FHCA 2014 Annual Conference & Trade Sho_Griffin.pdf · FHCA 2014 Annual Conference & Trade Show ... Crystal K – Assisted Living ... Report possible Adverse Incidents to the Agency

FHCA 2014 Annual Conference & Trade Show

CE Session #28 – Risk Management and Reporting Precision for ALFs Wednesday, July 9 – 2:30 to 3:30 p.m.

Crystal K – Assisted Living

Upon completion of this presentation, the learner will be able to:

apply basic risk management concepts to assisted living operations;

navigate incident decision making and reporting; and

compare aspects of Florida’s ALF Risk Management and Quality Assurance program to the Adverse Incident Reporting System.

Seminar Description: Florida’s assisted living facilities operate with specific resident protections, including reporting adverse incidents and allegations of abuse, neglect and exploitation. While risk management and quality assurance programs are voluntary in assisted living (except for those with the ECC specialty license), these concepts of managed risk are accessible to all ALFs and arguably already part of daily operations, though perhaps informally and undocumented. This session will review regulatory requirements for adverse incident and abuse reporting and explore how concepts of risk management connect with assisted living. Presenter Bio(s): Dorene Bissonette, RN Clinical Risk Manager has been with Opis Management Resources for the last 17 years. Serving the past four years as Clinical Risk Manager, she has covered their Assisted Living Center as well as Skilled Nursing Centers. In 2012, she completed the ALF Core Training. Dorene graduated from Cazenovia College in Upstate New York in 1977 and then completed her Nursing Education with Crouse Irving Memorial Hospital School of Nursing in Syracuse, N.Y. She lives in Palm Coast Florida. Lee Ann Griffin is the Director of Quality & Regulatory Services for Florida Health Care Association. Over a 15-year career, Lee Ann has developed extensive expertise in the rules, laws, and policy interpretations for nursing homes and assisted living facilities. Lee Ann holds a degree in Information Studies, has worked as a CNA, served as an appointee to the Florida Board of Nursing’s CNA Council and, most recently, completed the ALF Administrator’s Core Training.

Risk Management and Reporting Requirements in ALFs

5/21/2014

2014 Copyright Florida Health Care Association 1

Risk Management and Reporting Requirements for Florida’s Assisted Living Facilities

Risk Management and Reporting Requirements for Florida’s Assisted Living Facilities

Doreen Bissonette, RNClinical Risk Manager, OPIS

Lee Ann GriffinDirector/Quality & Regulatory ServicesFlorida Care Association

Defining Risk ManagementDefining Risk Management

The process to identify, control, and minimize the impact of uncertain events (DHS)

The likelihood that a threat will harm an asset and deciding on actions to reduce it (FEMA)

Figuring out which attacks are worth worrying about and spending money on and which are better left ignored (DeRugy)

The process to identify, control, and minimize the impact of uncertain events (DHS)

The likelihood that a threat will harm an asset and deciding on actions to reduce it (FEMA)

Figuring out which attacks are worth worrying about and spending money on and which are better left ignored (DeRugy)

July 2014Risk Management & Reporting Requirements for FL's ALFs 2


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Risk Management FocusRisk Management Focus

Financial

Litigation

Disaster

Health Care

Enterprise

Financial

Litigation

Disaster

Health Care

Enterprise


Risk Management UniversalsRisk Management Universals

Harm: unwanted consequences or losses

Uncertainty: an event may or may not happen

Allocation of resources to prevent or mitigate

Harm: unwanted consequences or losses

Uncertainty: an event may or may not happen

Allocation of resources to prevent or mitigate



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What’s your risk appetite?What’s your risk appetite?

High ToleranceHigh Tolerance You are okay if some risks

can’t be controlled

You ask: how much is that costing?

You see resident falls as a consequence of aging and declining abilities

Survey fines are a part of doing business

The only policies you have are those required by regulation

You are okay if some risks can’t be controlled

You ask: how much is that costing?

You see resident falls as a consequence of aging and declining abilities

Survey fines are a part of doing business

The only policies you have are those required by regulation

Low ToleranceLow Tolerance You are overcomplying with

regulations

You focus most on preventing high drama events with a low probability

You tend to internalize every fall

Survey fines are a reflection of your job

Your facility policies read like national best practices

You are overcomplying with regulations

You focus most on preventing high drama events with a low probability

You tend to internalize every fall

Survey fines are a reflection of your job

Your facility policies read like national best practices

6

Ranking Risks (to Residents)Ranking Risks (to Residents)

Outcome or ImpactOutcome or Impact Catastrophic

Major

Moderate

Minor

Insignificant

Catastrophic

Major

Moderate

Minor

Insignificant

Likelihood to HappenLikelihood to Happen Almost certain

Likely

Moderate

Unlikely

Remote

Almost certain

Likely

Moderate

Unlikely

Remote



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Directing resources

Preparing for the High/Very HighPreparing for the High/Very High

Resident Expectations

Third Parties

Employee Management

Incident Response

Resident Expectations

Third Parties

Employee Management

Incident Response



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Resident ExpectationsResident Expectations

Marketing Escalating resident

expectations

Admissions Unlimited levels of care

Marketing Escalating resident

expectations

Admissions Unlimited levels of care


Third PartiesThird Parties

Private duty aides

3rd party providers

Private duty aides

3rd party providers



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3rd Party ProvidersAdministrators must:

3rd Party ProvidersAdministrators must:

• Take action to assist in facilitating the provision of services, and

• Coordinate with the provider to meet the specific service goals

• Unless resident declines• Review annually

• Does not represent a guarantee

• Take action to assist in facilitating the provision of services, and

• Coordinate with the provider to meet the specific service goals

• Unless resident declines• Review annually

• Does not represent a guarantee


Employee ManagementEmployee Management

Employee Policies

Exit interviews

Employee Policies

Exit interviews



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Incident and Investigation ReportsIncident and Investigation Reports

Writing the report Writing the report


Priority 1:Resident is safe.

Writing the Internal ReportWriting the Internal Report

Why To make management aware something has occurred

When Upon becoming aware of incident

What Employees can recognize what is and what is not a

documentable incident

Why To make management aware something has occurred

When Upon becoming aware of incident

What Employees can recognize what is and what is not a

documentable incident



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Florida’s Risk Management and Reporting Environment for Assisted Living

Florida’s Risk Management and Reporting Environment for Assisted Living

Risk Management and Quality Assurance Program

External Incident Reporting


External Incident Reporting


Comparing Provisions, s. 429.23, F.S.Comparing Provisions, s. 429.23, F.S.

RM & QA Program AI Reporting

External

Mandatory

Specific definition

Some legal protections

Internal

Voluntary

Specific purpose

Some protections


Some legal protectionsSome protections


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ALF Risk Management and Reporting ProtectionsALF Risk Management and Reporting Protections


Risk Management and Quality Assurance Program No specific authority for

the Agency for Health Care Administration to have access to internal working incident reports and investigation papers not externally reported through AI or ANE

Agency cannot release records of a RMQA Committee (s.400.119, F.S.)

No specific authority for the Agency for Health Care Administration to have access to internal working incident reports and investigation papers not externally reported through AI or ANE

Agency cannot release records of a RMQA Committee (s.400.119, F.S.)

Adverse Incident Reporting

Adverse Incident Reporting

Confidential as provided by law, not discoverable or admissible in any civil or administrative action Except in disciplinary

proceedings re: an individual licensee

s. 429.23 (9), F.S.

Confidential as provided by law, not discoverable or admissible in any civil or administrative action Except in disciplinary

proceedings re: an individual licensee

s. 429.23 (9), F.S.

July 2014 19

Internal Risk Management and Quality Assurance ProgramInternal Risk Management and Quality Assurance Program

Voluntary

Purpose Assess

Resident care practices

Facility incident reports

Deficiencies

Adverse incident reports

Resident grievances

Develop plans of action to correct and quickly identify quality differences

Voluntary

Purpose Assess

Resident care practices

Facility incident reports

Deficiencies

Adverse incident reports

Resident grievances

Develop plans of action to correct and quickly identify quality differences



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Adverse Events in ContextAdverse Events in Context

Adverse Event An injury resulting from a medical intervention

Adverse events may not be errors

Adverse events may not be preventable A patient who has surgery and dies from

pneumonia postoperatively is an adverse event Due to poor instrument cleaning?

Due to a difficult surgery and recovery?

Not all adverse events result in harm

Adverse Event An injury resulting from a medical intervention

Adverse events may not be errors

Adverse events may not be preventable A patient who has surgery and dies from

pneumonia postoperatively is an adverse event Due to poor instrument cleaning?

Due to a difficult surgery and recovery?

Not all adverse events result in harmJuly 2014Risk Management & Reporting Requirements for FL's ALFs 22

Florida’s Adverse EventsIncidentsFlorida’s Adverse EventsIncidents

Florida’s take on Adverse Events They are called adverse incidents

They are always preventable

They are within the control of the ALF

They result in certain outcomes

Not every bad thing that happens in an ALF in an adverse incident

ANE is not always an adverse incident Resident to resident in some cases, or family member or guest

Ask: how would the facility have prevented the ANE from occurring?

Florida’s take on Adverse Events They are called adverse incidents

They are always preventable

They are within the control of the ALF

They result in certain outcomes

Not every bad thing that happens in an ALF in an adverse incident

ANE is not always an adverse incident Resident to resident in some cases, or family member or guest

Ask: how would the facility have prevented the ANE from occurring? 23


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FL’s Adverse Incident DefinedFL’s Adverse Incident Defined

An event over which facility personnel could exercise control rather than as a result of the resident’s condition and results in:

1. Death2. Brain or spinal damage3. Permanent disfigurement4. Fracture or dislocation of bones and joints5. Any condition that required medical attention to which the resident has

not given his or her consent, including failure to honor advanced directives

6. Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident’s condition before the incident; or

7. An event that is reported to law enforcement or its personnel for investigation

Resident elopement, if the elopement places the resident at risk of harm or injury.

An event over which facility personnel could exercise control rather than as a result of the resident’s condition and results in:

1. Death2. Brain or spinal damage3. Permanent disfigurement4. Fracture or dislocation of bones and joints5. Any condition that required medical attention to which the resident has

not given his or her consent, including failure to honor advanced directives

6. Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident’s condition before the incident; or

7. An event that is reported to law enforcement or its personnel for investigation


24

Reporting Adverse IncidentsReporting Adverse Incidents

Incident

Day 1

Day 15



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Abuse, Neglect, and ExploitationAbuse, Neglect, and Exploitation

Report to the Central Abuse Hotline, managed by the Department of Children and Families immediately 1/800-962-2873

Reports are based on: Knowledge of, or a reasonable cause to suspect ANE

Report to the Central Abuse Hotline, managed by the Department of Children and Families immediately 1/800-962-2873

Reports are based on: Knowledge of, or a reasonable cause to suspect ANE


Incident Reporting Decision TreeIncident Reporting Decision Tree

Begin investigation

Apply regulatory definitions to decide whether or not the incident is:• abuse, neglect, or exploitation – or gives you a

reasonable cause to suspect that ANE may have occurred, or

• a possible or definite adverse incident

What constitutes closure of responding to an incident?

Begin investigation

Apply regulatory definitions to decide whether or not the incident is:• abuse, neglect, or exploitation – or gives you a

reasonable cause to suspect that ANE may have occurred, or

• a possible or definite adverse incident

What constitutes closure of responding to an incident?



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Agency’s Online ReportingAgency’s Online Reporting

Note to Lee Ann: Consider showing the screen shots and advising about the incorrect nature of what’s asked as part of the reporting format

Note to Lee Ann: Consider showing the screen shots and advising about the incorrect nature of what’s asked as part of the reporting format


External Perspective of an IncidentExternal Perspective of an Incident

Residents are assessed (non-nursing sense of the word), cared for, and protected

All incidents are investigated Status as an adverse incident has been ruled out

Status as an allegation of abuse, neglect, or exploitation has been ruled out

Reporting timeframes were met

Residents are assessed (non-nursing sense of the word), cared for, and protected

All incidents are investigated Status as an adverse incident has been ruled out

Status as an allegation of abuse, neglect, or exploitation has been ruled out

Reporting timeframes were met



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Incident Response:Staff TrainingIncident Response:Staff Training

Do not major on the minor

Focus on the tasks that always have to be done regardless of the incident type Resident care response (elopement, harm, etc.)

How to write on an internal reporting form

Focus on the triggers for bumping up to a higher response level

Tailor the training to the employee response level

Do not major on the minor

Focus on the tasks that always have to be done regardless of the incident type Resident care response (elopement, harm, etc.)

How to write on an internal reporting form

Focus on the triggers for bumping up to a higher response level

Tailor the training to the employee response level


Parting WordsParting Words

Know thyself and thine own risk appetite

Prepare for the high/very high risk outcomes

Understand your internal Risk Management and Quality Assurance Program

Know the triggers for external incident reporting

Make sure staff training matches your priorities

If all else fails, do your best for the resident and document that

Know thyself and thine own risk appetite

Prepare for the high/very high risk outcomes

Understand your internal Risk Management and Quality Assurance Program

Know the triggers for external incident reporting

Make sure staff training matches your priorities

If all else fails, do your best for the resident and document that



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Thank youThank you

Doreen Bissonette, RNClinical Risk Manager, [email protected]

Lee Ann GriffinDirector/Quality & RegulatoryFlorida Care [email protected]

Doreen Bissonette, RNClinical Risk Manager, [email protected]

Lee Ann GriffinDirector/Quality & RegulatoryFlorida Care [email protected]

Risk Management & Reporting Requirements for FL's ALFs

Timeline for Adverse Incident Reporting Requirements429.23, Florida Statutes, applicable to Assisted Living Facilities

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Report possible Adverse Incidents to the Agency for Health Care Administration* Online: http://ahca.myflorida.com/reporting/index.shtml (within 1 business day after occurrence)

Incident

Report results of investigation of incident to the Agency, with determination of “Adverse” or “Not an Adverse Incident”:

Online: http://ahca.myflorida.com/reporting/index.shtml (within 15 days of occurrence)

Resources429.23, F.S.

58A-5.0241, FAC59A-35.110, FAC

ALF Adverse Incident Information at http://ahca.myflorida.com/reporting/

alf_advincd_info.shtmlL. Griffin 3-2013

Adverse incident means:

An event over which facility personnel could exercise control rather than as a results of the resident’s condition, and

results in one of the following:1. Death;2. Brain or spinal damage;3. Permanent disfigurement;4. Fracture or dislocation of bones or joints;5. Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives;7. Any condition that required the transfer of the resident, within or outside the facility, to a unit providing a more acute level of care due to the adverse incident, rather than the resident’s condition before the incident; or8. An event that is reported to law enforcement or its personnel for investigation; or


* “If it is determined within the 1 day reporting timeframe that an event does not meet the statutory definition of an adverse incident, no 1 day report is required.”

Agency for Health Care Administration, May 11, 2012.

http://ahca.myflorida.com/reporting/index.shtml




http://ahca.myflorida.com/reporting/alf_advincd_info.shtml

http://ahca.myflorida.com/reporting/alf_advincd_info.shtml

1 AHCA Recommended Form 1823 9/2013

RESIDENT HEALTH ASSESSMENT for ASSISTED LIVING FACILITIES This form must be completed annually for residents receiving assistive care services in order to comply with Medicaid

TO BE COMPLETED BY FACILITY: Resident’s Name

DOB:

INSTRUCTIONS TO LICENSED HEALTH CARE PROVIDERS: AFTER

COMPLETION OF ALL ITEMS IN SECTIONS 1 AND 2 OF THIS FORM (pages 1 through 4), PLEASE RETURN TO:

FACILITY NAME:

FACILITY ADDRESS:

TELEPHONE NUMBER:

CONTACT PERSON:

SECTION 1: HEALTH ASSESSMENT (MUST BE COMPLETED BY A LICENSED HEALTH CARE PROVIDER BY MEANS OF A FACE-TO-FACE EXAMINATION WITH THE RESIDENT.)

Known Allergies:

Height: Weight:

Medical history and diagnoses:

Physical or sensory limitations:

Cognitive or behavioral status:

Nursing/treatment/therapy service requirements:

Special precautions:

Elopement Risk:

Yes No

18

AHCA Recommended Form 1823

2


DOB:

SECTION 1: HEALTH ASSESSMENT (MUST BE COMPLETED BY A LICENSED HEALTH CARE PROVIDER BY MEANS OF A FACE-TO-FACE EXAMINATION WITH THE RESIDENT.)

A. To what extent does the individual need supervision or assistance with the following?

Key I = Independent S = Needs Supervision A = Needs Assistance T = Total Care

Indicate by a checkmark () in the appropriate column below the extent to which the individuals is able to perform each of the activities of daily living. If “needs supervision” or “needs assistance” is indicated, please explain the extent and type of supervision or assistance needed in the comments column.*

ACTIVITIES OF DAILY LIVING I S* A* T COMMENTS*

Ambulation

Bathing

Dressing

Eating

Self Care (grooming)

Toileting

Transferring

B. Special Diet Instructions

Regular Calorie Controlled No Added Salt Low Fat/Low Cholesterol

Other, please describe:

C. Does the individual have any of the following conditions/requirements? If yes, please include an explanation in the comments column.

STATUS YES/N0 (Y/N) COMMENTS

1. A communicable disease, which could be transmitted to other residents or staff?

2. Bedridden?

3. Any stage 2, 3, or 4 pressure sores?

4. Pose a danger to self or others?

5. Require 24-hour nursing or psychiatric care?

D. In your professional opinion, can this individual's needs be met in an assisted living facility, which is not a medical, nursing or psychiatric facility? Yes No ___

Comments (Use additional page if necessary):

19


3


DOB:

SECTION 2-A: SELF-CARE AND GENERAL OVERSIGHT ASSESSMENT (MUST BE COMPLETED BY A LICENSED HEALTH CARE PROVIDER BY MEANS OF A FACE-TO-FACE EXAMINATION WITH THE RESIDENT.)

A. ABILITY TO PERFORM SELF-CARE TASKS:

Indicate by a checkmark () in the appropriate column below the extent to which the individuals is able to perform each of the listed self-care tasks. If “needs supervision” or “needs assistance” is indicated, please explain the extent and type of supervision or assistance necessary in the comments column.* KEY: I = Independent S = Needs Supervision A = Needs Assistance

TASKS I S* A* COMMENTS*

Preparing Meals

Shopping

Making Phone Calls

Handling Personal Affairs

Handling Financial Affairs

Other

B. GENERAL OVERSIGHT:

Indicate by a checkmark () in the appropriate column below the extent to which the individual needs general oversight. If other, please explain in the comments column*.

KEY I = Independent W = Weekly D = Daily O* = Other

TASKS I W D O* COMMENTS*

Observing Wellbeing

Observing Whereabouts

Reminders for Important Tasks

Other

Other

Other

Other

C. ADDITIONAL COMMENTS/OBSERVATIONS (Use additional page if necessary):

20


4


DOB:

SECTION 2-B: SELF-CARE AND GENERAL OVERSIGHT ASSESSMENT—MEDICATIONS (MUST BE COMPLETED BY A LICENSED HEALTH CARE PROVIDER BY MEANS OF A FACE-TO-FACE EXAMINATION WITH THE RESIDENT.)

A. Please list all current medications prescribed below (additional pages may be attached):

MEDICATION

DOSAGE

DIRECTIONS FOR USE

ROUTE

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

B. Does the individual need help with taking his or her medications (meds)? Yes No . If yes, please place a checkmark () in front of the appropriate box below:

Needs Assistance with Self-Administration of Medications This allows unlicensed staff to assist with orals and topical medication.

Needs Medication Administration Not all ALFs have licensed staff to provide this service.

Able to Administer w/o Assistance

C. ADDITIONAL COMMENTS/OBSERVATIONS (Use additional page if necessary):

NOTE: MEDICAL CERTIFICATION IS INCOMPLETE WITHOUT THE FOLLOWING INFORMATION:

NAME OF EXAMINER (Please Print):

SIGNATURE OF EXAMINER:

MEDICAL LICENSE #:

ADDRESS OF EXAMINER:

TELEPHONE #:

TITLE OF EXAMINER (Please check the appropriate box): MD DO ARNP PA

DATE OF EXAMINATION:

21

5 AHCA Recommended Form 1823 9/2013


DOB:

SECTION 3: SERVICES OFFERED OR ARRANGED BY THE FACILITY FOR THE RESIDENT (MUST BE COMPLETED BY THE ALF ADMINISTRATOR OR DESIGNEE.)

Note: This section must be completed for all residents based on needs identified in Sections 1 and 2 of this form, or electronic documentation, which at a minimum includes the elements below. The facility may attach the resident’s service plan, care plan, or community living support plan to this document to satisfy this requirement provided the documentation captures the information listed below.

# (Column 1) Needs Identified

from Sections 1 & 2

(Column 2) Service Needed

(Column 3) Service Frequency

& Duration

(Column 4) Service Provider Name

(Column 5) Date Service

Began

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

NAME OF RECIPIENT OR GUARDIAN: (Please Print) SIGNATURE OF RECIPIENT OR GUARDIAN: NAME OF ADMINISTRATOR OR DESIGNEE: (Please Print) SIGNATURE OF ADMINISTRATOR OR DESIGNEE:

Does the facility intend to use this form to satisfy the Medicaid assessment for assistive care services? Yes No

If yes, page 6 is required to be completed. If no, Stop.

22


6

CERTICATE OF MEDICAID NECESSITY

THIS PAGE MUST ALSO BE FILLED OUT FOR RESIDENTS THAT RECEIVE

MEDICAID ASSISTIVE CARE SERVICES

Resident Name ________________________________________ DOB ____________

This is to certify that this recipient is in need of an integrated set of assistive care services on a 24-hour basis,

including at least two of the following four service components on a daily basis (check as applicable):

____ Assistance with activities of daily living, which is defined as individual assistance with ambulating,

transferring, bathing, dressing, eating, grooming, and/or toileting.

____ Assistance with instrumental activities of daily living, which is defined as individual assistance with

shopping for personal items, making telephone calls, managing money, etc.

____ Health support, which is defined as observing the resident’s whereabouts and well-being; reminding

the resident of any important tasks; and recording and reporting any significant changes in appearance,

behavior, or state of health to the health care provider, designated representative, or case manager.

____ Assistance with self-administration of medication, which is defined as assistance with or

supervision of self-administration of medication as permitted by law.

HEALTH CARE PROVIDER

Facility Name: ____________________________________________

License Number: __________________________________________

Administrators’ Signature: ___________________________________

Date Signed: ____________________________________________

CERTIFICATION OF MEDICAL NECESSITY:

Physician/Physician Assistant/

Advanced Registered Nurse Practitioner/

Registered Nurse: ____________________________________________

Date: ____________________________________________

The resident service log is still required for Medicaid residents.

23


7

24

Abuse, Neglect and Exploitation Regulatory Summary s. 415.102 and .1034, Florida Statutes

2014

Abuse means any willful act or threatened act by a relative, caregiver, or household member which causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. Abuse includes acts and omissions.

Exploitation means a person who:

1. Stands in a position of trust and confidence with a vulnerable adult and knowingly, by deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult; or

2. Knows or should know that the vulnerable adult lacks the capacity to consent, and obtains or uses, or endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.

(b) “Exploitation” may include, but is not limited to:

1. Breaches of fiduciary relationships, such as the misuse of a power of attorney or the abuse of guardianship duties, resulting in the unauthorized appropriation, sale, or transfer of property;

2. Unauthorized taking of personal assets;

3. Misappropriation, misuse, or transfer of moneys belonging to a vulnerable adult from a personal or joint account; or

4. Intentional or negligent failure to effectively use a vulnerable adult’s income and assets for the necessities required for that person’s support and maintenance.

Neglect means the failure or omission on the part of the caregiver or vulnerable adult to provide the care, supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services, which a prudent person would consider essential for the well-being of a vulnerable adult. The term “neglect” also means the failure of a caregiver or vulnerable adult to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by others. “Neglect” is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury or a substantial risk of death.

Mandatory Reporting is required for any person – including, but not limited to nursing home staff; assisted living facility staff; adult day care center staff; adult family-care home staff; social worker; or other professional adult care, residential, or institutional staff – who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited.

1-800-962-2873 or www.dcf.state.fl.us/programs/abuse/report.shtml

Florida Health Care Association 25

http://www.dcf.state.fl.us/programs/abuse/report.shtml

Mail To: P. O. Box 1459, Tallahassee, Florida 32302-1459 Telephone: (850) 224-3907 Fax: (850) 681-2075

www.fhca.org

ALFs with Extended Congregate Care Specialty License I. ALFs with an ECC license must use concepts of risk management (429.07 (3)(b) 3. f., F.S.)

a. Managed risk is defined in statute (429.02 (14), F.S.). II. ALFs must allow residents to share responsibility in decision-making (429.07 (3)(b) 3. e., F.S.)

a. Shared responsibility is defined in statute (429.02 (22), F.S.). Regulatory Authority: 429.07 License required; fee.— 3. A facility that is licensed to provide extended congregate care services must: e. Allow residents or, if applicable, a resident’s representative, designee, surrogate, guardian, or attorney in fact to make a variety of personal choices, participate in developing service plans, and share responsibility in decision-making. f. Implement the concept of managed risk. 429.02 Regulatory Definitions (14) “Managed risk” means the process by which the facility staff discuss the service plan and the needs of the resident with the resident and, if applicable, the resident’s representative or designee or the resident’s surrogate, guardian, or attorney in fact, in such a way that the consequences of a decision, including any inherent risk, are explained to all parties and reviewed periodically in conjunction with the service plan, taking into account changes in the resident’s status and the ability of the facility to respond accordingly. (22) “Shared responsibility” means exploring the options available to a resident within a facility and the risks involved with each option when making decisions pertaining to the resident’s abilities, preferences, and service needs, thereby enabling the resident and, if applicable, the resident’s representative or designee, or the resident’s surrogate, guardian, or attorney in fact, and the facility to develop a service plan which best meets the resident’s needs and seeks to improve the resident’s quality of life.

________________________________________________________________________________________

Street Address: 307 West Park Avenue, Tallahassee, FL 32301-1427 26

http://www.fhca.org/

Internal Risk Management and Quality Assurance Program and Adverse Incident Reporting Regulatory Authority

s. 429.23, F.S.; s. 58A-5, FAC; s. 59A-35, FAC 2014

Florida Statute 429.23 Internal risk management and quality assurance program; adverse incidents and reporting requirements.— (1) Every facility licensed under this part may, as part of its administrative functions, voluntarily establish a risk management and quality assurance program, the purpose of which is to assess resident care practices, facility incident reports, deficiencies cited by the agency, adverse incident reports, and resident grievances and develop plans of action to correct and respond quickly to identify quality differences. (2) Every facility licensed under this part is required to maintain adverse incident reports. For purposes of this section, the term, “adverse incident” means: (a) An event over which facility personnel could exercise control rather than as a result of the resident’s condition and results in: 1. Death; 2. Brain or spinal damage; 3. Permanent disfigurement; 4. Fracture or dislocation of bones or joints; 5. Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives; 6. Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident’s condition before the incident; or 7. An event that is reported to law enforcement or its personnel for investigation; or (b) Resident elopement, if the elopement places the resident at risk of harm or injury. (3) Licensed facilities shall provide within 1 business day after the occurrence of an adverse incident, by electronic mail, facsimile, or United States mail, a preliminary report to the agency on all adverse incidents specified under this section. The report must include information regarding the identity of the affected resident, the type of adverse incident, and the status of the facility’s investigation of the incident. (4) Licensed facilities shall provide within 15 days, by electronic mail, facsimile, or United States mail, a full report to the agency on all adverse incidents specified in this section. The report must include the results of the facility’s investigation into the adverse incident. (5) Each facility shall report monthly to the agency any liability claim filed against it. The report must include the name of the resident, the dates of the incident leading to the claim, if applicable, and the type of injury or violation of rights alleged to have occurred. This report is not discoverable in any civil or administrative action, except in such actions brought by the agency to enforce the provisions of this part. (6) Abuse, neglect, or exploitation must be reported to the Department of Children and Family Services as required under chapter 415. (7) The information reported to the agency pursuant to subsection (3) which relates to persons licensed under chapter 458, chapter 459, chapter 461, chapter 464, or chapter 465 shall be reviewed by the agency. The agency shall determine whether any of the incidents potentially involved conduct by a health care professional who is subject to disciplinary action, in which case the provisions of s. 456.073 apply. The agency may investigate, as it deems appropriate, any such incident and prescribe measures that must or may be taken in response to the incident. The agency shall review each incident and determine whether it potentially involved conduct by a

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Internal Risk Management and Quality Assurance Program and Adverse Incident Reporting Regulatory Authority

s. 429.23, F.S.; s. 58A-5, FAC; s. 59A-35, FAC 2014

health care professional who is subject to disciplinary action, in which case the provisions of s. 456.073 apply. (8) If the agency, through its receipt of the adverse incident reports prescribed in this part or through any investigation, has reasonable belief that conduct by a staff member or employee of a licensed facility is grounds for disciplinary action by the appropriate board, the agency shall report this fact to such regulatory board. (9) The adverse incident reports and preliminary adverse incident reports required under this section are confidential as provided by law and are not discoverable or admissible in any civil or administrative action, except in disciplinary proceedings by the agency or appropriate regulatory board. (10) The Department of Elderly Affairs may adopt rules necessary to administer this section.

Administrative Rule 58A-5.0241 Adverse Incident Report.

(1) INITIAL ADVERSE INCIDENT REPORT. The preliminary adverse incident report required by Section 429.23(3), F.S., must be submitted within one (1) business day after the incident on AHCA Form 3180-1024, Assisted Living Facility Initial Adverse Incident Report-1 Day, January 2006, and incorporated by reference. The form shall be submitted via electronic mail to [email protected]; on-line at http://ahca.myflorida.com/reporting/index.shtml; by facsimile to (850)922-2217; or by U.S. Mail to AHCA, Florida Center for Health Information and Policy Analysis, 2727 Mahan Drive, Mail Stop 16, Tallahassee, Florida 32308-5403, telephone (850)412-3731. AHCA Form 3180-1024 is available from the Florida Center for Health Information and Policy Analysis at the address stated above. The Initial Adverse Incident Report is in addition to, and does not replace, other reporting requirements specified in Florida Statutes.

(2) FULL ADVERSE INCIDENT REPORT. For each adverse incident reported under subsection (1) above, the facility shall submit a full report within fifteen (15) days of the incident. The full report shall be submitted on AHCA Form 3180-1025, Assisted Living Facility Full Adverse Incident Report-15 Day, dated January 2006, and incorporated by reference. The methods for obtaining and submitting the form are set forth in subsection (1) of this rule.

59A-35.110 Reporting Requirements; Electronic Submission.

(2) Electronic submission of information.

(a) The following required information must be reported through the Agency’s Internet site at http://www.ahca.myflorida.com/reporting/index.shtml:

2. Assisted living facilities:

a. Adverse incident reports required pursuant to Sections 429.23(3) and (4), F.S., and Rule 58A-5.0241, F.A.C.

(b) The licensee must retain the receipt issued from the Internet site indicating that their transaction was accepted.

(c) If the Agency’s Internet site is temporarily out of service, the required reports may be submitted by mail or facsimile as follows:

2. Adverse incident reports are sent to the Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, 2727 Mahan Drive, MS 16, Tallahassee, FL 32308 or facsimile to (850)922-2217.

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Documents

FHCA 2014 Annual Conference & Trade Sho_Griffin.pdf · FHCA 2014 Annual Conference & Trade Show ... Crystal K – Assisted Living ... Report possible Adverse Incidents to the Agency