Fraud, Ethics & Compliance Policy
To define the organizational structure of Homewatch CareGivers of Central New Jersey and ensure that the structure is in compliance with regulatory requirements set forth in Federal and New Jersey law governing home care agencies.
In compliance with the State of New Jersey, the responsibilities of the Homewatch CareGivers agency are upheld by the Owner and the Director of Nursing and may be delegated to senior management. The agency employs the following key functions:
- Director of Nursing / Director of Client & Caregiver Services (DON)
Director of Nursing (DON) means a New Jersey Board of Nursing licensed registered nurse with education and community health nursing experience and progressive management experience in community health nursing, who is responsible for the clinical oversight of a Health Care Services Firm’s (HCSF) health care services program and oversees services rendered by employees, including other registered nurses (RNs) and certified homemaker home health aides (CHHAs).
Homewatch CareGivers of Central New Jersey employs key positions to include Licensed/Certified Professional staff adequate to meet the needs of the client. All professional staff will be licensed, or registered as required in accordance with their appropriate practice act wherever they fit within the Functional Structure.
Employees will be provided with a job description for review prior to accepting a position. When the employment is finalized, the employee will sign the appropriate job description and it will be placed into the personnel record. The job description will be reviewed annually at the time of the performance evaluation and whenever changes are deemed necessary.
The corporate structure defines who the authority, ultimate responsibility and accountability of operations rest.
Code of Conduct and Ethics
The successful business operation and reputation of Homewatch CareGivers is built upon ideals of fair dealing and ethical conduct. Our reputation is critical to the continued success of the operation. We are known for our integrity, which requires all of us to be in complete observance of the spirit and letter of all applicable laws and regulations, as well as a scrupulous regard for the highest standards of conduct and personal integrity.
The continued success of Homewatch CareGivers is dependent upon our customers' trust. Employees owe a duty to Homewatch CareGivers and our customers to act in a way that will preserve this trust. We must also realize that our dealings with vendors and the public will act to enhance or deteriorate this relationship.
Homewatch CareGivers will comply with all applicable laws and regulations and expects its directors, officers, and employees to conduct business in accordance with the letter, spirit, and intent of all relevant laws and to refrain from any illegal, dishonest, or unethical conduct.
In general, the use of good judgment and common sense will guide each employee along the path that we consider to be acceptable conduct. If a situation arises in which an employee is uncomfortable making that determination, the matter should be discussed openly with an immediate supervisor and, if necessary, with the Director of Human Resources for advice and consultation.
Compliance with this policy of business ethics and conduct is the responsibility of every Homewatch CareGivers employee. Disregarding or failing to comply with this policy or any other policy referenced in this employee handbook could lead to disciplinary action, up to and including termination of employment.
The governing authority of Homewatch CareGivers has final authority on all business and ethics decisions. Monitoring and evaluation of the Code of Conduct and Ethics will be conducted annually by discussing regulation or law changes and by using tools such as a fraud risk analysis. This policy will be shared with the community by distributing the Policy Information Notice as a hard copy or electronically (email/website).
Homewatch CareGivers has appointed an Independent Compliance Officer (ICO). This officer is not an employee of Homewatch CareGivers. The purpose of the ICO is to receive and thoroughly and impartially document a report and pass it on to the organization. The ICO also is to report annually to the governing authority a written summary of all the reports they received, or a letter stating no reports were received.
Lastly, no written, copied or electronic documentation is to be altered or destroyed in anticipation of a request or as a result of a request for those documents by an authorized, lawful investigation.
Caregiver Code of Ethics
As a representative of Homewatch CareGivers, our employees must agree to conduct myself according to the following principles:
- My first priority is the client and their family.
- I will present our services in a truthful and honest manner, treating clients as if they were members of my own family.
- I will acknowledge the importance of the client, their family, or their advocate in the development of the customized Care Plan.
- I will, to the best of my ability, meet the needs of the client, as they define them, by listening and responding appropriately.
- I will keep all client information strictly confidential in accordance with HIPAA Regulations (Health Insurance Portability and Accountability Act of 1996).
- I will care for clients with respect and dignity because I know my actions will have a positive impact, helping them stay in their homes longer.
- I will report any signs of neglect or abuse to my supervisor immediately.
- I will conduct myself with the highest standards of integrity, compassion and responsibility; because I know my actions have far-reaching effects on Homewatch CareGivers.
- I will make the “Golden Rule” my daily priority – treating others as I would have them treat me.
- I will be courteous and prompt in handling all questions and complaints, following Homewatch CareGivers policies and procedures.
- I will maintain my competency with continued education, improving my skills, knowledge, commitment, and attitude, to provide the best possible care.
It is the policy of the Homewatch CareGivers agency that every complaint and incident that may occur shall be documented on the complaint form or the critical incident report form, and shall be maintained for a minimum of seven years from the date of the complaint or incident.
A complaint form will be completed and filed any time there is a complaint or incident filed with the office. These forms will be reviewed at least quarterly and annually to track trends and patterns, if any, to help determine the need for additional training, discipline, or changes in the client care plan.
All clients and employees shall be informed of the Homewatch CareGivers agency policy and procedures regarding Client Rights and Responsibilities and Complaints. Accordingly, any complaint made by a client or client’s responsible party, if applicable, whether orally or in writing, shall be documented on the Homewatch CareGivers Complaint form by the employee to whom the complaint is made.
All incidents or unusual occurrences (e.g., falls, accidents, suspicion of abuse, neglect or exploitation, criminal activity or significant changes in a client’s condition, etc.) that affect the health, safety and welfare of a client shall be reported immediately to the nurse supervisor. The supervisor shall determine what actions should be taken to protect the health, safety or welfare of the client, and shall notify the client’s responsible party if applicable, or the client’s family of the incident. The person reporting the incident, and the supervisor, shall complete the Incident Report form. The completed form shall be forwarded to the administrator of the Homewatch CareGivers agency.
Employees of the Homewatch CareGivers agency shall adhere to the following procedure to ensure compliance with this policy:
- The employee of the Homewatch CareGivers agency who first receives a complaint or becomes aware of an incident will take whatever actions possible to protect the health, safety and welfare of the client, if they are at risk. The employee will act with due diligence and within his/her scope of competency.
- The employee will then immediately contact his/her supervisor to report all known facts regarding the complaint or incident. All complaints and/or incidents that place the client or the employee’s health or welfare at risk must be reported immediately or as soon as the client and caregiver is safe.
- The supervisor shall review the information with the employee, discuss the information with the client or the client’s responsible party, if applicable, either by phone or in person, investigate the circumstances that gave rise to the complaint or incident, and direct such action indicated to resolve the complaint. They will also identify actions that might be taken to prevent future occurrences of similar incidents, if possible.
- The supervisor and the employee who first reported the complaint or incident shall complete the Complaint or Incident Report form to include: the name of the client, the name of the person making the complaint or reporting the incident, the names of other parties that may be involved, a description of the complaint or incident, a narrative of the circumstances that seemed to give rise to the complaint or incident the efforts to resolve the complaint, or for an incident, a narrative of actions that might be taken to prevent future occurrences of similar incidents. The complaint and incident report form must be completed and turned into the office with 24 hours of the complaint/incident.
- The administrator will review the completed form within one week of the complaint or incident. If the supervisor did not resolve the complaint, the administrator will attempt to do so, record the efforts on the form, and file the information in the complaint journal and/or incident journal or electronic file. The administrator will also ensure that the Complaint and Critical Incident journal report is reviewed in the Quality Improvement Program, so that relevant changes might be made to orientation and training activities, supervision practices, continuing education, policies and procedures, or communications with clients, family members or others involved in providing services to the client.
- All Complaint and Incident Report forms will be filed in the clients and/or caregivers personal file and be kept seven years, pursuant the documentation policies of the Homewatch CareGivers agency. Maintenance of these records may be kept in electronic files.
Reporting Concerns and Allegations of Misconduct
Homewatch CareGivers takes all reported concerns seriously, and when appropriate, will investigate to determine if there has been a violation. If you report an alleged violation, Homewatch CareGivers will make every reasonable effort to keep your identity confidential while conducting a thorough and fair investigation as required under the law. If you wish, you may remain anonymous when making a report.
If an employee has knowledge of or a concern of illegal or dishonest fraudulent activity, the employee is to contact his/her immediate supervisor or the Department Manager. The employee must exercise sound judgment to avoid baseless allegations. An employee who intentionally files a false report of wrongdoing will be subject to discipline up to and including termination.
A reporting employee is not responsible for investigating the activity or for determining fault or corrective measures; appropriate management officials are charged with these responsibilities.
Examples of illegal or dishonest activities are violations of federal, state or local laws; billing for services not performed or for goods not delivered; and other fraudulent financial reporting.
To the extent possible, the confidentiality of the reporting employee will be maintained. However, identity may have to be disclosed to conduct a thorough investigation, to comply with the law and to provide accused individuals their legal rights of defense. Homewatch CareGivers will not retaliate against a reporting employee. This includes, but is not limited to, protection from retaliation in the form of an adverse employment action such as termination, compensation decreases, poor work assignments or threats of physical harm. Any whistleblower who believes he/she is being retaliated against must contact the Department Manager or the Director of Human Resources immediately. The right of a reporting employee for protection against retaliation does not include immunity for any personal wrongdoing that is alleged and investigated.
All reports of illegal and dishonest activities will be promptly submitted to the Administrator or Owner who is responsible for investigating and coordinating corrective action. Anyone filing a false report and/or knowingly making a false accusation will be subject to disciplinary action, up to and including termination of employment.
Homewatch CareGivers prohibits taking negative action against any employee for reporting a possible deviation from this policy or for cooperating in an investigation. Any employee who retaliates against another employee for reporting a possible deviation from this policy or for cooperating in an investigation will be subject to disciplinary action, up to and including termination.
Employees with any questions regarding this policy should contact the Administrator or Owner. Nothing contained herein shall preclude an employee from engaging in conduct protected by Section 7 of the National Labor Relations Act.
Consequences of Unethical or Illegal Behavior
Violations of the laws and regulations discussed in this handbook and Homewatch Caregivers policies not only can have a negative impact on Homewatch Caregiver’s reputation; they can result in criminal and/or civil penalties to both the Company and the individual employee. Urging employees to report suspected misconduct is a necessary part of Homewatch Caregiver’s compliance activities. Stopping misconduct before it occurs and addressing misconduct as soon as possible gives Homewatch Caregivers the opportunity to limit damage to the business community and its reputation. Early reporting also helps Homewatch Caregivers to work with law enforcement authorities to ensure that the responsible parties are held accountable.
In addition to criminal and civil penalties, failure to comply with Homewatch Caregivers standards and to report suspected misconduct can have serious employment consequences, up to and including termination from employment at Homewatch Caregivers.
During orientation for all newly hired employees, both office staff and field staff, will receive one time instruction on corporate compliance. All field staff must complete orientation prior to start date of their first case. This instruction will be documented in the personnel record. (part of our compliance training)
All current employees, both office staff and field staff, shall receive one time instruction on corporate compliance. This instruction will be documented in the personnel record. An annual in-service will be completed by every employee including administrative staff.
Homewatch CareGivers annually reviews all aspects of the organization and service delivery operation in relation to its purpose. The purpose of this review is for ongoing performance improvement and organizational planning.
All levels of staff and board member are involved in this performance improvement process. The annual review of Homewatch CareGivers includes:
- Audit of client records
- Audit of personnel records
- Staff continuing education records
- Review of emergency and safety procedures
- Review and summary of client complaints/grievances
- Review of organizational policies
- Review of program eligibility and regulatory standards
- Analysis of service area demographics and community needs
- Summary and analysis of risk management and incident reports
- Outcome of the evaluation has written short and long-term goals
- Review of Performance Improvement results
Should you have questions or concerns, please contact:
Ada R. Otero, RN, Director of Nursing, Office: (732) 570-5713
Health Care Service Firm License Number: HP0106800