Meeting Notes April 16, 2018: Home Care and Assisted Living Program Advisory Council

Transcription

1 Meeting Ntes April 16, 2018: Hme Care and Assisted Living Prgram Advisry Cuncil Ntes prepared by: Lari Anne B. Mazzitell Lcatin: Orville Freeman Building, 625 Rbert Street Nrth, St. Paul, MN Attendance Cuncil members: Rene Crnquist (By Phne), Samantha Drst (by Phne), Cheryl Hennen (By Phne), Susan Mrgan, Jarrd Petersn, Melissa Plachecki (By Phne), Suzan Sinna MDH, Health Regulatin Divisin: Jeri Cummins (By Phne), Cathy Griffin, Lari Anne Mazzitell, Cindy Vargas (By Phne) Public Attendees: (Unknwn due t cnference line) Agenda Welcme and intrductins Cuncil interim terms Cuncil s recmmendatins t legislature Enfrcement actins Backgrund studies Licensing questin HCALP legislative updates Questins and cmments Next HCALP Advisry Cuncil Meeting Date: Mnday, June 4, 2018 Time: 2:00 4:00 pm Lcatin: The Wellstne Center, 179 Rbie Street East, St. Paul, MN Meeting Ntes Cuncil Interim Terms (Lari Anne Mazzitell, HCALP, MDH) Susan Mrgan, Suzan Sinna, and Melissa Plachecki were recently appinted t interim terms. The Ombudsman term expires in Octber 2018 and is the final seat that will have terms reset. Then, half f the cuncil seats will begin when the gvernr is seated in January every 4 years, and the ther half f the seats will begin the fllwing January per statutes. Cuncil s First Annual Recmmendatin t the Legislature (Jarrd Petersn, HCALP Cuncil) Minnesta Statutes 144A.4799, subdivisin 3 (7) (c) requires the Cuncil t submit annual review the balance f funds cllected frm fines issued t hme care prviders wh are nt fund in cmpliance at the time f a

2 Hme Care and Assisted Living Prgram Advisry Cuncil Page 2 April 16, 2018 survey. The Cuncil recmmends t the legislature and the legislature can chse t apprpriate funds frm the accunt t imprve hme care in Minnesta. The Cuncil submitted their recmmendatins t the apprpriate legislative chairs n January 16, 2018 with fur recmmendatins: Develp make available educatin t prepare prspective licensees fr a successful survey f their temprary license Cnduct desk audits fr all level 1 and level 2 crrectin rders Develp and prvide training fr existing licensed hme care prviders that is targeted t new management and supervisry persnnel Demnstrate leadership t encurage students t pursue hme care as a vcatin r career The Cuncil did nt receive a respnse frm any f the legislatrs that received the recmmendatins. Enfrcement Actins (Jeri Cummins, HCALP, MDH) In 2015, the Department tk tw enfrcement actins. T date, in 2018, there are nine enfrcement actins. Actins are split between temprary and established license types. The Department is using cnditinal licenses reached with a stipulated. It is a cllabrative prcess in which prviders are tasked t imprve the quality f care by fllwing the statutry requirements and using a nurse cnsultant. Typically, MDH cnducts ne r mre mnitring visits during each cnditinal license perid, which allws MDH t prvide technical assistance. The cuncil agreed that there are benefits with this type f cllabrative partnership with prviders. Backgrund Studies (Cathy Griffin, HCALP, MDH) The Department f Human Services (DHS) cnducts required backgrund studies fr MDH license applicants and licensees. Histrically the studies were cnducted using NetStudy (NS) 1.0, which recently upgraded t 2.0. The upgrade prvides imprved features fr cntinued tracking f wners, managers and emplyees. Hwever, there is a challenge fr licensed hme care prviders wh cmbined licenses frm the previus license structure f classes A - F and cntinued t serve clients under a single cmprehensive license. NS 1.0 cnducted a single pint backgrund study when emplyees were initially hired. NS 2.0 cntinually mnitrs fr ccurrences that may alter the status f a backgrund study. When the DHS transitined t NS 2.0, emplyees f licensed prviders were transferred int the new system if the prvider s licenses was still active. Fr prviders that clsed ne license and transferred emplyees t a different license, emplyees wh had backgrund studies under the clsed license were nt transferred int NS 2.0. The resulting impact is n the ptential f current (veteran) emplyees wh did pass a study in NS 1.0 but wh will nt be active fr cntinued mnitring in NS 2.0. There are tw ptins ging frward: 1. Accept the backgrund study frm NS 1.0 fr emplyees wh remained emplyed by the same prvider but started wrking under a different license fr that same prvider; r 2. Require a new backgrund study under NS 2.0 fr emplyees wh remained emplyed by the same prvider but started wrking under a different license fr that same prvider. After weighing the risk f emplyees wh d nt have an updated backgrund study that cntinues t mnitr and update the emplyee s status and cst and effrt f prviders, and pssibly emplyees, t btain a backgrund study and fingerprinting as required in NS 2.0, the Cuncil recmmends t:

3 Hme Care and Assisted Living Prgram Advisry Cuncil Page 3 April 16, Cnduct new backgrund studies under NS 2.0 fr affected emplyees; and 2. Establish a grace perid allwing emplyees t cntinue t wrk during the transitin prcess. Licensing Questin (Cathy Griffin, HCALP, MDH) Recently, a cuple prviders questined MDH s decisin t nt renew the license because they had nt prvided hme care services, as required by statute, during the past 12 mnths as required fr renewal in Minnesta Statutes 144A.472, subdivisin 3.(a)(3). One prvider was a PCA prvider and the ther an adult fster care prvider. Based n the definitin f hme care services in Minnesta Statutes 144A.43, subdivisin 3., the types f activities prvided by PCA prviders and sme adult fster care prviders can meet the definitin f hme care service. Current statute exempts PCA prviders and excludes adult fster care prviders frm hme care licensure. Under the frmer classes A F licensing structure, prviders culd decide t incrprate hme care services like PCA int the class A license. If they chse nt t include the PCA services they prvided, the prvided was required t separate the tw businesses int distinct cmpnents. It appears that at least sme hme care prviders prefer t maintain a hme care license even if nly prviding PCA services, which, by definitin, are als hme care services. MDH is seeking recmmendatins frm the Cuncil regarding if: 1. Prviders wh are exempt r excluded frm licensure can chse t have a hme care license and fllw hme care standards fr the exempt r excluded services they prvide. 2. MDH shuld disallw exempt and excluded prviders frm hlding a hme care license fr exempt r excluded services. 3. Licensed prviders wh als deliver exempt r excluded hme care services shuld separate the varius business cmpnents. The cuncil will review these issues and discuss them in the near future. Legislative Updates (Cathy Griffin, HCALP, MDH) T date, there are arund 22 bills regarding hw t prtect vulnerable adults. Many are similar in nature. Prpsed language includes dementia care certificatin, assisted living licensing, an assisted living reprt card and the ability fr MDH t cite husing with services entities fr bill f rights issues identified during the survey f an arranged hme care prvider in a husing with services setting. The cuncil is cncerned abut the likely increase f csts fr licensed prviders with each new regulatin and statutry requirement because inevitably the csts are passed alng t the cnsumer. Minnesta Department f Health PO Bx 3879 St. Paul, MN Health.Hmecare@state.mn.us 05/21/2018 T btain this infrmatin in a different frmat, call:

4 HCALP Enfrcement Actins April 13, 2018 LISTED BY CALENDAR YEAR Nte: The infrmatin belw is summary and des nt represent all the facts abut the situatin r the vilatins. 2018: Enfrcements Actins = 9 (*carryver frm 2017) Glden Hrizns Aitkin Cmprehensive license issued cnditinal licensing with stipulated Licensed since 2005 Cmplaint investigatin cmpleted June 2017 with five level 2 rders Fllw-up t cmplaint investigatin with fur rders reissued and ne new level 3 rder July 2017 survey with 27 rders including ne level 3 vilatin, 24 level 2 vilatins and 2 level 1 vilatins Fllw-up t cmplaint investigatin in Octber 2017 with ne vilatin reissued at a level 2 Survey fllw-up in Octber 2017 with 15 rders reissued plus 4 new rders all at level 2 Fllw-up t cmplaint investigatin in January 2018 with 1 rder reissued at a level 2 Fllw-up t the survey in January 2018 with six rders reissued and 3 new rders including 7 at a level 2 and ne level 3 vilatin Cnditinal license with a stipulated issued in March, 2018 The Wellstead f Rgers Cmprehensive license issued cnditinal license with stipulated Licensed since 1999 Full survey in January 2018 with 26 rders including 1 level 3 vilatin During the survey was a fllw-up fr three cmplaint investigatins with 1 level 3 reissued and a secnd fllw-up fr three cmplaint investigatins reissued 1 level 2 widespread rder In January there was als a fllw-up fr three cmplaint investigatins with rders (1 level 4 widespread and 2 level 3 widespread) resulting in reissuing 1 level 3 islated rder MDH cncerns include lack f systems, staffing and training, a level 3 vilatin n the full survey and failure t ttally crrect OHFC rders Cnditinal license with a stipulated issued in February 2018 CSL Rse Arbr Wildflwer Ldge Cmprehensive license issued cnditinal license with stipulated Licensed since 2001 Full survey Nvember 2017 with 29 vilatins all at a level 2 but 15 were widespread In Nvember there was als a fllw-up fr tw cmplaint investigatins resulting in the reissue f 1 level 2 widespread vilatin Cmplaint investigatin in May 2017 fr a client in memry care wh fell and died was substantiated maltreatment and nt crrected at the time f OHFC fllw-up

5 Cncerns include lack f systems, staffing, training and plicies alng with a lack f knwledge f hme care statute. Cntinued cncern abut safety f clients in memry care with unprtected stairways. Cnditinal license issued as part f a stipulated in January 2018 Cme Hme Ingleside Cmprehensive license hlder issued a cnditinal license with stipulated Licensed since 1996 Full survey in February 2018 with 20 vilatins including 1 level 4, 18 level 2 and 1 level 1 Cnditinal license issued as part f a stipulated in March 2018 Bridges Temprary Cmprehensive License issued a cnditinal license with stipulated Initial full survey f temprary license resulted in 28 rders with 26 at a level 2 and 2 at level 1 Cncerns include need t have a better understanding f the statutry requirements and mre rbust plicies and systems in place Cnditinal license issued as part f a stipulated in February *Tuch f Hme Cmprehensive license hlder issued a cnditinal license with stipulated Licensed since 2007 Full survey in Octber 2017 with 38 vilatins including with 36 level 2 including 12 widespread and 2 level 1 vilatins Cncerns include verall lack f understanding abut hme care licensing requirements, inadequate systems and prcedures, inadequate training and multiple medicatin errrs Cnditinal license issued as part f a stipulated in December 2017 Fllw-up survey in February 2018 with 18 rders reissued Cnditinal license was extended Edgewd Sartell Temprary Cmprehensive license issued a cnditinal license with stipulated Initial full survey in February 2018 with 18 crrectin rders including 1 level 3 and 17 level 2 vilatins with 1 that was widespread Cncerns include a pressure ulcer that prgressed because f lack f assessment and issues with service plans, medicatins, treatments and training Cnditinal license issued as part f a stipulated in March 2018 Brkdale Champlain Licensed Cmprehensive license issued a cnditinal license with stipulated Licensed since 2010 Full survey in February 2018 with 28 vilatins including 26 level 2 (9 were widespread) and 2 level 1 vilatins An OHFC investigatin in Nvember 2017 resulted in 2 level 3 vilatins and 1 level 2 Cnditinal license issued as part f a stipulated in March 2018 Nrth Oaks n Emersn Licensed Cmprehensive license vluntary clsure Licensed since 1996 Financial issues causing inability t maintain safe husing and services Vluntary clsure, nt an enfrcement actin Relcatin f 38 residents in a 30 day perid Clsed effective March 30,

6 2017: Enfrcement Actins = 12 Nte: On February 3, 2017, the MDH was upheld, fllwing a lengthy multiple year hearing prcess, in its denial f the renewal f Unity s cmprehensive hme care license in. Milestne: Cmprehensive license issued cnditinal license Clients in a husing with services setting Cncerns mstly in memry care Survey in March 2017 with 24 vilatins including ne level 3 Tw fllw-ups t fully crrect Three OHFC cmplaint investigatins September 2016 with ne rder at a level 2 March 2017 with 2 level 4 rders resulting in death f client May 2017 still pen Cnditins lifted when in full cmpliance in late July 2017 N & V: Cmprehensive license issued cnditinal license Clients in several small husing with services settings Mst clients with mental health diagnses Pr cmpliance since 2015 Multiple OHFC cmplaint investigatins, but nt all resulted with vilatins September 2015 investigatin with 1 rder March 2016 investigatin resulting in 4 rders with 2 at level 4 April 2016 investigatin resulting in 1 rder February 2017 investigatin resulting in 8 rders with 2 at level 3 Survey Octber 2016 resulting in 38 rders with 6 at level 3 Three fllw-ups t crrect Cmpliance came during the cnditinal license perid Serenity f Remer: T-cmp denied cmprehensive license 17 rders resulting in 2 at a level 3 and ne level 4 Rivers Edge Assisted Living: T-cmp denied cmprehensive license 28 rders resulting in ne level 3 MN Heritage Huse: Cmprehensive license Stipulated Agreement with cnditinal license t vluntarily transfer clients t new prvider and clse license Serving clients in three separate husing with services lcatins Multiple surveys and cmplaint investigatins during an 18 mnth perid Survey in December 2015 resulting in 25 rders with tw at a level 3 Fllw-up in February 2016 resulting in 15 rders nt crrected Fllw-up in May 2016 with 6 rders nt crrected Fllw-up in August 2016 with 7 rders issued including 4 new rders Fllw-up in Nvember 2016 with 3 rders nt crrected Fllw-up in February 2017 with 8 rders including 6 new rders Fllw-up in May 2017 Fllw-up in June 2017 with 31 rders with ne at level 3 Cmplaint investigatin May 2016 with 1 rder Cmpliant investigatin June 2016 with 1 rder at level 4 Cmplaint investigatin May 2017 resulting in 5 rders with tw at level 4 Cmplaint investigatin June 2017 with tw rders bth at level 3 3

7 Sanctuary West St. Paul: T-cmp License denied with Stipulated Agreement fr cnditinal cmprehensive license Survey f the temprary license resulted in 32 vilatins HCALP nt aware prvider was serving clients as prvider failed t infrm MDH as required by statute HCALP discvered prvider was serving clients via a cmpliant investigatin Multiple investigatins and surveys t date March 2017 cmplaint investigatins with fur rders June 2017 survey resulting in 32 rders Nvember 2017 fllw-up survey with 11 rders Nvember 2017 cmpliant fllw-up reissued tw rders Cncern f lack f understanding abut hme care requirements fr licensure in Minnesta Thrugh cnsultatin with prvider, denied license but agreed t cnditinal license First fllw-up t survey shwed prgress with 12 rders reissued Cnditinal license extended but sme cnditins lifted Secnd fllw-up in January with 2 rders reissued Cmprehensive license issued in January 2018 Edgemnt Place: T-cmp License denied with Stipulated Agreement fr cnditinal cmprehensive license Multiple cmplaint investigatins and surveys Cncern f lack f understanding abut hmecare requirements fr licensure in Minnesta May 2017 cmplaint investigatin resulting in 6 rders June 2017 survey resulting in 34 rders July 2017 cmplaint fllw-up with fur rders including 1 new rder Nvember 2017 fllw-up survey with ne rder Thrugh cnsultatin with prvider, denied license but agreed t cnditinal license Belief that prvider has the ability t be cmpliant Must shw prgress and becme cmpliant in shrt time perid Cllabrative apprach using cnsultant and MDH mnitring t bring int cmpliance One fllw-up shwed remarkable prgress with rders Cmprehensive license issued fllwing Nvember fllw-up survey Restratin: T-cmp License denied with Stipulated Agreement fr cnditinal cmprehensive license June 2017 survey resulting in 32 rders Octber 2017 fllw-up survey with 0 rders Thrugh cnsultatin with prvider, denied license but agreed t cnditinal license Belief that prvider has the ability t be cmpliant Must shw prgress and becme cmpliant in shrt time perid Cllabrative apprach using cnsultant and MDH mnitring t bring int cmpliance One fllw-up shwed all rders crrected Cmprehensive license issued fllwing Octber fllw-up survey 4

8 Avinity: Cmprehensive license agreed t cnditinal license using stipulated Histry f nncmpliance discvered during investigatins and surveys in 2016 and 2017 April 2016 cmplaint investigatin with 3 rders January 2017 survey resulting in 16 rders with a level 4 that impacted fur different clients April 2017 fllw-up t survey with 13 rders including 4 new rders June 2017 fllw-up t survey with 15 rders including 4 new rders with 2 at level 3 Octber 2017 cmplaint investigatin with 2 rders with ne at level 3 Nvember 2017 cmplaint investigatin with 1 rder With a cncern fr the welfare f the clients served by Avinity, the prvider agreed t a cnditinal license using a stipulated Currently perating under a cnditinal license since Nvember 22, 2017 Using a cllabrative prcess including a cnsultant and mnitring visits by MDH Must shw prgress and ability t maintain prgress in a shrt perid f time Cnditinal license ended n February 14, 2018 after a fllw-up survey shw the prvider is in cmpliance Watchen: T-cmp License denied with Stipulated Agreement fr cnditinal license July 2017 survey resulting in 28 rders December 2017 fllw-up survey with 2 rders Thrugh cnsultatin with prvider, denied license but agreed t cnditinal license Belief that prvider has the ability t be cmpliant Must shw prgress and becme cmpliant in shrt time perid Cllabrative apprach using cnsultant and MDH mnitring t bring int cmpliance One fllw-up shwed remarkable prgress Cnditinal license ended after December fllw-up survey shwing prvider in cmpliance Tuch f Hme: Cmprehensive license agreed t cnditinal license using stipulated Licensed prvider since 2004 Octber 2017 survey resulting in 38 rders Cncerned abut lack f understanding abut Minnesta hme care licensure requirements and plicies and prcedures that adequately prvide safe care fr clients Cnditinal license in place since December 2017 using a cllabrative prcess that utilizes a cnsultant and MDH mnitring Secnd cnditinal license issued fllwing first fllw-up survey. Sme cnditins lifted because f prgress tward cmpliance. Jennifer s: Cmprehensive license vluntarily clsed fllwing CHOW survey Licensing specialist cncerned with knwledge f new wner Octber survey resulting in 25 rders Cncerns: Owner is CNA and acting in sme respects like an RN RN reprts inability t wrk with wner and cntract being terminated Cnsultatin with wner Owner vluntarily clsed license 5

9 2016: Enfrcement Actins = 4 Meadw Ridge: T-cmp - denied cmprehensive 3 clients in memry care with multiple falls, resulting in multiple fractures and injuries. Fractures f ne client resulted in permanent limitatins with mbility Immediate crrectin rder at level 4 Vilatins with failure t reprt maltreatment, medicatins, treatments and plicies Lacked verall systems and training f unlicensed persnnel Tru Tuch f Glry: T-cmp - denied cmprehensive N clients had an RN assessment Multiple prblems with xygen including nt checking O2 levels as rdered. This was issued at a level 3 because O2 saturatin levels were never checked. Client had shrtness f breath and fell. Advertised that they emplyed an RN, but they did nt have an RN Lacked an adequate number f staff t prvide needed services Prblems with medicatins and treatments Lacked plicies and training f unlicensed persnnel Step Frward: T-cmp - denied cmprehensive Lacked training fr unlicensed staff Nt enugh staff t prvided needed services Served many clients with mental illness but nt understanding hw t prvide fr the needs f peple with mental illness Staff nt trained t administer medicatin and client was hspitalized after a medicatin errr t antipsychtic and Beta blcker. Issued at a level 4. RN with frged license and license was never verified N RN assessments Prblems with medicatins and treatments Lacking plicies and training f unlicensed persnnel Superir View: Cmprehensive license immediately suspended and revked Survey frm January 25 28, 2016 with 36 rders, many widespread, and multiple level 3 vilatins, resulting in several fllw-ups never reaching full cmpliance Seven OHFC investigatins frm May 2015 thrugh August 2016 by OHFC All but ne OHFC investigatin resulted in rders 2015: Enfrcement Actins = 2 Riverbend: T-cmp denied cmprehensive Client in memry care with a knwn histry f falls and histry f fractures with n initial assessment had 14 falls and sustained a fracture. N assessment fr causal factrs with the 14 falls/fracture. Level 4 immediate crrectin rdered. Vilatins with medicatins and treatments, reprting maltreatment, lacking general plicies and systems. Training cncerns fr unlicensed persnnel Salmi Hme: Cmprehensive license entered stipulated t change t new wnership July 24 thrugh 31, 2015 survey with 34 vilatins Tw OHFC investigatins with ne substantiated and ne nt 6