Chapter One

Licensing
and
inspecting
personal
care homes

The Pennsylvania Department of Public Welfare, in writing regulations about the licensing of personal care homes, expressed optimism about its ability to help the homes' residents in their everyday living. Title 55 of the Pennsylvania Code, Chapter 2620 -- Personal Care Home Licensing -- begins as follows:

The purpose of this chapter is to assure that PCHs provide safe, humane, comfortable and supportive residential settings for the aged, blind and disabled, and other dependent adults who require assistance beyond the basic necessities of food and shelter but who do not need hospitalization or skilled or intermediate nursing care. Residents who reside in homes meeting the standards found in this chapter will receive the encouragement and assistance they need to develop and maintain maximum independence and self-determination. Unnecessary institutionalization will be prevented and individuals who might otherwise be required to stay in institutions will be able to live in a PCH in the community. PCH licensees are encouraged to use the placement services of local agencies in assessing resident needs so that necessary services and the appropriate level of care may be identified and promptly secured.10
 

The law and regulations impose requirements for opening and operating a personal care home. Among them are the following:

  • The administrator of a PCH must be at least 21 years of age and must complete at least 40 hours of DPW-approved training. Table 1 on page 10 provides greater detail about the qualifications and training requirements for a PCH administrator.

  • Other staff who provide direct services to residents must be at least 16 years of age and must complete training specific to their job function in certain prescribed areas. Table 2 on page 11 provides more detail on the qualifications and training requirements for PCH staff.

  • Residents must be 18 years of age or older, and each resident must have a physician's medical evaluation stating that the resident does not need either hospital care or long-term nursing care.11

  • The administrator or a designee (who is at least 21 years old) must be available in the home on a 24-hour basis.

  • PCHs with 16 or more residents must have awake overnight staff.

  • All PCHs must maintain individual resident records on the premises where the resident lives, and the records must contain certain specified information.

  • All PCHs must maintain administrative records and employment application records with certain specified information, including documentation of staff and administrator training, staff work schedules, and lists of substitute personnel.

  • Each resident must sign a written agreement with the PCH containing such information as monthly charges for food, shelter, and services. The agreement must be filed in the resident's record, and a copy must be given to the resident.


Table 1

Qualifications and Training Requirements for
Administrators of Personal Care Homes
Qualifications:
  • At least 21 years old, high school diploma or General Education Development (GED) certificate, ability to provide personal care services or to supervise or direct those who do, knowledge of and ability to conform to DPW regulations, ability to maintain or supervise the maintenance of financial and other records, good moral character, no medical condition-including drug or alcohol addiction-that would limit the skillful and safe performance of duties.
Training:
At least 40 clock hours of DPW-approved training12 in the areas below.
 

  • First aid, medication procedures, medical terminology, personal hygiene, cardiopulmonary resuscitation (CPR), and the Heimlich maneuver.

  • Fire prevention and emergency planning.

  • Local, state, and federal laws and regulations pertaining to the operation of a PCH.

  • Nutrition, food handling, and sanitation.

  • Mental illness.

  • Recreation.

  • Gerontology.

  • Community resources and social services.

  • Staff supervision.

  • Development of orientation and training guidelines for the staff.

  • Financial record keeping and budgeting.

Administrators must also complete a DPW-approved orientation program. In addition, beginning the next calendar year after completing the above 40 hours of training, administrators must complete a minimum of 6 hours of annual DPW-approved training relating to the care and management of elderly and disabled persons or the operation and maintenance of a PCH, or both.


Table 2

Qualifications and Training Requirements for
Staff Members of Personal Care Homes13
Qualifications:
  • At least 16 years old, good moral character, no medical condition-including drug or alcohol addiction-that would limit the skillful and safe performance of duties.
Initial training:
  • A sufficient number of staff must be trained, certified, and recertified in cardiopulmonary resuscitation and first aid, and must be trained in the Heimlich maneuver, so that at least one such staff person is present in the home at all times-meaning 24 hours a day.
Training within 30 days of employment or volunteer service:

  • Orientation applicable to the general operation of the home.

  • Fire prevention.

  • Operation of safety equipment.

  • Emergency planning and evacuation procedures.

Training within 6 months of employment or volunteer service, and specific to job function:

  • Medication procedures, medical terminology, and personal hygiene.

  • Nutrition, food handling, and sanitation.

  • Recreation.

  • Mental illness.

  • Gerontology.

  • Staff supervision, if applicable.

 
  Staffing and building requirements vary. Staffing depends on the number of residents who receive personal care services. Building requirements depend on local ordinances or zoning restrictions, and also on the size of the home. PCHs with 4 to 8 residents are considered small, and homes with 9 or more residents are considered large.
 
  Applicants for a PCH license-also called a certificate of compliance-complete an application less than one page long and submit, as applicable, articles of incorporation, fictitious name approval, and federal tax exemption certification. In addition, the applicant must provide proof of fire and safety approval from the Pennsylvania Department of Labor and Industry,14 sign a declaration that the PCH will be operated in compliance with requirements, and pay a licensing fee ranging from $15 to $50 based on the number of beds.
 
  The law directs DPW to issue a one-year license to a facility that is in full compliance with standards. For a PCH that is in substantial, but not complete, compliance with standards, the law allows DPW to issue up to four provisional licenses. Each provisional license may be effective for as long as six months. For a PCH that does not comply with requirements, DPW may refuse to issue a license. For an existing PCH, DPW may impose monetary penalties, refuse to renew a license, or revoke a license.
 
  For licensed facilities, DPW is responsible for conducting an announced on-site inspection at least once during a licensing period-that is, within 12 months for regular licensees and within 6 months for provisional licensees. DPW may also conduct other inspections, both announced and unannounced, as necessary-for example, to follow up on a deficiency or to investigate a complaint.
 
 
  Objectives and Methodology for Chapter One
 
  Our overall objective related to this chapter was to determine whether DPW licensed, inspected, and monitored personal care homes in accordance with the law, the regulations, and related policies. More specifically, we determined whether DPW conducted inspections of homes prior to issuing or renewing licenses, cited facilities for violating regulations, followed up to ensure that violations were corrected, and appropriately documented licensing and inspection efforts.
 
 

To accomplish these objectives, we employed the following methodology:

  • Reviewed applicable law, regulations, policies, and procedures

  • Interviewed DPW staff

  • Conducted detailed analyses of all licensing and inspection activities for the two-year audit period for 56 personal care homes licensed by DPW. The 56 homes were selected randomly and judgmentally from the entire population of facilities in each region.

 

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