Maxim Healthcare Services Inc.

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observation, record review, and interview the agency failed to ensure home health staff followed standard precautions to prevent the transmission of infections and communicable diseases for 1 of 3 home visits conducted (RN 1). Findings include: Review of a policy titled “Hand Hygiene”, last revised on 09/07/2016 indicated but was not limited to: “To prevent cross-contamination and/or health care associated infections. Personnel providing care or services in the home setting will regularly wash their hands per the most recently published Centers for Disease Control regulations and guidelines for hand hygiene in the health care settings…when hands are not visibly soiled, they should be decontaminated using an alcohol-based hand rub…Hand decontamination using an alcohol-based hand rub should be performed: Before having direct contact with patient/clients. If applicable, before donning sterile gloves when performing sterile procedures…after contact with body fluids or excretions… when moving from a contaminated body site to a clean body site during patient care… after removing gloves…” During an observation on 10/09/2024 at 9:40 AM, RN 1 donned clean gloves without performing hand hygiene. The RN proceeded to change Patient #2’s soiled brief and threw it away in the trash. RN 1 picked up the patient’s socks and put them on the patient; he/she then picked up the patient’s pants, removed clean gloves and proceeded to put on the patient’s pants without performing hand hygiene. RN 1 removed the split 4x4 gauze from Patient #2’s tracheostomy, then opened a package of sterile split 4x4 gauze and placed it around the patient’s tracheostomy and placed a bib under the patient’s chin. RN 1 then opened a package of sterile gloves and put them on without performing hand hygiene. He/she turned on the suction machine at bedside and picked up a suction catheter and proceeded to suction the patient’s tracheostomy. RN 1 put the suction catheter down on the bedside table and touched the bedspread. He/she then removed the sterile glove from their left hand and proceeded to touch the patient’s oxygen mask and switched the patient’s tracheostomy tube to the oxygen mask to supply oxygen to the patient while the patient. RN 1 removed the sterile glove from their right hand without performing hand hygiene and transferred Patient #2 into the wheelchair, adjusted the patient in the wheelchair and applied the safety belt to the patient. RN 1 changed the patient’s pillowcase on the bed, removed the disposable pads from the bed and then made up the bed sheets. He/she then turned off the patient’s television with a remote control. He/she then donned a clean glove on their right hand, picked up the suction catheter and suctioned the patient’s tracheostomy. RN 1 then picked up trash off of the bed and placed it in the trash, adjusted the patient’s wheelchair, and then removed the clean glove from their right hand without performing hand hygiene. During an interview on 10/09/2024 at 10:20 AM, RN 1 indicated hand hygiene was not used before donning gloves or after removing gloves during patient care. He/she indicated gloves should have been removed and hand hygiene completed after changing the patient’s soiled brief. RN 1 indicated no hand hygiene was used prior to donning sterile gloves or after removing sterile gloves during patient care. During an interview on 10/09/2024 at 3:45 PM, the CM indicated the expectation for staff is to adhere to infection prevention measures. She indicated RN 1 should have performed hand hygiene before donning gloves and after removing gloves. Gloves need to be changed after performing incontinence care followed with hand hygiene; she expects staff should not keep dirty gloves on while touching other items in the patient care area.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on record review and interview the agency failed to ensure an initial nursing assessment occurred within 48 hours of receiving a referral for 1 of 3 active patient records. (Patient #3). Findings include: 1. Review of a policy titled “Patient/Client Record: Content and Requirements”, last revised on 09/12/2024 indicated but was not limited to: “To outline the components and requirements of the patient/client record…Admission paperwork, Client referral… and accompanying communication notes…” 2. The clinical record for Patient #3 included a referral received on 7/23/2024 with an initial nursing assessment and SOC admission completed on 9/25/2024 for the POC certification period of 09/25/2024 to 11/23/2024. The review failed to evidence any documentation, MD orders, or communication notes in the record to indicate a reason for the delay between referral receipt and admission into the agency with the initial nursing assessment. 3. During an interview on 10/10/2024 at 9:40 AM, the CM indicated after speaking with the Regional Operations Manager there was no information documented as to why there was a delay from the time the referral was received by the agency and when the initial nursing assessment was completed. The CM indicated the communication with the family and MD should have been documented while the patient was still in the hospital to assure the initial assessment occurred upon patient’s discharge from the hospital and discharge paperwork should have been attached into the EMR as well. 17-14-1(a)(1)(A)”