Every finding on record at Maxim Healthcare Services, Inc

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 03/03/22, Maxim Healthcare Services, Inc is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Extended Recertification Survey An entrance conference was conducted on 02/28/22 at 9:20 AM with administrative staff. An exit conference was conducted on 03/03/22 at 2:43 PM with administrative staff. The following deficiencies are based on the extended recertification survey completed 03/03/22. Maxim Healthcare Services, Inc 368258, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies. Maxim Healthcare Services, Inc is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the exit date of this survey.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on record review, policy review, and staff interview, the agency failed to ensure the patient's complaint was investigated (G478). The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' rights were not violated.

Investigate complaints made by patient CFR(s): 484.50(e)(1)(i) (i) Investigate complaints made by a patient, the patient's representative (if any), and the patient's caregivers and family, including, but not limited to, the following topics: This ELEMENT is not met as evidenced by: Based on record review, policy review, and staff interview, the agency failed to ensure the patient's complaint was investigated for one of two patient complaints reviewed (Patient #8). This could affect all patients receiving services from the agency. The census was 61. Findings include: Review of agency policy titled, "Grievances and Complaints," effective 01/16/17, revealed the grievance investigation shall begin within two business days of receipt. The office clinical leader is responsible for directing the investigation. The investigation shall be completed within 30 days. A recording of all investigative activities and outcomes shall be included in the report. Review of the agency policy titled, "Abuse, Neglect, or Exploitation," revised 04/09/21, revealed 3.1 Employees who identify, notice, 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 patient/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. All incidences or circumstances outlined in 3.1 will be thoroughly investigated. Review of a complaint/grievance report revealed a complaint dated 12/08/21 involving an employee (Staff F) and her daughter. Staff F's daughter provided aide services to Patient #8 through another agency and the patient and the aide had a big argument on 12/01/21 and the aide left at the end of her shift. Staff F, who was out on medical leave, called the patient when another nurse from this agency was in the home and "proceeded to scream and yell" at the patient for getting into a fight with her daughter. The nurse who was in the home at the time took the phone and explained that Staff F was being inappropriate and hung up the phone. On 12/04/21, Staff F proceeded to use the Maxim badge to get through the gates to go to the patient's home and continued to argue with Patient #8 and his family. This lead to security escorting Staff F and her daughter off the property. The security at Patient #8's home was to contact the Sheriff if Staff F or her daughter returned to the patient's home. Further review revealed no further documentation of an investigation or any outcome. Review of personnel file of Staff F revealed no documentation of the incident. Staff F was still on leave at the time of the survey. Interview on 02/28/22 at 11:00 AM with Staff B revealed she had talked to Staff F and would look for an email of the conversation. Staff B confirmed there was no further documentation of an investigation or any outcome. On 03/01/22 at 1:00 PM Staff B was asked again if there was any documentation of the conversation regarding Staff F’s behavior and Staff B stated “no”.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure the plan of care included the frequency of visits to be made for six of seven records reviewed (Patient #1, #2, #3, #4, #5 and #7). The could affect all patients receiving services from the agency. The census was 61. Findings include: 1. Review of medical record for Patient #1 and physician orders dated 02/15/22 revealed skilled nursing services 48 hours weekly for 60 days. There was no documented frequency of the visits to be provided weekly. 2. Review of medical record for Patient #2 and physician orders dated 02/01/22 revealed skilled nursing services for 168 hours per week. There was no documented frequency of the visits to be provided weekly. 3. Review of medical record for Patient #3 and physician orders dated 02/10/22 revealed skilled nursing services for 35 hours per week. There was no documented frequency of the visits to be provided weekly. 4. Review of medical record for Patient #4 and physician orders dated 01/18/22 revealed skilled nursing services for 120 hours per week for 60 days. There was no documented frequency of the visits to be provided weekly. 5. Review of medical record for Patient #5 and physician orders dated 12/30/21 revealed skilled nursing services for 60.5 hours per week for 60 days. There was no documented frequency of the visits to be provided weekly. 6. Review of medical record for Patient #7 and physician orders dated 12/03/21 revealed skilled nursing services 40 hours per week for 60 days. There was no documented frequency of the visits to be provided weekly. Interview on 02/28/22 at 11:55 AM with Staff B revealed frequency was reflected in hours per week because the patients changed their schedules frequently. Staff B confirmed the frequency was not documented as visits per week.

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 record review and staff interview, the agency failed to ensure the vaccine policy contained a process to track each staff members vaccination status to include the specific vaccine received, and the dates of each dose received, or the date of the next scheduled dose for a multi dose vaccine, a process to ensure all staff received first dose of vaccine prior to providing care, a process in place to ensure all staff are fully vaccinated, a process in place to track and document vaccine status of all staff, a process to track and document information provided by staff who requested exemption, or a process to track and document staff where vaccine must be delayed, as recommended by the Centers for Disease Control (CDC). This could potentially affect all patients receiving services from this agency. The census was 61. Findings include: Review of the facility policy titled, "COVID-19 CMS Vaccination Mandate," effective 01/27/22, revealed the vaccine policy did not include a process to track each staff members vaccination status to include the specific vaccine received, and the dates of each dose received, or the date of the next scheduled dose for a multi dose vaccine, a process to ensure all staff received first dose of vaccine prior to providing care, a process in place to ensure all staff are fully vaccinated, a process in place to track and document vaccine status of all staff, a process to track and document information provided by staff who requested exemption, or a process to track and document staff where vaccine must be delayed, as recommended by the Centers for Disease Control (CDC). Review of staff vaccination status report as of 02/28/22 at 2:00 PM revealed it did not include the specific vaccine received, and the dates of each dose received, or the date of the next scheduled dose for a multi dose vaccine. It did not include documentation that all staff received first dose of a vaccine prior to providing care, it did not track and document the vaccine status of all staff and it did not include a way to document the names of any staff where the vaccine must be delayed, as recommended by CDC. Per interview on 02/28/22 at 2:35 PM Staff A stated the staff vaccination status report did not include the "internal" staff including the Clinical Supervisors, Field Support Manager, Field Support Associate, Clinical manager, Administrator, Recruiters, or the Client Coordinator. Per interview on 03/01/22 at 1:30 PM Staff A and B both confirmed the vaccine policy and the staff vaccination status report was missing required components.

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 record review and staff interview, the agency failed to provide services as ordered by the physician or allowed practitioner as indicated in the plan of care for two of seven records reviewed (Patient #4 and #5). This could affect all patients receiving services as ordered. The census was 61. Findings include: 1. Review of medical record for Patient #4 revealed a physician ordered plan of care dated 01/18/22 with orders for skilled nursing services 120 hours per week. Review of visit sheets revealed the agency provided 113.5 hours the week of 01/16/22 and 112 hours the week of 01/30/22. There was no documentation the physician was notified that services were not provided as ordered. 2. Review of medical record for Patient #5 revealed a physician ordered plan of care dated 12/30/21 with orders for skilled nursing services 60.5 hours per week. Review of visit sheets revealed the agency provided 28 hours and 20 minutes the week of 01/02/22, 28 hours and 34 minutes the week of 01/09/22 and 29 hours and 19 minutes the week of 01/16/22. There was no documentation the physician was notified that services were not provided as ordered. Per interview on 03/01/22 at 2:33 PM Staff B confirmed the agency did not provide the ordered hours of skilled nursing services.