QA Investigation Results

Pennsylvania Department of Health
INDEPENDENCE AT HOME, LLC
Health Inspection Results

INDEPENDENCE AT HOME, LLC
Health Inspection Results For:

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Initial Comments:

Based on the findings of an onsite unannounced state relicensure survey completed 5/21/2025, Independence At Home Llc was found to be in compliance with the requirements of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart A, Chapter 51.

Plan of Correction:

Initial Comments:

Based on the findings of an onsite unannounced state relicensure survey completed 5/21/2025, Independence At Home Llc was found not to be in compliance with the following requirements 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:

611.56(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 CDC (Center for Disease Control) guidelines, personnel files (PF), and staff (EMP) interview, the agency failed to conduct tuberculosis (TB) screening in accordance with CDC guidelines and agency policy for six (6) of seven (7) PFs reviewed (PF1, PF2, PF3, PF5, PF6 and PF7).

Findings included:

Review of CDC Guidelines on 5/21/2025 at approximately 2:00 PM revealed, "TB Screening and Testing of Health Care Personnel Updated August 30 2022 ...All U.S. health care personnel should be screened for TB upon hire (i.e., preplacement). The local health department should be notified immediately if TB disease is suspected. Annual TB testing of health care personnel is not recommended unless there is a known exposure or ongoing transmission ...CDC and the National TB Controllers Association released updated recommendations for TB screening, testing, and treatment of health care personnel on May 17, 2019. These recommendations update the health care personnel screening and testing section of the 2005 CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings ..."

A review of the agency policy on 5/20/2025 at approximately 11:07 AM revealed, "Employee Handbook A Guide for Our Employees...Background Checks, FBI Clearance, Child Abuse Clearance, Exclusion Checks and TB Test...Orientation and Training...TB Test are required ANNUALLY on by your Anniversary Date of employment at Independence At Home, LLC..."

PF1, reviewed was conducted on 5/20/2025 at approximately 11:20 AM, date of hire 7/18/2023, A TST was administered on 10/2/2023 and read on 10/5/2023 with negative results. There was no additional documentation available to verify additional TB education/screening was conducted since 10/5/2023.

PF2, reviewed was conducted on 5/20/2025 at approximately 11:25 AM, date of hire 9/11/2023, A TST was administered on 9/27/2023 and read on 9/29/2023 with negative results. There was an additional TST conducted on 9/10/2024, the second TST was not documented. There was no additional TST documentation provided to confirm a second TST was conducted according to guidelines.

PF3, reviewed was conducted on 5/20/2025 at approximately 11:39 AM, date of hire 10/19/2024, A TST was administered on 9/30/2023 and read on 10/2/2023 with negative results. There was no additional TST documentation provided to confirm a second TST was conducted.

PF5 was reviewed on 5/20/2025 at approximately 11:54 AM, date of hire 10/17/2024. A TST was read on 10/16/2024 with negative results. The documentation did not list the date the TST was placed. There was no additional TST documentation provided to confirm a second TST was conducted.

PF6 was reviewed on 5/20/2025 at approximately 12:05 PM, date of hire 2/20/2025. A TST was placed on 2/17/2025 and read on 2/19/2025 with negative results. There was no additional TST documentation provided to confirm a second TST was conducted.

PF7 was reviewed on 5/20/2025 at approximately 12:11 PM, date of hire 1/3/2025. A TST was administered on 1/10/2025 and read on 1/13/2025 with negative results. There was no additional TST documentation provided to confirm a second TST was conducted.

An exit interview was conducted with the director on 5/21/2025 at approximately 9:25 AM which confirmed the above findings.

Plan of Correction:

Effective Immediately:

Tuberculosis (TB) Screening:

All new hires and current employees will be required to undergo a two-step TB skin test or a TB blood test (e.g., QuantiFERON-TB Gold or T-SPOT.TB).

CDC Educational Material:

Employees will receive educational materials provided by the Centers for Disease Control and Prevention (CDC) regarding TB, including transmission, symptoms, and prevention measures.

Risk and Symptom Assessment:

A CDC-based TB risk assessment and symptom screening will be conducted:

At the time of hire.

Annually for all employees thereafter.

These measures are being implemented to ensure early detection and prevention of TB, promote a safe work environment, and comply with public health guidelines. These measures are monitor by Independence at Home's office assistant and administrative assistance along with a final review from the Director.

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 Centers for Disease Control (CDC) guidance, agency policy, personnel files (PF) and staff (EMP) interview it was determined the agency failed to ensure an updated evaluation for mycobacterium tuberculosis (TB) at least every twelve (12) months for two (2) of three (3) PFs who were employed at least 12 months (PF1 and PF2).

Finding included:

Review of CDC guidance on 5/21/2025 at approximately 11:30 AM 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)..."

A review of the agency policy on 5/20/2025 at approximately 11:07 AM revealed, "Background Checks, FBI Clearance, Child Abuse Clearance, Exclusion Checks and TB Test...Orientation and Training...TB Test are required ANNUALLY on by your Anniversary Date of employment at Independence At Home, LLC..."

PF1, review was conducted on 5/20/2025 at approximately 11:20 AM, date of hire 7/18/2023, A TST was administered on 10/2/2023 and read on 10/5/2023 with negative results. There was no additional documentation available to verify additional TB education/screening was conducted since 10/5/2023.

PF2, review was conducted on 5/20/2025 at approximately 11:25 AM, date of hire 9/11/2023, A TST was administered on 9/27/2023 and read on 9/29/2023 with negative results. There was an additional TST conducted on 9/10/2024, the second TST was not documented. There was no documentation available to verify additional TB education/screening was conducted since 9/29/2023.

An exit interview was conducted with the director on 5/21/2025 at approximately 9:25 AM which confirmed the above findings.

Plan of Correction:

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 a review of the agency policy, consumer records (CR) and staff (EMP) interview, the agency failed to involve the consumer in the service planning process and to receive services with reasonable accommodation of individual needs and preferences for one (1) of seven (7) CR's reviewed (CR6).

Findings included:

A review of the agency policy on 5/20/2025 at approximately 11:07 AM revealed, "Consumers Rights...Health Information Rights & Consumers Rights...2) Consumer Rights The consumer of home care services provided by (Agency) shall have the following rights: To be involved in the services planning process and to receive services with reasonable accommodation of Individuals needs and preferences, except where the health and safety of the direct care worker is at risk..."

Review of CR6, start of services 10/12/2023, was conducted on 5/20/2025 at approximately 3:05 PM. The hours services were scheduled per the agency documentation "CLIENT'S PROFILE" and "CLIENT SCHEDULE" was "DAYS AND TIME OF SERVICE: MON-SUN 6PM 9PM..."
A review of the days and hours from April and May 2025 listed the following: "HHAeXchange Member Calendar...Sunday, Monday 18:00-21:00 Tuesday-Saturday 18:00-20:00..." The times did not match the caregiver service agreement for the agreed times services were to be provided for Tuesday through Saturday.

An exit interview was conducted with the director on 5/21/2025 at approximately 9:25 AM which confirmed the above findings.

Plan of Correction:

All schedules in consumer folder will be maintained in an up-to-date and accurate manner, ensuring consistency with the records in HHA and align with the service agreement. Schedules will be completed during intake visits with consumers and client coordinator.
If for any reason a schedule cannot be completed the consumers folder will be placed in a pending status by the client coordinator. When it is completed the office assistant or administrative assistant will notify the client coordinator or director. The administrative assistant or office assistant will take the folder out of pending status and file in the file cabinet. All folders contain a review and revise form. The review and revise form will be completed with a date and description of what was reviewed, revised and/or status.

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 the consumer records (CR) and staff interview, the agency failed to provide required information in writing to the consumers/consumer representatives prior to the commencement of services for two (2) of seven (7) CRs reviewed (CR2 and CR7).

Findings included:

A review of CR2 on 5/20/2025 at approximately 12:35 PM revealed start of services 1/29/2025. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The identity of the direct care worker who would provide services.

A review of CR7 on 5/20/2025 at approximately 3:12 PM revealed start of services 6/24/2024. No documentation was made available to confirm the consumer/consumer representative was provided an information packet containing the following:
1. The identity of the direct care worker who would provide services.
2. The hours when services would be provided.

An exit interview was conducted with the director on 5/21/2025 at approximately 9:25 AM which confirmed the above findings.

Plan of Correction:

Prior to the commencement of services or upon any change in the assigned Direct Care Worker and/or scheduled times, the consumer or consumer representative will be formally notified by the administrative assistant or office assistant of the change, and the update will be documented accordingly in the consumer's folder and documented on the review and revise form including date and time the consumer or consumer representee was notified. All folders are audited quarter by the office assistant and client coordinator to make sure folders are in compliance with state regulations.