Clearpath Templates

Pennsylvania · Template guide · Updated October 20, 2026

Pennsylvania Home Care Policies and Procedures Template: How to Fill It In

What a Pennsylvania template should already contain under 28 Pa. Code Chapter 611, the numbers Chapter 611 leaves to you, and what to check before you adopt it.

Short answer: A Pennsylvania home care policies and procedures template should already contain Chapter 611’s fixed rules: the 10-day termination notice, the 7 items clients must get in writing before services, State Police or FBI background checks, ChildLine clearance, the 30- or 90-day provisional hire limits, annual competency reviews and 12-month TB screening. Chapter 611 says nothing about supervisory visits, record retention or complaint timelines, so those numbers are yours to set.

What our Pennsylvania template fills in for you

Already written inChapter 611 section
Keep a current copy of Chapter 611 on site§611.4
Face-to-face interview and two satisfactory references before hiring or rostering§611.51
State Police record (2+ years’ residence) or FBI record with a Department of Aging letter, within 1 year before applying§611.52
ChildLine clearance if you serve anyone under 18§611.53
Provisional hire up to 30 days (residents) or 90 days (others), with the four conditions§611.54
Competency through a nurse license, competency exam or approved training; annual competency review§611.55
TB screening per CDC before consumer contact, updated every 12 months§611.56
At least 10 calendar days’ written notice before terminating services§611.57(a)
No power of attorney or guardianship over consumers; no required check endorsement§611.57(b)
The 7 written items before services, including the 1-866-826-3644 complaint hotline§611.57(c)

The choices you fill in

Bracket in the templateWhat to decidePennsylvania note
[AGENCY NAME], license numberYour name and Department of Health licenseAgency or registry: the template is written for an agency that employs its workers
[LOCAL AAA PHONE]Your local Area Agency on Aging numberGoes in the before-services packet (§611.57(c)) and the abuse-reporting policy
Service area [LIST]Counties you serveAgency choice
Supervisory visits every [90] daysHow often a supervisor checks each consumerChapter 611 sets no schedule; this is best practice
Service plan within [7] days; review every [90] daysCare planning timelinesAgency standard; §611.57(a) requires consumer involvement in planning
Complaint records [at least 6 years]Complaint file retentionChapter 611 sets no period; keep at least as long as payer contracts require
Personnel records [at least 3 years after employment ends]Personnel file retentionKeep §611.57(d) compliance documentation available for inspection
Visit cancellation [24] hours; payment within [__] daysClient-facing termsFees and total costs are one of the 7 required items (§611.57(c))

Check these before you adopt it

  • Whether your agency is a reporting “facility” under the Older Adults Protective Services Act (our OAPSA summary comes from DHS training material, not the statute text)
  • 28 Pa. Code Chapter 51 general rules, such as reporting events and notifying the Department of changes
  • The adult protective services number for adults 18 to 59 and the ChildLine number before you print staff materials
  • The current Department of Health licensing division contact on health.pa.gov

Agency or registry?

Chapter 611 licenses home care agencies, which employ their workers, and home care registries, which refer independent contractors (§611.5). Both must tell the consumer whether the worker is an employee or a contractor (§611.57(c)). A registry using this template has to adapt the care planning and personnel sections, which the template flags.

Adopt it

  1. Finish every bracket, delete services you don’t offer, and update the table of contents.
  2. Have it reviewed, then have your governing body sign the adoption page.
  3. Print Chapter 611 and keep it on site (§611.4).
  4. Build your before-services packet from Policy 3.04 and Form F-05 so every new consumer gets all 7 items.
  5. Train staff on the manual at orientation and keep signed acknowledgments (Form F-01).

Template ready to fill in

Pennsylvania Home Care Agency Policy Manual

The editable Word template described on this page: 105 pages, 15 sections, 17 forms and a Chapter 611 crosswalk. $79, instant download.

Get the Pennsylvania template

FAQ

Does Pennsylvania require a supervisory visit schedule?

Chapter 611 as we reviewed it doesn’t set one. The template uses every 90 days as an agency standard you can change.

What must a consumer get before services start?

Written information on the services and worker, hours, fees and total costs, the Department licensure contact, the complaint hotline and local Ombudsman number, worker hiring and competency requirements, and the worker’s employee or contractor status (§611.57(c)).

Is the Pennsylvania template state approved?

Chapter 611 doesn’t describe any process for approving a template, and we’re not aware of one. Customize it, have it reviewed and adopt it.

Is it editable?

Yes. You get an editable Word document plus a PDF, and it also opens in Google Docs.

Sources

  1. 28 Pa. Code Chapter 611 (Cornell LII)
  2. §611.4 Requirements
  3. §611.51 Hiring or rostering
  4. §611.52 Criminal background checks
  5. §611.54 Provisional hiring
  6. §611.55 Competency requirements
  7. §611.56 Health screening
  8. §611.57 Consumer protections
  9. PA DHS, OAPSA mandatory reporting training (PDF)

This page summarizes 28 Pa. Code Chapter 611 as reviewed on October 19–20, 2026 and is not legal advice. Rules change; confirm current requirements with the Pennsylvania Department of Health.