Criminal Background Checks for Adult Day Care Employees: What Providers Need to Know

Adult day care employees may work closely with older adults, adults with disabilities, and other people who depend on staff for assistance, supervision, transportation, meals, medication support, and personal care. Employees may also have access to confidential health, financial, and identifying information.

Because of these responsibilities, screening prospective workers is an important part of operating a safe and compliant adult day care center.

A criminal background check can help a provider identify information that may affect whether an applicant is legally eligible or reasonably suited for a particular position. However, a complete screening process may involve more than a criminal-history search.

Requirements vary by state and may be different for employees, contractors, volunteers, drivers, nurses, administrators, and anyone with direct or unsupervised access to clients. Providers must follow the requirements of their licensing agency, Medicaid program, payer contracts, and applicable employment laws.

Why background checks matter in adult day care

A consistent screening process can help providers:

• Protect clients and other vulnerable individuals
• Meet state licensing and program requirements
• Identify applicants who may be legally disqualified from certain positions
• Maintain eligibility for Medicaid and other health-care programs
• Demonstrate reasonable care when making hiring decisions
• Apply the same screening standards consistently to comparable positions
• Prepare for licensing inspections and compliance reviews

The CMS National Background Check Program supports comprehensive state background-check programs for certain long-term-care providers and prospective employees with direct access to patients or residents. However, participating states and the provider types covered by each program vary.

Providers should not assume that one search satisfies every requirement that applies to their center.

A background check may involve several separate searches

The phrase “background check” is sometimes used as though it describes one universal database. In practice, a provider may need to complete several different searches.

State criminal-history records

A state criminal-history agency or authorized state portal is often the starting point. Depending on the state and position, the required search may be:

• Name-based
• Fingerprint-based
• Statewide
• National
• Part of a broader health-care employee screening system

A state-only search may not identify records from another state or federal jurisdiction. Providers should verify whether their rules require a state search, a national fingerprint-based check, or both.

Abuse, neglect, and employee-misconduct registries

Some states require providers to search registries containing findings of abuse, neglect, exploitation, or misconduct involving people receiving care.

These searches are different from a criminal-history search. A registry finding may exist without appearing as a criminal conviction, and a criminal-history search may not include the required registry information.

Professional license verification

When a position requires a professional license or certification, the provider should verify that the credential:

• Belongs to the applicant
• Is currently active
• Has not expired
• Does not contain restrictions that prevent the applicant from performing the job
• Has not been suspended or revoked

This may apply to nurses, therapists, dietitians, and other licensed professionals.

Federal health-care exclusion searches

A criminal background check is not the same as a federal exclusion search.

The U.S. Department of Health and Human Services Office of Inspector General maintains the List of Excluded Individuals and Entities, commonly called the LEIE. Federal health-care programs generally may not pay for items or services furnished, ordered, or prescribed by an excluded person or entity.

The OIG provides guidance regarding the screening of employees and contractors. Providers should review the HHS-OIG exclusions guidance and determine how frequently their program, state, and payer contracts require exclusion searches.

Driving and position-specific checks

Employees who transport clients may be subject to additional requirements involving:

• Driver’s-license status
• Motor-vehicle records
• Vehicle insurance
• Transportation certifications
• Drug or alcohol testing
• Other state transportation requirements

The screening required for a driver may be different from the screening required for an administrator, direct-care employee, nurse, food-service worker, or maintenance employee.

Who may need to be screened?

Providers should not assume that screening requirements apply only to regular employees receiving a paycheck.

Depending on state rules and the person’s access to clients, requirements may extend to:

• Owners and administrators
• Direct-care employees
• Nurses and other licensed professionals
• Drivers and transportation attendants
• Food-service and maintenance workers
• Contractors
• Temporary-agency workers
• Volunteers
• Students and interns
• Other people with direct or unsupervised client access

Providers should pay particular attention to temporary and contract personnel. A staffing agency’s statement that it already completed a background check may not establish that the correct databases were searched, that the required method was used, or that the results remain current.

The adult day care provider may still have an independent responsibility to verify that all applicable requirements were satisfied.

When should checks be completed?

Providers should determine the required timing before allowing an applicant to begin working or have access to clients.

Depending on the applicable rules, screening may be required:

• Before an offer is made
• After a conditional offer but before employment begins
• Before direct or unsupervised client access is permitted
• At specified intervals after hiring
• When an employee changes positions or responsibilities
• After notice of an arrest, conviction, registry finding, license action, or exclusion
• When a contract or payer requirement changes

Some states require periodic rechecks. Others operate systems that notify authorized employers when new information becomes available.

A background check completed several years ago should not automatically be treated as proof of current eligibility.

A written screening schedule should identify which positions must be screened, which sources must be checked, when the initial checks must occur, whether rechecks are required, and who is responsible for completing and reviewing them.

Review results carefully and consistently

A possible database match does not always mean that the record belongs to the applicant. Providers should follow the official agency’s instructions for verifying names, birth dates, aliases, and other identifiers.

Providers should also distinguish between an arrest and a conviction. An arrest alone does not establish that criminal conduct occurred.

The Equal Employment Opportunity Commission advises employers to consider whether a criminal record is relevant to the position. Factors may include:

• The nature and seriousness of the offense or conduct
• The amount of time that has passed
• The duties and responsibilities of the position

The EEOC also advises employers to apply their policies consistently and avoid broad exclusions that are unrelated to the position. Review the EEOC resources on arrest and conviction records for additional information.

State law may automatically disqualify a person with certain convictions or findings from particular positions. When the law does not impose an automatic disqualification, providers should avoid inconsistent decisions or policies that reject every applicant with any type of record.

Questions about a specific applicant, offense, or disqualifying event should be referred to the provider’s licensing agency, human-resources adviser, or attorney.

Additional requirements may apply when using a screening company

When an employer obtains a background report from a third-party consumer reporting company, the federal Fair Credit Reporting Act generally requires additional steps.

These may include:

1. Giving the applicant or employee a clear, written, stand-alone disclosure
2. Obtaining written authorization before requesting the report
3. Certifying the permitted employment purpose to the reporting company
4. Providing a copy of the report and a summary of FCRA rights before taking adverse action
5. Providing an adverse-action notice when the final employment decision is based on the report

The Federal Trade Commission explains these requirements in Using Consumer Reports: What Employers Need to Know.

State and local fair-chance or “ban-the-box” laws may impose additional requirements or restrict when an employer may request criminal-history information.

Accessing a state-operated criminal-history portal directly is not necessarily the same as obtaining a consumer report from a third-party screening company. Providers should determine which requirements apply to the screening method they use.

Document the screening process

During an inspection or audit, a provider may need to demonstrate more than simply stating that a background check was completed.

The documentation required by the provider’s state or program may include:

• The employee or applicant’s name
• The type of check performed
• The agency, registry, or database searched
• The date the search was completed
• The name or initials of the person who completed it
• Confirmation that the applicant’s identity was verified
• The result or eligibility determination, when permitted
• Documentation of required follow-up
• The date the next check is due

Providers should retain only the information required by applicable rules and their established retention policy.

Protect background-check information

Background reports can contain sensitive personal information. Access should be limited to people with a legitimate need to participate in hiring or compliance decisions.

Records should be:

• Stored securely
• Protected from unauthorized access
• Separated from generally accessible employee information when appropriate
• Retained for the required period
• Destroyed securely when retention is no longer required

Providers should avoid storing detailed criminal-history information in locations accessible to employees who do not participate in hiring or compliance decisions.

Common mistakes to avoid

Frequent screening mistakes include:

• Using an unofficial people-search website instead of the required agency
• Assuming a name-based search is always sufficient
• Treating a registry or exclusion search as a criminal-history check
• Checking only at initial hire when rechecks are required
• Forgetting contractors, volunteers, students, or drivers
• Allowing unsupervised client access while a required check is pending
• Accepting a staffing agency’s screening without verifying its scope
• Failing to document when and how a search was completed
• Automatically rejecting every applicant with any record
• Leaving sensitive reports in an unsecured location

A written procedure and compliance calendar can help prevent these oversights.

How ElderSuite helps providers reach the correct state resource

ElderSuite makes it easier to begin the state criminal-history portion of the screening process.

From the ElderSuite main menu:

1. Open Provider Center.
2. Click Criminal History Check.
3. ElderSuite identifies the state associated with the provider’s account.
4. The appropriate official state criminal-history or background-check website opens in the computer’s default web browser.
5. Follow the instructions on the state website to complete the required search.

ElderSuite has a criminal-history resource configured for providers in all 50 states. This helps administrators avoid searching the internet and wondering whether they have reached the correct state agency.

ElderSuite provides the access point, but it does not perform the background check. The search takes place on the external state website. ElderSuite does not receive the result and does not store the criminal-history report.

The provider remains responsible for completing the appropriate searches, evaluating the results, retaining required documentation, and complying with applicable state, federal, licensing, payer, and contractual requirements.

If the state website does not open, confirm that the computer has an internet connection and a default web browser. If ElderSuite cannot identify the appropriate resource, contact ElderSuite Support so the provider’s account information or state resource can be reviewed.

Employee-screening checklist

Before permitting an employee, contractor, or volunteer to work with clients, confirm that:

• The position’s screening requirements have been identified
• The correct state criminal-history process has been completed
• Fingerprints were obtained if required
• Required abuse, neglect, and employee-misconduct registries were searched
• Professional licenses and certifications were verified when applicable
• Federal and state exclusion lists were checked when applicable
• Driving credentials and records were reviewed for transportation staff
• Possible identity matches were verified carefully
• Results were evaluated under applicable disqualification and fair-hiring rules
• Required FCRA disclosures and authorizations were provided when a screening company was used
• Evidence of the completed screening was stored securely
• Required recheck or renewal dates were added to the compliance calendar

Make screening an ongoing process

An effective background-check program is consistent, documented, and based on current requirements.

Providers should maintain a written procedure, apply it consistently to comparable positions, train the people responsible for hiring, and review the process whenever licensing rules, payer requirements, or job duties change.

ElderSuite helps simplify one important step by directing providers to the criminal-history resource configured for their state. Combined with a clear screening policy and reliable documentation, that shortcut can help adult day care centers protect clients, support fair hiring decisions, and prepare for licensing reviews.

This article provides general operational information and is not legal advice. Background-check and employment requirements vary by state, locality, program, payer, position, and screening method. Providers should verify current requirements with their licensing agency and qualified legal or human-resources advisers.

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