Every finding on record at Maxim Healthcare Services Inc

Based on the findings of an on-site unannounced home health agency Medicare recertification survey conducted July 10, 2023, through July 13, 2023, Maxim Healthcare Services Inc., was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced on-site home health agency Medicare recertification survey conducted July 10, 2023, through July 13, 2023, Maxim Healthcare Services, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of agency policy, clinical records (CR), staff, patient and primary caregiver interviews, the agency failed to provide services in accordance with the physician's orders for three (3) of seven (7) CR reviewed. (CR # 2, 5, and 6) Findings include: Review of agency policy titled "Patient/Client Scheduling" on July 17, 2023, at approximately 10:30 A.M. states, "If at any time the services provided do not match the ordering practitioner order (or range of orders) as required by the plan of care, a Missed Shift/Visit Note and notification to the ordering practitioner is required. The medical record will include all documentation related to the missed shift including alternative care for the patient." A review of CR's conducted on July 11, 2023, from approximately 9:00 A.M. to 9:30 A.M. and 1:00 P.M. to 3:00 P.M. and July 12, 2023, from approximately 8:30 A.M. to 10:15 A.M. and 12:00 P.M. to 4:30 P.M. revealed the following: CR #2, start of care April 28, 2023, contained a Home Health Certification and Plan of Care (POC) for certification period June 27, 2023, through August 25, 2023. Orders for treatment were as follows: Skilled Nursing - Frequency and Duration - Maxim Healthcare Services to provide skilled nursing services for 40-50 RN (registered nurse) hours/week and 15-20 LPN (licensed practical nurse) hours/week total of 70 hours/week for 60 days. RN services were provided 37.5 hours the week of July 3, 2023, through July 7, 2023. There was no documentation of a Missed Shift/Visit Note and notification to the ordering practitioner. CR #5, start of care June 29, 2021, contained a POC for certification period June 19, 2023, through August 17 2023. Orders for treatment were as follows: Skilled Nursing - Frequency and Duration - Maxim Healthcare Services to provide skilled nursing services for 5-8 hours per day, 5-7 days per week, for 60 days. Skilled nursing services were documented 4 hours on June 22, 2023, and June 24, 2023, 7.75 hours on June 25, 2023, and July 7, 2023, 4 hours on July 8, 2023, and 4.75 hours on July 9, 2023. July 3, 2023, and July 10, 2023, documentation revealed that no caregiver was available. There was no documentation of a Missed Shift/Visit Note and notification to the ordering practitioner. CR #6, start of care October 16, 2020, contained a POC for certification period June 3, 2023, through August 1, 2023. Orders for treatment were as follows: Skilled Nursing - Frequency and Duration - Maxim Healthcare Services to provide skilled nursing services for 6-13 hours per day, 3-4 days per week, for 60 days. Frequency and Duration according to authorization from [insurance company]. We co-vend with another agency in order to fulfill authorization. Hours are interchangeable between agencies. Services were provided on June 15, 2023, for 5.5 hours, on June 16, 2023, for 7.5 hours, on June 23, 2023, for 4.25 hours, and June 30, 2023, for 5.25 hours. There was no documentation of a Missed Shift/Visit Note and notification to the ordering practitioner. An interview was conducted with CR #2 on July 12, 2023, at approximately 10:45 A.M. during a home visit. CR #2 stated that some days there are shifts that the agency is not able to fill. An interview with PF #5 on July 12, 2023, at approximately 10:55 A.M. during the home visit, revealed that the family occasionally dismisses the nurse early when the family is visiting or when the primary caregiver is home. An interview was conducted with CR #5 on July 11, 2023, at approximately 11:45 A.M. during a home visit. CR #5 stated that the agency has difficulty staffing some of the shifts. An interview with CR #5's primary caregiver on July 11, 2023, at approximately 11:55 A.M. during the home visit revealed that the primary caregiver occasionally dismisses the nurse early and will provide care. An interview with the agency Administrator on July 13, 2023, at approximately 2:45 P.M. confirmed the above findings.