Initial Comments:
Based on the findings of an onsite state re-licensure survey completed 8/5/24, Bayada Home Health 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 state re-licensure survey completed 8/5/24, Bayada Home Health Care was found not to be in compliance with the 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:
611.55(d) LICENSURE
Competency Requirements
Name - Component - 00
(d) The home care agency or home care registry shall include documentation of the direct care worker's satisfactory completion of competency requirements in the direct care worker's file.
Observations:
Based on a review of personnel files (PFs) and interviews with staff (EMP) the agency failed to maintain documentation of a direct care worker's (DCW) completed competency requirements for two (2) of seven (7) PFs reviewed. (PFs 2 and 3)
A review of PFs on 8/2/24 between approximately 2:00 pm to 4:00 pm revealed:
PF2: Date of Hire (DOH): 5/15/24. Start of Service (SOS): 6/12/24. PF2 contained a Family Caregiver Competency Evaluation Skills Checklist which failed to include training in the task of " Assist with Elimination and Toileting. "
PF3: DOH: 4/5/24. SOS: 4/24/24. PF3 contained a Family Caregiver Competency Evaluation Skills Checklist which failed to include training in the task of " Assist with Elimination and Toileting. "
A review of the agency document Home Health Aide Competency Exam for Home Care Licensed and Dually Licensed Offices - PA on 8/2/24 revealed that the written competency test failed to contain a review of the required personal care topic of Toileting.
Interviews with EMP1 (Administrator), EMP2 (Clinical Manager), and EMP3 (Recruiting Manager) revealed that PF2 and PF3 did not receive competency skill reviews in the area of Toileting at the time of hire. The findings were reviewed during an exit interview on 8/5/24 at 2:30 pm with EMP1, EMP2, EMP3,
EMP4 (Senior Manager Accreditation Policy Support), and EMP5 (Director of Regulatory Support).
Plan of Correction:Based on an analysis of the specific deficiencies cited, the corrective plan and actions taken are to address the lack of demonstrated knowledge resulting in failure to maintain documentation of a Direct Care Worker's (DCW) completed competency requirements. The plan of correction will be completed through comprehensive focused education.
By 8/30/2024, all active Direct Care Workers, including family caregivers, will complete annual competency requirements which will include elimination and toileting.
By 8/16/2024, the Director/designee will educate all office staff on policy Agency Direct Care Worker (DCW) Program - PA with emphasis on the requirement for DCW competency to include elimination and toileting.
Effective 9/2/2024 for three months, the Director/designee will review weekly the records of all new hires to ensure initial competency includes elimination and toileting. The expected compliance threshold will be 100%. Failure to achieve 100% will be addressed through focused education with the individual staff members by the Director/designee.
The Director has overall responsibility for implementation and oversight of the plan.
Initial Comments:
Based on the findings of an onsite state re-licensure survey completed 8/5/24, Bayada Home Health Care was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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