Initial Comments:
Based on the findings of an onsite complaint investigation conducted on October 17, 2024, and off-site on October 18, 2024, October 21, 2024, and October 23, 2024, Apple Home Care, 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:
611.52(b) LICENSURE
State Police Criminal History Record
Name - Component - 00
If the individual required to submit or obtain a criminal history report has been a resident of this Commonwealth for 2 years preceding the date of the request for a criminal history report, the individual shall request a State Police criminal history record.
Observations:
Based on review of personnel files (PF), and interview with the administrator, it was determined that personnel files did not include documentation of a State Police Criminal History report on hire for four (4) of seven (7) personnel files reviewed. (PF1, PF3, PF5, and PF6)
Findings Include:
Review of personnel files (PF) was conducted on 10/21/2024 from approximately 10:17AM until approximately 12:30PM revealed:
PF1 - (Date of Hire): 10/27/2023 - File contained a Pennsylvania Access To Criminal History report (PATCH) dated 8/2/2024, which was ten (10) months after hire.
PF3 - (Date of Hire): 2/12/2024 - File contained a Pennsylvania Access To Criminal History report (PATCH) dated 10/18/2024, which was eight (8) months after hire.
PF5 - (Date of Hire): 1/8/2024 - File contained a Pennsylvania Access To Criminal History report (PATCH) dated 10/18/2024, which was nine (9) months after hire.
PF6 - (Date of Hire): 2/12/2024 - File contained a Pennsylvania Access To Criminal History report (PATCH) dated 10/18/2024, which was eight (8) months after hire.
An interview with the administrator via email on 10/24/2024 at approximately 2:10PM confirmed the above findings.
Plan of Correction:The corrective action will be that either the office manager or the compliance director will conduct background checks on all new hires prior to start date.
Corrective measures are that Apple Home Care will enforce this existing policy.
The office manager will sign off on this via updated employee file checklist.
All new hire start dates will be pushed back if background checks results are not immediately available.
The corrective action will be put into effect 11/08/2024
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 review of personnel files (PF), and interview with the administrator, it was determined that personnel files did not include documentation that TB testing, TB risk assessments, or TB symptom screens were conducted at time of hire or prior to assigning caregivers to provide services to consumers, for three (3) of seven (7) personnel files reviewed. (PF2, PF3, and PF4)
Findings Include:
"Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019 - Historically, U.S. health care personnel were at increased risk for latent TB infection (LTBI) and TB disease from occupational exposures, but recent data suggest that this is no longer the case. CDC and the National Tuberculosis Controllers Association have updated the 2005 CDC recommendations for testing health care personnel. The update includes 1) TB risk assessment, symptom screening, and TB testing upon hire with a TB blood test (e.g., interferon-gamma release assay) or tuberculin skin test for those without documented prior TB or LTBI; 2) no annual TB testing for most health care personnel without a known exposure or ongoing transmission; 3) for health care personnel with LTBI treatment is strongly encouraged; 4) annual symptom screening for health care personnel with untreated LTBI; and 5) annual TB education for all health care personnel. These recommendations apply to health care personnel and volunteers in all health care settings. However, state and local TB screening and testing regulations may have different requirements."
Review of personnel files (PF) was conducted on 10/21/2024 from approximately 10:17AM until approximately 12:30PM revealed:
PF2 - (Date of Hire): 9/18/2024 - File contained a 1-Step PPD skin test dated 9/18/2024, however, file did not contain documentation of the second PPD.
PF3 - (Date of Hire): 2/12/2024 - File contained a 1-Step PPD skin test dated 8/9/2023, however, file did not contain documentation of the second PPD.
PF4 - (Date of Hire): 9/23/2024 - File contained a 1-Step PPD skin test dated 11/16/2022. File did not contain documentation that TB testing was conducted on hire or prior to assigning direct care worker (DCW) to consumers.
An interview with the administrator via email on 10/24/2024 at approximately 2:10PM confirmed the above findings.
Plan of Correction:The corrective action will be that either the agency manager or compliance director will make sure that the two steps PPD is on file at hire.
Apple Home Care will audit all existing files to ensure every employee is in compliance. The audit will ensure all existing personnel file includes current and active PPD.
Moving forward, this item will be checked off by the office manager and any hire not in compliance will be taken off schedule until PPD is complete.
The corrective action will be put in effect 11/08/2024.
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