Initial Comments:
Based on the findings of an onsite announced state re-licensure survey conducted on May 14, 2026, C. Sincere Home Health & Concierge 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 announced state re-licensure survey completed on May 14, 2026, C. Sincere Home Health & Concierge LLC 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 direct care worker personnel files (PF) and interview with the agency Administrator, the agency failed to document two (2) satisfactory references prior to employment for one (1) of seven (7) PF reviewed. (PF #7).
Findings include:
A review of PF's conducted on May 14, 2026, from approximately 11:00 A.M. to 12:30 P.M. revealed the following:
PF #7, date of hire March 8, 2026, contained documentation of only one (1) satisfactory reference obtained prior to employment.
An interview with the Administrator on May 14, 2026, at approximately 12:45 P.M. and a follow-up email on May 15, 2026, confirmed the above finding.
Plan of Correction:Based on the findings of the onsite visit on May 14. 2026. The agency admin has reviewed all requirements of the 28 Pa code part 4 611 Subpart H. The agency updated personal file #7 5/28/2026 based on the findings and updated with 2 professional references.
All personnel files were audited immediately upon receipt of the findings. Missing documentation was identified and obtained. Personnel records were updated to include required references
The agency has developed and implemented a Personnel File Checklist to be completed before any employee is permitted to provide services
No employee file will be considered complete until all required items have been verified by Office Manager and Administrator. A monthly Audit of files will also be completed and reviewed by Admin/Office Manager to prevent reoccurence
611.52(a) LICENSURE
Criminal Background Checks
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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 a review of direct care worker personnel files (PF) and interview with the agency Administrator, the agency failed to provide documentation of a Pennsylvania State Police Criminal Background Check at the time of application or within one year immediately preceding the date of application for five (5) of seven (7) PF reviewed. (PF #1, 2, 4, 5, and 6)
Findings:
A review of PF's conducted on May 14, 2026, from approximately 11:00 A.M. to 12:30 P.M. revealed the following:
PF #1, date of application November 12, 2025, contained documentation of a Pennsylvania State Police background check completed on November 17, 2025, five (5) days after the date of application.
PF #2, date of application March 12, 2024, contained documentation of a Pennsylvania State Police background check completed on March 22, 2024, ten (10) days after the date of application.
PF #4, date of application October 3, 2024, contained documentation of a Pennsylvania State Police background check completed on December 11, 2024, thirty-nine (39) days after the date of application.
PF #5, date of application February 26, 2026, contained documentation of a Pennsylvania State Police background check completed on December 29, 2018. There was no documentation of a background check completed on the date of application.
PF #6, date of application January 12, 2022, contained documentation of a Pennsylvania State Police background check completed on May 10, 2023, one (1) year and four (4) months after the date of application.
An interview with the Administrator on May 14, 2026, at approximately 12:45 P.M. and a follow-up email on May 15, 2026, confirmed the above finding.
Plan of Correction:Based on the findings of the onsite survey on May 14, 2026. C Sincere Home Health Admin and Agency staff has been retrained and properly updated regarding PA Code 611.52 requiring State Background checks. All personnel files of all caregivers found not in compliance has been updated
PF #1 updated 5/28/26
PF #2 updated 5/28/2026
PF #4 updated 5/28/2026
PF #5 updated 5/28/2026
PF #6 updated 5/28/2026
Upon identification of the deficiency the agency admin conducted a 100% audit of all active employee files. Missing criminal history records were updated and will be kept on file.
To prevent reoccurrence A criminal background check will be completed upon hire. A completed check list for compliance has been created and must be checked off complete before the first day of caregiver's workday in the field. The admin/ manager will complete monthly compliance checks and verify all oncoming and current staff is compliant.
611.52(d) LICENSURE
Proof of Residency
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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 a review of direct care worker personnel files (PF) and interview with the agency Administrator, the agency failed to document proof of residency for the two years immediately preceding the date of hire for four (4) of seven (7) PF reviewed. (PF # 3 ,4, 6, and 7).
Findings include:
A review of PF's conducted on May 14, 2026, from approximately 11:00 A.M. to 12:30 P.M. revealed the following:
PF #3, date of hire October 6, 2025, contained a Pennsylvania driver's license issued July 8, 2025. There was no documentation that the applicant resided in Pennsylvania for the two (2) years immediately preceding the date of hire.
PF #4, date of hire October 30, 2024, contained a Pennsylvania driver's license issued January 20, 2023. There was no documentation that the applicant resided in Pennsylvania for the two (2) years immediately preceding the date of hire.
PF #6, date of hire January 12, 2022, contained a Pennsylvania driver's license issued May 21, 2024. There was no documentation that the applicant resided in Pennsylvania for the two (2) years immediately preceding the date of hire.
PF #7, date of hire March 8, 2026, contained a Pennsylvania driver's license issued September 25, 2025. There was no documentation that the applicant resided in Pennsylvania for the two (2) years immediately preceding the date of hire.
An interview with the Administrator on May 14, 2026, at approximately 12:45 P.M. and a follow-up email on May 15, 2026, confirmed the above finding.
Plan of Correction:Based on the findings of the survey on May 14.2026. C Sincere Home health Admin and Staff have been updated on the required training of Pa code 611.52. Upon completion of the survey C Sincere conducted a audit of active employees verifying proof of residency for the two years preceding the date of hire for PF#3, PF # 4, PF # 6, and PF# 7. updated on 5/29/2026. The agency identified missing proof of documentation, and employees were contacted immediately. Acceptable documentation includes drivers' licenses, State ID's, Bills, lease agreements, tax records voter reg. or other documentation.
The agency revised its hiring and onboarding procedures to require proof of residency documentation prior to employment; A checklist has been added to every new and old personnel before employee is permitted to provide services. No employee file will be considered until residency documentation has been reviewed by office Manager/Admin
The office Manager will conduct audits of employee files every 6 months and findings will be documented on a personnel audit log to avoid reoccurrence
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 direct care worker personnel files (PF) and interview with the agency Administrator, the agency failed to ensure baseline Tuberculosis (TB) testing was conducted in accordance with CDC (Centers for Disease and Control and Prevention) guidelines for three (3) of seven (7) PF reviewed. (PF# 1, 2, and 6).
Findings Include:
The CDC (Centers for Disease and Control and Prevention) guidelines state baseline (preplacement) screening and testing, in addition to the IGRA (interferon-gamma release assay) or tuberculin skin test (TST), shall include a symptom screen questionnaire and an individual tuberculosis (TB) risk assessment. Serial screening and testing not routinely recommended. Annual TB education is recommended. (CDC/MMWR/May 17, 2019/Vol. 68/No. 19).
A review of PF's conducted on May 14, 2026, from approximately 11:00 A.M. to 12:30 P.M. revealed the following:
PF #1, date of hire November 12, 2025, contained documentation of a single IGRA completed on February 26, 2026, more than three (3) months after the date of hire.
PF #2, date of hire March 12, 2024, contained documentation of a single TST completed on March 20, 2024, eight (8) days after the date of hire. There was no documentation of a second-step TST.
PF #6, date of hire January 12, 2022, contained documentation of a single TST completed on May 9, 2023, sixteen (16) months after the date of hire. There was no documentation of a second-step TST. There was documentation of single TST completed on June 2, 2025. There was no documentation of a second-step TST.
An interview with the Administrator on May 14, 2026, at approximately 12:45 P.M. and a follow-up email on May 15, 2026, confirmed the above finding.
Plan of Correction: Based on the findings of the onsite survey completed May 14.2026 the agency C Sincere has updated all staff and admin on training and implementing the correct procedure of compliance for the documentation of collecting Tb screening, yearly training and testing. Upon completion of survey all caregivers were notified pertaining to compliance. PF #1 was given a week to submit proper documentation and removed from schedule until submitted. PF #2 personnel files were updated as of 5/28/2026, PF #6 updated and submitted as of 6/1/2026. upon completion of the survey C Sincere will conduct audits on all files every 3 months to check for accuracy. A checklist of compliance was added to each file with dates to keep up with deadlines. Employees will be notified 30 days prior to any renewal dates. Personnel will not be considered until complete documentation is received and reviewed by Manager/Admin. The Admin/ Manager will monitor compliance to prevent reoccurrence.
Initial Comments:
Based on the findings of an onsite announced home care agency state re-licensure survey conducted on May 14, 2026, C. Sincere Home Health & Concierge LLC was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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