Presentation on theme: "Office of Regulatory Services"— Presentation transcript:
1Office of Regulatory Services “The Times, They Are A-Changin’”…For Providers and Regulators Alike
2The Changing Times… SB 433—CON issues and moving parts of ORS PCH Facility Reports--TransparencyHB 155—Fingerprint checks for owners, rule changes in PCH, COGENT systemHB 1044—Adult Day Centers and exemption of respitePrivate home care providers—web-based training tool and top 10 cites
3Realignment of Licensing Responsibilities—SB 433 Certain licensing and certification functions transferred to Department of Community Health (DCH) effective 7/1/09Personal care homes, private home care providers moving to DCH, etc.Adult day centers, community living arrangements, hospices not moving to DCH as of now
4Dividing Licensing Functions Goes to DCHHospitalsAmbulatory SurgeryBirthing CenterHome HealthPrivate Home CarePersonal Care HomesNursing HomesICF/MRTraumatic Brain FacilitiesSpecimen Collection StationsStays with DHRKidney Dialysis CentersRural Health ClinicsEye BankHospicesCommunity Living ArrangementsAdult Day CentersClinical Laboratories (&CLIA)X-Ray & MammographyDrug Abuse Treatment ProgramsOPT/CORFMaternity HomesResidential Child Care (CCI, CPA, OCCP)HMOs
5Unknowns:Governor’s Executive Order for Task Force on Restructuring DHR“ …Georgians receive most efficient service at least cost to taxpayers”Report due July 2, 2008
6HEALTH AND SAFETY STANDARDS RATINGS FOR PERSONAL CARE HOMES Why bother?Transparency, savvy consumersHelp consumers compare homes on complianceGive credit where due to homes that maintain complianceMarket-driven quality improvementThe Health and Standards Rating System is a method to assess, improve and communicate the level of quality in licensed personal care home facilities.The rating is based upon compliance with the Rules and Regulations for Personal Care Homes, Chapter These regulations establish basic health and safety standards for the operation of homes or facilities that provide residential services to adults.
7Long and Winding Road…Began in 2006 with work group, some provider representation, staff, consumer advocatesFirst meeting on 8/11/2006Researched other systemsCreated 9 versions or methodologies to rate facilitiesProject began 7/21/2006.First meeting of the stakeholder workgroup was 8/11/2006.Other systems – child care licensing has a quality rating system. Also looked at other countries.Between 8/11/2006 and 10/11/07, 9 versions were created before settling on one to be published for comments by the provider community.
8First Rating Methodology Method published to providers on 10/11/07:Potential for 2 ratings per facilityFirst rating based on most recent full survey2nd rating based on last 2 cumulative yearsStars assigned based on:Last year Vickie went over the rating system methodology with this group at St. Simons Island.Number of citationsSeverity and frequency of citationsNumber of critical tags written
9First Rating – 3 Method published to providers on 10/11/07: Posted on ORS website for providers to review until 11/13/07Providers rejected; felt did not accurately reflect their facility statusWorkgroup reconvened on 12/5/07Posted on ORS website for providers to review until 11/13/07Providers rejected; felt did not accurately reflect their facility status – Back to square 1Stakeholder committee reconvened on 12/5/07Thirteen more versions tested before committee agreed upon final version on 3/26/08
10Back To The Drawing Board New method has a single icon ratingRating is based on last two years of surveysBased on 100 point system with deductions for serious violations and any adverse actionsHas 5- tiered rating iconsDeciding on iconsAlso will include raw score
11Back on Track…Thirteen more versions tested before committee agreed upon “final” version on 3/26/08Workgroup is reviewing system nowAvailable to providers for review May 1, 2008Roll out for consumers on June 30, 2008
12New Requirements for Criminal Records Checks Result of HB 155 passed in 2007
13HB 155 – Effective July 1, 2007PCH and PHCP owners must have fingerprint CRCImplemented on July 1, 2007 for new applicationsOwners of facilities already licensed must submit to the fingerprint records checks by December 31, 2008These requirements are included in February 2008 revision of PCH rules. All licensed Personal Care Homes were advised in writing of this change earlier this month.
14Who 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; orEnters into a contract to acquire ownership of such a business or agency.“Owner” is defined as:Any individual or any person affiliated with a corporation, partnership, or association with 10 percent or greater ownership interest in the business or agency, and whoPurports to or exercises authority of an owner in the business or agency;Applies to operate the business or agency; orEnters into a contract to acquire ownership of such a business or agency.
15CRC--OWNER EXCEPTIONS CRC for an owner is NOT required IF the owner:Has had a satisfactory CRC within 12 months preceding the time of applicationDoes 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;An owner may not have to submit to a criminal records check if they can provide evidence that they have had a satisfactory criminal history background check within 12 months preceding the time of application
16CRC –OWNER EXCEPTIONS continued… 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 providedNOTE: Owner applies to all adult household members since they reside at the PCH, have direct access to residents, etc. Personal Care Home Guidelines are being revised to include information on CRCs for owners. If you have questions or issues, please call the PCH Program.
17“Covered” CrimesAn owner cannot generally be issued a license if they have been arrested, convicted of any of the following crimes :MurderAggravated assault or batteryCruelty to a child or elder personRape, aggravated sodomy, sexual assault or batteryChild molestation or enticing a child for indecent purposes
18“COVERED” CRIMES – CONTINUED… Armed robberyAbuse, neglect, or exploitation of a disabled adult or elder personA similar offense committed in another jurisdiction with a conviction under a different designation used in that jurisdiction
19OPPORTUNITY FOR HEARING… Mitigation factors for considerationLength of time since crimeAbsence of additional criminal chargesCircumstances surrounding commission of crimeIndicia of rehabilitationFacility’s history of complianceOwner’s involvement with facility
20Other Employees PCHs - No changes PHCPs - No new requirements NOTE that the “covered” crimes for owners are different than those for administrators or employees.No changes to previously required background checks for other employees and directors of personal care homes.No new requirements for background checks for employees of private home care providers, though still require that such programs not employ people who have committed such crimes.
21LiveScan Fingerprinting After May 1, 2008, no more manual fingerprint cardsFingerprints must be submitted through ‘LiveScan’Contract with Cogent for ‘LiveScan’ locationsAn “Account” is required before the prospective employee/director/owner goes to a location to be scanned; access requiredCall:Big Changes !After May 1, 2008, fingerprint cards will no longer be used by DHR to obtain criminal records checksFingerprints will need to be directly submitted through ‘LiveScan’DHR has a contract with Cogent to provide locations around the state where people can get the fingerprint scansEach provider must go on line or call Cogent to set up an account to which the scans are linked before the prospective employee/director/owner goes to a location to be scanned.Instructions for PCHs are being developed and will be mailed to you upon completion.
22LiveScan – Digital Fingerprinting Other Options:Schedule appointment at 2 Peachtree (DHR) to have their scan at that locationSchedule appointment at certain DFCS officesResults are sent within 48 hours to the DHR Office of Investigative Services, who promises to report the results out within two weeksDraft Instructions are attached
23Other PCH Rule ChangesAdded right to be treated with “dignity, kindness, consideration” to rightsAdded requirement to report elopements of any disabled person to police within 30 minutes of becoming aware they are missingChanged maximum hot water temperature to 120 degrees F.
24Reporting Requirements Added requirement to report certain type of incidents:Death of a residentSerious injury to a resident which requires medical attentionAny rape, assault, battery on a resident or abuse, neglect or exploitation of a residentAnytime a resident cannot be located and there are circumstances that place the resident or others at risk
25Reporting Requirements – 2 Any circumstance where staff are associated with a resident’s 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
26Reporting Requirements – 3 Reports must include the name of the home and the administratorThe date of the incident and the date the home became aware of the incidentThe type of incident with a brief descriptionAny immediate or corrective action taken by the staff of the home to ensure the incident does not repeatGuidelines and a form/format will be included with the guideline revisions.
27New Draft Rules and Regulations for Adult Day Centers: Rules provide for licensing and inspection of adult day centers, onlyThe term “adult day center” does not include part-time respite services programs (HB 1044)Rules establish minimum standards for the operation of adult day centersThese rules provide for licensing and inspection of adult day centers which provide adult day care services and/or adult day health services to three or more adults.Establish minimum standards for the operation of adult day centers.The term “adult day center” does not include a respite services program.
28Exemptions 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; andRespite care services programs as defined in lawIndividuals or organizations providing adult day services without compensation as a condition of the participant’s receiving services;Individuals or organizations that provide services for compensation to only one or two participants;Programs which provide day habilitation and treatment services exclusively for developmentally disabled persons; andRespite care services programs established prior to January 1, 2008.
29Respite Care—No 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; andHas as its sole purpose to provide primary caregivers of aging adults with relief from normal caregiving duties and responsibilities.
30Process for LicensingAll 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.All centers operating as of the effective date of these rules are required to submit an application to the Department for a license within 45 days of the effective date of these rules.Centers operating as of the effective date of these rules may continue to operate without disruption until an inspection is completed by the Department and there has been a determination of compliance or noncompliance with these rules and regulations.
31Required for Licensure – 1 The governing body of each center is required to submit:A completed applicationA non-refundable application fee and a license feeProof of the legal right to occupy the property where the adult day center is housedA completed application for a license on forms provided by the Department.A non-refundable application fee and a license fee as approved by the Board of Human Resources based upon the type of services provided.Proof of the legal right to occupy the property where the adult day center is housed.
32Required for Licensure – 2 The governing body of each center is required to submit:A floor sketchA completed affidavit of personal identificationFor corporations, partnerships, etc., legal papers such as certificate of incorporationA floor sketch of the facility showing windows, doors, room measurements, and the location of any other services provided on the premises.A completed affidavit of personal identification.In the case of corporations, partnerships, and other entities authorized by law, a copy of its certificate of incorporation or other acceptable proof of its legal existence and authority to transact business within the state.
33Required for Licensure – 3 The governing body of each center is required to submit:Fire safety inspectionDocumentation of approval for water source and sewage disposal systemZoning approvalA list of the locations of any other adult day centers operated by the governing bodyDocumentation that the center is in compliance with all applicable fire safety regulations. Such documentation must be dated within the six (6) months preceding the date of the application.Documentation of approval for water source and sewage disposal system.Documentation from local zoning authorities that the center is in compliance with local zoning codes.A list of the locations of any additional adult day centers operated by the governing body.
34Adult Day CareAdult day care refers to services provided under a social modelParticipants may have limitations that restrict their abilities to perform the normal activities of daily livingSocial model addresses the basic social and recreational activities neededThere are 2 types of adult day centers….Adult day care refers to the provision of a comprehensive plan of services that meets the needs of aging adults under a social model.Participants, Aging adults, may have physical or mental limitations that restrict their abilities to perform the normal activities of daily living and impede independent living.Social model adult day care programs address the basic social and recreational activities needed to be provided to aging adults and also provide limited personal care assistance, supervision, or assistance with the activities of daily living.The term “adult day care” does not include programs which provide day habilitation and treatment services exclusively for individuals with developmental disabilities.
35Adult Day Health Services Adult day health refers to services that meets the needs of aging adults under a medical modelMedical model programs provide basic social, rehabilitative, health and personal care services neededAn ongoing program of therapeutic activities designed to meet the physical, mental and psychosocial well-being of each participant is requiredThe term “adult day health care” does not include programs which provide day habilitation and treatment services exclusively for individuals with developmental disabilitiesAdult day health services refers to the provision of a comprehensive plan of services that meets the needs of aging adults under a medical model.Medical model programs provide aging adults with the basic social, rehabilitative, health and personal care services needed to sustain the essential activities of daily living and to restore or maintain optimal capacity for self-care.Centers that provide adult day health services must provide an ongoing program of therapeutic activities designed to meet the physical, mental and psychosocial well-being of each participant.The term “adult day health care” does not include programs which provide day habilitation and treatment services exclusively for individuals with developmental disabilities.
36Programs Required to be Licensed: Mobile Adult Day Centers Some centers offer services on a “remote” site one or two days per weekThese “mobile adult day centers” utilize staff that travels from one central location to off-site locationsStaff and/or volunteers, participant records, supplies and program materials are transported to each off-site locationServices may be adult day care or adult day healthMobile adult day centers are offered by a center which utilizes staff that travels from one central location to off-site locations in order to provide services.The mobile adult day center transports the staff and/or volunteers, participant records, supplies and program materials to each off-site location to provide services.The services offered by a mobile adult day center may either be adult day care services or adult day health services, or both, and are offered less than four days per week at any one location.
37Key Features: Disaster Preparedness A disaster preparedness plan is requiredMust identify emergency proceduresThe Department will provide a format for the disaster preparedness planEach center must submit a disaster preparedness plan that contains a set of procedures for responding to internal and external disasters or emergency situations.The emergency procedures should answer the questions of "who, what, when, where, and how," and allow the center to be ready to act in an emergency situation.The format or template for the disaster preparedness plan may be obtained directly from the Department. Template will be part of the interpretive guidelines.
38Key Features: Fire Safety Adult day centers, adult day health centers and mobile adult day centers must be in compliance with fire safety requirementsFire safety must be observed at all timesAdult day centers, adult day health centers and mobile adult day centers must ensure that all facilities where services are provided meet all applicable standards for fire and safety requirements.Fire safety must be observed at all times.
39Key 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 participantA written plan for notification of local law enforcement when a participant has been missing for more than thirty (30) minutes.Written emergency policies and procedures must include:A written plan and/or agreement for emergency care and emergency transportation.A file for each participant containing at least: hospital preference, insurance information, medications and allergies, current diagnoses and history, name and telephone number of emergency contact, advance directive or durable power of attorney information, and a photograph of the participant.A written plan for notification of local law enforcement when a participant has been missing for more than thirty (30) minutes. Mattie’s Call Legislation.
40Key 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 staffIndividual care plans (simple or detailed) are required for participantsEach center is required to provide appropriately qualified staff and/or volunteers in sufficient number to meet the needs of the participants and implement the participant’s individual plan of care.At a minimum, adult day centers and adult day health centers are required to provide a staff and/or volunteer to participant ratio of no less than 1:8.The staffing ratio refers to the staff providing direct services to participants and excludes such employees as clerical or office workers and food service staff.Individual plan of care” means a document describing the participant’s needs, services to be provided by the adult day center and, for adult day health services, identification of individuals who will deliver the required services, the expected outcomes and frequency of re-evaluation of the plan.
41Key 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 mealSnacks and fluids must be available and offeredMeals and snacks provided by the center must be planned to keep sugar, salt and cholesterol intake to a minimum.All adult day centers operating for more than four (4) hours a day and/or operating during regularly scheduled mealtimes are required to provide a nutritious meal to each participant in attendance.Snacks and fluids must be available and offered to meet the participant’s nutritional and fluid needs. At a minimum, a mid-morning and mid-afternoon snack is required to be offered daily to participants.Meals and snacks provided by the center must be planned to keep sugar, salt and cholesterol intake to a minimum.
42Key Features: Medications All medications in an adult day center that does not employ a licensed RN or LPN must be self-administered by the participantCenters 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; andStaff may physically assist a participant.All medications required by a participant 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 of the time to take medication;Staff may check the dosage according to the container label; andStaff may physically assist a participant in opening or pouring the medication.
43Anticipated 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?
44Orientation 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.Already scheduled for August 28, 2008 and October 23, 2008 for the Maloof Government Center in Decatur. If rules are passed earlier, will receive notification of training from the Program once rules are effective.
45PRIVATE HOME CARE PROVIDERS Web- Based Training Tool to assist new and existing providers with understanding the PHCP Rules & RegulationsOverview of the rules with test availableUse in orienting or as a refresher for existing staff with plan of correction
46Private Home Care Providers Web- Based Training Instructions for completing web-based trainingThe 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 cornerUnder for Providers select Training InformationSelect NEW PHCP – Program OverviewStart at course introductionContinue through each of the modulesRegulations for establishing a PHCPApplication and Regulatory ProcessPHCP Service ProvisionsPHCP Compliance RequirementsFinally you will reach the course conclusionSelect the button labeled Course Exam at the bottom center of the screenEnter your name and the name of your organization then press startAfter 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.
47The 10 most frequently cited deficiencies From March 2007-March 2008
48Top Ten Violations 1. TB Tests when first hired, annually Tag #0934, (4)(c)42. Supervisory Visits every 92 days where personal careTag # 1013, (2)(b)23. Service Plan ContentTag # 1101, (1)(a)4. Personal Care Aide QualificationsTag # 948, (5)(c)11. Personnel Records ... the records shall include the following: ...Documentation of a satisfactory TB screening test upon employment and annually thereafter;If a provider offers personal care task services...All employees must have an initial TB screening and an annual screening thereafter. We look to CDC to decide what constitutes an adequate screening.Skin test:All should have each year unless they:Are being treated for latent TB, or refused treatmentWere turned down for a skin test by the Health Dept.Have been treated in the past for TBFor employees who are being treated for latent TB, or were diagnosed with latent TB but refused treatment, were turned down for skin test by the Health Dept. due to BCG vaccine, or have been treated for TB in the past: You should have in the employee file evidence that the employee was determined to be free of active disease at the time of employment, and yearly completed assessments for signs and symptoms of TBThe appropriate supervisor shall make a supervisory home visit to each client's residence at least every 92 days, starting from date of initial service in a residence or as the level of care requires to ensure that the client's needs are met. The visit shall include an assessment of the client's general condition, vital signs, a review of the progress being made, the problems encountered by the client and the client's satisfaction with the services being delivered by the provider's staff. Such supervision shall also include observations about the appropriateness of the level of services being offered. Routine quarterly supervisory visits shall be made in the client's residence and shall be documented in the client's file or service plan.Deficiency is usually cited because the provider just isn’t doing the visits, not because they are a few days outside the 92-day limitAlso is cited if the supervisor isn’t doing all the tasks listed: Most often not taking vital signs or assessing whether the level of services is still appropriateThe PCA should be present in the home and actually providing the services during at least some of the supervisory visits.There needs to be an actual observation of competency.Service Plan Content. The service plan shall include the functional limitations of the client, types of service required, the expected times and frequency of service delivery in the client's residence, the expected duration of services that will be provided, the stated goals and objectives of the services, and discharge plans.Must contain all of the elements required-Functional limitations of client-Types of services required (This is the most common element found incomplete)-Needs to be clear what tasks the Personal Care Aide (PCA) or nurse is supposed to be doing-“Wound care” is not sufficient“-Housekeeping” is not sufficientExpected times, frequency and duration of services-# visits per week, approximate time of day and duration (e.g. Three times per week, 2:00-4:00 PM)-Goals and objectives-Discharge plans4. Any PCA hired after the effective date of these rules shall have the following training and/or experience:(i) successful completion of a nurse aide training and competency evaluation program pursuant to the requirements of 42 CFR Part 483, Subpart D, as revised or recodified, if applicable; or(ii) successful completion of a competency examination for nurse aides recognized by the department; or(iii) successful completion of a health care or personal care credentialing program recognized and approved by the department; or(iv) successful completion or progress in the completion of a 40 hour training program provided by a private home care provider, which addresses areas outlined in the Private Home Care Provider Rules & Regulations to includeUsually cited when the provider has not assured all of the PCAs receive the required 40 hours of training (20 before serving clients) or passed the NLN or GAHCA testFor training provided, surveyors look for a syllabus, curriculum, schedules, etc.Signatures of trainers and PCAs for each section of trainingDocumentation of observation of competency is requiredIf provider is using the NLN test to verify training, the NLN must be taken on-line. Paper tests cannot be copied and administered by the provider.Also, the passing of the NLN must be accompanied by a skills assessment (observation of competency), done by the provider for all tasks the PCA will perform.
49Top Ten Continued5. Service Agreement: description of services as stated by client, etc.Tag # (2)(a)36. Service Agreement: charges for services, mechanisms for billing, paymentTag # (2)(a)57. Governing Body ensures compliance with these rulesTag #8. Personnel Records: job description/statement of duties, responsibilitiesTag # (4)(c)6Request needs to be in language of client or responsible party—not what the service coordinator has requested. What service does client want of provider?6.Must specifically address the type of service (companion/sitter, personal care or nursing) how client will be billed, even if it is billed to a 3rd party and amount of charges (even if billed to a 3rd party payerThe service agreement must contain the description of what services the client says they need, and of those services, which services the program will provide.Like in the service plan, the agreement must include the expected frequency and duration of services.7.Tag most often cited in conjunction with other tags when provider lacks a policy and procedure or is not following their own policy and procedure (.e.g. TB screen, PCA qualifications8.Job descriptions should describe the waiver program tasks
50Top Ten Continued 9. Personnel Records: Annual performance evaluation Tag # (4)(c)810. Service Agreement: Description of services, frequency and expected durationTag # (2)(a)4Performance woes: just don’t do it.
51Questions, Comments Thank you Sharon E. Dougherty Director Office of Regulatory Services