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P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 1
Wisconsin Department of Health Services
STATE OF ASSISTED LIVING Mid-year 2017 August 15,2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 2
Wisconsin Department of Health Services
Agenda 1. BAL Staffing
2. Trends and Statistics
Assisted Living (AL) Capacity
AL Complaints
AL Self-Reports
AL Survey
Abbreviated Surveys
AL Enforcement
Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL)
3. Bureau of Assisted Living Strategies
4. Wrap-Up
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 3
Wisconsin Department of Health Services
Bureau of Assisted Living Staffing
Assisted Living Regional Directors
• Northeastern Regional Office (NERO)
o Kathy Lyons
• Western Regional Office (WRO)
o William Gardner
• Southern Regional Office (SRO)
o Linda Boswell
• Southeastern Regional Office (SERO)
o Michelle Crockett
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 4
Wisconsin Department of Health Services
Quality Assurance Program Specialists, Senior
• Sandra Finseth
• Cindy O’Connell
• Cheryl Bott
Bureau of Assisted Living Staffing
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 5
Wisconsin Department of Health Services
Central Office Staff
• Damon Scott, Office Operations Program Associate
• Lori Smithback, Central Licensing Associate
• Chquota Weis, Central Health Service Specialist
• Sharon Paulson, Central Health Service Specialist
Bureau of Assisted Living Staffing
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 6
Wisconsin Department of Health Services
Assisted Living Support Staff
• Southern Regional Office
o Thom Smith
o Julie Mallder
• Western Regional Office
o Moua Luedtke
o Wendy Badzinski
• Southeastern Regional Office
o Rothea Hunt
o Vacant
• Northeastern Regional Office
o Diane Van Rens
o Carrie Raasch
Bureau of Assisted Living Staffing
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 7
Wisconsin Department of Health Services
Assisted Living Surveyors
Northeastern Regional Office
o Jerome Riederer
o Heather Schweiner
o Phyllis Witter
o Jule Degrave
o Connie Van Rossum
o Trisha Piotraschke
o Cari Gast
o Vicky Whittman
o Sandra Culligan
o Nicole Hall
Bureau of Assisted Living Staffing
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 8
Wisconsin Department of Health Services
Assisted Living Surveyors
Southeastern Regional Office
o Bunny Booker
o MaryBeth Hoffman
o Sharon Gries
o Connie Knezic
o Tom Redding
o Joelle Verstegen
o Cindie Wilbur
o Kelly Clark
o Vacant
Bureau of Assisted Living Staffing
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 9
Wisconsin Department of Health Services
Bureau of Assisted Living Staffing Assisted Living Surveyors
Western Regional Office
o Cynthia Larson
o Mary Eckwright
o Ann Colbenson-Hallum
o Kris Carew
o Judy Jordan
o Kelly Haugen
o Ron Kunferman
o Angela Greger
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 10
Wisconsin Department of Health Services
Assisted Living Surveyors
Southern Regional Office
o Thomas Herrewig
o Leann Fox
o Geralyn Spitzer
o Tina Lubick
o Roda McLees
o Emily Wilson
o Stephanie Solberg
o Shannon Lane
Bureau of Assisted Living Staffing
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 11
Wisconsin Department of Health Services
Bureau of Assisted Living Regional Assignments
SERO • Kenosha, Milwaukee, Racine
NERO
• Adams, Brown, Calumet, Door, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, Ozaukee, Portage, Shawano, Sheboygan, Washington, Waushara, Waupaca, Winnebago, Wood
SRO • Columbia, Crawford, Dane, Dodge, Grant, Green, Iowa, Jefferson, Lafayette, Richland, Rock, Sauk,
Walworth, Waukesha
WRO • Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Douglas, Dunn, Eau Claire, Florence,
Forest, Iron, Jackson, Juneau, Langlade, La Crosse, Lincoln, Marathon, Monroe, Oneida, Pepin, Pierce, Polk, Price, Rusk, Sawyer, St. Croix, Taylor, Trempealeau, Vernon, Vilas, Washburn
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 12
Wisconsin Department of Health Services
Wisconsin Assisted Living Facilities
•Wis. Admin. Code ch. DHS 88
•Wis. Stat. ch. 50
•Wis. Admin. Code ch. DHS 89
•Wis. Stat. ch. 50
•Wis. Admin. Code ch. DHS 83
•Wis. Stat. ch. 50
•Adult Day Standards
Adult day care
Community-based
residential facility
Adult family home
Residential care
apartment complexes
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 13
Wisconsin Department of Health Services
Regulatory Trends
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 14
Wisconsin Department of Health Services
Regulatory Trends • Increase in:
o Number of Assisted Living Facilities
Licensing/Certification • Adult Family Homes largest provider type (2083)
• Change of Ownership
Facilities closing
• Never serving residents
• Financial issues
Increase in affiliated providers over single facility operators
More than 77% of facilities serve more than 3 client groups
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 15
Wisconsin Department of Health Services
Regulatory Trends • Increase in:
o Citing Trends
Medication administration
Care planning
Health monitoring
Investigating abuse and neglect
o Complaints
Complaint subject areas
• Program Services
• Physical Environment
• Resident Rights
• Staff Training and Proficiency
More complaints for affiliated provider vs single operator
Highest source of complaint is anonymous and relative/guardian/POA-HC
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 16
Wisconsin Department of Health Services
Regulatory Trends • As a result, BAL sees:
o Increased complexity of investigations o Serious outcomes to resident
Sexual assault Resident injuries Resident discharge
o Failure to sustain compliance Affiliated providers Repeat/uncorrected citations Process requirements
o Increased enforcement activity Revocations Directed Plan of Correction (DPOC) Forfeitures License Denials
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 17
Wisconsin Department of Health Services
Assisted Living Facilities
0
1000
2000
3000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
RCAC 152 171 188 203 218 245 271 278 295 303 308 313 320 342 334AFH 765 834 965 1049 1130 1185 1273 1392 1467 1544 1621 1759 1835 2061 2083CBRF 1352 1367 1372 1382 1403 1429 1458 1470 1476 1501 1514 1522 1536 1620 1622
Num
ber o
f Com
mun
ities
Trend in Number of Facilities
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 18
Wisconsin Department of Health Services
Assisted Living Capacity
0
10000
20000
30000
40000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
AFH 2964 3217 3727 4054 4358 4585 4916 5430 5730 5987 6285 6815 7105 7983 8042RCAC 6055 6614 8003 8980 9562 10579119881233013176135801406914338145521558315556CBRF 213922173921996224082282223490243662476525201259852675027597284143065331071
Capa
city
Trend in Assisted Living Capacity
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 19
Wisconsin Department of Health Services
Nursing Home and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
FIDs 37 35 32 22 19 16 14 14 13 13 12 10 7 7 7NHs 407 404 404 403 402 399 399 399 400 397 399 395 396 390 392
050
100150200250300350400450
Num
ber o
f Fac
ilitie
s
Year
Trend in Number of Facilities
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 20
Wisconsin Department of Health Services
Nursing Home and ICF/IID
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17FIDs 2,391 2,115 1,734 1,354 1,190 1,102 989 939 908 768 720 577 540 539 539NHs 40,661 39,959 39,276 38,700 38,106 37,494 36,557 36,022 35,661 34,992 34,639 33,886 33,893 32,666 32,232
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
Resi
dent
Cap
acity
Year
Trend in Capacity for Residents
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 21
Wisconsin Department of Health Services
Assisted Living vs. LTC Facilities
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
AL 2269 2372 2525 2634 2751 2859 3001 3238 3348 3348 3577 3727 3881 4166 4171LTC 444 439 436 425 421 415 413 413 413 410 411 405 403 397 399
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Num
ber
of F
acil
itie
s
Trend in Number of Facilities
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 22
Wisconsin Department of Health Services
Assisted Living vs. LTC Capacity
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
LTC 43052 42074 41010 40054 39296 38596 37546 36961 36569 35760 35359 34463 34433 33205 32771AL 30411 31570 33726 35442 36742 38654 41270 42525 44107 45552 51158 52719 54383 59224 59068
0
10000
20000
30000
40000
50000
60000
70000
Cap
acit
y
Trend in Capacity for Residents
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 23
Wisconsin Department of Health Services
Residential Care Apartment Complex (RCAC)
0
100
200
300
400
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
Registered 67 77 84 88 93 100 97 94 99 99 98 93 96 100 98Certified 86 94 104 115 125 147 174 184 196 204 210 220 224 242 236Total 153 171 188 203 218 247 271 278 295 303 308 313 320 342 334
Num
ber o
f RCA
C
Year
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 24
Wisconsin Department of Health Services
Adult Day Care (ADC) Centers
020406080
100120140160
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
ADC 101 105 106 97 102 114 115 121 128 134 134 133 140 143 132
Num
ber o
f AD
C
Year
Trend in Number of Centers
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 25
Wisconsin Department of Health Services
Adult Day Care Centers
0
1,000
2,000
3,000
4,000
5,000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
ADC 2,526 2,578 2,582 2,617 2,770 3,101 3,097 3,407 3,471 3,874 4,054 3,969 4,234 4,735 4,399
Capa
city
Year
Trend in the Capacity for Participants
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 26
Wisconsin Department of Health Services
Ownership by Count: All AL Facilities
CHURCH, 60
CORPORATION - BUSINESS, 1191
CORPORATION - NONPROFIT, 635
GOVERNMENT - COUNTY, 37
GOVERNMENT - STATE, 2 GOVERNMENT - OTHER,
9
LIMITED LIABILITY COMPANY, 1788
PARTNERSHIP, 78
PROPRIETORSHIP, 341
TRIBAL, 4 OTHER, 31
CHURCH
CORPORATION - BUSINESS
CORPORATION -NONPROFITGOVERNMENT - COUNTY
GOVERNMENT - STATE
GOVERNMENT - OTHER
LIMITED LIABILITYCOMPANYPARTNERSHIP
PROPRIETORSHIP
TRIBAL
OTHER
Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 27
Wisconsin Department of Health Services
Ownership-AFH
CHURCH, 13
CORPORATION - BUSINESS, 603
CORPORATION - NONPROFIT,
219
GOVERNMENT - COUNTY, 8
GOVERNMENT - STATE, 1
LIMITED LIABILITY COMPANY, 867
OTHER, 21
PARTNERSHIP, 64 PROPRIETORSHIP, 286
CHURCH
CORPORATION -BUSINESSCORPORATION -NONPROFITGOVERNMENT -COUNTYGOVERNMENT - STATE
LIMITED LIABILITYCOMPANYOTHER
PARTNERSHIP
PROPRIETORSHIP
Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 28
Wisconsin Department of Health Services
Ownership-CBRF CHURCH, 14
CORPORATION - BUSINESS, 506
CORPORATION - NON PROFIT, 295
GOVERNMENT - COUNTY, 17 GOVERNMENT - OTHER, 6
GOIVERNMENT - STATE, 1
LIMITED LIABILITY COMPANY, 727
OTHER, 4
PARTNERSHIP, 10
PROPRIETORSHIP, 38
TRIBAL, 4
CHURCH
CORPORATION -BUSINESSCORPORATION - NONPROFITGOVERNMENT -COUNTYGOVERNMENT - OTHER
GOIVERNMENT - STATE
LIMITED LIABILITYCOMPANYOTHER
PARTNERSHIP
Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 29
Wisconsin Department of Health Services
Ownership-ADC
CHURCH, 21
CORPORATION - BUSINESS, 30
CORPORATION - NONPROFIT, 36
GOVERNMENT - COUNTY, 7
GOVERNMENT - OTHER, 1
LIMITED LIABILITY COMPANY, 16
OTHER, 4
PARTNERSHIP, 1
PROPRIETORSHIP, 16
CHURCH
CORPORATION -BUSINESSCORPORATION -NONPROFITGOVERNMENT -COUNTYGOVERNMENT - OTHER
LIMITED LIABILITYCOMPANYOTHER
PARTNERSHIP
PROPRIETORSHIP
Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 30
Wisconsin Department of Health Services
Ownership-RCAC
CHURCH, 12
CORPORATION - BUSINESS, 52
CORPORATION - NON PROFIT, 84
GOVERNMENT - COUNTY, 5 GOVERNMENT - OTHER, 2
LIMITED LIABILITY COMPANY, 178
OTHER, 2
PARTNERSHIP, 3 PROPRIETORSHIP, 1
CHURCH
CORPORATION -BUSINESSCORPORATION - NONPROFITGOVERNMENT -COUNTYGOVERNMENT - OTHER
LIMITED LIABILITYCOMPANYOTHER
PARTNERSHIP
PROPRIETORSHIP
Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 31
Wisconsin Department of Health Services
CBRF Training Registry Services
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 32
Wisconsin Department of Health Services
CBRF Employee Registry Mid-year 2017
StandardPrecautions
MedicationAdministration Fire safety First Aid Total Number
since April 2010
Number of Students Trained Employees 6,884 5,101 6,419 6,094 24,498Number of Classes Held 2,635 1,278 1,311 1,320 6,544
0
5,000
10,000
15,000
20,000
25,000
30,000
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 33
Wisconsin Department of Health Services
Assisted Living Complaints Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 34
Wisconsin Department of Health Services
Assisted Living Complaints Received
0
200
400
600
800
1,000
1,200
1,400
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
# complaints 792 667 677 718 681 774 836 789 801 916 900 981 1,117 1,207 702
Num
ber o
f Com
plai
nts
Year
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 35
Wisconsin Department of Health Services
Complaints Received Mid-year 2017
1%
28%
63%
8%
Complaints ADC AFH CBRF RCAC
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 36
Wisconsin Department of Health Services
Source of Complaint Mid-year 2017
34%
13%
31%
3%
4% 3%
5% 6% 1%
AnonymousPublic OfficialRelative or GuardianCurrent EmployeeFormer EmployeeMedicalCitizenResidentAdvocate
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 37
Wisconsin Department of Health Services
Complaints vs. Growth
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
# complaints 792 667 677 718 681 774 836 789 801 916 900 981 1117 1207 702# AL Facilities 2370 2477 2631 2731 2853 2973 3117 3261 3366 3482 3577 3727 3881 4166 4171
0500
10001500200025003000350040004500
2003- 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 38
Wisconsin Department of Health Services
Percentage of Facilities with Complaints Submitted
11.3%
89.7%
% of Facilities withComplaints Submitted% of Facilities with NoComplaints
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 39
Wisconsin Department of Health Services
Assisted Living Self-Reports Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 40
Wisconsin Department of Health Services
Self-Reports Received
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
1,166 1,452
1,856 1,872
2,751
3,446 3,271
3,534 3,343
3,645 4,058
4,473
2,383
Tota
l Num
ber
Year
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 41
Wisconsin Department of Health Services
Self-Reports Received Mid-year 2017 (2,383)
10%
90%
Self-Reports Open Investigation File
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 42
Wisconsin Department of Health Services
Number of Self-Reports by Subject Area
54%
7% 9%
8%
9% 6%
2% 2% 1% 1% 0% 1%
Mid-year 2017 Falls Resident Behavior PoliceElopement Hospital (Not Fall) OtherMisappropriation Abuse NeglectFire Communicable Disease Disaster or Evacuation
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 43
Wisconsin Department of Health Services
No SOD 96%
SOD 4%
Self Reports Investigated – Mid-year 2017 (478)
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 44
Wisconsin Department of Health Services
Abbreviated Surveys Mid-year 2017
• No deficiency survey - 64%
• Statement of deficiency - 36%
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 45
Wisconsin Department of Health Services
Facilities Qualifying for Abbreviated Surveys Mid-year 2017
• Adult day care 65% • Adult family home 49% • Community-based residential facility 44% • Residential care apartment complex 64%
• Statewide 49%
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 46
Wisconsin Department of Health Services
Facilities Qualifying for an Abbreviated Survey
0%
10%
20%
30%
40%
50%
60%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
% Abbr. Surveys 37.2%37.9%38.2%40.5%39.3%42.4%45.7%46.7%46.8%50.8%53.5%49.1%47.7% 46.10 49.0%
% o
f Tot
al F
acili
ties
Year
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 47
Wisconsin Department of Health Services
Statewide Survey Results
0%10%20%30%40%50%60%70%
No Citations SOD Only Surveys withEnforcement
2007 62% 15% 23%2008 63% 15% 22%2009 61% 16% 23%2010 63% 12% 25%2011 63% 15% 22%2012 65% 14% 21%2013 65% 14% 21%2014 excludes initial & CHOW 55% 11% 33%2015 60% 10% 27%2016 63% 11% 26%Jun-17 54% 17% 29%
% o
f T
otal
Sur
veys
Year
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 48
Wisconsin Department of Health Services
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016June2017
Total Citations 2,421 2,625 2,569 2,759 2,369 2,417 2,623 2,471 2,420 2,091 2,423 2,437 2,719 1,322Average per Survey with Citation 3.3 3.3 3.7 3.3 3 2.9 3.4 3.6 3.3 3.2 2.5 3 3.3 3.2
0
0.5
1
1.5
2
2.5
3
3.5
4
0
500
1,000
1,500
2,000
2,500
3,000
Ave
rage
Cit
atio
ns p
er S
urve
y w
ith
Cit
atio
ns
Year
Tot
al C
itat
ions
Assisted Living Citations Issued
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 49
Wisconsin Department of Health Services
CBRF Top Ten Citations Mid-year 2017
05
101520253035
Number of Citations83.47(2)(d) FIRE DRILLS 3283.32(3)(h) RIGHTS OF RESIDENTS: TO RECEIVE
MEDICATION 31
83.47(2)(e) OTHER EVACUATION DRILLS 2683.35(3)(d) SERVICE PLANS UPDATED ANNUALLY OR
ON CHANGES 25
83.25 CONTINUING EDUCATION 2583.38(1)(b) SUPERVISION 1583.45(3) TOXIC SUBSTANCES 1483.20(2)(b) TRAINING IN FIRE SAFETY 1483.35(5)(b) ANNUAL EVALUATION OF EVACUATION
LIMITS 13
83.12(2)(a) CAREGIVER: INVESTIGATING ABUSE ANDNEGLECT 13
83.32(3)(i) RIGHTS OF RESIDENTS: PROMPT ANDADEQUATE TREATMENT 13
Citation
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 50
Wisconsin Department of Health Services
Top Ten Cites With Forfeiture CBRF Mid-year 2017
$18,655.00
$17,425.00
$10,950.00
$10,650.00
$6,575.00
$5,650.00
$5,500.00
$4,700.00
$4,675.00
$4,400.00
$4,000.00
RIGHTS OF RESIDENTS: TO RECEIVE MEDICATION
RIGHTS OF RESIDENTS: PROMPT AND ADEQUATETREATMENT
SERVICE PLANS UPDATED ANNUALLY OR ONCHANGES
SUPERVISION
HEALTH MONITORING
COMPREHENSIVE INDIVIDUALIZED SERVICE PLAN
LISTED AREAS FOR ASSESSMENTS
CAREGIVER: INVESTIGATING ABUSE ANDNEGLECT
NOTIFICATION: INCIDENT, INJURY, CHANGES
IMPLEMENT, FOLLOW THE INDIVIDUAL SERVICEPLAN
NOT PERMIT A CONDITION OF SUBSTANTIAL RISK
$0 $20,000
Cit
atio
n
Total Forfeiture Amount
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 51
Wisconsin Department of Health Services
AFH Top Ten Citations Mid-year 2017
0
5
10
15
20
25
30
Number of Citations88.05(3)(a) HOME ENVIRONMENT 2788.05(4)(b)2 SMOKE DETECTORS-TESTING AND
MAINTENANCE 24
88.10(3)(l) SAFE PHYSICAL ENVIRONMENT 1950.065(2)(b)intro ENTITY BACKGROUND CHECK
REQUIREMENTS 16
88.04(5)(a) TRAINING-15 HOURS WITHIN 6MONTHS 16
88.04(5)(b) TRAINING-8 HOURS ANNUALLY 1688.04(2)(a) RESPONSIBILITIES 1588.07(3)(d) MEDICATION- WRITTEN ORDER 1588.05(4)(d)2.b FIRE EVACUATION ANNUAL
EVALUATION 14
88.06(2)(a) ADMISSION-HEALTH EXAM 14
Citation
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 52
Wisconsin Department of Health Services
RCAC Top Ten Citations Mid-year 2017
00.20.40.60.8
11.21.41.61.8
2
Number of Citations13.05(3)(a) ENTITY ALLEGATION
REPORTING REQUIREMENTS 2
89.34(16) TENANT RIGHTS 2
89.34(18) TENANT RIGHTS 2
89.26(4) ANNUAL REVIEW 1
50.065(6)(am) FOUR YEAR CAREGIVERBACKGROUND REQUIREMENT 1
50.065(2)(bm) OUT OF STATEBACKGROUND CHECKS 1
89.23(2)(a)2.c SERVICES 1
89.23(3)(f) SERVICES 1
89.23(4)(d)1 SERVICES 1
89.34(12) TENANT RIGHTS 1
Citation
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 53
Wisconsin Department of Health Services
ADC Top Ten Citations Mid-year 2017
0
1
Number of CitationsADMINISTRATION OF MEDICATION 1
MEDICATION-DOCUMENTED IN INK 1
MEDICATION-WRITTEN ORDER 1
PERSONNEL-HEALTH EXAMINATION 1
PERSONNEL-STAFFING REPORTS 1
PLAN-QUARTERLY DOCUMENTING 1
PROGRAM SERVICES 1
RESPECT AND DIGNITY 1
SANITATION-PREMISES CLEAN 1
TRAINING-ORIENTATION. 1
Citation
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 54
Wisconsin Department of Health Services
Assisted Living Enforcement Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 55
Wisconsin Department of Health Services
0
100
200
300
400
500
600
2003 2004 2005 2006 2007 2008 2009 20094
YearEntit
y
2010 2011 2012 2013 2014 20144
YearEntit
y
2014SmallClass
C
2015 2016 Jun-17
Enforcements 471 442 409 475 546 474 444 42 522 475 421 439 410 240 46 484 496 266
Enfo
rcem
ent S
urve
ys
Year
AL Surveys With Enforcement
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 56
Wisconsin Department of Health Services
0
20
40
60
80
100
120
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
44
57 49
105
89 82 78 82
61
79
58 52
22
No
New
Adm
issi
on O
rder
s
Year
Assisted Living No New Admission Orders
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 57
Wisconsin Department of Health Services
Forfeiture Assessments
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Jun-17
$439,406
$547,300
$433,055
$614,952
$422,530
$608,989
$889,925
$816,600
$979,313 $1,036,165
$886,555 $932,791
$203,870.00 Forf
eitu
re A
sses
smen
ts
Year
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 58
Wisconsin Department of Health Services
Type of Sanctions per survey
Mid-year 2017
Comply POC 33%
Comply Req. 21%
Forfeiture 28%
Provide Training 1%
Revoke 2%
No Admission 6%
Other 8%
Accruing Forfeiture
0%
Deny 1%
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 59
Wisconsin Department of Health Services
Percentage of Facilities Receiving Enforcements Mid-year 2017
10.0%
90.0%
% FacilitiesReceivingEnforcement% Facilities WithNo Enforcements
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 60
Wisconsin Department of Health Services
Assisted Living Surveys with Citations and Percentage of Appeals
Mid-year 2017
99%
1%
Surveys With CitationsAppeals
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 61
Wisconsin Department of Health Services
Bureau of Assisted Living Initiatives
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 62
Wisconsin Department of Health Services
Key Code (Core Areas)
• Consumer Rights • Provision of Services / Quality of Care • Nutrition and Food Service • Physical Environment & Safety • Staff Training • Medication Management
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 63
Wisconsin Department of Health Services
BAL Initiatives • Completion of LEAN Application Project
• Applications
• Checklists
• Attestation documents
• Revision letters/2x
• Posted by end of August 2017
• Phase II E-Licensing/E-payment system
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 64
Wisconsin Department of Health Services
BAL Initiatives
• Transition in Care coordination guide • Home & Community Based Services
(HCBS) validation reviews • Ask BAL webpage • Strategies to enhance resident care
publication(s) • BAL self report publication • Increase provider participation in the usage
of BAL e-renewal system
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 65
Wisconsin Department of Health Services
BAL Initiatives
• Conduct regional forums • Study the use of technology in assisted
living facilities • Examine updates to annual/ biennial
reports • Promote internal quality improvement
strategies within assisted living facilities • Wisconsin Coalition for Collaborative
Excellence in Assisted Living
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 66
Wisconsin Department of Health Services
Wisconsin Coalition for Collaborative Excellence in Assisted
Living (WCCEAL)
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 67
Wisconsin Department of Health Services
Wisconsin Coalition for Collaborative Excellence in
Assisted Living
• Provider association sponsored
• Department approved
• Comprehensive quality assurance (QA) and quality improvement (QI)
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 68
Wisconsin Department of Health Services
Internal Quality Assurance
• Essential to maintain quality!
• Structure, process, and outcome measures used to evaluate quality
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 69
Wisconsin Department of Health Services
WCCEAL Regulatory Data Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 70
Wisconsin Department of Health Services
CBRFs AFHs RCACs WCCEAL Assisted Living
Communites 239 40 120
0
50
100
150
200
250
300N
umbe
r of F
acili
ties
WCCEAL Regulated Facilities Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 71
Wisconsin Department of Health Services
WCCEAL Regulated Facilities Surveys Conducted
Total Surveys Surveys WithCitations
Total CitationsIssued
Surveys With NoCitations
Jun-17 102 32 87 70
0
20
40
60
80
100
120
Num
ber o
f Sur
veys
Mid-year 2017
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 72
Wisconsin Department of Health Services
WCCEAL Members Complaints Mid-year 2017
Total Facilities 399Total Complaints 91Facilities With Complaints 54
050
100150200250300350400450
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 73
Wisconsin Department of Health Services
WCCEAL Regulated Facilities Qualifying for Abbreviated Surveys
Mid-year 2017
Total Number of Facilities 399Qualifying Facilities 236RCAC 90CBRF 113AFH 33
050
100150200250300350400450
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 74
Wisconsin Department of Health Services
WCCEAL Regulated Facilities Abbreviated Survey Results
Mid-year 2017
Total Abbreviated Surveys 42Surveys With No Citations 34Surveys With Citations Only 8Enforcement Action 0
05
1015202530354045
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 75
Wisconsin Department of Health Services
Percentage of Facilities with Complaints Mid-year 2017
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
13.5% 11.0%
% o
f Fac
ilitie
s W
ith C
ompl
aint
s
WCCEAL Non-WCCEAL
P-01726 (08/2017) Promoting Regulatory Compliance Division of Quality Assurance 76
Wisconsin Department of Health Services
Average Citations per Survey with Citations Mid-year 2017
2
2.2
2.4
2.6
2.8
3
3.2
2.7
3
Num
ber o
f Cita
tions
WCCEAL Non-WCCEAL
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Wisconsin Department of Health Services
Thank You
Alfred C. Johnson, Director Bureau of Assisted Living
Phone: 608-266-8598 Email: [email protected]
Wisconsin Division of Quality Assurance
The Division of Quality Assurance (DQA) is responsible for assuring the safety, welfare and health of persons using health and community care
provider services in Wisconsin.
DQA - Working to Protect - Promote - Provide Quality in Wisconsin's Health Care Facilities