QA Investigation Results

Pennsylvania Department of Health
BETTER LIVING HOME CARE, LLC
Health Inspection Results
BETTER LIVING HOME CARE, LLC
Health Inspection Results For:

This is the only survey for this facility

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.



Initial Comments:


Based on the findings of an onsite unannounced State Re-licensure survey completed March 5, 2020, Better Living Home Care was found not to be in compliance with the following requirement of PA Code, Title 28, Health and Safety, Part IV, Health facilities, Subpart A, Chapter 51.





Plan of Correction:




51.6 (a)(2) LICENSURE
IDENTIFICATION OF PERSONNEL

Name - Component - 00
51.6. Identification of personnel

(a) When working in a health care
facility and when clinically feasible,
the following individuals shall wear
an identification tag which displays
that person's name and professional
designation:
(2) Health care providers employed
by health care facilities.

Observations:


Based on observation and staff (EMP) interview, the agency failed to ensure employees wore an identification (ID) tag which displays name and professional designation.


Findings included:

Observation of ID tag provided by owner on March 5, 2020 at approximately 12:00 p.m. for review revealed plastic card on lanyard containing agency name in the middle of tag and "caregiver" near bottom of tag. ID tag did not contain employee name.

Interview with owner on March 5, 2020 at approximately 2:00 p.m. confirmed this is the ID tag provided to employees upon hire.






Plan of Correction:

NEW ID BADGES HAVE BEEN ORDERED FOR ALL CURRENT STAFF MEMBERS WITH THEIR FULL NAME, RECENT PHOTO, TITLE OF "CAREGIVER" AND THE COMPANY LOGO. ALL FUTURE CAREGIVERS WILL BE GIVEN A BADGE ONCE HIRED AND BEFORE CONSUMER ENGAGEMENT WITH THEIR FULL NAME, RECENT PHOTO, TITLE OF "CAREGIVER" AND THE COMPANY LOGO. PER POLICY ALL STAFF WILL WEAR ID BADGES AT ALL TIMES.

TO ENSURE ALL CURRENT STAFF HAVE THE PROPER BADGES, STAFF SUPERVISOR HAS MADE AND DELIVERED BADGES TO ALL STAFF MEMBERS.

TO ENSURE ALL INCOMING STAFF MEMBERS HAVE THE PROPER BADGES A PHOTO OF THE NEW EMPLOYEE WILL BE TAKEN DURING THE FIRST DAY OF TRAINING AT THE OFFICE. THE BADGE WILL BE MADE AND GIVEN TO THE EMPLOYEE THAT DAY. THIS WILL BE ADDED TO THE INITAL PF CHECKLIST.

TO MONITOR: DURING QUARTERLY VISITS SUPERVISORS MAKE TO THE CONSUMERS HOME, THEY WILL ENSURE THE CAREGIVER IS WEARING THE BADGE, THIS WILL BE DOCUMENTED IN THE PF.


Initial Comments:


Based on the findings of an onsite unannounced State Re-licensure survey completed March 5, 2020, Better Living Home Care was found not to be in compliance with the following requirement of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart H, Chapter 611, Home Care Agencies and Home Care Registries.






Plan of Correction:




611.51(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 agency personnel files (PF) and staff (EMP) interview, it was determined the agency failed to obtain two satisfactory references prior to hiring/rostering a direct care worker for six (6) of ten (10) PF reviewed. (PF1-4, 6, & 9)

Findings included:

Review of PF completed on March 5, 2020 between approximately 10:30 a.m. and 11:45 a.m. revealed:

PF1, date of hire (DOH) 2/18/2020, PF contained no documented evidence of reference checks.

PF2, DOH 2/5/2020, PF contained no documented evidence of reference checks.

PF3, DOH 12/9/19, PF contained no documented evidence of reference checks.

PF4, DOH 1/2/2020, PF contained no documented evidence of reference checks.

PF6, DOH 1/16/2020, PF contained no documented evidence of reference checks.

PF9, DOH 1/9/2020, PF contained no documented evidence of reference checks.


Interview with owner on March 5, 2020 at approx 2:00 p.m. confirmed findings.







Plan of Correction:

PRIOR TO HIRE AND BEFORE CONSUMER ENGAGEMENT ALL REFERENCE CHECKS WILL BE CONDUCTED, DOCUMENTED AND DATED. A CAREGIVER WILL NOT BE HIRED IF TWO SATISFACTORY REFERENCES ARE NOT OBTAINABLE. EDUCATE OFFICE STAFF ON.

AFTER INTERVIEW IS CONDUCTED BY SUPERVISOR, OWNER WILL CONDUCT AN AUDIT ON ALL APPLICANT FILES TO ENSURE TWO SATISFACTORY REFERENCES ARE OBTAINED BEFORE THE JOB OFFER IS EXTENDED TO THE APPLICANT.

OUR HIRING PROCESS WILL BE REVIEWED AND ALL OFFICE STAFF WILL BE EDUCATED TO ENSURE NO ONE WILL BE OFFERED A JOB WITHOUT TWO SATISFACTORY REFERENCES DOCUMENTED IN PF.

MONITOR: AGENCY WILL COMPLETE A MONTHY AUDIT FOR ALL PF (CHECKLIST). THIS INCLUDES ALL CURRENT AND FUTURE STAFF TO CORRECT ANY DEFICIENCIES THAT ARE OUT OF COMPLIANCE WITH THE AUDIT. ALL OFFICE STAFF WILL BE EDUCATED ON REGULATION REQUIREMENTS. A SIGN IN SHEET WILL BE REQUIRED DURING EDUCATION.


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 review of personnel files (PF), and staff (EMP) interview, it was determined that the agency failed to obtain a federal criminal history report and a letter of determination from the Department of Aging for three (3) of three (3) PF's reviewed who did not have evidence of residence of the Commonwealth within the preceding two years of hire. (PF3,7, & 9)




Findings included:

Review of PF completed on March 5, 2020 between approximately 10:30 a.m. and 11:45 a.m. revealed:


PF3, date of hire (DOH) 12/9/19,PF failed to contain evidence of residency in the Commonwealth within the preceding two years of hire and failed to contain evidence of a Federal criminal history report.


PF7, DOH 10/30/19, PF failed to contain evidence of residency in the Commonwealth within the preceding two years of hire and failed to contain evidence of a Federal criminal history report.


PF9, DOH 1/9/2020, PF failed to contain evidence of residency in the Commonwealth within the preceding two years of hire and failed to contain evidence of a Federal criminal history report.


Interview with owner on March 5, 2020 at approx 2:00 p.m. confirmed findings.








Plan of Correction:

UPDATE CURRENT POLCIY OF CONFIRMING RESIDENCE OF COMMONWEALTH WITHIN THE PRECEDING TWO YEAR OF HIRE. IF A CAREGIVER'S PHOTO ID/DRIVERS LICENSE DOES NOT COMPLY APPLICANT WILL BE REQUIRED TO PROVIDE PROOF OF RESIDENCY PER 611.52. IF THIS CAN NOT BE PROVIDED A FEDERAL CRIMINAL HISTORY REPORT AND A LETTER OF DETERMINATION FROM THE DEPARTMENT OF AGING WILL BE CONDUCTED. OFFICE STAFF WILL BE EDUCATED ON THIS UPDATE.

OWNER WILL DO A MONTHLY AUDIT ON ALL PF FILES FOR APPLICANTS BEFORE A JOB OFFER IS EXTENDED. SUPERVISOR WILL BE EDUCATED ON THE REQUIREMENTS AND WILL SIGN IN UPON TRAINING.
ANY DEFICIENCIES FOUND DURING THE ADUIT TO BE OUT OF COMPLIANCE WILL BE CORRECTED.


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 Centers for Disease Control (CDC) guidelines, personnel files (PF) and staff (EMP) interview, the agency did not conduct testing for mycobacterium tuberculosis (TB) according to the Centers for Disease Control guidelines for three (3) of ten (10) PF's reviewed. (PF2, 3, & 9)


Findings included:


According to the "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005," "...Baseline testing for M. Tuberculosis infection is recommended for all newly hired HCWs [health care workers]...If TST [tuberculin skin testing] is used for baseline testing, two-step testing is recommended for HCWs whose initial TST results are negative...If the first-step TST result is negative, the second-step TST should be administered 1--3 weeks after the first TST result was read...A second TST is not needed if the HCW has a documented TST result from any time during the previous 12 months. If a newly employed HCW has had a documented negative TST result within the previous 12 months, a single TST can be administered in the new setting...This additional TST represents the second stage of the two-step testing...".



Review of PF completed on March 5, 2020 between approximately 10:30 a.m. and 11:45 a.m. revealed:


PF2, date of hire (DOH) 2/5/2020, PF file contained 1 step TB test placed 8/14/19 and read 8/16/19. PF failed to contain evidence of 2nd step TB.

PF3, DOH 12/9/19, PF file contained 1 step TB test placed 12/9/19 and read 12/11/19. PF failed to contain evidence of 2nd step TB.


PF9, DOH 1/9/2020, PF file contained 1 step TB test placed 1/7/2020 and read 1/9/2020. PF failed to contain evidence of 2nd step TB.


Interview with owner on March 5, 2020 at approx 2:00 p.m. confirmed findings.











Plan of Correction:

PF2, PF3 AND PF9 WILL BE REQUIRED TO COMPLETE TB TESTING PER CDC GUIDELINES. REVIEW AND UPDATE CURRENT TB POLICY AND EDUCATE OFFICE STAFF AND CAREGIVERS ON THE POLICY.

OWNER, WILL CONDUCT A MONTHLY AUDIT ON ALL PF FOR APPLICANTS. A JOB OFFER WILL NOT BE EXTENDED UNTIL THE APPLICANT HAS COMPLETED TB STEP 1 OR BASELINE TESTING. AN EXCEL FILE HAS BEEN CREATED TO MONITOR WHEN AN EMPLOYEE IS DUE FOR STEP 2. OUR PROVISIONAL HIRING POLICY HAS BEEN UPDATED. ALL APPLICANTS SIGN A STATEMENT AGREEING TO THIS POLICY BASED ON CDC GUIDELINES. THE EXCEL FILE ALSO TRACKS WHEN ANNUALS ARE DUE. ALL OFFICE STAFF WILL BE EDUCATED ON THESE GUIDELINES AND WILL SIGN IN FOR EDUCATION DOCUMENTATION. ALL CURRENT PF WILL UNDERGO AUDIT AND ANY DEFICIENCIES WILL BE CORRECTED THAT ARE OUT OF 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 review of agency client handbook, consumer files (CF) and staff (EMP) interview it was determined the agency failed to ensure consumers were provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service for ten (10) of ten (10) CF reviewed. (CF1-10)


Findings included:

Review of New Consumer Welcome Pack on March 5, 2020 at approximately 12:30 p.m. revealed; "...Better living Home care LLC will provided a minimum of seven (7) days written notice to the Client or his/her representative before discontinuing services..."


Review of CF on March 5, 2020 between approximately 12:25 p.m. and 1:45 p.m. revealed:


CF1, start of service (SOS) 1/30/2020, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF2, SOS 10/31/19, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF3, SOS 11/16/19, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF4, SOS 11/23/19, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF5, SOS 1/16/2020, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF6, SOS 2/28/2020, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF7, SOS 3/3/2020, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF8, SOS 11/16/19, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF9, SOS 10/18/19, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

CF10, SOS 10/29/19, CF failed to contain evidence that consumer was provided at least 10 calendar days advance written note of the intent of the home care agency to terminate service. Service agreement includes evidence of 7 day written notice prior to discontinuing services.

Interview with owner on March 5, 2020 at approx 2:00 p.m. confirmed findings.










Plan of Correction:

CLIENT CONTRACTS WILL BE UPDATED SEE THE FOLLOWING :
TERMINATION OF SERVICES BY CLIENT: The Client may terminate services verbally or in writing by contacting a Care Coordinator at least 24 hours prior to the beginning of any scheduled shift. The Client's signature on this contract does not obligate him/her to use Better Living Home Care LLC's services for a minimum number of hours or time period. DISCHARGE: Better Living Home Care LLC has the right to discharge or choose not to enroll aClient if:
1.The Client presents a threat to him/herself and/or Better Living Home Care LLC staff.2.The Client requires personal care beyond the capability of the Caregivers as determined by theCare Coordinator, outside the scope of Home Services as defined by the PA Dept. of PublicHealth, or beyond the types of services offered by Better Living Home Care LLC.3.This agreement is not followed (financial obligations, unsafe work environment, disregard of theCaregiver's schedule, etc.).
2
Unless discharge is due to safety concerns, Better Living Home Care LLC will provide a minimum of ten (10) days written notice to the Client or his/her representative before discontinuing services. No person shall be refused services based on age, race, color, sex, marital status, or national origin.

OWNER HAS UPDATED THE CONTRACT FOR FUTURE NEW CONSUMERS. ALL CURRENT CONSUMERS FILES HAVE BEEN UPDATED. ALL CF WILL UNDERGO A MONTHLY AUDIT BY OWNER.


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 staff (EMP) interview it was determined the agency failed to ensure, prior to the commencement of services, consumers were provided the identity of the direct care worker who would provide the services for four (4) of ten (10) CF reviewed. (CF4-6, & 8)


Findings included:


Review of CF on March 5, 2020 between approximately 12:25 p.m. and 1:45 p.m. revealed:


CF4, SOS 11/23/19, CF failed to contain evidence that consumer was provided the identity of the direct care worker that would be providing services.

CF5, SOS 1/16/2020, CF failed to contain evidence that consumer was provided the identity of the direct care worker that would be providing services.


CF6, SOS 2/28/2020, CF failed to contain evidence that consumer was provided the identity of the direct care worker that would be providing services.


CF8, SOS 11/16/19, CF failed to contain evidence that consumer was provided the identity of the direct care worker that would be providing services.


Interview with owner on March 5, 2020 at approx 2:00 p.m. confirmed findings.





Plan of Correction:

OUR DOCUMENT SETTING HOURS SERVICES WILL BE PROVIDED TO CONSUMERS DURING THE TIME OF ADMISSION HAS BEEN UPDATED TO INCLUDE THE NAME OF THE CAREGIVER THAT WILL PROVIDE THOSE SERVICES.

OWNER WILL DO A MONTHLY AUDIT ON ALL INCOMING CF TO ENSURE THE CONSUMER HAS NOTICE OF THE CAREGIVERS IDENTITY. SHOULD THE CAREGIVER CHANGE AT ANY TIME, THE CONSUMER WILL BE NOTIFIED OF THE REPLACEMENT'S IDENTITY AND IT WILL BE DOCUMENTED. OFFICE STAFF WILL BE EDUCATED ON THE CHANGES AND SIGN DOCUMENTATION THAT THEY ARE AWARE OF THE CHANGES.


Initial Comments:


Based on the findings of an onsite unannounced State Re-licensure survey completed March 5, 2020, Better Living Home Care was found not to be in compliance with the following requirement of 35 P.S.448.809 b.





Plan of Correction:




35 P. S. 448.809b LICENSURE
Photo Id Reg

Name - Component - 00
(1) The photo identification tag shall include a recent photograph of the employee, the employee's FIRST name, the employee's title and the name of the health care facility or employment agency.

(2) The title of the employee shall be as large as possible in block type and shall occupy a one-half inch tall strip as close as practicable to the bottom edge of the badge.

(3) Titles shall be as follows:
(i) A Medical Doctor shall have the title " Physician. "
(ii) A Doctor of Osteopathy shall have the title " Physician. "
(iii) A Registered Nurse shall have the title " Registered Nurse. "
(iv) A Licensed Practical Nurse shall have the title " Licensed Practical Nurse. "
(v) Abbreviated titles may be used when the title indicates licensure or certification by a Commonwealth agency.

(4)A notation, marker or indicator included on an identification badge that differentiates employees with the same first name is considered acceptable in lieu of displaying an employee's last name.



Observations:


Based on observation and staff (EMP) interview, the agency failed to ensure employees wore an identification (ID) tag which includes a recent photograph of the employee, the employee's name, the employee's title and the name of the health care facility or employment agency.



Findings included:

Observation of ID tag provided by owner on March 5, 2020 at approximately 12:00 p.m. for review revealed plastic card on lanyard containing agency name in the middle of tag and "caregiver" near bottom of tag. ID tag did not contain employee photo or name.

Interview with owner on March 5, 2020 at approximately 2:00 p.m. confirmed this is the ID tag provided to employees upon hire.





Plan of Correction:


NEW ID BADGES HAVE BEEN ORDERED FOR ALL CURRENT STAFF MEMBERS WITH THEIR FULL NAME, RECENT PHOTO, TITLE OF "CAREGIVER" AND THE COMPANY LOGO. ALL FUTURE CAREGIVERS WILL BE GIVEN A BADGE ONCE HIRED AND BEFORE CONSUMER ENGAGEMENT WITH THEIR FULL NAME, RECENT PHOTO, TITLE OF "CAREGIVER" AND THE COMPANY LOGO. PER POLICY ALL STAFF WILL WEAR ID BADGES AT ALL TIMES.

TO ENSURE ALL CURRENT STAFF HAVE THE PROPER BADGES, STAFF SUPERVISOR HAS MADE AND DELIVERED BADGES TO ALL STAFF MEMBERS.

TO ENSURE ALL INCOMING STAFF MEMBERS HAVE THE PROPER BADGES A PHOTO OF THE NEW EMPLOYEE WILL BE TAKEN DURING THE FIRST DAY OF TRAINING AT THE OFFICE. THE BADGE WILL BE MADE AND GIVEN TO THE EMPLOYEE THAT DAY. THIS WILL BE ADDED TO THE INITAL PF CHECKLIST.

TO MONITOR: DURING QUARTERLY VISITS SUPERVISORS MAKE TO THE CONSUMERS HOME, THEY WILL ENSURE THE CAREGIVER IS WEARING THE BADGE, THIS WILL BE DOCUMENTED IN THE PF.