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