Every finding on record at Maxim Healthcare Serivces, Inc.

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Department of Health and Human Services. An unannounced on-site Recertification Survey at the above-named Home Health Agency (HHA) from 04/10/23 to 04/12/23 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.102.

A Recertification Survey was conducted by Healthcare Management Solutions, LLC on behalf of Nevada Department of Health and Human Services. An unannounced on-site recertification survey conducted at the above-named Home Health Agency (HHA) from 04/10/23 to 04/12/23 resulted in a finding of substantial compliance respective to the applicable Condition of Participation (CoP) under 42 CFR 484, Subparts A through C with the following standard-level deficiencies listed below.

Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This ELEMENT is not met as evidenced by: Based on record review, policy review, and interview, the agency failed to ensure that three of five eligible patients (Patients (P) 3, P4, and P5) had a recertification Outcome and Assessment Information Set (OASIS) completed during the last five days of the certification period. The failure to update the comprehensive assessment during the required timeframe had the potential to impact all adult patients receiving home care from the agency. Findings include: Review of the agency policy titled, Recertification Assessment dated 01/13/23, revealed the recertification assessment was to be completed, in the patient's home between days 55-60 of the current certification period. 1.Review of P3's OASIS data revealed the OASIS recertification assessment for the certification period from 02/09/23 to 04/09/23, was signed and dated 04/10/23. Review of the OASIS recertification assessment for the certification period from 12/11/22 to 02/08/23, revealed it was signed and dated 02/09/23. 2.Review of P4's OASIS data revealed the OASIS recertification assessment for the certification period from 01/12/23 to 03/12/23, was signed and dated 03/13/23. Review of the OASIS recertification assessment for the certification period from 09/14/22 to 11/12/22, revealed it was signed and dated 11/14/22. 3.Review of P5's OASIS data revealed the OASIS recertification assessment for the certification period from 01/12/23 to 03/12/23, was signed and dated 03/13/23. Review of the OASIS recertification assessment for the certification period from 09/14/23 to 11/12/23, revealed it was signed and dated 11/14/22. During an interview on 04/12/23 at 10:15 AM, the Clinical Manager confirmed the dates the recertification OASIS assessment were signed and stated, "The actual assessment of the patient in their home was completed during the last five days of the certification period but the OASIS wasn't signed and dated until later because we were very busy."

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, policy review, and interview, the agency failed to ensure that staff followed standard precautions for hand hygiene, appropriate use of personal protective equipment (PPE), and failed to follow the agency policy for bag technique during two home visit observations for (Patients (P)3 and P4). The failure to follow accepted standards of practice to prevent the transmission of infections and communicable disease had the potential to place all home care patients at risk. Findings include: 1.During a visit to P3's home on 04/11/23 at 8:45 AM, observation of the Licensed Practical Nurse (LPN) preparing medications to give via a gastrostomy tube (g-tube – a tube inserted through the belly to give nutrition and medications directly into the stomach) revealed the LPN completed hand hygiene and donned gloves prior to beginning the procedure which involved touching the patient's medications. During the process the LPN touched their hair on three separate occasions with gloved hand and continued to prepare the medications without removing gloves, completing hand hygiene, and re-gloving prior to touching the patient's medications again. During an interview on 04/11/23 at 9:00 AM, the LPN stated, "I usually push my hair back with the back of my hand but I must have pushed it back without thinking today." 2.During a visit to P4's home on 04/11/23 at 12:00 PM, observation of Registered Nurse (RN)1 arrived pulling a two-wheel roller bag into the home and letting it sit on the floor. RN1 was also observed setting up a tube feeding for P4. During the process of setting up the tube feeding RN1 removed their gloves and donned another set of gloves without completing hand hygiene. During an interview on 04/11/23 at 12:40 PM, RN1 confirmed had not completed hand hygiene between glove changes. During an interview on 04/11/23 at 2:20 PM, the Clinical Manager confirmed that hand hygiene should be completed between glove changes and stated was not aware that the agency policy addressed the use of roller bags in the patient's home. Review of an agency policy titled, Hand Hygiene, dated 09/07/16 revealed, hand decontamination using an alcohol-based hand rub should be performed: … after removing gloves. Review of an agency policy titled, Bag Technique, dated 09/01/14 revealed, rolling bags (If used) should be hand carried over threshold into home and placed on barrier.

Skilled services furnished CFR(s): 484.105(f) Standard: Services furnished. Skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are made available on a visiting basis, in a place of residence used as a patient's home. An HHA must provide at least one of the services described in this subsection directly, but may provide the second service and additional services under arrangement with another agency or organization. This STANDARD is not met as evidenced by: Based on document review and interview, the agency provided skilled nursing services and no other therapeutic service. The failure to make services available in the patient's home had the potential to result in some of the needs of patient's to not be addressed. Findings include: During the entrance conference on 04/10/22 at 9:30 AM, the Administrator stated that the agency is currently only able to provide skilled nursing service, did not have any other therapeutic service including physical therapy, occupational therapy, or speech therapy under contract, and did not have any home health aides. The Administrator stated, "We are trying to hire a home health aide." Review of the agency staff list provided by the agency confirmed that, other than office staff, the agency currently employs only Licensed Practical Nurses and Registered Nurses.