QA Investigation Results

Pennsylvania Department of Health
AHAVA HOME HEALTHCARE, LLC
Health Inspection Results
AHAVA HOME HEALTHCARE, LLC
Health Inspection Results For:


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Initial Comments:


Based on the findings of an onsite revisit and complaint investigation completed May 25, 2022, Ahava Home Healthcare, Llc was found not to be in compliance with PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart H, Chapter 611, Home Care Agencies and Home Care Registries, and had not corrected one (1) deficiency. The deficiency was cited as a result of a state license survey completed October 19, 2021, and March 17, 2022.



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 review of direct care worker personnel files (PF), and staff (EMP) interview the agency failed to, prior to hire, obtain two satisfactory references, and obtain criminal history reports in accordance with the requirements of 611.52 for two (2) of three (3) personnel files reviewed (PF1, & PF2).

Findings included:

According to 611.52(a), The home care agency or home care registry shall require each applicant for employment or referral as a direct care worker to submit a criminal history report obtained at the time of application or within 1 year immediately preceding the date of application.

According to 611.52(b), The home care agency or home care registry shall require each applicant for employment or referral as a direct care worker to submit a criminal history report obtained at the time of application or within 1 year immediately preceding the date of application." According to 611.52(b), "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.

According to 611.52(c), 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).

According to Department of Aging memo, "Background: The Older Adults Protective Services Act (OAPSA) requires all applicants/employees of specific facilities/agencies (see below for list of facilities/agencies defined by OAPSA) who are not, or have not been, a resident of the Commonwealth of Pennsylvania for the last two years, to obtain criminal history record information reports from both the Pennsylvania State Police (PSP) and the Federal Bureau of Investigation (FBI). The results for applicants/employees who require an FBI check must come from the Pennsylvania Department of Aging. ... Types of Facilities/Agencies mandated under the OAPSA ... Home Care Agency or Registry."

Review of personnel files was conducted on May 25, 2022, at 10 a.m. with EMP1.

PF1 was hired on 5/5/2022 and was an Ohio resident. The file contained no State Police criminal history report, and the Federal criminal history report was not initiated until 5/16/2022 (not initiated prior to hire or at time of application). PF1 contained no references.

PF2 was hired on 5/16/2022 but the State Police criminal history report was not requested until 5/23/2022.

Interview with EMP1 at time of review confirmed above findings.







Plan of Correction:

Agency failed to complete a PA state police criminal history report on an Ohio applicant prior to hire or at the time of application.

The owner will revise current policy and add that any out of state resident must have a PA background check as well as an FBI clearance. Agency will retrain care manager on the updated policy on hiring a new candidate and the procedure. As well as train with the care manager 1 on 1 with the next hire, Owner will monitor the next 2 new hire files with the care manager to ensure the correct procedure is being completed. New hire checklist will be reimplemented.





611.57(a) LICENSURE
Consumer Rights

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(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 a consumer record (CR) and staff (EMP) interview, the agency failed to provide services in accordance with the consumer's needs, and 10 days written notice of termination of services for one (1) of one (1) consumer record reviewed (CR1).

Findings include:

A review of CR1 was conducted on May, 25 2022, at 11 a.m. with EMP1. The review included staff time sheets from 4/1/2022 to 4/25/2022, and service authorization in HHAeXchange. There was no consumer file at the agency to show CR1 received and information packet or signed a service agreement. Cross reference Tag 830 for more information.

According to EMP1, who reviewed CR1's information in HHAeXchange, the consumer started services on 8/21/2021 and no services were provided after 4/25/2022. CR1's service authorization was from 7/30/2021 5/11/2022 for 1430 hours for that period. EMP1 noted, "She wanted Monday through Friday 35 hours per week or 7 hours per day ... she was supposed to get Monday through Friday 8:30 a.m. - 3:30 p.m."

The below hours of services for CR1 were provided by EMP1 who reviewed them in HHAeXchange on May 25, 2022, at 11 a.m.

April 1: 11:01 a.m. to 2:15 p.m. - 3 hours and 14 minutes (3:14)
April 4: 8:27 a.m. to 2:14 p.m. - 5:47
April 5: 8:36 a.m. to 2:01 p.m. - 5:25
April 6: 830 a.m. to 2:08 p.m. - 5:38
April 7: 8:35 a.m. to 2:33 p.m. - 5:58
April 11: 8:30 a.m. to 2:51 p.m. - 6:20
April 12: 9:02 a.m. to 3:15 p.m. - 6:13
April 13: no hours provided due to call off, "we called to make sure she was ok." No documentation to show agency contacted CR1 to notify her of this change in the service agreement (no services provided). When EMP1 was asked if he/she had documentation he/she noted, "I do not."
April 14: 9:57 a.m. to 3:21 p.m. - 5:24
April 18: 8:48 a.m. to 2:52 p.m. - 6:04
April 19: 8:36 a.m. and no clock out and no total hours per EMP1, "no."
April 20: 8:33 a.m. to 2:01 p.m. - 5:28
April 21: 9:20 a.m. to 2:33 p.m. - 5:13
April 25: 9:59 a.m. to 2:30 p.m. - 4:31 "Cut short because [CR1] went to the hospital."

Interview with EMP1 on May 25, 2022, at 11:15 a.m. confirmed agency did not provide the full 7 hours because of an undocumented arrangement between CR1 and her DCW. EMP1 confirmed no services provided after 4/25/2022, "[direct care worker] stopped going in," and there was no documentation to show consumer was notified of termination of services.












Plan of Correction:

AGENCY FAILED TO PROVIDE SERVICES IN ACCORDANCE WITH THE CONSUMERS NEEDS. AGENCY FAILED TO PROVIDE THE CONSUMER WITH A 10 DAY WRITTEN NOTICE OF TERMINATION.

CARE MANAGER WILL PROVIDE CONSUMER WITH NEW SERVICE AGREEMENT WITH ANY PERMANENT CHANGE MADE BY CONSUMER, TO SCHEDULED DATES AND TIMES.

OWNER WILL CREATE POLICY REGARDING TIMES WHEN NEW SERVICE AGREEMENT IS NEEDED AND TIME FRAME TO HAVE IT COMPLETED AND FILED.


AGENCY WILL PROVIDE CONSUMER WITH 10 DAY WRITTEN TERMINATION NOTICE WHEN AGENCY IS NO LONGER ABLE TO PROVIDE SERVICE IN A SITUATION LIKE THIS.

OWNER WILL CREATE POLICY REGARDING TERMINATION NOTICE.

CARE MANAGER AND OWNER WILL AUDIT CONSUMER FILES 8/5/2022 AND WILL DOCUMENT CONTINUED MONTHLY AUDITS.



611.57(d) LICENSURE
Documentation

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(d) The home care agency or home care registry shall maintain documentation on file at the agency or registry of compliance with the requirements of this section which shall be available for Department inspection.

Observations:


Based on review of a consumer record (CR) time sheets and staff (EMP) interview, the agency failed to maintain documentation to show compliance with 611.57(a) and 611.57(c). The agency did not maintain documentation to show the consumer was notified of changes in services to be provided and did not maintain documentation to show the consumer was provide required information prior to start of service for one (1) of one (1) consumer file reviewed (CR1).

Findings include:

Per 611.57(a) of this section, 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.

Per 611.57(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.

On May 25, 2022, at 10:45 a.m. surveyor requested CR1's file for review but EMP1 could not locate it, "I don't know where it is." At 11:15 a.m., EMP1 confirmed he/she had no file for CR1 to show compliance with 611.57(c) or that CR1 received above required information prior to start of service.

A review of CR1's electronic billing records was conducted on May 25, 2022, at 11 a.m. with EMP1. The review included staff time sheets from 4/1/2022 to 4/25/2022, and the service authorization in HHAeXchange. According to EMP1, who reviewed CR1's information in HHAeXchange, the consumer started services on 8/21/2021.

On April 13, 2022, no services were provided due to call off, "we called to make sure she was ok," but there was no documentation to show agency contacted CR1 to notify her of this change in the service agreement. When EMP1 was asked if he/she had documentation he/she noted, "I do not."





















Plan of Correction:

Agency failed to provide consumer file. Agency failed to complete and maintain documentation. Owner will complete documentation policy and retrain staff it pertains to. Owner currently seeking a program to keep files electronically. Care Managers no longer working remotely. Monthly consumer file audits to be completed by care manager on monthly basis and documented indefinitely.