Every finding on record at Maxim Healthcare Services

An emergency preparedness survey was completed at Maxim Healthcare Services from 6/11/2024 to 6/12/2024. The facility was in compliance with the Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

A recertification survey was conducted at Maxim Healthcare Services from 6/11/2024 to 6/12/2024. The facility was not in compliance with (CFR) 42, Part 484, Conditions of Participation Requirements for Home Health Agencies.

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on interviews, record and policy reviews, the agency failed to follow its policy for reporting abuse, neglect, or exploitation for 1 (#8) patient out of 8 records sampled. The findings included: A review of the agency policy titled Patient Abuse, Neglect or Exploitation with Reference # MD-ERR-006 and, an effective date of 1/14/2019 and a revised date of 4/11/2024. 3. Policy: 3.1 Employees who identify, notice, or suspect or recognize incidences or circumstances of mistreatment, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, neglect, misappropriation of personal patient property, or exploitation of patients/clients and or family/caregivers or employees must report these observations/concerns immediately to the agency and other appropriate authorities in compliance with applicable laws and regulations. 3.2 Alleged incidences or circumstances outlined in 3.1 will be reported first to the Legal Department and then to enforcement agencies according to applicable laws and regulations. Procedure: 5.1 The office operations leader, office clinical leader, or designee will be notified immediately of suspected or alleged abuse, neglect, exploitation, abandonment, or other high-risk situations." A review of the complaint log revealed a complaint report from Staff FF, Licensed Practical Nurse (LPN), dated 2/01/2024 with documentation: The Nurse called the office this morning to report environmental concerns of the home, including caked-on feces on the toilet for weeks, piled up unwashed dishes in the sink, constant roaches and black mold in the kitchen and found inside of the patient's sippy cup. The nurse stated she had tried to talk with the mom several times but was in denial and believed that her home was spotless and clean. Action taken by the agency documented, "I informed the caregiver that I would discuss her concerns with the case manager, and together, we will discuss potential solutions to assist in improving the home environment." The administrator documented that he spoke with the insurance case manager about the nurse's concerns and my concerns about the home environment's role in respiratory health and infection control. The case manager stated that she would discuss infection control and cleanliness options. "CM will follow up with the office after the conversation with the caregiver." There is nothing else documented in the report. A review of the medical record for Patient #8 revealed a start of care date of 11/13/2023 and a current certification period of 5//2024 to 7/09/2024. The primary diagnosis is Spina Bifida with medical complication ventricular intracranial shunt. The plan of care (POC) orders skilled nursing 56 hours per week. The POC documented a HIGH risk for re-hospitalization and/or transfer due to seizure/ VP Shunt Malfunction/GI&GU management, medication administration, and assistance with ADLs. SN will monitor the patient for clinically pertinent changes and report them as appropriate to the MD and clinical supervisor. An interview was conducted with the administrator on 6/12/2024 at 1:05 PM. He reviewed the report and what he did (the same as the documentation). The administrator was unaware that he should have reported the incident to the required authorities.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on interviews, records, and policy reviews, the agency failed to provide the contracted services for 4 (# 2, 3, 6, and 7) patients out of 7 records reviewed. The findings included: A review of the agency policy titled Acceptance and Admission with a Reference #MD-CL_006.3 and effective date of 9/01/2014 with a revision date of 8/19/2022 revealed Policy: 3.2 Patient/clients will be accepted for service based on the adequacy and suitability of the personnel, resources to provide required services, and the reasonable expectation that the patient's medical nursing, rehabilitative, and social needs can be adequately met in the patient/client's place of residence. A review of the agency policy titled Patient/Client Scheduling with Reference# MD-CL-016, the effective date of 9/01/2014 and a revised date of 7/14/2023, reeled: Policy: 3.21. The office operations leader or designee shall ensure that adequate resources are available to provide qualified Direct Care Staff to cover scheduled and unscheduled absences so that ordered and/or authorized services are not interrupted. 3.2.2. The office operations leader or designee will ensure that there is a pool of available staff or contract staff via a written agreement with another licensed home healthcare agency and/or healthcare staffing service agency to provide staff in the event that employed staff cannot fill an open shift/visit. 4.2 Missed Shift: A deviation from the plan of service. A missed shift occurs when the scheduled shift is not completed according to the plan of service or the ordering practitioner order (if applicable) for a particular previously assigned date and hours. 5.7. If at any time the services provided do not match the ordering practitioner (or range of orders) as required by the plan of care, a Missed Shift/Visit Note and notification to the ordering practitioner is required. The medical record will include all documentation related to missed shifts, including alternative care for the patient. During an interview on 6/11/2024 at 9:20 AM, the administrator said the agency has no staffing contracts with Health Care Service Pools or other healthcare facilities or entities. Review the plan of care (POC) for patient #2 with a start of care date of 4/09/2024 (SOC) and a current certification period of 4/15/2024 to 6/13/2024. Documented under line 21, Orders for Discipline and Treatments (specify amount/frequency/duration): the agency will provide skilled nursing (SN) services for 8 to 12 hours per day, 3-5 days per week throughout the certification period. The patient has a pertinent diagnosis of malformation of the peripheral vascular system with dysphagia. The patient is at risk for Rehospitalization/ED due to G-tube dependence, seizure/aspiration monitoring, GI management, / GI/GU management, medication administration, and assistance with ADLs. SN (Skilled Nurse) will monitor the patient for clinically pertinent changes and report them as appropriate to the physician and agency supervisor. A review of the Agreement for Homecare Services dated 4/09/2024 and signed by the caregiver for patient #2 and an agency representative listed on page 2 of 3 Cost of Services: Continuous Services has a checkmark with RN (Registered Nurse)/LPN (Licensed Practical Nurse) 40 hours per week. A review of the agency's Missed Shift Report revealed the following: 4/15/2024 5.30 hours caregiver canceled 4/22/2024 4.30 hours caregiver canceled 4/25/2024 5 hours caregiver canceled 4/29/2024 8 hours No qualified caregiver available 4/30/2024 8 hours No qualified caregiver available 5/01/2024 8 hours No qualified caregiver available 5/02/2024 8 hours No qualified caregiver available 5/03/2024 8 hours No qualified caregiver available 5/08/2024 8 hours No qualified caregiver available 5/13/2024 8 hours No qualified caregiver available 5/14/2024 8 hours No qualified caregiver available 5/16/2024 8.0 No qualified caregiver available. Review of the POC for patient #3 with a SOC of 4/14/2022 and a current certification period from 6/02/2024 to 7/31/2024. Documented under line 21 revealed Orders for Discipline and Treatments (specify amount/frequency/duration): the agency to provide skilled nursing services for 60 to 168 hours per week for a 60-day certification period. The patient has a pertinent diagnosis of encounter for attention to gastrostomy. SN will accompany the patient to scheduled appointments and developmentally appropriate activities in the community as needed. The patient is at high risk for rehospitalization/ED Risk due to G-tube, seizure, / GI/GU management, medication administration, and assistance with ADLs. SN (skilled Nurse) will monitor the patient for clinically pertinent changes and report them as appropriate to the physician and agency supervisor. The caregiver for patient #3 and an agency representative listed on page 2 of 3 reviewed and signed the Agreement for Homecare Services dated 4/14/2022. Cost of Services: Continuous Services for an RN /LPN 168 hours per week. A review of the agency's Missed Shift Report revealed the following: 1/1/2024 24.hours No qualified caregiver 1/5/2024 12 hours No qualified caregiver 1/06/2024 12 hours No qualified caregiver 1/19/2024 12 hours No qualified caregiver 1/26/2024 12 hours No qualified caregiver 2/2/2024 12 hours No qualified caregiver 2/03/2024 5 hours No qualified caregiver 2/4/2024 7 hours No qualified caregiver 2/6/2024 12 hours No qualified caregiver 2/13/2024 9 hours No qualified caregiver 2/16/2024 12 hours No qualified caregiver 2/17/2024 12 hours No qualified caregiver 2/23/2024 12 hours No qualified caregiver 2/25/2023 12 hours No qualified caregiver 3/1/2024 12 hours No qualified caregiver 3/08/2024 12 hours No qualified caregiver 3/15/2024 12 hours No qualified caregiver 3/22/2024 12 hours No qualified caregiver 3/23/2024 12 hours No qualified caregiver 4/5/2024 12 hours No qualified caregiver 4/6/2024 12 hours No qualified caregiver 4/19/2024 12 hours No qualified caregiver 4/20/2024 12 hours No qualified caregiver 4/26/2024 12 hours No qualified caregiver 4/29/2024 12 hours No qualified caregiver 5/04/2024 12 hours No qualified caregiver 5/06/2024 12 hours No qualified caregiver 5/09/2024 12 hours No qualified caregiver 5/10/2024 12 hours No qualified caregiver 5/13/2024 12 hours No qualified caregiver 5/20/204 12 hours No qualified caregiver 5/24/2024 12 hours No qualified caregiver 6/04/2024 12 hours No qualified caregiver. Review of the POC for patient #6 with a SOC of 11/03/2023 and a current certification period of 5/01/2024 to 6/29 2024. Documented under line 21 revealed Orders for Discipline and Treatments (specify amount/frequency/duration): the agency to provide skilled nursing services for 16-24 hours per day, 4-7 days per week throughout the certification period. The patient has a pertinent diagnosis of congenital malformation of the brain with attention to gastrostomy status. The patient is at high risk for rehospitalization/ED Risk due to a G-tube. SN (skilled Nurse) monitors the patient for clinically pertinent changes and reports them as appropriate to the physician and agency supervisor. The caregiver for patient #6 and an agency representative listed on page 2 of 3 reviewed and signed the Agreement for Homecare Services dated 4/14/2022. The cost of Services is continuous Services for an RN /LPN 168 hours per week. A review of the agency's Missed Shift Report revealed the following: 12/31/2023 6 hours No qualified caregiver 1/05/2024 12 hours No qualified caregiver 1/06/2024 24 hours No qualified caregiver 1/07/2024 24 hours No qualified caregiver 1/12/2024 12 hours No qualified caregiver 1/13/2024 5 hours No qualified caregiver 1/14/2024 19 hours No qualified caregiver 1/20/2024 12 hours No qualified caregiver 1/27/2024 12 hours No qualified caregiver 1/28/2024 12 hours No qualified caregiver 2/02/2024 12 hours No qualified caregiver 2/03/2024 12 hours No qualified caregiver 2/04/2024 18 hours No qualified caregiver 4/07/2024 12 hours No qualified caregiver 4/13/2024 12 hours No qualified caregiver Review of the POC for patient #7 with a SOC of 11/03/2023 and a current certification period of 5/01/2024 to 6/29 2024. Documented under line 21 revealed Orders for Discipline and Treatments (specify amount/frequency/duration): the agency to provide skilled nursing services 24 hours per day, 7 days per week throughout the certification period. The patient has a pertinent diagnosis of attention to gastrostomy status and encounter for attention to tracheostomy. The patient is at high risk for rehospitalization/ED Risk due to a G-tube. SN monitors the patient for clinically pertinent changes and reports them as appropriate to the physician and agency supervisor. A review of the Agreement for Homecare Services dated 1/13/2021 and signed by the caregiver for patient #7 and an agency representative listed on page 2 of 3 Cost of Services: Continuous Services is checkedmarked with the discipline RN documented, and the estimated hours a week is blank. A review of the agency Mised Shift Report revealed the following: 5/16/2024 12 hours No qualified caregiver 5/17/2024 12 hours No qualified caregiver 5/18/2024 12 hours No qualified caregiver 5/23/2024 12 hours No qualified caregiver 5/25/2024 12 hours No qualified caregiver 5/30/2024 12 hours No qualified caregiver 5/31/2024 12 hours No qualified caregiver 6/01/2024 12 hours No qualified caregiver 6/04/2024 12 hours No qualified caregiver 6/06/2024 12 hours No qualified caregiver 6/07/2024 12 hours No qualified caregiver 6/08/2024 24 hours no qualified caregiver. An interview was conducted with Staff H, a Licensed Practical Nurse (LPN), on 6/13/2024 at 9:30 AM. Staff H said, "Staffing is tight. We need more staff for the weekends. An interview was conducted with Staff I, LPN, on 6/12/2024 at 10:15 AM. Staff, I said this was her second day with Patient #2. Patient #2's mom stated that Staffing had been a nightmare, but she hoped the agency hiring Staff I, LPN, would help. During an interview with Staff J, Registered Nurse, on 6/1/2024 at 11:30 AM, she said that there were times they needed more staff. "Weekends and nights are the worst." A review of the agency Quality Meeting and agenda dated 2/07/2024 Initiatives and the report for Quarter 4 October, November, and December 2023 revealed under Missed Opportunities: Quarter 1 Client Hours Canceled 4103 and No Qualified Caregiver hours that were available 1506. Action Plan Initiated" is marked "NA." The agency continued to fall below the office goal of attaining a 95% fill rate. A review of the agency Quality Meeting and agenda dated 4/19/2024 Initiatives and the report for Quarter 4 October, November, and December 2023 revealed under Missed Opportunities: 91 "Caregivers canceled," 255 "No qualified caregiver." Our goal as an office is to increase the fill rate for all shifts. The Action Plan Initiated is marked "No." VI: Grievance Review documents two grievances concerning dissatisfied clients due to scheduling.