Newsletter #44 CCFFH NEWSLETTER March 2015 Aloha, There was no summer newsletter. This is the first newsletter under the review of The Department of Health (DOH), Office of Health Care Assurance (OHCA). This will be the last newsletter sent to you by mail. Beginning March 15, 2015, CTA will email newsletters and post them to the CTA website. Please ensure that CTA has a current email address for your home. You are responsible to read and understand the contents of all newsletters and will be responsible to check your emails and the CTA website periodically for updates in regards to regulation and compliance issues. If you have not yet given CTA your email address, please send it immediately to s.young@comties.com. Be sure to include your facility name as it appears on the CCFFH certificate. Mahalo. CMA and CTA unannounced visits ( 17-1454-2; 17-1454-9.1, 17-1454-41 and 17-1454-48.1) CCFFHs operate a 365-day 24-hour care Medicaid business and are subject to unannounced CMA and CTA visits for any reason. Visits can be conducted at any time day, night, or on weekends. Case managers are encouraged to incorporate both announced and unannounced visits as a proper way to oversee the care of clients. In addition, once a month visits are the minimum number of visits a CMA makes, a client or home may require more than once a month visits and a CMA can make as many visits as they deem necessary for follow up of client care and services based on client needs. A home cannot refuse visits from a CMA or CTA. Refusing visits would be a violation of the rules and regulations. Transportation ( 17-1454-2 and 17-1454-41) Transportation continues to be an issue. Homes are required to provide all transportation for medical, social and recreational activities for clients in a timely manner. Therefore, a home should utilize their substitute caregivers to provide client care for the clients remaining in the home or to provide transportation services in order for clients to attend necessary appointments and activities of the clients choosing in the community. Clients must be picked up in a timely manner from those appointments and activities. Unless specified in a client s service plan, a caregiver should be present for all appointments and activities as clients require 24/7 care.
2 Newsletter #44 Updated Forms on CTA Website Only current forms will be accepted so please check our website (http://www.comties.com/hiforms.html) for the most up-to-date versions as they are periodically updated Locking doors ( 17-1454-46, 17-1454-50 the Adult Protective Services Law HRS 346 Part X) All clients have the right to privacy and may lock their own bedroom and bathroom doors at anytime if they so wish. Caregivers are to respect client privacy and maintain client dignity at all times. A home may not lock clients inside the home or in their bedrooms against their will even if the client s family requests it. This is considered a physical restraint and a violation of client rights. Any restraint must have a proper assessment considering all least restrictive restraint alternatives and be listed on a client s service plan per the Hawaii Administrative Rules. However, caregivers may access locked client doors with a key when safety is a concern. Proper bed, seat, vest and door alarms can be utilized, as necessary, to alert caregivers if a client has issues with wandering or falling. Changing Case Management Agencies ( 17-1454-50) Clients cannot be told they must switch case management agencies in order to stay in a home or to move to another home. Clients have the right to keep the case management agency they have chosen. This may mean they have to move to another home to keep their current case management agency and a proper notice should be given to the client. Any home considering accepting a client into their home must work with that client s current case management agency. The client cannot be told they must change case management agencies and go with the case management agency of the caregiver s choice in order to be admitted to a home. This does not give the clients true choice of providers and violates their rights to freedom of choice of providers. Primary Caregivers do NOT have case management agencies. Only clients have case management agencies. The CMA s responsibility and duty is to the client, not to any caregiver or home. PCGs should not be advising clients on whether or not they should change CMAs. If a client wants to switch CMAs, the PCG must contact the current case manager. The current case manager has the responsibility of changing CMAs per the Hawaii Administrative Rules. If a PCG no longer wants to work with a particular CMA, the PCG must give the client a three-week written notice to let them know that the PCG no longer wishes to work with their CMA. The PCG may not tell the client the reason for no longer wanting to work with a particular CMA so as not to influence with the client s decision on whether or not to switch CMAs. If the client wants to switch CMAs to remain in the home, the PCG must contact the current case manager. If there is a conflict, the client can be given a list of licensed CMAs and the client or their representative may chose another CMA. A PCG may not assist the client in locating another CMA. If there is an issue with a client wishing to switch CMAs and the current CMA refuses to assist the client in locating another CMA, the client can make a complaint to CTA. Personnel Allowance ( 17-1454-47 and Social Security laws) Medicaid clients should be receiving at least $50 a month in personal allowance to spend on items of their own choosing. If the home is responsible for these funds, a log of all allowance money spent must be recorded and receipts must be kept using standard accounting principles. This money is not to be used for transportation costs, diapers, wipes, gloves, food supplements such as Ensure, or other services and supplies the home is paid to provide.
3 Newsletter #44 Illegal Care Homes (Hawaii State law) It is illegal to care for anyone, for a fee, who is unrelated in your own home without being certified/licensed. If CTA becomes aware of such a situation, it will be reported to the proper authority for investigation. Home policy & procedures ( 17-1454-44.1, 17-1454-48, 17-1454-48.1, 17-1454-50 and 17-1454-52) Beginning March 15, 2015, homes must have their own P&Ps per the HAR. Homes will no longer be able to use a CMA s P&Ps. Substitute Caregiver Approvals ( 17-1454-41, 17-1454-43 and 17-1454-46) Only approved caregivers, who have received delegation from a RN case manager, can provide care to clients. Untrained, unapproved caregivers are not allowed to assist in any form of hands-on client care. This includes household members, children, neighbors, friends and other family, even if that person is a PCG to someone else or is a licensed professional. Helpers, volunteers, household members, babysitters, housekeepers and assistants are not allowed to provide any care to clients, whether they are paid or unpaid. However, they may assist with household cleaning, cooking, emergency evacuation (if trained), etc. Any person observing direct care of clients has to have consent from that client to do so. Using unapproved, untrained caregivers is a serious violation of the rules and may result in revocation of a CCFFH certificate. **For SCG Change Notifications, no SCG approval will be sent to homes as the SCG is already approved. Be sure to get a copy of the SCG s approval from the SCG for home records. ** Compliance reminder for 2-year certificates ( 17-1454-9) In order to be eligible for a 2-year certificate, a home must meet stringent requirements. Typical reasons for not meeting those requirements are: 1. Having any dated requirement, such as CPR and background checks, expire during the current certificate period. If any requirement lapses even one day, the CCFFH is not eligible for a 2-year certificate. 2. Not reporting changes to CTA all changes to the structure of a home, changes to household members moving in/out, changes to SCGs, changes in background checks, etc. 3. Having a substantiated complaint during the current certificate period. The full listing of requirements can be found on CTAs website under Two Year Certification Requirements. Building and housing codes ( 17-1454-41) Homes are required to follow all county, state and federal rules, laws and regulations, not just those listed in the Hawaii Administrative Rules. Homes are required to meet all occupancy, electrical, mechanical and housing codes and obtain all proper building permits for all home improvements. CTA may ask for these permits, when applicable, and may ask if the home is meeting those requirements. If there are any doubts, CTA will require the home to obtain proof or verification that the home is meeting regulations from the proper agency or licensed professional. This includes having proper permits to section off a home, having an authorized kitchen and proper coded bedrooms for the number of occupants allowed by law to live in the home. Caregivers cannot utilize living rooms in lieu of their own bedroom. All occupants must be able to sleep in authorized permitted bedrooms. It is the home s responsibility to ensure proper fire and life safety procedures are in place. Homes must have an indoor dining and living room area that integrate clients for proper socialization and recreation. Clients should be encouraged to eat in the dining area when possible and should be out of their bedrooms for social and recreational activities throughout the day. Clients should not have their own separate eating and socialization areas and should eat with the rest of the CCFFH family. The CCFFH program is designed to integrate clients into the homes family life, not segregate to a separate section of the home where they have no interaction with the CCFFH family.
4 Newsletter #44 Household members and housing codes ( 17-1454-41) If a home has a connecting doorway leading to another area of the same dwelling and it is zoned as a singlefamily dwelling, then all people living in that dwelling are considered household members and must meet all requirements as such. If the home is considered a multiple family dwelling, and sealing off a connecting doorway can be completed by obtaining proper permits and authority to seal it off, then the people on the other side of the doorway would not have to be considered household members. TB clearance ( 17-1454-41 and HAR 11-164-1 through 11-164-12) Proof of a skin test result must be on file for all adult household members and caregivers. TB skin tests for individuals under the age of 18 are not required. Anyone with a negative skin test must have another annual skin test performed within 335-395 days of the previous skin test. A TB screening does not replace the skin test and will not be accepted in place of a negative skin test. Anyone with a positive skin test must have a subsequent chest x-ray. A chest x-ray is required only one time unless symptoms are present. After a positive test and a chest x-ray clearance is on file, only TB screenings/physicals are required (using the Department of Health form found on the CTA website) every 335-395 days. Individuals who have a positive skin test, then later have a negative skin test, must continue to have skin tests performed unless another positive skin test is obtained. Fall prevention CTA continues to see large numbers of falls and multiple falls for the same individuals. Falls can be avoided when appropriate, necessary steps are taken to assess risks, and prevention strategies are implemented. The following information should be reviewed by caregivers and case management agencies when addressing falls. Falls can be prevented by assessing how the fall occurred and how to prevent falls from occurring using a multifaceted approach. The approach should include but not be limited to the following: Medical assessment and management is there an underlying cause and can it be treated? Exercise including range of motion and physical therapy is crucial to maintain and improve strength. Medication adjustment are there medications affecting eyesight, mobility, or making a client drowsy? Home environmental hazards is the home well lit and is there adequate assistive devices? Behavioral therapy is the client afraid of falling or are the caregivers afraid? Education using educational resources to educate client, family and caregivers. Assessing caregiver ability to safeguard clients at risk for falls transferring to a different setting could be a consideration. Educational Resources for Falls there are more resources on the internet this is only a sample Health in Aging: http://www.healthinaging.org/aging-and-health-a-to-z/topic:falls/info:care-and-treatment/ Mayo Clinic: http://www.mayoclinic.org/healthy-living/healthy-aging/in-depth/fall-prevention/art-20047358 Centers for Disease Control and Prevention: http://www.cdc.gov/features/olderamericans/ Falls Prevention Center of Excellence: www.stopfalls.org National Council on Aging http://www.ncoa.org/improve-health/falls-prevention/
5 Newsletter #44 ER visits CTA continues to see adverse events for unnecessary ER visits. Please call the client s case management agency or Health Plan nurse hotline, when applicable, before taking a client to the ER. The following information was obtained from the U.S. National Library of Medicine, National Institutes of Health. When to use the emergency room - adult Whenever an illness or injury occurs, you need to decide how serious it is and how soon to get medical care. This will help you choose whether it is best to call the client s doctor, go to an urgent care clinic, or go to an emergency department. It pays to think about the right place to go. Treatment in an emergency department can cost 2-3 times more than the same care in the doctor s office. Think about this and the other issues listed below when deciding. When in doubt, call 9-1-1 or go to the emergency department. Signs of an Emergency How quickly do you need care? If a person or unborn baby could die or be permanently disabled, it is an emergency. Call 9-1-1 to have the emergency team come to you right away if you cannot wait, such as for: Choking Stopped breathing Head injury with passing out, fainting, or confusion Injury to neck or spine, especially if there is loss of feeling or inability to move Electric shock or lightning strike Severe burn Seizure that lasted 3-5 minutes Go to an emergency department or call 9-1-1 for help for problems such as: Trouble breathing Passing out, fainting Severe chest pain or pressure Pain in the arm or jaw Unusual or bad headache, especially if it started suddenly Suddenly not able to speak, see, walk, or move Suddenly weak or drooping on one side of the body Dizziness or weakness that does not go away Inhaled smoke or poisonous fumes Sudden confusion Heavy bleeding Possible broken bone, loss of movement, especially if the bone is pushing through the skin Deep wound Serious burn Coughing or throwing up blood Severe pain anywhere on the body Severe allergic reaction with trouble breathing, swelling, hives High fever with headache and stiff neck High fever that doesn t get better with medicine Throwing up or loose stools that don t stop Poisoning or overdose of drug or alcohol Suicidal thoughts Seizures
6 Newsletter #44 Visitation hours ( 17-1454-50) Visiting hours cannot be restricted to certain days. All homes must allow visitation by friends or family every day within reasonable hours to accommodate visitors schedules according to the Hawaii Administrative Rules. For example, a son of a client works 9 am to 5 pm so visitation hours would need to accommodate his schedule so he is allowed to visit his mother before 9 am or after 5 pm. Adding substitute caregivers during a recertification review If a home wants to add a substitute after their certification visit and before receiving their certificate, that request must be sent to the CTA compliance manager s attention that performed the review. Effective January 1, 2015 Survey results will be posted online (ACT 213) In order to comply with Hawaii legislative law and the Federal Affordable Care Act, all CTA certification surveys conducted on or after January 1, 2015, will be posted online on the Department of Health s website in order to provide for public access of information and to meet transparency requirements. The CCFFH s response to any deficiency report will also be posted online. Attached is a sample of a written plan of correction. Surveys will be listed using the CCFFH name on the CCFFH certificate. Instructions for completion of the statement of deficiencies and plan of correction: 1. Purpose the Corrective Action Report issued by CTA contains a listing of deficiencies cited by CTA as requiring correction. The statement of deficiencies is based on the reviewer s professional knowledge and interpretation of the Hawaii Administrative Rules and Regulation requirements. 2. Name and Address CTA will indicate the name and address of the facility identified on the official certification on record. 3. Summary statement of deficiencies CTA will cite each deficiency followed by full identifying information including the rule number and the regulation requirement. CTA will describe why the home does not meet the specified requirement. Client and caregiver names will not be used. Instead, client and caregiver identifiers will be used to maintain the privacy of protected and confidential information in accordance with HIPAA privacy rules. 4. Written plan of correction Each home shall be responsible for completing a written plan of correction. The statements must reflect the facility s plan for corrective action and the anticipated time of correction (an explicit date must be identified). If the correction has been completed, the plan must indicate the date completed. The date indicated for completion of the corrective action must be appropriate to the level of the deficiency (ies). The written plan of correction must maintain HIPAA compliance and therefore cannot contain any names of clients, caregivers, household members, doctors, case managers, and must avoid use of pronouns such as he/she, etc. Homes are required to utilize CTA identifiers written in the issued report. Homes must comply with HIPAA privacy rules. A written plan of correction is a statement made by the facility and recorded outlining how the facility will specifically correct each deficiency, the timeframe in which it will be corrected, and the method of determining that the correction is being implemented and followed over time to prevent the deficiency re-occurring in the future. 5. Signature the written plan of correction must be signed and dated by the primary caregiver. The original, with the facility s proposed corrective action, must be returned to CTA within the timeframe identified on the report. The home will maintain a copy for their records.
7 Newsletter #44 Sample Written Plan of Correction May 12, 2014 The statements made on this plan of correction are not an admission to and do not constitute an agreement with the alleged deficiencies therein. To remain in compliance with all State regulations, the CCFFH has taken or will take the actions set forth in the following plan of correction. The plan of correction constitutes the CCFFHs allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date or dates indicated. 17-1454-41.b.7 The home received a current 2014 TB clearance for CG#2 on April 3, 2014. It is on file in the home personnel record. The home will utilize a computer program to track when personnel requirements are due to prevent any requirement from expiring in the future. Attached is the TB clearance for CG#2. 17-1454-43.c.3 The home contacted client #1 s case management agency on April 1, 2014. The case manager came to the home on April 10, 2014 and performed an in-service for all caregivers regarding the client s service plan. All caregivers will follow client service plans and review of the service plans will be done by the primary caregiver, at least every 3 months, with all caregivers, to ensure understanding of the services to be provided to clients. The service plan reviews will be recorded and kept in the client record. 17-1454.44.1 The home gave a copy of the home s grievance policy and procedure to client #2 and the client s representative on April 9, 2014. The home will ensure that all clients admitted in the future receive this before or on the day of admission. The home will keep a copy of the signature page in all client records. 17-1454-47 The home could not locate all receipts for client #1 s personal monthly allowance. The account record has been updated to reflect the amount of the client s current available funds. The home will maintain all receipts and an accurate accounting of all client funds received and spent using the account record. The account record will be maintained in client record using standard accounting principles. 17-1454-49 The home could not locate copies of automobile insurance coverage from 2013. The home will keep copies of all insurance policies showing continued insurance with proper coverage amounts during the current certificate period. Signed: Jane Doe 5/12/14 Jane Doe 123 Corner Lane Honolulu, HI 12345 Retaliation ( 17-1454-9.1, 17-1454-41, 17-1454-44.1, 17-1454-48.1, 17-1454-50) Everyone, including clients, has a right to make a concerned call or file a grievance towards any caregiver (PCG or SCG), CMA or CTA without fear of retaliation. When CTA receives such a call or report, an investigation into the matter may result. An investigation does not automatically mean a rule has been broken. An investigation can help to resolve misunderstandings or miscommunications and may help bring about improvement and resolution of issues. If anonymity is requested, the name of the caller will not be revealed to the caregiver in question. We appreciate those who do report their concerns, as our common goal is the safety and welfare of the clients. Anyone found retaliating against the caller will be considered to be interfering with an investigation, which is a violation of the Hawaii Administrative Rules. The complainant should not be told they should not have called CTA or be retaliated against in any way. Clients also should not have to move from the home just because they are trying to make some improvement or increase communication. A home should not make any effort to find out who made the complaint, it is confidential and trying to locate the source could be considered retaliation. Getting complaints about your business is just the nature of doing business that requires customer service. If a rule has been violated, CTA will work with the home or CMA, whenever possible, to correct the violation.
8 Newsletter #44 ** This newsletter has been reviewed and approved by the Department of Health** 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) 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