Initial Comments:
Based on the findings of an unannounced onsite complaint investigation survey, conducted on January 9, 2024, off site on January 17, 2024 January 19, 2024 and January 24, 2024, Wellness Homecare Company, 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:
611.4(c) LICENSURE
Requirements for HCA and HCR
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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 review of personnel files (PF), an interview with the administrator, the City of Philadelphia Memorandum: Emergency Regulation Governing The Control and Prevention of COVID-19 Mandating Vaccines for Healthcare Workers and In Higher Education, Healthcare, and Related Settings ( " Vaccine Mandate Regulation " ) dated August 16, 2021; an Update to Mandatory Healthcare Vaccination from the City of Philadelphia, dated October 12, 2021; and a third update from the City of Philadelphia, Division of Disease Control dated October 5, 2022 pertaining to updates to vaccination and masking requirements for health care workers, the home care agency failed to provide evidence of direct care worker vaccination status or direct care worker exemption. The requirement was not evident in two (2) of four (4) PF's reviewed: (PF# 1 and 2).
Findings include:
The City of Philadelphia Memorandum - Emergency Regulation Governing the Control and Prevention of COVID-19 Mandating Vaccines for Healthcare Workers and In Higher Education, Healthcare and Related Settings ( " Vaccine Mandate Regulation " ), dated August 16, 2021, and reviewed October 6, 2022 at approximately 1:30 PM provides the following definitions: 1. "Covered Healthcare Personnel - an individual who falls into one or more of the following categories - a) an employee, contract workers, student or volunteer affiliated with a Healthcare Institution who performs duties in a builing where patients, clients or their visitors are present; b) a Healthcare Worker;" 2. "Healthcare Institution - any person or entity that employs, coordinates, or otherwise engages the services of Covered Healthcare Personnel in the City;' 3. "Healthcare Worker - an individual who provides Healthcare Related Services in person to patients or clients.." The regulation further states, "Effective October 15, 2021, no Healthcare Worker may work at a Healthcare Institution or provide Healthcare Related Services to a patient or client in Philadelphia unless such Healthcare Worker (i) has been Fully Vaccinated; or (ii) has been granted an exemption under paragraph 3 of this Regulation from any applicable Healthcare Institution for whom such individual works and documents ongoing compliance with one or more accommodation(s) set forth in paragraph 4 of this regulation. Paragraph 3 - Exemptions: For the purposes of this Regulation only, a Healthcare Institution subject to this Regulation shall grant a Covered Individual an exemption from the vaccination requirements of this Regulation if such individual qualified for one or both of the exemptions and agrees in writing to abide by the accommodation required by the Healthcare Institution. Medical Exemption - for the purpose of this Regulation only, an exemption shall be granted if the Healthcare Institution determines that the administration of any COVID-19 vaccine is contraindicated because the administration would be detrimental to the health of the Covered Individual (CI). A CI shall request an exemption by submitting a certification from a licensed healthcare provider to the Healthcare Institution certifying that the exemption applies and stating the specific reason that the vaccine is contraindicated for the CI. Such certification must be signed by both the healthcare providers and the CI...... Religions Exemption - For the purpose of this Regulation only, an exemption shall be granted if the CI certifies in writing that such individual has a sincerely held religious belief that precludes such individual from receiving the COVID-19 vaccination. Such certification must be signed the CI. Accommodations: Routine Testing - For Healthcare Institutions and Healthcare Workers - Requiring exempt Covered Healthcare Personnel to submit to either a PCR or antigen test at least twice per week, timed appropriately under the circumstances."
The City of Philadelphia Updates to Mandatory Healthcare Vaccination, dated October 12, 2021 and reviewed October 6, 2022 at approximately 1:30 PM, provided timeline updates for three groups......"Group Two: Group Two includes those designated as healthcare worker or healthcare institution worker that are NOT working in a hospital or LTCF. Employers of workers in all 3 groups must complete a written policy detailing how the employer will verify compliance with extended deadlines." The Update also provided the following definitions: 1. "Direct Care Worker: a) the individual employed by a home care agency or referred by a home care registry to provide home care services to a consumer; or b) a person employed for compensation by a provider or participant who provides personal assistance services or respite services. 2. Healthcare Workers: any individual involved in providing any of the following healthcare regulated services in-person to patients or clients or any individual working in a Healthcare Institution....3. Personal Care, which may include services provided in a personal care home or at the home of a patient or client....." The Update further clarified the following: 1. " Who is Covered Under the Mandate: Healthcare Institution Workers.....includes Direct Care Workers; 2. Limited Vaccination Deadline Extensions..... All other Healthcare Workers and Healthcare Institution Workers are required to receive at least one dose of vaccine in a two-dose vaccination series or the single dose in a one-dose series by October 22, 2021 and comply with all Interim Precautions. The second dose of a two-dose vaccine must be received by November 22, 2021. All workers hired after the vaccination deadline must receive at least one shot in a two-dose series or a single dose in a one-dose series before beginning in-person shifts. Final doses must be received within one month of hire. 3. Limited Home-Based Services Enforcement Exception - The Department will not enforce the Healthcare Worker Vaccine Mandate against certain individuals providing care for a Relative as defined below UNTIL the end of calendar year 2021 or until federal mandates require vaccinations for these individuals, whichever occurs first. Such individuals should be treated as employee who have received a valid religious or medical exemption. 4. Full Summary: The Emergency Regulation Governing the Control and Prevention of COVID-19 Mandating Vaccines for Healthcare Workers and In Higher Education, Healthcare and Related Settings ("Vaccine Mandate Regulation"), effective August 16, 2021, will not be enforced against a Direct Care Workers employed by a Pennsylvania licensed Home Care Agency or Home Care Registry or Participant or a Direct Support/Service Professional employed by a Provider or Participant to provide Personal Assistance Services (Instrumental Activities of Daily Living or Activities of Daily Living) or Respite Services to a Relative in such Relative's home until December 31, 2021 or until such time as the Centers for Medical and Medicaid Services (CMS) issue federal directives on the application of mandatory vaccines to such individuals, whichever occurs first. The term "Direct Care Worker" may have the definition provided in 28 PA. Code 611.5 or 55 PA. Code 52.3, depending upon employing entity and services provided. 5. Exemptions - An individual may not simply opt out of vaccination. The must submit a medical or religions exemption to the Healthcare Institution where such individual works according to policies set by the Institution. Healthcare Institutions and organizations that are granting exemptions must create appropriate exemption policies to implement this regulation. Healthcare Institutions are required to keep records of vaccination status of all vaccinated individuals, exemptions requested and granted, and participation in accommodations granted."
The City of Philadelphia Updates to Vaccination and Masking Requirements for Healthcare Workers dated October 5, 2022 and reviewed October 5, 2022 at approximately 10:00 AM states that healthcare institutions are no longer required to perform asymptomatic screening testing of exempt individuals.
A review of PF's was conducted on January 17, 2024, from approximately 12:00 pm to 12:36 pm.
PF #1, Date of Hire: 12/4/2023, did not contain any documentation that the employee received COVID-19 vaccination(s) and did not contain any documentation of exemption.
PF #2, Date of Hire: 12/4/2023, did not contain any documentation that the employee received COVID-19 vaccination(s) and did not contain any documentation of exemption.
An interview with the administrator conducted on January 17, 2024, at approximately 2:04 pm confirmed the above findings.
Plan of Correction:PF #1 and PF #2 were both hired on December 4, 2023, as a transfer from another provider with a Consumer Direct Care Worker (DCW)/family member. They both only worked for Wellness for three weeks before quitting. Wellness continuously requested that both provide evidence of their COVID-19 vaccination status numerous times, but they both had continuous excuses.
Wellness received notification of the consumer's transfer on December 2, 2023, with a start date of December 4, 2023. Wellness did not prohibit the DCW/family member from providing care because Wellness knew it was more important to ensure continuity of care for the consumer.
The consumer and DCW/family members transferred to another provider on December 29, 2023.
Wellness Policy will be updated to include:
Regulation 611.14 Requirements for HCA and HCR
The administrator will inform DCWs of the missing documentation five days before employment to allow DCWs to provide the required vaccination documentation or medical/exemption. Failure to provide the document will prohibit the DCW from working with Wellness consumers.
Wellness will not allow new employees, including transferring DCW/family members, to start working with consumers until vaccination documentation or exemptions are provided to Wellness. Verification of vaccination Documentation will be kept in all employees' files.
Effective February 25, 2024, the administrator will maintain an employee spreadsheet with all dates of compliance with vaccination status. The spreadsheet will be readily available for local, state, and federal surveyors within ten days of accepting this POC.
The administrator shall compare the spreadsheet with the employee's file quarterly to discover and reconcile any employee non-compliance issues within ten days.
The Policy shall apply to hiring, transferring, or promoting DCWs.
611.51(a) LICENSURE
Hiring or Rostering Prerequisites
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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 a review of personnel files (PF) and an interview with the administrator, the agency failed to provide documentation of conducting a face to face interview for two (2) of four (4) PF's, (PF #1 and 2). Also the agency failed to provide documentation of obtaining two satisfactory and verifiable references for two (2) of the four (4) PF's, (PF # 1 and 2).
Findings include:
A review of PF's was conducted on January 17, 2024 from approximately 12:13 pm to 12:28 pm.
PF #1 Date of Hire 12/4/2023 did not contain any documentation of a completed face to face interview. Also did not contain any documentation of two satisfactory and verifiable references.
PF #2 Date of Hire 12/4/2023 did not contain any documentation of a completed face to face interview. Also did not contain documentation of two satisfactory and verifiable references. One reference was a family member.
An interview with the administrator on January 17, 2024 at approximately 2:00 pm confirmed the above findings.
Plan of Correction:Face-to-face interviews were not conducted with PF #1 and PF #2 because Wellness was given a 2-day notice before the effective date of the services. PF #1 and PF #2 were both DCW/family members.
Satisfactory reference checks were not conducted on PF #1 and PF #2 because Wellness was given a 2-day notification of the effective date of the services. PF #1 and PF #2 were both DCW/family members.
Wellness received notification of the consumer's transfer on December 2, 2023, with a start date of December 4, 2023. Wellness did not prohibit the DCW/family member from providing care because Wellness knew it was more important to ensure continuity of care for the consumer.
PF #1 and PF #2 were both hired on December 4, 2023, as a transfer from another provider with a Direct Care Worker (DCW)/family member. They both only worked for Wellness for three weeks before quitting. Wellness continuously requested that both appear at the Wellness business office for a face-to-face interview and reference information, but they both had continuous excuses for not appearing.
Wellness received notification of the consumer's transfer to Wellness on December 2, 2023, with a start date of December 4, 2023. Wellness did not prohibit the DCW/family member from providing care because Wellness knew it was essential to ensure continuity of care for the consumer.
The consumer and PF #1 and PF #2 (DCW/family members) transferred to another provider on December 29, 2023.
Wellness Policy will be updated to include:
Regulation 611.51(a) Hiring or Rostering Prerequisites
The administrator will schedule and conduct face-to-face interviews with all new employees, including those transferred with consumer/family members. Within five days of notification of a potential DCW transferring with a consumer/family member, the administrator will require the potential DCW to meet the administrative for an in-person interview. The administrator will document the interaction in the DCW employee record.
The administrator will require the DCW to provide reference of at least two references before working with Wellness consumers, including those being transfer with consumer/family members. Within five days of notification of a potential DCW transferring with a consumer/family member, the administrator will require the potential DCW to provide the names and contacts of at least two former employers. The administrator will call the potential DCW's references and document whether the former employer of confirms the potential employee's abilities to provide home care services in the DCW employee record.
The administrator has created a spreadsheet with all employee's dates of compliance with vaccination status. The spreadsheet will be readily available for state and local surveyors within ten days of accepting this POC.
The administrator shall review the spreadsheet with the employee's file to discover and reconcile any employee non-compliance issues.
The administrator shall conduct the review quarterly. The review findings will be readily available for federal, state, and local surveyors.
The Policy shall apply to hiring, transferring, or promoting DCWs.
611.52(a) LICENSURE
Criminal Background Checks
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The home care agency or home care registry shall require each applicant for employment or referral as a direct care worker to submit a criminal history report obtained at the time of application or within 1 year immediately preceding the date of application.
Observations:
Based on a review of personnel files (PF) and an interview with the administrator, the agency failed to obtain a Pennsylvania State Police Criminal Background report at the time of application or within one year immediately preceding the date of application for four (4) of four (4) PF's reviewed, (PF # 1, 2, 3 and 4).
Findings include:
A review of PF' s was conducted on January 17, 2024 from approximately 11:55 am to 12:48 pm and January 24, 2024 from approximatley 3: 15 pm to 3:38 pm.
PF #1, Date of Hire: 12/4/2023, did not contain any documentation of a Pennsylvania State Police Criminal Background obtained at the time of application or within one year immediately preceding the date of application.
PF #2, Date of Hire: 12/4/2023, did not contain any documentation of a Pennsylvania State Police Criminal Background obtained at the time of application or within one year immediately preceding the date of application.
PF #3, Date of Hire: 12/8/2022, did not contain any documentation of a Pennsylvania State Police Criminal Background obtained at the time of application or within one year immediately preceding the date of application.
PF #4, Date of Hire: 10/13/2022, did not contain any documentation of a Pennsylvania State Police Criminal Background obtained at the time of application or within one year immediately preceding the date of application.
An interview with the administrator on January 24, 2024, at approximately 3:42 pm confirmed the above findings
Plan of Correction:Criminal Background Checks were not completed for PF #1 and PF #2 due to being transferred with the consumer.
PF #1 and PF #2 are no longer employed with Wellness. They were both hired on December 4, 2023, as a transfer from another provider with a Direct Care Worker (DCW)/family member. They both only worked for Wellness for three weeks before quitting. Wellness continuously requested that both provide copies of their Criminal Background Checks numerous times, but they both had continuous excuses.
Wellness received notification of the consumer's transfer on December 2, 2023, with a start date of December 4, 2023. Wellness did not prohibit the DCW/family member from providing care because Wellness knew it was more important to ensure continuity of care for the consumer.
The consumer and DCW/family members transferred to another provider on December 29, 2023.
Proper Criminal Background Checks were not completed for PF #3 and PF #4 in error.
PF #3 and PF #4 did not have the regulatory required Criminal Background Checks from PA Patch.
PF #3 is no longer employed with Wellness, effective September 1, 2023.
PA Patch was completed for PF #4 on January 24, 2024, and is currently under review.
Wellness Policy will be updated to include:
Regulation 611.52(a) Criminal Background Checks
The administrator will require all potential employees to provide copies of the criminal history reports and child abuse clearances five days prior to giving care to Wellness consumers. The administrator will ensure all Pennsylvania State Police background checks will have been completed upon hire and make sure documentation is in the employee's files.
Effective immediately, the administrator will maintain an employee spreadsheet with all dates of compliance with criminal background checks. The spreadsheet will be readily available for local, state, and federal surveyors within ten days of the acceptance of this POC.
On a quarterly basis, the administrator shall review the spreadsheet with the employee's file to discover and reconcile any employee non-compliance issues.
The Policy shall apply to hiring, transferring, or promoting the applicant who would pose an unreasonable risk to the business, its employees, or its customers and vendors.
611.55(a) LICENSURE
Competency Requirements
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Prior to assigning or referring a direct care worker to provide services to a consumer, the home care agency or home care registry shall ensure that the direct care worker has done one of the following: (1) Obtained a valid nurse ' s license in this Commonwealth;
(2) Demonstrated competency by passing a competency examination developed by the home care agency or home care registry which meets the requirements of subsection (b)and (c).
(3) Has successfully completed one of the following:
(i) A training program developed by a home care agency, home care registry, or other entity which meets the requirements of subsection (b) and (c).
(ii) A home health aide training program meeting the requirements of 42 C.F.R. 484.36 (relating to the Conditions of Participation; Home Health Aide Services).
(iii) The nurse aid certification and training program sponsored by the Department of Education and located at www.pde.state.pa.us.
(iv) A training program meeting the training standards imposed on the agency or registry by virtue of the agency ' s or registry ' s participation as a provider in a Medicaid waiver or other publicly funded program providing home and community based services to qualifying consumers.
(v) Another program identified by the Department by subsequent publication in the Pennsylvania Bulletin or on the Department ' s website.
Observations:
Based on a review of personnel files (PF) and an interview with the administrator, prior to assigning or referring a direct care worker to provide services to a consumer, the home care agency or home care registry did not show evidence that the direct care worker had completed one of the following: 1) Obtained a valid nurse ' s license in this Commonwealth; (2) Demonstrated competency by passing a competency examination developed by the home care agency or home care registry which meets the requirements of subsection (b)and (c). (3) Has successfully completed one of the following: (i) A training program developed by a home care agency, home care registry, or other entity which meets the requirements of subsection (b) and (c). (ii) A home health aide training program meeting the requirements of 42 C.F.R. 484.36 (relating to the Conditions of Participation; Home Health Aide Services). (iii) The nurse aid certification and training program sponsored by the Department of Education and located at www.pde.state.pa.us. (iv) A training program meeting the training standards imposed on the agency or registry by virtue of the agency ' s or registry ' s participation as a provider in a Medicaid waiver or other publicly funded program providing home and community based services to qualifying consumers. (v) Another program identified by the Department by subsequent publication in the Pennsylvania Bulletin or on the Department 's website for three (3) of four (4) PF's: (PF# 1, 2 and 3).
A review of personnel files conducted on January 17, 2024 from approximately 12:28 pm to 12:48 pm and January 24, 2024 from approximately 3:37 pm to 4:00 pm.
PF #1: Date of Hire 12/4/2023 did not contain any documentation of a completed initial competency conducted by the agency.
PF #2: Date of Hire 12/4/2023 did not contain any documentation of a completed initial competency conducted by the agency.
PF #3: Date of Hire 12/8/2022 did not contain any documentation of a completed initial competency conducted by the agency.
An interview with the administrator on January 24, 2024 at approximately 4:00 pm confirmed the above findings.
Plan of Correction:
Initial Competency exams were not completed for PF #1 and PF #2 because they were DCW/family members transferred from another provider with the consumer.
PF #1 and PF #2 are no longer employed with Wellness. They were both hired on December 4, 2023. They both only worked for Wellness for three weeks before quitting. Wellness continuously requested that both complete the Initial Competency exams numerous times, but they both had continuous excuses.
Wellness received notification of the consumer's transfer to Wellness on December 2, 2023, with a start date of December 4, 2023. Wellness did not prohibit the DCW/family member from providing care because Wellness knew it was important to ensure continuity of care for the consumer.
The consumer and DCW/family members transferred to another provider on December 29, 2023
The initial Competency exam was not completed with PF #3 in error.
PF #3 transferred with a consumer from another provider and is no longer employed with Wellness.
Wellness Policy will be updated to include:
Regulation 611.55(a) Competency Requirements
Potential DCWs will not provide any care to any consumers until they have completed the initial competency exam conducted by Wellness. The documentation verifying the successful completion of the competency requirements will be maintained, and the employees will be responsible for the initial and or competency reviews.
Potential DCWs will be required to successfully complete the initial competency exam five days prior to providing care to Wellness consumers.
DCWs will be required to successfully complete the annual competency exam 30 days prior to the DCW's anniversary date of hire.
The administrator will be responsible for tracking and maintaining Potential DCW and DCW initial evaluation and annual reviews. The administrator will ensure all competency exam documentation is in the employee's records.
Effective immediately, the administrator will maintain an employee spreadsheet verifying all dates of compliance with initial competency exams. The spreadsheet will be readily available for local, state, and federal surveyors within ten days of the acceptance of this POC.
On a quarterly basis, the administrator shall review the spreadsheet with the employee's file to discover and reconcile any employee non-compliance issues.
The Policy shall apply to hiring, transferring, or promoting DCWs.
611.55(e) LICENSURE
Competency Requirements
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The competency review must occur at least once per year after initial competency is established, and more frequently when discipline or other sanction, including, for example, a verbal warning or suspension, is imposed because of a quality of care infraction.
Observations:
Based on a review of personnel files (PF) and an interview, with the administrator, the agency failed to provide documentation of an annual competency evaluation for one (1) of four (4) PF's reviewed, (PF # 3).
Findings include:
A review of PF's was conducted on January 24, 2024 from approximately 3:40 pm to 3:52 pm.
PF #3, Date of Hire: 12/8/2022, did not contain any documentation of an annual competency evaluation for 2023.
An interview with the administrator on January 24, 2024 at approximately 4:00 pm confirmed the above findings.
Plan of Correction:PF #3 annual competency exam was not completed because the DCW had not been employed for a year before her separation.
PF #3 was hired on December 8, 2022, and resigned on September 1, 2023. She is no longer employed with Wellness. Annual review was not required for another 90 days.
Wellness Policy will be updated to include:
Regulation 611.55(e) Competency Requirements
DCW workers will be notified 60 days prior to their annual start date that they will be required to complete an Annual competency evaluation. After one year of service, DCW will not be allowed to work with consumers until the completion of the annual competency evaluation. In the event that a direct care worker needs "special supervision" that requires competency evaluations, more than annually, competency evaluations will be completed semiannually and placed in the employee's file.
DCWs will be required to successfully complete the annual competency exam 30 days prior to the DCW's anniversary date of hire.
The administrator will be responsible for maintaining and tracking the direct service worker's initial evaluation and annual reviews.
The administrator will ensure all competency exam documentation is in the employee's files.
Effective immediately, the administrator will maintain an employee spreadsheet with all dates of compliance with initial annual competency exams. The spreadsheet will be readily available for local, state, and federal surveyors within ten days of the acceptance of this POC.
On a quarterly basis, the administrator shall review the spreadsheet with the employee's file to discover and reconcile any employee non-compliance issues.
The Policy shall apply to hiring, transferring, or promoting DCWs.
611.56(a) LICENSURE
Health Screening
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The screening shall be conducted in accordance with CDC guidelines for preventing the transmission of mycobacterium tuberculosis in health care settings. The documentation must indicate the date of the screening which may not be more than 1 year prior to the individual's start date.
Observations:
Based on a review of personnel files (PF), recommendations from the Centers for Disease Control (CDC), an interview with the administrator the agency failed to provide documentation of an initial tuberculosis screening for two (2) of four (4) PF's, (PF # 1 and 2). Also agency facility did not contain documentation that the individual had completed symptom screen questionnaire and an individual TB risk assessment for two (2) of four (4) PF's, (PF # 1 and 2).
Findings include:
The CDC guidelines state that all Health Care Workers (HCW) should received baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) of a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. After baseline testing for infection with tuberculosis, HCWs should receive TB screen annually. HCWs with a baseline 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).
A review of PF's was conducted on January 17, 2024 starting at approximately 11:59 am to 12:16 pm.
PF # 1 DOH 12/4/2023 did not received baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) of a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. Also did not contain documentation of completion of a tuberculosis (TB) symptom screen questionnaire nor a TB risk assessment upon hire.
PF # 2 DOH 12/4/2023 did not received baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) of a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. Also did not contain documentation of completion of a tuberculosis (TB) symptom screen questionnaire nor a TB risk assessment upon hire.
An interview conducted with the administrator on January 17, 2024 starting at 1:00 pm confirmed the above findings.
Plan of Correction:PF #1 and PF #2 were both hired on December 4, 2023, as transfers from another provider with a consumer/family member. They both only worked for Wellness for three weeks before quitting.
Wellness continuously requested that they both provide evidence of their mycobacterium tuberculosis screening, numerous times but they both had continuous excuses.
Wellness received notification of the consumer's transfer on December 2, 2023, with a start date of December 4, 2023.
Wellness did not prohibit the consumer/family member from providing care because Wellness knew it was important to ensure continuity of care for the consumer.
The consumer and DCW/family members transferred to another provider on December 29, 2023.
Wellness Policy will be updated to include:
Regulation 611.56(a)
The administrator will inform Potential DCWs of the missing documentation five days prior to employment to give DCWs the opportunity to provide the required proof of TB Screening documentation. Failure to provide the document will prohibit the DCW from working with Wellness consumers.
Wellness will not allow new employees to start working with consumers until vaccination documentation or exemptions are provided. Documentation will be kept in all employee's files.
Effective February 25, 2024, the administrator will maintain an employee spreadsheet with all dates of compliance with TB Screening status. The spreadsheet will be readily available for local, state, and federal surveyors within ten days of the acceptance of this POC.
On a quarterly basis, the administrator shall compare the spreadsheet with the employee's file to discover and reconcile any non-compliance issues with the employee within ten days.
The Policy shall apply to hiring, transferring, or promoting DCWs.
611.57(a) LICENSURE
Consumer Rights
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(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 files (CF) and an interview with the administrator, the agency failed to provide documentation that the consumer received 10 calendar days advance written notice of the agency's intent to terminate services for one (1) of four (4) CF's, (CF # 1).
Findings include:
A review of CF's was conducted on January 17, 2024 from approximately 9:45 am to 10:50 am.
CF #1, Start of Care: 12/4/2023, did contain documentation in consumer file stating consumer received information that the agency will provide at least 10 calendar days advance written notice of the agency's intent to terminate services. The administrator verbally terminated service over the phone but did not provide in writing the 10 day notice of agency's intent to terminate services.
An interview with the administrator conducted on January 17, 2024 at approximately 10:50 am confirmed the above findings.
Plan of Correction:Wellness did not mail the consumer the required 10-day termination letter because there was some confusion with the separation. The separation of the consumer is due to the consumer and her DCW/family members. Although Wellness consistently had to reprimand the DCWs/family members for the failure to provide mandatory paperwork and signing in/out of shifts, Wellness was not planning on terminating the consumer and DCW/family members from services. The separation was initiated by the consumer and her DCW/family members who no longer desired Wellness's services. The administrator attempted numerous times to get the consumer and DCW/family members not to end services with Wellness, but they were insistent that they separate immediately. As a result, Wellness reluctantly agreed to allow the consumer and DCW/family members to transfer without the required ten-day notifications. It must be noted that Wellness did not initiate the separation.
Wellness Policy will be updated to include:
Consumer Rights 611.57(a)
Upon notification of all volunteer separation and terminations, a 10-day volunteer separation or terminations letter will be mailed to the consumer and support coordinator. The letter will include the effective date of the separation and information on how Wellness can be involved in the continuity of care planning process.
Wellness will continue to provide care until the consumer and the DCW/family members prohibit Wellness from providing care or receiving explicit instructions from the consumer's support coordinator.
The administrator will be responsible for maintaining and tracking volunteer separations and termination of services.
The administrator will ensure all separations comply with Regulation 611.57(a) by including documentation of the intent to separate from Wellness services in the consumer's record.
Effective immediately, the administrator will maintain a consumer separation spreadsheet. The spreadsheet will identify the start date of the intent to separate from service, the person/title initiating the separation, the reason for the separation, and the effective date of the separation. The spreadsheet will also identify the date the letter was mailed to the consumer and support coordinator, along with the effective date of the separation.
On a quarterly basis, the administrator shall review the spreadsheet of the former consumer's file to discover and reconcile any non-compliance issues with employees.
The spreadsheet will be readily available for local, state, and federal surveyors within ten days of the acceptance of this POC.
The Policy shall apply to hiring, transferring, or promoting DCWs.
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