Maxim Healthcare Services, Inc.

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on observation, interview and record review, the home health agency (HHA) failed to ensure all services were provided as outlined in the plan of care (POC-a personalized document created by a Registered Nurse (RN) and signed by a doctor or provider addressing health needs, services, and daily goal) for one of three sampled patients (Patient (Pt) 1), when the minimum total nursing hours for the month of June 2026 should have been at least 403 hours but only 361.03 hours were provided to Pt 1. This failure placed Pt 1 at risk for unmet care needs, caregiver burnout, regression of goals, and potential hospitalization. Findings: During a review of Pt 1’ s “POC,” dated 5/11/26, the POC indicated, “…[Home health Agency Name] to provide [License Vocation Nurse] nursing services for 403 [hours] minimum…” During a record review of Pt’s 1 “Total hours of Nursing Services,” dated 6/2026, the total hours indicated, “…Grand Total: 361.03...” During a record review of Pt’s 1 “Total Missed Opportunities,” dated 6/2026, the Total Missed Opportunities indicated, the total missed hours were 215 including 72 agency‑canceled hours, 55 family‑canceled hours, and 88 hours missed due to no qualified caregiver available. The agency did not meet the minimum requirements of the POC. During an interview on 7/7/26 at 3:07 p.m. with Family Member (FM) 1, FM 1 stated, “The patient did not have night shift coverage.” FM 1 stated the agency notified the family that night shift coverage would be provided. FM 1 stated, “We need night shift help due to my wife having pain.” FM 1 stated the night shift nursing shift has been “spotty” (inconsistent). FM 1 stated, “What we were promised was that they would try to recruit a night nurse.” FM 1 stated the night nurse had not yet started and expressed concern about night shift coverage. FM 1 stated the agency promised to provide night and weekend coverage. FM 1 stated the family had to reach out to another agency to obtain night shift coverage. FM 1 stated, “It has caused us anxiety for the night shift.” During an interview on 7/7/26 at 3:43 p.m. with the Client Coordinator (CC), the CC stated the regular night shift nurse went out on medical leave and the agency attempted to find coverage but has not been able to find a full-time nurse. During an observation and interview on 7/8/26 at 8:15 a.m. at Pt 1’s home, with FM 2, FM 2 was observed sitting in a chair and appeared tearful. FM 2 stated, “I feel abandoned, lied to, manipulated, and punished.” FM 2 stated the family was not receiving support from the agency. FM 2 stated, “We were promised a night nurse and did not get one after the previous nurse left.” FM 2 stated she had medical issues which made it difficult caring for Pt 1 throughout the night. FM 2 stated they felt disregarded. FM 2 stated, “We were told someone would come in and no one came on 5/25/26.” During an interview on 7/9/26 at 1:43 p.m. with the Recruitment Operations Manager (ROM), the ROM stated the agency attempted to recruit for night shifts and found a nurse; however, the nurse was not full-time. The ROM stated the agency had trouble hiring night shift nurses due to low insurance reimbursement rates. The ROM stated the nursing hours for Pt 1 should have been fulfilled to ensure patient safety and compliance with the physician’s orders. The ROM stated the failure to fulfill night nursing hours could result in missed hours and the agency should have provided the required coverage. The ROM stated the physician expected the night shift to be filled and emphasized the importance of the continuity of care. The ROM stated failure to provide nursing night shifts could result in decreased quality of care due to reliance on family members, contributing to caregiver burnout. The ROM stated Pt 1 could have returned to the hospital or a skilled nursing facility if care needs were not met. During a concurrent interview and record review on 7/9/26 at 3:34 p.m. with the Director of Patient Care Services (DPCS), Pt 1’s “June 2026 nursing hours (nursing hours),” dated 6/2026 and “Plan of Care” dated 5/11/26 were reviewed. The DPCS stated the nursing hours for the month of June 2026 were 306.03 and the minimum nursing hours of 403 were not met. The DPCS stated it was important to follow the plan of care to ensure patient safety. The DPCS stated, “We do the best we can.” The DPCS stated the approved hours were based on the payment source (Medi-Cal- public health insurance program for people with low income, Veterans Affairs (U.S government insurance or private insurance) treatment plan, and physician recommendations. The DPCS stated the minimum nursing hours should have been provided to ensure the agency met Pt 1’s goals. The DPCS stated failure to meet the minimum hours could place Pt 1 at risk for safety issues, regression of goals, and rehospitalization. During an interview on 7/8/26 at 3:36 p.m. with the Administrator (ADM), the ADM stated if the agency falls below the minimum nursing hours, it should be reported to the physician. The ADM stated falling below the required threshold could affect patient safety. During a record review of Pt 1’s consent form titled, “Agreement for Homecare Services” dated 1/14/26, the consent form indicated, “...Services to be Performed, The Company shall provide the following services to Patient as provided for in Patient’s plan of care and ordered by Patient’s physician...” During a record review of the agency’s policy and procedure (P&P) titled, “Patient/Client Rights and Responsibilities,” revised dated 4/3/26, the P&P indicated, “ … …Patient/Client Rights: The Company protects and promotes the right of each patient/client in its care…home care patients/clients will be afforded all rights provided …Home care patients/clients have the right to: received all services outlined in the plan of care and be informed, in advance of any changes to the plan of care…””

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on interviews and record reviews, the home health agency (HHA) failed to ensure the coordination of care was implemented for one of three sampled patients (Patient (Pt) 1), when the communication between the HHA and Pt 1 was not documented for cancelled shifts on 5/25/26. This failure placed Patient 1 and Family Members (FM) at risk for confusion and miscommunication. Findings: During a review of Pt 1 s “Plan of Care (POC-a personalized document created by a Registered Nurse (RN) and signed by a doctor/provider addressing health needs, services, and daily goals,” dated 5/11/26, the POC indicated, “…[Home health Agency Name] to provide [License Vocation Nurse ] nursing services for 576 [hours]/month [maximum] 403 [hours] minimum…” During a review of Pt 1’s “call log tracking form,” undated, the call log tracking form indicated there were no call logs for 5/25/26. During a record review of Pt’s 1 “Total Missed Opportunities,” dated 6/2026, the Total Missed Opportunities indicated, on 5/25/26 from 7:30 a.m. to 3:30 p.m. and 5/25/26 from 11:00 p.m. to 5/26/26 7:00 a.m. family called to cancel the visit. During a concurrent observation and interview on 7/8/26 at 8:15 a.m. FM 2 was tearful. FM 2 stated they felt abandoned, lied to, manipulated, and punished. FM 2 stated the agency told them care would be provided seven days a week, with morning coverage from 7:30 a.m. to 3:30 p.m. and midday coverage from 11 p.m. to 7 a.m. FM 2 stated the family called the agency on 5/23/25 to ask about night coverage. FM 2 stated the agency did not know who would be coming but told them someone would arrive for the night shift on 5/23/26, 5/24/26, and 5/25/26. FM 2 stated the family called again on 5/25/26 at 9 p.m. and was told a nurse would come; however, at 11 p.m. they were informed no nurse was scheduled and the agency could not provide coverage. During an interview on 7/9/26 at 2:02 p.m. with the Client Coordinator (CC), the CC stated there were no call logs or documentation for 5/25/26 and stated, “We should have more notes.” The CC stated on‑call nurses were expected to document calls, but “we do not have anything documented.” The CC stated holiday coverage was often refused by caregivers, but documentation should still be completed. During an interview on 7/10/26 at 10:30 a.m. with FM 1, FM 1 stated there was miscommunication over Memorial Day weekend. FM 1 stated the agency attempted to find coverage but did not know who was covering it. FM 1 stated there were no daily notes about who was coming or going. FM 1 stated, “They had no idea what was going on after hours during on call.” FM 1 stated we had no nurse for 5/25/26. FM 1 stated, “I did not call to cancel services on 5/25/26.” FM 1 stated, “I have to call daily to see if they had coverage for night shift and to check to see if anyone called out.” FM 1 stated it has caused a lot of miscommunications for the family. During an interview on 7/10/26 at 11:16 a.m. with the Director of Patient Care Services (DPCS), the DPCS stated communication notes were essential for staff and patient communication. The DPCS stated missed‑shift notes should be documented when the family calls, but “we don’t have the note.” She stated missing documentation caused confusion and that documentation was needed for a paper trail explaining why shifts were missed. During an interview on 7/10/26 at 12:35 p.m. with the Administrator (ADM), the ADM stated the agency was notified of a missed visit on 6/1/26. The ADM stated, “On our end, it showed that patient or family refused nursing shifts on 5/25/26 and on 6/1/26, we documented the refusal.” The ADM stated we do not have a record of the day the patient’s family refused the visit. The ADM stated, “When we generate a report it will generate a missed opportunity report and it will show the missed shifts.” The ADM stated, “We cannot do a look back to see who made the entry once it was past 6/1/26.” The ADM stated, “We cannot see who took the call.” The ADM stated “Based on our expectation there should be clear documentation regarding communication with the patient and family and us. The ADM stated, “It should have shown who cancelled it.” The ADM stated we do not have the notes or logs regarding the time the patient or family called and who they spoke with. The. The ADM stated there is no log record on our on-call log for 5/25/26. The ADM stated it was important to document who took the call and who they spoke with for communication and coordination among the team and family. The ADM stated documentation was essential for a paper trail explaining why the shift was missed and without it, could cause confusion among the team. During review of the agency’s policy and procedure (P&P) titled, “Care Coordination/Case Conference,” dated 1/16/2026, the P&P indicated, “…to ensure the coordination of services for each patient and to minimize the potential for missed, conflicting, or duplicated services” and “to facilitate effective communication amongst the health care team.” During a review of the agency’s P&P titled, “Patient/Client Scheduling,” dated 4/3/26, the P&P indicated, “If at any time the services provided do not match the ordering practitioner order (or range of orders) as required…Missed Shift/Visit…the medical record will include all documentation related to the missed shift…””