QA Investigation Results

Pennsylvania Department of Health
BETTER HOME HEALTH CARE SERVICES, LLC
Health Inspection Results
BETTER HOME HEALTH CARE SERVICES, 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 unannounced onsite state re-licensure survey conducted on April 22, 2024, Better Home Health Care Services, LLC 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 unannounced onsite state re-licensure survey conducted on April 22, 2024, Better Home Health Care Services, 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(b) LICENSURE
Direct Care Worker Files

Name - Component - 00
Files for direct care workers employed or rostered shall include documentation of the date of the face-to-face interview with the individual and of references obtained. Direct Care Worker files also shall include other information as required by 611.52, 611.53, if applicable, 611.54, 611.55 and 611.56 (relating to criminal background checks, child abuse clearance, provisional hiring, competency requirements; and health evaluations).

Observations:


Based on review of employee files (EFs) and interview with agency administrator, the agency failed to document and maintain face-to-face interviews with new employees in seven (7) out of seven (7) EFs reviewed ( EFs#1-7); and failed to document, complete, and maintain at least two satisfactory references in seven (7) out of seven (17) EFs reviewed (EFs#1-7).



Findings include:


Review conducted on April 22, 2024, at approximately 10:15 AM to 11:35 AM, of employee files (EFs) revealed:

EF#1 date of hire (doh) 8/1/21, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.

EF#2 doh 2/2/23, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.

EF#3 doh 2/15/23, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.

EF#4 doh 2/16/24, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.

EF#5 doh 4/5/24, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.

EF#6 doh 2/13/24, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.

EF#7 doh 12/20/23, face to face interview page had no employee name, no date or notes for interview, and no evaluator name; and listed references (names, address, relationship, and phone number) missing reference check dates, satisfactory/unsatisfactory evaluation, and no evaluator name.


Interview conducted on April 22, 2024, at approximately 1:30 PM, with agency administrator revealed confirmation of above findings.











Plan of Correction:

By June 21,2024, 2024, the Agency owner will create a face-to-face interview document/form to be use with all future protentional employees. This will be stored in the new employee's H/R file.

By June 21, 2024, the Agency owner will create a new form to document the agency's review of references to include the reference name. address, relationship, telephone number, reference check date, scored as either satisfactory or unsatisfactory and the evaluator name and date.

Additionally, all audit/monitoring of files will take place (every 4-6months) to identify any new gaps in compliance with this item.


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 upon review of employee files and interview with agency administrator, the agency failed to maintain a complete Pennsylvania State Police criminal history record (PATCH) for two (2) of seven (7) employees reviewed (EF#2-3).


Findings include:


Review conducted on April 22, 2024, at approximately 10:15 AM to 11:35 AM, of employee files (EFs) revealed:

EF#2 doh 2/2/23, PATCH document lacked official result dissemination date.

EF#3 doh 2/15/23, PATCH document lacked official result dissemination date.


Interview conducted on April 22, 2024, at approximately 2:00 PM, with administrator revealed confirmation of above findings.









Plan of Correction:

By June 21, 2024, EF#2 & 3 will obtain a current state Police Patch criminal background check.

Moving forward the Agency owner will conduct an internal audit (quarterly) of employees H/R files to make sure no other future individual will be affected by the same deficient practice.

Additionally, the Agency will use its onboarding check list to ensure PATCH is completed prior to consumer assignment.


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 upon review of employee files (EFs) and an interview with the agency manager, agency failed to obtain a Federal criminal history record and a letter of determination from the Pennsylvania (PA) Department of Aging for two (2) out of seven (7) EFs reviewed (EF#3, EF#5).


Findings include:


Review conducted on April 23, 2024, at approximately 10:15 AM to 11:35 AM, of employee files (EFs) revealed:

EF#3 date of hire (doh) 2/15/2023, no documentation of onhire Federal criminal history record. PA driver's license issue date 2/8/2022 with expiration 1/2/2024 observed.

EF#5 doh 4/5/2024, no documentation of onhire Federal criminal history record. PA driver's license issue date 1/2/2024 with expiration 3/7/2025 observed.


Interview conducted on April 23, 2024, at approximately 2:00 PM, with agency administrator confirmed above findings.








Plan of Correction:

By June 21, 2024, the Agency owner will obtain current federal criminal history check and current PA driver's license on EF # 3 & #5

Moving forward, the Agency owner will conduct an internal audit (every 4-6 months) of all employees files to make sure no other individuals have been affected by the same deficient practice. The Agency Owner will also create a new hire check list to avoid this deficient practice to occur with all new hires. This onboarding document will ensure FBI/Office of Aging letter is completed prior to consumer assignment.


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 a review of employee files (EFs) and interview with agency administrator, the agency failed to require direct care workers to furnish proof of residency for two years prior to 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; and (6) employment records, including records of unemployment compensation for two (2) of seven (7) EFs reviewed (EFs #3, #5).


Findings include:


Review conducted on April 22, 2024, at approximately 10:15 AM to 11:35 AM, of employee files (EFs) revealed:

EF#3 doh 2/15/23, noted Pennsylvania (PA) driver's license issued 2/8/2022 with expiration date 1/2/2024.

EF#5 doh 4/5/24, noted Pennsylvania driver's license issued 1/2/2024 with expiration date 3/7/2025.


Interview conducted on April 22, 2024, at approximately 1:40 PM, with agency administrator confirming the above findings.







Plan of Correction:

By June 21, 2024, the Agency owner will secure current proof of residency from EFs 3 & 5. This proof will be in the form of a current PA driver's license, rent lease, utility bill, mortgage and etc...

Moving forward, the Agency owner will develop and a New Hire checklist to include the proof of residency as an item listed to avoid this deficient practice.


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 employee files (EFs) and interview with the agency administrator, the agency failed to ensure documentation showing direct care workers, prior to providing services to consumers, completed/demonstrated an initial competency training covering all required sixteen (16) subject areas for five (5) of seven (7) EFs reviewed (EF#3-7).


Findings include:


Review conducted on April 22, 2024, at approximately 10:15 AM to 11:35 AM, employee files (EFs) revealed:

EF#3 date of hire (doh) 2/15/2023, no test evaluator name, date, or final test score on documents.

EF#4 doh 2/16/2024, no test evaluator name, date, or final test score on documents.

EF#5 doh 4/5/2024, no test evaluator name, date, or final test score on documents.

EF#6 doh 2/13/24, many test questions not completed, no test evaluator name, date, or final test score on documents.

EF#7 doh 12/20/23, no test evaluator name, date, or final test score on documents.


Interview conducted on April 22, 2024, at approximately 1:45 PM, with agency administrator revealed confirmation of above findings.









Plan of Correction:

By June 24, 2024, all current employees will have completed a competency assessment with a passing score of 70%. The employees will also complete (6) hours of training in the area of Home Health care.

Moving forward, the Agency owner will put in place a training calendar for current employees to complete (6) hours of training quarterly with in a (1) year period. All new hires will take a competency exam before the start of employment and will be given the Agency's training calendar (to complete training courses) to follow during employment.


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 review of employee files (EFs), agency employee handbook, and interview with agency administrator, the agency failed to complete and document individual Direct Care Worker (DCW) annual competency test in one (1) out of seven (7) EFs (EF#3).


Findings include:


Review conducted on April 22, 2024, at approximately 9:45 PM, of agency employee handbook revealed: Page 10, "Annual Review After the initial three-month review, employees will be reviewd at least once annually, or or around their anniversary date."


Review conducted on April 22, 2024, at approximately 10:15 AM to 11:15 AM, of employee files (EFs) revealed:

EF#3 date of hire 2/15/23, missing 2024 annual competency review.


Interview conducted on April 22, 2024, at approximately 1:45 PM, with agency administrator confirmed above findings.







Plan of Correction:

By June 21, 2024, the Agency owner will conduct an annual review of the EF # 3.

By June 21, 2024, the agency owner will develop an annual review check list and conduct annual reviews on each employee as outline below:
1. 3-months (90 days)
2. 6-months
3. 1 year review.


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 Centers for Disease Control (CDC) guidelines, agency employee handbook, employee files (EFs), and interview with agency administrator, the agency failed to ensure direct care workers, prior to consumer contact, that the individual had been screened for and was free from active mycobacterium tuberculosis (TB) in four (4) of seven (7) EFs reviewed (EFs#4-7).


Findings include:


Review conducted on April 22, 2024, at approximately 10:30 AM, CDC guidelines revealed: "All Health Care Workers (HCW) should receive 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. After baseline testing for infection with tuberculosis, HCWs should receive TB screening annually. HCWs 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 the 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)."


Review conducted on April 22, 2024, at approximately 9:45 AM, of agency employee handbook revealed: "Infection Control and Health Screening ... Health Screening :1. All Morning Star Home Care Services, LLC (old agency name) Nursing services employees must be screened for Tuberculosis exposure prior to work. A PPD test will be administered and if a positive result is obtained, a Chest X-ray will be performed at the employee's expense to assure a negative result before working."

Review conducted on April 22, 2024, at approximately 10:15 AM to 11:35 AM, of employee files (EFs) revealed:

EF#4 date of hire (doh) 2/16/2024, missing #2 TB tuberculin skin test (TST) and onhire TB risk assessment.

EF#5 doh 4/5/2024, missing #2 TB TST and onhire TB risk assessment.

EF#6 doh 2/13/2024, missing #1 and #2 TB TST and onhire TB risk assessment.

EF#7 doh 12/20/2023, missing #1 and #2 TB TST and onhire TB risk assessment.


Interview conducted on April 22, 2024, at approximately 1:45 PM, with agency administrator revealed confirmation of above findings.













Plan of Correction:

By June 21, 2024 the Agency owner will secure a TB step 2 or chest -Xray from the following employees ( #4, 5, 6, and 7) to continue employment.

Moving forward, the Agency owner will create and implement a new employee checklist to include TB Test 2 and or chest-Xray to make sure no other individuals have been affected by the same deficient practice.


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 Center for Disease and Control (CDC) guidelines, employee files (EFs), and an interview with the agency administrator, the agency failed to ensure each direct care worker completed annual tuberculosis (TB) risk education for three (3) out of seven (7) EFs reviewed (EF#1-3).


Findings:


Review conducted on April 22, 2024, at approximately 10:30 AM, of CDC guidelines revealed: "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).


Review conducted on April 22, 2024, at approximately 10:30 AM to 11:35 AM, of employee files (EFs) revealed:

EF#1 date of hire (doh) 8/1/2021, missing annual TB education for 2022, 2023.

EF#2 doh 2/2/23, missing annual TB education for 2024.

EF#3 doh 2/15/23, missing annual TB education for 2024.


Interview conducted on April 22, 2024, at approximately 2:00 PM, with agency administrator confirmed above findings.






Plan of Correction:

By June 21, 2024, the Agency Owner will secure a TB screening questionnaire signature document from EF's #1,2 &3.

Moving forward, the Agency owner, will create and implement a Health Screening tracking chart that will include the Tuberculosis annual questionnaire that will be used to ensure deficient practice does not recur.


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 (CFs) and an interview with the agency administrator, the agency failed to provide the consumer, prior to commencement of services, documented fees and total costs for services - owed by the consumer to the agency in five (5) out of five (5) CFs reviewed (CF#1-5).


Findings include:

Review conducted on April 22, 2024, at 11:35 AM to 1:15 PM, of consumer files (CFs) revealed:

CF#1 start of care (soc) 11/10/2021, Medicare Waiver consumer, page 79 service agreement section #3 "Consumer Financial" missing documentation of fees/costs for services owed by consumer to agency.

CF#2 soc 12/27/2023, Medicare Waiver consumer, page 79 service agreement section #3 "Consumer Financial" missing documentation of fees/costs for services owed by consumer to agency.

CF#3 soc 2/3/2023, Medicare Waiver consumer, page 79 service agreement section #3 "Consumer Financial" missing documentation of fees/costs for services owed by consumer to agency.

CF#4 soc 4/8/2023, Medicare Waiver consumer, page 79 service agreement section #3 "Consumer Financial" missing documentation of fees/costs for services owed by consumer to agency.

CF#5 soc 4/19/24, Medicare Waiver consumer, page 79 service agreement section #3 "Consumer Financial" missing documentation of fees/costs for services owed by consumer to agency.


Interview conducted on April 22, 2024, at approximately 1:45 PM, with agency administrator confirmed above findings.





Plan of Correction:

By June 21, 2024, the Agency owner will create and develop Ombudsman Acknowledgement form for all Consumer to sign once receiving the State document. Additionally, the Agency owner will create and implement a Consent to Provide service form to include a section on Consumer Financial. CF's #2,3,4,& 5 will secure the two mentioned documents in their files on/before the June 11th date.

Moving forward, the Agency Owner will implement the above documents immediately for management to ensure deficient practice does not recur.



Initial Comments:

Based on the findings of an unannounced onsite state re-licensure survey conducted on April 22, 2024, Better Home Health Care Services, LLC was found to be in compliance with the requirements of 35 P.S. 448.809 (b).




Plan of Correction: