What a Pennsylvania Direct Care Worker File Needs to Contain

When a surveyor, a client's family, or your own insurer asks whether a caregiver was properly screened, the answer lives in a file. For a Pennsylvania home care agency, a missing or outdated record is the kind of small gap that turns into a large problem. This guide covers two record types that the state's home care regulations address directly, and how to keep them from slipping.

Start with which rules apply to you

Chapter 611 of Title 28 of the Pennsylvania Code covers licensed home care agencies and home care registries. Source: 28 Pa. Code Chapter 611, Pennsylvania Code and Bulletin. Home health agencies are regulated under separate rules, so confirm which licensing category your agency falls under before using any checklist, including this one.

Criminal history records

Under the regulation on criminal background checks, a home care agency must require each caregiver applying for a direct care position to submit a criminal history report. The report must be obtained at the time of application or within the year before it. The agency may not hire, roster, or retain someone whose State Police record shows a prohibited conviction listed in state law, and it must keep copies of State Police records, or Department of Aging letters of determination for federal records, in the individual's file. Source: 28 Pa. Code § 611.52.

Two practical points follow from that wording:

• The date matters. A report that was current when the caregiver first applied somewhere else may be too old for your file. Check the date at intake, not at the end of onboarding.
• The type of check matters. Department of Health guidance says the State Police check must be requested for employment purposes. A record pulled for another reason may not satisfy the requirement. Source: PA Department of Health, home care regulations.

Pennsylvania's Older Adults Protective Services Act also adds a federal fingerprint-based check for caregivers who have not lived in the state for the two years before applying. The Department of Aging publishes the current process and forms, so use its guidance rather than a secondhand summary. Source: PA Department of Aging, criminal history background checks.

Tuberculosis screening

The Department of Health lists TB screening for direct care workers, contractors, and office staff with direct consumer contact among an agency's obligations. As summarized from the regulation, the documentation must show screening for and freedom from active tuberculosis in line with CDC guidelines. It must be in place before consumer contact, with a screening date no more than one year before the start date, and it must be updated at least every 12 months and kept in the file. Source: summary of 28 Pa. Code § 611.56. Read the regulation itself for the exact language before you rely on this summary.

Competency and training

The same Department of Health guidance describes competency requirements for direct care workers and expects agencies to review each worker's competency at least annually, more often if warranted. How you document that review is up to you, but it should be as easy to find as the clearances.

Where files go wrong

The records most likely to cause trouble are the ones with clocks on them: a criminal history report older than a year at application, a TB screening that was fine at hire and quietly lapsed, or an annual review nobody scheduled. A few habits help:

1. Record the document date and the review date for every item, not just whether it is present.
2. Track expirations in one place and look ahead a month or more, so a lapse never pulls a caregiver off a schedule.
3. Separate what the regulation requires from what your agency policy adds. When a surveyor asks, you want to know which is which.
4. Note who reviewed each record and when. A complete file that nobody reviewed is a weaker file than it looks.
5. Ask your compliance counsel to review the checklist each year. Regulations and agency guidance change.

None of this replaces your agency's own review or a compliance attorney's advice. It is a way to make sure that when someone asks for the file, the file can answer.

Last reviewed October 21, 2026. Regulations change, so confirm current requirements in 28 Pa. Code Chapter 611 and with the Pennsylvania Department of Health, and consult a qualified Pennsylvania healthcare compliance attorney about your agency's specific obligations. This article is general information, not legal advice.