Initial Comments:
Based on the findings of an unannounced onsite state relicensure survey completed May 8, 2025, A+ Home Care was found to be in compliance with the requirements of 28 PA Code, Part IV, Health Facilities, Chapter 51, Subpart A.
Plan of Correction:
Initial Comments:
Based on the findings of an unannounced onsite state relicensure survey completed May 8, 2025, A+ 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:
611.4(c) LICENSURE
Requirements for HCA and HCR
Name - Component - 00
Home care agencies and home care registries licensed under this Chapter shall comply with applicable environmental, health, sanitation and professional licensure standards which are required by Federal, State, and local authorities.
Observations:
Based on review of employee files and an interview with the agency Assistant Regional Manager, the agency failed to ensure employees who have routine interaction with children have had the required certifications conducted, for three (3) out of three (3) employee file (EF) criminal history background checks reviewed (EF#9 - EF#11).
Findings include:
'House bill No. 1276, Session of 2015'
Pa.C.S 'Recertification' states "New certifications shall be obtained in accordance with the following: Effective December 31, 2014 section (1) (iii) "Any person identified in section 6344 with a current certification issued prior to the effective date of this section shall be required to obtain the certifications required by this chapter within 60 months of the date of the persons oldest certification, or, if the certification is older then 60 months, within one year of the effective date of this section."
Section (iv) "Any person identified in section 6344 without a current certification ......... shall be required to obtain the certifications required by this chapter (Pennsylvania Child Abuse History Clearance, Pennsylvania State Police Criminal Record Check, and a Federal Bureau of Investigation Criminal Background Check) .........."
A review of EF criminal background checks was conducted on May 8, 2025 at approximately 9:30 a.m.
EF#9: No documentation provided of a Pennsylvania Child Abuse History Clearance nor a Federal Bureau of Investigation Criminal Background Check being conducted. Documentation provided of a Pennsylvania State Police Criminal Record Check being conducted on 06/11/24.
Documentation provided of this employee (Direct Care Worker) providing services to a consumer (Consumer #6) 06/13/24 -06/30/24 and 07/03/24- 07/31/24. The scheduled/completed work shifts included Monday - Sunday 7:00 a.m.- 12:00 p.m
.
Documentation provided of (Consumer #6) signing (06/12/24) an agency form upon start of service 'Child Abuse Clearance'. The form included but was not limited to ".... A Child Abuse Clearance (Childline) must be completed for all employees of A+ Home Care who work in environments where individuals under the age of 18 years of age reside or will be present. If you have an individual under the age of 18 residing in your home or who visits the home during the hours an A+ Home Care employee is present, please confirm by checking the correct box below: ...." The consumer/consumer representative checked the box "Yes - Children under the age of 18 reside in my home or visit my home during the hours an A+ Home Care employee is present."
EF#10: No documentation provided of a Pennsylvania Child Abuse History Clearance nor a Federal Bureau of Investigation Criminal Background Check being conducted. Documentation provided of a Pennsylvania State Police Criminal Record Check being conducted on 07/30/24.
Documentation provided of this employee (Direct Care Worker) providing services to a consumer (Consumer #10) 01/01/25 - 01/31/25 and 02/03/25 - 02/28/25. The typical scheduled/completed work shifts included Monday - Friday 8:00 a.m.- 4:00 p.m. and included weekends 8:00 a.m. - 12:00 a.m.
Documentation provided of (Consumer #10) signing (07/12/24) an agency form upon start of service 'Child Abuse Clearance'. The form included but was not limited to ".... A Child Abuse Clearance (Childline) must be completed for all employees of A+ Home Care who work in environments where individuals under the age of 18 years of age reside or will be present. If you have an individual under the age of 18 residing in your home or who visits the home during the hours an A+ Home Care employee is present, please confirm by checking the correct box below: ...." The consumer/consumer representative checked the box "Yes - Children under the age of 18 reside in my home or visit my home during the hours an A+ Home Care employee is present."
EF#11: No documentation provided of a Pennsylvania Child Abuse History Clearance nor a Federal Bureau of Investigation Criminal Background Check being conducted. Documentation provided of a Pennsylvania State Police Criminal Record Check being conducted on 02/21/25.
Documentation provided of this employee (Direct Care Worker) providing services to a consumer (Consumer #10) 02/25/25 - 02/28/25. The scheduled/completed work shifts included was Tuesday - Friday 4:00 p.m.- 10:00 p.m.
Documentation provided of (Consumer #10) signing (07/12/24) an agency form upon start of service 'Child Abuse Clearance'. The form included but was not limited to ".... A Child Abuse Clearance (Childline) must be completed for all employees of A+ Home Care who work in environments where individuals under the age of 18 years of age reside or will be present. If you have an individual under the age of 18 residing in your home or who visits the home during the hours an A+ Home Care employee is present, please confirm by checking the correct box below: ...." The consumer/consumer representative checked the box "Yes - Children under the age of 18 reside in my home or visit my home during the hours an A+ Home Care employee is present."
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. The employee files currently missing these clearances (EF#9, EF#10, EF#11) will have completed clearances prior to the corrective action date.
2. A full audit of all files will be conducted prior to the corrective action date to ensure no additional files are affected by the same deficiency. All files that may be affected will have necessary clearances completed prior to the corrective action date.
3. A re-education is being provided to all office staff on the requirements for home care agencies. Any direct care worker that may interact with children in the consumer's home must have a child abuse clearance and FBI check completed. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring.
611.51(a) LICENSURE
Hiring or Rostering Prerequisites
Name - Component - 00
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 request/review of employee files and an interview with the agency Assistant Regional Manager, the agency failed to obtain not less than two satisfactory references and/or conducting a face-to-face interview, prior to hire, for three (3) out of eight (8) employee files (EF) reviewed (EF#4, EF#7, EF#8).
Findings include:
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#4 DOH 06/10/24: Employee file was requested for review. No employee file provided. No documentation provided of obtaining not less than two satisfactory references and conducting a face-to-face interview prior to hire.
EF#7 DOH 03/03/24: No documentation provided of conducting a face to face interview prior to hire. Blank face-to-face interview form was in the employees file.
EF#8 DOH 02/14/24: No documentation provided of conducting a face to face interview prior to hire. Blank face-to-face interview form was in the employees file.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. The employee files currently missing these documents (EF#7, EF#8) will have these documents fully completed prior to the corrective action date. EF#4 was located. Face-to-face document and reference checks were previously completed for this individual prior to their start date. Documentation will be submitted by the corrective action date.
2. A full audit of all files will be conducted prior to the corrective action date to ensure no additional files are affected by the same deficiency. All files that may be affected will have necessary onboarding documents completed prior to the corrective action date.
3. A re-education will be provided to all staff during a mandatory team meeting on all needed onboarding documents for incoming Direct Care Workers. Staff were retrained on the Reference Check and the Face-to-Face Interview forms. The importance of least two positive professional references is necessary, along with a dated, complete face-to-face document will be explained to the team. A+ Home Care requires managers to review all new hire folders examining each hiring document. A signature is required at the bottom of the checklist to ensure the regional manager has reviewed the file prior to storing the file in the filing cabinets. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring.
611.52(a) LICENSURE
Criminal Background Checks
Name - Component - 00
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 on review of employee files and an interview with the agency Assistant Regional Manager, the agency failed to submit a criminal history report obtained at the time of application or within 1 year immediately preceding the date of application for one (1) out of eight (8) employee files (EF) reviewed (EF#4).
Findings include:
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#4 DOH 06/10/24: Employee file was requested for review. No employee file provided. No documentation provided of criminal history report being obtained at the time of application or within 1 year (365 days) immediately preceding the date of application.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. The employee files currently missing these clearances (EF#4) will have completed clearances prior to the corrective action date. Documentation will be added to employee files.
2. A full audit of all files will be conducted prior to the corrective action date to ensure no additional files are affected by the same deficiency. All files that may be affected will have necessary clearances completed prior to the corrective action date.
3. A re-education was provided to all staff during a mandatory staff meeting on all needed onboarding documents for incoming Direct Care Workers. A+ Home Care will require all managers to review new hire applications upon completion to ensure necessary background checks/clearances are completed. All background checks and exclusions also must be run with results within a month of the start date, not earlier or later than the start date. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring.
611.52(c) LICENSURE
Federal Criminal History Record
Name - Component - 00
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).
Observations:
Based on a review of employee files and an interview with the agency Assistant Regional Manager, agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging for five (5) out of eight (8) employee files (EF) reviewed (EF#1 - EF#5).
Findings include:
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#1 DOH 09/16/24: No documentation provided to show that the applicant was a resident of Pennsylvania (Pa.) for the 2 years immediately preceding application for employment. Agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging. Pa. Identification Card issued 09/09/23 with an expiration date of 09/30/27. 'Application for Employment' work history record was reviewed. Employer listed with an incomplete address. No other Pa. proof of residency documentation provided.
No proof of Pa. residency from 09/16/22 - 09/09/23.
EF#2 DOH 06/24/24: No documentation provided to show that the applicant was a resident of Pennsylvania (Pa.) for the 2 years immediately preceding application for employment. Agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging. 'Application for Employment' work history record was reviewed. Employer listed with a Venezuela address. No other Pa. proof of residency documentation provided.
No proof of Pa. residency from 06/24/22 - 06/24/24.
EF#3 DOH 11/27/24: No documentation provided to show that the applicant was a resident of Pennsylvania (Pa.) for the 2 years immediately preceding application for employment. Agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging. Pa. Drivers License issued 03/02/24 with an expiration date of 11/02/27. 'Application for Employment' work history record was reviewed. Employer listed with an employer with an incomplete address. No other Pa. proof of residency documentation provided.
No proof of Pa. residency from 11/27/22 - 03/02/24.
EF#4 DOH 06/10/24: Employee file was requested for review. No employee file provided. No documentation provided to show that the applicant was a resident of Pennsylvania (Pa.) for the 2 years immediately preceding application for employment. Agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging.
EF#5 DOH 11/01/24: No documentation provided to show that the applicant was a resident of Pennsylvania (Pa.) for the 2 years immediately preceding application for employment. Agency failed to obtain a federal criminal history record and a letter of determination from the Department of Aging. Pa. Identification Card issued 06/20/24 with an expiration date of 06/30/28. 'Application for Employment' work history record was reviewed. No prior employers listed. No other Pa. proof of residency documentation provided.
No proof of Pa. residency from 11/01/22 - 06/20/24.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. The employee files currently missing the proof of PA residency (EF#1, EF#2, EF#3, EF#5) will have the proper documentation available or will have completed a PA Dept of Aging Federal clearance, if residency for the missing time periods is unable to be obtained. Documentation will be added to the employee files.
The file for EF#4 was located but PA residency was not complete. The proper documentation will be collected or a Dept of Aging Federal clearance will be complete prior to the corrective action date.
2. A full audit of all files will be conducted prior to the corrective action date to ensure no additional files are affected by the same deficiency. All files that may be affected will have necessary clearances completed prior to the corrective action date.
3. A re-education was provided to all staff during a mandatory staff meeting on all needed onboarding documents for incoming Direct Care Workers. A+ Home Care will require all managers to review new hire applications upon completion to ensure necessary proof of PA residency was examined and completed. The importance of proof of PA residency was reiterated. The list of acceptable documentation was provided and reviewed with all staff. If the correct proof of PA residency is unable to be obtained, a Dept of Aging Federal clearance will be completed in a timely manner. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring.
611.55(a) LICENSURE
Competency Requirements
Name - Component - 00
Prior to assigning or referring a direct care worker to provide services to a consumer, the home care agency or home care registry shall ensure that the direct care worker has done one of the following: (1) Obtained a valid nurse ' s license in this Commonwealth;
(2) Demonstrated competency by passing a competency examination developed by the home care agency or home care registry which meets the requirements of subsection (b)and (c).
(3) Has successfully completed one of the following:
(i) A training program developed by a home care agency, home care registry, or other entity which meets the requirements of subsection (b) and (c).
(ii) A home health aide training program meeting the requirements of 42 C.F.R. 484.36 (relating to the Conditions of Participation; Home Health Aide Services).
(iii) The nurse aid certification and training program sponsored by the Department of Education and located at www.pde.state.pa.us.
(iv) A training program meeting the training standards imposed on the agency or registry by virtue of the agency ' s or registry ' s participation as a provider in a Medicaid waiver or other publicly funded program providing home and community based services to qualifying consumers.
(v) Another program identified by the Department by subsequent publication in the Pennsylvania Bulletin or on the Department ' s website.
Observations:
Based on a review of employee files and an interview with the agency Assistant Regional Manager, the agency failed to ensure direct care workers, prior to providing services to consumers, completed/demonstrated an initial competency training covering all required sixteen (16) subject areas for eight (8) of eight (8) employee files (EF) reviewed (EF#1 - EF#8).
Findings include:
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#1 DOH 09/16/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 09/09/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
EF#2 DOH 06/24/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 06/26/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
EF#3 DOH 11/27/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 11/13/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
EF#4 DOH 06/10/24: Employee file was requested for review. No employee file provided. No documentation provided of initial competency training containing all sixteen (16) required elements.
EF#5 DOH 11/01/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 10/30/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
EF#6 DOH 10/09/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 10/04/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
EF#7 DOH 02/28/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 11/13/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
EF#8 DOH 02/14/24: No documentation provided of initial competency training containing all sixteen (16) required elements. Documentation provided of a competency test completed on 01/05/24. The test did not include/but was not limited to not including the following required elements: Toileting, Mouth Care, Shaving, Hair Care, nor Dressing.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. 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. Recognizing 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. We will also include all elements: 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.
Upon completion of the updated competency exam, all direct care files that were reviewed(EF#1, EF#2, EF#3, EF#4, EF#5, EF#6, EF#7, EF#8) will complete the updated competency exam to ensure all direct care workers have been trained and demonstrate competency in all 16 required areas. These files will have updated competency exam certificates to be presented at the time the corrective action date. Documentation will be added to the employee files.
EF#4 was located. The initial competency exam was completed prior to the direct care worker's first day of work, however, due to the current competency exam not covering all 16 required subject areas, the direct care worker will complete the updated competency exam.
2. A+ Home Care will require all currently active direct care workers to complete the updated competency exam to be sure all direct care workers are fully trained on the 16 required subject areas.
3. The dates of the competency exam will be placed in our tracking system to ensure that reminders are sent to both direct care worker and internal staff. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring.
611.55(e) LICENSURE
Competency Requirements
Name - Component - 00
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 a review of employee files and an interview with the agency Assistant Regional Manager, agency failed to provide documentation showing annual competency review covering all required sixteen (16) subject areas for two (2) of two (2) employee files (EF) annual documentation reviewed (EF#7, EF#8).
Findings include:
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#7 DOH 02/28/24: No documentation provided of a 2025 annual competency review containing all sixteen (16) required elements.
EF#8 DOH 02/14/24: No documentation provided of a 2025 annual competency review containing all sixteen (16) required elements.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:A+ Home Care will have the competency exam edited to add all 16 required elements. The competency review will be completed yearly for each direct care worker going forward. Internal staff will be using our system to track when yearly exams are to be completed by direct care workers. They will then reach out to each direct care worker to have them completed and kept in their folders.
Direct Care workers who were missing their annual competency exam (EF#7 & EF#8) will complete their annual competency prior to the corrective action date. The date on which they complete their competency exam will become their annual review date. This date will be placed into the tracking system in HHA so both the employees and the office staff will receive reminders prior to their next annual date so A+ Home Care can ensure the competency exam is completed annually, in a timely manner. Documentation will also be added to the employee files.
The Executive Director and Regional manager will review the current active employee list and run a report to pull the annual competency dates. Any employee who is out of compliance will be contacted and sent the updated competency exam. This date will be placed into the tracking system in HHA so both the employees and the office staff will receive reminders prior to their next annual date so A+ Home Care can ensure the competency exam is completed annually, in a timely manner.
Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
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 a review of employee files and an interview with the agency Assistant Regional Manager, the agency failed to ensure each direct care worker and other office staff or contractors with direct consumer contact, prior to consumer contact, was screened for and is free from active mycobacterium tuberculosis, in accordance with CDC (Center for Disease and Control) guidelines, for three (3) out of eight (8) employee files (EF) reviewed (EF#3 - EF#5).
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) or a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. After baseline testing for infection with tuberculosis, HCWs should receive TB screening annually. HCWs with a baseline positive or newly 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).
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#3 DOH 11/27/24: Employees first work shift with a consumer was on 12/02/24. No documentation provided of a TB test being conducted nor a TB symptom screening questionnaire being completed prior to consumer contact.
EF#4 DOH 06/10/24: Employee file was requested for review. No employee file provided. Employees first work shift with a consumer was on 06/10/24. No documentation provided of a TB test being conducted, and individual TB risk assessment being completed, nor a TB symptom screening questionnaire being completed prior to consumer contact.
EF#5 DOH 11/01/24: Employees first work shift with a consumer was on 11/02/24. No documentation provided of a TB symptom screening questionnaire being completed prior to consumer contact.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. Direct care workers who are missing their initial TB tests (EF#3, EF#4) will have the TB tests administered prior to the corrective action date. EF#5 will have the TB symptom screening questionnaire completed prior to the corrective action date. This will be tracked in our system to ensure completion of the screening and risk assessment on an annual basis. EF#4 was located. The documentation was printed and placed into the employee file. The documentation will be available at the time of the corrective action date.
2. A full audit of all files will be conducted prior to the corrective action date to ensure no additional files are affected by the same deficiency. Direct care workers who are missing their initial TB will be contacted to have them completed prior to the corrective action date. If a direct care worker can render a TB test that was completed within a year prior to their hire date, the TB will be submitted with the corrective action plan.
3. A re-education was provided to all staff during a mandatory staff meeting on all needed onboarding documents for incoming Direct Care Workers. Staff training has taken place with each staff member on the importance of screening each incoming employee and that they are free from current mycobacterium tuberculosis. Each new employee will have a baseline tuberculosis screening upon hire, within the appropriate timeframe. The test will include a two-step TB skin test, a single blood test, or a chest x-ray. In addition to baseline, each employee will also have an individual TB risk assessment and a symptom questionnaire.
The Executive Director and Regional Manager will review the current active employee list and run a report to pull the TB screenings/risk assessment, as well as the TB test dates. Any employee who is out of compliance will be contacted and sent the TB screening/risk assessment or requested to complete a TB test. This date will be placed into the tracking system in HHA. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring.
611.56(b) LICENSURE
Health Screening
Name - Component - 00
(b) A home care agency or home care registry shall require each direct care worker, and other office staff or contractors with direct consumer contact, to update the documentation required under subsection (a) at least every 12 months and provide the documentation to the agency or registry. The 12 months must run from the date of the last evaluation. The documentation required under subsection (a) shall be included in the individual's file.
Observations:
Based on a review of employee files and an interview with the agency Assistant Regional Manager, agency failed to ensure each direct care worker and other office staff or contractors with direct consumer contact, were provided with annual mycobacterium tuberculosis education, for two (2) of two (2) employee files (EF) annual documentation reviewed (EF#7, EF#8).
Findings Include:
The CDC (Center for Disease and Control) guidelines state that all Health Care Workers (HCW) should receive baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) or a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. ........ HCWs with a baseline positive or newly 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).
A request/review of EFs was conducted on May 8, 2025 at approximately 9:30 a.m. Employee date of hire (DOH) is listed below.
EF#7 DOH 02/28/24: No documentation provided of 2025 annual TB education.
EF#8 DOH 02/14/24: No documentation provided of 2025 annual TB education.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:A re-education was provided to all staff during a mandatory staff meeting on all needed onboarding documents for incoming Direct Care Workers. All employees will receive TB education annually. TB education shall include individual TB risk assessment and a TB symptom questionnaire.
Direct care workers who did not have documentation of their 2025 annual TB education (EF#7, EF#8), will be contacted and sent the education prior to the corrective action date. This date will entered into the tracking system in HHA and documentation will be added to the employee file. The Executive Director and Regional manager will review the current active employee list and run a report to pull the annual TB screenings/risk assessment. . Any employee who is out of compliance will be contacted and sent the TB screening/risk assessment to be reviewed.
Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new employees- to ensure all forms and clearances are complete, and 5 aged to ensure annual deficiencies are not occurring. The team will be instructed to better utilize the checklist to be sure deficiencies do not occur again.
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 a request/review of consumer files, the consumer admission packet, and an interview with the agency Assistant Regional Manager, the agency failed to provide the consumer, prior to the commencement of services, all or segments of the following: 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, 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 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), the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry, and 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, for one (1) out of ten (10) consumer files (CF) reviewed (CF#4).
Findings include:
A request/review of CFs was conducted on May 8, 2025 at approximately 9:30 a.m. Consumer start of service (SOS) is listed below.
CF#4 SOS 06/10/24: Consumer file was requested for review. No consumer file provided No documentation provided of the agency providing the consumer, prior to the commencement of services, the following: 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, 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 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), the hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry, and 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.
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. CF#4 was located. A current authorization letter present and will be rendered at the corrective action date.
2. A full audit of all files will be conducted prior to the corrective action date to ensure no additional files are affected by the same deficiency.
3. A re-education was provided to all staff during a mandatory staff meeting. Our Authorization Letter will be updated to include the hours when the home care services will be provided and the fees with total costs for the services on an hourly and/or weekly basis. The participant specific orientation will be updated to include the list of available services that will be provided to the consumer by the direct care worker along with the hiring and competency requirements applicable to the direct care worker employed by A+ Home Care. A signature will be added to the document to ensure all direct care workers and consumers are aware of the services provided and the telephone numbers of the Dept Hotline and AAA.
4. Quarterly audits of personnel files will be conducted by the Executive Director, and the regional manager to ensure completion of the files. These file audits will include a review of 10 total files- 5 new consumer files- to ensure a face-to-face was complete in addition to all necessary paperwork, and 5 aged to ensure deficiencies are not occurring.
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 a request to review consumer files and an interview with the agency Assistant Regional Manager, agency failed to maintain consumer documentation on file at the agency for one (1) of ten (10) consumer files (CF) requested (CF#4) and failed to maintain employee documentation on file at the agency for one (1) of eight (8) employee files (EF) requested (EF#4).
Findings include:
CFs and EFs were requested for review on May 8, 2025 at approximately 9:30 a.m. Consumer start of service (SOS) and employee date of hire (DOH) is listed below.
CF#4 SOS 06/10/24: Consumer file was requested for review. No consumer file provided (electronically nor paper form).
EF#4 DOH 06/10/24: Employee file was requested for review. No employee file provided (electronically nor paper form).
An interview conducted with the agency Assistant Regional Manager on May 8, 2025 at approximately 12:00 p.m. confirmed the above findings.
Plan of Correction:1. EF#4 and CF#4 files were located after the onsite survey. A different location completed the intake and the files were never created at the correct location. All teams have been re-educated on the importance of tracking consumer and employee files.
2. A full audit of both consumer and personnel files will be conducted prior to the corrective action date to ensure all files are able to be located within the correct office.
3. A+ Home Care will ensure that we maintain all documentation on file at the agency for all consumer and direct care workers. Re-education was provided to all staff and the importance of having all consumer and direct care worker files on site was discussed.
4. Quarterly audits of personnel and consumer files will be conducted by a member of the A+ Home Care Corporate team.
Initial Comments:
Based on the findings of an unannounced onsite state relicensure survey completed May 8, 2025, 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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