Initial Comments:
Based on the findings of an on-site unannounced State relicensure survey completed 9/8/2023, Home Instead was found to be in compliance with the requirements of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart A, Chapter 51.
Plan of Correction:
Initial Comments:
Based on the findings of an onsite unannounced state relicensure survey completed 9/8/2023, Home Instead was found not to be in compliance with the following requirements of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart H, Chapter 611, 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 agency documents, personnel files (PF), and staff (EMP) interview it was determined agency failed to obtain verification of two (2) positive references for the applicant for four (4) of seven (7) reviewed (PF1-PF4).
Findings included:
Review of the consumer packet conducted on 9/7/2023 at approximately 2:25 PM revealed, "Consumer Notice of Direct Care Worker Status...(Agency) is also responsible for paying workers' compensation insurance...Direct care workers are hired according to section 611.51 and 611.56 of the Pennsylvania Department of Health regulation, including face-to-face interviews, references, background checks, and documentation of competency required..."
A review of PF1 was conducted on 9/7/2023 at approximately 12:50 PM revealed, date of hire 2/20/2023. The PF did not provide evidence of two references having been completed by the agency.
A review of PF2 was conducted on 9/7/2023 at approximately 1:03 PM revealed, date of hire 3/6/2023. The PF provide evidence of one personal reference. A second reference was not completed or verified as positive by the agency.
A review of PF3 was conducted on 9/7/2023 at approximately 1:40 PM revealed, date of hire 12/27/2022. The PF provide evidence of one personal reference. A second reference was not completed or verified as positive by the agency.
A review of PF4 was conducted on 9/7/2023 at approximately 1:22 PM revealed, date of hire 1/27/2023. The PF provide evidence of one personal reference. A second reference was not completed or verified as positive by the agency.
An exit interview was conducted with the administrator and office manager on 9/7/2023 at approximately 3:15 PM which confirmed the above findings.
Plan of Correction:The company has updated it's internal processing paperwork to include reference checks for only professional and other references that can ascertain their ability to provide care services under home health. The company has implemented internal controls to ensure no candidate is hired without 2 references that validate a candidate's ability to provide care. At least one of these references will be required to be secured from a professional source such as a former place of employment or supervisor. It is clearly stated in our process form that hiring cannot proceed until one professional reference has been validated and is a competitive reference check.
As a correction going forward, our HR Manager will only allow a new candidate to proceed with orientation when a professional reference has been secured. She will ensure that this complete and will internally document their eligibility to move forward in the process with the orientation team. This will be monitored by internally checking all files 2 times per year of all caregiver to ensure compliance with this protocol by the office manager. An internal auditing document will be used to track any discrepancies to correct immediately upon discovery if any are found to exist.
This place was implemented with the agency on 9.11.2023.
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 a review of policy, personnel files (PFs) and staff (EMP) interview it was determined the agency failed to show proof of residency in this Commonwealth for the 2 years preceding the date of hire (DOH) for two (2) of seven (7) PFs reviewed (PF1 and PF3).
Findings included:
Review of the consumer packet conducted on 9/7/2023 at approximately 2:25 PM revealed, "Consumer Notice of Direct Care Worker Status...(Agency) is also responsible for paying workers' compensation insurance to cover the direct care worker in the event of and accident or injury on the job. Direct care workers are hired according to section 611.51 and 611.56 of the Pennsylvania Department of Health regulation, including face-to-face interviews, references, background checks, and documentation of competency required..."
Review of the employee handbook was conducted on 9/7/2023 at approximately 12:20 PM revealed, "...Employment Screening Prior to being employed, each potential (Agency) will have a thorough background check conducted. This background check will consist of 7-year criminal history check, adult and child protective services check, skip trace, a driving record check, a drug screen, and two references (one personal and one professional) will be contacted to verify character. If a potential (Agency) does not successfully complete these pre-employment screenings, the offer of employment will be rescinded ...If potential employee has lived out of the state within the last two years the employee is required to submit an application for a Department of Aging FBI clearance. This is done by submitting an online application followed by fingerprinting. Employees are required to pay the cost for the FBI fingerprint testing. These results may take longer to obtain. If potential employee has not lived out of the state with in the last two years, the employee is required to submit proof of residency by providing one of the six following documents: 1. Motor vehicle records, such as a valid driver's license or state-issued identification card. 2. Housing records, such as mortgage records or rent receipts. 3. Public utility records or receipts, such as an electric bill. 4. Local tax return records. 5. A completed and signed, federal, state or local income tax return with the address preprint on it. 6. Employment records, including records of unemployment compensation."
Review of PF1 date of hire (DOH) 2/23/2023, was conducted on 9/7/2023 at approximately 1:10 PM. There was a Pennsylvania identification card with an issue date of 8/18/2021. Also, a 1040 U.S. Individual Income Tax Return dated 2021 was provided as proof of residency. There was no additional documentation in PF to confirm the agency verified proof of residency in this Commonwealth for two (2) years immediately preceding the date of hire.
Review of PF3 date of hire (DOH) 12/27/2022, was conducted on 9/7/2023 at approximately 1:40 PM. There was a Pennsylvania driver's license with an issue date of 6/24/2021. There was no additional documentation in PF to confirm the agency verified proof of residency in this Commonwealth for two (2) years immediately preceding the date of hire.
An exit interview was conducted with the administrator and office manager on 9/7/2023 at approximately 3:15 PM which confirmed the above findings.
Plan of Correction:Issue has been corrected and proactive measures taken to ensure no future violations. The inconsistencies identified were W-4 and tax return documents that lacked dates of employment for said individuals and did not meet the two year threshold to substantiate proof of residency. As a corrective action, we have corrected our process for this and will ensure any documents are from at least 2 full years back prior to the date of employment. For the two documents that were out of compliance, we have given the employees a 15 day notice to provide an updated proof of residency form that meets the document requirements as established by that State.
The individuals who had a tax return and tax filing that were not past the two year date have been corrected and the agency has the appropriate paperwork in place for both emloyees.
As a correction going forward, our HR Manager will only allow the prescribed documents to be utilized to certify proof of residency. Furthermore, this will be monitored by internally checking all files 2 times per year of all caregiver to ensure compliance with this protocol by the office manager. An internal auditing document will be used to track any discrepancies to correct immediately upon discovery if any are found to exist.
This place was implemented with the agency on 9.11.2023.
611.57(a) LICENSURE
Consumer Rights
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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.
Observations:
Based on a review of the admission packet, consumer records (CR) and staff (EMP) interview, the agency failed to involve the consumer in the service planning process and to receive services with reasonable accommodation of individual needs and preferences for four (4) of nine (9) CR's reviewed (CR3, CR4, CR5 and CR6).
Findings included:
Review of the consumer packet was conducted on 9/7/2023 at approximately 2:25 PM revealed, "Client Care File Checklist Client: Start Date...*Start/Open File-Creation on Clear Care (staff) File Given to Scheduling: *Scheduling Sets Up Schedule and Call Client 24 hours of file handoff (staff) Date ...Call to confirm introduction time with client day before visits (staff) Date...Green Hanging Folder, Name and Start Date on tab, Interior Folder 1 Left Side, QA-In order by date, Right Side *Service Agreement (Top Page) *Customer Notice of Direct Care *Service Agreement Addendum *ISP *Home Safety Checklist *Client Schedule, if no physical copy, reference Clear Care System *Client information..."
Review of CR3, start of services 3/2/2023, was conducted on 9/7/2023 at approximately 2:34 PM. No days or hours were documented within the CR to compare with the hours and days listed for the clients April and May 2023 calendars.
Review of CR4, start of services 7/18/2023, was conducted on 9/7/2023 at approximately 2:40 PM. Per document "Assessment & Care Plan...Initial Contact: 7/18/2023 ...Proposed Schedule: Monday-Friday-4-hour shifts, 20 hours per week. Prefers afternoons with start time from 11 am -1 pm and end time 4 hours after shift start. Review of August 2023 schedule revealed no services provided on the following dates:
8/2/2023, 8/3/2023, 8/8/2023, 8/9/2023, 8/11/2023, 8/22/2023, 8/23/2023, 8/24/2023, 8/25/2023, 8/29/2023 and 8/30/2023.
Review of CR5, start of services 12/22/2022, was conducted on 9/7/2023 at approximately 2:45 PM. No days or hours were documented within the CR to compare with the hours and days listed for the clients August and September 2023 calendars.
Review of CR6, start of services 10/18/2022, was conducted on 9/7/2023 at approximately 12:15 PM. No days or hours were documented within the CR to compare with the hours and days listed for the clients August and September 2023 calendars.
The surveyor could not confirm from the agency documentation that scheduled changes in times were reviewed with the consumers or consumers representative. The surveyor requested any additional documentation that changes were review or agreed upon, no other documentation was provided by the agency.
An exit interview was conducted with the administrator and office manager on 9/7/2023 at approximately 3:15 PM which confirmed the above findings.
Plan of Correction:The files reviewed did not include scheduling desires and paramenters for scheduling of each new client. The company has developed a form that will allows our care consultant at intake to secure scheduled days of the weeks and times of day requirements at the time on intake.
The form allows for conversation to occur regarding is there is flexibility in shift time or days of week as it is sometimes necessary to adapt the schedule based on staffing constraints.
The company will ensure that prior to start of services, consumer has communication of upcoming schedule and documentation is secured in scheduling system using form created. Form was reviewed with PA DOH representative on date of visit and feedback was given that form meets the requirements.
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 a review of policy, consumer records (CR) and staff (EMP) interview, the agency failed to provide required information in writing to consumers/consumer representatives prior to the commencement of services for four (4) of ten (10) CRs reviewed (CR3, CR4, CR5 and CR6).
Findings included:
Review of the consumer packet was conducted on 9/7/2023 at approximately 2:25 PM revealed, "Client Care File Checklist Client: Start Date...*Start/Open File-Creation on Clear Care (staff) File Given to Scheduling: *Scheduling Sets Up Schedule and Call Client 24 hours of file handoff (staff) Date ...Call to confirm introduction time with client day before visits (staff) Date ...Green Hanging Folder, Name and Start Date on tab, Interior Folder 1 Left Side, QA-In order by date, Right Side *Service Agreement (Top Page) *Customer Notice of Direct Care *Service Agreement Addendum *ISP *Home Safety Checklist *Client Schedule, if no physical copy, reference Clear Care System *Client information..."
Review of CR3, start of services 3/2/2023, was conducted on 9/7/2023 at approximately 2:34 PM. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The identity of the direct care worker who would provide services.
2. The hours when services would be provided.
Review of CR4, start of services 7/18/2023, was conducted on 9/7/2023 at approximately 2:40 PM. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The identity of the direct care worker who would provide services.
2. The hours when services would be provided.
Review of CR5, start of services 12/22/2022, was conducted on 9/7/2023 at approximately 2:45 PM. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The identity of the direct care worker who would provide services.
2. The hours when services would be provided.
Review of CR6, start of services 10/18/2022, was conducted on 9/7/2023 at approximately 12:15 PM. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The identity of the direct care worker who would provide services.
2. The hours when services would be provided.
An exit interview was conducted with the administrator and office manager on 9/7/2023 at approximately 3:15 PM which confirmed the above findings.
Plan of Correction:Upon scheduling a client for services, the client or family member and/or POA making decisions on behalf of the client, said parties will be notified of the schedule, first shift information to include date of service, times of shift and name of caregiver fulfilled the first shift with the client. The staff of Home Instead will secure from the client, family member and/or their power of attorney to approve the schedule that has been written for the client. Prior to the audit, there was always in interaction with all clients prior to implementation the schedule, but it just was not clearly documented. Going forward, this process will be clearly documented in all client files.
Form was reviewed with PA DOH representative on date of visit and feedback was given that form meets the requirements.
All files with be reviewed by owner, care coordinator, or office manager prior to fist shift scheduled with client to verify this stage is being completed.
Initial Comments:
Based on the findings of an on-site unannounced State Relicensure survey completed 9/8/2023, Home Instead was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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