Initial Comments:
Based on the findings of an onsite unannounced state re-licensure survey conducted on January 5, 2024, Paradise Care Llc, 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 unannounced home care agency state re-licensure survey conducted on January 5, 2024, Paradise Care 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:
611.51(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 review of personnel files (PF) and interview with agency administrator and office manager, it was determined the agency failed to ensure that two (2) verifiable references were obtained prior to hiring each direct care worker for ten (10) of ten (10) files reviewed. (PF# 1-10)
Review of personnel files (PF) conducted on 1/5/24 from 11:05 AM-12:55 PM revealed the following:
PF # 1, Date of hire (DOH): 1/31/23; had documentation of only one (1) reference being verified.
PF # 2, Date of hire (DOH): 8/4/23; had documentation of only one (1) reference being verified.
PF # 3, Date of hire (DOH): 7/14/23; had documentation of only one (1) reference being verified.
PF # 4, Date of hire (DOH): 8/27/23; had documentation of only one (1) reference being verified.
PF # 5, Date of hire (DOH): 9/8/23; had documentation of only one (1) reference being verified.
PF # 6, Date of hire (DOH): 7/14/23; had documentation of only one (1) reference being verified.
PF # 7, Date of hire (DOH): 3/1/23; had documentation of only one (1) reference being verified.
PF # 8, Date of hire (DOH): 9/18/23; had documentation of only one (1) reference being verified.
PF # 9, Date of hire (DOH): 11/9/23; had documentation of only one (1) reference being verified.
PF # 10, Date of hire (DOH): 8/24/23; had documentation of only one (1) reference being verified.
An interview with the agency administrator and office manager conducted on January 5, 2024 at approximately 1:40 PM confirmed the above findings.
Plan of Correction:On Jan 5, 2024, there was an on-site survey performed. There was a deficit noted that only one verifiable reference was obtained instead of two verifiable references before hiring per the Department of Health Policy. The violations have been recognized and corrected as follows:
Paradise Care LLC has updated its hiring policy effective Jan 15, 2024. All new hires must have two verifiable references obtained before hiring. The agency manager and the staff were educated by the agency administrator about the policy update. The agency manager will maintain a checklist on each employee's folder to ensure that two references have been obtained before deciding to hire DCW. The agency manager had obtained two verifiable references of existing DCW as a part of the corrective action plan on January 15, 2024 employees are missing two references. As a plan of action, the deficit has been corrected as of January 15, 2024.
Initial Comments:
Based on the findings of an onsite unannounced home care agency state re-licensure survey conducted on January 5, 2024, Paradise Care Llc, was found not to be in compliance with the requirements of 35 P.S. 448.809 (b).
Plan of Correction:
35 P. S. § 448.809b LICENSURE
Photo Id Reg
Name - Component - 00
Law amended July 11, 2022 Act 79 2022 HB 2604
(1) The photo identification tag shall include a recent
photograph of the employee, the employee's first name, the
employee's title and the name of [the health care facility or
employment agency.] any of the following:
(i) The health care facility.
(ii) The health system.
(iii) The employment agency.
(iv) The fictitious name of an entity under
subparagraph (i), (ii) or (iii) which is registered with
the Department of State under 54 Pa.C.S. Ch. 3 (relating
to fictitious names) or a successor statute.
(2) The title of the employee shall be as large as possible
in block type and shall occupy a one-half inch tall strip as
close as practicable to the bottom edge of the badge.
(3) Titles shall be as follows:
(i) A Medical Doctor shall have the title "Physician."
(ii) A Doctor of Osteopathy shall have the title
"Physician."
(iii) A Registered Nurse shall have the title
"Registered Nurse."
(iv) A Licensed Practical Nurse shall have the title
"Licensed Practical Nurse."
(v) All other titles shall be determined by the
department. Abbreviated titles may be used when the title
indicates licensure or certification by a Commonwealth
agency.
(4)A notation, marker or indicator included on an identification badge that differentiates employees with the same first name is considered acceptable in lieu of displaying an employee's last name.
Observations:
Based upon observation of employee Identification badge (ID) and interview with agency administrator and office manager, agency failed to correctly format the employee ID badges as per requirement for ten (10) of ten (10) active direct care workers (DCW). (PF # 1-# 10).
Findings included:
Photo of employee ID badge showed title less than 1/2-inch-tall strip as close as practicable to the bottom edge of the badge and employee job position was not spelled out.
An interview with the agency administrator and office manager conducted on January 5, 2024 at approximately 1:40 PM confirmed the above findings.
Plan of Correction:As a plan of action, on January 15, 2024, Paradise Care violated DOH requirements on employee ID agency, Paradise Care LLC updated its DCW's ID based on the Department of Health's requirements. The employee ID has been corrected based on the Department of Health's policy and requirements as "Employee title must be in block letters and fully spelled out, ½ inch tall and as close as possible to the bottom edge of the badge". All existing employees are issued new IDs as of January 15, 2024, as a part of the correction plan. Moving forward, the Agency manager with monitor ID requirements before issuing them to the new employees. The deficit had been corrected as of January 15, 2024.
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