Initial Comments:
Based on the findings of an unannounced complaint investigation survey, conducted on January 5, 2024 through January 16, 2024, Quality Health 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:
611.52(a) LICENSURE
Criminal Background Checks
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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.
Observations:
Based upon review of personnel files (PF), and interview with employees (EMP1-agency marketer and EMP2-agency owner), the agency failed to provide proof of criminal background checks being requested for two (2) of seven (7) files reviewed ( PF #1 and 2 ).
Findings included:
Review of personnel files (PF) conducted on 1/5/24 from approximately 12:00pm - 2:00pm revealed the following:
PF#1, Start of Service date (SOS) - date PF began servicing consumers: 6/5/2023: Pennsylvania State Police Background Check, Federal Background check and Child Abuse Clearance are absent from PF#1 file - per phone interview with facility administrator (FA) conducted on 1/5/24 approximately 4:15pm - FA states PF#1 " was terminated in October 2023 " .
PF#2, Start of Service date (SOS) - date PF began servicing consumers: 6/1/2023: Pennsylvania State Police Background Check, Federal Background check and Child Abuse Clearance are absent from PF#2 file.
1/5/24 phone interview approximately 4:15pm with FA revealed: " we have our ongoing plan of correction with criminal background checks from previous state survey deficiencies. I will check with our human resources representative to ensure PF#2 is in process of receiving or has been processed to receive their criminal background checks. "
Repeat deficiency noted from previous survey conducted March 8, 2023.
Plan of Correction:Our intake coordinators will provide new applicants with applications, and run background checks prior to their start date.
Files will be reviewed by me, the owner to assure that all documents are completed and accurate.
The corrective action has implemented and will be completed by 2/9/2024
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 a review of consumer records (CR), personnel files (PF), interviews with consumers and interview with the facility administrator, the agency failed to provide services as scheduled and direct care workers continued to clock their time into HHAexchange when not completing or providing services as scheduled. for 2 (two) of 3 (three) CRs. CR#2 and CR#3.
Findings include:
1/11/24 at approximately 10:30 AM review of Quality Health Services Llc. - Reynoldsville Intake/Admission Service Agreement Home health: " New Patient Welcome Guide and consumer notices " revealed:
" p43 of 111 " (a) Consumer rights. 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...."
" ...(c) Information to be provided. 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: (3) 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. The hours when those services will be provided. 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 ... "
1.Review of CR#1 on 1/5/24 from approximately 3:00PM to 3:15PM and 1/16/24 from approximately 9:00AM to 9:30AM revealed:
1)Start of Care: 6/21/22
2) Time and Frequency-schedule amount-weekly: schedule to be 7 days a week 7-10 hours daily - overnight care from 9pm to 7am or Midnight to 7am, dependent on consumer needs.
3) Care provided to this client to include the following for activities of daily living (ADL)/Independent daily living (IDL): meal prep, bowel/bladder management, transfers/stairs/bed mobility, eating, hygiene.
" patient ' s plan of care service: PLEASE SELECT THE SERVICES YOUR INTERESTED IN: Bathing, Dressing, Eating/Feeding , Grooming , Mobility , Toilet Bowel & Bladder Care , Transferring from Bed or Chair , Self-Medication Administration, Housekeeping, Laundry, Meal Prep/Planning, Personal Shopping, Accompany to Appointments, Personal Errands, Telephone Use, Other ... " signed by CR#1 representative (daughter) on 6/21/22.
4) No documentation of telephone call logs from agency to client.
5) 1/11/24 at approximately 10:00AM review of CR #1 HHAeXchange Homecare software network patient calendar from September 2023 to December 2023 revealed:
a. CR#1 received services provided by PF#2 as scheduled Sunday through Saturday from 9:00pm to 7am or midnight to 7am 9/1/23 to 12/31/23 at consumer discretion.
6) 1/5/24 at approximately 3:30 PM - phone interview with consumer representative (daughter) revealed: " Everything is great with Quality Health Services. The staff communicate, they wear their ID badge and I ' ve never had a problem with them taking care of my mom. "
2.Review of CR # 2 (complainant) on 1/5/24 from approximately 3:15PM to 3:30PM and 1/16/24 from approximately 9:30AM to 10:00AM revealed:
2)Start of Care: 11/28/22
2) Time and Frequency-schedule amount-weekly: schedule to be 5 days a week, Monday through Friday, 8 hours daily - from 9:00am to 5:00pm, dependent on consumer needs.
3) Care provided to this client to include the following for activities of daily living (ADL)/Independent daily living (IDL): self-medication administration reminder, housekeeping, laundry, meal prep/planning, personal shopping, accompany to appointments and personal errands.
" patient ' s plan of care service ... " signed by CR#2 on 11/28/22.
4) No documentation of telephone call logs from agency to client.
5) 1/11/24 at approximately 11:00am review of CR #2 HHAeXchange Homecare software network patient calendar from September 2023 to December 2023 revealed:
a. CR#2 received services provided by PF#3 as scheduled Monday through Friday from 9:00am to 5:00pm - 9/1/23 to 9/30/23.
b. CR#2 received services provided by PF#3 as scheduled Monday through Friday from 9:00am to 5:00pm -10/1/23 to 10/31/23.
c. CR#2 received services provided by PF#3 as scheduled Monday through Friday from 9:00am to 5:00pm - 11/1/23 to 11/24/23.
6) 1/5/24 at approximately 4:05 PM - phone interview with facility administrator revealed: " We are aware of the discrepancy in hours that were billed and not provided to the consumer on the dates of 11/23/23 and 11/24/23. We have alerted our billing department and are continuing and internal investigation. These inaccurate payments are to be refunded to the insurance company. "
3. Review of CR # 3 on 1/5/24 from approximately 3:35PM to 4:00PM and 1/16/24 from approximately 10:00AM to 10:30 AM revealed:
1) Start of Care (SOC): 8/18/22 - (patient did not sign intake service agreement for Quality Health Services until 8/26/22) and second SOC: 11/8/23
2) Time and Frequency-schedule amount-weekly: schedule to be 5 days a week 5- 5 hours daily - consumer care plan agreement from 10am to 2pm dependent on consumer needs.
3) Care provided to this client to include the following for activities of daily living (ADL)/Independent daily living (IDL): mobility, housekeeping, laundry, personal shopping, and personal errands.
" patient ' s plan of care service agreement ... " signed by CR#3 on 8/26/22.
4) No documentation of telephone call logs from agency to client.
5) 1/5/24 at approximately 1:45 pm - review of authorization for services revealed: CR#3 received authorization for (1194.25 hours/units) 5 - 5 hours/day for 5 days/week starting 12/2/22 through 10/1/23.
6) 1/5/24 at approximately 1:45 pm - review of authorization for services revealed: CR#3 received authorization for (129 hours/units) 2 hours/day for 1day/week, starting 11/16/23 through 12/17/23.
7) 1/5/24 at approximately 3:40 PM - phone interview with consumer revealed: PF#3 last day of work for CR#3 was 8/14/23, CF#3 states " August 14, 2023, was the last day she worked for me. I did not have any services from them again until December 8, 2023. My UPMC coordinator was aware of the lack of services. It ' s a small community and they couldn ' t find me anybody. "
8) 1/11/24 at approximately 9:00AM review of CR # 3 HHAeXchange Homecare software network patient calendar from September 2023 to December 2023 revealed:
a)CR#3 received services on Tuesday 8/1/23 through Friday 8/4/23; Monday 8/7/23 through Friday 8/11/23; Monday 8/14/23 through Friday 8/18/23; Monday 8/21/23 through Friday 8/25/23 and Monday 8/28/23 through Thursday 8/31/23 from 11:00AM to 16:30PM. PF#3 documented as providing services.
b)CR#3 received services on Friday 9/1/23, Monday 9/4/23 through Friday 9/8/23, Monday 9/11/23 through Friday 9/15/23, Monday 9/18/23 through Friday 9/22/23 and Monday 9/25/23 from 11:00 AM to 16:30 PM. PF# 3 documented as providing services.
c)CR#3 did not receive services from Tuesday 9/26/23 through Friday 9/29/23.
d)CR#3 did not receive services at all for the Month of October 2023
e)CR#3 did not receive services at all for the Month of November 2023
f)CR#3 received services on 12/8/23 from 1:30 PM to 3:30 PM and 12/15/23 from 1:19PM to 3:17PM - provided by a new caregiver. CR#3 did not receive any services on any other date in December 2023.
1-11-24 approximately 9:15 am phone interview with agency administrator and Health Care Nurse surveyor was conducted. The phone interview confirmed above findings. Administrator states that CR#3 " fired PF#3 on August 14, 2023. PF#3 did not provide services to CR#3 after August 14, 2023, and PF#3 did not provide services for CR#3 at all in the month of September. " Administrator verbally confirmed that no replacement caregiver was assigned to CR#3. Administrator states " Our facility does not have documentation that CR#3 ' s UPMC service coordinator was notified that services were interrupted."
Plan of Correction:We will continue to utilize the EVV system in order to record clock ins and outs, and timesheets as a backup. We will strengthen our approach and tighten our policies on clocking in and out. We will also confirm with clients that hours are being worked prior to billing.
We currently utilize Alora to monitor time keeping for caregivers, as well as calling participants monthly to check on them, making sure they are getting what they need, and that caregivers are there when they should be. Our intake coordinators will continue to monitor each of these things weekly.
The corrective action plan will be completed by 2/9/2024
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