Newsletter #42 CCFFH NEWSLETTER Winter 2013 Welcome to: Hawaii: Kauai: Oahu: New CC CFFHs from October, November and Decem mber 2013 Elizabeth Galanto,CNA; Sandra Kapela,CNA; Romeo Salom Jr,CNA; Irene Vidad,CNA Jesusa Sebastian,CNA Paulina Alboroto,CNA; Natti Asentista,NA; Rosebella Balan,CNA; Joerelyn Bugauisan,CNA; Heidi Cafirma,NA; Sheila Marie Calantoc,NA; Catirina Concepcion,NA; Marites Domingo,CNA; John Ignacio,NA; Matilde Limarag,CNA; Ricky Mericle,CNA; Manilyn Nagtalon,NA; Jociel Nones,CNA; Juliet Orpilla,CNA; Vilma Penuliar,CNA; Ronald Reyes,CNA; Faatu Ripley,NA; Loida Sanchez, LPN; Eurose Savellano,CNA; Elizabeth Soriano,NA; Marilyn Speichinger,CNA; Leocardio Tactacan Jr,CNA; Imelda Vea,CNA; Gina Yoshikawa,CNA Primary caregivers (PCG) are responsible for reading the CCFFH Quarterly Newsletters and for following Hawaii Administrative Rules (HAR) Chapter 17-1454 CCFFH caregivers are responsible for all current and amended regulatory requirements as noted in HAR, CCFFH newsletters, and DHS transmittals CCFFH clients require 24-hour supervision and nursing facility level of care. Leaving clients without an approved substitute caregiver even for one minute - will result in your CCFFH certification being revoked. Expecting an email from Community Ties Association (CTA) but can t find it? CHECK your SPAM or JUNK email folders Send Your Email Address to CTA... CCFFH operators are required to access certain items on-line. In the future, most information will be available only by email. If you have not done so already, please send your email address to s.young@comties.com at CTA. Put CCFFH EMAIL ADDRESS in the subject line. Include the PCG s full name so we can match the email address to the PCG. Electronic communications will enable us to serve you better. Household Members Providing Care to Clients Household members are not allowed to provide any direct care to clients. Even if household members complete in-services and CPR/First aid/bloodborne/infection Control trainings, they may not provide direct care unless they are approved by CTA and trained by the client s case management agency (CMA).
2 Newsletter #42 All caregivers, including those who work for less than 3 hours, must be approved by CTA and trained by the client s CMA, prior to providing direct care. In the event of emergencies including fire or natural disasters, household members can help the PCG evacuate clients, if that person is physically capable and has been trained to safely evacuate clients. Using a CTA-Approved SCG Before SCGs can care for clients, CTA must receive your change notification form, even if CTA already approved the SCG. Contact the CMA to receive delegation and then keep a copy of the Change Notification form in your file. CTA does not approve changes; the form is only filed and the change recorded. To care for clients in the event of an emergency, the DHS requires one- and two- person certified homes to have at least one CTA-approved SCG listed. There must be at least two CTA-approved SCGs listed for three-person certified homes. When a three-person home becomes certified all SCGs under age 21, and/or those with less than one full year of experience, must be removed as SCGs. They cannot serve as SCGs regardless of how many clients reside in the home. SCGs not working in a home must be removed from the home s list of SCGs by sending in a Change Notification form. Use of Legal Names All caregivers and adult household members are required to use their legal name. Please report any name changes to CTA immediately, along with a copy of legal proof of the name change. PCGs and SCGs also must submit an updated Disclosure Form. New certificates and New SCG approval forms are issued by CTA, as applicable. All names and variations of names must be listed when performing background checks. Be sure to provide Fieldprint and ECrim every name that you ve ever used. Social Security Numbers Please do not send CTA your social security number or put your social security number on any CTA form. CTA does not require this personal and confidential information to certify a home or approve a caregiver. Social Security numbers do not need to be kept in home records unless the health plans require it. CMA and CTA visits CCFFHs operate a 365-day 24-hour care business and are subject to unannounced CMA and CTA visits for any reason, including annual and bi-annual recertification visits. Visits can be conducted at any time day or night, or on weekends. Contracts No later than the day of admission, there must be a client-signed contract with Medicaid and Private Pay clients describing both CCFFH and CMA services and financial payment expectations. Sign-out Sheets for Three-bed Certified Homes Any time a PCG leaves the home, they must sign out. A qualified, trained, and approved SCG then must sign in. At the end of the day, the PCG totals the number of hours they have been out of the home and puts the total in the Daily Total column. At the end of the week, the PCG will place the total hours for the week in the Weekly Total column.
3 Newsletter #42 A PCG may utilize nurse aides for a maximum of 5 hours a day, not to exceed 28 hours in a week. Keep all sign-out sheets in your CCFFH binder. This new version of the Three-Bed Certified CCHH Sign-out Sheet is posted on the CTA website http://www.comties.com/hiforms.html. DATE PRINT NAME SIGNATURE NA CHECK ONE CNA LPN/ RN CHECK ONE PCG SCG TIME IN TIME OUT 6/4/11 Sarah Smith ftüt{ få à{ X X 9:30am 6/4/11 John Doe X X ]É{Ç WÉx 6/4/11 Sarah Smith X X 10:30am ftüt{ få à{ 6/14/11 Not out of home this week 6/21/11 Not out of home this week 9:15 am 10:45am Daily Total Hours 1 ½ hours Weekly Total Hours 1 ½ hours Private-Pay Clients/Boarders/Renters It is against Hawaii State Law for a caregiver to charge a fee if the client is unrelated, and living in the caregiver s home. Therefore, a home cannot close and then reopen for the purpose of providing care to private-pay clients only. If you rent out an apartment or room in your home, the tenant must be able to care for themselves independently, or be receiving care from an outside caregiver or agency. The client or their family must arrange for direct payment. If the rented room or apartment connects to the CCFFH, or the renter frequently visits the CCFFH, that person must be added as a care home household member. Suspended or Closed Homes and Client Contact If a CCFFH is closed, or its new admissions suspended, the home s disclosure/consent forms also are suspended or revoked. This leaves the home without legal authority. Neither caregivers, nor family members of caregivers, are permitted to make any contact with any clients that have transferred to another home. Making contact is a violation of client rights and confidentiality. Confidentiality and Privacy Training Many people still have questions about the Confidentiality/Privacy rights training for SCGs and adult household members. The Hawaii Administrative Rules state: 17-1454-13.1 Confidentiality of applicant and recipient information. (a) All information relating to individuals who apply for or receive home and community-based case management and community care foster family home services shall be confidential. (b) Case management agencies and homes licensed or certified under this chapter will: (1) Have written policies and procedures that relate to confidentiality and privacy rights of applicants and recipients; (2) Safeguard all confidential information about applicants and recipients of services;
4 Newsletter #42 (3) Inform clients about their confidentiality practices; (4) Respect client privacy rights; (5) Provide training to all employees, and for homes, other adults in the home, on their confidentiality policies and procedures and client privacy rights. The PCG is responsible for training all SCGs (employees) and all other adults on the home s confidentiality policies and procedures, and client privacy rights. The home must maintain policies and procedures that relate to confidentiality and privacy rights of clients. Each home operator is responsible for creating and providing trainings that include but are not limited to: locations of charts and medications; how privacy and confidentiality is handled for visitation; and client access to private phone calls and mail. CTA strongly recommends that homes develop a standard signature sheet for all SCGs and adult household members to verify they received proper training. A copy of the home s policies and procedures should be kept in the home s administrative binder. Homes may develop their own system, as long as it can prove to CTA the training was completed. CMA Access to Client Charts Client charts are private information and cannot be accessed by anyone other than current providers and regulatory surveyors. CMAs that are not the client s current CMA are not authorized to access the client s charts. Caregivers may not give any client chart or family contact information to any case manager who is not working for the client s current case management agency. Unauthorized access is a violation of the Hawaii Administrative Rules and a violation of the client s confidentiality. Job Experience CTA has revised its Job Experience Form and Instructions. You can find both documents at http://www.comties.com/hiforms.html. The Department of Human Services defines one year of experience as: Having worked at least 1,920 hours in no less than 12 months; Qualifying work experience is credited based on a maximum 40-hour work week; Sleep hours do not qualify as time worked; Hours spent observing someone else providing care does not qualify as time worked; and Registered Nurse educational experience can be substituted for the required work experience if that person has been licensed as a Registered Nurse in the State of Hawaii. Adverse Events All adverse events should be verbally reported to the CMA within 24 hours of the incident, excluding weekends and holidays. Within a maximum of 72 hours, the CCFFH should have sent the report to the CMA. The CMA forwards the report to CTA and the Health Plans. Incidents that must be reported to the CMA in an Adverse Event Report include: Injury Fall (with or without medical treatment) Pressure Ulcer Medication Error ER visit Hospitalization Elopement wandering off not knowing where the client is Death (when the death occurred in the home)
5 Newsletter #42 Whenever police, EMS, adult protective services (APS) or Child Welfare Services (CWS) come to the CCFFH, an Adverse Event form must be filled out. IMPORTANT NOTE: Mandatory reporting timelines vary among CMA. Follow the client s CMA policy for reporting adverse events. The client s CMA also may require that Adverse Event reports contain additional information related to the incident, changes in condition, or behavior. Medication Administration and Reporting Errors Medication errors are the most common errors in any healthcare setting, yet CTA rarely receives Adverse Event reports about medication errors. It is a violation of the rules if adverse events, including medication errors are not reported. Whenever a medication is not given as prescribed an Adverse Event form must be completed and sent to the CMA. The CCFFH should contact the client s physician. Medication Errors Include: Giving the wrong medication; Medication is given by the wrong route (for example: ear drops given in the eye, eye drop given in left eye when it was the right eye, swallowed instead of putting under tongue for sublingual meds); Medication is given at the wrong time (outside of the window of the CMA policy usually ½ hour before to ½ hour after check with the client s CMA as they could be different); Given to the wrong person (you give one person s medication to another person even if it is the same medication); Wrong dosage is given (you give someone too much or too little medication); Not documenting properly (you don t document morning meds until later in the evening); and Medication not stored properly (not refrigerating meds that should be refrigerated or not keeping medications out of sunlight that should be) To Minimize Medication Errors: Compare the medication label to the Medication Administration Record and MD orders; all 3 should match (this includes over the counter meds make sure you have the right over-thecounter medication and dosage); Only administer medication that you have prepared personally; do not administer medication that someone else has prepared; Know the purpose of the medications, the expected outcomes and side effects of the medication Always observe a client taking the medications. DO NOT leave medications for a client to take later. Clients have the right to refuse any medication or treatment. If a client refuses, document the incident. If they continue to refuse their medication or treatment, contact the CMA. If there has been a change to any medication, inform the CMA immediately to determine if the medication change is within recommended ranges Never crush pills that should not be crushed (there are over a hundred always ask a doctor or pharmacist before crushing any medication many times a liquid form can be prescribed) Never touch the pills themselves Never put pills from one container into another container Do not use someone else s medication even if it is the same medication Clients have a right to know what medications they are taking, and their potential side effects. If they ask, provide that information before dispensing the medication.
6 Newsletter #42 Every Time You Give Medication Check that you have the correct client Check to make sure you store the medication according to the label (i.e., refrigerated, stored at room temperature, out of sunlight) Check the name of the medication Check the dosage of the medication on the label and the MAR (strength and amount) Check the route the medication is to be given (by mouth, feeding tube, under the tongue, eye, ear) Document that you gave the medication immediately after the client takes the medication Wash hands before and after administering medications Wear gloves if helping put pills into a client s mouth The client s CMA is responsible for ensuring that medication is properly administered. Refer to the client s CMA Medication Administration Policy to ensure the policy is followed for every client. ** This newsletter has been reviewed and approved by the Department of Human Services** Community Ties of America, Inc 45-955 Kamehameha Hwy., Suite 300, Kaneohe, HI 96744 PHONE: 808-234-5380 or 877-236-5380 (toll-free) FAX: 808-234-5470 Vacancy Report Fax: 888-539-1112 (toll-free) NOTE: Vacancy Report Fax is an 8 8 8 Number, not 8 0 8 For forms: http://www.comties.com/hiforms.html CTA Office Hours Monday Friday, 8:00am 4:30pm Appointments are recommended to ensure your needs are met