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Guidance for Common Deficiency Findings

Common Health Care Worker Registry Survey Finding

Failure to Conduct Six Website Verifications

When the new employee has an “eligible” work eligibility status

The new hire or rehire does not need another background check, HOWEVER, you are required to check the six registries in the web portal.

In this situation do the following:

  • Click on the green plus sign in the Livescan Requests section of the profile.
  • Click on each link of the six registries, perform the search, and then check each box if the individual is not found.
  • Do not click “save.” Selecting save will create a new Livescan Request.
    • Instead, click “Print,” this will allow you to print the documentation.
    • Put this printout in the employee’s file.
  • Return to the employee’s profile page.

What do you do if you clicked “save?”

You will need to delete the request.

  • Click on “Livescan Requests” (the header, not the date).
  • Click the dropdown arrow next to “Edit” and click “Delete.”
  • You will be asked to confirm that you want to delete the Livescan request. Click “Yes.”

Additional Health Care Worker Registry questions:
Phone: 844-789-3676

Common Survey Deficiencies

Annual Health Care Worker Registry Verification and Annual Education

Annual Health Care Worker Registry Verification

Admin. Code 955.145 (Home Services and Home Nursing) Compliance

Each health care employer or its designee shall provide an employment verification and update the demographic information for each employee no less than annually. (Section 33(i) of the Act)

  • The health care employer or its designee shall log into the Health Care Worker Registry through a secure login in a method prescribed by the Department. (Section 33(i) of the Act)
  • The health care employer or its designee shall indicate employment and termination dates (separation dates) within 30 days after hiring or terminating an employee. (Section 33(i) of the Act)
  • The health care employer shall provide the employment category and type. (Section 33(i) of the Act)

Annual Education Requirements

Admin. Code 245.71 (Home Services ONLY) and 973.140 (Home Services and Home Nursing) compliance

Each home services agency shall provide or arrange for a minimum of 10 hours of training for each home services worker. (Section 245.71c) After the first 365 days of employment, each employee will be required to minimally cover the required annual topics, but still meet the 10 total hours of training. All training shall be documented with the date of training, the length of time spent on each topic, instructors and their qualifications, short description of content, and participating worker signature. (Section 245.71 h)

All required annual topics

  • Promoting resident dignity, independence, individuality, privacy, and choice
  • Resident rights and principles of self-determination
  • Care of elderly persons with physical, cognitive, behavioral, and social disabilities
  • Effectively communicating with individuals with dementia
  • Disaster procedures
  • Hygiene and infection control
  • Abuse and neglect prevention and reporting requirements

Links to the Administrative Codes

Initial Education Requirements

Admin. Code 245.71 (Home Services ONLY) & 973.140 (Home Services and Home Nursing) compliance

Each home services agency shall provide or arrange for a minimum of 10 hours of training for each home services worker. Five hours of training shall be provided prior to the home services worker's first assignment, and the remaining five hours shall be provided within the worker's first 30 days after employment. The training shall include the components of subsection (e). (Section 245.71 c) All training must be documented with the following: date of training, length of time spent on each topic, instructors and their qualifications, short description of content, and participating worker signature.

  • If the new hire has proof of completion of the training listed below from another licensed home service agency within the last 365 days this can act in place of the training, including a certified nursing assistant (CNA) who is eligible on the Health Care Worker Registry.
  • The home services agency shall not give a worker an assignment until the worker has first passed a competency evaluation given by the agency of the topics included in the first five hours of training. The competency evaluation shall ensure that the home services worker is competent to provide the services required in his or her first assignment. The worker shall be similarly tested following the remaining five hours of training. (Section 245.71 c)

Staff with direct access to clients with Alzheimer’s disease or related dementia must complete minimally six hours of initial training in the first 60 days of employment with the dementia related topics listed below.

Required initial topics (Section 245.71 e) 1-14 and section 973.140 e) 1-7)

  • The employee's job responsibilities and limitations
  • Communication skills relating to persons who are hard of hearing, have dementia, or have other special needs
  • Observing, reporting, and documenting client status and the care or service provided, including changes in functional ability and mental status demonstrated by the client
  • Performing personal care tasks for clients, including bathing, skin care, hair care, nail care, mouth care, shaving, dressing, feeding, assistance with ambulation, exercise and transfers, positioning, toileting, and medication reminding
  • Assisting in the use of specific adaptive equipment, such as a mechanical lifting device, if the worker will be working with clients who use the device
  • Basic hygiene and basic infection prevention and control practices
  • Maintaining a clean, safe, and healthy environment
  • Basic personal and environmental safety precautions
  • Recognizing emergencies and initiating emergency procedures, including basic first aid and implementation of a client's emergency preparedness plan
  • Confidentiality of client's personal, financial, and health information
  • Understanding dementia (e.g., hoarding, paranoia, hallucinations, and Sundown syndrome)
  • Problem solving skills to care for patients with dementia who exhibit challenging behavior (e.g., aggressive and catastrophic behaviors)
  • Effective communication with individuals with dementia
  • Assisting individuals with dementia in performing activities of daily living
  • Fundamentals of dementia care
  • Safe environments (e.g., wandering)
  • Managing the activities of individuals with dementia
  • Behaviors that would constitute abuse or neglect and the legal prohibitions against these behaviors, as well as knowledge and understanding of abuse and neglect prevention and reporting requirements
  • Any other task that the agency may choose to have the worker perform

Links to the Administrative Codes

Service Plans

Home Services Agencies: Admin. Code 245.210 e) & g) compliance

The agency shall establish a service plan for each client, in consultation with the client and his or her appropriate family members or representative, that outlines the services to be provided to the client. The plan must be reviewed and updated as necessary, but not less than once annually (at least once every 365 days) (Section 245.210 g).

The plan shall address and include, but not be limited to:

  • The level, type, frequency, and scope of services the client is receiving.
  • Identification of any functional limitations of the client and the importance of the limitation to the services to be provided.
  • Information received from the client and his or her appropriate family members or representative, which shall be communicated to the home services worker, on circumstances that may have an impact on the client's activity or involvement, such as basic information on medications being taken, treatments received, client's physician, activity, diet, and mental status. (Section 245.210 e)

Home Nursing Agencies: Admin. Code 245.205 d) 1, e) & f)

Persons shall be accepted for services with a plan of treatment established by the patient's health care professional. This plan shall be promulgated in writing within 30 days after acceptance and shall be signed by the prescribing health care professional within 45 days after acceptance. (Section 245.205 d) 1) Skilled nursing services shall be in accordance with a plan based on the client's diagnosis, an assessment of the client's immediate and long- range needs and resources, and client participation. The plan is to be established in consultation with the nursing personnel, the client's health care professional, other pertinent members of the agency staff, the client, and client's advocate.

The plan shall include (Section 245.205 e) 1-6):

  • diagnoses
  • client limitations and prognosis
  • expected outcomes for the client
  • the prescribing health care professional's regimen (plan) of care designed to address identified client needs, including medications, treatments, activity, diet, specific procedures deemed essential for the health and safety of the client, mental status, and potential for discharge
  • the types and frequency of services to be provided
  • assessment of need for influenza and pneumococcal vaccinations

The client's health care professional must be notified on any plan of treatment modifications deemed necessary and documented. The prescribing health care professional's signature shall be obtained within 45 days after any modification of the plan. The home nursing services team shall review the plan every 90 days, or more often should the patient's condition warrant. An updated plan of treatment shall be given to the client's health care professional for review, for any necessary revisions, for signature every 90 days, or more often as indicated. (Section 245.205 f)1-2)

Links to the Administrative Codes