QA Investigation Results

Pennsylvania Department of Health
3G EXQUISITE SUPPORT HOME CARE SERVICES, LLC.
Health Inspection Results
3G EXQUISITE SUPPORT HOME CARE SERVICES, LLC.
Health Inspection Results For:


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Initial Comments:

Based on the findings of an onsite state re-licensure survey conducted on November 14, 2022, 3G Exquisite Support Home Care Services 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 November 14, 2022, 3G Exquisite Support Home Care Services 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

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 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 six (6) of six (6) PF's reviewed: PF#1, PF#2, PF#3, PF#4, PF#5, and PF#6.

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.

An interview was conducted with the administrator on November 14, 2022 at approximately 10:35 AM. The administrator stated that several of the direct care workers have received the COVID-19 vaccination.

A review of personnel files was conducted on November 14, 2022 starting at approximatley 09:50 AM. The date of hire is indicated below:

PF#1 DOH 10/07/2020 contained no evidence that the COVID-19 vaccination had been received, nor was there evidence of a religious exemption being granted by the agency, nor a medical exemption being granted by a medical provider.

PF#2 DOH 10/07/2020 contained no evidence that the COVID-19 vaccination had been received, nor was there evidence of a religious exemption being granted by the agency, nor a medical exemption being granted by a medical provider.

PF#3 DOH 01/06/2022 contained no evidence that the COVID-19 vaccination had been received, nor was there evidence of a religious exemption being granted by the agency, nor a medical exemption being granted by a medical provider.

PF#4 DOH 04/07/2022 contained no evidence that the COVID-19 vaccination had been received, nor was there evidence of a religious exemption being granted by the agency, nor a medical exemption being granted by a medical provider.

PF#5 DOH 03/01/2022 contained no evidence that the COVID-19 vaccination had been received, nor was there evidence of a religious exemption being granted by the agency, nor a medical exemption being granted by a medical provider.

PF#6 DOH 08/19/2021 contained no evidence that the COVID-19 vaccination had been received, nor was there evidence of a religious exemption being granted by the agency, nor a medical exemption being granted by a medical provider.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.





Plan of Correction:

Effective immediately all direct care workers files will be updated with required documentation of COVID-19 Mandating Vaccines and Mandated Regulations or exemption. Agency has addressed such findings by placing required documents in PF#1, PF#2, PF#3, PF#4,PF#5, and PF#6.
Agency Administrator will implement a checklist that will ensure all required COVID-19 Mandating Vaccines and Mandated Regulations or exemption documents will be obtained at date of hire.
Agency Administrator will monitor system twice a year to ensure compliance is achieved.


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 a review of personnel files (PF), and an interview with the administrator, the home care agency failed to assure that prior to hiring a direct care worker, the agency conducted an interview with the individual for five of six PF's: PF#1, PF#2, PF#4, PF#5, and PF#6, and 2) obtained not less than two (2) satisfactory references for the individual for six (6) of six (6) PF's: PF#1, PF#2, PF#3, PF#4, PF#5, and PF#6.

Findings include:

A review of personnel files was conducted on November 14, 2022 starting at approximately 09:50 AM. The date of hire (DOH) is indicated below.


PF#1 DOH 10/07/2020 contained no evidence that prior to hiring the direct care worker, an interview was conducted. Only one (1) reference was obtained and present in the personnel file.

PF#2 DOH 10/07/2020 contained no evidence that prior to hiring the direct care worker, an interview was conducted nor that two (2) satisfactory, non-family member references were obtained.

PF#3 DOH 01/06/2022 contained no evidence that two (2) satisfactory, non-family member references were obtained.

PF#4 DOH 04/07/2022 contained no evidence that prior to hiring the direct care worker, an interview was conducted. Only one (1) reference was obtained and present in the personnel file.

PF#5 DOH 03/01/2022 contained no evidence that prior to hiring the direct care worker, an interview was conducted nor that two (2) satisfactory, non-family member references were obtained.

PF#6 DOH 08/19/2021 contained no evidence that prior to hiring the direct care worker, an interview was conducted nor that two (2) satisfactory, non-family member references were obtained.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.




Plan of Correction:

For PF#1 Initial face to face interview will be obtained documented and placed in file. A second reference check obtained and placed in file.
For PF#2 Initial face to face interview will be obtained documented and placed in file. Two satisfactory, references will be obtained and placed in file.
For PF#3 two satisfactory, non-family member references will be obtained and placed in file.
For PF#4 Initial face to face interview will be obtained documented and placed in file. A second reference check was obtained and placed in file.
Agency Administrator will implement a checklist and practice of checking to ensure that two satisfactory, non-family member reference checks have been obtained, an initial interview is conducted, and documented on date of hire.
For PF#5 Initial face to face interview will be obtained documented and placed in file. Two satisfactory, non- family member reference check will be obtained and placed in file.
For PF#6 Initial face to face interview will be obtained documented and placed in file. Two non-family member reference check will be obtained and placed in file.

Agency Administrator will conduct and document initial face to face interviews and obtain two non-family member reference checks prior to hiring.
Agency Administrator will implement a checklist that will ensure an initial interview was conducted prior to hiring, the checklist will also include obtaining two satisfactory non-family member reference prior to hiring.
Agency Administrator will monitor personnel files twice a year to ensure compliance is achieved.



611.52(a) LICENSURE
Criminal Background Checks

Name - Component - 00
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 did not obtain a criminal history report at the time of application or within one (1) year immediately preceding the date of application for four (4) of six (6) PF's: PF#3, PF#4, PF#5, and PF#6.

Findings include:

A review of PF's was conducted on November 14, 2022 starting at approximately 09:50 AM. The date of hire (DOH) is indicated below.

PF#3 DOH 01/06/2022 did not contain evidence of a Pennsylvania Access to Criminal History (PATCH) Report conducted by the State Police at the time of application or 1 year immediately preceding the date of application. The date of the PATCH was 02/08/2022 which was one month after date of hire.

PF#4 DOH 04/07/2022 did not contain any evidence of a Pennsylvania Access to Criminal History (PATCH) Report being conducted by the State Police at the time of application or 1 year immediately preceding the date of application.

PF#5 DOH 03/01/2022 did not contain evidence of a Pennsylvania Access to Criminal History (PATCH) Report conducted by the State Police at the time of application or 1 year immediately preceding the date of application. The date of the PATCH was 03/28/2022.

PF#6 DOH 08/19/2021 did not contain any evidence of a Pennsylvania Access to Criminal History (PATCH) Report being conducted by the State Police at the time of application or 1 year immediately preceding the date of application.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.









Plan of Correction:

Agency has begun addressing such findings For PF#3 PF#4, PF#5, and PF#6. Pennsylvania Access Criminal History(PATCH) Report will be obtained printed out an placed in file prior to hiring or within one (1) year immediately preceding the date of application.
Agency Administrator will implement a checklist that will ensure that all Employees at the time of hire or within one year immediately preceding the date of application will have conducted a Pennsylvania Access Criminal History Report.
Agency Administrator will confirm that the checklist is effective by quarterly monitoring files.


611.52(d) LICENSURE
Proof of Residency

Name - Component - 00
The home care agency or home care registry may request an individual required to submit or obtain a criminal history record to furnish proof of residency through submission of any one of the following documents:
(1) Motor vehicle records, such as a valid driver ' s license or a State-issued identification.
(2) Housing records, such as mortgage records or rent receipts.
(3) Public utility records and receipts, such as electric bills.
(4) Local tax records.
(5) A completed and signed, Federal, State or local income tax return with the applicant ' s name and address preprinted on it.
(6) Employment records, including records of unemployment compensation

Observations:

Based on review of personnel files (PF) and an interview with the Administrator, the agency failed to document proof of Pennsylvania (PA) residency for two (2) consecutive years immediately preceding date of hire through submission of any one of the following documents: (1) Motor vehicle records, such as a valid driver's license or a State-issued identification; (2) Housing records, such as mortgage records or rent receipts; (3) Public utility records and receipts, such as electric bills; (4) Local tax records; (5) A completed and signed, Federal, State or local income tax return with the applicant's name and address preprinted on it; (6) Employment records, including records of unemployment compensation for four (4) of six (6) PF's reviewed: PF#1, PF#2, PF#5, and PF#6.

Findings include:

A review of personnel files was conducted on November 14, 2022 starting at approximately 09:50 AM. The date of hire (DOH) is indicated below.

PF#1 DOH 10/07/2020 contained a copy of a Pennsylvania Driver's License issued on 05/03/2022. There was no verifiable documentation contained in the PF of Pennsylvania residency for two (2) consecutive years immediately preceding date of hire from 10/07/2018 to 10/07/2020 through submission of any one of the following documents: (1) Motor vehicle records, such as a valid driver's license or a State-issued identification; (2) Housing records, such as mortgage records or rent receipts; (3) Public utility records and receipts, such as electric bills; (4) Local tax records; (5) A completed and signed, Federal, State or local income tax return with the applicant's name and address preprinted on it; (6) Employment records, including records of unemployment compensation.

PF#2 DOH 10/07/2020 contained a copy of a Pennsylvania Driver's License issued on 09/29/2020. There was no verifiable documentation contained in the PF of Pennsylvania residency for two (2) consecutive years immediately preceding date of hire from 10/07/2018 to 10/07/2020 through submission of any one of the following documents: (1) Motor vehicle records, such as a valid driver's license or a State-issued identification; (2) Housing records, such as mortgage records or rent receipts; (3) Public utility records and receipts, such as electric bills; (4) Local tax records; (5) A completed and signed, Federal, State or local income tax return with the applicant's name and address preprinted on it; (6) Employment records, including records of unemployment compensation.

PF#5 DOH 03/01/2022 contained a copy of a Pennsylvania Driver's License issued on 08/04/2021. There was no verifiable documentation contained in the PF of Pennsylvania residency for two (2) consecutive years immediately preceding date of hire from 03/01/2020 to 03/01/2022 through submission of any one of the following documents: (1) Motor vehicle records, such as a valid driver's license or a State-issued identification; (2) Housing records, such as mortgage records or rent receipts; (3) Public utility records and receipts, such as electric bills; (4) Local tax records; (5) A completed and signed, Federal, State or local income tax return with the applicant's name and address preprinted on it; (6) Employment records, including records of unemployment compensation.

PF#6 DOH 08/19/2021 contained a copy of a Pennsylvania Driver's License issued on 03/25/2021. There was no verifiable documentation contained in the PF of Pennsylvania residency for two (2) consecutive years immediately preceding date of hire from 08/19/2019 to 08/19/2021 through submission of any one of the following documents: (1) Motor vehicle records, such as a valid driver's license or a State-issued identification; (2) Housing records, such as mortgage records or rent receipts; (3) Public utility records and receipts, such as electric bills; (4) Local tax records; (5) A completed and signed, Federal, State or local income tax return with the applicant's name and address preprinted on it; (6) Employment records, including records of unemployment compensation.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.








Plan of Correction:

For PF#1 a valid state issued id was obtained and placed in file to verify Pennsylvania residency for two consecutive years immediately preceding date of hire.
For PF#2 a valid Motor vehicle license was obtained and placed in file
For PF#5 a valid Motor vehicle license was obtained and placed in file
For PF#6 a valid Motor vehicle license was obtained and placed in file.
Agency Administrator will implement a checklist & practice of checking that will ensure obtaining Proof of Residency for two consecutive years, immediately preceding date of hire.
Agency Administrator will monitor files twice a year to ensure compliance is effective .


611.55(a) LICENSURE
Compentency Requirements

Name - Component - 00
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 and an interview with the administrator, agency failed to ensure that prior to assigning a direct care worker to provide services to a consumer, that the direct care worker has done one of the following: 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 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. Six (6) of six (6) personnel files reviewed did not meet the requirement: PF#1, PF#2, PF#3, PF#4, PF#5, and PF#6.

Findings include:

An interview was conducted with the administrator on November 14, 2022 at approximately 10:40 AM. The administrator stated that the direct care workers employed by the agency complete the Pennsylvania Department of Human Services Direct Care Staff Person Training at the time of hire, along with an agency-specific orientation. The administrator stated that upon completion of the training, a certificate is generated and placed in the personnel file.

A review of personnel files (PF) was conducted on November 14, 2022 starting at approximately 09:50 AM. The date of hire (DOH) is indicated below.

PF#1 DOH 10/07/2020 did not contain any evidence of completion of an initial competency nor any other training upon hire.

PF#2 DOH 10/07/2020 did not contain any evidence of completion of an initial competency nor any other training upon hire.

PF#3 DOH 01/06/2022 did not contain any evidence of completion of an initial competency nor any other training upon hire.

PF#4 DOH 04/07/2022 did not contain any evidence of completion of an initial competency nor any other training upon hire.

PF#5 DOH 03/01/2022 did not contain any evidence of completion of an initial competency nor any other training upon hire.

PF#6 DOH 08/19/2021 did not contain any evidence of completion of an initial competency nor any other training upon hire.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.





Plan of Correction:

For Pf#1 Initial completion of competency training certificate was placed in file.
For PF#2 initial completion of competency training certificate was placed in file.
For PF#3 initial completion of competency training was placed in file.
For PF#4 initial completion of competency training was placed in file.
For PF#5 Initial completion of competency training was placed in file.
For PF#6 Initial completion of competency training was placed in file.
Agency Administrator will implement a checklist & practice of checking to ensure that initial completion of competency training has been documented and placed in file.
Agency Administrator will monitor the files quarterly to ensure compliance. All files will be updated with Initial competency training documentation, upon hire, along with agency specific orientations annually.


611.55(e) LICENSURE
Competency Requirements

Name - Component - 00
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 and an interview with the administrator, the agency failed to demonstrate that a competency review for direct care workers occurred at least once per year after the initial competency was established. Two (2) of six (6) PF's did not meet the requirement: PF#1 and PF#2.

Findings include:

A review of personnel files was conducted on November 14, 2022 starting at approximately 09:50 AM. The date of hire (DOH) is indicated below.

PF#1 DOH 10/07/2020 contained no evidence of an annual competency review in 2021.

PF#2 DOH 10/07/2020 contained no evidence of an annual competency review in 2021.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.




Plan of Correction:

For PF#1 A signed copy of 2021 annual competency training was placed in file.
For PF#2 A signed copy of 2021 annual competency training was placed in file.
Agency Administrator will implement a checklist & practice of checking to ensure all annual competency training conducted will be documented and placed in direct care workers file.
Agency Administrator will monitor files quarterly to confirm that the plan is effective.


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 a review of personnel files (PF), the Centers for Disease Control (CDC) guidelines and an interview with the administrator, the agency did not provide documentation that a direct care worker completed a baseline tuberculosis symptom screen questionnaire and/or individual tuberculosis risk assessment upon hire for six (6) of six (6) PF's: PF#1, PF#2, PF#3, PF#4, PF#5 and PF#6.

Findings include:

In May 2019, the Centers for Disease Control (CDC) updated its recommendation for TB testing of health care personnel. The CDC guidelines state that all Health Care Workers (HCW) should receive 1) 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; 2) Completion of a tuberculosis symptom questionnaire, and 3) Completion of a tuberculosis risk assessment. After baseline testing for infection with tuberculosis, HCW's should receive TB screening annually. HCW's 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 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 November 14, 2022 starting at approximately 09:50 AM. The date of hire (DOH) is indicated below.

PF#1 DOH 10/07/2020 did not contain evidence that a baseline tuberculosis (TB) symptom screen questionnaire or an individual TB risk assessment was completed upon hire.

PF#2 DOH 10/07/2020 did not contain evidence that a baseline tuberculosis (TB) symptom screen questionnaire or an individual TB risk assessment was completed upon hire.

PF#3 DOH 01/06/2022 did not contain evidence that a baseline tuberculosis (TB) symptom screen questionnaire or an individual TB risk assessment was completed upon hire.

PF#4 DOH 04/07/2022 did not contain evidence that a baseline tuberculosis (TB) symptom screen questionnaire or an individual TB risk assessment was completed upon hire.

PF#5 DOH 03/01/2022 did not contain evidence that a baseline tuberculosis (TB) symptom screen questionnaire or an individual TB risk assessment was completed upon hire.

PF#6 DOH 08/19/2021 did not contain evidence that a baseline tuberculosis (TB) symptom screen questionnaire or an individual TB risk assessment was completed upon hire.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.




Plan of Correction:

For PF#1 a completed baseline tuberculosis symptom screen questionnaire was updated and placed in file
For PF#2 a completed baseline tuberculosis symptom screen questionnaire was updated and placed in file
For PF#3 a completed baseline tuberculosis symptom screen questionnaire was updated and placed in file
For PF#4 a completed baseline tuberculosis symptom screen questionnaire was updated and placed in file
For PF#5 a completed baseline tuberculosis symptom screen questionnaire was updated and placed in file
For PF#6 a completed baseline tuberculosis symptom screen questionnaire was updated and placed in file
Agency upon hire will provide direct care workers with a baseline tuberculosis screening and completion of a tuberculosis symptom questionnaire or risk assessment that will be placed in file.
Agency Administrator will implement a checklist & practice checking to ensure that a completed baseline tuberculosis symptom screen questionnaire was completed upon hire.
Agency Administrator will monitor files twice a year to ensure 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 files (CF) and an interview with the administrator, the agency failed to demonstrate that the consumer was involved in the service planning process for five (5) of five (5) consumer files reviewed: CF#1, CF#2, CF#3, CF#4, and CF#5.

Findings include:

A review of the agency's blank welcome package/admission packet that is provided to consumers took place on November 14, 2022 at 9:15 AM. The documents contained in the blank welcome package included the following items: 1) a five (5) page service agreement that contained a listing of the services to be provided to the consumer, the days & frequency of the services, and a signature page (page 5) whereby the consumer would attest to receiving, via consumer and agency personnel signatures, various documents including the consumer protections; 2) a separate document listing the consumer protections as outlined in PA Chapter 611, 28 PA Code 611.57 (a, b, and c) referencing back to the service agreement; 3) a separate document intended to state the identity of the direct care worker who would be providing services.

In an interview conducted with the administrator on November 14, 2022 starting at approximately 10:45 AM, the administrator stated that the page 5 of the service agreement is intended to document the materials received by the consumer via the consumer's signature, and is maintained in the consumer file.

A review of consumer files was conducted on November 14, 2022 starting at approximately 09:20 AM. The start of care (SOC) is indicated below.

CF#1 SOC 03/27/2021 contained only the 1st page of the service agreement. The remainder of the service agreement was not present in the file, nor was there evidence that the consumer signed the agreement nor was otherwise involved in the service planning process.

CF#2 SOC 01/20/2022 contained only the 1st page of the service agreement. The remainder of the service agreement was not present in the file, nor was there evidence that the consumer signed the agreement nor was otherwise involved in the service planning process.

CF#3 SOC 10/07/2020 contained only the 1st page of the service agreement. The remainder of the service agreement was not present in the file, nor was there evidence that the consumer signed the agreement nor was otherwise involved in the service planning process.

CF#4 SOC 05/12/2022 contained only the 1st page of the service agreement. The remainder of the service agreement was not present in the file, nor was there evidence that the consumer signed the agreement nor was otherwise involved in the service planning process.

CF#5 SOC 03/15/2022 contained only the 1st page of the service agreement. The remainder of the service agreement was not present in the file, nor was there evidence that the consumer signed the agreement nor was otherwise involved in the service planning process.

An interview conducted with the administrator on November 14, 2022 starting at 10:55 AM confirmed the above findings.





Plan of Correction:

For CF#1 The full service agreement signed by consumer was obtained and placed in file
For CF#2 The full service agreement signed by consumer was obtained and placed in file
For CF#3 The full service agreement signed by consumer was obtained and placed in file
For CF#4 The full service agreement signed by consumer was obtained and placed in file
For CF#5 The full service agreement signed by consumer was obtained and placed in file
The agency Administrator will implement a check list & practice checking to ensure all required documents for consumer agreement are signed and placed in consumer file prior to start of service.
Agency Administrator will monitor consumer files twice a year to ensure all documents for service agreement are signed & obtained.


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 on a review of consumer files (CF) and an interview with the administrator, the agency failed to ensure that the consumer received information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency. Five (5) of five (5) consumer files did not meet the requirement: CF#1, CF#2, CF#3, CF#4, and CF#5.

Findings include:

A review of the agency's blank (template) welcome package/admission packet took place on November 14, 2022 at 9:15 AM. The documents contained in the blank welcome package included a service agreement whereby on page 5 of the agreement, the consumer would attest (via signature) to receiving information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency.

In an interview conducted with the administrator on November 14, 2022 starting at approximately 10:45 AM, the administrator stated that the page 5 of the service agreement is intended to document the materials received by the consumer via the consumer's signature, and is maintained in the consumer file.

A review of consumer files was conducted on November 14, 2022 starting at 9:20 AM. The start of care (SOC) is indicated below:

CF#1 SOC 03/27/2021 did not contain evidence that the consumer received information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency. Page 5 of the service agreement, which was intended to show evidence that the consumer received information regarding the prohibitions, was not contained in the consumer file. There was no other evidence that the consumer received information regarding the prohibitions.

CF#2 SOC 01/20/2022 did not contain evidence that the consumer received information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency. Page 5 of the service agreement, which was intended to show evidence that the consumer received information regarding the prohibitions, was not contained in the consumer file. There was no other evidence that the consumer received information regarding the prohibitions.

CF#3 SOC 10/07/2020 did not contain evidence that the consumer received information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency. Page 5 of the service agreement, which was intended to show evidence that the consumer received information regarding the prohibitions, was not contained in the consumer file. There was no other evidence that the consumer received information regarding the prohibitions.

CF#4 SOC 05/12/2022 did not contain evidence that the consumer received information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency. Page 5 of the service agreement, which was intended to show evidence that the consumer received information regarding the prohibitions, was not contained in the consumer file. There was no other evidence that the consumer received information regarding the prohibitions.

CF#5 SOC 03/15/2022 did not contain evidence that the consumer received information regarding the prohibitions that no individual as a result of the individual's affiliation with a home care agency may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency, and that the home care agency may not require a consumer to endorse checks over to the home care agency. Page 5 of the service agreement, which was intended to show evidence that the consumer received information regarding the prohibitions, was not contained in the consumer file. There was no other evidence that the consumer received information regarding the prohibitions.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.







Plan of Correction:

For CF#1 Page 5 of the service agreement was obtained and placed in file
For CF#2 Page 5 of service agreement was obtained and placed in file
For CF#3 Page 5 of service agreement was obtained and placed in file
For CF#4 Page 5 of service agreement was obtained and placed in file
For CF#5 Page 5 of service agreement was obtained and placed in file
Agency will implement a consumer agreement check list that will ensure all required documentation is placed in consumer file
Agency Administrator will implement a checklist & practice checking to ensure all pages of consumer agreement are signed and placed in file prior to start of service.
Agency Administrator will monitor consumer files twice a year to ensure plan is effective.


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 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 to be provided to the consumer by the direct care worker (DCW) and the identity of the DCW who would be providing the services; 2) the hours when those services would be provided; 3) who to contact at the department for information regarding the agency's compliance and licensure; 4) the Department's Complaint Hot Line and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA), 5) the hiring and competency requirements applicable to direct care workers employed by the agency, and/or 6) 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 for five (5) of five (5) consumer files: CF#1, CF#2, CF#3, CF#4, and CF#5.

Findings include:

A review of the agency's blank (template) welcome package/admission packet took place on November 14, 2022 at 9:15 AM. The documents contained in the blank welcome package included a service agreement whereby on page 5 of the agreement, the consumer would attest (via signature) to receiving information regarding 1) a listing of the available home care services to be provided to the consumer by the direct care worker (DCW) and the identity of the DCW who would be providing the services; 2) the hours when those services would be provided; 3) who to contact at the department for information regarding the agency's compliance and licensure; 4) the Department's Complaint Hot Line and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA), and 5) the hiring and competency requirements applicable to direct care workers employed by the agency.

In an interview conducted with the administrator on November 14, 2022 starting at approximately 10:45 AM, the administrator stated that the page 5 of the service agreement is intended to document the materials received by the consumer via the consumer's signature and is maintained in the consumer file.

A review of consumer files was conducted on November 14, 2022 starting at 9:20 AM. The start of care (SOC) is indicated below:

CF#1 SOC 03/27/2021 did not contain evidence that the consumer received, prior to the start of services, information regarding a listing of available home care services to be provided by the direct care worker, the identity of the direct care worker who would be providing the services, the hours when the services would be provided, contact information/telephone number for the Department regarding the home care agency's compliance information and licensure requirements, the Department's Complaint Hot Line telephone number and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). Page 5 of the service agreement, intended to show evidence that the consumer received the information to be provided, was missing from the consumer file. A disclosure addressing the employee or independent contract status of the direct care worker was present in the file, but both sections of the form intended to identify whether a direct care worker was or was not an employee of the agency were checked, and the section denoting whether or not the home care agency maintained professional and general liability insurance was blank.

CF#2 SOC 01/20/2022 did not contain evidence that the consumer received, prior to the start of services, information regarding a listing of available home care services to be provided by the direct care worker, the identity of the direct care worker who would be providing the services, the hours when the services would be provided, contact information/telephone number for the Department regarding the home care agency's compliance information and licensure requirements, the Department's Complaint Hot Line telephone number and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). Page 5 of the agreement, intended to show evidence that the consumer received the information to be provided, was missing from the consumer file. There was no disclosure form in the file addressing the employee or independent contract status of the direct care worker and whether or not the home care agency maintained professional and general liability insurance.

CF#3 SOC 10/07/2020 did not contain evidence that the consumer received, prior to the start of services, information regarding a listing of available home care services to be provided by the direct care worker, the identity of the direct care worker who would be providing the services, the hours when the services would be provided, contact information/telephone number for the Department regarding the home care agency's compliance information and licensure requirements, the Department's Complaint Hot Line telephone number and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). Page 5 of the service agreement, intended to show evidence that the consumer received the information to be provided, was missing from the consumer file. A disclosure addressing the employee or independent contract status of the direct care worker was present in the file, but both sections of the form intended to identify whether a direct care worker was or was not an employee of the agency were checked, and the section denoting whether or not the home care agency maintained professional and general liability insurance was blank.

CF#4 SOC 05/12/2022 did not contain evidence that the consumer received, prior to the start of services, information regarding a listing of available home care services to be provided by the direct care worker, the identity of the direct care worker who would be providing the services, the hours when the services would be provided, contact information/telephone number for the Department regarding the home care agency's compliance information and licensure requirements, the Department's Complaint Hot Line telephone number and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). Page 5 of the service agreement, intended to show evidence that the consumer received the information to be provided, was missing from the consumer file.

CF#5 SOC 03/15/2022 did not contain evidence that the consumer received, prior to the start of services, information regarding a listing of available home care services to be provided by the direct care worker, the identity of the direct care worker who would be providing the services, the hours when the services would be provided, contact information/telephone number for the Department regarding the home care agency's compliance information and licensure requirements, the Department's Complaint Hot Line telephone number and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). Page 5 of the service agreement, intended to show evidence that the consumer received the information to be provided, was missing from the consumer file. A disclosure addressing the employee or independent contract status of the direct care worker was present in the file, but both sections of the form intended to identify whether a direct care worker was or was not an employee of the agency were checked, and the section denoting whether or not the home care agency maintained professional and general liability insurance was blank.

An interview conducted with the administrator on November 14, 2022 starting at 10:50 AM confirmed the above findings.





Plan of Correction:

For consumer files CF#1, CF#2, CF#3, CF#4, and CF#5 A listing of the available homecare services that will be provided to the consumer by the direct care worker and the identity and the hours the service will be provided.Hourly or weekly costs for services. Who to contact about licensure requirements or homecare registry compliance information. The Ombudsman program located with the local AAA and the complaint hotline updated on required documents. The hiring competency requirements applicable to direct care workers, information addressing the employee or independent contractor status of the direct care worker providing services. Updating the section of the agency maintained professional and general liability insurance.
Agency Administrator will implement a checklist & practice checking to ensure all required documents are presented to consumer, all documents are updated to current date.
Agency Administrator will monitor this plan quarterly in order to confirm that the plan of correction is effective and sustained.


Initial Comments:

Based on the findings of an onsite state re-licensure survey conducted on November 14, 2022, 3G Exquisite Support Home Care Services was found to be in compliance with the requirements of 35 P.S. 448.809 (b).




Plan of Correction: