QA Investigation Results

Pennsylvania Department of Health
CARING HEART COMPANIONS, INC.
Health Inspection Results
CARING HEART COMPANIONS, INC.
Health Inspection Results For:


There are  4 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.



Initial Comments:


Based on the findings of an offsite complaint investigation survey completed 04/16/2020, Caring Heart Companions, Inc., was found to be in substantial 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 offsite complaint investigation survey completed 04/16/2020, Caring Heart Companions, Inc was found not to be in compliance with the following requirement(s) 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 a focused review of consumer record (CR), personnel files (PF), and homecare regulation, the agency failed to provide services within the scope of a licensed home care agency in accordance with consumer individual needs and preferences and guidance issued by state authorities for one (1) of one (1) CRs reviewed (CR1).

Specifically, Direct Care Workers (DCW) administered and assisted with administration of an Intramuscular Injection (Avonex Pen) for multiple sclerosis (MS). The agency failed to include Avonex Injection within the service agreement and was not noted as an authorized service on the service authorization form. Avonex Pen is an "injection for intramuscular use, single-dose prefilled auto injector pen....utilized for relapsing multiple sclerosis (MS).

Findings included:

Review of agency correspondence on April 16, 2020 at approximately 3:30 p.m. that detailed the exact role of the caregiver revealed "....There is an administration record related to the injection (CR1) received. I believe the log is still in (CR1)'s home and I do no have access to it. More than one aide received training. The aide who most recently administered the Avonex shot, (PF1), was trained by the MS Society......The role of the caregiver for this injection was to assist. The aide would get the injection out and give it to (CR1). (CR1) would place the shot at the injection site and our aide would place their hand over (CR1)'s to help steady it and help (CR1) push the plunger..."

A review of "Guidance to Home Care Agencies and Registries Licensed by Pennsylvania Department of Health" on April 20, 2020 at approximately 9:30 a.m. revealed "...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...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...DCWs may perform these non-skilled services/activities, provided they do not represent or hold themselves out as being licensed nurses, licensed registered nurses, registered nurses, or practical nurses; or use in connection with their names, any designation tending to imply they are licensed to practice nursing....Direct Care Worker: individual employed by a home care agency or referred by a home care registry to provide home care services to a consumer.
Home care services: the term encompasses the following activities:...(v) Specialized care- Nonskilled services/activities unique to the individual 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.

A 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."

A review of CR1 on 4/16/2020 at approximately 9:30 a.m. revealed:

CR1, start of services 7/2/2014, did not contain items numbered 1-4 as required by the Department and provided in "Guidance to Home Care Agencies and Registries Licensed by Pennsylvania Department of Health". Included within CR1:

" 07/01/2019-06/30/2020 " revealed "DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE):" medication management section was not marked as an authorized service.

" 07/01/2018-06/30/2019 " revealed " Revision (change in need) ....DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): ....Medication management-set up pills, verbal reminders. "

" 07/01/2016-6/30/2017 " revealed " DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): ... " medication management section was not marked as an authorized service.

" 07/01/2015-6/30/2016 " revealed " DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): ... " medication management section was not marked as an authorized service.

" Sept. 21, 2014-June 30, 2015 ...Revision (change in need) ...DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): ... " medication management was not marked as an authorized service.

" July 21, 2014-June 30, 2015 ...Revision (change in need) ... " DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): ... " medication management was not marked as an authorized service.

" July 1, 2014 - June 30, 2015 ...New referral ...DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): ... " medication management was not marked as an authorized service.

A review of provider care logs from March 2019 through March 2020 on April 16, 2020 at approximately 3:30 p.m. revealed the term "Meds" appeared handwritten separate from "med reminder" for the "Week Ending" 8/24/19, 10/26/19, 11/16/19, 12/28/19, and 2/1/2020. The term "shot" appeared hand written separate from "med reminder" was handwritten on care logs for the "Week Ending" 7/20/19, 8/21/2019, and 8/28/2019.

Correspondence from agency dated April 16, 2020 confirmed the findings.
















Plan of Correction:

To protect the consumer in the future, the Agency Administrator will verify compliance with all requirements needed in regards to 611.4(c) Licensure. Specifically, any assistance with Specialized Services/non-skilled activities will be performed 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."

To monitor our performance and ensure solutions/remedies are sustained, we will implement the use of a new "Specialized Services" check-off form. This form will become part of the sign on process and will be used any time a consumer requires new Specialized Services. This form will be in each consumer file and reviewed annually.

The individual responsible for monitoring the process will be the Agency Administrator, Lori Reed.



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 direct care worker (DCW) personnel file (PF), consumer file (CF), agency documentation and agency correspondence, it was determined that the agency failed to ensure "Avonex Administration Supervision Training" was completed for three (3) of four (4) personnel files reviewed (PF2 - PF4) that cared for CF1 who was receiving specialized services.

Findings Included:

A review of CF1 was conducted on 4/16/2020 at approximately 10:30 a.m. that revealed a start of care date of 07/02/2014. Per medication list CF1 was receiving "Avonex Pen...1 @ week".

A review of DCW personnel files and was conducted on 4/16/2020 between 12:30 p.m. and 2:00 p.m.

PF2 was hired on 12/8/15, and was providing care to CF1 during time frame March 2019 through March 2020 per care logs. PF did not contain documentation to show that "Avonex Admistration Supervision Training" was completed for the specialized service provided to CF1.

PF3 was hired on 1/23/20 and was providing care to CF1 during time frame March 2019 through March 2020 per care logs. PF did not contain documentation to show that "Avonex Administration Supervision Training" was completed for the specialized service provided to CF1.

PF4 was hired on 7/6/15 and was providing care to CF1 during time frame March 2019 through March 2020 per care logs. PF did not contain documentation to show that "Avonex Admistration Supervision Training" was completed for the specialized service provided to CF1.

A review of provider care logs from March 2019 through March 2020 on April 16, 2020 at approximately 3:30 p.m. revealed the term "Meds" appeared handwritten separate from "med reminder" for the "Week Ending" 8/24/19, 10/26/19, 11/16/19, 12/28/19, and 2/1/2020. The term "shot" appeared hand written separate from "med reminder" was handwritten on care logs for the "Week Ending" 7/20/19, 8/21/2019, and 8/28/2019.

Correspondence with the agency on April 16, 2020, confirmed the above findings.








Plan of Correction:

To protect the consumer and be in compliance with training and documentation requirements, new procedure practices will be put into place. All Direct Care Workers who provide Specialty Services will be trained and full documentation will be kept in their personnel file.

In this case, the Findings are not accurate. Findings state 3 of the 4 personnel that cared for CF1 did not receive specialized training. That is because they did not administer the shot. Not all Direct Care Workers who cared for CF1 administered the shot. The DCW who administered the shot during the time period in question was trained and documented. Other DCW's who were trained and administered the shot are no longer employed and their file was not asked for.

The hand written notes on the Care Logs were not the official record for the Avonex administration. The official record was kept at the client home. Our investigation determined the record was taken to the hsopital to remain with the Consumer.

To correct this lack of documentation at the Home Care Agency, we will implement new paperwork to document any Specialized Care being performed and it will be maintained in the Consumer file.

The Agency Supervisor, Kari Bickel, will be responsible for maintaining complete and accurate personnel files to include all required training records.

She will also keep complete Consumer files to reflect any Specialized Services performed.

The Supervisor will audit the charts every 90 days in order to ensure compliance is sustained.


611.57(d) LICENSURE
Documentation

Name - Component - 00
(d) The home care agency or home care registry shall maintain documentation on file at the agency or registry of compliance with the requirements of this section which shall be available for Department inspection.

Observations:


Based on review of agency documentation and a focused consumer file review, and correspondence with agency owner, the agency failed to ensure documentation for care or services involved "specialized services" that were provided by the agency. Specialized services were not documented on "Service Agreement" or authorized on "OLTL (Office of Long-Term Living) Service Authorization Form" for one (1) of one (1) consumer files reviewed. CR1

Findings:

Review of agency correspondence on April 16, 2020 at approximately 3:30 p.m. detailing role of caregivers for CR1 revealed "....There is an administration record related to the injection (CR1) received. I believe the log is still in (CR1)'s home and I do no have access to it. More than one aide received training. The aide who most recently administered the Avonex shot, (PF1), was trained by the MS Society......The role of the caregiver for this injection was to assist. The aide would get the injection out and give it to (CR1). (CR1) would place the shot at the injection site and our aide would place their hand over (CR1)'s to help steady it and help (CR1) push the plunger..."

Review of CR1 on April, 16 2020 between approximately 9:30 a.m. through 11:00 a.m. revealed a signed "service plan and agreement" dated 7/2/14 that did not contain "specialized services" or mention of Avonex injection. An updated service agreement was not provided by the agency. Updated "OLTL Service Authorization Form" revealed:

" OLTL Service Authorization Form HCBS Waiver Programs ...6/16/2019 ...Annual Renewal...Independence Waiver ....SERVICE AUTHORIZED (TYPE): ....Personal assistance services (agency) ....SERVICE PROVISION DATES ...7/01/2019-06/30/2020 ...DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): Bathing-supervision, sometimes hands on assist, Hair care-at times, Dressing-supervision, at times assistance ...Meal Preparation-max assist, Eating/drinking-set up, Laundry-max assist, Shopping-carry packages for consumer, transport consumer for errands and shopping ....Social/Leisure activities-minimal assist ...Caring for personal possessions-hands on assist, Obtaining seasonal clothing-minimal assist ...Ambulating-supervision ...Transfers-supervision, some assistance " . The details of current waiver for consumer did not contain indication or authorization for "specialized services", specifically Avonex administration or assistance.
" OLTL Service Authorization Form HCBS Authorization Form HCBS Waiver Programs ...9/20/2018 ...Revision (change in need) ...Independence Waiver ...Personal assistance services (agency) ...SERVICE PROVISION DATES ...7/01/2018-6/30/2019 ...DETAILS OF CURRENT NEEDS: THE CONSUMER WILL NEED ASSISTANCE WITH THE FOLLOWING ADL/IADLS (SCOPE): Bathing-supervision, sometimes hands on assist, Hair care-hands on assistance with brushing hair daily, Dressing-supervision, at times assistance ...Meal preparation-max assist, Eating/drinking-may need hands on assistance with feeding at times, Laundry-max assist, Light housekeeping-max assist, Shopping-carry packages for consumer, transport consumer for errands and shopping, Medication management-set up pills, verbal reminders ....Social/leisure activities-minimal assist ...Securing transportation-assist with transportation to doctor appointments, Appointment scheduling-make calls for appointment, Caring for personal possession-hands on assist, Obtaining seasonal clothing-minimal assist ...Ambulation-supervision ....Toileting-hands on assist on and off toilet ...Transfers-supervision, some assistance, Incontinence Care-consumer has accidents at times ...Wound care-open wounds on foot/foot care/dress wounds " The details for consumer did not contain indication for "specialized services", specifically Avonex administration or assistance.
Electronic correspondence with the agency on April 16, 2020 confirmed the above findings.






Plan of Correction:

The Agency Administrator will review all OLTL Service Authorization Forms to verify any Specialized Services requested by the consumer is listed. Administrator will also ensure Consumer has given written authorization on the "Service Agreement" for any Specialized Services.

To be sure proper guidelines are followed, a new "Specialized Services" check off form will be included in each Consumer file. If any Specialized Services are required, the Agency Administrator, Lori Reed, will use the new form as a guide to be certain Specialized Services are documented on the Service Agreement and also listed on the OLTL Service Authorization Form.

The Supervisor will audit the charts every 90 days in order to ensure compliance is sustained.


Initial Comments:


Based on the findings of an offsite complaint investigation survey completed 04/16/2020, Caring Heart Companions, Inc., was found to be in compliance with the requirements of 35 P.S. 448.809 (b).





Plan of Correction: