Division of Health Service Regulation Adult Care Licensure County Oversight Process Required at G.S. 131D-2.11: Monitoring done timely Identify and document noncompliance 1
AHS Facility Report replaces the Adult Care Monitoring Report Form DHSR/AC 4606 and 4606b Allows for quick summary of visit and results Reduces amount of narrative needed Organizes visit function and results AHS Facility Report Form - DHSR/AC 4606 Visit Identification Section A Census Section B Regulatory Focus and Results Section C Communication with Facility Section D Signatures Note to denote use of Attachment B 2
New Forms AHS Facility Report (Form 4606) replaces the Adult Care Monitoring Report Allows for quick summary of visit and results Reduces amount of narrative needed Organizes visit function and results AHS Facility Report Form DHSR/AC 4606b Facility Identification Section A Complaint Information Section B Results of Complaint Investigation Section C Review of HCPR Report and Results Section D Review of Staff and Results 3
AHS Facility Report On Attachment B (Form 4606b) Facility Identification Section A Complaint Information Section B Results of Complaint Investigation Section C Review of HCPR Report and Results Section D Review of Staff and Results Annual County Tracking Form Two pages including the Tracking Form and the Substantiated Violation Report Submitted the first week of July to your team supervisor for inclusion in annual review 4
Annual Tracking Form Developed to assist AHS scheduling a facility s monitoring visit and tracking those visits while meeting the regulatory focus A complaint investigation in one of the designated regulatory focus areas counts as meeting the monitoring focus Annual Tracking Form Developed to assist AHS in scheduling a facility s monitoring visit and tracking those visits while meeting the regulatory focus A complaint investigation in one of the designated regulatory focus areas counts as meeting the monitoring focus 5
Substantiated Violations of Resident Rights Meets requirement of G.S. 131D-26 References Violations as defined at G.S.131D-34 Requires number of Violations cited at each of the Resident Rights 6
Oversight Process Conducted quarterly Requires communication if problem noted on review of CAR, monitoring report or CIR Promotes opportunities for discussion on specific and overall performance Provides documentation ACLS Co Oversight Report Review of AHS Facility Reports Licensure Consultant reviews one monitoring report per quarter for each facility Document on county oversight report Discuss questions or issues with supervisor to ensure follow-up Consultant or Supervisor may contact 7
ACLS Co Oversight Report Review of CARs/CIRs Completed by team supervisors Timely review allows for ability to address issues with county and the facility Discuss and document Team supervisor should be contacting to pre-schedule quarterly review with the county DSS supervisor. Quarterly report is sent to DSS supervisor and director 8
Questions Who What Where When and How??? How do you know a report has been received? Where are keeping pending review work? When are you communicating with your supervisor-problems-work status, etc? Use the feedback-we are all moving forward 9
Annual Review County AHS Supervisor submits tracking form and resident rights violations report the first week of July to team supervisor for inclusion in annual review. Final discussion with team supervisor and county AHS supervisor regarding annual results Memo with annual results of the review and any necessary action required will be submitted to the AHS Supervisor and DSS director by August 15. The completed annual ACLS County Oversight Report form including the county tracking review documentation and results of the county monitoring visits will be included. The next year s evaluation will begin with the following first quarter s review.?questions? 10
Division of Health Service Regulation Adult Care Licensure Section 2708 Mail Service Center Raleigh, NC 27699-2798 Phone: (919) 855-3765 Fax: (919) 733-9379 Website: http://www.ncdhhs.gov/dhsr/ Questions may be sent to: DHSR.AdultCare.Questions@lists.ncmail.net 11
ADULT CARE HOME ABRUPT CLOSURE PROCESS Purpose: The purpose of this information is to provide guidance in activities required in resident placement when an Adult Care facility is abruptly closing its operations. Items to Support Notification and Resident Transfer: The County Department of Social Services (DSS) will prepare a Contact Sheet for staff use. This will include contact information including contact names, numbers (phone and fax) for licensee, facility, relevant DSS staff, law enforcement, ACLS Raleigh office and relevant regional office, DHHS Communications Office; site address with travel directions from DSS office to facility. Remember to have name tag and business cards with you. Obtain items and resources necessary for moving residents available prior to entry into the facility. Items normally needed are: gloves; hand sanitizer; gallon size Ziploc bags (enough for two for each resident) to hold resident medications, Medicaid card, etc.; boxes of heavy duty trash bags for resident possessions; adhesive labels; permanent markers; and if necessary, a portable copier (if available) and paper or camera. Entrance Conference and Initial Activities (DSS Staff) 1. Upon arriving at the facility, announce your presence, usually at the business office; present your business cards. 2. Request to speak to the Administrator or person-in-charge. Introduce yourself, state the purpose of the visit. Indicate that staff from DHSR will also be onsite to monitor and document regulatory compliance. 3. Proceed to ask for a current census of residents, including any residents signed out. In addition, request a current roster of residents and for the facility to identify residents in the hospital or currently out of the facility. DSS and DHSR staff should perform a head count and verify residents by name in the facility for accuracy. 4. Explain to the administrator or designee of the need to gather residents and explain that the facility is closing. Offer the administrator or designee the opportunity to inform residents. If the administrator or designee is unable or unwilling to do this, County DSS staff will inform residents. County DSS staff will also meet individually with residents confined to bed who are unable to attend the group meeting. Abrupt Closure Process Page 1 03/07/2014
ADULT CARE HOME ABRUPT CLOSURE PROCESS 5. Request that facility staff currently on duty continue to work and assist residents with caring for residents and packing their belongings. Ask if any residents are to receive medications during the remainder of the shift. Explain that the residents should continue to receive medications as ordered by their physicians as well as meals and other services until all residents are relocated. Explain that medications and the original Medicaid and insurance cards, guardianship, POA, responsible party documents, living will and/or DNR documents, and individual identified by resident upon admission to be notified of discharge need to be placed in bag with a copy of these items placed back in the resident s file. In addition, copies of current administration records, controlled substance logs, TB screening, PASRR, PCS authorization for services, FL-2, Independent Assessment, DMA 3050-R or other care plan, need to placed in a bag. The bag should be labeled with the resident s name and include itemized checklist of bag s contents. See Resident Documentation Sheet. Managing Contingencies 1. If the facility staff becomes upset upon learning of the closure of the home, validate that this is a difficult time for the staff as well as the residents. Emphasize that the process will be less traumatic for residents if the provider can assist in the transition. 2. If residents become upset upon learning of the closure of the home, validate their feelings. It is helpful to ask the resident to move to their room and address their concerns individually. If family members come to the facility upon learning of the closure of the home meet with them individually to answer questions and address specific concerns about their family member. Assist residents, if they request, to contact their family member if staff are unwilling or unavailable to do so. 3. If staff leave the facility and services are not available, DSS will obtain necessary resources to ensure residents needs are met. This would include contact with DSS county programs and resources including local public health department, MCO/LME. 4. If the media arrive onsite, refer to the DHHS Communication staff or as the county DSS management directs. Protect the identities and confidentiality of residents. Informing the Residents After the facility staff has gathered the residents in a common room they are informed of the need to close the home. If the administrator or designee delays in presenting this information to residents the DSS staff should take the lead in addressing residents. The following points should be communicated: a) State your name and that you are from the county DSS. b) Explain that due to the licensee s decision to close the home, it is unsafe for residents to remain in the facility. Inform the residents that the home is being closed immediately. Validate residents feelings as they are expressed. c) Introduce the county DSS and MCO/LME staff persons and explain that they will meet with each resident and discuss their options for a new place to live. Further explain that county DSS staff will remain in the facility until each resident has been moved to a safe placement. Abrupt Closure Process Page 2 03/07/2014
ADULT CARE HOME ABRUPT CLOSURE PROCESS d) Advise residents that their medications, necessary paperwork and belongings will be moved with them to the new location. e) Tell residents that their families will also be contacted regarding the facility s closure and to help in determining where residents might move. f) Answer any questions posed by residents as simply and succinctly as possible. Ask residents to begin packing their belongings. Organizing Residents Medications, Information and Belongings: County Staff: Adult Protective Services, Placement Specialists and Adult Home Specialists Placement: 1. Ideally the facility medication aide will agree to put residents medications in individual bags, labeled with each resident s name. 2. The residents paperwork should also be placed in this labeled bag. This would include copies of medication administration records, controlled substance logs, PASRR, PCS authorization for services, FL-2, Independent Assessment, TB screening, DMA 3050-R or other care plan, original Medicaid or insurance card, Living Wills or DNR forms, and a list of guardians, POAs, and other identified individuals specified to be contacted on behalf of the resident. Complete an itemized checklist of all items contained in the bag. 3. The individual bags of residents paperwork and medications should remain in a secure location (usually medication room) until the resident leaves the facility. 4. In the event, facility staff refuse to assist with gathering residents medications and paperwork county DSS staff will perform this function. 5. County DSS staff will take the lead role in organizing residents and their belongings for transition to the new placement including coordinating times with the receiving facility for residents/responsible parties to return to retrieve any remaining personal items (including residents funds, if available). 1. DSS and MCO/LME staff will take the lead role in identifying residents placement needs, contacting the resident s legally responsible party and appropriate facilities and arranging for placement in the new facility. 2. Set aside an area in the facility for DSS/MCO/LME staff to interview residents and assess their needs. DSS/MCO/LME staff will inform the resident of available placement options and assist them in choosing a new home. 3. If possible, the receiving facility will pick up the resident, their belongings, medications and paperwork and transport back to the receiving facility. 4. County DSS and DHSR staff will remain in the home until all residents are safely placed. Abrupt Closure Process Page 3 03/07/2014
ADULT CARE HOME ABRUPT CLOSURE PROCESS 5. DSS and MCO/LME staff will notify DHSR staff onsite regarding regulatory concerns or if difficulties arise Abrupt Closure Process Page 4 03/07/2014