QA Investigation Results

Pennsylvania Department of Health
ALWAYS BEST CARE SENIOR SERVICES
Health Inspection Results
ALWAYS BEST CARE SENIOR SERVICES
Health Inspection Results For:


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Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on October 17, 2018, Always Best Care Senior Services, 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 state re-licensure survey conducted on October 17, 2018, Always Best Care Senior Services, was found to not be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 611, Subpart H. Home Care Agencies and Home Care Registries.







Plan of Correction:




611.51(a) LICENSURE
Hiring or Rostering Prerequisites

Name - Component - 00
Prior to hiring or rostering a direct care worker, the home care agency or home care registry shall: (1) Conduct a face-to-face interview with the individual. (2) Obtain not less than two satisfactory references for the individual. A satisfactory reference is a positive, verifiable reference, either verbal or written, from a former employer or other person not related to the individual that affirms the ability of the individual to provide home care services. (3) Require the individual to submit a criminal history report, in accordance with the requirements of 611.52 (relating to criminal background checks), and a ChildLine verification, if applicable, in accordance with the requirements of 611.53 (relating to child abuse clearance).

Observations:



Based on review of personnel files (PFs) and interview with agency administrator, it was determined the agency failed to maintain documentation of a face-to-face interview and two satisfactory references prior to registering direct care workers for three (3) of ten (10) PFs reviewed. (PF# 3, 7 and 9)

Findings include:
Review of PFs was conducted on October 17, 2018 at approximately between 12:00 PM to 1:30 PM revealed the following:

1. PF# 3, Date of Hire: November 11, 2016: no documentation of a face to face interview prior to start date.
2. PF# 7 Date of Hire: March, 10, 2018: no documentation of two references being verified prior to start date.
3. PF# 9 Date of Hire August 13, 2015: no documentation of a face to face interview nor documentation of two references being verified prior to start date.

An interview with agency administrator on October 17, 2018 approximately 2:00 PM confirmed the above findings.























Plan of Correction:

Steps have been taken to assure that references are checked for every applicant/new hire. Face to face interviews do take place with notes being taken. They are then signed and attached to the applicants resume. My review shows that the notes existed but are sometimes not signed.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by executive director/ceo


611.52(a) LICENSURE
Criminal Background Checks

Name - Component - 00
The home care agency or home care registry shall require each applicant for employment or referral as a direct care worker to submit a criminal history report obtained at the time of application or within 1 year immediately preceding the date of application.

Observations:



Based on review of direct care worker personnel files (PF) and an interview with agency staff, it was determined that the agency failed to ensure criminal background checks were obtained at the time of application for employment and/or have the potential employee submit documentation of a criminal background check that was obtained within one year preceding the application date, in accordance with regulatory requirements, for one (1) of ten (10) PF reviewed. (PF# 6)

Findings Include:

An interview with agency administrator stated no policy in place for obtaining background checks.

Review of PF conducted on October 17, 2018, from approximately 12 P.M. to 1:30 P.M. revealed the following:

1. PF #6, date of hire May 23, 2017, criminal background check was not obtained until May 5, 2018 which was not at the time of application for employment nor obtained one year preceding application date.


An interview with the administrator on October 17, 2018, at approximately 2:00 P.M. confirmed the above findings.







































Plan of Correction:

Criminal background checks are obtained for each employee. The previous lack of efficient action has been corrected. Every attempt is now made to obtain this within 48 hours of the interview.
Every applicant is told that a criminal background check will be performed and asked if it would contain any infractions, especially those that would preclude them from working in the health care industry.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by executive director/ceo.


611.55(e) LICENSURE
Competency Requirements

Name - Component - 00
The competency review must occur at least once per year after initial competency is established, and more frequently when discipline or other sanction, including, for example, a verbal warning or suspension, is imposed because of a quality of care infraction.

Observations:



Based on a review of personnel files (PFs) and an interview with the administrator, it was determined that the agency failed to provide documentation of an annual review of competency for five (5) of ten (10) direct care workers. (PFs #3, #6, #8, #9, #10)

Findings include:

A review of the PF files was conducted on October 17. 2018, between the hours of 12:00 PM and 1:30 PM. The following was noted:

1. PF # 3, date of hire November 23, 2016, contained no documentation of an annual review of competency for 2017.

2. PF# 6, date of hire May 23, 2017, contained no documentation of an annual review of competency for 2018.

3. PF# 8, date of hire July 11, 2016, contained no documentation of an annual review of competency for 2018.

4. PF# 9, date of hire August 13, 2015, contained no documentation of an annual review of competency for 2018.

5. PF# 10, date of hire March 13, 2017, contained no documentation of an annual review of competency for 2018.


2. An interview was conducted with the agency Administrator on October 17, 2018 at approximately 2:00 PM which confirmed the above findings.
























Plan of Correction:

All employees are NOW required to attend a training class. All required topics will be discussed. For those that are deficient, they are being prioritized. For all new hires, they are being scheduled as soon after their hiring as possible.
Annual review training is being scheduled as soon as possible for all those that need it. All employees will now have annual training review as close to one year from their initial training, and then each year that they are employed.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by executive director/ceo


611.56(a) LICENSURE
Health Screening

Name - Component - 00
(a) A home care agency or home care registry shall insure that each direct care worker and other office staff or contractors with direct consumer contact, prior to consumer contact, provide documentation that the individual has been screened for and is free from active mycobacterium tuberculosis.

Observations:


Based on a review of direct care worker personnel files (PF) and interview with the agency administrator, the agency failed to ensure that direct care workers with consumer contact be screened in accordance with CDC (Centers for Disease Control) guidelines for the transmission of mycobacterium tuberculosis for seven (7) of ten (10) PF reviewed. (PF # 2, 3, 4, 5, 6, 7, 10).

The CDC guidelines state that all Health Care Workers (HCW) should receive baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) of a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. After baseline testing for infection with tuberculosis, HCWs should receive TB screening annually. HCWs with a baseline positive or newly positive test for tuberculosis infections should receive one chest radiograph result to exclude tuberculosis disease.
CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. Morbidity and Mortality World Report 2005;(RR-17) http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf.

Findings include:

Agency policy was requested on October 17, 2018, at approximately 1:00 P.M. Agency staff unable to provide policy for TB screening.

Review of PF on October 17, 2018, from approximately 12:00 P.M. to 1:30 P.M. revealed the following:

1. PF #2 date of hire June 22, 2018 contained documentation of a single TST conducted on January 15, 2018. There was no documentation of the second step of the initial two step TST being conducted.

2. PF #3 date of hire November 23, 2016, contained documentation of a single TST conducted on September 23, 2015. There was no documentation of the second step of the initial two step TST being conducted. There was no documentation of an annual TST being conducted in 2016 and 2017.

3. PF #4 date of hire March 21, 2015, contained documentation of a single TST conducted on April 2, 2014. There was no documentation of the second step of the initial two step TST being conducted.

4. PF #5 date of hire January 3, 2018, contained documentation of a single TST conducted on October 4, 2017. There was no documentation of the second step of the initial two step TST being conducted.

5. PF #6 date of hire May 23, 2017, contained documentation of a single TST conducted on May 24, 2017. There was no documentation of the second step of the initial two step TST being conducted.

6. PF #7 date of hire March 10, 2018 contained documentation on placement of TST on April 17, 2018 but was not read. And there was no documentation of the second step of the initial two step TST being conducted

7. PF #10 date of hire March 13, 2017 contained documentation of a single TST conducted on March 15, 2017. There was no documentation of the second step of the initial two step TST being conducted.

Interview with the agency Administrator on October 17, 2018, at approximately 2:00 P.M. confirmed the above findings.








Plan of Correction:

For all of the employees that do not have a second step PPD, they are being required to obtain ASAP. This assumes that they are still within one year of getting the first step done. The two step mandate is being strictly enforced going forward for all new hires. Annual recertification will be mandated for all employees. If they have provided the results of a chest x ray, their doctor is sent a review form for signature.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by executive director/ceo


611.57(a) LICENSURE
Consumer Rights

Name - Component - 00
(a) The consumer of home care services provided by a home care agency or through a home care registry shall have the following rights: (1) To be involved in the service planning process and to receive services with reasonable accommodation of individual needs and preferences, except where the health and safety of the direct care worker is at risk. (2) To receive at least 10 calendar days advance written notice of the intent of the home care agency or home care registry to terminate services. Less than 10 days advance written notice may be provided in the event the consumer has failed to pay for services, despite notice, and the consumer is more than 14 days in arrears, or if the health and welfare of the direct care worker is at risk.

Observations:



Based on reviews of consumer records (CR), agency consumer information packet and interviews with the agency administrator, the agency failed to provide the consumer/consumer representative of home care services the right to be involved in the service planning process for three (3) of seven (7) consumer records reviewed (CR# 1, 2, 3), and the agency failed to provide the consumer/consumer representative of home care services the right to receive at least 10 calendar days advance written notice of the intent of the home care agency or home care registry to terminate services. Less than 10 days advance written notice may be provided in the event the consumer has failed to pay for services, despite notice, and the consumer is more than 14 days in arrears, or if the health and welfare of the direct care worker is at risk for three (3) of seven (7) consumer records reviewed (CR #1, 2, 3).
.
Findings included:

A review of consumer records was conducted on October 17, 2018 at 11:00 AM.


1. CR#1, Start of Services: August 23, 2018 contained no documented evidence of the consumer right to receive at least 10 calendar days advance written notice of the intent of the home care agency to terminate services. Less than 10 days advance written notice may be provided in the event the consumer has failed to pay for services, despite notice, and the consumer is more than 14 days in arrears, or if the health and welfare of the direct care worker is at risk the agency consumer service agreement and/or consumer information packet. Although the above items are listed in the Client Service Agreement, the Client Service Agreement was not signed by the consumer or consumer representative.

2. CR#2, Start of Services: March 10, 2017 contained no documented evidence of the consumer right to receive at least 10 calendar days advance written notice of the intent of the home care agency to terminate services. Less than 10 days advance written notice may be provided in the event the consumer has failed to pay for services, despite notice, and the consumer is more than 14 days in arrears, or if the health and welfare of the direct care worker is at risk the agency consumer service agreement and/or consumer information packet. Although the above items are listed in the Client Service Agreement, the Client Service Agreement was not signed by the consumer or consumer representative.



3. CR#3, Start of Services: February 14, 2018 contained no documented evidence of the consumer right to receive at least 10 calendar days advance written notice of the intent of the home care agency to terminate services. Less than 10 days advance written notice may be provided in the event the consumer has failed to pay for services, despite notice, and the consumer is more than 14 days in arrears, or if the health and welfare of the direct care worker is at risk the agency consumer service agreement and/or consumer information packet. Although the above items are listed in the Client Service Agreement, the Client Service Agreement was not signed by the consumer or consumer representative.


During an exit interview on October 17, 2018 at approximately 2:00 PM, the agency Administrator confirmed the above findings.























Plan of Correction:

All clients will be given, reviewed with, and signed for a start of care folder. Included are all of the required forms and information for compliance with the guidelines and best business practices.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by executive director/ceo


611.57(b) LICENSURE
Prohibitions

Name - Component - 00
(b) No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry. The home care agency or home care registry may not require a consumer to endorse checks over to the home care agency or home care registry.

Observations:



Based on a review of consumer records (CR) and interview with the Administrator, the agency failed to provide consumer information regarding the prohibition of assuming power of attorney or guardianship over a consumer utilizing the services of that home care agency or not requiring a consumer to endorse checks over to the home care agency for three (3) of seven (7) consumer records reviewed (CR #'s 1, 2, 3 ).

Findings include:

A review of consumer records was conducted on October 17, 2018 at approximately 11:00 AM through 12:30 PM revealed the following:


1. CR #1. Start of Care August 23, 2018. There was no documentation that consumer was made aware of the prohibition regarding assuming power of attorney or guardianship over a consumer or the endorsement of checks.

2. CR #2. Start of Care March 10, 2017. There was no documentation that consumer was made aware of the prohibition regarding assuming power of attorney or guardianship over a consumer or the endorsement of checks.

3. CR #3. Start of Care February 14, 2018. There was no documentation that consumer was made aware of the prohibition regarding assuming power of attorney or guardianship over a consumer or the endorsement of checks.


Interview with the Administrator on October 17, 2018 at approximately 2:00 P.M. confirmed that the consumer records lacked the above mentioned information.



































Plan of Correction:

All clients will be given, reviewed with, and signed for a start of care folder. Included are all of the required forms and information for compliance with the guidelines and best business practices.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by executive director/ceo


611.57(c) LICENSURE
Information to be Provided

Name - Component - 00
(c) Prior to the commencement of services, the home care agency or home care registry shall provide to the consumer, the consumer's legal representative or responsible family member an information packet containing the following information in a form that is easily read and understood: (1) A listing of the available home care services that will be provided to the consumer by the direct care worker and the identity of the direct care worker who will provide the services. (2) The hours when those services will be provided. (3) Fees and total costs for those services on an hourly or weekly basis. (4) Who to contact at the Department for information about licensure requirements for a home care agency or home care registry and for compliance information about a particular home care agency or home care registry. (5) The Department's complaint Hot Line (1-800-254-5164) and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). (6) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry. (7) A disclosure, in a format to be published by the Department in the Pennsylvania Bulletin by February 10, 2010, addressing the employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant respective tax and insurance obligations and other responsibilities of the consumer and the home care agency or home care registry.

Observations:




Based on review of consumer records (CR) and interview with the Administrator, it was determined the agency failed to ensure that the consumers received all the required information prior to the initiation of services for three (3) of seven (7) consumer records (CR #'s 1, 2, 3 ) reviewed.

Findings include:

A review of consumer records, conducted on October 17, 2018 at approximately 11:00 AM through 12:30 PM revealed the following:


1. CR#1, start of care August 23, 2018, revealed that the consumer had no documentation of receiving the following information prior to receiving care: (1) A listing of the available home care services that will be provided to the consumer by the direct care worker and the identity of the direct care worker who will provide the services. (2) The hours when those services will be provided. (3) Fees and total costs for those services on an hourly or weekly basis. (4) Who to contact at the Department for information about licensure requirements for a home care agency or home care registry and for compliance information about a particular home care agency or home care registry. (5) The Department's complaint Hot Line (1-800-254-5164) and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). . (6) A disclosure, in a format to be published by the Department in the Pennsylvania Bulletin by February 10, 2010, addressing the employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant respective tax and insurance obligations and other responsibilities of the consumer and the home care agency or home care registry.


2. CR #2, start of care March 10, 2017, revealed that the consumer had no documentation of receiving the following information prior to receiving care: (1) A listing of the available home care services that will be provided to the consumer by the direct care worker and the identity of the direct care worker who will provide the services. (2) The hours when those services will be provided. (3) Fees and total costs for those services on an hourly or weekly basis. (4) Who to contact at the Department for information about licensure requirements for a home care agency or home care registry and for compliance information about a particular home care agency or home care registry. (5) The Department's complaint Hot Line (1-800-254-5164) and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). . (6) A disclosure, in a format to be published by the Department in the Pennsylvania Bulletin by February 10, 2010, addressing the employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant respective tax and insurance obligations and other responsibilities of the consumer and the home care agency or home care registry.

3. CR #3, start of care February 14, 2018, revealed that the consumer had no documentation of receiving the following information prior to receiving care: (1) A listing of the available home care services that will be provided to the consumer by the direct care worker and the identity of the direct care worker who will provide the services. (2) The hours when those services will be provided. (3) Fees and total costs for those services on an hourly or weekly basis. (4) Who to contact at the Department for information about licensure requirements for a home care agency or home care registry and for compliance information about a particular home care agency or home care registry. (5) The Department's complaint Hot Line (1-800-254-5164) and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). . (6) A disclosure, in a format to be published by the Department in the Pennsylvania Bulletin by February 10, 2010, addressing the employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant respective tax and insurance obligations and other responsibilities of the consumer and the home care agency or home care registry.

Interview with the Administrator on October 17 2018 at approximately 2:00 P.M. confirmed that the consumer records lacked the above mentioned information.



































Plan of Correction:

All clients will be given, reviewed with, and signed for a start of care folder. Included are all of the required forms and information for compliance with the guidelines and best business practices.

Facility will hire a HR staff person to review and correct any files that do not contain a signed face to face interview form

Implementation and follow up will be done by administrator/ceo


Initial Comments:


Based on the findings of an onsite unannounced state re-licensure survey conducted on October 17, 2018, Always Best Care Senior Services, was found to be in compliance with the requirements of 35 P.S. 448.809 (b).






Plan of Correction: