eight days afteradmission) there were no further physical therapyvisits made even when the physical therapistrequested orders for 'PT visits 3 times a week for6 weeks' after the initial evaluation. In addition.although thereWas no .OT(OccUpatioilalTherapy) evaluation completed there was noevidence of notification of either the physician oragency administrative staff.

Per interview with the Acting Director on 6/13/11at 12 noon, slhe confirmed the case manager forPatient # 1 (who was no longer working for theagency) had documented in the nursing notes on1/2/11 that 'physical therapy came and did eval(evaluation) and has not returned.' S/heconfirmed there was no documentation of a

Division of Ucenslng and protection

STATE FORM HK9D11If continuation sheet 3 017

07/01/2011 16:04 BayadaNurses (FAX)802 254 7072 P.Ol0/010

I-UKM AtJtJKUVt:U

Division of Licenslnn and Protection"


~1}PRO~D~UPPUSVCUAIDENTIFICATION NUMBER:

477019

(Xl) MULTIPLE CONSTRUCTION

A. BUILDINGa.WlNG

(xi) DATE SURVEYCOMPLETED

C"06/13/2011


BAYADA NURSES. INC

STREET AOORESS. cm, STATE. ZIP CODe

110 KIMBAlL AVENUE, SUITE 250SO BURLINGTON, VT 05403

(X4)IDPREFIX

TAG

•• SOMMARY"SPliTEMENT-OF'DEFlCIENCIES----- •.• -.,-."------m--'--- .,' ',-, '-' _PRO~OER!S.PlANOF.c"ORRECTION-_ ..-----.•---.-- ...(XS) __•__(EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE

REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATEDEFICIENCY}

H 828 Continued From page 3 H'828

follow-up by the case manager to notlfy thephysician or the agency administrative staff andthat the first s1he was made aware of this waseither on 1/3 or 1/4/11.

H1421 14,4(1) Clinical Records55=0

XIV. Clinical Records

14.4 A home health agency r S patient clinicalrecords, whether written or electronic, shallcontain at a minimum:'

(i) A copy of appropriate patient transferinformation. if the patient Is transferred to ahealth care facility or other home health agency;

This REQUIREMENT is not met as evidencedby:Based on record review and staff Interview, theagenc:y failed to have evidence of a referral foronepatleiiflifthe 'sample'(Patienf#1 raftefthlf "patient's family requested a transfer to anotherhome health agency. Findings Include:

Per record review on 6/13/11 Patlent # 1 whowas admitted to the agency on 12/21/10 withphysicianidentified physical therapy (PT) and occupationaltherapy (OT) needs had orders for PT & OT .evaluations after being discharged from a skillednursing facility. The agency failed to provide theserVices even after an initial PT evaluation(which occurred on 12/29/10 , 8 days after thepatient was admitted) identified the need 'for 'therapy services. When the initial PT evaluationwas completed, the physical therapist requestedorders from the physician to see the patient '3 x a

H1421

H 1421:

Bayada Nurses has a 'referral form which isto be included as part of every client record.The clinical manager or their designee willbe responsible for reviewing this form at thetime of referral to ensure It is comPlete: ~signing the referral, and shall then ensure • bothat this form is part of the client chart beingput together at the time of admission.

All transfer of Clients to another providershall be documented on a HHABN andBayada Form 37-6 "client transfer Form"shall be completed. appropriatelydisseminated and included in the client chart

Each Office Clinical manager is responsibleto ensure that this standard, as well asapplicable Bayada Nurses policies andprocedures, are being met. Office Directorwill review each transfer to ensure completecompliance on an ongoing basis.

/'(Jt! ~ ?- ')-/1

1)t.. H ~4 -===..

Division of Ucensmg and Protection

STATE FORM56gg HK9D11

If continuatiDn sheet 4 of 7

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