QA Investigation Results

Pennsylvania Department of Health
MAXIM HEALTHCARE SERVICES, INC
Health Inspection Results

MAXIM HEALTHCARE SERVICES, INC
Health Inspection Results For:

There are 12 surveys for this facility. Please select a date to view the survey results.

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Initial Comments:Based on the findings of an unannounced onsite home health agency Medicare recertification and state re-licensure survey completed 3/14/24, 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.

Plan of Correction:

484.50(c)(5) ELEMENT
Receive all services in plan of care
Name - Component - 00
Receive all services outlined in the plan of care.

Observations: Based on the review of agency policies, clinical records (CR), and interviews with the administrator, the agency failed to ensure services were provided in accordance with the plan of care for seven (7) of eight (8) CR reviewed. (CR #1, CR#2, CR#3, CR#4, CR#6, CR#7, CR#8) Review of agency Policy #MD-CL-006.3 on 3/13/24 at approximately 2:00 PM states, "Policy: 3.2 Patients/clients will be accepted for services based on a the adequacy and suitability of the personnel, resources to provide required services, and the reasonable expectation that the patient/client's medical, nursing, rehabilitative, and/or social needs can be adequately met in the patient/client's place of residence." Review of clinical records (CR) conducted 3/12/24 from 10:30 AM-2:00 PM and 3/13/24 from 9:00 AM-3:00 PM revealed: CR#1: Start of care 2/14/24 (certification period 2/14/24-4/13/24): The plan of care (POC) contains orders as follows: Skilled Nursing (SN) services for 18-24 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 2/14/24 through 3/10/24 there were 56 missed shifts. CR#2: Start of care 2/27/24 (certification period 2/27/24-4/26/24): The POC contained orders as follow: SN services 6-10 hours per day, 3-5 days per week and 4-8 hours per night, 4-7 nights per week. Review of missed shift documentation revealed from 2/4/24 through 3/9/24 there were 26 missed shifts. CR#3: Start of care 1/30/24 (certification period 1/30/24-3/29/24): The POC contained orders as follows: SN services for 7-12 hours per day, 3-5 days per week and 5-8 hours per night, 5-7 nights per week. Review of missed shift documentation revealed from 2/14/24 through 3/10/24 there were 41 missed shifts. CR#4: Start of care 2/24/22 (certification period 10/17/23-12/15/23): The POC contained orders as follows: SN services for 5-8 hours per night, 5-7 days per week and 5-8 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 10/17/23 through 12/12/23 there were 72 missed shifts. CR#6: Start of care 3/1/24 (certification period 3/1/24-4/29/24): The POC contained orders as follows: SN services 15-24 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 3/1/24 through 3/9/24 there were 13 missed shifts. CR#7: Start of care 2/13/23 (certification period 2/8/24-4/7/24): The POC contained orders as follows: SN services for 6-9 hours per day, 3-5 days per week and 5-8 hours per night, 5-7 nights per week. Review of missed shift documentation revealed from 2/20/24 through 2/23/24 there were 4 missed shifts. CR#8: Start of care 8/18/23 (certification period 2/9/24-4/8/24): The POC contained orders as follows: SN services for 14-24 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 2/9/24 through 3/9/24 there were 59 missed shifts. Interview with the agency administrator on 3/14/24 at approximately 10:00 AM confirmed the above findings.

Plan of Correction:

By submitting this POC the agency does not admit the allegations in the survey report or that it violated any regulations. The agency is submitting this POC in response to its regulatory obligations and commitment to compliance. The agency further reserves the right to contrast any alleged findings, conclusions and deficiencies. The agency intends to request that this POC service as its Credible Allegation of Compliance.

G0436
It is the practice of Maxim Healthcare Services to comply with company policy in accordance with Patient Acceptance.

To address this citation, Clinical Manager/Designee will ensure that all Clinical staff will be educated on POLICY-MD-CL-006.3 ACCEPTANCE AND ADMISSION, POLICY-MD-CL-016 PATIENT/CLIENT SCHEDULING and POLICY-HH-CL-007 HOME HEALTH CERTIFICATION AND PLANS OF CARE. Clinical Manager/designee will ensure that all Internal staff will be educated on POLICY-MD-CL-016 PATIENT/CLIENT SCHEDULING. This will be completed by the Clinical Manager/designee during weekly office meeting confirmed by signature on attendance sheet by 04/05/2024. Clinical Manager/designee will obtain clarification orders regarding hours of service and update physician orders for covended cases by 04/05/2024. Operations Manager/designee will update patient schedule for CR#1, CR#2, CR#3, CR#6, CR#7, and CR#8 by 04/12/2024.

To ensure that there are no other patients with similar issues, the Clinical Manager/ designee will review 100% of patients that receive co-vended services, obtain clarified order from physician and update plan of care, and Operations Manager/designee will update schedule to correlate to order. Operations Manager/designee will conduct/ follow up daily on 100% of all covended schedules completed to ensure schedule accounts for hours staffed, and review weekly during Leadership Meeting, in efforts of ensuring all schedules and missed shifts are accurately entered, cancelled out, and sent to physician for notification with a threshold of 100% expected compliance by 04/12/2024.

To monitor the situation so that the alleged deficiency does not reoccur, the Clinical Manager/designee Clinical Manager/designee will ensure all POC reflect the hours authorized and the Operation Manager/designee will ensure schedules are entered appropriately, in accordance with POLICY-MD-CL-006.3 ACCEPTANCE AND ADMISSION, POLICY-MD-CL-016 PATIENT/CLIENT SCHEDULING and POLICY-HH-CL-007 HOME HEALTH CERTIFICATION AND PLANS OF CARE for 4 weeks with a threshold of 100% expected compliance by 05/10/2024.

For ongoing monitoring so this alleged deficiency does not reoccur, 10 clinical records or 10% of all clinical records, whichever is greater, will be audited quarterly by the Clinical Manager /designee to ensure that the agency has complied with PA regulatory and agency policy standards on an ongoing basis, until 100% compliance is reached.

484.55(c)(5) ELEMENT
A review of all current medications
Name - Component - 00
A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.

Observations: Based on review of agency policy, clinical records (CR) and interview with the agency administrator, the agency failed to ensure that a comprehensive assessment included a review of all medications that the patient was currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, and noncompliance with drug therapy for (8) of eight (8) CR reviewed (CR#1 through CR#8) Review of policy on 3/15/24 at 12:30 PM states, "Reassessments/recertifications MD-CL-028, 5.2 The update of the follow-up assessment must, at a minimum, include... 5.2.2. Drug regimen review of all medications to include: 5.2.2.1. Drug interactions 5.2.2.2. Potential adverse effects and drug reactions 5.2.2.3. Duplicative drug therapy 5.2.2.4. Ineffective drug therapy 5.2.2.5. Significant side effects 5.2.2.6. Significant drug interactions 5.2.2.7. Any over-the-counter medications." CR#1: Start of care 2/14/24 (certification period 2/14/24-4/13/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, and noncompliance with drug therapy CR#2: Start of care 2/27/24 (certification period 2/27/24-4/26/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, and noncompliance with drug therapy CR#3: Start of care 1/30/24 (certification period 1/30/24-3/29/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, and noncompliance with drug therapy CR#4: Start of care 2/24/22 (certification period 10/17/23-12/15/23): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications 6: Start of care 3/1/24 (certification period 3/1/24-4/29/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#7: Start of care 2/13/23 (certification period 2/8/24-4/7/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#8: Start of care 8/18/23 (certification period 2/9/24-4/8/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications Interview with the agency administrator on 3/14/24 at approximately 10:00 AM confirmed the above findings

Plan of Correction:

484.60(b) STANDARD
Conformance with physician orders
Name - Component - 00
Standard: Conformance with physician or allowed practitioner orders.

Observations: Based on review of clinical records (CR), policies/procedures and interview with the Agency Administrator, the agency failed to ensure compliance with the physician's orders for one (1) of one (1) clinical record review ordering wound measurements (CR # 1). Review of wound care policy reference # MD-CL-027.4 on 3/14/24 at approximately 12:00 PM states, "2.3 Wound measurements shall be obtained and documented by the qualifying clinician at least once each week. 4.3 weekly wound measurements will be completed by the qualified clinician. Documentation of wound measurement(s)will be noted and include a description of: 4.3.1 Wound size: length, width and depth." Review of clinical records (CR) conducted 3/12/24 from 10:30 AM-2:00 PM and 3/13/24 from 9:00 AM-3:00 PM revealed: MR # 1: SOC: 2/14/24; certification period 2/14/24-4/13/24. The plan of care signed by the physician on 3/1/24 orders documentation of sacral area wound measurements weekly and as needed. There was no documentation that wound measurements had ever been completed. Interview with the agency administrator on 3/14/24 at approximately 10:00 AM confirmed the above findings

Plan of Correction:

Initial Comments:Based on the findings of an onsite unannounced home health agency Medicare recertification and state re-licensure survey completed 3/14/24, 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.

Plan of Correction:

Initial Comments:Based on the findings of an unannounced onsite home health agency Medicare recertification and state re-licensure survey completed on 3/14/24, Maxim Healthcare Services, Inc., was found not to be in compliance with the requirements of 28 Pa. Code, Part IV, Health facilities, Subpart G. Chapter 601.

Plan of Correction:

601.31(a) REQUIREMENT
PATIENT ACCEPTANCE
Name - Component - 00
601.31(a) Patient Acceptance.
Patients are accepted for treatment on
the basis of a reasonable expectation
that the patient's medical, nursing
and social needs can be met adequately
by the agency in the patient's place
of residence. Care follows a written
plan of treatment established and
periodically reviewed by a physician
and care continues under the general
supervision of a physician.

Observations: Based on the review of agency policies, clinical records (CR), and interviews with the administrator, the agency failed to ensure services were provided in accordance with the plan of care for seven (7) of eight (8) CR reviewed. (CR #1, CR#2, CR#3, CR#4, CR#6, CR#7, CR#8) Review of agency Policy #MD-CL-006.3 on 3/13/24 at approximately 2:00 PM states, "Policy: 3.2 Patients/clients will be accepted for services based on a the adequacy and suitability of the personnel, resources to provide required services, and the reasonable expectation that the patient/client's medical, nursing, rehabilitative, and/or social needs can be adequately met in the patient/client's place of residence." Review of clinical records (CR) conducted 3/12/24 from 10:30 AM-2:00 PM and 3/13/24 from 9:00 AM-3:00 PM revealed: CR#1: Start of care 2/14/24 (certification period 2/14/24-4/13/24): The plan of care (POC) contains orders as follows: Skilled Nursing (SN) services for 18-24 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 2/14/24 through 3/10/24 there were 56 missed shifts. CR#2: Start of care 2/27/24 (certification period 2/27/24-4/26/24): The POC contained orders as follow: SN services 6-10 hours per day, 3-5 days per week and 4-8 hours per night, 4-7 nights per week. Review of missed shift documentation revealed from 2/4/24 through 3/9/24 there were 26 missed shifts. CR#3: Start of care 1/30/24 (certification period 1/30/24-3/29/24): The POC contained orders as follows: SN services for 7-12 hours per day, 3-5 days per week and 5-8 hours per night, 5-7 nights per week. Review of missed shift documentation revealed from 2/14/24 through 3/10/24 there were 41 missed shifts. CR#4: Start of care 2/24/22 (certification period 10/17/23-12/15/23): The POC contained orders as follows: SN services for 5-8 hours per night, 5-7 days per week and 5-8 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 10/17/23 through 12/12/23 there were 72 missed shifts. CR#6: Start of care 3/1/24 (certification period 3/1/24-4/29/24): The POC contained orders as follows: SN services 15-24 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 3/1/24 through 3/9/24 there were 13 missed shifts. CR#7: Start of care 2/13/23 (certification period 2/8/24-4/7/24): The POC contained orders as follows: SN services for 6-9 hours per day, 3-5 days per week and 5-8 hours per night, 5-7 nights per week. Review of missed shift documentation revealed from 2/20/24 through 2/23/24 there were 4 missed shifts. CR#8: Start of care 8/18/23 (certification period 2/9/24-4/8/24): The POC contained orders as follows: SN services for 14-24 hours per day, 5-7 days per week. Review of missed shift documentation revealed from 2/9/24 through 3/9/24 there were 59 missed shifts. Interview with the agency administrator on 3/14/24 at approximately 10:00 AM confirmed the above findings.

Plan of Correction:

By submitting this POC the agency does not admit the allegations in the survey report or that it violated any regulations. The agency is submitting this POC in response to its regulatory obligations and commitment to compliance. The agency further reserves the right to contrast any alleged findings, conclusions and deficiencies. The agency intends to request that this POC service as its Credible Allegation of Compliance.

M1017
It is the practice of Maxim Healthcare Services to comply with company policy in accordance with Patient Acceptance.

To address this citation, Clinical Manager/Designee will ensure that all Clinical staff will be educated on POLICY-MD-CL-006.3 ACCEPTANCE AND ADMISSION, POLICY-MD-CL-016 PATIENT/CLIENT SCHEDULING and POLICY-HH-CL-007 HOME HEALTH CERTIFICATION AND PLANS OF CARE. Clinical Manager/designee will ensure that all Internal staff will be educated on POLICY-MD-CL-016 PATIENT/CLIENT SCHEDULING. This will be completed by the Clinical Manager/designee during weekly office meeting confirmed by signature on attendance sheet by 04/05/2024. Clinical Manager/designee will obtain clarification orders regarding hours of service and update physician orders for covended cases by 04/05/2024. Operations Manager/designee will update patient schedule for CR#1, CR#2, CR#3, CR#6, CR#7, and CR#8 by 04/12/2024.

To ensure that there are no other patients with similar issues, the Clinical Manager/ designee will review 100% of patients that receive co-vended services, obtain clarified order from physician and update plan of care, and Operations Manager/designee will update schedule to correlate to order. Operations Manager/designee will conduct/ follow up daily on 100% of all covended schedules completed to ensure schedule accounts for hours staffed, and review weekly during Leadership Meeting, in efforts of ensuring all schedules and missed shifts are accurately entered, cancelled out, and sent to physician for notification with a threshold of 100% expected compliance by 04/12/2024.

To monitor the situation so that the alleged deficiency does not reoccur, the Clinical Manager/designee Clinical Manager/designee will ensure all POC reflect the hours authorized and the Operation Manager/designee will ensure schedules are entered appropriately, in accordance with POLICY-MD-CL-006.3 ACCEPTANCE AND ADMISSION, POLICY-MD-CL-016 PATIENT/CLIENT SCHEDULING and POLICY-HH-CL-007 HOME HEALTH CERTIFICATION AND PLANS OF CARE for 4 weeks with a threshold of 100% expected compliance by 05/10/2024.

For ongoing monitoring so this alleged deficiency does not reoccur, 10 clinical records or 10% of all clinical records, whichever is greater, will be audited quarterly by the Clinical Manager /designee to ensure that the agency has complied with PA regulatory and agency policy standards on an ongoing basis, until 100% compliance is reached.

601.31(d) REQUIREMENT
CONFORMANCE WITH PHYSICIAN'S ORDERS
Name - Component - 00
601.31(d) Conformance With
Physician's Orders. All prescription
and nonprescription (over-the-counter)
drugs, devices, medications and
treatments, shall be administered by
agency staff in accordance with the
written orders of the physician.
Prescription drugs and devices shall
be prescribed by a licensed physician.
Only licensed pharmacists shall
dispense drugs and devices. Licensed
physicians may dispense drugs and
devices to the patients who are in
their care. The licensed nurse or
other individual, who is authorized by
appropriate statutes and the State
Boards in the Bureau of Professional
and Occupational Affairs, shall
immediately record and sign oral
orders and within 7 days obtain the
physician's counter-signature. Agency
staff shall check all medicines a
patient may be taking to identify
possible ineffective drug therapy or
adverse reactions, significant side
effects, drug allergies, and
contraindicated medication, and shall
promptly report any problems to the
physician.

Observations: Based on review of agency policy, clinical records (CR) and interview with the agency administrator, the agency failed to ensure that a comprehensive assessment included a review of all medications that the patient was currently using in order to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications for eight (8) of eight (8) CR reviewed (CR#1 through CR#8) Review of policy on 3/15/24 at 12:30 PM states, "Reassessments/recertifications MD-CL-028, 5.2 The update of the follow-up assessment must, at a minimum, include... 5.2.2. Drug regimen review of all medications to include: 5.2.2.1. Drug interactions 5.2.2.2. Potential adverse effects and drug reactions 5.2.2.3. Duplicative drug therapy 5.2.2.4. Ineffective drug therapy 5.2.2.5. Significant side effects 5.2.2.6. Significant drug interactions 5.2.2.7. Any over-the-counter medications." CR#1: Start of care 2/14/24 (certification period 2/14/24-4/13/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#2: Start of care 2/27/24 (certification period 2/27/24-4/26/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#3: Start of care 1/30/24 (certification period 1/30/24-3/29/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#4: Start of care 2/24/22 (certification period 10/17/23-12/15/23): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#6: Start of care 3/1/24 (certification period 3/1/24-4/29/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#7: Start of care 2/13/23 (certification period 2/8/24-4/7/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications CR#8: Start of care 8/18/23 (certification period 2/9/24-4/8/24): The clinical record failed to contain documented evidence of a review of all medications the patient is currently taking to identify possible ineffective drug therapy or adverse reactions, significant side effects and contraindicated medications Interview with the agency administrator on 3/14/24 at approximately 10:00 AM confirmed the above findings

Plan of Correction:

Initial Comments:Based on the findings of an onsite unannounced home health care agency Medicare recertification and state re-licensure survey completed on 3/14/24, Maxim Healthcare Services, Inc, was found to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 51, Subpart A.

Plan of Correction:

Initial Comments:Based on the findings of an onsite unannounced home care agency Medicare recertification and state re-licensure survey completed on 3/14/24, Maxim Healthcare Services, Inc., was found to be in compliance with the requirements of 35 P.S. � 448.809 (b).

Plan of Correction: