Initial Comments:
Based on the findings of an onsite unannounced state relicense survey completed 5/5/2025, Community Resources For Independence Inc. 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 5/5/2025, Community Resources For Independence Inc. 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:
611.56(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 Centers for Disease Control (CDC) guidance, agency policy, personnel files (PF) and staff (EMP) interview it was determined the agency failed to ensure an updated evaluation for mycobacterium tuberculosis (TB) at least every twelve (12) months for two (2) of five (5) PFs reviewed who were employed by the agency for at least 12 months (PF1 and PF2).
Findings included:
Review of the agency documentation on 5/5/2025 at approximately 2:00 PM revealed, 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. After baseline testing for infection with tuberculosis, HCWs should receive TB screening annually. 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.)0
*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.
Review of the agency documentation on 5/2/2025 at approximately 10:55 AM revealed, " Hiring Requirements for Direct Care Workers ...Health Screening *Direct Care Workers are screened at hire for Mycobacterium Tuberculosis in accordance with CDC guidelines, and re-screened annually ... "
DCW PF#1, reviewed on 5/2/2025 at approximately 12:40 PM, date of hire 1/16/2024, confirmed two TST that were read on 1/18/2024 and 2/2/2024 with negative results. An additional (Agency) Annual Tuberculosis (TB) Symptom Evaluation, Risk Assessment, and Education Form was dated 3/10/2025.
DCW PF#2, reviewed on 5/2/2025 at approximately 12:55 PM, date of hire 11/7/2023, confirmed two TST that were read on 11/9/2023 and 11/28/2023 with negative results. An additional (Agency) Annual Tuberculosis (TB) Symptom Evaluation, Risk Assessment, and Education Form was dated 12/13/2024.
An exit interview was conducted with the regional manager on 5/2/2025 at approximately 2:45 PM which confirmed the above findings.
Plan of Correction:CRI's Regional Manager will provide Altoona office staff with re-training of CDC Guidelines of mycobacterium tuberculosis (TB) requirements, emphasizing the timelines to ensure an updated evaluation at least every twelve (12) months.
CRI Altoona's administrative assistant will track and monitor date of hire TB reading(s) and CRI annual TB symptom Evaluation, Risk Assessment, and Education form, ensuring dates are within the twelve (12) month threshold as required.
Then, the Regional Manager overseeing the Altoona office will be responsible to ensure continued implementation of tracking and monitoring of TB reading(s) and CRI annual form to ensure compliance, indefinitely.
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 involve the consumer in the service planning process and to receive services with reasonable accommodation of individual needs and preferences for two (2) of five (5) CR's reviewed (CR1 and CR2).
Findings included:
Review of the agency documentation on 5/2/2025 at approximately 10:55 AM revealed, "Act 69 of 2006 Consumer Acknowledgement, I understand that consumers shall have the following rights under Act 69 of 2006: To be involved in the service planning process and to receive services with reasonable accommodation of individual needs and preferences ...I acknowledge that I have received and/or reviewed the following information: *A copy of my Service Plan or Individual Support Plan, listing of the home care services that will be provided by the direct care worker ...Service plans are discussed with me to ensure proper delivery and understanding of needed tasks. *A copy of the service schedule which shows the hours when services will be provided and the identity of the direct care worker that will provide the services. I acknowledge my needs and preferences were discussed as part of the schedule review process..."
Review of the agency documentation on 5/2/2025 at approximately 10:55 AM revealed, "(Agency) RECORD OF DISCUSSION WITH PARTICIPANT REGUARDING SCHEDULE STARTUP INFORMATION ...INITIAL SCHEDULE TO BE REVIEWED WITH CONSUMER: Inform the consumer: A paper schedule listing the dates and times of services, and who will be providing your services, is being mailed to you. In the meanwhile, here is your schedule for the first week. Your first date of service will be: __________(date), Day: Sun, Mon, Tue, Wed, Thu, Fri, Sat Date: Times and DCW (direct care worker) Name..."
A review of CR1 was conducted on 5/2/2025 at approximately 11:25 AM which revealed start of services of 4/22/2024. The agency documentation "...RECORD OF DISCUSSION WITH PARTICIPANT REGUARDING SCHEDULE STARTUP INFORMATION ...INITIAL SCHEDULE TO BE REVIEWED WITH CONSUMER..." was not available within the consumer record. No additional documentation was provided by the agency to confirm the times or days services were agreed upon between the agency and consumer/consumer representative.
A review of CR2 was conducted on 5/2/2025 at approximately 11:55 AM which revealed start of services of 7/31/2024. The agency documentation "...RECORD OF DISCUSSION WITH PARTICIPANT REGUARDING SCHEDULE STARTUP INFORMATION ...INITIAL SCHEDULE TO BE REVIEWED WITH CONSUMER..." was not available within the consumer record. No additional documentation was provided by the agency to confirm the times or days services were agreed upon between the agency and consumer/consumer representative.
An exit interview was conducted with the regional manager on 5/2/2025 at approximately 2:45 PM which confirmed the above findings.
Plan of Correction:CRI's Regional Manager will provide Altoona office staff with re-training on how to complete CRI's Agency "Record of Discussion with Participant Regarding Schedule Startup Information" form. As part of this re-training, staff will be required to place the completed form in the CIF as a means of providing written documentation confirming times and days services that were agreed upon between CRI and the consumer/consumer representative.
Following a consumer visit wherein CRI's Agency form is completed, CRI Altoona's administrative assistant will monitor its completion and ensure it is placed in the consumer information file (CIF).
The Regional Manager overseeing the Altoona office will be responsible for continued monitoring of CIFs to ensure the Agency form is available within it, indefinitely.
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 agency 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 five (5) of five (5) CR's reviewed (CR1-CR5).
Findings included:
Review of the agency documentation on 5/2/2025 at approximately 10:55 AM revealed, "Act 69 of 2006 Consumer Acknowledgement, I understand that consumers shall have the following rights under Act 69 of 2006: To be involved in the service planning process and to receive services with reasonable accommodation of individual needs and preferences ...I acknowledge that I have received and/or reviewed the following information: *A copy of my Service Plan or Individual Support Plan, listing of the home care services that will be provided by the direct care worker ...Service plans are discussed with me to ensure proper delivery and understanding of needed tasks. *A copy of the service schedule which shows the hours when services will be provided and the identity of the direct care worker that will provide the services. I acknowledge my needs and preferences were discussed as part of the schedule review process..."
Review of the agency documentation on 5/2/2025 at approximately 10:55 AM revealed, "(Agency) RECORD OF DISCUSSION WITH PARTICIPANT REGUARDING SCHEDULE STARTUP INFORMATION ...INITIAL SCHEDULE TO BE REVIEWED WITH CONSUMER: Inform the consumer: A paper schedule listing the dates and times of services, and who will be providing your services, is being mailed to you. In the meanwhile, here is your schedule for the first week. Your first date of service will be: __________(date), Day: Sun, Mon, Tue, Wed, Thu, Fri, Sat Date: Times and DCW (direct care worker) Name..."
A review of CR1 was conducted on 5/2/2025 at approximately 11:25 AM which revealed start of services of 4/22/2024. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The services to be provided and the identity of the direct care worker who would provide services.
2. The hours when services would be provided.
A review of CR2 was conducted on 5/2/2025 at approximately 11:55 AM which revealed start of services of 7/31/2024. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The services to be provided and the identity of the direct care worker who would provide services.
2. The hours when services would be provided.
A review of CR3 on 5/2/2025 at approximately 12:05 PM revealed start of services 4/15/2024. 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.
A review of CR4 on 5/2/2025 at approximately 12:20 PM revealed start of services 9/7/2023. 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.
A review of CR5 on 5/2/2025 at approximately 12:30 PM revealed start of services 9/12/2023. 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.
An exit interview was conducted with the regional manager on 5/2/2025 at approximately 2:45 PM which confirmed the above findings.
Plan of Correction:CRI's Regional Manager will provide Altoona office staff with re-training on how to complete CRI's Agency "Record of Discussion with Participant Regarding Schedule Startup Information" form correctly. This re-training will require the form to be completed in its entirety and, specifically, to ensure the following information is present 1. The services to be provided and the identity of the direct care worker who will provide services; 2. The hours when services will be provided
CRI Altoona's administrative assistant will monitor CRI's Agency form to ensure it is completed in its entirety, requiring information related to services to be provided, identity of direct care work who will provide services, and the hours when services will be provided are present, prior to the CRI Agency form being filed.
CRI's Regional Manager will be responsible to monitor the continued implementation and monitoring of consumer information files (CIFs) to ensure the CRI Agency form is completed in its entirety and correct information that is required is present, indefinitely.
Initial Comments:
Based on the findings of an onsite unannounced state relicense survey completed 5/5/2025, Community Resources For Independence Inc. was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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