Initial Comments:
Based on the findings of an onsite home care agency state re-licensure survey conducted on March 10, 2026, Gemstone Human Services, LLC 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 home care agency state re-licensure survey conducted on March 10, 2026, Gemstone Human Services, LLC was found to be not 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 (PF) and interview with the agency Administrator, the agency failed ensure documentation of a face to face interview for four (4) of seven (7) files reviewed. PF #3, PF #4, PF #5, and PF #7; failed to ensure documentation of at least two (2) satisfactory references for seven (7) of seven (7) files reviewed. PF #1, PF #2, PF#3, PF #4, PF #5, PF #6, and PF #7.
Findings Include:
Review of personnel files (PF) completed March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed:
PF #1, Date of Hire (DOH), 6/26/2025: No documentation of two (2) references.
PF #2, Date of Hire (DOH), 4/3/2024: No documentation of two (2) references.
PF #3, Date of hire (DOH), 2/10/2025: No documentation of a face to face interview. No documentation of two (2) references.
PF #4, Date of hire (DOH), 5/19/2024: No documentation of a face to face interview. No documentation of two (2) references.
PF #5, Date of hire (DOH), 5/27/2025: No documentation of a face to face interview. No documentation of two (2) references.
PF #6, Date of Hire (DOH), 12/21/2025: No documentation of two (2) references.
PF #7, Date of hire (DOH), 6/6/2024: No documentation of a face to face interview. No documentation of two (2) references.
An interview conducted with the agency Administrator on March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
611.52(c) LICENSURE
Federal Criminal History Record
Name - Component - 00
If the individual required to submit or obtain a criminal history report has not been a resident of this Commonwealth for the 2 years immediately preceding the date of the request for a criminal history report, the individual shall obtain a federal criminal history record and a letter of determination from the Department of Aging, based on the individual ' s Federal criminal history record, in accordance with the requirements at 6 PA. Code § 15.144(b) (relating to procedure).
Observations:
Based on review of personnel files (PF) and interview with agency Administrator, the agency failed to obtain a federal criminal history report for one (1) out of seven (7) files reviewed. PF #4.
Findings include:
Review of personnel files (PF) completed March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed:
PF #2, date of hire (DOH), 5/17/2024: Failed to show proof of residency, no Federal criminal history report on file.
Interview with agency Administrator completed March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
611.52(d) LICENSURE
Proof of Residency
Name - Component - 00
The home care agency or home care registry may request an individual required to submit or obtain a criminal history record to furnish proof of residency through submission of any one of the following documents:
(1) Motor vehicle records, such as a valid driver ' s license or a State-issued identification.
(2) Housing records, such as mortgage records or rent receipts.
(3) Public utility records and receipts, such as electric bills.
(4) Local tax records.
(5) A completed and signed, Federal, State or local income tax return with the applicant ' s name and address preprinted on it.
(6) Employment records, including records of unemployment compensation
Observations:
Based on review of personnel files (PF) and interview with agency Administrator, the agency failed to ensure proof of residency for entire two years immediately proceeding the date of hire for one (1) out of seven (7) files reviewed. PF #4.
Findings include:
Review of personnel files (PF) completed March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed:
PF #4, date of hire (DOH): 5/19/2024, contained PA Identification Card issued 1/21/2024. No other documentation in file to show proof of non-interrupted residency prior to 5/19/2024.
Interview with agency Administrator completed March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
611.55(a) LICENSURE
Competency Requirements
Name - Component - 00
Prior to assigning or referring a direct care worker to provide services to a consumer, the home care agency or home care registry shall ensure that the direct care worker has done one of the following: (1) Obtained a valid nurse ' s license in this Commonwealth;
(2) Demonstrated competency by passing a competency examination developed by the home care agency or home care registry which meets the requirements of subsection (b)and (c).
(3) Has successfully completed one of the following:
(i) A training program developed by a home care agency, home care registry, or other entity which meets the requirements of subsection (b) and (c).
(ii) A home health aide training program meeting the requirements of 42 C.F.R. 484.36 (relating to the Conditions of Participation; Home Health Aide Services).
(iii) The nurse aid certification and training program sponsored by the Department of Education and located at www.pde.state.pa.us.
(iv) A training program meeting the training standards imposed on the agency or registry by virtue of the agency ' s or registry ' s participation as a provider in a Medicaid waiver or other publicly funded program providing home and community based services to qualifying consumers.
(v) Another program identified by the Department by subsequent publication in the Pennsylvania Bulletin or on the Department ' s website.
Observations:
Based on review of personnel files (PF), and an interview with the agency administrator, it was determined the agency failed to demonstrate an initial competency assessment prior to assigning to provide services to a consumer for one (1) of seven (7) files reviewed. PF #6.
Findings include:
A review of PF conducted on March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed the following:
PF #6, Date of Hire (DOH) 12/21/2025: No documentation showing an initial competency was completed.
An interview conducted with the agency administrator on March 10, 2026 at approximately 1:50 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
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 review of personnel files (PF) and interview with agency Administrator, it was determined agency failed to show annual competency review for three (3) of seven (7) PFs reviewed. PF #2, PF #4, and PF #7.
Findings include:
Review of PF conducted on March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed the following:
PF# 2, Date of Hire (DOH), 4/3/2024: No documentation of annual competency for year of 2025.
PF# 4, Date of Hire (DOH), 5/19/2024: No documentation of annual competency for year of 2025.
PF# 7, Date of Hire (DOH), 6/6/2024: No documentation of annual competency for year of 2025.
An interview with the agency Administrator conducted on March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
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 review policy and procedures, personnel files (PF) and interview with Administrator the agency failed to provide documentation for health examination for Mycobacterium Tuberculosis (TB) for five (5) of seven (7) files reviewed. PF #1, PF #3, PF #4, PF #5, and PF #7
Findings include:
"Each direct service employee must have a PPD test upon hire and annually thereafter. The employee with a positive skin test must have a chest x-ray. Thereafter, the employee may have a chest x-ray every five (5) years unless the employee becomes symptomatic."
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) or a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. 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.)
*Baseline (preplacement) screening and testing, in addition to the IGRA (interferon-gamma release assay) or TST, shall include a symptom screen questionnaire and an individual TB risk assessment. Serial screening and testing not routinely recommended. Annual TB education is recommended. (CDC/MMWR/May 17, 2019/Vol. 68/No. 19).
Review of personnel files (PF) completed March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed:
PF #1, Date of hire (DOH), 6/26/2025: One (1) step of a two (2) step PPD completed on 7/6/2025.
PF #3, Date of hire (DOH), 2/10/2025: One (1) step of a two (2) step PPD completed on 2/7/2025.
PF #4, Date of hire (DOH), 5/19/2024: No documentation showing a completed PPD upon hire using a two-step tuberculin skin test (TST) or a single blood assay.
PF #5, Date of hire (DOH), 5/27/2025: No documentation showing a completed PPD upon hire using a two-step tuberculin skin test (TST) or a single blood assay.
PF #7, Date of hire (DOH), 6/6/2024: One (1) step of a two (2) step PPD completed on 6/25/2024.
Interview with the agency Administrator on March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
611.56(b) LICENSURE
Health Screening
Name - Component - 00
(b) A home care agency or home care registry shall require each direct care worker, and other office staff or contractors with direct consumer contact, to update the documentation required under subsection (a) at least every 12 months and provide the documentation to the agency or registry. The 12 months must run from the date of the last evaluation. The documentation required under subsection (a) shall be included in the individual's file.
Observations:
Based on review of personnel files (PFs) and interview with agency Administrator, it was determined agency failed to ensure each direct care worker and other staff or contractors with direct consumer contact, was provided annual TB education for three (3) of seven (7) PFs reviewed. PF# 2, PF #4, and PF #7.
Findings include:
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) or a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. 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.)
*Baseline (preplacement) screening and testing, in addition to the IGRA (interferon-gamma release assay) or TST, shall include a symptom screen questionnaire and an individual TB risk assessment. Serial screening and testing not routinely recommended. Annual TB education is recommended. (CDC/MMWR/May 17, 2019/Vol. 68/No. 19).
Review of PFs conducted on March 10, 2026 between approximately 11:00 AM and 1:00 PM revealed the following:
PF# 2, Date of Hire (DOH), 4/3/2024: No documentation provided of a completed annual TB education for 2025.
PF# 4, Date of Hire (DOH), 5/19/2024: No documentation provided of a completed annual TB education for 2025.
PF# 7, Date of Hire (DOH), 6/6/2024: No documentation provided of a completed annual TB education for 2025.
An interview with the agency Administrator conducted on March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
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 files (CFs) and interview with agency Administrator, it was determined agency failed to provide an information packet/service agreement to the consumer, consumer's legal reprentative, or family member prior to the commencement of services for four (4) of five (5) files reviewed. CF #2, CF #3, CF #4, and CF #5.
Findings include:
Review of CF conducted on March 10, 2026 between approximately 10:00 AM and 10:30 AM revealed the following:
CF #2, Start of Service (SOS), 9/13/2025: Service agreement signed and information paket given to consumer on 9/23/2025.
CF #3, Start of Service (SOS), 7/24/2025: Service agreement signed and information paket given to consumer on 7/25/2025.
CF #4, Start of Service (SOS), 1/19/2026: Service agreement and information packet not completed/given to consumer.
CF #5, Start of Service (SOS), 1/30/2026: Service agreement and information packet not completed/given to consumer.
An interview with the agency Administrator conducted on March 10, 2026 at approximately 1:15 PM confirmed the above findings.
Plan of Correction:An approved Plan of Correction is not on file.
Initial Comments:
Based on the findings of an onsite home care agency state re-licensure survey conducted on March 10, 2026, Gemstone Human Services, LLC was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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