Every finding on record at Maximum Care Hospice, Inc.

Observed in Patient Home. In 1 of 3 home visits, the surveyor noted that the organization failed to provide the patient with care, treatment, or services according to the patient's individualized plan of care. For example, in HOSRRHV#1, during the assessment of the patient, the nurse moved the patient's hospital bed away from the wall in order to be able to turn and reposition patient to conduct a skin assessment. The surveyor observed that the side rail on the hospital bed closest to the wall was not raised in the up position prior to the nurse moving the hospital bed, and the nurse did not raise the side rail prior to moving the bed back to it's original position after the assessment was completed; however, the plan of care stated full bed rails to be in the up position and locked while the patient is laying in bed to maintain safety. This was reviewed with the CEO.

Observed in Document Review. During review of contracted services documentation, surveyor noted that the contracted agreement for SNF services did not include a provision stating that the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice. This was reviewed with the CEO.

Observed in Patient Home. During HV#1 the surveyor observed that an LVN did not perform medication reconciliation. According to policy, this is to be done at every nursing visit. This was reviewed with the Owner, Executive Director and QAPI RN.

Observed in Record Review. In 11 of 11 patient records reviewed, interdisciplinary group meeting notes did not document decline and progress towards desired outcomes and goals occurring in the previous 14 days and plans for the following 14 days. This was reviewed with the Owner, Executive Director and QAPI RN.

Observed in Record Review. In 11 of 11 patient records reviewed, patient goals did not include metrics by which to measure decline or progress. This was reviewed with the Owner, Executive Director and QAPI RN.

Observed in Record Review. In 2 of 11 patient records reviewed, the organization did not provide the patient with treatment or services according to his or her individualized plan of care. At HV#3 the Spiritual Counselor stated that he met with the patient regularly. A review of the plan of care revealed that visits were ordered only at recertification. In the same record the Social Worker did not document completion of visits every month as ordered. And in the record of RR#6 both the Social Worker and Registered Nurse did not document completion of ordered visits. There were no change of frequency orders or documentation to explain why these visits were not completed as ordered. This was reviewed with the Owner, Executive Director and QAPI RN.

Observed in Patient Home. In 1 of 3 home visits conducted, staff failed to comply with proper bag technique as required by manufacturer’s information for use. During HV#1 an LVN used 70% Sani-wipes with a two-minute contact time to clean equipment before and after use. She failed to ensure that the required contact time was met before placing equipment back into the clean section of her visit bag. This was reviewed with the Owner, Executive Director and QAPI RN. Observed in Patient Home. In 1 of 3 home visits conducted, staff failed to perform hand hygiene consistent with policy and manufacturer’s information for use. During HV#1 the surveyor observed that between a glove change, an LVN used gel for hand hygiene but did not continue to rub the product until dry. Instead, she waved her hands in the air to accelerate drying. The surveyor also observed that the LVN had long, artificial nails that did not comply with the XXX policy. This was reviewed with the Owner, Executive Director and QAPI RN.

Observed in Patient Home. the organization did not identify and address potential safety risks in a patient’s home. During HV#2 the surveyor observed that three M-34 oxygen cylinders were stored in holders in a closet with the door closed. A CHHA did nothing to correct this during the visit. This was reviewed with the Owner, Executive Director and QAPI RN.