Every finding on record at Maxim Healthcare Services, Inc.

The following reflects the findings of the California Department of Public Health during the Emergency Preparedness survey from 1/23/23 through 1/25/23. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 36471, HFEN 39448, and HFEN 40615. No deficiencies were identified from this survey.

The following reflects the findings of the California Department of Public Health during a home health recertification survey conducted from 1/23/23 through 1/25/23. The agency reported 15 unduplicated admissions for the last 12 months. The total number of sampled patients was 7, and 3 home visits were conducted. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 36471, HFEN 39448, and HFEN 40615.

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 record review, the agency failed to provide therapy visits and skilled nursing hours per the plan of care for three of seven sampled patients (1, 2, 7). As a result, patients did not receive the care and services ordered by their physicians. Findings: 3. Per the Home Health Certification and Plan of Care, dated 8/31/22 through 10/29/22, Patient 7 was admitted to the agency on 5/13/20 with diagnoses to include spina bifida (a congenital disability in which the spine and spinal cord do not develop properly). The plan of care included an order for 32 to 40 hours of skilled nursing care per week and Physical Therapy (PT) and Occupational Therapy (OT) to visit twice a week. On 1/24/23 at 3 P.M., an interview and concurrent record review was conducted with the DBO. The DBO stated the agency documented providing 24 hours of skilled nursing care on the week of 9/4/22 instead of 32 hours. In addition, the DBO said Patient 7 was seen by OT once the week of 9/4/22 instead of twice and was not seen by the PT on the weeks of 9/4/22 and 9/11/22. The DBO stated, the process was to notify the practitioner of the missed visit and he could not find evidence that the agency notified Patient 7’s practitioner of the missed visits. Per the agency’s policy, titled Missed Shift/Visit, revised 4/9/21, “… practitioner notification…is required when the missed shift/visit causes the care to fall below the ordering practitioner ordered frequency…” 1 Per the Home Health Certification and Plan of Care, dated 11/28/22 through 1/26/23, Patient 1 was admitted to the agency on 1/9/15 and had a diagnoses to include congenital myopathy (a disorder of weakness and lack of muscle tone). The plan of care included orders for Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST) to each provided one visit per week to Patient 1. On 1/24/23 at 3:30 P.M., an interview and concurrent review of Patient 1’s record was conducted with the Director of Business Operations (DBO). The DBO stated, he Patient 1’s medical record, and was unable to find evidence of the agency notifying Patient 1’s practitioner of 6 missed visits. The missed visits were by PT on the weeks of 12/18/22 and 12/25/22, OT on the weeks of 12/11/22 and 12/25/22, and ST on the weeks of 1/1/23, and 1/8/23. 2 Per the Home Health Certification and Plan of Care, dated 11/15/22 through 1/13/23, Patient 2 was admitted to the agency on 7/18/22 with diagnoses to include amyotrophic lateral sclerosis (a nerve disease that weakens muscles and impacts physical function). The plan of care included an order for 45 to 56 hours of skilled nursing care per week. On 1/24/23 at 1:30 P.M., an interview and concurrent review of Patient 2’s record was conducted with the DBO. The agency documented providing 40 hours of skilled nursing care on the week of 11/20/22, and 36 hours of skilled nursing care on the week of 11/27/22. The DBO stated, he was unable to find evidence that the agency notified Patient 2’s practitioner that the agency did not provide 45 to 56 hours of skilled nursing care to Patient 2 on those 2 weeks.

The following reflects the findings of the California Department of Public Health during the investigation of a complaint survey. Complaint Number: 40854 Representing the Department: Health Facilities Evaluator Nurse: HFEN 36471. The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. Deficiencies were issued for this complaint. See G- 482 and G- 488.

Mistreatment, neglect or abuse CFR(s): 484.50(e)(1)(i)(B) (i)(B) Mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and/or misappropriation of patient property by anyone furnishing services on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure the licensed nurse (LN) supervised Patient 1 while in the shower. As a result, Patient 1 sustained a second-degree water burn and stayed in the hospital for three weeks to recover. Findings: Patient 1 was admitted to the agency on 6/21/13 with diagnoses which include anoxic brain damage (lack of oxygen to the brain caused by brain tissue death), per the agency’s Face Sheet. A review of Patient 1's medical record was conducted. Per the Clinical Note, dated 7/19/21, Licensed Nurse (LN) 2 documented that LN 1 called to inform them that the paramedics took Patient 1 to the Emergency Room for a hot water burn injury. Per the Emergency Department Notes dated 7/19/21, "...Caregiver [LN 1] was giving a shower with handheld hose, stepped away for a couple minutes and came back to burns to patients left foot, left thigh and perineal area. Blistering..." Patient 1 had one percent total body surface area burn, sloughing (shedding), blisters, and erythematous (red and inflamed) on the left foot. The burn extends to bilateral inner thighs through the perineum with four to five percent skin burn. On 10/6/21 at 4 P.M., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated LN 1 should ensure all necessary supplies were available before providing Patient 1 a shower, not leave the patient unattended, turn off the water before leaving Patient 1, and call the family member to ask for the item that was not available. On 10/7/21 at 8 A.M., an interview was conducted with LN 1. LN 1 stated Patient 1 required total care with a shower and was non-verbal. LN 1 said she got Patient 1 ready to take a shower and placed Patient 1 on the shower bed with Patient 1's feet slightly elevated on the shower tub. LN 1 further stated she wet Patient 1’s body using the handheld shower head and realized she did not have a shampoo. LN 1 stated she put the handheld shower head on Patient 1’s feet with the water running on Patient 1’s feet and left the shower room. When she returned, the shower room was steamy, and Patient 1 had a facial effect like grimacing. LN 1 further said she lifted the handheld shower head, and the water was scolding hot. In addition, LN 1 stated Patient 1’s skin was bright red and peeling off. LN 1 further said she took cool water from the nearby sink and splashed water on Patient 1’s skin, and Patient 1’s skin blistered. LN 1 stated she called Patient 1’s family member to call emergency responders, and the emergency responders took Patient 1 to the hospital. LN 1 further said she should have prepared all the supplies she needed to complete the shower and should not leave Patient 1 in the shower room with the water running and unattended.

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to notify the Department of possible neglect when a licensed nurse left Patient 1 during a shower. As a result, there was a potential for the Department not to investigate the abuse allegation or neglect. Findings: Patient 1 was admitted to the agency on 6/21/13 with diagnoses which include anoxic brain damage (lack of oxygen to the brain caused by brain tissue death), per the agency’s Face Sheet. A review of Patient 1's medical record was conducted. Per the Clinical Note, dated 7/19/21, Licensed Nurse (LN) 2 documented that LN 1 called the agency to inform them that the paramedics took Patient 1 to the Emergency Room for a hot water burn injury. Per the Emergency Department Notes, dated 7/19/21, "...Caregiver [LN 1] was giving a shower with handheld hose, stepped away for a couple minutes and came back to burns to patients left foot, left thigh and perineal area. Blistering..." Patient 1 had one percent total body surface area burn, sloughing (shedding), blisters, and erythematous (red and inflamed) on the left foot. The burn extends to bilateral inner thighs through the perineum with four to five percent skin burn. On 10/6/21 at 4 P.M., an interview was conducted with the Director of Patient Care Services (DPCS). The DPCS stated she was aware of the incident and responsible for the investigation and notification of the Department of an allegation of abuse, neglect, and misappropriation. The DPCS further said she did not report the incident to the Department and should have. Per the agency’s policy and procedure, revised 4/9/21, titled Abuse, Neglect, or Exploitation, “…Alleged incidences or circumstances outlined in 3.1 will be reported first to the Legal Department and then to enforcement agencies according to applicable laws and regulations. These agencies may include but are not limited to: 3.2.1. State law enforcement 3.2.2. State Survey and Certification Agency…The office operations leader, office clinical leader, or designee shall: 5.3.1.1. Ensure a report is made to the appropriate authorities for investigation as required by law…”