Initial Comments:
Based on the findings of an unannounced complaint investigation survey that was conducted on March 12, 2024, Smart People Choice, LLC, was found not to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 611, Subpart H. Home Care Agencies and Home Care Registries.
Plan of Correction:
611.51(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 Personal files (PF) and an interview with the administrator, the agency failed to ensure that 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 for one (1) of three (3) PF's, (PF #1).
Findings include:
A review of PF's was conducted on March 12, 2024 at approximately 11:15 am-12:25 pm.
PF # 1 Date of Hire 10/13/23 did not contain any documentation that a face-to-face interview was conducted. PF#1 did not have two satisfactory and verifiable references.
An interview with the administrator on March 12, 2024 at approximately 2:30 pm confirmed the above findings.
Plan of Correction:The agency will ensure that DCW who were reviewed receive a face-to-face interview and obtain at least two positive references from their previous employer to obtain positive references. The agency will ensure that each future DCW is interviewed and positive references obtained. The agency will conduct criminal backgrounds prior to start of service with any participant. The agency will regularly review department policies and procedures to ensure the agency is in compliance with department's standards.
The facility will monitor performance through quarterly audits conducted by the compliance manager.
611.52(c) LICENSURE
Federal Criminal History Record
Name - Component - 00
If the individual required to submit or obtain a criminal history report has not been a resident of this Commonwealth for the 2 years immediately preceding the date of the request for a criminal history report, the individual shall obtain a federal criminal history record and a letter of determination from the Department of Aging, based on the individual ' s Federal criminal history record, in accordance with the requirements at 6 PA. Code § 15.144(b) (relating to procedure).
Observations:
Based on a review of employee files and an interview with the agency Administrator, agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging for one (1) out of three (3) Personal Files (PF) reviewed (PF#1).
Findings include:
A review of PFs was conducted on March 12, 2024 at approximately 11:15
am - 12:25 p.m.
PF#1, Date of Hire 9/23/23: No documentation provided to show that the applicant was a resident of Pennsylvania (Pa.) for the 2 years immediately preceding application for employment. Agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging. Pa. NJ Drivers License issued 11/28/2022 with an expiration date of 12/13/2026. According to the application, PF#1 resides in Cinnaminson, NJ.
An interview conducted with the agency Administrator on March 12, 2024 at approximately 2:30 p.m. confirmed the above findings.
Plan of Correction:The agency will ensure that Federal Criminal History results are obtained for the aide who has not been a resident of PA for more than two years. The agency will ensure that background check through the PATCH website are completed prior to the start of services for any participant. The agency will ensure that background checks have been completed for PA residents of over 2 years prior to the start of services of any participant. The agency will ensure that any aide who has not been a PA resident for at least two years has obtained fingerprinting and result prior to the start of service with any participant. The results of background checks and fingerprinting will be kept in the employees files. The agency will cross check results of each background check and fingerprint results to ensure a prohibited offense has not been committed.
The facility will monitor performance through quarterly audits completed by the compliance manager. The agency will ensure prior to the start of service of any future participants that a background check and/or fingerprinting has been completed and results are made available and filed in each direct care workers file. The agency will ensure that prohibited offenses are not present on the background check prior to the start of service. The agency will go through each file of each direct care worker who is currently employed with the company and ensure they have a background check and fingerprints where applicable, with results, readily available in their file. The agency's compliance manager, director of operations, will audit files quarterly to ensure paperwork is maintained in accordance with the departments regulations in regards to this plan put in place onward. Any violations will be immediately addressed.
The facility will suspend any worker who is not in compliance with background check policies until compliance has been met.
Director of Operations will continue to monitor the implementation of the plan and ensure compliance has been met before or by the corrective action date through quarterly audits and routine monitoring of employee 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 upon review of Personal Files (PFs) and interview with the agency administrator, the agency failed to ensure proof of residency for one (1) of two (2) PFs reviewed. (PF# 4)
Findings include:
Review of PFs conducted on March 12, 2024 from 11:15 am-12:25 pm. determined the following:
PF# 4, Date of Hire 12/28/2023: Agency failed to obtain one of the following as 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.
An interview with the agency administrator conducted on March 12, 2024 at approximately 2:30 p.m. confirmed the above findings.
Plan of Correction:The agency will ensure that proof of residency is obtained from any DCW that has resided outside of PA within 2 years of being hired. The facility will ensure that each DCW who presents and obtains a criminal record obtains proof of residency.
The agency will ensure prior to the start of service of any future participants that full agency training and observation has been completed Director of Operations will continue to monitor the implementation of the plan and ensure compliance has been met before or by the corrective action date through quarterly audits and routine review of employee files.
611.55(a) LICENSURE
Competency 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 review of personnel files (PF), and an interview with the agency administrator, it was determined the agency failed to demonstrate, prior to assigning or referring a direct care worker to provide services to a consumer, competency by passing an initial competency examination for two (2) of four (4) PF reviewed. (PF #2 and PF #4)
Findings include:
A review of PF conducted on March 12, 2024 from appropriate 11:45am-12:45pm revealed the following:
PF #2, Date of Hire 9/23/2023: Initial competency exam dated for 9/23/2023 was completed but unscored.
PF #4, Date of Hire 12/15/2023: Initial competency exam dated for 12/15/2023 was not completed (questions 10 and 11 were not answered) and the exam was left unscored.
An interview conducted with the agency administrator on March 12, 2024 at approximately 2:30 PM confirmed the above findings.
Plan of Correction:The agency will ensure the DCW who were reviewed are trained competently on their consumers POC as well as agency training, policies and procedures. The agency will ensure that DCWs either have a valid nursing license, passed a competency exam, completed agency training, HHA or CNA training, or another approved department training program prior to the start of service for any participant. The agency will ensure that DCWs are trained at minimum annually. The agency will ensure that routine audits are done internally to ensure that DCWs are trained at ongoing basis at minimum annually. The agency will check with participants and support coordinators regularly to ensure updates are made to POCs and DCWs are trained on updated plans. The agency will regularly review department policies and procedures to ensure the agency is in compliance with department standards.
The facility will ensure that each direct care worker has been trained on the plan of care for the participant they will serve. The agency will ensure competency is met through agency training which will include videos, slideshows and a competency exam based upon the required subjects of the DOH.
The facility will monitor performance through quarterly audits completed by the compliance manager. The agency will ensure prior to the start of service of any future participants that full agency training and observation has been completed and test results are made available and filed in each direct care workers file. The agency will go through each file of each direct care worker who is currently employed with the company and ensure they have read, trained and understand each duty required in the plan of care as well as their ability to provide the service has been evaluated through a competency exam, results will readily available in their file. The agency's compliance manager will audit files quarterly to ensure paperwork is maintained in accordance with the department's regulations. Direct care workers will be trained at minimum annually on all polices, procedures, plan of care updates and competency to complete services. Any violations will be immediately addressed. The facility will suspend any worker who is not in compliance with training policies until compliance has been met.
Director of Operations will continue to monitor the implementation of the plan and ensure compliance has been met before or by the corrective action date through quarterly audits and routine review of employee files.
611.56(a) LICENSURE
Health Screening
Name - Component - 00
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), the Centers for Disease Control Guidelines, and an interview with the administrator, the agency failed to provide documentation of a two (2) step PPD being administered and initial tuberculosis screening questionnaire/risk assessment for four (4) of four (4) PF's reviewed, (PF#1,2,3, and 4).
In May 2019, the CDC updated its recommendations for TB testing of health care personnel. The CDC guidelines state that all Health Care Workers (HCW) should: 1: receive baseline tuberculosis screening upon hire by using: a two-step tuberculin skin test (TST), a single blood assay for tuberculosis (TB), or a negative chest x-ray 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, HCWs should receive TB education 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;(5-16-19)
A review of PF's was conducted on March 12, 2024 from approproximatley 11:45- 12:25 pm determined the following:
PF #1 Date of Hire 10/13/2024: Contained documentation of an intial TB skin test dated 11/8/2022 but never read. No documentation of a 2 step PPD being administered. File did not contain documentation that a TB risk assessment or TB symptom screen was conducted at time of hire or prior to assigning direct care worker (DCW) to consumers.
PF#2 Date of Hire 9/23/2023: Contained documentation of an initial TB skin test dated 8/31/2023 with a negative result. Documentation of a QuantiFERON Gold dated 2/3/2024 with a negative result was on file. No documentation of a 2 step PPD being administered. File did not contain documentation that a TB risk assessment or TB symptom screen was conducted at time of hire or prior to assigning direct care worker (DCW) to consumers.
PF#3 Date of Hire 8/23/2023: Contained documentation of a QuantifFERON Gold dated 7/8/2022 with a negative result on file. A one step PPD on file dated for 9/23/2023 with a negative result was on file. File did not contain documentation that a TB risk assessment or TB symptom screen was conducted at time of hire or prior to assigning direct care worker (DCW) to consumers.
PF #4 Date of Hire 12/15/2023: Contained documentation of a one-step tuberculosis skin test dated 11/17/2023, however, file did not contain documentation of the second tuberculosis skin test. File did not contain documentation that a TB risk assessment or TB symptom screen was conducted at time of hire or prior to assigning direct care worker (DCW) to consumers.
Interview with administrator on March 12, 2024 at approximately 2:30PM confirmed the above findings.
Plan of Correction:The agency will ensure that the DCWs reviewed are screened and tested for TB. The agency will ensure that each employee has been screened and tested for TB prior to the start of service in accordance with CDC and department guidelines. The agency will ensure a two step PPD has been completed prior to the start of service with any participant. The agency will review DCW files to ensure each employee has completed a screening as well as a two step PPD assessment. The agency will ensure that TB test are completed for each employee through a two step PPD, blood sample and chest Xray as applicable through results of the TB screening. The agency will ensure DCWs are trained on signs and symptoms to TB. The agency will ensure employees are trained on when and how to test for TB. The agency will keep results of PPD screenings in DCW files. The agency will regularly audit employee files to ensure compliance with PPD/TB screening. The agency will regularly review CDC regulations to remain in compliance with recommendations.
The agency's compliance manager will ensure performance and solutions are met by auditing each employee file to ensure that the employee has been screened, trained and tested for TB. The facility will ensure that training, testing and screening is done on an annual basis.
Prior to the start of service of any future participants the agency will ensure that the direct care working has been screened, trained on signs, symptoms and exposure, as well as tested through a two step PPD test. The agency will ensure that testing and training has been completed and results are made available and filed in each direct care workers file. The agency will ensure that abnormal testing is addressed prior to the start of service. The agency will go through each file of each direct care worker who is currently employed with the company and ensure they have a screening form, training and two step PPD testing, with results, readily available in their file. The agency's compliance manager will audit files quarterly to ensure paperwork is maintained in accordance with the department's regulations. Any violations will be immediately addressed. The facility will suspend any worker who is not in compliance with TB screening, testing and training policies until compliance has been met.
Director of Operations will continue to monitor the implementation of the plan and ensure compliance has been met before or by the corrective action date through quarterly audits and routine review of employee files.
611.57(b) LICENSURE
Prohibitions
Name - Component - 00
(b) No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry. The home care agency or home care registry may not require a consumer to endorse checks over to the home care agency or home care registry.
Observations:
Based on a review of consumer files (CF) and an interview with the manager, there was no evidence that the agency provided the consumer with information regarding the prohibitions that 1) no individual as a result of the individual's affiliation with the home care agency may assume power of attorney or guardianship of a consumer using the services of the agency, and 2) the home care agency may not require a consumer to endorse checks over to the home care agency for two (2) of three (3) CF's reviewed: CF#1, CF#2.
Findings include:
The admission packet provided by the agency to the consumer, reviewed on March 12, 2024 found that information pertaining to the prohibitions was not included in the admission packet.
A review of CF's was conducted on March 12, 2024 at approximately 12:30-2:30 pm. The start of care (SOC) is indicated below:
CF#1 SOC 12/28/2023, did not contain evidence that the consumer received information concerning 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 using its services and that the agency may not require a consumer to endorse checks over to the agency.
CF#2 SOC 10/13/2022, did not contain evidence that the consumer received information concerning 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 using its services and that the agency may not require a consumer to endorse checks over to the agency.
An interview conducted with the administrator on March 12, 2024 starting at 2:30 PM confirmed the above findings.
Plan of Correction:The agency currently has a policy in place that outlines prohibitions of POA, guardianship, collection of checks or any other financial compensation direct from consumer to DCW. The agency will ensure that each consumer and DCW has read, reviewed, signed and understands the policies currently in place by the agency as well as the department. The agency will ensure that the policy is not being violated through regular reviews and audits of consumer files. The agency will ensure that a signed copy of all prohibitions is kept on file. The agency will ensure that each consumer is aware of the policy and thoroughly understands the polices of the agency as well as the DOH. The agency will ensure that any client who needs services such as power of attorney or guardianship is referred to the appropriate party for assistance.
The agency's compliance manager, will ensure that each client has been informed of the agencies policy in regards to prohibited offenses. The agency will ensure that each consumer has read and thoroughly understands the agencies prohibition policy that caretakers are not to assume power of attorney, guardianship, endorsement of checks. The agency will maintain a signed copy of the policy in each consumers file. The agency will ensure that prior to the start of service of any future participant that they have been given this information and are not in violation of the policy prior to rendering services. The compliance manager will audit folders quarterly to ensure signed copies of the policies are readily available in the file. The compliance manager will also ensure that the policy is not being violated by following up with consumers and direct care workers. The agency may audit, review and interview members of the family to ensure that paperwork is provided for any consumer who requires POA or guardianship. The agency will ensure the direct care worker is not POA or guardian over any consumer we serve.
The agency's compliance manager, will audit files quarterly to ensure paperwork is maintained in accordance with the departments regulations. Any violations will be immediately addressed. The facility will suspend any worker who is not in compliance with the prohibition policies until an investigation and compliance has been met. The agency will immediately dismiss any DCW who is in violation of this policy.
Director of Operations will continue to monitor the implementation of the plan and ensure compliance has been met before or by the corrective action date through quarterly audits and routine review of consumer files.
611.57(c) LICENSURE
Information to be Provided
Name - Component - 00
(c) Prior to the commencement of services, the home care agency or home care registry shall provide to the consumer, the consumer's legal representative or responsible family member an information packet containing the following information in a form that is easily read and understood: (1) A listing of the available home care services that will be provided to the consumer by the direct care worker and the identity of the direct care worker who will provide the services. (2) The hours when those services will be provided. (3) Fees and total costs for those services on an hourly or weekly basis. (4) Who to contact at the Department for information about licensure requirements for a home care agency or home care registry and for compliance information about a particular home care agency or home care registry. (5) The Department's complaint Hot Line (1-800-254-5164) and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). (6) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry. (7) A disclosure, in a format to be published by the Department in the Pennsylvania Bulletin by February 10, 2010, addressing the employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant respective tax and insurance obligations and other responsibilities of the consumer and the home care agency or home care registry.
Observations:
Based on a review of consumer files (CF) and an interview with the administrator, prior to the commencement of services, the home care agency did not provide to the consumer, (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 for three (3) of the three (3) CF's reviewed.
Findings include:
A review of CF's were conducted on March 12, 2024 12:30PM-2:30PM. The start of care is (SOC) indicated below:
CF#1 SOC 12/28/2023, did contain 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 was present but did not have all areas for the consumer to initial the appropriate sections.
CF#2 SOC 10/13/2022, did contain 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 was present but did not have all areas for the consumer to initial the appropriate sections.
CF#3 SOC 9/20/2023, did contain 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 was present but did not have all areas for the consumer to initial the appropriate sections.
An interview conducted with the administrator on March 12, 2024 starting at 2:30 PM confirmed the above findings.
Plan of Correction:The agency will 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. The agency will review the current packet and update all incorrect phone numbers. The agency will be sure to include any phone numbers that are not currently included in the packet to ensure that the consumer has been provided with all required information. The agency will regularly review the packet to make sure necessary phone numbers have been added and updated. The agency will ensure that in instances where the client is unable to accept the information that family member or guardian is able to do so. The agency will ensure that a signed copy of the receipt of information is kept on file in the agency office. The agency will regularly review files to ensure that consumers are updated as phone number and address change.
The agency's compliance manager will ensure that each client has been informed of all hotline and complaint phone numbers, as well AOA, ombudsman and any other agency required by the department. The compliance manager has updated the current packet to include all required phone numbers and addresses. The agency will ensure that each consumer has read and thoroughly understands the agencies welcome packet which includes a completed disclosure addressing the employee or independent contractor status of the direct care worker. The agency will maintain a signed copy of the packet in each consumers file. The agency will ensure that prior to the start of service of any future participant that they have been given this information and are aware of all rights, phone numbers and services in which they are entitled. The compliance manager will audit folders quarterly to ensure signed copies of the policies and welcome packets are readily available in the file. The compliance manager will also ensure that the phone numbers are updated with the consumers as they change in the departments.
The agency's compliance manager will audit files quarterly to ensure paperwork is maintained in accordance with the department's regulations. Any violations will be immediately addressed. The agency will ensure that participants are given updated phone numbers and addresses on an ongoing basis as they change within the agency as well as the departments we are licensed and contracted with. Agency staff will meet with each consumer currently receiving services to update files. Each consumer will be given updated welcome packets which will include updated addresses and phone numbers for AOA, ombudsman, department complaint and hotlines, agency address and phone number, as well as a correctly completed disclosure addressing the employee or independent contractor status of the direct care worker (DCW) providing services to the consumer, and the resultant respective tax and insurance obligations and of the consumer and the home care agency.
Director of Operations will continue to monitor the implementation of this plan and ensure compliance has been met before or by the corrective action date through quarterly audits and routine review of consumer files.
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