Every finding on record at Maxim Healthcare Services, Inc

A complaint Investigation for Incident 61215 in iQies was opened on 11/12/2021 with an on-site visit to the Home Health Agency (HHA). The complaint investigation was completed on 11/18/2021. A face to face exit meeting was held with the Administrator and a Clinical Coordinator on 11/18/2021. The agency staff were afforded the opportunity to ask questions during the exit meeting. The HHA was found out of compliance with 484.60 Condition of Participation Care Planning-Coordination of Services and Quality of Care for failure to meet the care and services outlined in the Plan of Care and ordered by the physician for skilled nursing services.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on agency policy, medical record review and interview, the agency failed to ensure the Plan of Care was implemented as ordered by a physician for skilled nursing services. The findings included: Review of the agency "Plan of Care" policy revealed, ”The plan of care will describe specific services...and will include amount, frequency, and duration of services and expected outcomes for the patient/client…Direct Care Staff shall provide services according to the individualized plan of care…” Medical record review for Patient #1, 2 and 3 revealed the skilled nursing care provided was not in adherence with the Plan of Care or physician orders to ensure the patients care needs were met. During telephone interviews with the parents of Patient #1, 2 and 3, all parents reported the Home Health Agency (HHA) was not providing the amount of skilled nursing services approved by their insurance and ordered by their physicians During interviews with the HHA Administrator, the Administrator verified the nursing services provided for Patient #1, 2 and 3 did not follow their written plan of care or the physician orders. Refer to A572

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 agency policy, medical record review and interview, the agency failed to ensure the Plan of Care was followed for skilled nursing services in order to meet the individualized care needs of 3 of 3 (Patient #1, 2 and 3) sampled patients. The findings included: 1. Review of agency Plan of Care policy revealed, "The plan of care will describe specific services to be provided based on the clinical assessment and will include amount, frequency, and duration of services and expected outcomes for the patient/client…Direct Care Staff shall provide services according to the individualized plan of care…” 2. Medical record review for Patient #1 revealed an 18-year-old male with diagnoses of Spastic Quadriplegic Cerebral Palsy, Dysphagia and Tracheostomy for ventilator support. Review of the physician orders dated 4/22/21 revealed, “Skilled nursing services for 168 hours per week [24 hours a day 7 days a week].” Review of the most recent plan of care/certification period 10/18/2021 through 12/18/2021 revealed Patient #1 was to receive skilled nursing services 24 hours a day for 7 days per week. Review of the Skilled Nursing Clinical hours for 11/1/2021 through 11/11/2021 revealed Patient #1 did not receive skilled nursing services from 7:00 AM through 7:00 PM on 11/1/2021, 11/6/2021, 11/7/2021 and 11/8/2021. Patient #1 also did not receive skilled nursing services from 7:00 PM- 7:00 AM on 11/5/2021 and 11/7/2021. The agency did not provide the care necessary, as ordered by the physician and documented in the plan of care for Patient #1 During a telephone interview on 11/12/2021 at 10:11 AM, Patient #1’s father reported the Home Health Agency (HHA) did not provide the number of hours of Private Duty Nursing ordered by the physician. Patient #1’s father stated the agency had been providing 12 hours per day 4 days a week and 12 Hours per night 4 Days a week instead of the 24 hours per day, as ordered. During an interview on 11/18/2021 at 10:00 AM, the Administrator verified the reason for the missed skilled nursing visits documented on the Home Health Missed Visit form notification to Patient #1’s insurance company was “Agency unable to staff”. 3. Medical record review for Patient #2 revealed a six-year-old male with diagnoses of Cerebral Palsy, Congenital deformities of Hip, and Encounter of attention to Gastrostomy. Review of the physician orders dated 2/10/2021 revealed “…skilled nursing services for 60 hours per week for 60 days. This order may be repeated for 52 weeks…” Review of the most recent plan of care/certification period 10/1/2021 through 11/29/2021 revealed Patient #2 was to receive 60 hours of skilled nursing services per week. Review of the Skilled Nursing Clinical hours revealed Patient #2 received 17.50 hours the week of 10/3/2021 through 10/9/2021, received 36.70 hours from 10/10/2021 through 10/16/2021, received 30 hours from 10/17/2021 through 10/23/2021 and received 11.40 hours from 10/24/2021 through 10/30/2021. The agency did not provide the care necessary, as ordered by the physician and documented in the plan of care for Patient #2 During a telephone interview on 11/12/2021 at 11:10 AM Patient #2’s mother stated her son had not had consistent private duty nursing staff for 4 (four) months. Patient #2’s mother stated her son was supposed to get 40 hours per week private duty nursing, but since the last week of July the agency had not met the requirements. During an interview on 11/18/2021 at 10:30 AM, the Administrator stated that Patient #2’s Mother had refused the staff sent by the agency or failed to answer the door when staff arrived. When asked if this was documented, the Administrator stated the recruiters had not documented the refusals of staff. The Administrator further verified the reason for the missed skilled nursing visits documented on the Home Health Missed Visit form notification to Patient #2’s insurance company was “Agency unable to staff”. 4. Medical record review for Patient #3 revealed a nine-year-old female with diagnoses of Athetoid Cerebral Palsy, Failure to Thrive, and Encounter of attention to Gastrostomy. Review of the physician orders dated 10/28/2021 revealed “…private duty nursing services 50 hours per week x [times] 52 weeks…” Review of the most recent plan of care/certification period 10/28/2021 through 12/26/2021 revealed Patient #3 was to receive 50 hours of skilled nursing services per week. Review of the Skilled Nursing Clinical hours revealed Patient #3 received 33.27 hours the week of 10/31/2021 through 11/6/2021 and received 37.68 hours from 11/7/2021 through 11/13/2021. The agency did not provide the care necessary, as ordered by the physician and documented on the plan of care for Patient #3 During a telephone interview on 11/17/2021 at 11:10 AM, Patient #3’s mother stated her daughter was supposed to receive 50 hours of private duty nursing each week but was only provided 40 hours per week by the HHA. During an interview on 11/18/2021 at 10:18 AM, the Administrator reported that Patient #3’s Mom and the Nurse worked out the hours the nurse would be in the home. The Administrator stated Patient #3’s Mom only wanted the specific nurse to provide care. During a subsequent interview at 10:22 AM with the Administrator, the surveyor requested documentation of Patient #3’s family refusal of nursing services. At 10:25 AM, the Administrator stated there was no documentation to support the Mom’s refusal of staffing and no documentation as to why the full 50 hours of private duty nursing was not provided.