Initial Comments:
Based on the findings of an onsite state re-licensure survey conducted on 4/11/25, A+ 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 home care agency state re-licensure survey conducted on 4/11/25, A+ Home Care, was not found 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:
611.55(b) LICENSURE
Competency Requirements
Name - Component - 00
A competency examination or training program developed by an agency or registry for a direct care worker shall address, at a minimum, the following subject areas: 1. Confidentiality; 2. Consumer control and the independent living philosophy; 3. Instrumental activities of daily living; 4. Recoginizing changes in the consumer that need to be addressed; 5. Basic infection control; 6. Universal precautions; 7. Handling of emergencies; 8. Documentation; 9. Recognizing and reporting abuse or neglect; and 10. Dealing with difficult behaviors.
Observations:
Based on review of direct care worker employee files (EF), and staff interview the agency failed to develop a competency training program that addressed all required subject areas for ten (10) of ten (10) personnel files (EF#1 through EF#10).
Findings included:
A review of EFs was conducted on 4/11/25 at approximately 10:30 AM Employee date of hire (DOH) is listed below.
EF#1 DOH 12/23/24: The competency training program lacked the required topic of instrumental activities of daily living.
EF#2 DOH 2/17/25: The competency training program lacked the required topic of instrumental activities of daily living.
EF#3 DOH 2/25/25: The competency training program lacked the required topic of instrumental activities of daily living.
EF#4 DOH 1/31/25: The competency training program lacked the required topic of instrumental activities of daily living.
EF#5 DOH 6/23/24: The competency training program lacked the required topic of instrumental activities of daily living.
EF#6 DOH 1/1/25: The competency training program lacked the required topic of instrumental activities of daily living.
EF#7 DOH 9/28/23: The competency training program lacked the required topic of instrumental activities of daily living.
EF#8 DOH 1/9/25: The competency training program lacked the required topic of instrumental activities of daily living.
EF#9 DOH 1/20/25: The competency training program lacked the required topic of instrumental activities of daily living.
EF#10 DOH 4/4/24: The competency training program lacked the required topic of instrumental activities of daily living.
An interview conducted with the Executive Director on 4/11/25 at approximtely 11:00 AM confirmed the above findings.
Plan of Correction:A+ Home Care will edit its caregiver training to include all of the required subject areas including: 1. Confidentiality; 2. Consumer control and the independent living philosophy; 3. Instrumental activities of daily living; 4. Recoginizing changes in the consumer that need to be addressed; 5. Basic infection control; 6. Universal precautions; 7. Handling of emergencies; 8. Documentation; 9. Recognizing and reporting abuse or neglect; and 10. Dealing with difficult behaviors.
These subjects will be added to the competency quiz as well, this is given to all staff prior to hire and on an annual basis.
This will be rectified for current staff through having the updated training sent via email to all current DCWs regardless of hire/date/employment timeline.
Quarterly audits of personnel files will be audited by Kenneth McCabe, Executive Director to ensure completion and compliance
611.55(c) LICENSURE
Competency Requirements
Name - Component - 00
A competency examination or training program developed by an agency or registry for a direct care worker who will provide personal care must address the following additional subject areas: 1. Bathing, shaving, grooming and dressing; 2. Hair, skin and mouth care; 3. Assistance with ambulation and transferring; 4. Meal preparation and feeding; 5. Toileting; 6. Assistance with self-administered medications.
Observations:
Based on review of direct care worker employee files (EF), and staff interview the agency failed to develop a competency training program that aaddressed the following additionl subject areas for ten (10) of ten (10) personnel files (EF#1 through EF#10).
Findings included:
A review of EFs was conducted on 4/11/25 at approximately 10:30 AM Employee date of hire (DOH) is listed below.
EF#1 DOH 12/23/24: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#2 DOH 2/17/25: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#3 DOH 2/25/25: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#4 DOH 1/31/25: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#5 DOH 6/23/24: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#6 DOH 1/1/25: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#7 DOH 9/28/23: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#8 DOH 1/9/25: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#9 DOH 1/20/25: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
EF#10 DOH 4/4/24: The competency training program lacked the required additional subject areas of shaving, grooming, dressing, hair, skin and mouth care, assistance with ambulation and transfer, meal prepaaration and feeding, toileting and assistance with self administered medications.
An interview conducted with the Executive Director on 4/11/25 at approximtely 11:00 AM confirmed the above findings.
Plan of Correction:A+ Home Care will edit its caregiver training to include all of the required subject areas including: 1. Bathing, shaving, grooming and dressing; 2. Hair, skin and mouth care; 3. Assistance with ambulation and transferring; 4. Meal preparation and feeding; 5. Toileting; 6. Assistance with self-administered medications.
These subjects will be added to the competency quiz as well, this is given to all staff prior to hire and on an annual basis.
This will be given to all current staff who have not completed the updated trainings with necessary topics upon their annual.
Quarterly audits of personnel files will be audited by Kenneth McCabe, Executive Director to ensure completion and compliance
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 agency consumer records (CR) reviews and interview with the Executive Director the agency failed to provide services with reasonable accommodation of individual needs and preference for seven (7) of eleven (11) consumer records (CR) reviewed (CR#1, CR#2, CR#5, CR#6, CR#9, CR#10 & CR#11)
Findings included:
Review of consumer records on 4/11/25 at approximately 1:00 PM revealed the following:
CR#1: Start of services 2/14/25. Client is on the waiver program and authorized for 22 hours per week.
For the week ending 2/22/25 the client only received 14 hours of care
For the week ending 3/1/25 the client only received 17.5 hours of care
For the week ending 3/8/25 the client only received 15 hours of care
For the week ending 3/15/25 the client only received 21.5 hours of care
For the week ending 3/22/25 the client only received 17.5 hours of care
For the week ending 3/29/25 the client only received 15.5 hours of care
For the week ending 4/5/25 the client only received 10 hours of care
CR#2: Start of services 2/6/25. Client is on the waiver program and authorized for 21 hours per week.
For the week ending 2/22/25 the client only received 19 hours of care
For the week ending 3/1/25 the client only received 19 hours of care
For the week ending 3/8/25 the client only received 20 hours of care
For the week ending 3/15/25 the client only received 14 hours of care
For the week ending 3/22/25 the client only received 20 hours of care
For the week ending 3/29/25 the client only received 20 hours of care
For the week ending 4/5/25 the client only received 20 hours of care
CR#5: Start of services 2/26/25. Client is on the waiver program and authorized for 56 hours per week.
Documentation on 2/27/25 reveled the agency was unable to staff the case due to bed bugs and fleas in the home. On 3/1/25 documentation showed 8 hours of caare was provided. There were no additional hours of care provided after 3/1/25 to present with no explanatory documentation.
CR#6: Start of services 3/26/25. Client is on the waiver program and authorized for 22 hours per week.
For the week ending 4/5/25 the client only received 45 hours of care
CR#9: Start of services 2/14/25. Client is on the waiver program and authorized for 17 hours per week.
For the week ending 3/1/25 the client only received 16.75 hours of care
For the week ending 3/8/25 the client only received 8.75 hours of care
For the week ending 3/15/25 the client only received 16.25 hours of care
For the week ending 3/29/25 the client only received 13.75 hours of care
For the week ending 4/5/25 the client only received 16.75 hours of care
CR#10: Start of services 1/17/25. Client is on the waiver program and authorized for 11 hours per week.
For the week ending 2/22/25 the client only received 6.75 hours of care
For the week ending 3/1/25 the client only received 4 hours of care
For the week ending 3/8/25 the client only received 6 hours of care
For the week ending 3/15/25 the client only received 0 hours of care
For the week ending 3/22/25 the client only received 3 hours of care
CR#11: Start of services 3/24/25. Client is on the waiver program and authorized for 90 hours per week.
For the week ending 4/5/25 the client only received 18.5 hours of care
Interview with the Executive Director on 4/11/25 at approximately 2:00 PM confirmed the above findings.
Plan of Correction:A+ Home Care will implement changes to its participant intake/admission packet reviewed prior to start of care to include clear notification and review of participant rights including: (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.
In addition to the edits made to the participant packet to ensure completion with participant prior to start of care, A+ will begin compiling and analyzing missed opportunity data in comparison to active authorizations to ensure services and accommodations are being effectively carried out for each participant alongside the plan of care established by the MCO/Agency/Participant.
Quarterly audits of personnel files will be
Quarterly audits of participant files will be audited by Kenneth McCabe, Executive Director to ensure completion and compliance
611.57(b) LICENSURE
Prohibitions
Name - Component - 00
(b) No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry. The home care agency or home care registry may not require a consumer to endorse checks over to the home care agency or home care registry.
Observations:
Based on review of consumer files (CF) and interviews with the Regional Director it was determined the agency failed to ensure documentation the consumer was notified of the following prohibitions: (1) No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry. (2) The home care agency or home care registry may not require a consumer to endorse checks over to the home care agency or home care registry for eleven (11) of eleven (11) consumers files reviewed (CF#1 through CF#11).
Findings include:
Review of consumer records on 4/11/25 at approximately 1:00 PM revealed the following:
CF1, Start of Service 2/14/25, The file contained no documentation of notification of the above prohibitions.
CF2, Start of Service 2/6/25, The file contained no documentation of notification of the above prohibitions.
CF3, Start of Service 1/16/25, The file contained no documentation of notification of the above prohibitions.
CF4, Start of Service 1/23/25, The file contained no documentation of notification of the above prohibitions.
CF5, Start of Service 2/26/25, The file contained no documentation of notification of the above prohibitions.
CF6, Start of Service 3/26/25, The file contained no documentation of notification of the above prohibitions.
CF7, Start of Service 3/23/25, The file contained no documentation of notification of the above prohibitions.
CF8, Start of Service 1/20/25, The file contained no documentation of notification of the above prohibitions.
CF9, Start of Service 2/14/25, The file contained no documentation of notification of the above prohibitions.
CF10, Start of Service 1/17/25, The file contained no documentation of notification of the above prohibitions.
CF11, Start of Service 3/24/25, The file contained no documentation of notification of the above prohibitions.
Interview with the Executive Director on 4/11/25 at approximately 2:00 PM confirmed the above findings.
Plan of Correction:A+ Home Care will implement changes to its participant intake/admission packet reviewed prior to start of care to include clear notification and review of Prohibitions for the participant and their staff prior to the start of care including: 1. No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry. 2. The home care agency or home care registry may not require a consumer to endorse checks over to the home care agency or home care registry
This information will be added to the participant information packet/handbook within the intake/admission packet, this will be reviewed and signed by all participants prior to starting services.
Quarterly audits of personnel files will be This will be given to all current staff who have not completed the updated trainings with necessary topics upon their annual.
Quarterly audits of personnel files will be audited by Kenneth McCabe, Executive Director to ensure completion and compliance
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 review of consumer files (CF) and interviews with the Regional Director there wsa no evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry for eleven (11) of eleven (11) consumers files reviewed (CF#1 through CF#11).
Findings include:
Review of consumer records on 4/11/25 at approximately 1:00 PM revealed the following:
CF1, Start of Service 2/14/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF2, Start of Service 2/6/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF3, Start of Service 1/16/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF4, Start of Service 1/23/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF5, Start of Service 2/26/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF6, Start of Service 3/26/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF7, Start of Service 3/23/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF8, Start of Service 1/20/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF9, Start of Service 2/14/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF10, Start of Service 1/17/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, the specific hours those services would be provided, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
CF11, Start of Service 3/24/25, CF did not contain evidence that the agency provided the consumer with information regarding: the identity of the direct care worker who was to provide services, fees and total costs for those services on an hourly or weekly basis, 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, and the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry
Interview with the Executive Director on 4/11/25 at approximately 2:00 PM confirmed the above findings.
Plan of Correction:A+ Home Care will implement changes to its participant intake/admission packet reviewed prior to start of care to include clear notification and review of participant rights and responsibilities including: 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.
This information will be added to the Participant Authorization Letter and Participant Specific Orientation form both of which will be reviewed and signed by all participants prior to starting services.
Quarterly audits of personnel files will be This will be given to all current participants who have not received the updated policies/amendments with necessary topics prior to their next supervisory visit 180 day via mail and postage/log will be saved when sent out.
Quarterly audits of participant files will be audited by Kenneth McCabe, Executive Director to ensure completion and compliance
Initial Comments:
Based on the findings of an onsite home care agency state re-licensure survey conducted on 4/11/25, A+ 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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