Maxim Healthcare Services, Inc.

“Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This Element is not met as evidenced by: Based on a review of personnel files (PF), agency policies, the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard, 29 CFR 1910,1030, the CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, and an interview with the director of business operations, clinical manager and support manager, the agency failed to demonstrate the presence of the following: screening for mycobacterium tuberculosis (TB) for three (3) of ten (10) PF: PF#1, PF#4, PF#6, and Hepatitis B Vaccination acceptance or declination for one (1) of ten (10) PF reviewed: PF#8. Findings include: The Centers for Disease Control and Prevention (CDC) and the National TB (Tuberculosis) Controllers Association released updated recommendations for Tuberculosis (TB) screening, testing, and treatment of health care personnel on May 17, 2019 which were reviewed on May 3, 2024 at approximately 3:00 PM. These recommendations update the health care personnel screening and testing section of the 2005 CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings. All health care personnel should be screened for TB upon hire (i.e., preplacement). TB screening is a process that includes: a baseline individual TB risk assessment, a TB symptom evaluation, and a TB test (e.g., a TB single blood assay test or a two-step tuberculin skin test (TST), and additional evaluation for TB disease as needed. Health care personnel with a positive TB test result should receive a symptom evaluation and a chest x-ray to rule out TB disease. Additional workup may be needed based on those results. All health care personnel should receive TB education annually. TB education should include information on TB risk factors, the signs and symptoms of TB disease, and TB infection control policies and procedures. (CDC/MMWR/May 17, 2019/Vol.68/No.19). A review of Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Fact Sheet was conducted on May 3, 2024 approximately 3:30 PM. The fact sheet reads in part, “Hepatitis B virus (HBV) is a pathogenic microorganism that can cause potentially life-threatening disease in humans. HBV infection is transmitted through exposure to blood and other potentially infectious materials (OPIM) as defined in the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030. Any workers who have reasonably anticipated contact with blood or OPIM during performance of their jobs are considered to have occupational exposure and to be at risk of being infected. An employer must develop an exposure control plan.... employers must make hepatitis B vaccination available to these workers.... employers must offer the vaccination series to all workers who have occupational exposure. Examples of workers who may have occupational exposure include, but are not limited to, healthcare workers...the vaccine must be offered at no cost to the worker and at a reasonable time and place.” A review of OSHA Bloodborne Pathogens Standard, 29 CFR 1910,1030 was conducted on May 3, 20241, 2023 at approximately 3:45 PM. Standard 1910.1030b defines Occupational Exposure as “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties. Standard 19.10.1030(c)(1)(i) states “each employer having an employee(s) with occupational exposure shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure.” Section 1910.1030(f)(1)(i) states, “the employer shall make available the hepatitis B Vaccine and vaccination series to all employee who have occupational exposure.” Section 1910.1030(f)(1)(ii)(A) states, “made available at no cost to the employee.” Section 1910.1030(F)(1)(ii)(B) states, “made available to the employee at a reasonable time and place.” A review of the agency’s policy Tuberculosis Screening For Employees – Reference #HR-014 conducted on May 9, 2024 at 2 PM reads in part, “State Program Specific Requirements Pennsylvania – All other offices: Comply with the requirements of the Centers for Disease Control Guidelines for Preventing the Transmission of Tuberculosis in Health Facilities Setting which requires all health care workers to receive a baseline TB screening upon hire using two (2) step TST or a single BAMT to test for infection with M. tuberculosis.” A review of the agency’s policy Hepatitis B Vaccine conducted on May 9, 2024 at 2:15 reads in part, “Each employee and/or independent contractor shall sign an Agency Acknowledgement of Hepatitis B Vaccine form which includes a decision to accept of decline the vaccination series.” A review of personnel files (PF) was conducted on May 9, 2024 starting at approximately 8:00 AM. The date of hire (DOH) is indicated below. PF#1 DOH 07/07/2023 did not contain evidence that testing for tuberculosis was conducted upon hire or any time thereafter. PF#4 DOH 11/22/2022 contained a tuberculin skin test (TST) that was administered on 11/22/2022. There was no evidence that a second step TST was conducted. PF#6 DOH 12/07/2023 contained a tuberculin skin test (TST) that was administered on 04/19/2023. There was no evidence that a second step TST was conducted. PF#8 DOH 09/29/2020 was transferred from another Maxim home health agency in PA to the facility currently being surveyed on 12/14/2022 with uninterrupted employment. There was no evidence of an acceptance or declination of the Hepatitis B Vaccination at any time during employment. An interview conducted with the director of business operations, clinical manager, and support manager on May 10, 2024 starting at 11:15 AM confirmed the above findings.”