Every finding on record at Maxim Healthcare Services, Inc.

The following reflects the findings of the California Department of Public Health during a recertification survey conducted from 9/16/24 through 9/19/24. The unduplicated census in the last 12 months was 64. The census at the time of the survey was 58. The survey sample size was 7 with 4 record reviews and 3 home visits with record reviews.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review, the home health agency (HHA) failed to ensure one of three home visit patient's (7) family members (FM) were informed of the California Department of Public Health (CDPH) toll-free home health hotline telephone number and it's purpose for filing complaints. This failure had the potential to delay the complaint process and compromise patients' rights. Review of Patient 7's face sheet (written document of patient information) for the certification period, 7/21/24 through 9/18/24, indicated a start of care date of 2/18/19, and a diagnosis of generalized epilepsy (chronic brain disorder that causes abnormal brain activity that can affect how the brain works), and encephalopathy (any disease, disorder, or damage that affects the brain's structure or function). Further review indicated Patient 7's FM was his responsible party (RP, decision maker). Review of Patient 7's plan of care (POC, written document summarizing current orders and treatments), for the certification period, 7/21/24 through 9/18/24, indicated disciplines ordered were for licensed vocational nurse (LVN) services 44-56 hours per week times 60 days, registered nurse (RN) supervision services 1-2 visits per certification period, and one RN recertification visit every 56-60 days. During a concurrent observation and interview on 9/17/24, at 3:30 p.m., with Patient 7's FM and registered nurse A (RN A), in Patient 7's home, Patient 7's FM stated if she had a grievance she would call the Integrity Hotline telephone number listed in the patient information booklet. FM stated she was not aware or advised of the state toll free hotline telephone number and it's purpose for filing complaints about the agency. During an interview on 9/19/24, at 11:00 a.m., with the director of patient care services (DPCS), DPCS stated she would tell the nurses to review the state toll free hotline telephone number with patient's FM at every recertification visit. Review of the HHA's policy and procedure titled, "Patient/Client Rights and Responsibilities," revised 10/07/2022, indicated "be advised of the state toll free home health telephone hotline, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local home health agencies."

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 home health agency (HHA) failed to follow accepted standards of practice to prevent the spread of infection when: 1. Registered Nurse A (RN A) did not place her nurse bag (otherwise known as visiting bag or supply bag) on a barrier and perform hand hygiene each time she re-entered her bag and; 2. Unopened shipping boxes of vinyl, synthetic, powder-free, non-sterile gloves were observed stored on the floor. These failures had the potential to lead to the spread of infection. 1. Review of Patient 7's face sheet (written document of patient information) for the certification period, 7/21/24 through 9/18/24, indicated a start of care date of 2/18/19, and a diagnosis of generalized epilepsy (chronic brain disorder that causes abnormal brain activity that can affect how the brain works), and encephalopathy (any disease, disorder, or damage that affects the brain's structure or function). Further review indicated Patient 7's family member (FM) was his responsible party (RP, decision maker). Review of Patient 7's plan of care (POC, written document summarizing current orders and treatments), for the certification period, 7/21/24 through 9/18/24, indicated disciplines ordered were for licensed vocational nurse (LVN) services 44-56 hours per week times 60 days, registered nurse (RN) supervision services 1-2 visits per certification period, and one RN recertification visit every 56-60 days. During an observation on 9/17/24, at 3:30 p.m., in Patient 7's home, RN A placed her nurse bag on a stool next to her. RN A did not place a barrier underneath her bag. RN A did not perform hand hygiene each time she re-entered her bag during the visit. Each time RN A re-entered her bag, she used the hand sanitizer kept inside her bag and sanitized her hands. During an interview on 9/19/24, at 11:00 a.m., with RN A, RN A acknowledged a barrier was not placed under her nurse bag and she did not sanitize her hands prior to re-entering her bag. RN A stated normally the visit was done at Patient 7's bedside and not at the kitchen table. RN A stated the hand sanitizer was stored at Patient 7's bedside. RN A stated she should have stored her hand sanitizer outside her bag or placed it on the kitchen table and sanitized her hands prior to re-entering her bag. During an interview on 9/19/24, at 11:00 a.m., with the director of patient care services (DPCS), DPCS stated RN A should have sanitized her hands each time she re-entered her bag. DPCS stated she provided RN A with a hand sanitizer she could hang outside her bag. DPCS stated she had ordered nurse bags with an outside pocket for all the clinicians so they could store their hand sanitizer outside their bag. Review of the HHA's policy and procedure titled, "Bag Technique," revised 4/21/2011, indicated "place a barrier...on flat surface before setting bag down" and "decontaminate hands prior to re-entering bag for any reason." 2. During a concurrent observation and interview, on 9/19/24, at 10:53 a.m., with the DPCS, in the room, where the gloves are stored, unopened shipping boxes of vinyl, synthetic, powder-free, non-sterile gloves were observed stored on the floor. DPCS acknowledged the boxes of gloves stored on the floor. DPCS stated the gloves were used by licensed nurses in patient homes. During a subsequent, concurrent interview and record review, with the DPCS, the Statement of Deficiencies and Plan of Corrections, dated 1/31/2020 was reviewed. The Statement of Deficiencies and Plan of Correction indicated boxed gloves were found on the floor and the plan of correction was to place the gloves on shelving. DPCS stated she was not here during the last recertification survey and she was not aware of the deficiency or the plan of correction. According to the Center for Disease Control and Prevention (CDC): sterile supplies should be stored far enough from the floor (8 to 10 inches), the ceiling (5 inches unless near a sprinkler head [18 inches from sprinkler head]), and the outside walls (2 inches) to allow for adequate circulation, ease of cleaning, and compliance with local fire codes.