QA Investigation Results

Pennsylvania Department of Health
ACCUCARE HOME NURSING, INC.
Health Inspection Results
ACCUCARE HOME NURSING, INC.
Health Inspection Results For:


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Initial Comments:
Based on the findings of an unannounced onsite complaint investigation conducted October 26, 2021, and concluded on October 27, 2021, Accucare Home Nursing, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.



Plan of Correction:




484.60(b) STANDARD
Conformance with physician orders

Name - Component - 00
Standard: Conformance with physician or allowed practitioner orders.

Observations:
Based on review of agency policy, clinical records (CR), electronic time keeping reports, communication notes, and staff interviews, the agency failed to provide services in accordance with the "Home Health Certification and Plan of Care" (POC) for one (1) of three (3) CR reviewed. (CR# 1).

Review of clinical records, electronic time keeping records, and communication logs on October 26, 2021, from approximately 9:30 A.M. to 11:00 A.M. revealed the following:

CR #1, start of care February 25, 2021. Certification period October 2, 2021,through November 30, 2021, POC contained orders for HHA (home health aide) 22-24 hours per day, 5-7 days per week to assist with personal care, ADLs (activities of daily living) and IADLs (instrumental activities of daily living). Review of " Home Health Aide Activity Report and Care Plan " identified the personal care tasks to be completed to include bathing, hair care, oral hygiene, lotion/ointment, and assistance with dressing. Review of " Home Health Aide Activity Report and Care Plan " revealed that the HHA documented that the patient was bathed on October 2, 5, 8, and 14, 2021. There was no documentation of CR #1 receiving a bath On October 3, 4, 6, 7, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19 and 20, 2021. Communication log notes document calls from the HHA ' s on October 1, 4, 8, and 15, 2021, stating that the patient is refusing to allow the HHA to give the patient a bath. Communication log notes contain documentation on October 3 and 15, 2021, that the caseworker was notified that the patient is refusing to allow the HHA ' s to help the patient get a bath.

Review of " Home Health Aide Activity Report and Care Plan " revealed that the HHA only provided services in the duration and frequency ordered for the period reviewed on five (5) of nineteen (19) days. Services were provided as follows: October 2, 2021, 15 hours of care provided, October 3, 2021, 22.25 hours of care provided, October 4, 2021, 19.4 hours of care provided, October 5, 2021, 21.75 hours of care provided, October 6, 2021, 21.75 hours of care provided, October 7, 2021, 15 hours of care provided, October 8, 2021, 21 hours of care provided, October 9, 2021, 13.25 hours of care provided, October 10, 2021, 20 hours of care provided, October 11, 2021, 23.75 hours of care provided, October 12, 2021, 21.75 hours of care provided, October 13, 2021, 22.25 hours of care provided, October 14, 2021, 23.75 hours of care provided, October 15, 2021, 20.5 hours of care provided, October 16, 2021, 15.25 hours of care provided, October 17, 2021, 19.5 hours of care provided, October 18, 2021, 23.75 hours of care provided, and October 19, 2021, 20.75 hours of care provided. Review of " Communication Logs " on October 20, 2021, stated, " Patient daughter called the on call phone at 7A.M. to say that the caregiver overnight never showed up. Caregiver or patient did not call that on call to inform that no one showed up. " Note in HHA Exchange dated October 20, 2021, at 4:25 P.M. which was a calendar note for October 8, 2021, stated, " caregiver did no call/no show. The patients said is ok that [patient] will wait for [next shift caregiver] to arrive on Saturday. " Note in HHA Exchange dated October 20, 2021, at 4:32 P.M. which was a revised calendar note from October 15, 2021, stated, " Caregiver did no call/no show and the patient said is ok that [patient] will wait for [next shift caregiver] to arrive on Saturday. " There were no other notes, physician notifications or verbal order for the remaining missed shifts.

CR #2, start of care July 13, 2021, certification period September 11, 2021, through November 9, 2021, contained orders for HHA 8-10 hours per day, 5-7 days per week to assist with personal care, ADLs and IADLs. Review of " Home Health Aide Activity Report and Care Plan " for the certification period revealed that HHA services were provided in accordance with the POC.

CR #3, start of care March 25, 2021, certification period September 22, 2021, through November 19, 2021, contained orders for HHA 6-8 hours per day, 5-7 days per week to assist with personal care, ADLs and IADLs. Review of " Home Health Aide Activity Report and Care Plan " for the certification period revealed that HHA services were provided in accordance with the POC.

An interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above findings.



Plan of Correction:

AccuCare Home Nursing Inc (AccuCare) has applied for an additional home care license (vs home health) to be used for unskilled cases. The transfer of unskilled cases from the Home Health License to the Home Care License will begin upon approval of the said license, therefore, a date for completion cannot be given at this time.

1) AccuCare's EVV system (HHAeXchange) did not have the Plan of Care for the HHA (tasks) to check at the end of their shifts. After discussing with HHAeXchange, we now know and are able to enter the HHA POC tasks into the system. This system prompts the caregiver to check the tasks completed AND tasks refused by the client.
November 1, 2021, POC training for all staffing coordinators was completed, and uploading the tasks into the system was initiated.
PLAN: 100% of available HHA POC tasks submitted to EVV system (HHAeXchange) by 12/26/2021.
2) "Providing Services in Accordance with the POC" Review/Re-training of Scheduling Coordinators, Field Staff, and RN Field Supervisors to be completed by 12/26/2021. Noncompliance to the information discussed in the re-training Inservice will result in disciplinary measures in the form of a verbal / written warning and/or termination.
A. Scheduling Coordinators Review/Re-training in the importance of:
1) Compliance with the hours/week ordered in the Physician's POC when creating schedules for each client.
2) Notifying the Nursing Supervisor of any deviation from the hours or tasks ordered in the POC.
3) Documenting and communicating changes in service hours and/or tasks repeatedly refused by the client. This will be done through the "on-call log", communication forms, and/or EVV notes on the client's calendar.
B. Field Staff Review/Re-training in the importance of:
1) Following the Plan of Care for the HHA
2) Documenting the completion or client refusal of tasks ordered. This will be done using EVV OR paper submission of the "Home Health Aide Activity Report and Care Plan"
2) Importance of notifying the office (or on-call) of any changes in schedule, lateness, or inability to cover a shift.
3) Knowledge of the Caregiver Protocol for 24HR Client Care. This includes notifying the office if the replacement staff does not arrive on time.
4) The client cannot be left alone (even if the client gives permission to leave), this is for the protection of the client.
C) RN Field Supervisors Review/Re-training in the importance of:
1) Completion of the "Home Health Aide Supervision and Care Plan" which assesses/documents at the very least:
-Caregivers' knowledge of and compliance to the POC
-changes in schedule,
-hours for appropriateness
-knowledge of the on-call procedure, emergency plan, and safety.
-need to communicate changes in client's status, needs, hours, or POC
-completion/knowledge/of tasks
-Infection control
-changes of the POC needed, verbal order to be sent to the physician within 24 hours
2) Submission of Supervisory notes or changes in orders within 24 hrs. unless otherwise instructed by the office.
3) AccuCare will act to protect patients in the future as it relates to the individual through:
a) Texting staff members when EVV shows they have a missed check-in or missed check-out.
b) Texting on-call coordinators whenever a missed check-in or out is displayed on EVV; coordinators will contact the staff involved and remind them to clock in/out. These two actions will allow AccuCare to be aware of missed visits / late shifts in a timely manner and act on a resolution.

AccuCare will monitor its performance to ensure solutions/remedies are sustained.
- THE staff responsible to monitor the continued implementation of the plan of correction: QMP EVV Compliance Team: Office Manager, Director of Nursing, Staffing Coordinator, and Billing Coordinator. AccuCare's QMP "Monitoring of EVV" will specifically target check-in/out data, completion of tasks, and missed shifts. The first meeting and report will be completed by 12/26/2021. AccuCare's QMP will continue to monitor the EVV compliance at least quarterly throughout 2022.
- The staff responsible to monitor the completion of Review/Re-training: Office Manager and Director of Nursing.



484.80(b)(1) ELEMENT
Classroom and supervised practical training

Name - Component - 00
Home health aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while providing services to an individual under the direct supervision of a registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse. Classroom and supervised practical training must total at least 75 hours.

Observations:
Based on a review of agency policy, personnel files (PFs), and an interview with agency staff, the agency failed to employ Home Health Aides (HHA) with a minimum of 75 hours of training for four (4) of four (4) HHA personnel files reviewed. (PF # 1, 2, 3, and 4)

Review of the Home Health Aide job description on October 26, 2021, at approximately 11:30 A.M. stated, " Qualifications: 1. A certificate of accreditation of an approved home health aide training program; or, 2. Certified as a nurse aide by the State of Pennsylvania ... "

Review of PF on October 26, 2021, at approximately 11:00 A.M. and October 27, 2021, at approximately 3:30 P.M. revealed the following:

PF #1, date of hire March 23, 2021, contained no documentation of the required 75 hours of training or a CNA (certified nursing assistant) certification.

PF #2, date of hire September 5, 2020, contained no documentation of the required 75 hours of training or a CNA certification.

PF #3, date of hire August 27, 2021, contained no documentation of the required 75 hours of training or a CNA certification.

PF #4, date of hire September 7, 2021, contained no documentation of the required 75 hours of training or a CNA certification.

Interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above findings.



Plan of Correction:

"Home health aide training must include classroom and supervised practical training... Classroom and supervised practical training must total at least 75 hours."
Training is offered in the forms of in-person training, online courses, independent reading and discussion, and webinars. This training is documented on the "Certificate of Completion" which lists the 60 hours of training topics. The aide's knowledge is also evaluated using the "Home Health Aide Competency Test". The aide must attain a score of 80% or above on the competency test.
The practical training is documented on the supervisory note where the tasks are evaluated by the supervising RN and rated as: "(I) instruction given, (D) demonstrates understanding," or "(V) verbally demonstrates understanding". The practical evaluations are then summarized on the initial Performance Evaluation. Both of these training methods combined equal 75 hours.
Steps to bring staff into compliance:
Plan: Review/retrain all staff involved with the hiring and orientation process in:
1)The required training, hours, and documentation needed. Also, the need for prompt completion of the documentation and filing of those forms in the personnel files once completed.
This training will be completed by 12/26/2021. AccuCare's Director of Nursing and Office Manager will be responsible for the implementation of this plan.
2) A Personnel file audit by the compliancy staff (Office Manager, Director of Nursing, Scheduling Coordinator) will be completed. Any staff member without the 75hrs of training will receive training.
The audit will be completed for baseline data by December 26, 2021. To ensure the corrective actions are sustained, this audit will become part of the QMP for 2022. AccuCare's Director of Nursing and Office Manager will be responsible for the implementation of this plan.
3) Administrator and Director of Nursing will update Agency policy #510 to clarify the "Home Health Aide Competency Valuation" procedure and documentation thereof. This will be completed by 12/26/2021.



484.80(h)(4)(i-vi) ELEMENT
HH aide supervision elements

Name - Component - 00
Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements:
(i) Following the patient's plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional;
(ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family;
(iii) Demonstrating competency with assigned tasks;
(iv) Complying with infection prevention and control policies and procedures;
(v) Reporting changes in the patient's condition; and
(vi) Honoring patient rights.

Observations:
Based on review of agency policy, Home Health Aide (HHA) personnel file (PF) reviews, and interview with agency staff, the agency failed to ensure that the HHA furnished care in a safe and effective manner by demonstrating competency with assigned tasks for four (4) of four (4) PF reviewed. (PF #1, 2, 3, and 4)

Review of agency policy #510 title " Home Health Aide Competency Valuation " on October 26, 2021, at approximately 12:30 P.M. stated, " Procedure: 1. The registered nurse will evaluate through direct observation the individual ' s ability to competently perform the following tasks: reading and recording temperature, pulse, respiration and blood pressure, bed bath, sponge, tube or shower bath, shampoo, sink, tub or bath, nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques, normal range of motion and positioning, and making an occupied bed ... The evaluation of the aide ' s performance by the qualified registered nurse will be documented on the " Checklists or Skills Demonstration " or other similar document ... "

Review of PF on October 26, 2021, at approximately 11:00 A.M. and October 27, 2021, at approximately 3:30 P.M. revealed the following:

PF #1, date of hire March 23, 2021, contained a skills assessment, which was not the required "Aide Skills Inventory" form, that was part of a supervisory visit dated March 25, 2021.

PF #2, date of hire September 5, 2020, contained an " Aide Skills Inventory " form completed by PF #2 on September 5, 2020, but was not documented as skills observed by the registered nurse (RN).

PF #3, date of hire August 27, 2021, contained an " Aide Skills Inventory " form completed by PF #3 on August 27, 2021, but was not documented as skills observed by the registered nurse (RN).

PF #4, date of hire contained an " Aide Skills Inventory " form completed by PF #2 on September 5, 2020, but was not documented as skills observed by the registered nurse (RN).

An interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above finding.



Plan of Correction:

The "Aide Skills Inventory" form is completed with the application and is only used as a guide for training purposes.
Verification of Competency:
The registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse, will evaluate through direct observation the individual's ability to competently perform specific tasks following CoP 484.36. The observations of these tasks are noted on the Performance Evaluation and the Home Health Aide Supervision report. "Classroom" Training is documented on the "Certificate of Completion" which lists the 60 hours of training topics. The aide's knowledge is also evaluated using the "Home Health Aide Competency Test". The aide must attain a score of 80% or above on the competency test.
Plan 1. Personnel file audit by our compliancy staff (Office Manager, Director of Nursing, Scheduling Coordinator) will be completed. Any staff member without the 75hrs of training will receive training. This audit become part of the QMP for 2022 to monitor performance to ensure compliance is sustained. AccuCare's Director of Nursing and Office Manager will be responsible for the implementation of this plan.
An initial Audit will be completed for baseline data by December 26, 2021.
Plan 2: Administrator and Director of Nursing will update Agency policy #510 to clarify the "Home Health Aide Competency Valuation" procedure and documentation thereof. This will be completed by 12/26/2021.



Initial Comments:
Based on the findings of an unannounced onsite complaint investigation conducted on October 26, 2021, and concluded on October 27, 2021, Accucare Home Nursing, Inc. was found not to be in compliance with the requirements of 28 Pa. Code, Part IV, Health facilities, Subpart G. Chapter 601.


Plan of Correction:




601.31(d) REQUIREMENT
CONFORMANCE WITH PHYSICIAN'S ORDERS

Name - Component - 00
601.31(d) Conformance With
Physician's Orders. All prescription
and nonprescription (over-the-counter)
drugs, devices, medications and
treatments, shall be administered by
agency staff in accordance with the
written orders of the physician.
Prescription drugs and devices shall
be prescribed by a licensed physician.
Only licensed pharmacists shall
dispense drugs and devices. Licensed
physicians may dispense drugs and
devices to the patients who are in
their care. The licensed nurse or
other individual, who is authorized by
appropriate statutes and the State
Boards in the Bureau of Professional
and Occupational Affairs, shall
immediately record and sign oral
orders and within 7 days obtain the
physician's counter-signature. Agency
staff shall check all medicines a
patient may be taking to identify
possible ineffective drug therapy or
adverse reactions, significant side
effects, drug allergies, and
contraindicated medication, and shall
promptly report any problems to the
physician.

Observations:


Based on review of agency policy, clinical records (CR), electronic time keeping reports, communication notes, and staff interviews, the agency failed to provide services in accordance with the "Home Health Certification and Plan of Care" (POC) for one (1) of three (3) CR reviewed. (CR# 1).

Review of clinical records, electronic time keeping records, and communication logs on October 26, 2021, from approximately 9:30 A.M. to 11:00 A.M. revealed the following:

CR #1, start of care February 25, 2021. Certification period October 2, 2021,through November 30, 2021, POC contained orders for HHA (home health aide) 22-24 hours per day, 5-7 days per week to assist with personal care, ADLs (activities of daily living) and IADLs (instrumental activities of daily living). Review of " Home Health Aide Activity Report and Care Plan " identified the personal care tasks to be completed to include bathing, hair care, oral hygiene, lotion/ointment, and assistance with dressing. Review of " Home Health Aide Activity Report and Care Plan " revealed that the HHA documented that the patient was bathed on October 2, 5, 8, and 14, 2021. There was no documentation of CR #1 receiving a bath On October 3, 4, 6, 7, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19 and 20, 2021. Communication log notes document calls from the HHA ' s on October 1, 4, 8, and 15, 2021, stating that the patient is refusing to allow the HHA to give the patient a bath. Communication log notes contain documentation on October 3 and 15, 2021, that the caseworker was notified that the patient is refusing to allow the HHA ' s to help the patient get a bath.

Review of " Home Health Aide Activity Report and Care Plan " revealed that the HHA only provided services in the duration and frequency ordered for the period reviewed on five (5) of nineteen (19) days. Services were provided as follows: October 2, 2021, 15 hours of care provided, October 3, 2021, 22.25 hours of care provided, October 4, 2021, 19.4 hours of care provided, October 5, 2021, 21.75 hours of care provided, October 6, 2021, 21.75 hours of care provided, October 7, 2021, 15 hours of care provided, October 8, 2021, 21 hours of care provided, October 9, 2021, 13.25 hours of care provided, October 10, 2021, 20 hours of care provided, October 11, 2021, 23.75 hours of care provided, October 12, 2021, 21.75 hours of care provided, October 13, 2021, 22.25 hours of care provided, October 14, 2021, 23.75 hours of care provided, October 15, 2021, 20.5 hours of care provided, October 16, 2021, 15.25 hours of care provided, October 17, 2021, 19.5 hours of care provided, October 18, 2021, 23.75 hours of care provided, and October 19, 2021, 20.75 hours of care provided. Review of " Communication Logs " on October 20, 2021, stated, " Patient daughter called the on call phone at 7A.M. to say that the caregiver overnight never showed up. Caregiver or patient did not call that on call to inform that no one showed up. " Note in HHA Exchange dated October 20, 2021, at 4:25 P.M. which was a calendar note for October 8, 2021, stated, " caregiver did no call/no show. The patients said is ok that [patient] will wait for [next shift caregiver] to arrive on Saturday. " Note in HHA Exchange dated October 20, 2021, at 4:32 P.M. which was a revised calendar note from October 15, 2021, stated, " Caregiver did no call/no show and the patient said is ok that [patient] will wait for [next shift caregiver] to arrive on Saturday. " There were no other notes, physician notifications or verbal order for the remaining missed shifts.

CR #2, start of care July 13, 2021, certification period September 11, 2021, through November 9, 2021, contained orders for HHA 8-10 hours per day, 5-7 days per week to assist with personal care, ADLs and IADLs. Review of " Home Health Aide Activity Report and Care Plan " for the certification period revealed that HHA services were provided in accordance with the POC.

CR #3, start of care March 25, 2021, certification period September 22, 2021, through November 19, 2021, contained orders for HHA 6-8 hours per day, 5-7 days per week to assist with personal care, ADLs and IADLs. Review of " Home Health Aide Activity Report and Care Plan " for the certification period revealed that HHA services were provided in accordance with the POC.

An interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above findings.



Plan of Correction:

AccuCare Home Nursing Inc (AccuCare) has applied for an additional home care license (vs home health) to be used for unskilled cases. The transfer of unskilled cases from the Home Health License to the Home Care License will begin upon approval of the said license, therefore, a date for completion cannot be given at this time.
1) AccuCare's EVV system (HHAeXchange) did not have the Plan of Care for the HHA (tasks) to check at the end of their shifts. After discussing with HHAeXchange, we now know and are able to enter the HHA POC tasks into the system. This system prompts the caregiver to check the tasks completed AND tasks refused by the client.
November 1, 2021, POC training for all staffing coordinators was completed, and uploading the tasks into the system was initiated.
PLAN: 100% of available HHA POC tasks submitted to EVV system (HHAeXchange) by 12/26/2021. The staff responsible to monitor the completion of this plan will be the Office Manager and Director of Nursing.

2) "Providing Services in Accordance with the POC"
PLAN: Review/Re-training of Scheduling Coordinators, Field Staff, and RN Field Supervisors to be completed by 12/26/2021.
The Office Manager and Director of Nursing will monitor the completion of the Review/Re-training:
A. Scheduling Coordinators Review/Re-training in the importance of:
1) Compliance with the hours/week ordered in the Physician's POC when creating schedules for each client.
2) Notifying the Nursing Supervisor of any deviation from the hours or tasks ordered in the POC.
3) Documenting and communicating changes in service hours and/or tasks repeatedly refused by the client. This will be done through the "on-call log", communication forms, and/or EVV notes on the client's calendar.
4) Noncompliance to the information discussed in the re-training Inservice will result in disciplinary measures in the form of a verbal / written warning and/or termination.
B. Field Staff Review/Re-training in the importance of:
1) Following the Plan of Care for the HHA
2) Documenting the completion or client refusal of tasks ordered. This will be done using EVV OR paper submission of the "Home Health Aide Activity Report and Care Plan"
2) Importance of notifying the office (or on-call) of any changes in schedule, lateness, or inability to cover a shift.
3) Knowledge of the Caregiver Protocol for 24HR Client Care. This includes notifying the office if the replacement staff does not arrive on time.
4) The client cannot be left alone (even if the client gives permission to leave), this is for the protection of the client.
5) Noncompliance to the information discussed in the re-training Inservice will result in disciplinary measures in the form of a verbal / written warning and/or termination.
C) RN Field Supervisors Review/Re-training in the importance of:
1) Completion of the "Home Health Aide Supervision and Care Plan" which assesses/documents at the very least:
-Caregivers' knowledge of and compliance to the POC
-changes in schedule,
-hours for appropriateness
-knowledge of the on-call procedure, emergency plan, and safety.
-need to communicate changes in client's status, needs, hours, or POC
-completion/knowledge/of tasks
-changes of the POC needed, verbal order to be sent to the physician within 24 hours
2) Submission of Supervisory notes or changes in orders within 24 hrs. unless otherwise instructed by the office. Noncompliance to the information discussed in the re-training Inservice will result in disciplinary measures in the form of a verbal / written warning and/or termination.

3) AccuCare will act to protect patients in the future as it relates to the individual through:
a) Texting staff members when EVV shows they have a missed check-in or missed check-out.
b) Texting on-call coordinators whenever a missed check-in or out is displayed on EVV; coordinators will contact the staff involved and remind them to clock in/out. These two actions will allow AccuCare to be aware of missed visits / late shifts in a timely manner and act on a resolution.
AccuCare will monitor its performance to ensure solutions/remedies are sustained. The staff responsible to monitor the continued implementation of the plan of correction will be the QMP EVV Compliance Team: Office Manager, Director of Nursing, Staffing Coordinator, and Billing Coordinator. AccuCare's QMP "Monitoring of EVV" will specifically target check-in/out data, completion of tasks, missed shifts, and compliance to the POC/authorization.
The first meeting and report will be completed by 12/26/2021. AccuCare's QMP will continue to monitor the EVV compliance at least quarterly throughout 2022.
Given the critical shortage of caregivers, AccuCare is only accepting new referrals that can be fully staffed including backup staff to cover call-outs. AccuCare is actively recruiting new staff to be able to meet the needs of our clients



601.35(a) REQUIREMENT
SELECTION OF AIDES

Name - Component - 00
601.35(a) Selection of Aides. Home
health aides are selected on the basis
of such factors as sympathetic
attitude toward the care of the sick,
ability to read, write, and carry out
directions, and maturity and ability
to deal effectively with the demands
of the job. Aides are carefully
trained in assisting patients to
achieve maximum self-reliance,
principles of nutrition and meal
preparation, the aging process and
emotional problems of illness,
maintaining a clean, healthful, and
pleasant environment, changes in
patient's condition that should be
reported, work of the agency and the
health team, ethics and
confidentiality, and recordkeeping.

Home Health Aid Training. All home
health aides have completed a minimum
of 60 hours of classroom instruction
prior to or during the first 3 months
of employment.

They are closely supervised to assure
their competence in providing care.



Observations:
Based on review of agency policy, Home Health Aide (HHA) personnel file (PF) reviews, and interview with agency staff, the agency failed to employ Home Health Aides (HHA) with a minimum of 60 hours of training and failed to ensure that the HHA furnished care in a safe and effective manner by demonstrating competency with assigned tasks for four (4) of four (4) HHA personnel files reviewed. (PF # 1, 2, 3, and 4)

Review of the Home Health Aide job description on October 26, 2021, at approximately 11:30 A.M. stated, " Qualifications: 1. A certificate of accreditation of an approved home health aide training program; or, 2. Certified as a nurse aide by the State of Pennsylvania ... "

Review of agency policy #510 title " Home Health Aide Competency Valuation " on October 26, 2021, at approximately 12:30 P.M. stated, " Procedure: 1. The registered nurse will evaluate through direct observation the individual ' s ability to competently perform the following tasks: reading and recording temperature, pulse, respiration and blood pressure, bed bath, sponge, tube or shower bath, shampoo, sink, tub or bath, nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques, normal range of motion and positioning, and making an occupied bed ... The evaluation of the aide ' s performance by the qualified registered nurse will be documented on the " Checklists or Skills Demonstration " or other similar document ... "

Review of PF on October 26, 2021, at approximately 11:00 A.M. and October 27, 2021, at approximately 3:30 P.M. revealed the following:

PF #1, date of hire March 23, 2021, contained no documentation of the required 60 hours of training or a CNA (certified nursing assistant) certification. The PF contained a skills assessment, which was not the required "Aide Skills Inventory" form, that was part of a supervisory visit dated March 25, 2021.

PF #2, date of hire September 5, 2020, contained no documentation of the required 60 hours of training or a CNA certification. The PF contained an " Aide Skills Inventory " form completed by PF #2 on September 5, 2020, but was not documented as skills observed by the registered nurse (RN).

PF #3, date of hire August 27, 2021, contained no documentation of the required 60 hours of training or a CNA certification. The PF contained an " Aide Skills Inventory " form completed by PF #3 on August 27, 2021, but was not documented as skills observed by the registered nurse (RN).

PF #4, date of hire September 7, 2021, contained no documentation of the required 60 hours of training or a CNA certification. The PF contained an " Aide Skills Inventory " form completed by PF #4 on September 5, 2020, but was not documented as skills observed by the registered nurse (RN).

Interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above findings.




Plan of Correction:

"Home health aide training must include classroom and supervised practical training... Classroom and supervised practical training must total at least 75 hours."
Training is offered in the forms of in-person training, online courses, independent reading and discussion, and webinars. This training is documented on the "Certificate of Completion" which lists the 60 hours of training topics. The aide's knowledge is also evaluated using the "Home Health Aide Competency Test". The aide must attain a score of 80% or above on the competency test.
The practical training is documented on the supervisory note where the tasks are evaluated by the supervising RN and rated as: "(I) instruction given, (D) demonstrates understanding," or "(V) verbally demonstrates understanding". The practical evaluations are then summarized on the initial Performance Evaluation. Both of these training methods combined equal 75 hours.
Steps to bring staff into compliance:
Plan: Review/retrain all staff involved with the hiring and orientation process in:
1)The required training, hours, and documentation needed. Also, the need for prompt completion of the documentation and filing of those forms in the personnel files once completed.
This training will be completed by 12/26/2021. AccuCare's Director of Nursing and Office Manager will be responsible for the implementation of this plan.
2) A Personnel file audit by the compliance staff (Office Manager, Director of Nursing, Scheduling Coordinator) will be completed. Any staff member without the 75hrs of training will receive training.
The audit will be completed for baseline data by December 26, 2021. To ensure the corrective actions are sustained, this audit will become part of the QMP for 2022. AccuCare's Director of Nursing and Office Manager will be responsible for the implementation of this plan.
3) Administrator and Director of Nursing will update Agency policy #510 to clarify the "Home Health Aide Competency Valuation" procedure and documentation thereof. This will be completed by 12/26/2021.