Every finding on record at Maxim Healthcare Services, Inc

Emergency Preparedness Survey At the time of the emergency preparedness survey completed on 12/16/21, Maxim Healthcare Services is in compliance with the provisions of 42 CFR Part 484.102

Partial Extended Recertification Survey The following deficiencies are based on the partial extended recertification survey completed on 12/16/21. Maxim Healthcare Services, Inc., is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C.

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 medical record review, staff interview, and policy review, the agency failed to complete wound dressing changes per physician orders and follow the wound care policy to obtain measurements weekly. This affected one (Patient #1) patient with the potential to affect all patients cared for by this agency. Findings include: The medical record for Patient #1 revealed a start of care (SOC) date of 9/08/21 with a diagnosis of anoxic brain damage and quadriplegia. The certification periods reviewed were for 9/08/21-11/06/21 and 11/07/21-1/05/22. Nursing flowsheets indicated Patient #1 had a coccyx wound and wound on the left leg, both which requiredg dressing changes. Daily visits completed by a licensed practical nurse (LPN) noted dressing changes were completed but did not identify which wound was treated. A request was made to Staff A on 12/15/21 at 11:00 AM requesting documentation of dressing changes and wound measurements. Staff A provided Wound Care Flow Sheets stating these were kept in the clients home and staff forget to send them to the agency. Review of physician orders on 10/25/21 had instructions for this agency and a different agency to provide wound management and treatment plan for the coccyx and left lower leg wounds. The coccyx wound included to cleanse with soap and water, rinse well and pat dry, cover palpable bone with white foam (2 o'clock and 11 o'clock), then cover with black foam to the wound bed, and set the wound vacuum (vac) at 125 millimeters of mercury (mm/hg) continuously. The left anterior calf and left lateral calf treatments included wash open areas with soap and water, rinse well, pat dry, apply collagen with silver, and cover with a dry sterile dressing every other day and as needed. Further orders from the wound clinic on 11/19/21 indicated to keep the wound vac off until 11/22/21, Until 11/22/21 complete dressing changes alternating a dressing of Dakin soution 0.125% twice a day, then cleanse with soap and water, rinse well and pat dry. On 11/22/21 use hydrocolloid dressing to periwound and skin tear, cover palpable bone with white foam, then cover with black foam to wound bed and set the wound vac at 125 mm/hg continuously, change this twice per week. Nursing notes on 11/20/21 at 8:00 AM indicated a wet to dry dressing was completed to the buttocks. The wound was pinkish, reddish and brown, with no indication the Dakin soution dressing change was completed. Notes on 11/21/21 at 1:00 PM indicated wound care completed to left leg but no description of the type of dressing applied. The dressing change notes of 11/22/21 indicate the wound vac was re-applied. Interview with Staff A on 12/14/21 prior to the home visit indicated the wounds are managed by another home care agency. Observations upon entering the home on 12/14/21 at 9:45 AM revealed the LPN and Patient #1's wife were just completing the dressing change to the coccyx area and were repositioning the patient. Staff A provided documentation of dressing change with measurements completed on 10/25/21 to the coccyx and one left leg wound. Wound measurements were completed on 11/03/21 to the coccyx, left leg and right buttocks. The next wound measurement were completed by the LPN on 11/15/21 for the coccyx and left leg. The last documented wound measurements were completed on 11/29/21 for the coccyx and left leg. Review of the a policy titled "Wound Care," dated 10/10/16, revealed wound care should be done in accordance with the ordering practitioner's order. Wound measurements shall be obtained and documented by the qualified clinician at least once each week to include size, length width and depth as well as evidence of healing or deterioration. Interview on 12/16/21 at 9:50 AM, Staff A verified Patient #1's dressing changes were not clearly documented as being completed twice per week and measurements were completed every other week instead of weekly. Staff A further stated other agencies are managing Patient #1's wound care and there needs to be better communication with them.

Substantial Allegation Survey Substantial Allegation Survey 31897 The following deficiencies are based upon substantial allegation 31897 completed on 09/29/21. Maxim Healthcare Services, Inc 367799, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on interview and medical record review, the facility failed to ensure home health services were received as ordered in the written plan of care for two of four patient records reviewed (Patient #1 and #3). Findings include: 1.A review of Patient #1's clinical record was completed on 09/29/21. The patient's care began with the agency on 01/09/16 with diagnoses of quadriplegia, neuromuscular dysfunction, and dysfunction of the bladder. A review of the care plan for period beginning 09/02/21 revealed the patient was to receive 30 hours of skilled nursing services a week, to, among other things, administer medications and provide wound care to a wound on the patient's left ischium. The medical record review revealed for the weeks beginning 09/05/21 and 09/12/21 the patient received 16 and 12 hours respectively. The medical record review did not reveal physician notification that services were not provided as ordered. On 09/28/21 at 4:30 PM in an interview the Clinical Manager confirmed the hours were not being provided as ordered because very often the patient refused the nurse they did send. 2.The medical record review for Patient #3 was completed on 09/29/21. The patient's care began with the agency on 04/02/15. The medical record review revealed a plan of care for the certification period beginning 08/28/21 that stated the patient was diagnosed with major depression, bipolar, asthma, and an antisocial personality disorder. The plan of care directed the agency to provide 14 skilled nurse visits a week. The medical record review revealed for the weeks beginning 09/05/21 and 09/12/21, seven visits were provided. On 09/29/21 at 12:38 PM in an interview, Staff #10 confirmed the plan of care called for 14 visits a week and the agency was providing seven visits per week. She said the frequency had changed awhile ago, but the plan of care had not been updated. This substantiates Substantial Allegation 31897.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on interview and medical record review, the agency failed to promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered for one of four patients reviewed (Patient #1). Findings include: A review of Patient #1's clinical record was completed on 09/29/21. The patient's care began with the agency on 01/09/16 with diagnoses of quadriplegia, neuromuscular dysfunction, and dysfunction of the bladder. A review of the care plan for period ending 09/01/21 revealed the patient was to receive 30 hours of skilled nursing services a week, to, among other things, administer medications and provide wound care to a wound on the patient's left ischium. The medical record review revealed Staff #1 visited the patient on 08/23/21. On 09/28/21 at 4:00 PM Staff #1 was interviewed by telephone. She said while the patient was in bed, he told her to just stand there and do nothing while he and his aide worked toward doing a shower. She said she offered to leave the room, which she said he had her do, and then, not too much later, demanded she come back in. She said when she stepped back in she saw the home health aide holding a marijuana cigarette and helping the patient to smoke it. She denied notifying the physician of this behavior. On 09/28/21 at 4:00 PM in an interview, the Clinical Manager confirmed hearing Staff #1 state in the interview of 09/28/21 at 4:00 PM by telephone that she walked in on a home health aide helping the patient smoke marijuana and that she did not notify the physician.