QA Investigation Results

Pennsylvania Department of Health
ARCADIA HOME CARE & STAFFING
Health Inspection Results
ARCADIA HOME CARE & STAFFING
Health Inspection Results For:


There are  9 surveys for this facility. Please select a date to view the survey results.

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Initial Comments:



Based on the findings of an onsite unannounced complaint survey completed 5/3/2021, Arcadia Home Care &Staffing 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 complaint investigation survey completed 5/3/2021, Arcadia Home Care & Staffing 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:




611.4(c) LICENSURE
Requirements for HCA and HCR

Name - Component - 00
Home care agencies and home care registries licensed under this Chapter shall comply with applicable environmental, health, sanitation and professional licensure standards which are required by Federal, State, and local authorities.

Observations:


Based on review of the regulation's definition of home care services, consumer records, personnel files and staff interview, it was determined the agency's direct care workers were working outside of the scope of the definition for home care agency services for one (1) of three (3) CR reviewed (CR1).

Findings include:

A review on 5/3/2021at approximately 1:00 PM am of Title 28. Health and Safety Part IV. Health Facilities Subpart H. Home Care Agencies and Home Care Registries. Chapter- 611. Home Care Agencies and Home Care Registries under 611.5 Definitions includes "Home Care Services- The term encompasses the following activities:
(i) Personal care.
(ii) Assistance with instrumental activities of daily living.
(iii) Companionship services.
(iv) Respite care.
(v) Specialized care."... Specialized care is further defined as "Nonskilled services unique to the consumer's care needs that facilitate the consumer's health, safety and welfare, and ability to live independently."

A review of CR #1 on 4/30/2021 at approximately 11:21 AM revealed start of services 9/8/2018. A review of the service authorization form revealed: " HHA Authorization Date: 01/25/2021 AUTH REASON: Revised HHA SAF OFFICE: BLAIR CONSUMERS ...NOTES ...FREQUENCY: WEEKLY AMOUNT: WEEK 1:50 HOURS: WEEK 2: 58 HOURS SCOPE ITEMS: BATHING; ORAL CARE; DRESSING; MEAL PREP; ROM; LOTION/SKIN CARE; LIGHT HOUSEKEEPING; LAUNDRY; MED REMINDERS; BOWEL/BLADDER MANAGEMENT; SUPERVISED WALKS; SHOPPING/ERRANDS; TRANSPORTATION ...DURATION: 12/1/2020-11/24/2021 "

An interview with EMP1 on 4/30/2021 at approximately 10:35 AM confirmed: EMP1 confirmed the consumer has limited range of motion and not able to feed themselves or take their own medication? EMP1 confirmed the patient has to be feed by the DCW and medication is given by the DCW. The surveyor asked EMP1 are the DCW ' s counting out medication and administering the medication. EMP1 confirmed the medications are in daily peel packs and the DCW ' s are not counting out the medications. The surveyor confirmed the DCW ' s are placing the medications in the patient ' s mouth.

During an interview with EMP1 and EMP2 on 4/30/2021 at approximately 1:25 PM, EMP2 was asked , are the direct care workers permitted to perform medication administration, EMP2 confirmed DCW should only be completing medication reminders.

The surveyor confirmed with EMP2 that no specialized care training was completed by the DCW ' s proving services for CR1. EMP1 confirmed "no specialized training had occurred." The surveyor confirmed EMP1 and EMP2 were not aware of specialized care requirements.

An exit interview was conducted with the branch manager and office manager on 4/30/2021 at approximately 1:30 PM which confirmed the findings.





Plan of Correction:

The agency's direct care workers were working outside of the scope of the definition for home care agency services for one of three consumer files reviewed by providing medication administration. It was discovered that the direct care worker was placing medication in one of three consumer's mouth after removing medications from a peel pack. All applicable direct care staff will be re-trained on the limitations of providing medication reminders only by using the Arcadia Medication Acknowledgement training document. This re-training will be completed by 6/28/21. Evidence of this re-training will be maintained in each direct care worker's personnel file. This re-training will ensure that consumers receive medication reminders only and ensure that medication administration is excluded from service provision. The Medication Acknowledgement training document is also completed with each new employee hired with the agency, which will ensure all direct care workers going forward also are trained on the limitations of providing medication reminders. The Branch Manager will review all new hire documentation to ensure the Medication Acknowledgement training is completed prior to consumer contact.


611.55(e) LICENSURE
Competency Requirements

Name - Component - 00
(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.

Observations:


Based on review of agency policy, training documents, direct care worker personnel files (DCWF) and staff (EMP) interview, the agency failed to include documentation of agency review of method used to determine the direct care worker's satisfactory completion of competency evaluations for specialized services for three (3) of three (3) PF's reviewed ( PF1, PF2 and PF3).

Findings included:

Review of the specialized guidance on 4/30/2021 at approximately 1:25 PM revealed,
Guidance to Home Care Agencies and Registries Licensed by Pennsylvania Department of Health February 23, 2017
On November 23, 2016 the Wolf Administration issued a policy clarification through the departments of Health, Human Services, and State that clarifies the types of non-skilled services/activities that can be performed by direct care workers (DCWs) to assist individuals with disabilities with activities of daily living that could be performed independently but for their disability. DCWs include personal attendants, nursemaids, or other household aides.
These non-skilled activities/services include assistance with bowel and bladder routines, assistance with medication, ostomy care, clean intermittent catheterization, assistance with skin care, and wound care.

These non-skilled activities/services include assistance with bowel and bladder routines, assistance with medication, ostomy care, clean intermittent catheterization, assistance with skin care, and wound care.

Definitions ...
(v) Specialized care - Nonskilled services/activities unique to the consumer's care needs that facilitate the consumer's health, safety and welfare, and ability to live independently.

Consumer Characteristics
The non-skilled activities/services are specialized care that are unique to the individual consumer ' s care needs that facilitate the consumer's health, safety and welfare, and ability to live independently. This applies to consumers regardless of age or nature of disability.

DCW may perform the non-skilled activities/services included in this policy only for a consumer whose characteristics meet all of the following guidelines:

1. The consumer is capable of directing his or her own care or has a health care representative or agent who is capable to make choices for the consumer about home care services, understands the impact of these choices, and assumes responsibility for the results of the choices.

2. The specific non-skilled activity/service provided is of a nature that the consumer would be able to perform independently but for his or her disability.

3. The consumer's service plan documents that the consumer has a need for assistance with the non-skilled activity/service to facilitate the ability to live independently while maintaining his or her health, safety, and welfare, as defined by the consumer, the consumer ' s health care representative, or the consumer's agent.

4. The consumer has an order from a health care practitioner, service authorization form, or service plan/agreement that authorizes the home care agency/registry to provide the non-skilled service/activity. The order, service authorization form, or service plan/agreement is renewed yearly or when a significant change in condition occurs.

5. The consumer's health conditions, care needs, and the outcomes of the non-skilled service/activity are generally predictable to the consumer...

Home Care Agency/Registry Responsibility
Prior to assigning a DCW employee to provide the non-skilled activities/services included in this policy, the home care agency or registry must evaluate the DCW and document that the DCW has received training and demonstrated competency in any specialized care activities/services that the DCW will provide to the consumer, per 28. Pa. Code Section 611.55.

Training and demonstrated competency must be individualized for each consumer, take into consideration the service delivery preferences of the consumer, and emphasize delivery methods that ensure the safety and maintain the dignity of the consumer. The home care agency or registry should ensure an individual meets the consumer characteristics defined above after initial assessment...

()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. 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 quality of care infraction ... "

A review of PF1 on 4/30/2021 at approximately 12:30 PM, date of hire (DOH) 11/4/2020 revealed: No documentation for specialized service training for staff members was located in the DCW ' s PF. There was no additional documentation provided to confirm the agency completed competency training for specialized services for CR1.

A review of PF2 on 4/30/2021 at approximately 12:37 PM, date of hire (DOH) 12/4/2017 revealed: No documentation for specialized service training for staff members was located in the DCW ' s PF. There was no additional documentation provided to confirm the agency completed competency training for specialized services for CR1.

A review of PF2 on 4/30/2021 at approximately 1:05 PM, date of hire (DOH) 11/15/2018 revealed: No documentation for specialized service training for staff members was located in the DCW ' s PF. There was no additional documentation provided to confirm the agency completed competency training for specialized services for CR1.

An interview with EMP1 on 4/30/2021 at approximately 10:35 AM confirmed: EMP1 confirmed the consumer (CR1) has limited range of motion and not able to feed themselves or take their own medication? EMP1 confirmed the patient must be fed by the DCW and medication is given by the DCW. The surveyor asked EMP1 are the DCW's counting out medication and administering the medication. EMP1 confirmed the medications are in daily peel packs and the DCW's are not counting out the medications. The surveyor confirmed the DCW ' s are placing the medications in the patient's mouth.

During an interview with EMP1 and EMP2 on 4/30/2021 at approximately 1:25 PM, EMP2 was asked , are the direct care workers permitted to perform medication administration, EMP2 confirmed DCW should only be completing medication reminders.

The surveyor confirmed with EMP2 that no specialized care training was completed by the DCW's proving services for CR1. EMP1 confirmed "no specialized training had occurred." The surveyor confirmed EMP1 and EMP2 were not aware of specialized care requirements.

An exit interview was conducted with the branch manager and office manager on 4/30/2021 at approximately 1:30 PM which confirmed the findings.





Plan of Correction:

The agency failed to include documentation of direct care worker's satisfactory completion of competency evaluations for specialized services for three of the three personnel files reviewed. The agency did not provide training on specialized services to these direct care workers on the topic of medication administration. All applicable direct care staff will be re-trained on the limitations of providing medication reminders only by using the Arcadia Medication Acknowledgement training document. This re-training will be completed by 6/28/21. Evidence of this re-training will be maintained in each direct care worker's personnel file. This re-training will ensure that consumers receive medication reminders only and ensure that medication administration is excluded from service provision. The Medication Acknowledgement training document is also completed with each new employee hired with the agency, which will ensure all direct care workers going forward also are trained on the limitations of providing medication reminders. The Branch Manager will review all new hire documentation to ensure the Medication Acknowledgement training is completed prior to consumer contact.


611.57(a) LICENSURE
Consumer Rights

Name - Component - 00
(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 consumer records (CR) and staff interview, the agency failed to provide services with reasonable accommodation of individual needs and preferences for one (1) of three (3) CR's reviewed (CR3).

Findings included:

Review of the agency consumer packet on 4/30/2021 at approximately 11:40 AM revealed, " Consumer Guidelines ...Contact your local (Agency), office if your Personal Care Aide fails to report to their scheduled shift. We want to provide you with tall of your authorized care, and will make arrangements to do so if your scheduled aide does not or cannot work your shift. We may not be aware that you are not receiving your care, so please contact the office to report any missed shifts. If the shift is after business hours, contact the emergency on-call cell phone ...Consumers have the right to be involved in the service planning process and to receive their services within a reasonable accommodation of their needs an d preferences, as long as their services are in line with the Service Authorization provided by the consumer ' s case manager ...(Agency) will make every effort to provide a qualified Personal Care Aide to provide your services when employees have to call off or miss their scheduled shift. While we understand that it is not preferred to have a new employee in your home Providing care with minimal notice, our top priority is to ensure you receive your care. It is the policy of (Agency) to have office staff provide essential care (personal care, meal preparation, medication reminders, etc.) in the event that a Personal Care Aide is not available. Office staff is trained to provide care and wants you to receive your services, they will provide no more than two hours of essential care unless there are extenuating circumstances that require all authorized hours to be provided. "

A review of CR #3 on 4/30/2021 at approximately 12:07 PM revealed start of services 9/15/2013. A review of the service authorization form revealed: " HHA Authorization Date: 01/12/2021 ...Continued authorization of 24 hours per week or 14 units per day ...Preferred Schedule:, Frequency: Daily ...FREQUENCY: WEEKLY AMOUNT: 24 HOURS PER WEEK SCOPE ITEMS: BATHING; HAIR CARE; DRESSING; LOTION/SKIN CARE; MEAL PREP; LAUNDRY; LIGHT HOUSEKEEPING; SHOPPING/ERRANDS; MED REMINDERS; SOCIAL/LEISURE ACTIVITIES; SECURE TRANSPORTATION; ASSIST W/APPT SCHEDULING; AMBULATING; ROM; SUPERVISED WALKS; TOILETING; TRANSFERS ...DURATION: 01/14/2021-12/31/2021.

During an interview with EMP2 on 4/30/2021 at approximately 11:40 EMP2 confirmed monthly schedules are mailed or emailed to the consumers, and additional schedules are provided if there are changes in schedule or staffing.

A review of March and April of 2021 schedules were completed. The follow dates and times of services were not provided. No additional documentation was provided by the agency to confirm why services were not provided on the following dates:

3/1/2021 12:00 PM-4:00 PM
3/19/2021 1:30 PM-5:30 PM
3/28/2021 12:15 PM-2:45 PM
4/2/2021 1:30 PM-5:30 PM
4/3/2021 9:00 AM-11:30 AM
4/4/2021 9:00 AM-11:30 AM
4/9/2021 1:30 PM- 5:30 PM
4/16/2021 1:30 PM-5:30 PM
4/17/2021 9:00 AM-11:30 AM
4/18/2021 9:00 AM-11:30 AM
4/23/2021 1:30 PM-5:30 PM

An exit interview was conducted with the branch manager and office manager on 4/30/2021 at approximately 1:30 PM which confirmed the findings.





Plan of Correction:

The agency failed to provide services as authorized to one of the three consumers identified. The Agency Director or Branch Manager will review this consumer file and enter documentation for each day/time service was not provided with an explanation as to why services were not provided (for every date/time listed on the statement of deficiencies). This documentation will be completed by 6/28/21. The Agency Director and Branch Manager will review and sign off on PA Policy 2.10 (On Call and Back Up Policy) to ensure services are provided and/or to ensure there is thorough documentation to explain why services could not be provided. The Agency Director and Branch Manager will review and sign off on PA Policy 2.15 (Missed Visits) to ensure missed visits are thoroughly documented and reported as required. The Agency Director or Branch Manager will complete these reviews and signature confirmations by 6/28/21. Going forward, missed visits will be monitored and analyzed at least weekly by the Agency Director or Branch Manager and Service Coordinator to ensure proper documentation is completed.