Initial Comments:
Based on the findings of an onsite state re-licensure survey conducted on March 20, 2025, A+ Home Care 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 state re-licensure survey conducted on March 20, 2025, A+ Home Care 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(b) LICENSURE
Direct Care Worker Files
Name - Component - 00
Files for direct care workers employed or rostered shall include documentation of the date of the face-to-face interview with the individual and of references obtained. Direct Care Worker files also shall include other information as required by § 611.52, § 611.53, if applicable, § 611.54, § 611.55 and § 611.56 (relating to criminal background checks, child abuse clearance, provisional hiring, competency requirements; and health evaluations).
Observations:
Based on a review of personnel files (PF) and interview with the administrator and staff, it was determined that the agency failed to retain within direct care worker (DCW) files documentation of a dated face to face interview and at least two positive, verifiable references, 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 for four (4) of seven (7) PFs reviewed (PF#1, PF#3, PF#4, and PF#7).
Findings include:
Personnel file review conducted March 20, 2025 from approximately 3:30 pm to 4:15 pm revealed the following:
PF#1 Date of Hire (DOH) 1/14/24: Did not contain documentation of at least two positive, verifiable references, either verbal or written and documentation of a dated face to face interview.
PF#3 DOH 6/29/23: Did not contain documentation of at least two positive, verifiable references, either verbal or written and documentation of a dated face to face interview.
PF#4, DOH 9/15/22: Did not contain documentation of at least two positive, verifiable references, either verbal or written and documentation of a dated face to face interview.
PF#7, DOH 6/7/22: Did not contain documentation of a dated face to face interview.
An interview with the administrator and staff conducted on March 20, 2025, at approximately 4:15pm confirmed the above.
Plan of Correction:Re-education was provided to all staff during our mandatory annual staff meeting. The mandatory meeting included a re-training on all necessary onboarding documents for potential Direct Care workers. Additionally, staff were retrained on the Reference Check and Face to Face interview forms. It was explained to all staff that at least two positive professional references are required along with a completed (and dated) face to face document. A+ Home Care will require all managers to review new hire documents before to be sure that all new documentation is completed in full. Our Executive Director, will also review new hire employees files on a quarterly basis to audit the completion of files.
611.52(b) LICENSURE
State Police Criminal History Record
Name - Component - 00
If the individual required to submit or obtain a criminal history report has been a resident of this Commonwealth for 2 years preceding the date of the request for a criminal history report, the individual shall request a State Police criminal history record.
Observations:
Based on a review of personnel files (PF), and an interview with the agency administrator and staff, the agency failed to provide documentation of a Pennsylvania State Police Criminal Background Check (PATCH) at the time of application or within one (1) year immediately preceding the date of application for one (1) of seven (7) PF's reviewed. ( PF #5)
Findings include:
Personnel file review conducted March 20, 2025 from approximately 3:30 pm to 4:15 pm revealed the following:
PF#5, Date of Hire (DOH) 3/7/23: Contained no documentation of a Pennsylvania State Police Criminal Background Check (PATCH) at the time of application or within one (1) year immediately preceding the date of application. PATCH dated 8/7/24, after the hire date.
An interview with the administrator and staff conducted on March 20, 2025, at approximately 4:15pm confirmed the above.
Plan of Correction:Re-education was provided to all staff during our manual, annual staff training on all necessary onboarding documents to potential direct care workers.
A+ Home Care will require all managers to review all new hire applications upon completion to ensure all necessary documentation is completed. This documentation includes but is not limited to PA state background checks, child abuse checks and exclusions. All background checks and exclusions will be run with results within a month prior to the employee start date and no later than the employee start date. Our Executive Director will review new hire files on a quarterly basis to audit the completion and compliance of the new hire employee files.
611.56(a) LICENSURE
Health Screening
Name - Component - 00
(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 review of personnel files (PF), the Centers for Disease Control Guidelines, and an interview with the agency administrator and staff, it was determined the agency failed to ensure direct care workers were screened for and were free from active mycobacterium tuberculosis prior to assignment with clients for three (1) out of seven (7) direct personnel files reviewed. (PF #4).
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.)
*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. 19).
Findings include:
Personnel file review conducted March 20, 2025 from approximately 3:30 pm to 4:15 pm revealed the following:
PF#4, Date of Hire (DOH) 9/15/22: Did not contain documentation of any TB testing upon hire or within the year prior to the hire date. Also did not contain a baseline risk and symptom screening questionnaire.
An interview with the administrator and staff conducted on March 20, 2025, at approximately 4:15pm confirmed the above.
Plan of Correction:Re-education was provided to all staff during our annual, mandatory staff training on all necessary onboarding direct care worker documentation. A staff training has taken place with each staff member on the importance of tuberculosis screening each incoming employee. All incoming employees must be free from current mycobacterium tuberculosis. All incoming employees will have a baseline tuberculosis screening upon hire, within the appropriate time frame. The screening can include a 2 step TB skin test, a single blood test or a chest X-ray within the appropriate time frame according to Dept of Health regulations. In addition to a baseline TB screening, each incoming employee will also complete an individual TB risk assessment and a symptom questionnaire. Our Executive Director will review new hire files on a quarterly basis to ensure completion and compliance for all new hires.
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 CDC guidance and personnel files (PF), the agency failed to ensure updated documentation of annually Mycobacterium Tuberculosis (TB) education and risk assessment for three (3) of seven (7) files reviewed.( PF#3, PF#4, and PF#7)
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.)
*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. 19).
Findings include:
Personnel file review conducted March 20, 2025 from approximately 3:30 pm to 4:15 pm revealed the following:
PF#3 Date of Hire (DOH) 6/29/23: Contained no documentation of annual TB risk assessment or education for 2024.
PF#4, DOH 9/15/22: Contained no documentation of annual TB risk assessment or education for 2024.
PF#7, DOH 6/7/22: Contained no documentation of annual TB risk assessment or education for 2023 and 2024.
An interview with the administrator and staff conducted on March 20, 2025, at approximately 4:15pm confirmed the above.
Plan of Correction: Re-education was provided to all staff during our annual, mandatory staff training on all necessary onboarding direct care worker documentation. All employees will receive a Tuberculosis screening to be completed on an annual basis. The Tuberculosis screening will include the Tuberculosis risk assessment, as well as the tuberculosis symptom questionnaire. Our Executive Director will review new hire files on a quarterly basis to ensure completion and compliance.
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 consumer records (CRs) and an interview with the administrator and staff, the agency failed to provide the consumer with information explaining their rights to be involved in the service planning process and to receive services with reasonable accommodation of individual needs for five (5) of nine (9) records CFs reviewed. (CR#1, CF#2,CF#3, CF#4, and CF#5)
Findings include:
A review of consumer files (CFs) was conducted on March 20, 2025, between approximately 1:00 p.m. and 3:30 p.m., revealed the following:
CF#1 Start of care (SOC) 4/3/2023: Contained no documentation that the consumer was involved in the service planning process and received services with reasonable accommodation of individual needs. Service agreement signed on 12/15/22, four (4) months before SOC.
CF#2 SOC 3/16/24: Contained no documentation that the consumer was involved in the service planning process and received services with reasonable accommodation of individual needs. Service agreement signed on 11/23/22, one (1) year and four (4) months before the SOC.
CF#3 SOC 10/1/23: Contained no documentation that the consumer was involved in the service planning process and received services with reasonable accommodation of individual needs. Service agreement signed on 5/12/23, five (5) months before SOC.
CF#4 SOC 9/11/22: Contained no documentation that the consumer was involved in the service planning process and received services with reasonable accommodation of individual needs. Service agreement signed on 5/6/22, four (4) months before SOC.
CF#5 SOC 4/3/23: Contained no documentation that the consumer was involved in the service planning process and received services with reasonable accommodation of individual needs. Service agreement signed on 1/12/23, three (3) months before SOC.
An interview with the administrator and staff conducted on March 20, 2025, at approximately 4:15 pm confirmed the above.
Plan of Correction: Re-education was provided to all staff during our annual, mandatory staff training on all necessary onboarding participant documentation. All intake paperwork and service agreements will be completed once the participant has been approved for service. The participant will have an active authorization and a plan of care will be discussed at the time of the service agreement being signed and dated. The participant paperwork and intake will be done in a timely manner and not in advance of the approval for services. This will allow the participant to have active involvement in the planning of their services. Managers will examine all documentation after the intake meeting is complete. Our Executive Director will review new participant files on a quarterly basis to ensure compliance and completion of the new participant files.
611.57(b) LICENSURE
Prohibitions
Name - Component - 00
(b) No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry. The home care agency or home care registry may not require a consumer to endorse checks over to the home care agency or home care registry.
Observations:
Based upon review of consumer files (CFs) and an interview with agency owner, agency failed to include documentation of providing consumer with information regarding no individual affliliated with a home care agency or registry may not assume power of attorney (POA) or guardianship over a consumer utilizing the services of that home care agency or home care registry, including check endorsement over to Agency, for nine (9) out of nine (9) consumers (CF#1-CF#9).
Findings include:
A review of consumer files (CFs) was conducted on March 20, 2025, between approximately 1:00 p.m. and 3:30 p.m. revealed the following:
CF#1 Start of care (SOC) 4/3/2023: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#2 SOC 3/16/24: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#3 SOC 10/1/23: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#4 SOC 9/11/22: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#5 SOC 4/3/23: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#6 SOC 9/26/24: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#7 SOC 6/3/22: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#8 SOC 6/10/24: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
CF#9 SOC 1/26/23: No evidence of documentation provided to consumer concerning agency assuming POA or check endorsement over to agency.
An interview with the administrator and staff conducted on March 20, 2025 at approximately 4:15pm confirmed the above.
Plan of Correction:A+ Home Care will update the participant onboarding documentation. All staff were educated on "Consumer Prohibitions" during our annual, mandatory staff training. Staff were educated on regulation 611.57 stating that as an employee of A+ Home Care, any and all staff are unable to assume POA or Guardianship over a participant utilizing agency services. Staff will receive additional training on the updated paperwork as it is completed and added to all staff binders and participant folders to ensure all staff understanding. A+ Home Care will require all managers to review all new participant folders. Our Executive Director will review new participant files on a quarterly basis to ensure completion and compliance.
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 consumer files (CF) and an interview with the administrator and staff, the agency failed to provide the following information to the consumer, the consumer's legal representative, or a responsible family member prior to the start of services:
(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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry for nine (9) of the nine (9) CF's reviewed. (CF#1-9)
Findings include:
A review of consumer files (CFs) was conducted on March 20, 2025, between approximately 1:00 p.m. and 3:30 p.m., revealed the following:
CF#1 Start of care (SOC) 4/3/2023: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#2 SOC 3/16/24: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#3 SOC 10/1/23: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#4 SOC 9/11/22: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#5 SOC 4/3/23: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#6 SOC 9/26/24: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#7 SOC 6/3/22: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#8 SOC 6/10/24: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#9 SOC 1/26/23: Contained no documentation the consumer, the consumer's legal representative, or a responsible family member received the following: (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) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
An interview with the administrator and staff conducted on March 20, 2025, at approximately 4:15 pm confirmed the above.
Plan of Correction: Re-education was provided to all staff during our annual, mandatory staff training on all necessary onboarding documentation. The Authorization Letter will be updated to include the specific schedule and number of hours that home care services will be provided. The Authorization letter will also be updated to included the necessary fees with total cost for services on an hourly or weekly basis. The Participant Specific Orientation document will be updated to include the list of available services to be utilized by the participant and provided by the direct care worker along with all hiring and competency requirements applicable to the direct care worker employed by A+ Home Care. All staff will be re-educated on updated documents once they are implemented by A+ Home Care management. A+ Home Care will require all managers to review and sign off on all new participant folders to ensue completion of all documentation. Our Executive Director will review all new participant files on a quarterly basis to ensure the completion and compliance of the new files.
Initial Comments:
Based on the findings of an onsite state re-licensure survey conducted on March 20, 2025, A+ Home Care was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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