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~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
STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION
~1) PRO~D~SUPPU~CUAIDENTIFICATION NUMBER:
477019
(X2) MULTIPLE CONSTRUCTION
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
(X2) MULTIPLE CONSTRUCTION
ABUILDING
B. WING
. "
FORMAPPROVEDOMB NO. 0938-0391(X3) DATE SURVEY
COMPLETED
C06/13/2011
NAME OF PROVIDER OR SUPPUER
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
DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICES
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
DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION
~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
STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLlER/CLlAIDENTlFICATION NUMBER:
477019
(X2) MULTIPLE CONSTRUCTlON .
A. BUILDING
B. WING
(X3) DATE SURVEYCOMPLETED
C06/13/2011
NAME OF PROVIDER OR SUPPUER
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
STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION
(X1) PROVlDERISUPPUERICLIAIDENTIFICATION NUMBER:
4n019
(X2) MULTIPLE CONSTRUCTION
A. BUILDING
B. WING
(X3) DATE SURVEYCOMPLETED
C06/13/2011
NAME OF PROVIDER OR SUPPLIER
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"
STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION
~1}PRO~D~UPPUSVCUAIDENTIFICATION NUMBER:
477019
(Xl) MULTIPLE CONSTRUCTION
A. BUILDINGa.WlNG
(xi) DATE SURVEYCOMPLETED
C"06/13/2011
NAME OF PROVIDER OR SUPPLIER
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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