Regulatory Update Training - Florida Health Care … · Regulatory Update Training ... Adverse...

Agency for Health Care Administration

Agency For Health Care Administration

Regulatory Update TrainingSeptember 2004 / January 2005

Presenters:Polly Weaver, Chief of Field Operations Molly McKinstry, Chief of Long Term Care ServicesSusan Acker, Ph.D., Director of Nursing ServicesAgency for Health Care Administration-Division of Health Quality Assurance


Hurricane Season 2004


Emergency Plans• Check Current Plans to Ensure They Are Up-to-date• Consider Lessons Learned From Recent Experience• Check Vendors to Ensure They Will Honor

Agreements – Supplies, Transportation, Receiving Facilities

• Consider Secondary Evacuation Plan/location If Initial Is Affected

• Ensure Appropriate Receiving Facility• Prior to Evacuation, Reach Agreement on Supplies

and Resources and Who Will Provide


Emergency Preparedness

• Test Emergency Generators• Check Supply of Drinking Water; If Contractor Is

Used Ensure Service Provider Is Able to Meet Needs

• Check Non-perishable Food Supplies; Assure Regulatory Minimums Are Met

• Review Loss of Power Plans


Evacuation • Notify AHCA Of Evacuation• Staffing and Other Basic Requirements to

Meet Resident Needs Are Not Waived• Ensure Resident Information Follows the

Resident• When Returning Residents to a Facility

After Damage, Obtain AHCA Approval First


Emergency Resources

• First Contact: Local Emergency Management http://www.floridadisaster.org/County_EM/county_list.htm#

• Florida Emergency Information Line800-342-3557

• Emergency Support Function – 8850-410-1822800-320-0519 (request ESF-8)


Regulatory Update

• Regulatory Changes• AHCA Information Regarding Trends• Regulatory Statistics

2004 Legislative Changes• Inactive License for a Portion of Facility

– Rule Must First be Established– Allows a Contiguous Portion of Nursing Home Beds to Become

Inactive for 12 Months, Renewable Annually– Retains Ability for Entire Facility to be Inactive for up to 18 Months– Established Requirements for Request and Approval

• Staffing – CNA Increase to 2.9 Delayed from May 1, 2004 to July 1, 2005

• Certificate of Need– Allows Development of New Nursing Home Beds in Limited

Circumstances; An Exception to the CON Moratorium– Rural Counties in Limited Circumstances– Counties Without a Nursing Home Where a Nursing Home Closed

Since July 2001

2004 Legislative ChangesNursing Homes• CNA In-service Hours

– Requires In-Services Hours as a Condition of CNA Certification Rather Than Nursing Home Employment

– Refers the In-Service Requirements of S. 464.203(7), F.S.– Remains 18 Hours Annually

• DON Signature on Care Plans– Allows Another RN to Sign Resident Care Plans for DON– RN Must Have Institutional Responsibilities in Writing– RN Cannot be a Temporary Staff Person

• Gold Seal– State and Federal Nursing Homes are Deemed Financially Stable and

Not Required to Submit Financial Statements


Nursing Home Gold Seal • Thirteen Homes Received the Award in November,

2004

• Performance Criteria Include: • Financial Soundness and Stability• High Quality of Care Ranking Among Other

Nursing Homes in Their Region• Excellent Record With the State Long-term

Care Ombudsman Program• No “Conditional” Licenses nor Nursing Home

Watch List Appearances in the Past 30 Months• Evidence of Community Involvement• Stable Workforce


Gold Seal AwardsNew Gold Seal Recipients: • Baldomero Lopez Memorial Veterans’ Nursing

Home, Land O Lakes• Bay Village of Sarasota, Sarasota• Life Care Center of Hilliard, Hilliard• Mayflower Healthcare Center, Winter Park• Miami Jewish Home & Hospital for the Aged,

Miami• Ponce Plaza Nursing and Rehabilitation, Miami• Sunnyside Nursing Home, Sarasota• Water’s Edge Extended Care, Palm City


Nursing Home Gold Seal

Renewing Gold Seal Recipients: • Harbour’s Edge, Delray Beach• John Knox Village Medical Center, Tampa• The Pavilion for Health Care, Penney Farms• River Garden Hebrew Home for the Aged,

Jacksonville• Village on the Green, Longwood


Report to the LegislatureMay 2004 – Status Report

Nursing Home and Assisted Living Facility: Adverse Incidents & Notices of Intent Filed

http://www.fdhc.state.fl.us/Publications/index.shtml

Also see Semi-Annual Report on Nursing Homes Report to the Legislature December 30, 2004


Adverse Incident Analysis

For The One Year Period May 15, 2003 Through May 14, 2004, The Agency Received:

• 3,175 Nursing Home Adverse Incidents• 1,996 Assisted Living Facility Adverse Incidents

• 19,378 Total Reports Submitted - 5,171 Were Determined To Be Adverse Incidents After Final Facility Staff Review


Adverse Incident Analysis

AHCA On Site Visits In Response To Adverse Incidents:

• 84 On-Site Visits To Nursing Homes• 48 On-Site Visits To Assisted Living Facilities

Of These Surveys 3 Nursing Homes And 5 Assisted Living Facilities Were Cited For Class I and/or Class II Deficiencies


Adverse Incident Outcomes

0200400600800

10001200140016001800

May 15, 2001 to May 14, 2002 1505 1030 879 383 318

May 15, 2002 to May 14, 2003 1568 948 1088 357 238

May 15, 2003 to May 14, 2004 1493 837 1063 474 395

Transfer Fracture A buse/Neglect Elopement Law Enf orcement


Nursing Home NOIsNursing Home Notices of Intent July 2002 - June 2004

0

10

20

30

40

50

60

70

80

90

100

110

*Based on NOI received by facility for month **This data may change due to later reporting by facilitiesSeries1 56 74 46 60 82 80 106 96 83 74 103 72 75 56 75 71 49 57 56 64 50 54 50 33

7/02 8/02 9/02 10/02 11/02 12/02 1/03 2/03 3/03 4/03 5/03 6/03 7/03 8/03 9/03 10/03 11/03 12/03 1/04 2/04 3/04 4/04 5/04 6/04


Characteristics of Reported Litigation

For-Profit

Non-Profit

Total

Multi-

Facility Owner

Licensed Nursing Homes 491 179 670 527 Lic NH Submitting NOI 410 123 533 438

Total # of Lic NOI Submitted 2,289 454 2,743 2,449 Total # of Lic Beds 60,937 21,464 82,401 65,021

# Of NOI per 1000 Lic Beds 37.56 21.15 33.29 37.66 Total # of Lic Complaints 509 88 597 558

Complaints per 1000 Lic Beds 8.35 4.10 7.25 8.58


Notices of Intent Past 3-Years 548 Nursing Homes Reporting NOIs

May 2001 - May 2004

# Nursing Homes

# NOI Reported

100 1 224 2 to 4 149 5 to 9 75 10 or more


Notices of Intent Past Year339 Nursing Homes Reporting NOIs

May 2003 - May 2004

# Nursing Homes

# NOI Reported

153 1 149 2 to 4 35 5 to 9 2 10 or more


Nursing Home Complaints Filed in Clerk of CourtComplaint Service Dates June 2002 - April 2004

0

5

10

15

20

25

30

35

40

Jun-02

Jul-0 2

Aug-02

Sep -02

Oct -0 2

No v-02

Dec-0 2

Jan-03

Feb-03

M ar-03

Ap r-03

M ay-03

Jun-03

Jul-0 3

A ug -03

Sep-03

Oct -03

No v-03

Dec-03

Jan-04

Feb-0 4

M ar-04

A p r-04

Total 17 23 30 30 24 26 31 35 40 26 36 39 28 32 13 25 25 11 23 17 15 16 14

Jun-02

Jul-02

Aug-02

Sep-02

Oct-02

Nov-02

Dec-02

Jan-03

Feb-03

Mar-03

Apr-03

May-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04


Nursing Home Complaints Filed in Clerk of Court

By AHCA Receipt Date June 2002 - April 2004

010

20

3040

50

6070

80

90

Jun-02

Jul-02

Aug-02

Sep-02

Oct-02

Nov-02

Dec-02

Jan-03

Feb-03

Mar-03

Apr-03

M ay-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

M ar-04

Apr-04

Total 8 7 9 13 10 15 87 37 26 38 20 31 25 16 26 16 21 14 10 82 21 14 25

Jun-02

Jul-02

Aug-02

Sep-02

Oct-02

Nov-02

Dec-02

Jan-03

Feb-03

Mar-03

Apr-03

May-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04


Number of Nursing Homes on The Watch List

Calendar Quarter Number of Facilities April 1, 2001 – June 30, 2001 79 July 1, 2001 – September 30, 2001 90 October 1, 2001 – December 31, 2001 89 January 1, 2002 – March 31, 2002 82 April 1, 2002 – June 30, 2002 87 July 1, 2002 – September 30, 2002 71 October 1, 2002 – December 31, 2002 50 January 1, 2003 - March 31, 2003 52 April 1, 2003 - June 30, 2003 51 July 1, 2003 - September 30, 2003 46 October 1, 2003 - December 31, 2003 44 January 1, 2004 – March 31, 2004 39


Nursing Home DeficienciesNursing Home

Type of Deficiencies by Year

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

1999 2000 2001 2002 2003 Jan-Jun 2004

Year

Num

ber o

f Def

icie

ncie

s

Sc/Sv B through F Defs

Sc/Sv G and higher Defs


Nursing Home Deficiencies for Failure to Have Sufficient Staff to Meet Resident Needs

Citations for F353

050

100150

2000 2001 2002 2003 2004thruJune

Citations forF353


All Nursing Home Staffing Deficiencies

2000 2001 2002 20032004

(June)Citations for F353 120 110 78 64 28N063 11 28 166 83 36N063 & F353 0 6 15 7 2N069 0 2 16 4 10


Grant Proposal RequestsUse of Civil Money Penalty (CMP) Funds

• CMPs Returned to Florida Based Upon Medicaid Participation of Sanctioned Nursing Homes

• Deposited in State Quality of Long Term Care Improvement Trust Fund

• Authorization to Spend $500,000 Annually• Expenditures Must be Consistent with State

and Federal Requirements


Federal Guidance

• Federal Regulations 42 CFR 488.442(g) and Section 7534B of the State Operations Manual Direct

• Use of CMPs for Protection of Health or Property of Residents of Facilities That the State or the Centers for Medicare and Medicaid Services (CMS) Finds Deficient


Federal Guidelines• Prevention of Deficient Practice Through Educational

Means by Development of Videos, Pamphlets, or Other Publications Providing Best Practices

• Development of Public Service Announcements on Issues Directly Related to Identified Deficient Areas

• Employment of Consultants to Provide Expert Training to Deficient Facilities

• Issuing Grants to Facilities for Projects Such As the Eden Alternative

• Other Projects That Directly Benefits Facility Residents


Federal Limitations

• A Loan to a Facility Having Financial Difficulty Meeting Payroll or Paying Vendors is an Inappropriate Use of the Funds

• Funds Cannot Be Used to Bring a Facility Into Current Regulatory Compliance

• Projects Should Be Limited to Funding on Hand and Should Be Relatively Short-term Projects


Grant Proposals• All Florida Nursing Homes May Apply• Proposals Must be Innovative and:

– Provide Well Conceived Vision/Plan with Detailed Explanation and Steps to Achieve Improvement

– Propose Achievable Goals– Provide Education Plan for Residents/Staff– Provide Detailed Implementation Plan– Provide Budget of Expenditures


Grant Proposals• All Florida Nursing Homes May Apply• Proposals Must be Innovative and:

– Provide Well Conceived Vision/Plan with Detailed Explanation and Steps to Achieve Improvement

– Propose Achievable Goals– Provide Education Plan for Residents/Staff– Provide Budget of Expenditures


Grant Process

• Initial Request for Interest and Proposals, Nursing Home Letter December 22, 2004

• Applications Will be Provided for Completion

• Proposals Will be Reviewed Within Available Funding

• Presentation May be Requested


Grant Participation

• Recipients of Grants Will Enter Into a Contract With the Agency

• Contracts Will Generally Be One Year; No More Than Two Years

• Monitoring Will Be Developed Based Upon the Project

• Quarterly Reports• Onsite Reviews


Grant Information & Proposal Submission

Bureau of Long Term Care ServicesBarbara Dombrowski

Phone: (850) 922-0048E-mail: [email protected]


Top 10 Nursing Home DeficienciesTop Ten Nursing Home Cites

Tag DescriptionCount 2004*

Rank 2004

Rank 2003

Rank 2002

Rank 2001

F371Food must be stored, prepared, and distributed under sanitary conditions 142 1 1 1 1

F281Services provided by the facility must meet professional standards 100 2 2 3 4

F241Facility must treat residents with dignity and respect 86 3 4 4 3

F514Facility must maintain clinical records professionally and accurately 83 4 6 5 6

F253Facility must provide adequate housekeeping and maintenance services 74 5 5 10 22

F279Facility must develop comprehensive care plan for each resident 68 6 3 2 2

* January-June, 2004


Top 10 Nursing Home DeficienciesTop Ten Nursing Home Cites

Tag DescriptionCount 2004*

Rank 2004

Rank 2003

Rank 2002

Rank 2001

F280

Comprehensive care plan must be timely, accurate and periodically reviewed 63 7 10 11 16

F282Services must be delivered by qualified persons in accordance with care plan 63 7 11 13 7

F432Drugs must be stored in locked compartments at proper temperature 52 8 9 6 5

F465Facility must provide a safe, functional, sanitary, and comfortable environment 48 9 15 14 12

F363Menus must meet nutritional needs of residents 46 10 22 23 33



Top 10 Nursing Home Complaint Allegations

Allegation Count 2004* Rank 2004 Rank 2003 Rank 2002 Rank 2001Resident Care 380 1 1 1 1Resident/Patient Abuse/Neglect 187 2 5 5 4Resident Rights 179 3 2 3 3Medicine Prob/Errors/Formulary 163 4 3 4 5Staffing 155 5 4 2 2Lack of Assessment 137 6 8 27 27Administrative 120 7 14 14 13Falls/Injury 102 8 6 6 8Pressure Sores 99 9 9 10 7Dietary 94 10 7 8 6



AHCA Resources

Long Term Care Unit (850) 488-5861Bureau of Long Term Care (850) 414-9707Bureau of Field Operations (850) 414-9796

Health Standards and Quality Unit (850) 922-9138

AHCA Website: www.fdhc.state.fl.usNew Format

AHCA Facilities and Agencies Directory Website:www.floridahealthstat.com/qs/owa/facilitylocator.facllocator

Federal Link to Survey Guidance:www.cms.hhs.gov/medicaid/survey-cert/siqhome.asp

Regulatory Update Training - Florida Health Care … · Regulatory Update Training ... Adverse...

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