Initial Comments:
Based on the findings of an onsite unannounced compliant investigation conducted on August 26, 2024, Alani Home Care 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 unannounced complaint investigation that was conducted on August 23, 2024 and August 26, 2024, Alani Home Care, Inc., was not found 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 a review of personnel files (PF) and an interview with the director of compliance, the agency failed to provide documentation of a Pennsylvania (PA) State Police Criminal Background Check (PATCH) at the time of application or within 1 year immediately preceding the date of application for three (3) of six (6) PF's reviewed, (PF #4,5 and 6).
Findings include:
A review of PF's was conducted on August 23, 2024 at approximately 10:40 am.
PF#4, Date of Hire: 2/15/2024. PF contained a PATCH that was completed after hire date. PATCH was dated for 3/05/204.
PF#5, Date of Hire: 6/6/2021. PF contained a PATCH that was completed after hire date. PATCH was dated for 6/28/2021
PF#6, Date of Hire: 6/6/2021. PF contained a PATCH that was completed after hire date. PATCH was dated for 6/28/2021.
An interview with the Director on August 26, 2024 at approximately 12:00 pm confirmed the above findings.
Plan of Correction:Alani Home Care will check and obtain criminal backgrounds prior to the start date of the participant. Alani Home Care Inc has made this a main priority with every caregiver applying for a caregiver position. Alani Home Care Human resource director will be conducting this matter for every new caregiver hired and active with our agency. This correction has been implemented since 8/30/2024.
611.56(b) LICENSURE
Health Screening
Name - Component - 00
(b) A home care agency or home care registry shall require each direct care worker, and other office staff or contractors with direct consumer contact, to update the documentation required under subsection (a) at least every 12 months and provide the documentation to the agency or registry. The 12 months must run from the date of the last evaluation. The documentation required under subsection (a) shall be included in the individual's file.
Observations:
Based on review of personnel files (PFs), the Centers for Disease Control guidelines, and interview with the Director, the agency failed to ensure each direct care worker were provided with annual mycobacterium tuberculosis education for five (6) of six (6) PF's reviewed, (PF#1, 2, 3, 4, 5 and 6).
Findings include:
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 August 26, 2024 at approximately 10:45 am.
PF#1 , Date of Hire: 3/29/2022. PF contained a one-step PPD dated for 10/07/2021. No documentation that a 2 step PPD was administered upon hire. PF did not contain documentation that an initial symptom screening/risk assessments were completed upon hire. In addition, TB education annually was not conducted for 2023 and 2024.
PF#2, Date of Hire: 3/27/2022. PF did not contain documentation that an initial symptom screening/risk assessments were completed upon hire. In addition, TB education annually was not conducted for 2023 and 2024.
PF#3, Date of Hire: 5/11/2023. PF did not contain documentation that an initial symptom screening/risk assessments were completed upon hire. In addition, TB education annually was not conducted for 2024.
PF#4, Date of Hire: 2/15/2024. PF did not contain documentation that an initial symptom screening/risk assessments were completed upon hire.
PF#5, Date of Hire: 6/6/2021. PF did not contain documentation that an initial symptom screening/risk assessments were completed upon hire. In addition, TB education annually was not conducted for 2022, 2023 and 2024.
PF#6, Date of Hire: 6/6/2021. PF contained a one-step PPD dated for 6/08/2021. No documentation that a 2 step PPD was administered upon hire. PF did not contain documentation that an initial symptom screening/risk assessments were completed upon hire. In addition, TB education annually was not conducted for 2022, 2023 and 2024.
An interview with the Director on August 26, 2024 at approximately 12:00 pm confirmed the above findings.
Plan of Correction:Alani Home Care Inc before hire will need the caregivers to submit a 2 step ppd a single blood assay for Tb or a chest X-Ray. A questionnaire will also be given every year as an annual questionnaire is required. Alani Home Care Administrator will be implementing these questionnaires to all the new hires and also to prior hired caregivers. Alani Home Care will be making home visits to get these questionnaires sign and updated. All of this correction will be completed before 10/1/2024.
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 consumer records (CR), and interview with the Director, it was determined that the agency failed to ensure that the consumer received services according to the service plan for one (1) (CR#4) of five (5) consumer records (CR) reviewed.
Findings Include:
Review of email communication with the Care Coordinator conducted on August 29, 2024 at approximately 11:30 am, revealed that PF#5 and PF#6 were selecting tasks that they were not supposed to be checking off via the Electronic Visit Verification System.
CR#4 - (Start of Care: 6/6/2021) - Cosumer receives personal assistance services for sixteen (16) hours per day; seven (7) days per week.
Review of the Electronic Visit Verification System indicated that PF#5 and PF#6 were checking off tasks that should not have been checked off.
EVV Review - Agency random selection of PF5 and PF6 duties selected on EVV were provided to surveyor for review. Surveyor reviewed EVV on August 29, 2024 at approximately 11:30 am. PF#5 and 6 selected tasks that were not relevant to the clients care. As per the Office Coordinator, the employees were selecting most, if not all of the tasks that were available for selection rather than the tasks that the consumer were supposed to receive. The following tasks were selected for the consumer during the visit:
(142) Catheter Care, (144) G-Tube Feeding (202) Via Telephone (239) Record Output (Urine/BM) (240) Assist with catheter care (241) Empty foley bag (242) Assist with ostomy care (1) Hygiene, (116) Housework/Chore, (117) Managing Finances, (118) Managing Medications, (119) Shopping, (122) Hygiene
(123) Dressing Upper, (124) Dressing Lower, (125) Locomotion, (126) Transfer, (127) Toilet Use, (128) Bed Mobility, (129) Eating, (130) Bladder Incontinence, (131) Bowel Incontinence, (132) Personal Care T1019, (135) Bathing, (39) Reading/Writing, (141) Incontinence Care, (143) Wound Care,(2) Meal Prep, (201) In Person, (204) Bath-Tub (205) Bath-Shower, (206) Bath-Bed, (207) Patient Requires Total Care, (208) Mouth Care/Denture Care, (209) Hair Care-Comb, (210) Hair Care-Shampoo, (211) Grooming-Shave, (212) Grooming-Nails, (213) Dressing, (214) Skin Care, (215) Foot Care, (216) Toileting-Diaper, (218) Toileting-Bedpan/Urinal, (219) Toileting-Toilet (220) Patient is on a prescribed diet, (221) Prepare-Breakfast, (222) Prepare-Lunch, (223) Prepare-Dinner, (224) Prepare Snack, (225) Assist with feeding, (226) Record intake - Food, (227) Record intake - Fluid, (228) Transferring, (229) Assist with walking, (231) Assist with home exercise program, (232) Range of Motion Exercises (233) Turning and positioning (At least Q2), (234) Take Temperature, (235) Take Pulse, (236) Take Blood Pressure, (237) Weigh Patient, (238) Take respirations, (243) Remind to Take Medication, (244) Assist with Treatment, (245) Change bed linen, (246) Patient Laundry, (247) Light Housekeeping, (248) Clean Patient Care Equipment (249) Do Patient Shopping and Errands, (250) Accompany Patient to medical appointment, (3) Light Housekeeping, (4) Shopping, (5) Dressing
Random Selection review for PF#5-
1.EVV Dated For: 9/16/2021 - 79 tasks checked off, when only 14 tasks should have been selected.
2.EVV Dated For: 3/8/2022 - 67 tasks checked off, when only 14 tasks should have been selected.
3.EVV Dated For: 10/10/2023 - 73 tasks checked off, when only 14 tasks should have been selected.
4.EVV Dated For: 5/17/2024 - 73 tasks checked off, when only 14 tasks should have been selected.
5.EVV Dated For: 8/12/2024 - 73 tasks checked off, when only 14 tasks should have been selected.
Random Selection review for PF#6 -
1.EVV Dated For: 6/9/2021 - 79 tasks checked off, when only 14 tasks should have been selected.
2.EVV Dated For: 12/01/2022 - 79 tasks checked off, when only 14 tasks should have been selected.
3.EVV Dated For: 6/7/2023 - 73 tasks checked off, when only 10 of the 14 tasks were selected.
4.EVV Dated For: 5/10/2024 - 73 tasks checked off, when only 10 of the 14 tasks were selected.
EVV Dated For: 8/26/2024 - 73 tasks checked off, when only 10 of the 14 tasks were selected
Interview with the Care Coordinator on August 29, 2024 at approximately 1:00 PM confirmed the above findings.
Plan of Correction:Alani Home Care will provide all the caregivers a plan of care that our participant and Alani home Care coordinator will have drawn up to provide that best service that matches the participant needs. Furthermore, a copy of the care of plan will be required to be sing by both parties. Alani home care will also provide a list of duties and codes that will guide the Caregiver when they clock out through the EVV or through the participant phone. Alani home Care Inc Human Resource Director and Coordinator will remind each caregiver about the task that has to be check off and match the care plan for the participant. Alani Home Care will be making these actions as soon as possible and making home visits to have each participant and caregiver sign the documentation. All this correction will be completed on or before 10/1/2024
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 Director, 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 four (4) of four (4) CF's reviewed: (CF#1,2, 3 and 4).
Findings include:
The admission packet provided by the agency to the consumer, reviewed on August 26, 2024 at approximately 12:40 PM found that information pertaining to the prohibitions was not complete in the admission packet.
A review of CF#1,2 and 3 was conducted on August 23, 2024 at approximately 12:45 pm. CF#4 file was not available for review until August 26, 2024, as the file was not in the office, as per the Care Coordinator. CF#4 file was conducted 10:30 am. The start of care (SOC) is indicated below:
CF#1 SOC 5/11/2023. CF did not contained information regarding 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. In addition, the information regarding the home care agency may not require a consumer to endorse checks over to the home care agency was not provided to the consumer.
CF#2 SOC 2/27/2024. CF did not contained information regarding 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. In addition, the information regarding the home care agency may not require a consumer to endorse checks over to the home care agency was not provided to the consumer
CF#3 SOC 3/27/2022. CF did not contained information regarding 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. In addition, the information regarding the home care agency may not require a consumer to endorse checks over to the home care agency was not provided to the consumer
CF#4 SOC 6/6/2021. CF did not contained information regarding 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. In addition, the information regarding the home care agency may not require a consumer to endorse checks over to the home care agency was not provided to the consumer
An interview conducted with the Director on August 26, 2024 starting at 12:00 PM confirmed the above findings.
Plan of Correction:Alani Home Care Inc will implement in our service agreement form the prohibitions that states that no individual affiliated with the home care agency may assume power of attorney or guardianship of the participant using services of the agency. Alani Home Care Administrator and Coordinator will make home visits to have these documents signed. All these documents will be sign and acknowledged on or before 10/1/2024.
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 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. (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. (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 for four (4) of the four (4) CF's reviewed. (CF#1,2,3 and 4)
Findings include:
A review of CF's were conducted on August 26, 2024 starting at approximately 12:00 PM indicated the following with the Start of Care (SOC) indicated below:
CF#1 Start of Care 5/11/2023. File did not contain the identity of the direct care worker, hours when services will be provided, a phone number for who to contact at the Department for information about licensure requirements for a home care agency or home care registry. No information was listed regarding the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#2 Start of Care 2/27/2024 . File did not contain the identity of the direct care worker, hours when services will be provided, a phone number for who to contact at the Department for information about licensure requirements for a home care agency or home care registry. No information was listed regarding the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#3 Start of Care 3/27/2022 . File did not contain the identity of the direct care worker, hours when services will be provided, a phone number for who to contact at the Department for information about licensure requirements for a home care agency or home care registry. No information was listed regarding the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry.
CF#4 Start of Care 6/6/2021. File did not contain the identity of the direct care worker, hours when services will be provided, a phone number for who to contact at the Department for information about licensure requirements for a home care agency or home care registry. No information was listed regarding the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry. 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
An interview conducted with the Director on August 26, 2024 starting at 12:00PM confirmed the above findings.
Plan of Correction:Alani Home Care Inc will have a form where both participant and caregiver sign that will provide the task the hours and the days on what the caregivers needs to complete for the participant on a daily basis. Furthermore, on the Participant handbook our agency will implement the contact information that is required to be provided to each participant. Also, a form was created where we will also have the participant sign that acknowledge our agency trains all our caregivers prior to their start date. Alani Home Care Director and Coordinator will be conducting these actions and making sure each patient has signed this form. All this correction will be completed on or before 10/1/2024.
Initial Comments:
Based on the findings on an onsite un-announced complaint investigation conducted on August 23, 2024 and August 26, 2024, Alani Home Care, Inc., was found to be in compliance with the requirments of of 35 P.S. 448.809 (b).
Plan of Correction:
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