TALA Annual Conference - 2019 Surveyor Perspective related to the Licensing Standards for Assisted Living Facilities Galveston, TX April 1, 2019

Surveyor Perspective ….. This will include a broad understanding of a surveyor’s role of inspections related to the Licensing Standards for Assisted Living Facilities and understanding the importance of maintaining compliance.

Surveyor – State Government STATE GOVERNMENT Statute – state legislature Rule – state agency STATE AGENCY – Texas Health and Human Services Commission

Inspection Process Purpose: The Texas Health and Human Services Commission (HHSC), Regulatory Services Division (Long Term Care) inspects most assisted living facilities. The inspection and enforcement process is intended: - protect the health, safety, and rights of residents - ensure compliance with regulations, and - ensure equitable and consistent enforcement of regulatory requirements

License Required – Assisted Living Facility State Law defines an assisted living facility as an establishment that - furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment - provides personal care services; or administration of medication by a person licensed or otherwise authorized in this state to administer the medication; and - may provide assistance with or supervision of the administration of medication. (Texas Health & Safety Code (HSC), Section 247.002(1))

License Required – Assistive Living Facility (cont) Personal care services are defined by statute as: - assistance with feeding, dressing, moving, bathing, or other personal needs or maintenance; or - general supervision or oversight of the physical and mental well- being of a person who needs assistance to maintain a private and independent residence in an assisted living facility or who needs assistance to manage the person’s personal life, regardless of whether a guardian has been appointed for the person. (Texas Health & Safety Code (HSC), Section 247.005(5))

License Required – Assisted Living Facility (cont) Assisted Living Facility must comply with the minimum standards contained in: - Chapter 247 of the Texas Health & Safety Code (HSC) - Texas Administrative Code (TAC), Title 40, Part 1, Chapter 92, Licensing Standards for Assisted Living Facilities

Confidentiality Generally, ALL licensed inspections, complaint investigations, and other visits are unannounced During the inspection, the inspection team attempts to maintain resident confidentiality to the greatest extent possible, particularly regarding information gathered from interviews. The inspection is usually assigned to one person. However, other team members (such as those with particular areas of expertise) may be assigned as needed. The team size depends on the purpose of the inspection, the size of the facility, the services provided by the facility, and other factors.

Inspection Tasks The seven inspection tasks include: 1. Off-site Preparation 2. Entrance Conference

Inspection Tasks (cont) 3. Initial Tour 4. Sample Selection 5. Information Gathering

Inspection Tasks (cont) 6. Decision Making Immediate Threat is defined as follows: Immediate threat to the health or safety of a resident – A situation that causes , or is likely to cause, serious injury, harm, or impairment to or the death of resident. (effective 10/28/2018) 7. Exit Conference

Scenarios Clinical Discussion

Scenarios Clinical Discussion

Scenarios Clinical Discussion

Assisted Living Facility (ALF) Rule ALF TAC 92.41(e)(1) A facility must not admit or retain a resident whose needs cannot be met by the facility or who cannot secure the necessary services from an outside resource. As part of the facility’s general supervision and oversight of the physical and mental well-being of its residents, the facility remains responsible for all care provided at the facility. If the individual is appropriate for placement in a facility, then the decision that additional services are necessary and can be secured is the resident’s attending physician, or legal representative. Regardless of the possibility of “aging in place” or securing additional services, the facility must meet all Life Safety Code requirements based on each resident’s evacuation capabilities, except as provided (f) of this section.

Assisted Living Facility (ALF) Rule ALF TAC §92.41(h)(2)(G) [Resident Records] documentation by health care professionals of any services delivered in accordance with the licensing, certification, or other regulatory standards applicable to the health care professional under law; ALF TAC §92.2(31) [Definition – Health Care Professional] An individual licensed, certified, or otherwise authorized to administer health care, for profit or otherwise, in the ordinary course of business or professional practice. The term includes a physician, registered nurse, licensed vocational nurse, licensed dietitian, physical therapist, and occupational therapist.

Risk Management Risk management is the identification, evaluation prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability or impact of unfortunate events or to maximize the realization of opportunities. (Wikipedia)

Resources Texas Health and Human Services Commission (HHSC) website: https://hhs.texas.gov/ HHSC website: Assisted Living Facilities Portal https://hhs.texas.gov/doing-business-hhs/provider-portals/long- term-care-providers/assisted-living-facilities-alf

Resources HHSC Assisted Living Facilities Portal: Texas Health & Safety Code, Title 1, Chapter 247 Assisted Living Facilities https://statutes.capitol.texas.gov/Docs/HS/htm/HS.247.htm Texas Administrative Code, Title 40, Part 1, Chapter 92 Licensing Standards for Assisted Living Facilities https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view= 4&ti=40&pt=1&ch=92

Resources Texas Board of Nursing (BoN) website: https://www.bon.texas.gov/

Questions

MJ Consulting Mark Jeffers RN MS MJ Consulting Assisted Living Facilities Email address: mjeff0152@hotmail.com Cell: (512) 787-5952