Based on the findings of an unannounced, on-site complaint investigation survey conducted on March 15, 2019, Comfort Keepers #488, was not found to 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:
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(e) The home care agency or home care registry also shall include documentation in the direct care worker's file that the agency or registry has reviewed the individual's competency to perform assigned duties through direct observation, testing, training, consumer feedback or other method approved by the Department or through a combination of methods.
Based on review of consumer records, agency records, employee records (ER) and interview with staff (EMP), it was determined that the agency failed to provide documentation that staff were trained and competent on the use of a hoyer lift for six (6) of six (6) employee records reviewed. (ER 1 - 6)
Review on 3/15/2019 at approximately 10:00 AM of consumer record #1 and consumer record # 2, revealed that each consumer required the use of a hoyer lift.
Review on 3/15/2019 at approximate 11:00 AM of agency policy "Orientation and On--Boarding Standard for Caregivers" revealed the policy did not specifically address training in the use of a hoyer lift or other specialized equipment.
Review on 3/15/2019 at approximately 10:30 AM of the agency's staffing schedule for consumer #1 identified at least six employees that were providing care for these two consumer.
Review on 3/15/2019 at approximately 1:00 PM of ER #1 revealed there was no documentation of training and competency evaluation on the use of a hoyer lift.
Review on 3/15/2019 at approximately 1:05 PM of ER #2 revealed there was no documentation of training and competency evaluation on the use of a hoyer lift.
Review on 3/15/2019 at approximately 1:10 PM of ER #3 revealed there was no documentation of training and competency evaluation on the use of a hoyer lift.
Review on 3/15/2019 at approximately 1:15 PM of ER #4 revealed there was no documentation of training and competency evaluation on the use of a hoyer lift.
Review on 3/15/2019 at approximately 1:20 PM of ER #5 revealed there was no documentation of training and competency evaluation on the use of a hoyer lift.
Review on 3/15/2019 at approximately 1:25 PM of ER #6 revealed there was no documentation of training and competency evaluation on the use of a hoyer lift.
Interview on 3/15/2019 at approximately 1:30 PM with EMP #2 confirmed the above findings.
Plan of Correction:
The yearly competency are completed at the time of hire and annually. We have added under Assisting Transfers/Ambulation specifically stating "Hoyer" as well as when being in the home of a client with a Hoyer lift the documentation specific training, observed and documented on a separate "Using Mechanical Lift Device" worksheet. Schedule for refresher and administrative training is scheduled for April 30th by our staffed Registered Nurse. This training will continue every 6 months for our administrative staff to be able to train our caregivers for the field. The Staffing Coordinators will be held responsible to complete training and competencies, as well as, the Staffing Coordinator Lead and Operations Manager will complete monthly audits that all trainings and accurate documentations are completed.
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(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.
Based on review of the consumer record, agency records, consumer interview and employee interview (EMP) , the agency failed to accommodate the needs of one consumer reviewed. (CR #1).
Review on 3/15/2019 at approximately 10:30 AM of consumer record # 1 revealed the consumer required extensive assistance, required constant supervision and needed assistance with attending appointments, turning and repositioning, transfers with the use of a hoyer lift, showering, reading and writing. The agency was to provide caregivers daily from 4:00 PM through 8:00 AM. Additionally, they were to provide services from 8:00 AM through 4:00 PM on Saturday and Sundays.
Review on 3/15/2019 at approximately 12:00 PM of the caregiver schedule for consumer #1, revealed the agency was unable to provide caregivers on Saturday, 3/2/2019 at 11:00 PM through Sunday, 3/3/2019 at 9:00 AM and from 2:00 PM on Sunday, 3/3/2019, through Monday, 3/4/2019, morning at 8:00 AM. The agency failed to provide a total of 28 hours of care for this period of time.
The following weekend, the agency was unable to provide caregivers on Saturday, 3/9/2019 from 8:00 AM through 2:00 PM and from 11:00 PM on 3/9/2019, through Sunday afternoon, 3/10/2019, at 2:00 PM, then again on Sunday, 3/10/2019 at 4:30 PM, through Monday morning, 3/11/2019, at 8:00 AM. The agency failed to provide a total of 29 hours of care for this period of time.
Interview on 3/8/2019 at approximately 2:00 PM with consumer #1 revealed this individual had been incontinent of bowel at approximately 11:00 AM on 3/9/2019. The consumer stated the agency was contacted at that time, but was told no one could come until 2:00 PM. The consumer was unable to receive incontinence care until that time. (three (3) hours.)
Interview on 3/15/2019 at approximately 12:00 with EMP #1 confirmed the above findings.
Plan of Correction:
Maintain communication with client to discuss schedule and coverage. Communicate and document all missed shifts with client, case manager, and in system in Clear Care. Document when client declines staff. Document and communicate when staff is unavailable for covering shift for client and contact emergency contact for consumer coverage. The Staffing Coordinators will be responsible to complete 1:1 training in office and in clients home. Training with caregivers and other caregivers as well. All documented per shift of trainings. Communication with client, case manager, and client's back up regarding staffing shifts. Open shifts will be communicated in advance with case manager, back up of client, and consumer/client. Per the Client Conduct Rights and Responsibilities that the consumer signed and is aware as well as governing agencies; #20 "Have you scheduling needs met. We will make every attempt to honor your request for coverage. If it is not possible to meet this request, the final scheduling responsibility rests with the consumer."
This has been in effect as part of our policy since 2014. Consumer the audit was conducted for was signed 1.11.2019. Consumer is aware. We will document every attempt of meeting staffing needs and communication with all parties involved. When client declines caregiver we will also document. With this also, client cancel and loss of hours due to staffing, report will be audited monthly by Operations Manager to meet the needs of our consumers and find solutions with recruitment and plan of care of consumer. Internal audits will be completed monthly of communication, staffing, scheduling and documentations with trainings and accurate coverage.