Initial Comments:
Based on the findings of an onsite unannounced agency state re-licensure survey conducted on September 24, 2021, Resilient Home Care, 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 September 24, 2021, Resilient Home Care, was found not 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:
611.51(a) LICENSURE
Hiring or Rostering Prerequisites
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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 a review of personnel files (PF) and an interview with the administrator, the agency failed to provide documentation of an interview for two (2) of seven (7) PF's, (PF # 1, and 6); and the agency failed to obtain at least two satisfactory and verifiable references for seven (7) of seven (7) PF's, (PF #1, 2, 3, 4, 5, 6, and 7.)
Findings include:
A review of PF's was conducted on September 24, 2021 from approximately 10:00 am to 10:15 am.
PF #1, Date of Hire: 5/25/2020, did not contain any documentation of an interview and did not contain any documentation of at least two satisfactory and verifiable references.
PF #2, Date of Hire: 4/12/2021, did not contain any documentation of at least two satisfactory and verifiable references.
PF #3, Date of Hire: 10/18/2020, did not contain any documentation of at least two satisfactory and verifiable references.
PF #4, Date of Hire: 3/23/2020, did not contain any documentation of at least two satisfactory and verifiable references.
PF #5, Date of Hire: 5/10/2021, did not contain any documentation of at least two satisfactory and verifiable references.
PF #6 Date of Hire: 7/22/2021, did not contain any documentation of an interview and did not contain any documentation of at least two satisfactory and verifiable references.
PF #7, Date of Hire: 12/18/2020, did not contain any documentation of at least two satisfactory and verifiable references.
An interview with the administrator on September 24, 2021 at approximately 10:15 am confirmed the above findings.
Plan of Correction:1. Administrator Provider will create a form used to monitor and document completion of face-to-face interviews and reference verification for all newly hired employees
611.55(e) LICENSURE
Competency Requirements
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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 (PF) and an interview with the administrator, the agency failed to provide documentation of an annual competency evaluation for two (2) of seven (7) PF's reviewed, (PF #1 and 4).
Findings include:
A review of PF's was conducted on September 24, 2021 from approximately 10:00 am to 10:15 am.
PF #1, Date of Hire: 5/25/2020 did not contain any documentation of an annual competency evaluation for 2021.
PF #4, Date of Hire: 3/23/2020, did not contain any documentation of an annual competency evaluation for 2021.
competency evaluation for 2021.
An interview with the administrator on September 24, 2021 at approximately 10:15 am confirmed the above findings.
Plan of Correction:Provider will create a form and implement a training management system to document trainings to ensure that employees have completed required annual trainings
611.56(a) LICENSURE
Health Screening
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(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 personnel files (PF), Centers for Disease Control Guidelines, and an interview with the administrator, the agency failed to provide documentation that the individual has received baseline tuberculosis screening upon hire for seven (7) of seven (7) PF's, (PF #1, 2, 3, 4, 5, 6, and 7.)
Findings include:
In May 2019, the CDC updated its recommendations for TB testing of health care personnel. The CDC guidelines state that all Health Care Workers (HCW) should: 1: receive baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) or a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. 2. Completion of a tuberculosis symptom questionnaire. 3. Completion of a tuberculosis risk assessment. After baseline testing for infection with tuberculosis, HCWs should receive TB education annually. HCWs with a baseline 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;(5-16-19)
A review of PF's was conducted on September 24, 2021 from approximately 10:00 am to 10:15 am.
PF #1, Date of Hire: 5/25/2020, did not contain documentation of a completed symptom questionnaire or risk assessment upon hire.
PF #2, Date of Hire: 4/12/2021, did not contain any documentation of baseline tuberculosis screening upon hire.
PF #3, Date of Hire: 10/18/2020, did not contain any documentation of baseline tuberculosis screening upon hire.
PF #4, Date of Hire: 3/23/2020, did not contain any documentation of baseline tuberculosis screening upon hire.
PF #5, Date of Hire: 5/10/2021, did not contain documentation of a completed symptom questionnaire or risk assessment upon hire.
PF #6, Date of Hire: 7/22/2021, did not contain documentation of a completed symptom questionnaire or risk assessment upon hire.
PF #7, Date of Hire: 12/18/2020, did not contain any documentation of baseline tuberculosis screening upon hire.
An interview with the administrator on September 24, 2021 at approximately 10:15 am confirmed the above findings.
Plan of Correction:Provider will create a form and also implement an employee management system to track and document beginning and expiration dates of TB screenings to ensure that employees have required screenings upon hire and throughout employment.
Initial Comments:
Based on the findings of an onsite unannounced state re-licensure survey conducted on September 24, 2021, Resilient Home Care, was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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