QA Investigation Results

Pennsylvania Department of Health
ANN'S CHOICE, INC.
Health Inspection Results
ANN'S CHOICE, INC.
Health Inspection Results For:


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Initial Comments:


Based on the findings of a state re-licensure survey completed May 28, 2024, Ann's Choice, Inc 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 a state re-licensure survey completed May 28, 2024, Ann's Choice, Inc was found to not 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

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 an interview with agency administrator, the agency failed to retain documentation of face-to-face interview prior to hiring or rostering two (2) of the seven (7) PF's reviewed.
(PF#2 and PF#6)

Findings include:
Personnel file review conducted May 22, 2024 from approximately 12 pm to 4pm revealed the following:

PF #2, DOH 2/27/2023: Contained no documentation of a face to face interview.

PF#2, DOH 10/16/2022: Contained no documentation of a face to face interview.

An interview with the administrator on May 22, 2024 at approximately 4pm confirmed the above findings.




Plan of Correction:

All perspective home care employees will have a face to face interview in the Home Care office with the Home Care Administrator or Assistant Home Care Administrator. The Human Resources department will conduct a face to face interview in the absence of the Home Care Administrator and Assistant Home Care Administrator. Human Resources have been provided with the approved documentation for a face to face interview as well as competency test provided at time of interview. The Home Care office will secure the face to face documentation in confidential location in the Home Care office as well as provide a copy to the Human Resources department. If completed by Human Resources, they will secure in a confidential location and provide a copy to the Home Care office. This action has been in effect with all new hires in 2024 and will continue to be monitored with all new hires by the Assistant Home Care Administrator.


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 (CF) and an interview with the administrator, the agency failed to provide the consumer with the identity of the direct care worker and the hours when the the services will be provided for seven (7) of seven (7) consumer files. CF#1-7)

Findings include:

A review of consumer files (CF) was conducted on May 22, 2024 from approximately 12pm to 4pm revealed the following:


CF#1, Start of Care (SOC) 3/15/2024: Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.

CF#2, SOC 12/18/2023: Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.

CF#3, SOC 4/21/2022: Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.

CF#4, SOC 10/19/2021: Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.

CF#5 SOC 9/20/2022: Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.

CF#6 SOC 4/9/2024: Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.

CF#7 SOC 3/12/2024 : Contained no documentation of the consumer, the consumer's legal representative, or a responsible family member receiving the following information prior to the start of services: 1) the identity of the DCW who would be providing the services, 2) the hours when the services would be provided.


An interview with the administrator on May 22, 2024 at approximately 4pm confirmed the above findings.








Plan of Correction:

All clinical staff completing the consent forms for a new admission will be educated on required information to be documented and received by the consumer, the consumer's legal representative, or a responsible family member prior to start of care services. The consent form has been updated to include information for the direct care work as well as the hours the services will be provided, days that the services will be provided and cost per hour for services to be provided. Every consent for a start of services will be monitored by the Home Care Administrator and Assistant Home Care Administrator in the absence of the Home Care Administrator on the same day the consent is obtained. This has been in effect since 6/5/2024 with all new admissions.


Initial Comments:

Based on the findings of a state re-licensure survey completed May 28, 2024, Ann's Choice, Inc was found to be in compliance with the requirements of 35 P.S. 448.809 (b).





Plan of Correction: