Welcome to Community Based Care News Hour January

Welcome to Community Based Care News Hour January, 25 th, 2018 Please remember to put your phone on mute

Agenda Compliance Tips: Compliance Trend Report Hot Topics: HB 3359 MOVE on-line training Manager’s Corner: Ana Potter

Compliance Tips Dave Mackowski

CBC Survey “Tips” Series New Survey Processes for 2018

Learning Objectives At the conclusion of this presentation you will be able to: • Understand the additional documentation survey will be asking for. • Understand what you will need to do to be prepared for your next survey.

Why the Changes? The changes are a response to two issues: • Survey was finding instances where rules were not being followed in areas we weren’t reviewing regularly; and • The recent legislation – HB 3359 – changed or introduced some rules.

RN License • Survey will now be asking the facility to provide a copy of the RN’s current license. • Per 411 -054 -0045: (1) Resident Health Services The facility must provide health services and have systems in place to respond to the 24 -hour care needs of residents. The system must: (b) Include an Oregon licensed nurses [sic] who is regularly scheduled for onsite duties at the facility and who is available for phone consultation.

Administrator CEUs • Survey will now be asking the administrator to provide a record of CEUs completed in the last full calendar year. • Per 411 -054 -0065 (3) Administrator Requirements (b) Continuing Education: Administrators must have 20 hours of documented Department approved continuing education credits each year.

Staff Training • The specifics of the new staff training requirements are still in the Rules Advisory Committees. • However, survey will be reviewing how your facility is determining and documenting staff competency. • Survey will provide technical assistance regarding how you are documenting that staff competency was demonstrated.

Demonstrating Competency • Per 411 -054 -0070 (2) Requirements Applicable To All Training (a) The facility shall have a training program that has methods to determine competency through evaluation, observation, or written testing. (b) The facility shall maintain written documentation of all trainings completed by each employee. The facility shall also maintain documentation regarding each employee’s demonstrated competency.

Documenting Competency • At a minimum, staff training records should state something to the effect of: “I have observed this staff perform these tasks and attest to his/her competency. ” or “This staff has successfully completed written testing to demonstrate knowledge of the following subjects: ”

Documenting Competency (continued) • Whatever form you use to document competency should be signed by the staff person and the trainer/supervising staff. • If written testing was used, copies of the tests should be retained for review by survey if necessary.

Safe Medication System • Survey will now be asking the facility to provide a copy of its policy for reducing errors in the tracking and administration of medications. • Per 411 -054 -0055 (4) Medication and Treatment – General (b) The facility shall ensure that prescription drugs dispensed to residents are packaged in a manner that reduces errors in the tracking and administration of the drugs, including, but not limited to, the use of unit dose systems or blister packs.

Safe Medication System (continued) (A) The facility shall have as its primary goal dispensing prescription drugs in unit dose systems, blister packs or similar packaging. When such packaging cannot be reasonably achieved, the facility shall have a written policy describing how prescription drugs that are not prepared as unit dose or blister packs shall be dispensed. Written policies shall be in effect not later than July 1, 2018.

What’s It Mean? ? ? • If at all possible, the facility should try to obtain and dispense medications using unit dose systems or blister/bubble packs. • If this isn’t possible, the facility must have a written policy explaining how it will ensure safe administration of medications. • You have until July 1, 2018 to develop your written policy. Until then, survey will only provide technical assistance (no citations).

There’s One Exception • Yep, the rule also provides an exception for residents who receive their medications thru the VA: (B) Subsection (b) of this rule does not apply to residents receiving pharmacy benefits through the United States Department of Veterans Affairs, if the pharmacy benefits do not reimburse cost of such packaging.

Home & Community-Based Services • The HCBS rules are still in various phases of roll-out. • Survey will continue to evaluate the facility’s compliance with the rules and document noncompliance as technical assistance (no citations). • However, new facilities designed after January 1, 2016 need to be in full compliance now (except for “limitations”).

Two more observations and some recommendations

Delegation: Even with the OSBN self-study course and test, survey continues to cite almost every facility for delegation issues. • You must document your rationale for how you decided how often you will re-evaluate the staff and reassess the resident’s diabetic condition. • If you document on the skill and ability of the staff person, you can use this as part of your rationale for how often you are going to re-evaluate the staff.

Quality Improvement Program Survey does come across instances where key staff are not familiar with the Rules, which leads to a deficiency. • Please make sure that when you welcome a new staff to your team, you give them access to or a copy of the Rules. • A good Quality Improvement Program should include regular review of the Rules, and of your systems for meeting the Rules.

Resources: The CBC Provider webpage: http: //www. oregon. gov/DHS/providerspartners/licensing/cbc/Pages/index. aspx • The home page includes a link to the most current version of the Rules. • There also pages containing info about the HCBS rules and copies of Power. Point training materials (click on “Training for Providers”).

Resources: The OSBN webpage: http: //www. oregon. gov/OSBN/pages/delegation _process. aspx • This webpage gives you links to the Division 47 rules regarding delegation and links to the self-study course.

Thanks for your attention and participation! CBC Survey Team January 2018

Compliance Trend Report Top Ten Citations: 11/1/2017 -1/22/2018 1: C 270 Change of Condition(7) 6: C 303 Treatment orders(3) 2: C 310 Med Administration(5) 7: C 370 caregiver training (2) 3: C 252 Resident evaluation (4) 8: C 154 Facility Administration(2) 4: C 260 Service Plan (3) 9: C 240 Food Sanitation (2) 5: C 282 RN delegation (3) 10: C 280 Resident Health Services(2) 999: Technical assistance (7)

Hot Topics House Bill 3359 • License fees • Enhanced Oversight • Civil Penalties • Acuity Staffing tool • Corrective Action • Medication Packaging • Quality Measures • Memory community name change • Intensive intervention Communities • Conversion Facilities

Hot Topics-1 License Fee increase Initial licensing fee (new building; recently purchased building) Capacity 1 -15 beds: $2000 16 -49 beds: $3000 50 -99 beds: $4000 100 -150 beds: $5000 151 or more beds: $6000 Biennial license renewal fee Capacity 1 -15 beds: $1000 16 -49 beds: $1500 50 -99 beds: $2000 100 -150 beds: $2500 151 or more beds: $3000

Hot Topics-2 Civil Penalties (cp) When a cp is assessed: Prior violations Did the facility benefit Past history of violation correction Scope and severity of violation Amounts: $250, $500, $1, 500, $15, 000 cp of $1, 000 for not self reporting abuse

Hot Topics-3 Corrective Action: Immediate Jeopardy defined Substantial Compliance defined Conditions: Immediate Jeopardy; potential harm for future residents Restriction of Admission IJ removed if not substantiated in 30 days. Description of how condition will remedy concerns. Re-inspection/Re-evaluation

Hot Topics-4 Quality Measures Metric program: Facilities to compare metrics Annual report from DHS: patterns and trends Quality Measure Council: Appointed by Governor Web based reporting: Starts 1/31/2020 Web based results Staff retention, falls, antipsychotic use, staff training compliance More RAC’s scheduled

Hot Topics-5 Conversion Facilities Nursing facility converting over to RCF Letter of intent Intensive Intervention Community, (IIC): 5 or less for people with challenging behaviors. More RAC’s scheduled

Hot Topics-6 Enhanced Oversight Frame work for assessing compliance Regulatory requirements, and corrective action tied to the framework Potentially level system related to scope and severity of deficiencies. More RAC’s scheduled

Hot Topics-7 Acuity Based Staffing tool: Software used for comparing acuity to staffing. Available to all providers Can be utilized if State has concerns with facilities staffing More RAC’s scheduled

Hot Topics-8 Direct Care Staffing Training Approved Dementia Training Competency Assessment Pre-Service Dementia training (1/1/2019) Six hours of dementia training by 7/1/2018 More RAC’s scheduled

Hot Topics-9 Prescription Drug Packaging Blister Packs (1/1/2018) Facility needs to have policy

Hot Topics-10 Memory Care Name Change Endorsed Memory Care Community (EMCC)

Hot Topics-11 MOVE( Making Oregon Vital for Elders) Online training: “Let’s get Real: Being Person-Centered in a Task Oriented World” For more information go to: www. orculturechange. org

Manager’s Corner Ana Potter, Community Based Care Manager HB 3359 training dates: February 9 th from 9 am-10: 30 am February 20 th from 1 pm-2: 30 pm

Thanks so much! Next News hour: April 26 th 2018 9: 00 am Questions? ? CBCTeam@state. or. us CBC web site Address: : http: //www. oregon. gov/DHS/PROVIDERS-PARTNERS/LICENSING/CBC/Pages/index. aspx