Every finding on record at Maxim Healthcare Services, Inc

The following reflects the findings of the California Department of Public Health- Licensing and Certification during a PARTIAL EXTENDED RECERTIFICATION survey. Representing the Department of Public Health by Federal ID: 27390, Health Facilities Evaluator Nurse. Sample Size : 7 Record Review with Home Visits : 3 Record Review without Home Visits : 4 The agency was found to be in substantial compliance with the Conditions of Participation. Standard deficiencies issued.

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, interview and record review, the agency failed to follow standard precautions to prevent the transmission of infection diseases for one of three sampled patients with a home visit (Patient 3) when Registered Nurse (RN) 3 did not remove soiled gloves and reused them repeatedly by using hand sanitizer. This failure placed Patient 3 at risk for cross contamination. Findings: During an observation on 1/12/23, at 1:40 p.m., in Patient 3’s home, RN 3 was observed wearing gloves on both hands as she examined Patient 3. RN 3 was observed touching Patient 3’s chest and back with her stethoscope listening to Resident 3’s breath sounds. RN 3 then checked Patient 3’s elbow to see the rash. RN 3 then sanitized her gloved hands with hand sanitizer. RN 3 did not remove her gloves after having direct contact with Patient 3. RN 3 was later observed walking away from Patient 3 to the medication storage area in the back of the living room, where Patient 3’s medications were kept. RN 3 did not remove her gloves. RN 3 was observed holding a medication bottle with the same gloved hands. RN 3 once again sanitized the same gloved hands with hand sanitizer as she did earlier. During an interview on 1/12/23, at 2:50 p.m., with RN 3, RN 3 stated, she should have taken the gloves off and sanitized her hands. RN 3 stated since the gloves were not visibly soiled she forgot to take her gloves off. RN 3 stated she did not have an answer for sanitizing the gloved hands. RN 3 stated the gloves were used to protect her hands only. RN 3 stated sanitizing soiled gloves was not acceptable. RN 3 stated hand hygiene was critical to prevent cross contamination from surface to surface. During an interview on 1/12/23, at 3:10 p.m., in Patient 3’s home, with Licensed Vocational Nurse (LVN) 3, LVN 3 stated, it was not an acceptable standard of practice to sanitize gloved hands. LVN 3 stated it was the standard of nursing practice that used gloves needed to be discarded after the task and a proper handwashing need to be followed. LVN 3 stated, “Never sanitize gloves.” During an interview on 1/18/23, at 11:25 a.m., with the director of patient care services (DPCS), the DPCS stated, she never heard of someone sanitizing the gloved hands. The DPCS stated the gloves were disposable not reusable. The DPCS stated sanitizing gloved hands and moving on to the next task could spread germs. The agency’s policy and procedure (P&P) titled, “Hand Hygiene” dated 9/7/16 indicated,” Hand decontamination using an alcohol-based hand rub should be performed: Before having direct contact with patients/clients…After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient…After removing gloves…”

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to develop and implement policy and procedures (P&P) for three of three sampled staff (Licensed Vocational Nurse [LVN] 4, Registered Nurse [RN] 5 and LVN 5) when SARS-CoV-2 (Covid-19, a contagious serious respiratory infection transmitted from person to person) vaccination exemption records did not contain the information of which authorized or licensed Covid-19 vaccine was clinically contraindicated (condition indicate that should not be used). This failure had the potential to place patients at risk for Covid 19 and place the staff at risk for not seeking for vaccinations available to protect from being severely ill from Covid-19 infection. During a concurrent interview and record review on 1/18/23, at 11 a.m., with the Administrator (Adm), the list of staff who were exempted from Covid-19 vaccination was reviewed. The Adm stated the Cooperate Human Resources (CHR) was the person designated to track and maintain documentation of Covid-19 vaccination exemption records. During a review of LVN 4 ’s letterhead from a physician’s office, dated 10/8/21, the letterhead from a physician’s office indicated, LVN 4 had a medical condition to be excused from receiving Covid -19 vaccines. The letterhead from a physician’s office contained the medical diagnosis but did not contain which vaccine was clinically contraindicated for LVN 4. During a review of RN 5’s “Request for Covid-19 Vaccination Exemption,” dated 8/13/21, the “Request for Covid-19 Vaccination Exemption” indicated, RN 5 had a medical condition to be excused from receiving Covid -19 vaccines. The request did not contain which vaccine was clinically contraindicated for RN 5. During a phone interview on 1/17/23, at 4:36 p.m., with RN 5, RN 5 stated, she was a contracted employee for [the agency] and her primary contact regarding Covid-19 related matter was the Field Support Manager (FSM). RN 5 stated the agency did not require their own form to be exempted. RN 5 stated, when she asked for the exemption, she was told to provide the exemption request she already had to the CHR, and she was exempted. During a review of LVN 5’s letterhead from a physician’s office, dated 10/19/22, the letterhead from a physician’s office indicated, LVN 5 had a medical condition to be excused from receiving Covid -19 vaccines. The request did not contain which vaccine was clinically contraindicated for LVN 5. During an interview on 1/18/23, at 11 a.m., with the Adm, the Adm stated when the employee request to be exempt email is sent to the CHR and the staff would communicate directly with CHR. The Adm stated he is informed once that staff is approved by the CHR. During a phone interview on 1/19/23, at 11:30 a.m., with the CHR, the CHR stated, she was not familiar with regulations related to Covid-19 exemption requirements and she did not check whether the specific names of vaccines needed to be included in the doctor’s note. The CHR stated she thought the signed note from the physician was sufficient to be exempt. The CHR stated she would ensure LVN 4, RN 5 and LVN 5 provided the names of vaccines that were clinically contraindicated. During a review of the agency’s P&P titled, “Covid-19 CMS (Center for Medicare & Medicaid Services) Vaccination mandate,” dated 10/7/22, the P&P indicated, “Medical Accommodations: Employees requesting medical accommodation must provide documentation from their health care practitioner specifying which of the authorized COVID -19 vaccines are clinically contraindicated for the employee to receive and the recognized clinical reasons for the contraindications ; and a statement by the authenticating practitioner recommending that the employee be exempted from the COVID-19 vaccination requirement based on the recognized clinical contraindications.” During a review of QSO-23-02-All (a notice of regulation by Center for Clinical Standards and Quality/Quality, Safety & Oversight Group) dated 10/26/22, the QSO-23-02-All indicated, “Medical exemption documentation must specify which authorized or licensed COVID-19 vaccine is clinically contraindicated for the staff member and the recognized clinical reasons for the contraindication. The documentation must also include a statement recommending that the staff member be exempted from the HHA (Home Health Agency)’s COVID-19 vaccination requirements based on the medical contraindications.”

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 interview and record review, the agency failed to provide the services as ordered by the physician for one of seven sampled patients (Patient 4) when Registered Nurse (RN) 4 did not check Patient 4’s full set of vital signs (group of the four most crucial medical signs that indicate the status of the body’s vital functions) prior to the start of the infusion (receiving medication through a needle or catheter) as indicated in the plan of care (POC-written plan of care established by a home health agency that describes maintenance care to be provided). This failure had the potential to place Patient 4 at risk for inaccurate monitoring of base line vital signs and placed Patient 4 at risk for a delay in recognition of a clinical reaction during the infusion. Findings: During a review of Patient 4's “POC,” dated 11/30/22 to 1/28/23, the “POC” indicated, Patient 4 was receiving immune glob G (the medication is used to strengthen the body’s natural defense system to lower the risk of infection with a weakened immune system) 300 cc (cubic centimeter-unit measurement of volume) every three weeks. During a review of Patient 4’s “POC,” dated 11/30/22 to 1/28/23, the “POC” indicated, “Vital Signs: Temperature, pulse, respiratory rate, B/P (Blood Pressure) every upon arrival, beginning of infusion, every rate change, 30 minutes post infusion, and as needed for changes in condition.” During a review of Patient 4’s “Skilled Nursing Note,” dated 1/12/23, the skilled nursing note indicated, RN 4 arrived at Patient 4’s home at 11:20 a.m., and started the infusion therapy at 11:30 a.m. The skilled nursing note indicated, Patient 4’s vital signs were checked upon arrival at 11:20 a.m. The skilled nursing note contained the value of Patient 1’s temperature (measure of hotness or coldness expressed in terms of several scales, including Fahrenheit and Celsius) and blood pressure (the pressure of circulating blood against the walls of blood vessels) but did not contain the value of Patient 1’s pulse (heart rate-number of times heart beats per minute) and respiration (the movement of air or dissolved gases into and out of the lungs). During a concurrent interview and record review on 1/18/23, at 11:25 a.m., with the director of patient care services (DPCS), Resident 4’s” Skilled Nursing Note” dated 1/12/23 was reviewed. The DPCS stated, “[RN 4] checks vital signs a lot…see there at 11:30 a.m. she checked the vital signs. [RN 4] forgot to write that information over to the skilled nursing note.” During a phone interview, on 1/18/23, at 1:39 p.m., with RN 4, RN 4 stated, “Vital signs should contain temperature, pulse and respiration and BP. It is important. I possibly did not record on the visit note. I always check full set of vital signs before I start anything. It sets the base line for infusion monitoring. [doctor] ordered the vital signs to be checked, before, at start and more as infusion progressed. It is possible I might write on a piece of paper and forgot to transfer.” During a record review of the agency’s policy and procedure (P&P) titled, “Measurements: Vital signs,” dated 9/12, the P&P indicated, “Vital signs give crucial information about the patient’s heart and lungs, if patient is developing an infection, and if everything is normal for the patient or if something is going wrong…Vital signs are: a. Temperature b. Pulse c. Respirations d. Blood Pressure (BP)…”