Office of Regulatory Services

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Office of Regulatory Services

• The Times, They Are A-Changin
• For Providers and Regulators Alike

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The Changing Times

• SB 433CON issues and moving parts of ORS
• PCH Facility Reports--Transparency
• HB 155Fingerprint checks for owners, rule
  changes in PCH, COGENT system
• HB 1044Adult Day Centers and exemption of
  respite
• Private home care providersweb-based training
  tool and top 10 cites

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Realignment of Licensing ResponsibilitiesSB 433

• Certain licensing and certification functions
  transferred to Department of Community Health
  (DCH) effective 7/1/09
• Personal care homes, private home care providers
  moving to DCH, etc.
• Adult day centers, community living arrangements,
  hospices not moving to DCH as of now

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Dividing Licensing Functions

• Goes to DCH
• Hospitals
• Ambulatory Surgery
• Birthing Center
• Home Health
• Private Home Care
• Personal Care Homes
• Nursing Homes
• ICF/MR
• Traumatic Brain Facilities
• Specimen Collection Stations

• Stays with DHR
• Kidney Dialysis Centers
• Rural Health Clinics
• Eye Bank
• Hospices
• Community Living Arrangements
• Adult Day Centers
• Clinical Laboratories (CLIA)
• X-Ray Mammography
• Drug Abuse Treatment Programs
• OPT/CORF
• Maternity Homes
• Residential Child Care (CCI, CPA, OCCP)
• HMOs

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Unknowns

• Governors Executive Order for Task Force on
  Restructuring DHR
• Georgians receive most efficient service at
  least cost to taxpayers
• Report due July 2, 2008

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HEALTH AND SAFETY STANDARDS RATINGS FOR PERSONAL
CARE HOMES

• Why bother?
• Transparency, savvy consumers
• Help consumers compare homes on compliance
• Give credit where due to homes that maintain
  compliance
• Market-driven quality improvement

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Long and Winding Road

• Began in 2006 with work group, some provider
  representation, staff, consumer advocates
• First meeting on 8/11/2006
• Researched other systems
• Created 9 versions or methodologies to rate
  facilities

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First Rating Methodology

• Method published to providers on 10/11/07
• Potential for 2 ratings per facility
• First rating based on most recent full survey
• 2nd rating based on last 2 cumulative years
• Stars assigned based on

• Number of citations
• Severity and frequency of citations
• Number of critical tags written

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First Rating 3

• Method published to providers on 10/11/07
• Posted on ORS website for providers to review
  until 11/13/07
• Providers rejected felt did not accurately
  reflect their facility status
• Workgroup reconvened on 12/5/07

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Back To The Drawing Board

• New method has a single icon rating
• Rating is based on last two years of surveys
• Based on 100 point system with deductions for
  serious violations and any adverse actions
• Has 5- tiered rating icons
• Deciding on icons
• Also will include raw score

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Back on Track

• Thirteen more versions tested before committee
  agreed upon final version on 3/26/08
• Workgroup is reviewing system now
• Available to providers for review May 1, 2008
• Roll out for consumers on June 30, 2008

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New Requirements for Criminal Records Checks

• Result of HB 155 passed in 2007

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HB 155 Effective July 1, 2007

• PCH and PHCP owners must have fingerprint CRC
• Implemented on July 1, 2007 for new applications
• Owners of facilities already licensed must submit
  to the fingerprint records checks by December 31,
  2008

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Who is an Owner?

• Owner is defined as
• Any individual or any person owning 10 or
  greater who
• Exercises authority of an owner
• Applies to operate the business or agency or
• Enters into a contract to acquire ownership of
  such a business or agency.

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CRC--OWNER EXCEPTIONS

• CRC for an owner is NOT required IF the owner
• Has had a satisfactory CRC within 12 months
  preceding the time of application
• Does NOT maintain an office at the location where
  services are provided to residents/clients
• Does NOT reside at a location where services are
  provided to residents/clients

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CRC OWNER EXCEPTIONS continued

• CRC for an owner is NOT required IF the owner
• Does NOT have direct access at any time to those
  receiving care
• Does NOT provide direct personal supervision of
  personnel by being available to provide
  assistance and direction during the time services
  are being provided

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Covered Crimes

• An owner cannot generally be issued a license if
  they have been arrested, convicted of any of the
  following crimes
• Murder
• Aggravated assault or battery
• Cruelty to a child or elder person
• Rape, aggravated sodomy, sexual assault or
  battery
• Child molestation or enticing a child for
  indecent purposes

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COVERED CRIMES CONTINUED

• Armed robbery
• Abuse, neglect, or exploitation of a disabled
  adult or elder person
• A similar offense committed in another
  jurisdiction with a conviction under a different
  designation used in that jurisdiction

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OPPORTUNITY FOR HEARING

• Mitigation factors for consideration
• Length of time since crime
• Absence of additional criminal charges
• Circumstances surrounding commission of crime
• Indicia of rehabilitation
• Facilitys history of compliance
• Owners involvement with facility

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Other Employees

• PCHs - No changes
• PHCPs - No new requirements

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LiveScan Fingerprinting

• After May 1, 2008, no more manual fingerprint
  cards
• Fingerprints must be submitted through LiveScan
• Contract with Cogent for LiveScan locations
• An Account is required before the prospective
  employee/director/owner goes to a location to be
  scanned e-mail access required
• www.gacogentid.com
• Call 1-888-439-2512

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LiveScan Digital Fingerprinting

• Other Options
• Schedule appointment at 2 Peachtree (DHR) to have
  their scan at that location
• Schedule appointment at certain DFCS offices
• Results are sent within 48 hours to the DHR
  Office of Investigative Services, who promises to
  report the results out within two weeks
• Draft Instructions are attached

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Other PCH Rule Changes

• Added right to be treated with dignity,
  kindness, consideration to rights
• Added requirement to report elopements of any
  disabled person to police within 30 minutes of
  becoming aware they are missing
• Changed maximum hot water temperature to 120
  degrees F.

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Reporting Requirements

• Added requirement to report certain type of
  incidents
• Death of a resident
• Serious injury to a resident which requires
  medical attention
• Any rape, assault, battery on a resident or
  abuse, neglect or exploitation of a resident
• Anytime a resident cannot be located and there
  are circumstances that place the resident or
  others at risk

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Reporting Requirements 2

• Any circumstance where staff are associated with
  a residents will, trust, or insurance policy (to
  verify it is not as a result of coercion)
• When an owner, director, or employee acquires a
  relevant criminal record

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Reporting Requirements 3

• Reports must include the name of the home and the
  administrator
• The date of the incident and the date the home
  became aware of the incident
• The type of incident with a brief description
• Any immediate or corrective action taken by the
  staff of the home to ensure the incident does not
  repeat

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New Draft Rules and Regulations for Adult Day
Centers

• Rules provide for licensing and inspection of
  adult day centers, only
• The term adult day center does not include
  part-time respite services programs (HB 1044)
• Rules establish minimum standards for the
  operation of adult day centers

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Exemptions in Law and Draft Rules

• Those providing services without compensation
• Those providing services for compensation to no
  more than two participants
• Programs that provide day habilitation and
  treatment services exclusively for
  developmentally disabled persons and
• Respite care services programs as defined in law

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Respite CareNo License Required

• Provide services for aging adults who can
  function in a group setting and who can feed and
  toilet themselves with or without the assistance
  of a personal aide accompanying them and which
• Is operated by a nonprofit organization
• Provides no more than 25 hours of services per
  week
• Is managed by a director who has completed an
  adult day care services training and orientation
  program approved by the Department
• Is staffed primarily by volunteers and
• Has as its sole purpose to provide primary
  caregivers of aging adults with relief from
  normal caregiving duties and responsibilities.

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Process for Licensing

• All centers are required to submit an application
  to within 45 days of the effective date of these
  rules.
• Centers may continue to operate without
  disruption until an inspection is completed and
  the license granted or denied.

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Required for Licensure 1

• The governing body of each center is required to
  submit
• A completed application
• A non-refundable application fee and a license
  fee
• Proof of the legal right to occupy the property
  where the adult day center is housed

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Required for Licensure 2

• The governing body of each center is required to
  submit
• A floor sketch
• A completed affidavit of personal identification
• For corporations, partnerships, etc., legal
  papers such as certificate of incorporation

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Required for Licensure 3

• The governing body of each center is required to
  submit
• Fire safety inspection
• Documentation of approval for water source and
  sewage disposal system
• Zoning approval
• A list of the locations of any other adult day
  centers operated by the governing body

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Adult Day Care

• Adult day care refers to services provided under
  a social model
• Participants may have limitations that restrict
  their abilities to perform the normal activities
  of daily living
• Social model addresses the basic social and
  recreational activities needed

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Adult Day Health Services

• Adult day health refers to services that meets
  the needs of aging adults under a medical model
• Medical model programs provide basic social,
  rehabilitative, health and personal care services
  needed
• An ongoing program of therapeutic activities
  designed to meet the physical, mental and
  psychosocial well-being of each participant is
  required
• The term adult day health care does not include
  programs which provide day habilitation and
  treatment services exclusively for individuals
  with developmental disabilities

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Programs Required to be LicensedMobile Adult
Day Centers

• Some centers offer services on a remote site
  one or two days per week
• These mobile adult day centers utilize staff
  that travels from one central location to
  off-site locations
• Staff and/or volunteers, participant records,
  supplies and program materials are transported to
  each off-site location
• Services may be adult day care or adult day health

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Key Features Disaster Preparedness

• A disaster preparedness plan is required
• Must identify emergency procedures
• The Department will provide a format for the
  disaster preparedness plan

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Key Features Fire Safety

• Adult day centers, adult day health centers and
  mobile adult day centers must be in compliance
  with fire safety requirements
• Fire safety must be observed at all times

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Key Features Emergencies

• Written emergency policies and procedures must
  include
• A written plan and/or agreement for emergency
  care and emergency transportation.
• A file for each participant
• A written plan for notification of local law
  enforcement when a participant has been missing
  for more than thirty (30) minutes.

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Key Features Staffing Ratios and Care Plans

• Each center must provide appropriately qualified
  staff and/or volunteers in sufficient numbers,
  minimum ratio of 18 excludes office works and,
  food service staff
• Individual care plans (simple or detailed) are
  required for participants

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Key Features Nutrition

• Centers operating for more than four (4) hours a
  day and/or operating during regularly scheduled
  mealtimes are required to provide a nutritious
  meal
• Snacks and fluids must be available and offered
• Meals and snacks provided by the center must be
  planned to keep sugar, salt and cholesterol
  intake to a minimum.

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Key Features Medications

• All medications in an adult day center that does
  not employ a licensed RN or LPN must be
  self-administered by the participant
• Centers that provide assistance with medication
  without employing a licensed RN or LPN may do so
  to the following extent
• Staff may remind participants
• Staff may check the dosage and
• Staff may physically assist a participant.

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Anticipated Timetable

• House Bill 1044 signed into law early April
• DHR Board meeting on 4/16/08 - revised rules are
  authorized for a public hearing which is
  scheduled for approx. 30 days later
• Public hearing in May
• Rules adopted at DHR Board meeting in June
• Rules effective as early as July?

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Orientation Training Session

• An orientation session will be scheduled for
  providers.
• Providers will have the opportunity to ask
  questions and meet program staff.
• Resources and materials will be provided to
  assist providers with the licensure application
  process.

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PRIVATE HOME CARE PROVIDERS Web- Based Training

• Tool to assist new and existing providers with
  understanding the PHCP Rules Regulations
• Overview of the rules with test available
• Use in orienting or as a refresher for existing
  staff with plan of correction

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Private Home Care Providers Web- Based
Training

• Instructions for completing web-based training
• The Private Home Care Provider (PHCP) program
  overview is housed at the following link
  www.ors.dhr.georgia.gov
• You can access the presentation for ORS home page
  by following the steps below
• Click Provider Tools in the upper left hand
  corner
• Under for Providers select Training Information
• Select NEW PHCP Program Overview
• Start at course introduction
• Continue through each of the modules
• Regulations for establishing a PHCP
• Application and Regulatory Process
• PHCP Service Provisions
• PHCP Compliance Requirements
• Finally you will reach the course conclusion
• Select the button labeled Course Exam at the
  bottom center of the screen
• Enter your name and the name of your organization
  then press start
• After you have completed the 46 question course
  exam scroll back to the top of the screen and
  select Check Answers
• You will receive an exam score.

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The 10 most frequently cited deficiencies

• From March 2007-March 2008

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Top Ten Violations

• 1. TB Tests when first hired, annually
• Tag 0934, 290-5-54-.09(4)(c)4
• 2. Supervisory Visits every 92 days where
  personal care
• Tag 1013, 290-5-54-.10(2)(b)2
• 3. Service Plan Content
• Tag 1101, 290-5-54-.11(1)(a)
• 4. Personal Care Aide Qualifications
• Tag 948, 290-5-54-.09(5)(c)1

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Top Ten Continued

• 5. Service Agreement description of services as
  stated by client, etc.
• Tag 905 290-5-54-.09(2)(a)3
• 6. Service Agreement charges for services,
  mechanisms for billing, payment
• Tag 907 290-5-54-.09(2)(a)5
• 7. Governing Body ensures compliance with these
  rules
• Tag 400 290-5-54-.04
• 8. Personnel Records job description/statement
  of duties, responsibilities
• Tag 0936 290-5-54-.09(4)(c)6

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Top Ten Continued

• 9. Personnel Records Annual performance
• evaluation
• Tag 0938 290-5-54-.09(4)(c)8
• 10. Service Agreement Description of services,
  frequency and expected duration
• Tag 0906 290-5-54-.09(2)(a)4

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Questions, Comments

• Thank you
• Sharon E. Dougherty
• Director
• Office of Regulatory Services
• 404-657-5700