Initial Comments:
Based on the findings of an onsite unannounced state re-licensure survey conducted on October 23, 2024, Age in Place 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 home care agency state re-licensure survey conducted on October 23, 2024, Age In Place Home Care 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(a) LICENSURE
Hiring or Rostering Prerequisites
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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 employee files (EFs), agency policy, and interview with agency Care Coordinator, the agency failed to document face-to-face interviews for one (1) of seven (7) EFs reviewed (EF#7); and failed to obtain two satisfactory references for one (1) of seven (7) EFs reviewed (EF#7).
Findings included:
Review conducted on October 23, 2024, at approximately 12:00 PM, of agency employee files (EFs) revealed:
EF#7 date of hire 9/27/22, missing documentation for onhire face to face interview and two satisfactory references.
Review conducted on October 23, 2024, at approximately 1:45 PM, of agency policy "Criminal History Background Checks" revealed: "Prerequisites for hiring Direct Care Workers .... Face-To-Face interview with applicant, Two satisfactory references not related to the the individual that affirms their ability to provide home care services."
Interview conducted on October 23, 2024, at approximately 1:45 PM, with agency Care Coordinator revealed confirmation of above findings.
Plan of Correction: 1. By 12/22/2024, Field Office Staff will review all active caregiver files to ensure face-to-face interviews and two satisfactory references are completed and documented. If anyone is missing this item, a letter will be placed in the caregivers file stating that "survey finding on 10/23/2024 found this document missing and a corrective action plan was instituted to correct future similar non-compliance".
2. By 12/22/2024, Agency Director will add face-to-face document to the caregiver new hire checklist.
3. By 12/22/2024, Agency Director will retrain agency office staff on the required face-to face interview compliance. Agency staff will acknowledge training with signatures, title and date of training.
4. Starting 12/12/2024, Field Office Staff Member will begin conducting 10 new client file self-audits per month specifically pertaining to face-to-face interviews and two satisfactory reference checks.
All oversight will be conducted by Agency Director and Agency Office Supervisor.
611.55(e) LICENSURE
Competency Requirements
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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) and interview with agency Care Coordinator, the agency failed to complete and document individual Direct Care Worker (DCW) annual competency in four (4) out of seven (7) EFs (EF#1, #4, #6-7).
Findings include:
Review conducted on October 23, 2024, at approximately 12:00 PM, of employee files (EFs) revealed:
EF#1 date of hire (doh) 6/27/22, missing annual competency review 2023.
EF#4 doh 5/1/21, missing annual competency reviews in 2022, 2023.
EF#6 doh 7/22/22, missing annual competency review in 2023.
EF#7 doh 9/27/22, missing annual competency review in 2023.
Interview conducted on October 23, 2024, at approximately 1:30 PM, with agency Care Coordinator revealed confirmation of above findings.
Plan of Correction:1. By 12/22/2024, Area Development Manager will require EFs #1, #4, #6, and #7 to complete DCW knowledge test to satisfy competency requirement.
2. By 12/22/2024 Field Office Staff will run a compliance report to ensure all active caregivers have completed the DCW knowledge test. The Field Office Staff will identify any missing and have them completed.
3. By 12/22/2024, Agency Director will conduct an education to ensure the office staff understand the regulation and the new process we put into place. Re: Upon hire all caregivers are required to complete the direct care worker knowledge test. This test touches base on all 16 elements required. Within 90 days of hire date, the caregivers are also required to complete watching video in-services followed by a 5-10 question quiz passing with an 80% or better at which time a certificate is received. Annually the same process is completed where the caregiver completes a list of in-services selected by the Agency Director, which touch base on all 16 elements, the certificates are then uploaded to the caregiver file in HHA. In addition to the video in-services, we will also have the caregivers complete the DCW knowledge test annually. We will continue to monitor our competency requirements by conducting our monthly self- audit checks. Agency staff will acknowledge training with signatures, title and date of training.
All oversight will be conducted by the Agency Director and Agency Office Supervisor.
611.56(a) LICENSURE
Health Screening
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(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, employee files (EFs), agency policy, and interview with agency Care Coordinator, 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) for three (3) of seven (7) EFs reviewed. (EFs #1, #4, #7).
Findings include:
Review conducted on October 23, 2024, at approximately 12:00 PM, of Centers for Disease Control (CDC) Guidelines for "Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019" revealed: "1) TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement); 2) TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI); ... 5) annual symptom screening for health care personnel with untreated LTBI; and 6) annual TB education of all health care personnel.; ... Baseline (preplacement) screening and testing. All U.S. health care personnel should have baseline TB screening, including an individual risk assessment (Box), which is necesfor interpreting any test result. The 2005 guidelines state that baseline test results provide a basis for comparison in the event of a potential or known exposure to M. tuberculosis, facilitate detection and treatment of LTBI or TB disease in health care personnel before placement, and reduce the risk to patients and other health care personnel (1). The risk assessand symptom evaluation help guide decisions when interpreting test results."
Review conducted on October 23, 2024, at approximately 12:30 PM, of employee files (EFs) revealed:
CF#1 date of hire (doh) 6/27/22, missing onhire Tuberculosis (TB) risk assessment questionnaire (TB-RAQ).
CF#4 doh 5/1/21, missing onhire TB-RAQ.
CF#7 doh 9/27/22, missing onhire TB-RAQ.
Review conducted on October 23, 2024, at approximately 1:15 PM, of agency policy "Tuberculosis Screening" revealed: ... "The [TB] shall be conducted in accordance with CDC guidelines for preventing the transmission of tuberculosis in health care settings."
Interview conducted on October 23, 2024, at approximately 1:45 PM, with agency Care Coordinator revealed confirmation of above findings.
Plan of Correction:1. By 12/22/2024, Area Development Manager will require EFs #1, #4, and #7 to complete a 2024 TB risk assessment questionnaire. These documents will be maintained in the individual's electronic file.
2. By 12/22/2024, Field Office Staff Member will run a compliance report from HHA to determine if anyone is missing the on-hire Tuberculosis testing and TB risk assessment questionnaire. If anyone is missing this compliance item, Area Development Manager will ensure the individuals obtain required test results and TB risk assessments. These results and documents will be stored in the employee's file.
3. By 12/22/2024, Agency Director will create a monthly self-audit form specifically to monitor the PPD Testing.
4. By 12/22/2024, Field Office Staff Member will begin to monitor 10 random new employee files monthly (specifically for TB testing and on-hire/annual TB risk assessment questionnaire) to ensure continued compliance. If gaps are noted, Agency Director and Agency Office Supervisor will address the issue and require completed competency exams. These results will be maintained in the individual's electronic file.
All oversight will be conducted by Agency Director and Agency Office Supervisor.
611.57(c) LICENSURE
Information to be Provided
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(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), the consumer admission packet, 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); failed to identify assigned direct care worker in one (1) of five (5) CFs reviewed (CF#3); and failed to provided hours, days/frequency of provided care to consumer in one (1) of five (5) CFs reviewed (CF#2).
Findings include:
Review conducted on October 23, 2024, at approximately 10:45 AM, of consumer files (CFs) revealed:
CF#1 start of care (soc) 9/22/23, missing documentation of fees and total costs for provided services, owed by consumer to agency.
CF#2 soc 4/8/22, missing documentation of days and time for provided services, and missing documentation of fees and total costs for provided services, owed by consumer to agency.
CF#3 soc 10/23/24, missing agreement date for personnel service document (page 3 of 4), no identity of assigned direct care worker, and missing documentation of fees and total costs for provided services, owed by consumer to agency.
CF#4 soc 5/12/24, missing documentation of fees and total costs for provided services, owed by consumer to agency.
CF#5 soc 6/25/24, missing documentation of fees and total costs for provided services, owed by consumer to agency.
Reviewed conducted on October 23, 2024, at approximately 10:40 PM, of new consumer welcome package revealed no clearly documented space for third-party payers (Medicare, Medicaid, insurances, or waiver programs) payment for provided services. No documentation space for a percentage or total costs (dollars amount) that may be owed by consumer for provided services to home care agency, if third-party payer amount is not sufficient to cover care charges.
Interview conducted on October 23, 2024, at approximately 1:30 PM, with agency Care Coordinator revealed confirmation of above findings.
Plan of Correction: 1. By 12/22/2024, Field Office Staff Member will review all active client files and ensure agency's statement of work document is completed for: caregiver's name, who is providing the services; and provided care hours, days/frequency.
2. By 12/22/2024, Agency Director will revise/add a line on our Statement Of Work admission form to include "fees and total costs for provided services, owed by consumer to agency".
3. On 11/13/2024, Agency Director will retrain agency office staff on the required completion for new consumer information items. Agency staff will acknowledge training with signatures, title and date of training.
3. With audit data, Field Office Staff Member will contact all current enrolled clients who did not received correct information (caregiver name, hours and days of care, and fees and total costs owed by consumer to agency) by [Method – letter]. The letter documentation of this updated information will be retained in the consumer's file.
4. Starting 12/12/2024, Field Office Staff Member will begin conducting 10 new client file self-audits per month specifically pertaining to the notification (to client) of DCW to provide services, fees/total costs owed by consumer to agency, and hours and days of care. If gaps are noted, Agency Director and Agency Office Supervisor will address the issues.
All oversight will be conducted by Agency Director and Agency Office Supervisor.
Initial Comments:
Based on the findings of an onsite unannounced home care agency state re-licensure survey conducted on October 23, 2024, Age In Place Home Care was found to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
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