Failure to Submit Criminal History Record Check Forms
Penalty
Summary
The facility failed to ensure the submission of a New York State Department of Health Request for Criminal History Record Check (Form 103) for two out of five employees reviewed during a recertification survey. Specifically, there was no documented evidence that Form 103 was submitted for Employees #28 and #29. The facility's policy, revised in November 2018, requires the Director of Human Resources or designee to obtain a signed authorization for the search and exchange of records (Form 102) from prospective employees. However, during an interview, the Human Resources Director acknowledged that Form 103 was missing for these employees and recognized gaps in the policy that needed addressing to prevent future occurrences.
Plan Of Correction
Plan of Correction: Approved February 10, 2025 The following corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: - Form 103 Criminal History and Record Check completed for employees #28 & #29. The facility will identify other residents having the potential to be affected by the same deficient practice and the following corrective action will be taken: - Audit employee files for form 103 for CHRC. The following measures will be put in place and/or systemic changes will be made to ensure that the deficient practice does not recur: - Education to Human Resources on CHRC regulation/license. The corrective action(s) will be monitored to ensure the deficient practice will not recur: - Auditing of new hires and current employees for form 103 to occur x10/month for 3 months at 100%. The date for correction and the title of the person responsible for correction of each deficiency: - Date of Correction: 3/5/2025 - Person Responsible: Director of Human Resources.