Initial Comments:
An off-site follow-up survey conducted on November 30, 2023, found that Delight Homecare, Llc, had not corrected the deficiencies cited under the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 611, Subpart H. Home Care Agencies and Home Care Registries. The deficiencies were cited as a result of a re-licensure survey conducted August 15, 2023.
Plan of Correction:
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 review of personnel files (PF) and interview with the agency administrator, it was determined the agency failed to ensure direct care workers had a screening for mycobacterium tuberculosis on hire in two (2) of eight (8) files reviewed. (PFs # 1-# 2)
Findings include:
The CDC guidelines state that all Health Care Workers (HCW) should receive baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) of a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. After baseline testing for infection with tuberculosis, HCWs should receive TB screen 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;(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 of Delight Homecare (DHC) Tuberculosis screening company policy on 11/29/23 at approximately 3:30 PM revealed: "Purpose: DHC has established and maintains a policy to comply with regulations pertaining to current and new office staff, interns, volunteers and employees regarding Tuberculosis (TB) testing and pre-hire TB screening." Policy: "All DHC employees,...who have direct patient contact and contact with the public will be tested for active tuberculosis utilizing a two-step process in accordance with Center for Disease Control (CDC) guidelines prior to patient contact and screening annually thereafter....""This agency requires all staff....to be tested for TB prior to patient contact....and additionally screened in accordance with directives from CDC...May 16, 2019; updated guidelines."" Provide pre-employment health screenings, which includes a test for TB, within sixty (60) days prior to employment, it is DHC policy not to provide any employment offers prior to receiving the applicants TB test results."
Review of personnel files (PF) conducted on 11/29/23 from 3:20 PM-3:35 PM revealed the following:
PF #1, Date of hire (DOH): 10/18/23, the file did not contain documentation that TB testing was completed upon hire. File contained a one-step TB dated 9/6/23.
PF #2, (DOH): 10/5/23, the file did not contain documentation of two-step TB testing upon hire. File contained a one-step TB dated 9/26/23.
An interview with the agency human resource manager conducted on November 29, 2023 at approximately 3:40 PM confirmed the above findings.
Plan of Correction:The facility already schedule the employee for two step screening and we are waiting on result. Depending on the nature of the employee's role, the facility polices, temporary work adjustment might be made to minimize direct contact until the TB health screening is completed. They will be reminded of the importance of completing any documents to ensure patient safety and comply with health care regulation and follow CDC Guidelines. Training programs implemented to ensure all staff members understand the importance of proper documentation and compliance.
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