Valley Health at Home by Bayada

The HHA failed to participate or conduct exercises to test the emergency plan at least annually based on their all-hazards risk assessment.

The home health agency (HHA) failed to maintain an infection surveillance program which included identification, investigation, and analysis of infections that was an integral part of the HHA's quality assessment and performance improvement (QAPI) program.

The home health agency failed to conduct an initial assessment visit within 48 hours of the referral, or within 48 hours of the patients' return home from an inpatient hospital stay, or on the physician ordered start of care (SOC) date for seven of 12 patients (Patient (P)1, P4, P5, P6, P8, P9, and…

The home health agency (HHA) failed to ensure that the Administrator reported directly to the governing body.

The Agency failed to establish and maintain a current, comprehensive Emergency Preparedness program which included policies and procedures in accordance with 42 CFR 418.113. Failure to meet this requirement has the potential to hinder agency response during an emergency which requires coordination…

The Agency failed to develop and maintain an emergency preparedness plan based on an all-hazard approach.

The Agency failed to develop and maintain an emergency plan based on a facility and community based risk assessment using an all-hazard approach.

The Agency failed to develop and maintain an emergency preparedness plan that included process for cooperation with local, State and Federal emergency preparedness officers and agencies.

The Agency failed to develop and implement an emergency preparedness plan, which included a system of medical documentation to preserve patient information, protect confidentiality, secure and maintains availability of records.

The Agency failed to develop and implement an emergency preparedness plan, that included a communication plan with contact information for Federal, State, tribal, regional, and local emergency preparedness staff and other sources of assistance.

The Agency failed to develop and implement an emergency preparedness plan, which included a method for sharing information and medical documentation for patients under Agency care, with other health providers to maintain the continuity of care, and provide information about the general condition…

The agency failed maintain a less than 10 percent late submission rate by ensuring Outcome and Assessment Information Set (OASIS) data was transmitted within 30 days of completing the assessment for 10 of 10 quarters since the first quarter of 2016 (2016 Q1, 2016 Q2, 2016 Q3, 2016 Q4, 2017 Q1, 2017…

The agency did not provide services for 2 of 17 patients (Patients #3 & #4) and failed to ensure plan of care orders were signed by the physician for 1 of 17 patients (Patient #8).

The agency failed to ensure Infection Prevention and Control practices were conducted to ensure agency staff was free of active pulmonary Tuberculosis for 6 of 10 employees (Employee #1, #10, #11, #12, #13 and #14).

The agency failed to ensure a patient or patient's representative was appropriately informed of patient's rights and responsibilities for 2 of 17 sampled patients (Patients #7 & #9).

The agency failed to ensure patients were provided with the state toll free home health telephone hot line for 17 of 17 patients.

The agency failed to ensure Advance Directive information was included in the patient record for 1 of 17 patients (Patient #8).

The agency failed to ensure medication instructions were accurately conveyed to the caregivers for 2 of 7 sampled patients (Patients #5 & #6).