1. Annual RAP Session April 26, 2012
California Department Of Public Health Licensing and Certification Division Carol Littler,
Annual RAP Session
April 26, 2012

3. Center for Health care quality Overview
Patient safety protection through:
Licensing & Certification (L&C): Evaluate facilities, agencies, and professionals for compliance with state and federal laws and regulations in order to license/certify them to operate in California.
Laboratory Field Services: Enforce quality standards in clinical and public health laboratories, and blood and tissue banks both within and outside California serving Californians.
Healthcare Associated Infection Program: Conduct surveillance, prevention and public reporting of infection rates.
Facility Licensing and Certification
Certified 6,307
Licensed Only 1,490
Professional Licensing: Total 222,800
Nursing Home Administrators 2,074
Home Health Aides 50,047
Certified Hemodialysis Technicians 4,356
Certified Nurse Assistants 166,325
Laboratory Field Services
15,286 labs licensed
68,808 professionals in 17 categories
(includes Clinical Laboratory Scientist, Medical Laboratory Technician, Laboratory Directors, Clinical Laboratory Technologist Trainees, Phlebotomists, Public Health Microbiologist Certification)

4. Licensing & Certification PROGRAM

5. VISION AND MISSION Vision:
L&C strives to operate a responsive, uniform enforcement program in accordance with state licensing and federal certification requirements, to encourage provider-initiated compliance and quality of care improvement activities, and to assure quality of care.
Mission:
Promote the highest quality of care in community settings and health facilities, improve access to care and assure quality of care.

6. MAJOR ACTIVITIES
Ensure quality health care delivery by nearly 8,000 facilities in 30 different facility and agency types.
Certify facility and agency compliance with federal requirements.
Conduct approximately 27,000 complaint investigations and 7,000 licensing surveys annually.
Certify over 160,000 nurse assistants, home health aides and hemodialysis technicians.
License over 3,000 Nursing Home Administrators.
Train, inspect, drill, and educate facilities in emergency preparedness response and recovery efforts.
Public Service – Responding in timely and effective ways to the public’s questions, complaints, and other concerns about the standards of care in health facilities and about the health care workers that L&C monitors.
Effective Enforcement – Operating a uniform and effective enforcement program in accordance with state licensing and certification requirements.
Meaningful Standards – Providing leadership in initiating and implementing changes to licensing and certification requirements that: improve quality of care; remove barriers to access; recognize new technologies and changes in scopes of practice; respond to California’s changing health care delivery system; and, reflect the diversity of California’s demographics.
Quality Improvement – Encouraging provider-initiated compliance, quality of care and access improvement activities; and, promoting research regarding the quality and effectiveness of health care services.
L&C strives to operate a responsive, uniform enforcement program in accordance with state licensing and federal certification requirements, to encourage provider-initiated compliance and quality of care improvement activities, and to assure quality of care.

7. Licensing and certification MAJOR ACTIVITIES, CONT.
Field Operations Branch:
Employs approximately 600 dedicated, highly skilled and qualified Registered Nurses, Medical, Pharmaceutical and Nutritional Consultants.
Conducts approximate 1,350 on-site inspections of nursing homes, annually.
Inspection (or survey) include:
Observe of resident care.
Inspect all areas of nursing home
Interview residents, family members, staff/other individuals.
Inspect medical records and other documents.
Evaluate quality of resident care through:
Analysis of statistical data reported by nursing homes/
Review of reportable event information/other notices filed with CDPH.

8. Licensing & certification STAFFING AND BUDGET
1, positions in 14 district offices, statewide:
Survey Staff –
Professional Certification Branch – 87
Administrative Staff –
Los Angeles County Department of Public Health
200 staff under contract
Conducts licensing and certification activities within LA County.
*Survey staff include HFEN’s in the District Offices, AB1629 AGPA/SSAs, Consultants and Life Safety Code
**Administrative staff is all staff not counted in survey staff/Professional Certification Branch

9. COMPLAINTS & ENTITY REPORTED INCIDENTS
Fiscal
Year
Complaints
Entity Reported Incidents
Total Complaints + ERIs
Change from Baseline
Annual Increase
Closed Complaints
Closed Entity Reported Incidents
2004/05
9,007
14,778
23,785
Baseline
99.2%
99.6%
2005/06
8,900
19,701
28,601
20.2%
98.5%
99.5%
2006/07
9,155
21,705
30,860
29.7%
7.9%
98.0%
2007/08
10,544
24,046
34,590
45.4%
12.1%
96.3%
98.9%
2008/09
9,643
26,217
35,860
50.8%
3.7%
90.3%
95.6%
2009/10
9,452
28,533
37,985
59.7%
5.9%
82.9%
91.5%
2010/11
9,586
28,676
38,262
60.9%
0.7%
69.5%
82.6%
2011/12 projection
9,830
*29,633
39,463
65.9%
3.1%
64.6%
79.8%
* Includes adverse events and Breach reported incidents.

10. Complaints Completed within 45 and 90 Days 07/01/10-06/30/11
Facility Type
# Complaints to Investigate
# Complaints done in 45 days
% Complaints done in 45 Days
# Complaints done in 90 days
% Complaints done in 90 days
SNFs
5063
2879
56.86%
3415
67.75%
GACHs
2872
764
26.60%
1113
38.75%
IMRs
435
256
58.85%
309
71.1%
HHAs
217 63
29.03% 86
39.63%
ESRDs
132 36
27.27% 75
56.82%
Hospice 79 25
31.65% 46
58.22%
FQHCs 59 29
49.15% 42
71.18%
ASCs 40 6
15.00% 16
40.0%
RHCs 8 2
25.00% 3
37.5%
45 and 90 days are based on work days.

11. ERIs Completed within 45 and 90 Days 07/01/10-06/30/11
Facility Type
# ERIs to Investigate
# ERIs done in 45 days
% ERIs done in 45 Days
# ERIs done in 90 days
% ERIs done in 90 days
SNFs
7468
3933
52.66%
4730
63.33%
GACHs
6618
1909
28.85%
2546
38.47%
IMRs
2919
1014
34.74%
1587
54.37%
HHAs 85 19
22.35% 26
30.59%
FQHCs 37 10
27.03% 16
43.24%
Hospice 36 9
25.00% 12
36.33%
ESRDs 35 18
51.43% 21
60.00%
ASCs 4 1
RHCs 2
50.00%

12. Complaint/ERI & POC Challenges
Implementation of LTC Federal complaint process
Phased in approach
Development of Complaint P&P and retraining of staff
Impact on Federal Grant Allocation
Timely initiation of backlog and closure of initiated investigations
OIG Plan of Correction Audit Findings
Reinforce CMS requirements that each POC include the 5 elements for an acceptable POC (OIG audit report)
Reinforce the need to on-site visits to determine if facility is implementing its POC
Solutions
Implementation of SOM Chapter 5, Section 5070
(Closure of LTC ERIs if received and not initiated before recertification survey.) Would like this for non-LTC as well
Preparing All Facility Letter and District Office Memo

13. Quality and Accountability Program
For SKILLED NURSING FACILITIES

14. Quality and Accountability Program
Collaborative effort between Departments of Public Health and Health Care Services.
Implement Skilled Nursing Facility Quality and Accountability Program.
Provide incentive payments to facilities for achieving minimum scores on Quality Measures.
Established as a result of SB 853, chaptered in October 2010
Quality and accountability program will include:
performance targets as a possible means of determining the quality of care provided to residents; and
staffing performance measures.

15. Quality and Accountability Program
Quality Measures
Staffing
Physical Restraints
Facility-acquired Pressure Ulcers
Immunizations
Influenza
Pneumococcal
Patient/Family Satisfaction Survey
Other measures added in subsequent years

16. Quality and Accountability Program
All Facility Letter for compliance audits:
In-depth accounting of facility compliance with 3.2 nurse-staffing requirements.
Helps determine whether program yields staffing rates that are instrumental to changes in health care outcomes.
Audit all SNFs every year
Administrative Penalties
$15,000 non-compliant 5-49% of audited days
$30,000 non-compliant >49% of audited days
AFL issued January 31, 2011, as a result of SB 853.
L&C conducts audits as part of standard licensing surveys/as stand-alone staffing audits to determine compliance with the staffing requirements of Health & Safety Code Section
All 1,150 free-standing SNFs must be audited for 3.2 compliance every year. Facilities found non-compliant with 3.2 at any point during the performance year are ineligible to receive a supplemental payment.
SB 853 established administrative penalties for non-compliance with 3.2 nursing hours per patient day.

17. Emergency preparedness/ disaster response Branch

18. Emergency Preparedness/ Disaster Response
Core Responsibilities/Activities
Life Safety Code
Emergency Preparedness/Disaster Response
State Facilities Unit
Background:
 Created in 1998 following Northridge Earthquake.
Assists licensed facilities to prepare for, respond to, and recover from disasters/emergencies.
Ensure patient health and safety during extreme events.
Educate and train response partners including: facilities, counties, provider associations, and state/federal agencies and departments.
Mission/Goal: To protect the health and safety of individuals in licensed healthcare facilities.
 Customers/Population Served: As citizens of and key organizations of the State, all patients, staff and visitors of, and the functionality of all healthcare facilities licensed by the Department of Public Health.
 Core Responsibilities/Activities: To ensure the health and safety of patients, staff and visitors of licensed healthcare facilities, and to ensure the continued operational status of healthcare facilities licensed by the Department of Public Health. This is accomplished by providing training, assist in enforcement activities, assist in drills, and work with all stakeholders to ensure that healthcare facilities and their patients are adequately prepared for, and can effectively respond to and recover from emergencies.
 Background:  The Emergency Preparedness Disaster Response (EPDR) Branch was created in 1998 in response to the Northridge Earthquake. Working through the Licensing and Certification (L&C) District Offices, the EPDR Branch assists licensed facilities to prepare for, respond to, and recover from disasters / emergencies. Description of Current Issues: The EPDR Branch provides support to L&C district office staff to assist licensed facilities prepare for, respond to, and recover from emergencies and disasters, and to ensure the health and safety of their patients during these extreme events. The EPDR Branch is also involved in providing education and training to a full range of response partners including, facilities, counties, provider associations, and other state and federal agencies and departments.
Challenges and Accomplishments: Despite the State’s diverse nature and multi-jurisdictional issues, The EPDR Branch has been able to communicate essential information in a much more organized and effective manner, thus ensuring stakeholders are provided with data and information needed to effectively respond to events. The EPDR Section has taken a pro-active role in training, pre-event scenario drills, and continues to develop new and healthy relationships with all known stakeholders.  The EPDR Branch has also provided District Office staff with training on emergency preparedness regulatory compliance, which has brought more healthcare facilities to a par standard of preparedness. The Branch has also provided consultation to and worked through provider associations to assist the associations and facilities to develop response and recovery guidance that enhances prior preparedness standards. 
Next Steps: Provide district office staff with initial and on-going training on the following subjects. Develop an All Hazard Emergency Response Document that provides guidance to all L&C Staff on how to prepare for and respond to major disaster events most likely to be experienced within the State. Assist healthcare facilities to better take care of patients in less than optimal locations (evacuated to temporary shelters, etc.), and assist healthcare facilities to more respond and recover at the end of a disaster.
These last two steps require district office staff to take on a support role rather than their usual enforcement role. District office staff must, therefore, adopt a collaborative approach to their normal tasks.
Timelines:
April 30, 2012: Complete Emergency Preparedness and Response Plan revision, the basis for the above goals and intents.

19. Open Issues 3.2 NHPPD Audit Process High Profile Facility Closures
LA County Contract Renewal
CMS Grant Compliance
Medical Breaches
Health Facility Consumer Information System

20. Administrative Services Branch

21. Administrative services branch
Personnel and Business Services Section
Ensures timely processing of hiring and benefit documents and related personnel requests.
Provides effective, efficient business services and operational support to internal & external customers.
Liaisons with CDPH Human Resources, Program Support and Contracts Management, as well as Department of Personnel Administration.
Fiscal Operations& Grant Administration Section
Program fiscal liaison with CDPH Budget and Accounting, Centers for Medicaid and Medicare Services, Department of Finance, Health and Human Services Agency, Legislature, Legislative Analyst's Office and public.
The Administrative Services Branch main functions are to ensure L&C's operational and fiscal functions are optimal and in compliance with state administrative policies and procedures. The Branch consists of the Personnel and Business Services Section and the Fiscal Operations and Grant Administration Section. The Personnel and Business Services Section: Ensures timely processing of hiring and benefit documents and related personnel requests. Provides effective, efficient business services and operational support to internal & external customers. Operational functions include, but are not limited to: Contracts development, purchase orders and service order processes; invoice processing and monitoring, facility operations and fleet administration management, telecommunications, ergonomic evaluation coordination, CalATERS management oversight, oversight of L&C main switch phone line. This Section liaisons with CDPH Human Resources, Program Support and Contracts Management, as well as Department of Personnel Administration. The Fiscal Operations and Grant Administration Section is responsible for all fiscal matters related to all of L&C’s funding sources. It is the program’s fiscal liaison with CDPH Budget and Accounting, the Centers for Medicaid and Medicare Services, Department of Finance, Health and Human Services Agency, Legislature, Legislative Analyst's Office and public.

22. Administrative services branch Health Care Facility Fees
Annual Fees
H&S Code 1266(d) requires by Feb. 1:
Budget Year Health Facility License Fees;
Based on L&C Program activity costs;
Staffing and system analysis data includes, but not limited to:
Surveyors and other personnel devoted to licensing & certification activities.
Facilities receiving full surveys.
Timeliness of complaint investigations.
Citation review conferences and arbitration hearings.
Data on deficiencies and citations issued.
Estimates Process
November 2010 Legislative directive required L&C to submit estimate package reflecting L&C Field Operations Section, as well as Los Angeles County contract, data.
Workload based on major and detailed assumptions for surveyor managerial and support staff workload. 
May Revise will include State Facilities Unit workload.
L&C will phase in the remaining program areas in future.
Los Angeles County Contract:
Los Angeles County Health Department contract has provided licensing and certification activities for health facilities in Los Angeles area for several decades
Typically a three-year contract renewed upon expiration.
Current contract # term: July 1, 2008 through June 30, 2011
Total contract amount: $79,121,610 ($26,373,870 per year).
Annual Fees
Licensing and Certification Program (L&C), Health Facility License Fees is published in accordance with California Health and Safety (H&S) Code Section 1266(d) as follows:
Publish the list of estimated fees by February 1 of each year;
Publish a report of all costs for activities of the L&C Program, and;
Prepare a staffing and system analysis report including;
The number of surveyors and administrative support personnel devoted to the licensing and certification of health care facilities;
The percentage of time devoted to licensing and certification activities for the various types of health facilities;
The number of facilities receiving full surveys and the frequency and number of follow up visits;
The number and timeliness of complaint investigations;
Data on deficiencies and citations issued, and numbers of citation review conferences and arbitration hearings; and
Other applicable activities of the licensing and certification division.

23. Systems, technology and research Branch

24. Systems, Technology, and Research Branch
Research Section
Conduct research on quality of health care provided by California's health professionals, health facilities, and laboratories.
Staffing Audits Section
Monitor, enforce, and report on nursing staff levels in long-term care facilities.
Program Applications Support Section
Support and oversee information technology needs for staff and health services providers.
Research: SIGNIFICANT CHALLENGES Incomplete and invalid data in the federal ASPEN and state ELMS databases; Insufficient field knowledge of investigative/data entry processes; inconsistent field processes; and dynamic administrative databases. SIGNIFICANT ACCOMPLISHMENTS Contributes to legislative reports, ad hoc reports, and grant reports; establishing interagency agreements with UC Davis for hospital nurse-to-patient ratio and adverse-events collaborative research projects, audits and analyses of adverse-event and medical-breach data, assessments of L&C’s compliance with state and federal performance standards, and responds to Public Record Act requests.
Staffing Audits: SIGNIFICANT CHALLENGES Rapid growth during 2011 (from 1 Manager and 8 staff to 6 managers and 38 staff) continues to raise team building issues. Continuing hiring competent staff and enhancing processes to coincide with recent legislation and building infrastructure to support the Section. SIGNIFICANT ACCOMPLISHMENTS Quadrupled the number of staff while completing 300+ audits within six month period; Developed a quality assurance process to ensure audits are performed consistently.
Program Applications Support: SIGNIFICANT CHALLENGES Deployment of approximately 600 tablet PC's to support mandated federal systems; Conversion to Windows 7 and required encryption software; Coordination with CMS on software versions and upgrade schedule; Continued system software updates to state systems; Resource limitations delay IT projects; Departmental band-width restrictions cause significant data transmission delays and prevent use of video conferencing equipment. SIGNIFICANT ACCOMPLISHMENTS Help desk support for ~1200 users with only eight staff; Upgrade to Office 2010; On-time implementation of Nursing Hours per Patient Day database, MEDication System Event Tracker (MEDSET), and Time Entry and Activity Management (TEAM) system; Development and recognition of L&C mobile application, Mobile.ca.

25. Policy & Enforcement Branch

26. Policy & enforcement Policy Section:
promotes program-wide consistency and standardization; communicate Department position on legislation impacting Program; assess need for new/revised field policies and procedures.
Provider Certification Section:
Process certification requests and monitor enforcement actions against Title 19 certified providers.
Policy:
SIGNIFICANT CHALLENGES
The Policy Section faces significant challenges with staying current with the ever changing regulatory environment which it supports. Policy was Primary on 43 legislative bills in 2011, with 21 of those designated "priority bills" by L&C. Agency determined that 6 of the bills were "hot bills."
SIGNIFICANT ACCOMPLISHMENTS: The Policy Section prides itself on having staff that are considered experts in the area of statutory and regulatory requirements related to the licensure and certification of a variety of health care facilities. The Section is both proactive and consistently responsive to all stakeholders concerning the responsibility of the Licensing and Certification Program (L&C), legal requirements for the facilities under L&C’s oversight, and impacts of the law to the California population we serve.
Provider Certification Section:
SIGNIFICANT CHALLENGES The agreement of the information technology systems is a challenge. PCU has to interface with three different electronic systems that do not communicate with each other and require multiple entries of the same data into different systems. There are difficulties in reviewing each to make sure all have the same information in them. These three systems are the L&C Electronic Licensing Management System, the Federal Aspen Central Office System and the DHCS Affiliated Computer Services Network. Another challenge is the need for tremendous amounts of paper files rather than having an electronic system that would be usable for the keeping and tracking of facility files and paperwork. The unit passed a state audit with no problems found. The audit consisted of a review of PCU paper files to ensure all facility licenses were current, all certificates of certification were up-to-date, and all facilities had a current provider agreement on file. The Department of Health Care Services released a new Provider Agreement in 2010 and the Provider Certification Unit ensured all Dually Certified and Title 19 only health facilities received and returned updated Provider Agreements

27. Policy & enforcement Registered Nurse Section:
Assists in legislative analysis, writing regulations, providing technical assistance to headquarters and L&C Field staff on survey issues, monitoring regulatory compliance of providers enrolled in waiver programs, and assisting in handling appeals of L&C investigations.
Registered Nursing Section
SIGNIFICANT CHALLENGES The Title 22 regulations enforced by L&C are approximately 40 years old. L&C is in the process of updating these regulations, working closely with the Department’s Office of Legal Services. Due to the complexity and magnitude of the task, the update is planned over a dynamic 10 year timeline at the end of which all the regulations should be current and the process of keeping them current should be smoother. There are currently about 30 regulatory packages to be completed. SIGNIFICANT ACCOMPLISHMENTS The RN Unit was started as a new unit in In 2009 the L&C Program had a backlog of over 32 packages that needed to be promulgated. This backlog did not include the need to update all of the outdated regulations in Title 22, Division 5. The RN Unit has now developed a plan to update all of the outdated regulations in a systematic approach and at the same time incorporate the backlog of packages into the update in order to expedite the goal of updating regulations as expeditiously as possible. The time line to accomplish this is over a dynamic 10 year period. Since the start of the unit two non emergency rulemaking packages have been completed and one Rule 100 package has been completed. 11 other packages are in various stages of completion

28. Regulations in Process
ICF DD-N Regulations—
Health and Safety Code mandates that the Department of Public Health and the Department of Developmental Services jointly develop and implement licensing and Medi-Cal regulations appropriate for ICF DD-N regulations.
Tuberculosis Testing Regulation
Allows for use of a broader choice of TB screening test.
Medical Information Breach Regulation
Clarify and specify statutory language related breach violations in all affected facility types.
ICF DD N Regulations:
The RN Unit is drafting regulatory language with Department of Developmental Services assistance.
: Both Departments have been coordinating efforts to write the regulations.
The Department has made progress in identifying the unique needs of this client population, differences with the federal regulations and the differences between Habilitative, Nursing and Continuous Nursing facility types.
2012: The draft regulation package is approximately 70% complete.
The proposed regulations will consolidate the ICF DD-Habilitative/Nursing/Continuous Nursing facility types into one common chapter, with separate articles for the respective type.
Consolidating the three separate facility types allowed the Department to address a common complaint of providers as to what the real differences were between the three facility types.
Having a shared chapter will standardize the requirements for all of the common elements and allow for a common standard for most of the licensure requirements.
Scheduled to be released to Office of Administrative Law by the first quarter 2013.
Tuberculosis Testing
Package is undergoing final program review
Anticipate submitting package to Office of Administrative Law by end of second quarter 2012.
Surgical Site Infection Reporting
Currently under development by the Office of Regulations and Hearings
Anticipate submitting package to Office of Administrative Law by end of third quarter 2012

29. Regulations in Process
General Acute Care Infection Control Revision
Revises Title 22 Section Infection Control Program to reflect changes in current infection control statutes.
General Acute Care & Special Hospitals Regulations
Reviews and revises Title 22 Division 5 Chapter 1-General Acute Care Hospital regulations in order to modernize an increasingly obsolete regulation set.
Medical information Breach
Will make specific mitigating factors and the assessment of penalties as outlined in HSC Section
Pre-notice meeting held on December 14, 2010.
Currently undergoing internal review and revisions, with concurrent management review.
Anticipate submitting package to Office of Administrative Law by first quarter 2013.
General Acute Care Infection Control Revision
Will provide a review and revision of the infection control requirements within the Acute Hospital regulations
Will incorporate relevant infection control Health and Safety Code Sections
Currently under development with the assistance of the HAI-AC committee.
General Acute Care & Special Hospitals–Will provide a review and revision of Chapter 1 with the adoption of new regulations required by recently chaptered statutes.
The RN Unit is consolidating initial recommendations from Department consultant staff and external stakeholder solicited during 3 pre-notice meetings.
The RN Unit will create internal work teams of field staff and Department consultants to review and make recommendations for regulation development.

30. Professional certification Branch

31. Professional Certification Branch
Aide and Technician Certification Section
Certifies Nurse Assistants (CNA), Home Health Aides (HHA), and Hemodialysis Technicians (CHT); maintains State Registry; and has oversight of Training Programs.
 Criminal Background Section
Grants/denies criminal record clearances for CNAs, HHAs; deny applications, revoke/suspend certificate; represents Department at administrative appeal hearings.
Professional Certification Branch
Talking Points for PCB:
The Professional Certification Branch ensures the availability of competent and qualified individuals in a long term care, dialysis, hospice and home health settings through the licensure, certification, criminal conviction screening and investigation of complaints involving CNAs, HHAs, CHTs, NHAs.  PCB also grants criminal record clearance for specific individuals living, working and/or assoc. w/ Intermediate Care Facilities and administrators, program directors, and the fiscal officers of the Home Health Agencies and Adult Day Health Care Centers. 
Currently there are over 220,000 certified nurse assistants, home health aides, hemodialysis technicians and licensed nursing home administrators.
Significant Accomplishments:
Customer Service Enhancements
Award of the CMS National Background Check Program Grant
Partnership with the California Department of Social Services
Administrative Hearings
Developed action plan to ensure timely investigations
Preceptor Training
Enhanced tracking systems
Significant Challenges:
Continuing to provide excellent customer service and respond to the high volume of, processed over 100,000 initial/renewal certification application; responded to over 84,000 phone and/or inquiries; processed over 35,000 Criminal Offender Record Information (CORI) with no criminal conviction(s); and processed over 17,100 CORI with one/more criminal convictions in 2011.
Recruitment and retention of qualified staff.
Identifying and implementing IT automation which would address the needs of those being served while improving the efficiencies and effectiveness of the service provided. 
SLIDE 2
ADP TRANSITION
Department of Alcohol and Drug Programs transferring into the Center for Health Care Quality effective July 1, 2012:
Driving Under the Influence Program
Narcotic Treatment Program
Counselor Certification
Talking Points:
PCB is preparing for the transition of 3 programs currently within the Department of Alcohol and Drug Program. 
Driving Under the Influence
As the California Department of Public Health is dedicated to optimizing the health and well-being of the people of California, it is appropriate to transfer the Driving Under the Influence Program (DUI) to CDPH’s Licensing and Certification Division.  CDPH provides education services and implements public health interventions which are consistent with the DUI Program goals and functions.  CDPH also enforces laws and regulations that protect health and ensure safety.  Transferring the DUI program to CDPH will position the pervasive issue of substance use disorders, specifically driving under the influence, within the arena of licensing and certification of health care facilities.
CDPH’s Licensing and Certification Division is responsible for ensuring that health care facilities comply with state laws and regulations.  One of CDPH’s essential public health services is to link people to needed personal health services.  The purpose of NTP licensing is to ensure that replacement narcotic therapy is available for persons addicted to opiates.  The transfer of the NTP will integrate the licensing of such programs into the licensing of health care facilities and may enhance the existing links to primary health care for the specialized NTP medical component. 
CDPH assures a competent public health workforce and detects and investigates health problems in communities.  CDPH certifies various workforce staff working in health care facilities which operate a clinically-based service system.  This transfer to CDPH creates a nexus and furthers the efforts to align the certification of alcohol and other drug counselors within the movement toward integration of services in health care reform.

32. Professional Certification Branch
Investigation Section
Investigates allegations/complaints against CNAs, HHAs, and CHTs; initiates administrative actions (denying an application, revoking/suspending a certificate/placing the certificate holder on a diversion program); and represents Department at administrative appeal hearings.
Nursing Home Administrator Program
Licenses Nursing Home Administrators; administers Nursing Home Administrator State Examination; investigates allegations/ complaints; oversees Administrator-in-Training Program and Preceptors; and approves/denies continuing education providers and courses for Nursing Home Administrators.
Professional Certification Branch
Talking Points for PCB:
The Professional Certification Branch ensures the availability of competent and qualified individuals in a long term care, dialysis, hospice and home health settings through the licensure, certification, criminal conviction screening and investigation of complaints involving CNAs, HHAs, CHTs, NHAs.  PCB also grants criminal record clearance for specific individuals living, working and/or assoc. w/ Intermediate Care Facilities and administrators, program directors, and the fiscal officers of the Home Health Agencies and Adult Day Health Care Centers. 
Currently there are over 220,000 certified nurse assistants, home health aides, hemodialysis technicians and licensed nursing home administrators.
Significant Accomplishments:
Customer Service Enhancements
Award of the CMS National Background Check Program Grant
Partnership with the California Department of Social Services
Administrative Hearings
Developed action plan to ensure timely investigations
Preceptor Training
Enhanced tracking systems
Significant Challenges:
Continuing to provide excellent customer service and respond to the high volume of, processed over 100,000 initial/renewal certification application; responded to over 84,000 phone and/or inquiries; processed over 35,000 Criminal Offender Record Information (CORI) with no criminal conviction(s); and processed over 17,100 CORI with one/more criminal convictions in 2011.
Recruitment and retention of qualified staff.
Identifying and implementing IT automation which would address the needs of those being served while improving the efficiencies and effectiveness of the service provided. 

33. Professional Certification Branch ADP Transition
Department of Alcohol and Drug Programs transferring into Center for Health Care Quality effective July 1, 2012:
Driving Under the Influence Program
Narcotic Treatment Program
Counselor Certification
ADP TRANSITION
Department of Alcohol and Drug Programs transferring into the Center for Health Care Quality effective July 1, 2012:
Driving Under the Influence Program
Narcotic Treatment Program
Counselor Certification
Talking Points:
PCB is preparing for the transition of 3 programs currently within the Department of Alcohol and Drug Program. 
Driving Under the Influence
As the California Department of Public Health is dedicated to optimizing the health and well-being of the people of California, it is appropriate to transfer the Driving Under the Influence Program (DUI) to CDPH’s Licensing and Certification Division.  CDPH provides education services and implements public health interventions which are consistent with the DUI Program goals and functions.  CDPH also enforces laws and regulations that protect health and ensure safety.  Transferring the DUI program to CDPH will position the pervasive issue of substance use disorders, specifically driving under the influence, within the arena of licensing and certification of health care facilities.
CDPH’s Licensing and Certification Division is responsible for ensuring that health care facilities comply with state laws and regulations.  One of CDPH’s essential public health services is to link people to needed personal health services.  The purpose of NTP licensing is to ensure that replacement narcotic therapy is available for persons addicted to opiates.  The transfer of the NTP will integrate the licensing of such programs into the licensing of health care facilities and may enhance the existing links to primary health care for the specialized NTP medical component. 
CDPH assures a competent public health workforce and detects and investigates health problems in communities.  CDPH certifies various workforce staff working in health care facilities which operate a clinically-based service system.  This transfer to CDPH creates a nexus and furthers the efforts to align the certification of alcohol and other drug counselors within the movement toward integration of services in health care reform.

34. CDPH/DHCS Antipsychotic Collaborative
Goal: Identify facilities where inappropriate antipsychotic medication is being used; and once identified corrective action is implemented—ultimately improving patient care and reducing health care costs.
Resident Selection
Polypharmacy: those who are older than 55 y/o (with diagnosis of SMI or dementia);
Monopharmacy: with dementia, no SMI, and greater than 65 y/o
Serious Mental Issues (SMI) includes for example major depression, scizophrenia, bi-polar disorder, etc.
IAA date of approval
DHCS – Department of Health Care Services

35. Issues Independent Information Dispute Resolution
Standard Admission Agreement
Retail Food Requirements
Other issues