Every finding on record at Maxim Healthcare Services Inc

A recertification survey was completed on 12/6/23. One deficiency was cited.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on interview and record review the agency failed to ensure services and treatments were provided in accordance with physician orders for 1 of 1 active patients who received private duty nursing (PDN) reviewed (Patient #3). Findings include: 1. The clinical record for Patient #3 was reviewed on 12/5/23. The plan of care (POC) for the certification period dated 9/2/23 to 10/31/23 and 11/1/23 to 12/30/23 revealed a start of care date of 5/10/22; diagnoses included congenital malformation of respiratory system, encounter for attention to tracheostomy, encounter for attention to gastrostomy and feeding difficulties. POC orders included PDN visits for 50 to 80 hours per week for 60 days for skilled assessment, vital sign evaluation, medication administration and personal care, which included bathing, dressing, diapering, skin and oral care. a) The agency failed to ensure PDN service hours were being provided as ordered by the physician. Review of the PDN visit hours for Patient #3 revealed the agency failed to schedule PDN hours for the patient to meet the required 50 to 80 hours during multiple weeks. During the week of 11/5/23 to 11/11/23 Patient #3 received 46.75 hours of PDN care, during the week of 10/29/23 to 11/4/23 Patient #3 received 48 hours of PDN care, during the week of 11/22/23 to 11/28/23 Patient #3 received 49 hours of PDN care and during the week of 9/24/23 to 9/30/23 Patient #3 received 41.75 hours of PDN care. The POC for all these weeks required Patient #3 receive between 50 to 80 hours weekly. During a home visit interview on 12/4/23 at approximately 3:19 p.m., registered nurse (RN) #5 stated she worked three days a week and worked about eight hours per day, for a total of 24 hours per week. During a home visit interview on 12/4/23 at approximately 3:19 p.m., the family member of Patient #3 stated one nurse would come in for three days a week and worked eight hours a day and the other nurse would come in twice a week and worked twelve hours per day. The total number of hours worked for the two nurses would be 48 hours, which would be less than required on the POC. During an interview on 12/5/23 at 3:17 p.m., the clinical supervisor for Patient #3 stated the reason the agency did not meet the required 50 to 80 hour range per week was due to staffing issues. The clinical supervisor also stated the agency was in the process of hiring new nurses for Patient #3 so they could meet the required number of hours on the POC. During an interview on 12/5/23 at 3:03 p.m., the administrator and director of nursing (DON), stated the agency had lost one of the staff that worked weekends with Patient #3. The administrator and DON also stated when the agency lost the staff they did not contact the physician to receive a reduction of PDN hours.