Embed Size (px)
Citation preview
5/19/2017
1
May 19, 2017 1
New AdministratorTraining
May 19, 2017
Division of ACF / Assisted Living Surveillance
Patricia Hasan
May 19, 2017 3
Division of ACF/Assisted Living Surveillance
Director Valarie Deetz
Central Office Staff
Regional Office StaffWestern - Noreen NickasonCentral - John VanDykeCapital District – Patricia HasanMetropolitan Area - Bobbi Barrington, John Pinto
5/19/2017
2
May 19, 2017 4
Regional Offices and Counties Served
Western Regional Office 355 E. Main StreetRochester, NY 14604(585) 423-8185Counties: Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, and Yates
Central Field Office 217 South Salina Street4th FloorSyracuse, NY 13202-3592 (315) 477-8472Counties: Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, and Tompkins
May 19, 2017 5
Regional Offices and Counties Served
Capital District Regional Office 875 Central Avenue Albany, NY 12206(518) 408-5287Counties: Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
Metropolitan Area Office 90 Church Street15th FloorNew York, NY 10007-2919(212) 417-4440Counties: Kings, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, and Westchester.
May 19, 2017 6
Types of Assisted Living Facilities
Adult Home Enriched Housing Program
Assisted Living ResidenceSpecial Needs Assisted Living ResidenceEnhanced Assisted Living Residence
Assisted Living Program
5/19/2017
3
May 19, 2017 7
Regulations
All ACFs18 NYCRR Codes Rules & Regulations Part 485 18 NYCRR Codes Rules & Regulations Part 486Adult Home18 NYCRR Codes Rules & Regulations Part 487Enriched Housing Program18 NYCRR Codes Rules & Regulations Part 488Assisted Living Residence10 NYCRR Codes Rules and Regulations Part 1000Assisted Living Program18 NYCRR Codes Rules & Regulations Part 49410 NYCRR Codes Rules and Regulations Parts 763 and 766
May 19, 2017 8
Waivers and Equivalencies
Upon request by the operator, the department may waive nonstatutory requirements of this Part. An operator must request and receive written approval prior to instituting any alternative. Applications for approval must be submitted in writing to the appropriate regional office and shall include: (i) the specific regulation for which a waiver is sought; (ii) the reason the waiver is necessary; and (iii) a description of what will be done to achieve or maintain the intended outcome of the regulation and to protect the health, safety and well‐being of the residents. (2) The department may require that the operator make physical plant modifications or adopt special methods or procedures to protect resident health and safety and shall grant written approval only upon determination that the proposed waiver will not adversely affect the health, safety and well‐being of residents.
May 19, 2017 9
Waivers and Equivalencies
Index of Equivalencies in Dear Administrator Letters and on DOH web
Adult Care Facility Waiver Request/Equivalency Notification Form DOH-4235
Why is it necessary and how intent of the regulation will be met
5/19/2017
4
May 19, 2017 10
Waivers and Equivalencies
Water Temperature
Issue: Water Temperature above 110 degrees (43 degrees Celsius).
Conditions for approved equivalency: The water temperature may be raised above 110 degrees Fahrenheit provided that the following conditions are met: 1) The maximum water temperature allowed in resident areas is 120 degrees Fahrenheit. 2) Periodic logs of all water temperature readings must be maintained and immediate action taken should temperatures exceed 120 degrees Fahrenheit . 3) All current residents must receive advance notice and newly admitted residents must receive notice that their water temperature may reach up to 120 degrees Fahrenheit with additional reminders as necessary. 4) The operator must provide assistance with bathing/showering as needed or requested, even if only precautionary due to the higher water temperatures.
Regulations: 487.11 (h) (4) (11) The water temperature at faucets for bathing, showering and handwashing must be capable of attaining a temperature of 95 degrees Fahrenheit and must not attain a temperature in excess of 110 degrees Fahrenheit. 488. 11(e) (9) The water temperature at faucets for bathing, showering, and handwashing must be capable of attaining a temperature of 95 degrees Fahrenheit but must not attain a temperature in excess of 110 degrees Fahrenheit where controllable by the operator.
May 19, 2017 11
Regulation Review
Redefining Adult Care Facilities for the 21st Century
Revise regulations incorporating policy interpretations, waivers and equivalencies; streamline, clarify and reduce duplicity across various sets of regulations.
Members – Residents, Associations, Resident Advocacy Organizations, Administrators, NYS LTC Ombudsman, Independent Living Organization, the Justice Center
May 19, 2017 12
Adult Care Facility (ACF)
Family-type Homes Residence for AdultsShelter for AdultsAdult Homes
Provide temporary or long term residential care and services to adults who, though not requiring continual medical or nursing care as provided by facilities licensed or operated pursuant to article 28 of Public Health Law or articles 19, 23, 29, and 31 of the Mental Hygiene Law, are by reason of physical or other limitations associated with age, physical or mental disabilities or other factors, unable or substantially unable to live independently
5/19/2017
5
May 19, 2017 13
Adult Home (AH)
An adult care facility established and operated for the purpose of providing long-term residential care, room, board, housekeeping, personal care and supervision to 5 or more adults unrelated to the operator
18 NYCRR Part 487
May 19, 2017 14
Enriched Housing Program (EHP)
An adult care facility established and operated for the purpose of providing long-term residential care to 5 or more adults, primarily persons 65 years of age or older, in community-integrated settings resembling independent housing units. Such program shall provide or arrange for the provision of room, and provide board, housekeeping personal care and supervision18 NYCRR Part 488
May 19, 2017 15
Assisted Living Residence (ALR)
Provides or arranges for housing, onsite monitoring, and personal care services and/or home care services in a home-like setting to 5 or more adult residents unrelated to the assisted living provider. An ALR must also provide food, 24 hour on-site monitoring, case management services, and the development of an individualized service plan (ISP).
5/19/2017
6
May 19, 2017 16
Assisted Living Residence (ALR)
A licensed ALR may also be certified as an Enhanced Assisted Living Residence (EALR), and/or Special Needs ALR (SNALR)
EALR Supports aging in placeProvides or arranges nursing care
SNALRServes a those with a special needs, such as cognitive impairment
May 19, 2017 17
Enhanced Assisted Living Residence
Aging in place
Chronically chairfast and unable to transfer
Chronically require the physical assistance of another person to transferwalkclimb/descend stairs
Are dependent on medical equipment and require more than intermittent or occasional assistance from medical personnel
Chronic unmanaged urinary or bowel incontinence
May 19, 2017 18
Special Needs Assisted Living Residence (SNALR)
Provision of Services
Department approved plan
Services provided by appropriately trained individuals
Consistent with Individualized Service Plans
5/19/2017
7
May 19, 2017 19
Special Needs Assisted Living Residence (SNALR)
Disruptive/Aggressive behaviors
Evaluation by the Operator
Determine precipitating factors
Make staff aware of precipitating factors that need to be avoided
Develop a plan to include successful interventions and to promote the highest level of resident function
May 19, 2017 20
Special Needs Assisted Living Residence (SNALR)
Resistance to personal care
ISPs and Case Management documentation including a plan for addressing such services
Staff considerations
Pain
May 19, 2017 21
Assisted Living Program ALP
Adult Home or Enriched House Program and Licensed home care services agency LHCSA orCertified home health agency CHHA orLong term home health care program LTHHCP
If not a CHHA or LTHHCP, must contract with one for nursing and therapy services.
5/19/2017
8
May 19, 2017 22
Assisted Living Program ALP
ALP Regulations Title 18 NYCRR Part 494
Supportive housing and home care to those eligible for placement in a nursing facility
Facility provides or arranges for room, board, personal care, supervision, case management and housekeeping
CHHA, LHCSA or LTHHCP provide nursing and therapy
May 19, 2017 23
Assisted Living Program ALP
Services included in the Medicaid Capitated rate include:
Personal care servicesHome health aide servicesPersonal emergency response servicesNursing ServicesPhysical, Occupational and Speech therapyMedical supplies and equipmentAdult Day Health Care
May 19, 2017 24
Assisted Living Program ALP
Surveillance
5/19/2017
9
May 19, 2017 25
Department Communication
Health Commerce System HCS
Dear Administrator Letter DAL
Statement of Deficiencies SOD, Electronic Plan of Correction
Monthly Association Meetings
BML – Bureau Mail Log (email)
May 19, 2017 26
Health Commerce System
Secure internet based electronic portal used for communications and critical information sharing
DAL # 15-02 March 19, 2015Required and recommended roles
DAL 16-20 September 7, 2016HCS Contact information
May 19, 2017 27
Health Commerce System
Request Accounts
HCS Director and Health Provider Network Coordinator (HPN) Accounts(518)408-1133
Criminal History Record Authorized Person Role 518(402-5549)
Following request ACF Director receives document via email to complete, sign before a notary, and send to the Department’s Commerce Account Management Unit (CAMU)
Populate require HCS Communication Directory Roles
5/19/2017
10
May 19, 2017 28
Health Commerce System
Content – all applications
A – Z index of applications
Choose application, application profile, and green + to add to applications displayed on your home page
May 19, 2017 29
Health Commerce System
HCS Applications
CHRC Criminal History Record CheckEfinds Evacuation of Facilities in Disaster SystemePoc Electronic Plan of Correction HERDS Health Emergency Response in Data SystemUAS_NY Uniform Assessment System for New YorkSecure File Transfer
May 19, 2017 30
Health Commerce System
CHRC Criminal History Record Check
What do you want to doHelp – tutorials, FAQLinks to submit/terminate an employee, schedule fingerprint, manage AP assignments, forms, contact CHRC
5/19/2017
11
May 19, 2017 31
Health Commerce System
Efinds Evacuation of Facilities in Disaster System for New York
DAL 6/5/13
Bar coded bracelets applied to residents, scanned upon evacuation, arrival at new location, and when returning to the ACF
Include in facility’s evacuation plan
Inservice and reinforce with staff periodically
Tutorials, practice tools, quick guide card on HCS/DOH web http://www.health.ny.gov/
[email protected] for questions and replacement bracelets
L‐Tron Corporation (585)383‐0050, ext 111 for replacement scanner
May 19, 2017 32
Health Commerce System
Epoc Electronic Plan of Correction
DAL 15-03 April 21, 2015DAL 15-09 July 1, 2015 DAL 16-24 November 8, 2016
Administrator role may read, edit, save, submit
POC Editor role may read, edit and save POCs
Operator may read
May 19, 2017 33
Health Commerce System
HERDS Health Emergency Response in Data System
Add to My Applications
Submit reports and requested information to the Department
5/19/2017
12
May 19, 2017 34
Health Commerce System
UAS-NY Uniform Assessment System for New York
Comprehensive assessment used in Medicaid home and community-based long term care programs, including the Assisted Living Program.
Can be used as a basis for plan of care
May 19, 2017 35
Health Commerce System
Secure File Transfer
Transmit sensitive information between HCS users
File remains on the HCS for 14 days
May 19, 2017 36
Health Commerce System
Dear Administrator letters
Primary method of communication from Department to ACFs
Location: Health Commerce System ‐ My Content ‐ Documents by Group ‐ Long Term Care ‐Dear Administrator Letters ‐ (select the year you wish to review) ‐ ACF
5/19/2017
13
May 19, 2017 37
Bureau Mail Log
ACF CON BML (Licensure and Certification) [email protected]
ACF Financial Report BML (HCS Finance questions) [email protected]
Adult Home, Enriched Housing Program, and Assisted Living Program [email protected]
Assisted Living Residence (ALR), Special Needs Assisted Living Residence
(SNALR), and Enhanced Assisted Living Residence (EALR)
CHRC (Criminal History Record Check) [email protected]
Health Homes, Managed Long Term Care plans, housing contractors,
Managed Care Plans (Questions regarding: inreach, assessments and
development of care plans for adult home residents with serious mental
illness transitioning to the community with support services.)
efinds [email protected]
EQUAL [email protected]
Justice Center [email protected]
Transitional Adult Home [email protected]
UAS‐NY [email protected]
May 19, 2017 38
New Administrator Checklist
SFS Statewide Financial SystemNYS accounting and financial management system
Set up account @ SFS helpdesk 1-855-233-8363
www.sfs.ny.gov
ACF/Assisted Living Mandated forms
Adult Care Facilities Formswww.health.ny.gov/facilities/adult_care/forms.htm
May 19, 2017 39
New Administrator ChecklistClass 3a License
Title 10 New York Codes, Rules and Regulations (NYCRR) Part 80
Bureau of Narcotics Enforcement [email protected]
Loss of Controlled Substance DOH-4330
Request for Approval of Disposal/Destruction of Controlled Substance DOH-2340https://www.health.ny.gov/professionals/narcotic/forms.htm
5/19/2017
14
May 19, 2017 40
New Administrator Checklist
Emergency Preparedness
Review Disaster and Emergency Evacuation Plan
Inservice Staff
List of residents requiring assistance evacuatingCurrentStaffing sufficient to carry out the plan
Public Health Duty Officer Helpline 1-866-881-2809
May 19, 2017 41
Inspection
Full
Summary
Follow-up
Partial
Complaint
May 19, 2017 42
Inspection
Entrance conference
Tour
Observations
Interviews with residents and staff
Record review
Exit conference
Inspection report
epoc
Inspection Review Process
Enforcement
5/19/2017
15
May 19, 2017 43
Inspection
Requested Items Lists
Surveillance Posters for full inspections
Notification to the Long Term Ombudsman Program
Inspection team interview residents, staff, and others as appropriate
May 19, 2017 44
Inspection/Medication System
System for ordering, receiving and providing medications,
Procedure for notifying MD of missed medications and changes in orders
Labels following changes in orders
Medication storage – clean, secure
Discontinued medications
Controlled substances
Filling syringes
May 19, 2017 45
Inspection/Medication System
Observation of the medication pass
Residents who self administer
Glucose testing, and other medical equipment
Crushed medications
Medications placed in food
Fluid restrictions
Altered consistency diets
5/19/2017
16
May 19, 2017 46
Inspection/Medication System
Record review
Physician orders in the resident’s record
Physician attestation resident can administer medication, manage medical equipment
Rx, Medication Assistance Record, and Medication Label match
ALR requirements – diagnosis, allergies, indications
Dementia - prn Rx includes signs and symptoms, licensed staff are consulted
May 19, 2017 47
Inspection/Food Service and Nutrition
Staff in charge of the kitchen
Type of service, number of dining rooms, meal and snack times
Diets offered, consistency modifications and fluid restrictions
Posting of menu and substitutions
May 19, 2017 48
Inspection/Food Service and Nutrition
Physician notification of weight changes
Residents not eating well, using adaptive equipment, have swallowing impairment, are receiving room trays, bagged meals, supplements, hospice, or dialysis, physician notification of weight changes
Sanitation NYCRR Part 14
5/19/2017
17
May 19, 2017 49
Inspection/Environment
Name of maintenance director
Staff with HCS access
Smoking policy, designated area, unsafe smoking
Bed bugs
Special services
May 19, 2017 50
Inspection/Environment
Equipment and Systems
Fire Safety – drills, extinguishers, alarm system
Disaster and Emergency Plan
CHRC review
Sanitation NYCRR Part 14
May 19, 2017 51
Inspection/Program
Resident review – preadmission, persistent efforts, post discharge
Case management
Supervision
Business records
Resident council
5/19/2017
18
May 19, 2017 52
Inspection/Program
Day program
Activities
Staff qualifications, training, continuing education
Medical equipment
Posting
May 19, 2017 53
Inspection
Postings
Operating CertificateDALs EALR vacanciesWeekly menusResident Rights PosterInspection ReportOmbudsmanNo tipping notice (not EHP)Grievance Procedure (not EHP)Personal Needs Accounts Banking Hours
May 19, 2017 54
Inspection
CHRC
5/19/2017
19
May 19, 2017 55
Inspection
Most Frequent Citations
Resident Services – medications, case management, supervision
Environmental Standards – maintenance of the building, grounds, equipment, housekeeping/vermin, fire protection
Records and Reports – maintenance and availability of resident recordsFood Service – purchasing, storage, preparation, prescribed diets and allergies
Admission Standards – admission criteria, medial evaluations, mental health evaluations, persistent efforts
May 19, 2017 56
Incident Reporting
DSS-3122 DOH - 5175
May 19, 2017 57
Outbreak of Illness
Notify both Local and Regional Health Department
Local Health Department provides infection control expertise
Staff considerations
A-Z index on HCS as well as DOH web
5/19/2017
20
May 19, 2017 58
Notify the Department
Disaster and emergency procedures. ...... (l) Any time there is a work stoppage, a fire within the building that affects the program, the failure of any of the fire prevention or detection systems, a lack of hot water, interruption or shut off of essential services or any circumstance necessitating the implementation of the disaster and emergency plan, the appropriate regional office of the department will be notified by the next business day.
Other events ……….
May 19, 2017 59
Assessment
May 19, 2017 60
Resident Evaluation
Pre-admission/initial Every 6 months for ALPChange in condition resulting in change in service planAnnual
Ongoing documentation in resident record of resident needs and staff activity undertaken to meet those needs
5/19/2017
21
May 19, 2017 61
Flu and Pneumonia Immunizations
May 19, 2017 62
Termination
May 19, 2017 63
Policies and ProceduresPolicy:A predetermined course of action that is stated clearly and simply
Used to set direction in an organization and assist in guiding decisions
Procedure:Describes step-by-step instructions to accomplish the policy
Identifies the staff person(s) responsible to implement and monitor the procedures
Include sufficient clear detail that end users will easily understand how to comply
5/19/2017
22
May 19, 2017 64
Guidance When Writing a PolicyInformation should be stated in an easy to read format
Language should be clear and easily understood so that it can be retained and used
Avoid lengthy complex information
Remember your objective(s)
Keep language specific to reflect the policy’s intent so there is no misinterpretation
Reference information from a credible source
May 19, 2017 65
Guidance When Writing a Policy cont.Suggested information to be included in each policy:
Agency Name
Title: Clear and concise
Policy Statement/Purpose: Include a purpose which indicates the intent or objective of the policy
Date: Policy date and revision date is clearly indicated
Page Number: Number each page, e.g. 1 of 4 pages
May 19, 2017 66
Guidance When Writing a Policy cont.Information to consider when developing a policy:
Authority: Reference to the guidance which governs the policy, statute or regulation
Application: Who or what the policy applies to is clearly identified (e.g. new employees, food service staff)
Responsible Party: Identify the Title, Position or Department
Terminology: Is defined so that it is easily understood in context of the policy, e.g. authorized person or temporary employee are terms thatmust be defined in the CHRC policy.
5/19/2017
23
May 19, 2017 67
Guidance When Writing a ProcedureDescribe each step by step in the process and actions needed to comply with a policy (while policies guide decisions, procedures show how to complete the task or process)
A well written procedure communicates effectively and should contain the following information: An overview of the procedure Identification of any necessary skills and/or materials needed A logical sequence of steps in the order they occur (steps should be clear, concise and easy to follow) Use illustrations or examples, if appropriate, that may increase the clarify of the steps identified.
May 19, 2017 68
Policy TemplateAgency Name:_____________ Page Number:______Effective Date:_____________ Revised Date:_______
Policy Title:_____________________
Statement/Purpose: Statement of purpose for the policy
Authority: Reference to regulations, rules a/or policy directives that govern the policy
Application: Who/What the policy applies to
Terminology: Policy is defined, clear and easily understood
Responsible Party: Title, Position or Department
Procedure: Overview of Procedure if appropriate
A. Identification of skills and/or materials neededB. Steps in the order they occur
May 19, 2017 69
THANK YOUCentral Office (518) 408-1133 [email protected]
Regional Offices
Western - Noreen Nickason (585) 423-8185
Central - John VanDyke (315) 477-8472
Capital District – Patricia Hasan (518) 408-5287
Metropolitan – Bobby Barrington, John Pinto (212) 417-4440
