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Office of Regulatory Services The Times, They Are A-Changin …For Providers and Regulators Alike.

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Presentation on theme: "Office of Regulatory Services The Times, They Are A-Changin …For Providers and Regulators Alike."— Presentation transcript:

1 Office of Regulatory Services The Times, They Are A-Changin …For Providers and Regulators Alike

2 The Changing Times… SB 433CON issues and moving parts of ORS PCH Facility Reports--Transparency HB 155Fingerprint checks for owners, rule changes in PCH, COGENT system HB 1044Adult Day Centers and exemption of respite Private home care providersweb- based training tool and top 10 cites

3 Realignment of Licensing ResponsibilitiesSB 433 Certain licensing and certification functions transferred to Department of Community Health (DCH) effective 7/1/09 Personal care homes, private home care providers moving to DCH, etc. Adult day centers, community living arrangements, hospices not moving to DCH as of now

4 Dividing Licensing Functions Goes to DCH Hospitals Ambulatory Surgery Birthing Center Home Health Private Home Care Personal Care Homes Nursing Homes ICF/MR Traumatic Brain Facilities Specimen Collection Stations Stays with DHR Kidney Dialysis Centers Rural Health Clinics Eye Bank Hospices Community Living Arrangements Adult Day Centers Clinical Laboratories (&CLIA) X-Ray & Mammography Drug Abuse Treatment Programs OPT/CORF Maternity Homes Residential Child Care (CCI, CPA, OCCP) HMOs

5 Unknowns: Governors Executive Order for Task Force on Restructuring DHR …Georgians receive most efficient service at least cost to taxpayers Report due July 2, 2008

6 HEALTH AND SAFETY STANDARDS RATINGS FOR PERSONAL CARE HOMES Why bother? Transparency, savvy consumers Help consumers compare homes on compliance Give credit where due to homes that maintain compliance Market-driven quality improvement

7 Long and Winding Road… Began in 2006 with work group, some provider representation, staff, consumer advocates First meeting on 8/11/2006 Researched other systems Created 9 versions or methodologies to rate facilities

8 First Rating Methodology Method published to providers on 10/11/07: Potential for 2 ratings per facility First rating based on most recent full survey 2nd rating based on last 2 cumulative years Stars assigned based on: Number of citations Severity and frequency of citations Number of critical tags written

9 First Rating – 3 Method published to providers on 10/11/07: Posted on ORS website for providers to review until 11/13/07 Providers rejected; felt did not accurately reflect their facility status Workgroup reconvened on 12/5/07

10 Back To The Drawing Board New method has a single icon rating Rating is based on last two years of surveys Based on 100 point system with deductions for serious violations and any adverse actions Has 5- tiered rating icons Deciding on icons Also will include raw score

11 Back on Track… Thirteen more versions tested before committee agreed upon final version on 3/26/08 Workgroup is reviewing system now Available to providers for review May 1, 2008 Roll out for consumers on June 30, 2008

12 New Requirements for Criminal Records Checks Result of HB 155 passed in 2007

13 HB 155 – Effective July 1, 2007 PCH and PHCP owners must have fingerprint CRC Implemented on July 1, 2007 for new applications Owners of facilities already licensed must submit to the fingerprint records checks by December 31, 2008

14 Who is an Owner? Owner is defined as: Any individual or any person owning 10% or greater who… Exercises authority of an owner; Applies to operate the business or agency; or Enters into a contract to acquire ownership of such a business or agency.

15 CRC for an owner is NOT required IF the owner: Has had a satisfactory CRC within 12 months preceding the time of application Does NOT maintain an office at the location where services are provided to residents/clients; Does NOT reside at a location where services are provided to residents/clients; CRC--OWNER EXCEPTIONS

16 CRC for an owner is NOT required IF the owner: Does NOT have direct access at any time to those receiving care; Does NOT provide direct personal supervision of personnel by being available to provide assistance and direction during the time services are being provided CRC –OWNER EXCEPTIONS continued…

17 An owner cannot generally be issued a license if they have been arrested, convicted of any of the following crimes : Murder Aggravated assault or battery Cruelty to a child or elder person Rape, aggravated sodomy, sexual assault or battery Child molestation or enticing a child for indecent purposes Covered Crimes

18 Armed robbery Abuse, neglect, or exploitation of a disabled adult or elder person A similar offense committed in another jurisdiction with a conviction under a different designation used in that jurisdiction COVERED CRIMES – CONTINUED…

19 OPPORTUNITY FOR HEARING… Mitigation factors for consideration Length of time since crime Absence of additional criminal charges Circumstances surrounding commission of crime Indicia of rehabilitation Facilitys history of compliance Owners involvement with facility

20 PCHs - No changes PHCPs - No new requirements Other Employees

21 After May 1, 2008, no more manual fingerprint cards Fingerprints must be submitted through LiveScan Contract with Cogent for LiveScan locations An Account is required before the prospective employee/director/owner goes to a location to be scanned; access required Call: LiveScan Fingerprinting

22 LiveScan – Digital Fingerprinting Other Options: Schedule appointment at 2 Peachtree (DHR) to have their scan at that location Schedule appointment at certain DFCS offices Results are sent within 48 hours to the DHR Office of Investigative Services, who promises to report the results out within two weeks Draft Instructions are attached

23 Other PCH Rule Changes Added right to be treated with dignity, kindness, consideration to rights Added requirement to report elopements of any disabled person to police within 30 minutes of becoming aware they are missing Changed maximum hot water temperature to 120 degrees F.

24 Reporting Requirements Added requirement to report certain type of incidents: Death of a resident Serious injury to a resident which requires medical attention Any rape, assault, battery on a resident or abuse, neglect or exploitation of a resident Anytime a resident cannot be located and there are circumstances that place the resident or others at risk

25 Reporting Requirements – 2 Any circumstance where staff are associated with a residents will, trust, or insurance policy (to verify it is not as a result of coercion) When an owner, director, or employee acquires a relevant criminal record

26 Reporting Requirements – 3 Reports must include the name of the home and the administrator The date of the incident and the date the home became aware of the incident The type of incident with a brief description Any immediate or corrective action taken by the staff of the home to ensure the incident does not repeat

27 New Draft Rules and Regulations for Adult Day Centers : Rules provide for licensing and inspection of adult day centers, only The term adult day center does not include part- time respite services programs (HB 1044) Rules establish minimum standards for the operation of adult day centers

28 Exemptions in Law and Draft Rules Those providing services without compensation; Those providing services for compensation to no more than two participants; Programs that provide day habilitation and treatment services exclusively for developmentally disabled persons; and Respite care services programs as defined in law

29 Respite CareNo License Required Provide services for aging adults who can function in a group setting and who can feed and toilet themselves with or without the assistance of a personal aide accompanying them and which: Is operated by a nonprofit organization; Provides no more than 25 hours of services per week; Is managed by a director who has completed an adult day care services training and orientation program approved by the Department; Is staffed primarily by volunteers; and Has as its sole purpose to provide primary caregivers of aging adults with relief from normal caregiving duties and responsibilities.

30 Process for Licensing All centers are required to submit an application to within 45 days of the effective date of these rules. Centers may continue to operate without disruption until an inspection is completed and the license granted or denied.

31 Required for Licensure – 1 The governing body of each center is required to submit: A completed application A non-refundable application fee and a license fee Proof of the legal right to occupy the property where the adult day center is housed

32 Required for Licensure – 2 The governing body of each center is required to submit: A floor sketch A completed affidavit of personal identification For corporations, partnerships, etc., legal papers such as certificate of incorporation

33 Required for Licensure – 3 The governing body of each center is required to submit: Fire safety inspection Documentation of approval for water source and sewage disposal system Zoning approval A list of the locations of any other adult day centers operated by the governing body

34 Adult Day Care Adult day care refers to services provided under a social model Participants may have limitations that restrict their abilities to perform the normal activities of daily living Social model addresses the basic social and recreational activities needed

35 Adult Day Health Services Adult day health refers to services that meets the needs of aging adults under a medical model Medical model programs provide basic social, rehabilitative, health and personal care services needed An ongoing program of therapeutic activities designed to meet the physical, mental and psychosocial well-being of each participant is required The term adult day health care does not include programs which provide day habilitation and treatment services exclusively for individuals with developmental disabilities

36 Programs Required to be Licensed: Mobile Adult Day Centers Some centers offer services on a remote site one or two days per week These mobile adult day centers utilize staff that travels from one central location to off-site locations Staff and/or volunteers, participant records, supplies and program materials are transported to each off-site location Services may be adult day care or adult day health

37 Key Features: Disaster Preparedness A disaster preparedness plan is required Must identify emergency procedures The Department will provide a format for the disaster preparedness plan

38 Key Features: Fire Safety Adult day centers, adult day health centers and mobile adult day centers must be in compliance with fire safety requirements Fire safety must be observed at all times

39 Key Features: Emergencies Written emergency policies and procedures must include: A written plan and/or agreement for emergency care and emergency transportation. A file for each participant A written plan for notification of local law enforcement when a participant has been missing for more than thirty (30) minutes.

40 Key Features: Staffing Ratios and Care Plans Each center must provide appropriately qualified staff and/or volunteers in sufficient numbers, minimum ratio of 1:8; excludes office works and, food service staff Individual care plans (simple or detailed) are required for participants

41 Key Features: Nutrition Centers operating for more than four (4) hours a day and/or operating during regularly scheduled mealtimes are required to provide a nutritious meal Snacks and fluids must be available and offered Meals and snacks provided by the center must be planned to keep sugar, salt and cholesterol intake to a minimum.

42 Key Features: Medications All medications in an adult day center that does not employ a licensed RN or LPN must be self-administered by the participant Centers that provide assistance with medication without employing a licensed RN or LPN may do so to the following extent: Staff may remind participants; Staff may check the dosage; and Staff may physically assist a participant.

43 Anticipated Timetable: House Bill 1044 signed into law early April; DHR Board meeting on 4/16/08 - revised rules are authorized for a public hearing which is scheduled for approx. 30 days later; Public hearing in May; Rules adopted at DHR Board meeting in June; Rules effective as early as July?

44 Orientation Training Session: An orientation session will be scheduled for providers. Providers will have the opportunity to ask questions and meet program staff. Resources and materials will be provided to assist providers with the licensure application process.

45 PRIVATE HOME CARE PROVIDERS Web- Based Training Tool to assist new and existing providers with understanding the PHCP Rules & Regulations Overview of the rules with test available Use in orienting or as a refresher for existing staff with plan of correction

46 Private Home Care Providers Web- Based Training Instructions for completing web-based training The Private Home Care Provider (PHCP) program overview is housed at the following link: You can access the presentation for ORS home page by following the steps below; Click Provider Tools in the upper left hand corner Under for Providers select Training Information Select NEW PHCP – Program Overview Start at course introduction Continue through each of the modules Regulations for establishing a PHCP Application and Regulatory Process PHCP Service Provisions PHCP Compliance Requirements Finally you will reach the course conclusion Select the button labeled Course Exam at the bottom center of the screen Enter your name and the name of your organization then press start After you have completed the 46 question course exam scroll back to the top of the screen and select Check Answers You will receive an exam score.

47 The 10 most frequently cited deficiencies From March 2007-March 2008

48 Top Ten Violations 1. TB Tests when first hired, annually Tag # 0934, (4)(c)4 2. Supervisory Visits every 92 days where personal care Tag # 1013, (2)(b)2 3. Service Plan Content Tag # 1101, (1)(a) 4. Personal Care Aide Qualifications Tag # 948, (5)(c)1

49 Top Ten Continued 5. Service Agreement: description of services as stated by client, etc. Tag # (2)(a)3 6. Service Agreement: charges for services, mechanisms for billing, payment Tag # (2)(a)5 7. Governing Body ensures compliance with these rules Tag # Personnel Records: job description/statement of duties, responsibilities Tag # (4)(c)6

50 Top Ten Continued 9. Personnel Records: Annual performance evaluation Tag # (4)(c)8 10. Service Agreement: Description of services, frequency and expected duration Tag # (2)(a)4

51 Questions, Comments Thank you Sharon E. Dougherty Director Office of Regulatory Services

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