office of regulatory services the times, they are a-changin …for providers and regulators alike
TRANSCRIPT
Office of Regulatory Services
“The Times, They Are A-Changin’”
…For Providers and Regulators Alike
The Changing Times…
SB 433—CON issues and moving parts of ORS
PCH Facility Reports--Transparency HB 155—Fingerprint checks for owners,
rule changes in PCH, COGENT system HB 1044—Adult Day Centers and
exemption of respite Private home care providers—web-
based training tool and top 10 cites
Realignment of Licensing Responsibilities—SB 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
Dividing Licensing Functions
Goes to DCHHospitalsAmbulatory Surgery Birthing CenterHome HealthPrivate Home CarePersonal Care HomesNursing HomesICF/MRTraumatic Brain FacilitiesSpecimen Collection Stations
Stays with DHRKidney Dialysis CentersRural Health ClinicsEye BankHospices Community Living ArrangementsAdult Day CentersClinical Laboratories (&CLIA)X-Ray & MammographyDrug Abuse Treatment ProgramsOPT/CORFMaternity HomesResidential Child Care (CCI, CPA, OCCP)HMOs
Unknowns:
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
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
Long and Winding Road…
Began in 2006 with work group, some provider representation, staff, consumer advocates
First meeting on 8/11/2006Researched other systemsCreated 9 versions or
methodologies to rate facilities
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
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
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
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
New Requirements for Criminal Records Checks
Result of HB 155 passed in 2007
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
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.
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
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 EXCEPTIONScontinued…
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
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…
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 Facility’s history of compliance Owner’s involvement with facility
PCHs - No changes
PHCPs - No new requirements
Other Employees
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; e-mail access required www.gacogentid.com Call: 1-888-439-2512
LiveScan Fingerprinting
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
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.
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
Reporting 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
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
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
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
Respite 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; and
Has as its sole purpose to provide primary caregivers of aging adults with relief from normal caregiving duties and responsibilities.
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.
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
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
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
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
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
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
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
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
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.
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
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.
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.
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?
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.
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
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: www.ors.dhr.georgia.gov
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.
The 10 most frequently cited deficiencies
From March 2007-March 2008
Top Ten Violations
1. TB Tests when first hired, annually Tag #0934, 290-5-54-.09(4)(c)4
2. Supervisory Visits every 92 days where personal care
Tag # 1013, 290-5-54-.10(2)(b)2
3. Service Plan Content
Tag # 1101, 290-5-54-.11(1)(a)
4. Personal Care Aide Qualifications
Tag # 948, 290-5-54-.09(5)(c)1
Top Ten Continued
5. Service Agreement: description of services as stated by client, etc.Tag # 905 290-5-54-.09(2)(a)3
6. Service Agreement: charges for services, mechanisms for billing, paymentTag # 907 290-5-54-.09(2)(a)5
7. Governing Body ensures compliance with these rulesTag # 400 290-5-54-.04
8. Personnel Records: job description/statement of duties, responsibilitiesTag #0936 290-5-54-.09(4)(c)6
Top Ten Continued
9. Personnel Records: Annual performance
evaluation
Tag # 0938 290-5-54-.09(4)(c)8
10. Service Agreement: Description of services, frequency and expected duration
Tag # 0906 290-5-54-.09(2)(a)4
Questions, Comments
Thank you
Sharon E. Dougherty
Director
Office of Regulatory Services
404-657-5700